[Federal Register Volume 70, Number 223 (Monday, November 21, 2005)]
[Rules and Regulations]
[Pages 70116-70476]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 05-22160]



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Part II





Department of Health and Human Services





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Centers for Medicare & Medicaid Services



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42 CFR Part 405, et al.



Medicare Program; Revisions to Payment Policies Under the Physician Fee 
Schedule for Calendar Year 2006 and Certain Provisions Related to the 
Competitive Acquisition Program of Outpatient Drugs and Biologicals 
Under Part B; Final Rule

Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / 
Rules and Regulations

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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

42 CFR Part 405, 410, 411, 413, 414, 424, and 426

[CMS-1502-FC and CMS-1325-F]
RINs 0938-AN84 and 0938-AN58


Medicare Program; Revisions to Payment Policies Under the 
Physician Fee Schedule for Calendar Year 2006 and Certain Provisions 
Related to the Competitive Acquisition Program of Outpatient Drugs and 
Biologicals Under Part B

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

ACTION: Final rule with comment.

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SUMMARY: This rule addresses Medicare Part B payment policy, including 
the physician fee schedule that are applicable for calendar year (CY) 
2006; and finalizes certain provisions of the interim final rule to 
implement the Competitive Acquisition Program (CAP) for Part B Drugs. 
It also revises Medicare Part B payment and related policies regarding: 
Physician work; practice expense (PE) and malpractice relative value 
units (RVUs); Medicare telehealth services; multiple diagnostic imaging 
procedures; covered outpatient drugs and biologicals; supplemental 
payments to Federally Qualified Health Centers (FQHCs); renal dialysis 
services; coverage for glaucoma screening services; National Coverage 
Decision (NCD) timeframes; and physician referrals for nuclear medicine 
services and supplies to health care entities with which they have 
financial relationships. In addition, the rule finalizes the interim 
RVUs for CY 2005 and issues interim RVUs for new and revised procedure 
codes for CY 2006. This rule also updates the codes subject to the 
physician self-referral prohibition and discusses payment policies 
relating to teaching anesthesia services, therapy caps, private 
contracts and opt-out, and chiropractic and oncology demonstrations.
    As required by the statute, it also announces that the physician 
fee schedule update for CY 2006 is -4.4 percent, the initial estimate 
for the sustainable growth rate for CY 2006 is 1.7 percent and the 
conversion factor for CY 2006 is $36.1770.

DATES: Effective Date: These regulations are effective on January 1, 
2006.
    Comment Date: To be assured consideration, comments must be 
received at one of the addresses provided below, no later than 5 p.m. 
on January 3, 2006.

ADDRESSES: In commenting, please refer to file code CMS-1502-FC. 
Because of staff and resource limitations, we cannot accept comments by 
facsimile (FAX) transmission.
    You may submit comments in one of four ways (no duplicates, 
please):
    1. Electronically. You may submit electronic comments on specific 
issues in this regulation to http://www.cms.hhs.gov/regulations/ecomments. (Attachments should be in Microsoft Word, WordPerfect, or 
Excel; however, we prefer Microsoft Word.)
    2. By regular mail. You may mail written comments (one original and 
two copies) to the following address ONLY:
    Centers for Medicare & Medicaid Services, Department of Health and 
Human Services, Attention: CMS-1502-FC, P.O. Box 8017, Baltimore, MD 
21244-8017.
    Please allow sufficient time for mailed comments to be received 
before the close of the comment period.
    3. By express or overnight mail. You may send written comments (one 
original and two copies) to the following address ONLY:
    Centers for Medicare & Medicaid Services, Department of Health and 
Human Services, Attention: CMS-1502-FC, Mail Stop C4-26-05, 7500 
Security Boulevard, Baltimore, MD 21244-1850.
    4. By hand or courier. If you prefer, you may deliver (by hand or 
courier) your written comments (one original and two copies) before the 
close of the comment period to one of the following addresses. If you 
intend to deliver your comments to the Baltimore address, please call 
telephone number (410) 786-7197 in advance to schedule your arrival 
with one of our staff members. Room 445-G, Hubert H. Humphrey Building, 
200 Independence Avenue, SW., Washington, DC 20201; or 7500 Security 
Boulevard, Baltimore, MD 21244-1850.
    (Because access to the interior of the HHH Building is not readily 
available to persons without Federal Government identification, 
commenters are encouraged to leave their comments in the CMS drop slots 
located in the main lobby of the building. A stamp-in clock is 
available for persons wishing to retain a proof of filing by stamping 
in and retaining an extra copy of the comments being filed.)
    Comments mailed to the addresses indicated as appropriate for hand 
or courier delivery may be delayed and received after the comment 
period.
    Submission of comments on paperwork requirements. You may submit 
comments on this document's paperwork requirements by mailing your 
comments to the addresses provided at the end of the ``Collection of 
Information Requirements'' section in this document.
    For information on viewing public comments, see the beginning of 
the SUPPLEMENTARY INFORMATION section.

FOR FURTHER INFORMATION CONTACT: Pam West (410) 786-2302 (for issues 
related to practice expense).

Rick Ensor (410) 786-5617 (for issues related to the nonphysician 
workpool and supplemental survey data).
Stephanie Monroe (410) 786-6864 (for issues related to the geographic 
practice cost index and malpractice RVUs).
Craig Dobyski (410) 786-4584 (for issues related to list of telehealth 
services).
Ken Marsalek (410) 786-4502 (for issues related to multiple procedure 
reduction for diagnostic imaging services and payment for teaching 
anesthesiologists).
Henry Richter (410) 786-4562 (for issues related to payments for end 
stage renal disease facilities).
Angela Mason (410) 786-7452 or Catherine Jansto (410) 786-7762 (for 
issues related to payment for covered outpatient drugs and 
biologicals).
Fred Grabau (410) 786-0206 (for issues related to private contracts and 
opt out provision).
David Worgo (410) 786-5919 (for issues related to Federally Qualified 
Health Centers).
Dorothy Shannon (410) 786-3396 (for issues related to the outpatient 
therapy cap).
Vadim Lubarsky (410) 786-0840 (for issues related to National Coverage 
Decision timeframes).
Bill Larson (410) 786-7176 (for issues related to coverage of screening 
for glaucoma).
Lia Prela (410) 786-0548 (for issues related to the competitive 
acquisition program (CAP) for part B drugs).
Diane Milstead (410) 786-3355 or Gaysha Brooks (410) 786-9649 (for all 
other issues).

SUPPLEMENTARY INFORMATION:
    Submitting Comments: We welcome comments from the public on the 
following issues: interim RVUs for selected procedure codes identified 
in Addendum C; and the physician self referral designated health 
services listed in tables 32 and 33. You can assist us by referencing 
the file code CMS-1502-FC and the specific ``issue identifier'' that 
precedes the section on which you choose to comment.
    Inspection of Public Comments: All comments received before the 
close of

[[Page 70117]]

the comment period are available for viewing by the public, including 
any personally identifiable or confidential business information that 
is included in a comment. CMS posts all comments received before the 
close of the comment period on its public web site as soon as possible 
after they are received. Hard copy 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 Centers for Medicare & Medicaid Services, 7500 
Security Boulevard, Baltimore, Maryland 21244, Monday through Friday of 
each week from 8:30 a.m. to 4 p.m. To schedule an appointment to view 
public comments, phone 1-800-743-3951.
    This Federal Register document is also available from the Federal 
Register online database through GPO Access a service of the U.S. 
Government Printing Office. The web site address is:  http://www.access.gpo.gov/nara/index.html.
    Information on the physician fee schedule can be found on the CMS 
homepage. You can access this data by using the following directions:
    1. Go to the CMS homepage (http://www.cms.hhs.gov).
    2. Place your cursor over the word ``Professionals'' in the blue 
areas near the top of the page. Select ``physicians'' from the drop-
down menu.
    3. Under ``Billing/Payment'' select ``Physician Fee Schedule''.
    To assist readers in referencing sections contained in this 
preamble, we are providing the following table of contents. Some of the 
issues discussed in this preamble affect the payment policies, but do 
not require changes to the regulations in the Code of Federal 
Regulations. Information on the regulation's impact appears throughout 
the preamble and is not exclusively in section VI.

Table of Contents

I. Background
    A. Introduction
    B. Development of the Relative Value System
    C. Components of the Fee Schedule Payment Amounts
    D. Most Recent Changes the Fee Schedule
II. Provisions of the Final Rule
    A. Resource-Based Practice Expense Relative Value Units (PE 
RVUs)
    1. Current Methodology
    2. PE Proposals for CY 2006
    3. PE Recommendations on CPEP Inputs for CY 2006
    4. Payment for Splint and Cast Supplies
    5. Miscellaneous PE Issues
    B. Geographic Practice Cost Indices (GPCIs)
    C. Malpractice RVUs
    1. Five Percent Specialty Threshold
    2. Specialty Crosswalk Issues
    3. Cardiac Catheterization and Angioplasty Exception
    4. Dominant Specialty for Low-Volume Codes
    5. Collection of Premium Data
    D. Medicare Telehealth Services
    1. Requests for Adding Services to the List of Medicare 
Telehealth Services
    2. Definition of an Originating Site
    3. Other Issues
    E. Contractor Pricing of Unlisted Therapy Modalities and 
Procedures
    F. Payment for Teaching Anesthesiologists
    G. End Stage Renal Disease (ESRD) Related Provisions
    1. Revised Pricing Methodology for Separately Billable Drugs and 
Biologicals Furnished by ESRD Facilities.
    2. Adjustment to Account for Changes in the Pricing of 
Separately Billable Drugs and Biologicals, and the Estimated 
Increase in Expenditures for Drugs and Biologicals
    3. Revisions to Geographic Designations and Wage Indexes Applied 
to the ESRD Composite Payment Rate
    4. Miscellaneous Comments on ESRD Issues
    5. Revisions to the Composite Payment Rate Exceptions Process
    H. Payment for Covered Outpatient Drugs and Biologicals
    1. ASP issues
    2. Payment for Drugs Furnished During CY 2006 in Connection With 
the Furnishing of Renal Dialysis Services if Separately Billed by 
Renal Dialysis Facilities
    3. Clotting Factor Furnishing Fee
    4. Payment for Inhalation Drugs and Dispensing Fee
    5. Supplying Fee
    6. Competitive Acquisition of Outpatient Drugs And Biologicals 
Under Part B
    I. Private Contracts and Opt-out Provision
    J. Multiple Procedure Payment Reduction for Diagnostic Imaging
    K. Therapy Cap
    L. Chiropractic Demonstration Discussion
    M. Supplemental Payments to FQHCs Subcontracting with Medicare 
Advantage Plans
    N. National Coverage Decisions Timeframes
    O. Coverage of Screening for Glaucoma
    P. Additional Issues
    1. Corrections to Conditions for Medicare Payment (Sec.  424.22)
    2. Chemotherapy Demonstration Project
III. Refinement of RVUs for CY 2006 and Response to Public Comments 
on Interim RVUs for 2005
    A. Summary of Issues Discussed Related to the Adjustment of RVUs
    B. Process for Establishing Work RVUs for the 2005 PFS
    C. Work RVU Refinements of Interim RVUs
    1. Methodology (Includes Table titled ``Work Relative Value Unit 
Refinements of the 2004 Interim and Related Relative Value Units'')
    2. Interim 2005 Codes
    D. Establishment of Interim Work RVUs for New and Revised 
Physician's Current Procedural Terminology (CPT) Codes and New 
Healthcare Common Procedure Coding System Codes (HCPCS) for 2006 
(Includes Table titled ``American Medical Association Specialty 
Relative Value Update Committee and Health Care Professionals 
Advisory Committee Recommendations and CMS's Decisions for New and 
Revised 2006 CPT Codes'')
    E. Discussion of Codes for Which There Were No RUC 
Recommendations or for Which the RUC Recommendations Were Not 
Accepted
    F. Establishment of Interim PE RVUs for New and Revised 
Physician's Current Procedural Terminology (CPT) Codes and New 
Healthcare Common Procedure Coding System (HCPCS) Codes for 2006
IV. Five-Year Refinement of RVUs -Status update
V. Physician Self-Referral Prohibition: Nuclear Medicine and Annual 
Update to the List of CPT/HCPCS Codes
    A. General
    B. Nuclear Medicine
    1. Response to Comments
    2. Revisions to the List of Codes Identifying Nuclear Medicine 
Services
    C. Annual Update to the Code List
    1. Response to Comments
    2. Revisions Effective for 2006
VI. Physician Fee Schedule Update for CY 2006
    A. Physician Fee Schedule Update
    B. The Percentage Change in the Medicare Economic Index (MEI)
    C. The Update Adjustment Factor
VII. Allowed Expenditures for Physicians' Services and the 
Sustainable Growth Rate
    A. Medicare Sustainable Growth Rate
    B. Physicians' Services
    C. Preliminary Estimate of the SGR for 2006
    D. Revised Sustainable Growth Rate for 2005
    E. Final Sustainable Growth Rate for 2004
    F. Calculation of 2006, 2005, and 2004 Sustainable Growth Rates
VIII. Anesthesia and Physician Fee Schedule Conversion Factors for 
CY 2006
    A. Physician Fee Schedule Conversion Factor
    B. Anesthesia Fee Schedule Conversion Factor
IX. Telehealth Originating Site Facility Fee Payment Amount Update
X. Provisions of the Final Rule
XI. Waiver of Proposed Rulemaking
XII. Collection of Information Requirements
XIII. Response to Comments
XIV. Regulatory Impact Analysis
Addendum A--Explanation and Use of Addendum B.
Addendum B--Relative Value Units and Related Information
Addendum C--Codes with Interim RVUs
Addendum D--2006 Geographic Practice Cost Indices by Medicare 
Carrier and Locality
Addendum E-2006 GAFs
Addendum F--CAP: Revised Single Drug Category List
Addendum G--CAP: Revised New Drugs for CAP Bidding for 2006
Addendum H--List of CPT/HCPCS Codes Used to Describe Certain 
Designated Health Services Under Section 1877 of the Social Security 
Act


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    In addition, because of the many organizations and terms to which 
we refer by acronym in this proposed final rule with comment, we are 
listing these acronyms and their corresponding terms in alphabetical 
order below:
AADA American Academy of Dermatology Association
AAH American Association for Homecare
ABN Advanced Beneficiary Notice
ACC American College of Cardiology
ACG American College of Gastroenterology
ACR American College of Radiology
AFROC Association of Freestanding Radiation Oncology Centers
AGA American Gastroenterological Association
AMA American Medical Association
AMP Average manufacturer price
AOAO American Osteopathic Academy of Orthopedics
ASA American Society of Anesthesiologists
ASGE American Society of Gastrointestinal Endoscopy
ASP Average sales price
ASTRO American Society for Therapeutic Radiation Oncology
AUA American Urological Association
AWP Average wholesale price
BBA Balanced Budget Act of 1997
BBRA Balanced Budget Refinement Act of 1999
BIPA Benefits Improvement and Protection Act of 2000
BLS Bureau of Labor Statistics
BMI Body mass index
BNF Budget neutrality factor
BSA Body surface area
CAP Competitive Acquisition Program
CBSA Core-Based Statistical Area
CF Conversion factor
CFR Code of Federal Regulations
CMA California Medical Association
CMS Centers for Medicare & Medicaid Services
CNS Clinical nurse specialist
COBC Coordination of Benefits Contractor
CPEP Clinical Practice Expert Panel
CPI Consumer Price Index
CPO Care Plan Oversight
CPT (Physicians') Current Procedural Terminology (4th Edition, 2002, 
copyrighted by the American Medical Association)
CRNA Certified Registered Nurse Anesthetist
CT Computed tomography
CTA Computed tomographic angiography
CY Calendar year
DAW Dispense as written
DHS Designated health services
DME Durable medical equipment
DMERC Durable Medical Equipment Regional Carrier
DSMT Diabetes outpatient self-management training services
EAC Estimated acquisition cost
ECP External counterpulsation
E/M Evaluation and management
EPO Erythopoeitin
ESRD End stage renal disease
FAX Facsimile
FDA Food and Drug Administration
FI Fiscal intermediary
FQHC Federally qualified health center
FR Federal Register
GAF Geographic adjustment factor
GAO Government Accountability Office
GPCI Geographic practice cost index
GPOs Group Purchasing Organizations
HCPAC Health Care Professional Advisory Committee
HCPCS Healthcare Common Procedure Coding System
HHA Home health agency
HHS (Department of) Health and Human Services
HIC Health Insurance Number
HIPAA Health Insurance Portability and Accountability Act of 1996, 
Public Law 104-191
HOCM High Osmolar Contrast Media
HPSA Health professional shortage area
HRSA Health Resources and Services Administration (HHS)
IDTFs Independent diagnostic testing facilities
IPF Inpatient psychiatric facility
IPPS Inpatient prospective payment system
IRF Inpatient rehabilitation facility
ISO Insurance Services Office
IVIG Intravenous immune globulin
JCAAI Joint Council of Allergy, Asthma, and Immunology
JUA Joint underwriting association
LCD Local coverage determination
LTCH Long-term care hospital
LOCM Low Osmolar Contrast Media
MA Medicare Advantage
MCAC Medicare Coverage Advisory Committee
MCG Medical College of Georgia
MedPAC Medicare Payment Advisory Commission
MEI Medicare Economic Index
MMA Medicare Prescription Drug, Improvement, and Modernization Act of 
2003
MNT Medical nutrition therapy
MRA Magnetic resonance angiography
MRI Magnetic resonance imaging
MSA Metropolitan statistical area
MSN Medicare summary notice
NCD National coverage determination
NCQDIS National Coalition of Quality Diagnostic Imaging Services
NDC National drug code
NECMA New England County Metropolitan Area
NECTA New England City and Town Area
NP Nurse practitioner
NPP Nonphysician practitioners
NPWP Nonphysician work pool
OBRA Omnibus Budget Reconciliation Act
OIG Office of Inspector General
OMB Office of Management and Budget
OPPS Outpatient prospective payment system
OT Occupational therapy
PA Physician assistant
PC Professional component
PE Practice Expense
PEAC Practice Expense Advisory Committee
PERC Practice Expense Review Committee
PET Positron emission tomography
PFS Physician Fee Schedule
PLI Professional liability insurance
PPAC Practicing Physicians Advisory Council
PIN Provider identification number
PPI Producer price index
PPO Preferred provider organization
PPS Prospective payment system
PRA Paperwork Reduction Act
PT Physical therapy
RFA Regulatory Flexibility Act
RIA Regulatory impact analysis
RN Registered nurse
RUC (AMA's Specialty Society) Relative (Value) Update Committee
RVU Relative value unit
SGR Sustainable growth rate
SMS (AMA's) Socioeconomic Monitoring System
SNF Skilled nursing facility
SNM Society for Nuclear Medicine
TA Technology assessment
TC Technical component
TEB Thoracic electrical bioimpedance
tPA Tissue-type plasminogen activator
UAF Update adjustment factor
UPIN Unique provider identification number
WAC Wholesale acquisition cost
WAMP Widely available market price

I. Background

A. Introduction

    Since January 1, 1992, Medicare has paid for physicians' services 
under section 1848 of the Social Security Act (the Act), ``Payment for 
Physicians` Services.'' The Act requires that payments under the 
physician fee schedule (PFS) be based on national uniform relative 
value units (RVUs) based on the resources used in furnishing a service. 
Section 1848(c) of the Act requires that national RVUs be established 
for physician work, practice expense (PE), and malpractice expense. 
Prior to the establishment of the

[[Page 70119]]

resource-based relative value system, Medicare payment for physicians' 
services was based on reasonable charges.
    Section 1848(c)(2)(B)(ii)(II) of the Act provides that adjustments 
in RVUs may not cause total physician fee schedule payments to differ 
by more than $20 million from what they would have been had the 
adjustments not been made. If adjustments to RVUs cause expenditures to 
change by more than $20 million, we must make adjustments to ensure 
that they do not increase or decrease by more than $20 million.

B. Development of the Relative Value System

1. Work RVUs
    The concepts and methodology underlying the PFS were enacted as 
part of the Omnibus Budget Reconciliation Act (OBRA) of 1989, Public 
Law 101-239, and OBRA 1990, (Public Law 101-508). The final rule 
published November 25, 1991 (56 FR 59502) set forth the fee schedule 
for payment for physicians' services beginning January 1, 1992. 
Initially, only the physician work RVUs were resource-based, and the PE 
and malpractice RVUs were based on average allowable charges.
    The physician work RVUs established for the implementation of the 
fee schedule in January 1992 were developed with extensive input from 
the physician community. A research team at the Harvard School of 
Public Health developed the original physician work RVUs for most codes 
in a cooperative agreement with the Department of Health and Human 
Services (HHS). In constructing the code-specific vignettes for the 
original physician work RVUs, Harvard worked with panels of experts, 
both inside and outside the government, and obtained input from 
numerous physician specialty groups.
    Section 1848(b)(2)(A) of the Act specifies that the RVUs for 
radiology services are based on a relative value scale we adopted under 
section 1834(b)(1)(A) of the Act, (the American College of Radiology 
(ACR) relative value scale), which we integrated into the overall PFS. 
Section 1848(b)(2)(B) of the Act specifies that the RVUs for anesthesia 
services are based on RVUs from a uniform relative value guide. We 
established a separate conversion factor (CF) for anesthesia services, 
and we continue to utilize time units as a basis for determining 
payment for these services. As a result, there is a separate payment 
methodology for anesthesia services.
    We establish physician work RVUs for new and revised codes based on 
recommendations received from the American Medical Association's (AMA) 
Specialty Society Relative Value Update Committee (RUC).
2. Practice Expense Relative Value Units (PE RVUs)
    Section 121 of the Social Security Act Amendments of 1994 (Pub. L. 
103-432), enacted on October 31, 1994, amended section 
1848(c)(2)(C)(ii) of the Act and required us to develop resource-based 
PE RVUs for each physician's service beginning in 1998. We were to 
consider the staff, equipment, and supplies used in the provision of 
various medical and surgical services. The legislation specifically 
required that, in implementing the new system of PE RVUs, we apply the 
same budget-neutrality provisions that are applicable to other 
adjustments under the physician fee schedule.
    Section 4505(a) of the Balanced Budget Act of 1997 (BBA) (Pub. L. 
105-33), amended section 1848(c)(2)(C)(ii) of the Act to delay 
implementation of the resource-based PE RVU system until January 1, 
1999. In addition, section 4505(b) of the BBA provided for a 4-year 
transition period from charge-based PE RVUs to resource-based RVUs.
    We established the resource-based PE RVUs for each physician's 
service in a final rule, published November 2, 1998 (63 FR 58814), 
effective for services furnished in 1999. Based on the requirement to 
transition to a resource-based system for PE over a 4-year period, 
resource-based PE RVUs did not become fully effective until 2002.
    This resource-based system was based on two significant sources of 
actual PE data: The Clinical Practice Expert Panel (CPEP) data and the 
AMA's Socioeconomic Monitoring System (SMS) data. The CPEP data were 
collected from panels of physicians, practice administrators, and 
nonphysicians (for example, registered nurses) nominated by physician 
specialty societies and other groups. The CPEP panels identified the 
direct inputs required for each physician's service in both the office 
setting and out-of-office setting. The AMA's SMS data provided 
aggregate specialty-specific information on hours worked and PEs.
    Separate PE RVUs are established for procedures that can be 
performed in both a nonfacility setting, such as a physician's office, 
and a facility setting, such as a hospital outpatient department. The 
difference between the facility and nonfacility RVUs reflects the fact 
that a facility receives separate payment from Medicare for its costs 
of providing the service, apart from payment under the PFS. The 
nonfacility RVUs reflect all of the direct and indirect PEs of 
providing a particular service outside a facility setting.
    Section 212 of the Medicare, Medicaid and State Child Health 
Insurance Program Balanced Budget Refinement Act of 1999 (BBRA) (Pub. 
L. 106-113) directed the Secretary to establish a process under which 
we accept and use, to the maximum extent practicable and consistent 
with sound data practices, data collected or developed by entities and 
organizations to supplement the data we normally collect in determining 
the PE component. On May 3, 2000, we published the interim final rule 
(65 FR 25664) that set forth the criteria for the submission of these 
supplemental PE survey data. The criteria were modified in response to 
comments received, and published in the Federal Register (65 FR 65376) 
as part of the November 1, 2000 final rule. The PFS final rules 
published in 2001 and 2003, respectively, (66 FR 55246 and 68 FR 63196) 
extended the period during which we would accept these supplemental 
data.
    As discussed in the January 7, 2004 physician fee schedule final 
rule (69 FR 1092), section 303(a)(1)(B) of MMA amended section 
1848(c)(2) of the Act by adding new subparagraph (H), ``Adjustments in 
Practice Expense Relative Value Units for Certain Drug Administration 
Services beginning in 2004''. Subparagraph (H)(i) requires the 
Secretary to determine the practice expense RVUs for 2004 using 
practice expense surveys submitted to the Secretary as of January 1, 
2003 by a physician specialty organization in accordance with section 
212 of the Medicare, Medicaid, and SCHIP Balanced Budget Refinement Act 
(BBRA) of 1999 if the survey: (1) Covers practice expenses for oncology 
drug administration services; and (2) meets criteria established by the 
Secretary for acceptance of such surveys. Consistent with section 
1848(c)(2)(H)(i) of the Act, in January 7, 2005 final rule, we 
announced we would use the ASCO survey to determine the practice 
expense RVUs for physician fee schedule services furnished on or after 
January 1, 2004 because it: (1) Was submitted prior to January 1, 2003; 
(2) includes expenses for drug administration services; and (3) meets 
criteria we have established for use of surveys.

[[Page 70120]]

3. Resource-Based Malpractice RVUs
    Section 4505(f) of the BBA amended section 1848(c) of the Act to 
require us to implement resource-based malpractice RVUs for services 
furnished on or after 2000. The resource-based malpractice RVUs were 
implemented in the PFS final rule published November 2, 1999 (64 FR 
59380). The malpractice RVUs are based on malpractice insurance premium 
data collected from commercial and physician-owned insurers from all 
the States, the District of Columbia, and Puerto Rico.
4. Refinements to the RVUs
    Section 1848(c)(2)(B)(i) of the Act requires that we review all 
RVUs no less often than every five years. The first 5-year review of 
the physician work RVUs went into effect in 1997, published on November 
22, 1996 (61 FR 59489). The second 5-year review went into effect in 
2002, published on November 1, 2001 (66 FR 55246). The next 5-year 
review is scheduled to go into effect in 2007.
    In 1999, the AMA's RUC established the Practice Expense Advisory 
Committee (PEAC) for the purpose of refining the direct PE inputs. 
Through March of 2004, the PEAC provided recommendations to CMS for 
over 7,600 codes (all but a few hundred of the codes currently listed 
in the AMA's Current Procedural Terminology (CPT) codes).
    In the November 15, 2004, PFS final rule (69 FR 66236), hereinafter 
referred to as the CY 2005 final rule, we implemented the first 5-year 
review of the malpractice RVUs (69 FR 66263).
5. Adjustments to RVUS Are Budget Neutral
    Section 1848(c)(2)(B)(ii)(II) of the Act provides that adjustments 
in RVUs for a year may not cause total PFS payments to differ by more 
than $20 million from what they would have been if the adjustments were 
not made. In accordance with section 1848(c)(2)(B)(ii)(II) of the Act, 
if adjustments to RVUs cause expenditures to change by more than $20 
million, we make adjustments to ensure that expenditures do not 
increase or decrease by more than $20 million.

C. Components of the Fee Schedule Payment Amounts

    Under the formula set forth in section 1848(b)(1) of the Act, the 
payment amount for each service paid under the physician fee schedule 
is the product of three factors: (1) A nationally uniform relative 
value unit (RVU) for the service; (2) a geographic adjustment factor 
(GAF) for each physician fee schedule area; and (3) a nationally 
uniform conversion factor (CF) for the service. The CF converts the 
relative values into payment amounts.
    For each physician fee schedule service, there are 3 relative 
values: (1) An RVU for physician work; (2) an RVU for practice expense; 
and (3) an RVU for malpractice expense. For each of these components of 
the fee schedule, there is a geographic practice cost index (GPCI) for 
each fee schedule area.
    To calculate the payment for every physician service, the 
components of the fee schedule (physician work, PE, and malpractice 
RVUs) are adjusted by a geographic practice cost index (GPCI). The 
GPCIs reflect the relative costs of physician work, PEs, and 
malpractice insurance in an area compared to the national average costs 
for each component.
    Payments are converted to dollar amounts through the application of 
a CF, which is calculated by the Office of the Actuary and is updated 
annually for inflation.
    The general formula for calculating the Medicare fee schedule 
amount for a given service and fee schedule area can be expressed as:

Payment = [(RVU work x GPCI work) + (RVU PE x GPCI PE) + (RVU 
malpractice x GPCI malpractice)] x CF.

    The CF for calendar year (CY) 2005 appears in section VI, Physician 
Fee Schedule Update for CY 2006. The RVUs for CY 2006 are in Addendum 
B. The GPCIs for CY 2006 can be found in Addendum D.
    Section 1848(e) of the Act requires us to develop GAFs for all 
physician fee schedule areas. The total GAF for a fee schedule area is 
equal to a weighted average of the individual GPCIs for each of the 
three components of the service. However, in accordance with the 
statute, the GAF for the physician's work reflects one-quarter of the 
relative cost of physician's work compared to the national average.

D. Most Recent Changes to the Fee Schedule

    In the CY 2005 final rule (69 FR 66236), we refined the resource-
based PE RVUs and made other changes and clarifications to Medicare 
Part B payment policy. These included:
    <bullet> Supplemental survey data for PE;
    <bullet> Updated GPCIs for physician work and PE;
    <bullet> Updated malpractice RVUs;
    <bullet> Revised requirements for supervision of therapy 
assistants;
    <bullet> Revised payment rules for low osmolar contrast media 
(LOCM);
    <bullet> Payment policies for physicians and practitioners managing 
dialysis patients;
    <bullet> Clarification of care plan oversight (CPO) requirements;
    <bullet> Requirements for supervision of diagnostic psychological 
testing services;
    <bullet> Clarifications to the policies affecting therapy services 
provided incident to a physician's service;
    <bullet> Requirements for assignment of Medicare claims;
    <bullet> Additions to the list of telehealth services;
    <bullet> Changes to payments for drug administration services; and
    <bullet> Several coding issues.
    The CY 2005 final rule (69 FR 66236) also addressed the following 
provisions of the Medicare Prescription Drug, Improvement, and 
Modernization Act of 2003 (MMA) (Pub. L. 108-173):
    <bullet> Coverage of an initial preventive physical examination.
    <bullet> Coverage of cardiovascular screening blood tests.
    <bullet> Coverage of diabetes screening tests.
    <bullet> Incentive payment improvements for physicians in physician 
shortage areas.
    <bullet> Changes to payment for covered outpatient drugs and 
biologicals and drug administration services.
    <bullet> Changes to payment for renal dialysis services.
    <bullet> Coverage of routine costs associated with certain clinical 
trials of category A devices as defined by the Food and Drug 
Administration.
    <bullet> Coverage of hospice consultation service.
    <bullet> Indexing the Part B deductible to inflation.
    <bullet> Extension of coverage of intravenous immune globulin 
(IVIG) for the treatment in the home of primary immune deficiency 
diseases.
    <bullet> Revisions to reassignment provisions.
    <bullet> Payment for diagnostic mammograms.
    <bullet> Coverage of religious nonmedical health care institution 
items and services to the beneficiary's home.
    In addition, the CY 2005 PFS final rule finalized the calendar year 
(CY) 2004 interim RVUs for new and revised codes in effect during CY 
2004 and issued interim RVUs for new and revised procedure codes for CY 
2005; updated the codes subject to the physician self-referral 
prohibition; discussed payment for set up of portable x-ray equipment; 
discussed the third 5-year refinement of work RVUs; and solicited 
comments on potentially misvalued work RVUs.
    In accordance with section 1848(d)(1)(E) of the Act, we also 
announced that the PFS update for CY 2005 would be 1.5 percent; the 
initial

[[Page 70121]]

estimate for the sustainable growth rate for CY 2005 was 4.3; and the 
CF for CY 2005 would be $37.8975.

II. Provisions of the Final Rule

    In response to the August 8, 2005 proposed rule (70 FR 45764), we 
received approximately 15,000 comments. We received comments from 
individual physicians, health care workers, professional associations 
and societies, and beneficiaries. The majority of the comments 
addressed the proposals related to PE and the negative update to the 
PFS, GPCIs, and Teaching Anesthesiology.
    The proposed rule discussed policies that affected the RVUs on 
which payment for certain services would be based and other changes to 
Medicare Part B payment policy. We also discussed changes related to 
payment for covered outpatient drugs and biologicals; supplemental 
payments to federally qualified health centers (FQHCs); payment for 
renal dialysis services; the national coverage decision (NCD) process; 
coverage of screening for glaucoma; private contracts; and physician 
referrals for nuclear medicine services and supplies to health care 
entities with which they have financial relationships. RVU changes 
implemented through this final rule with comment are subject to the $20 
million limitation on annual adjustments contained in section 
1848(c)(2)(B)(ii)(II) of the Act.
    After reviewing the comments and determining the policies we would 
implement, we have estimated the costs and savings of these policies 
and discuss in detail the effects of these changes in the Regulatory 
Impact Analysis in section XIV.
    For the convenience of the reader, the headings for the policy 
issues correspond to the headings used in the August 8, 2005 proposed 
rule. More detailed background information for each issue can be found 
in the August 8, 2005 proposed rule.

A. Resource Based Practice Expense (PE) RVUs

    Based on section 1848(c)(1)(B) of the Act, PEs are the portion of 
the resources used in furnishing the service that reflects the general 
categories of physician and practitioner expenses (such as office rent 
and wages of personnel, but excluding malpractice expenses).
    Section 121 of the Social Security Amendments of 1994 (Pub. L. 103-
432), enacted on October 31, 1994, required us to develop a methodology 
for a resource-based system for determining PE RVUs for each 
physician's service. Up until that point, physicians' PEs were based on 
historical allowed charges. This legislation stated that the revised PE 
methodology must consider the staff, equipment, and supplies used in 
the provision of various medical and surgical services in various 
settings beginning in 1998. The Secretary has interpreted this to mean 
that Medicare payments for each service would be based on the relative 
PE resources typically involved with performing the service.
    The initial implementation of resource-based PE RVUs was delayed 
until January 1, 1999, by section 4505(a) of the BBA. In addition, 
section 4505(b) of the BBA required the new payment methodology be 
phased-in over 4 years, effective for services furnished in CY 1999, 
and fully effective in CY 2002. The first step toward implementation 
called for by the statute was to adjust the PE values for certain 
services for CY 1998. Section 4505(d) of BBA required that, in 
developing the resource-based PE RVUs, the Secretary must:
    <bullet> Use, to the maximum extent possible, generally accepted 
cost accounting principles that recognize all staff, equipment, 
supplies, and expenses, not solely those that can be linked to specific 
procedures.
    <bullet> Develop a refinement method to be used during the 
transition.
    <bullet> Consider, in the course of notice and comment rulemaking, 
impact projections that compare new proposed payment amounts to data on 
actual physician PEs.
    Beginning in CY 1999, Medicare began the 4 year transition to 
resource-based PE RVUs. In CY 2002, the resource-based PE RVUs were 
fully transitioned.
1. Current Methodology
    The following sections discuss the current PE methodology.
a. Data Sources
    There are two primary data sources used to calculate PEs. The AMA's 
SMS survey data are used to develop the PEs per hour for each 
specialty. The second source of data used to calculate PEs was 
originally developed by the CPEP. The CPEP data include the supplies, 
equipment, and staff times specific to each procedure.
    The AMA developed the SMS survey in 1981 and discontinued it in 
1999. Beginning in 2002, we incorporated the 1999 SMS survey data into 
our calculation of the PE RVUs, using a 5-year average of SMS survey 
data. (See Revisions to Payment Policies and Five-Year Review of and 
Adjustments to the Relative Value Units Under the Physician Fee 
Schedule for CY 2002 final rule, published November 1, 2001 (66 FR 
55246).) The SMS PE survey data are adjusted to a common year, 1995. 
The SMS data provide the following six categories of PE costs:
    <bullet> Clinical payroll expenses, which are payroll expenses 
(including fringe benefits) for clinical nonphysician personnel.
    <bullet> Administrative payroll expenses, which are payroll 
expenses (including fringe benefits) for nonphysician personnel 
involved in administrative, secretarial or clerical activities.
    <bullet> Office expenses, which include expenses for rent, mortgage 
interest, depreciation on medical buildings, utilities and telephones.
    <bullet> Medical material and supply expenses, which include 
expenses for drugs, x-ray films, and disposable medical products.
    <bullet> Medical equipment expenses, which include depreciation 
expenses, leases, and rent of medical equipment used in the diagnosis 
or treatment of patients.
    <bullet> All other expenses, including expenses for legal services, 
accounting, office management, professional association memberships, 
and any professional expenses not mentioned above.
    In accordance with section 212 of the BBRA, we established a 
process to supplement the SMS data for a specialty with data collected 
by entities and organizations other than the AMA (that is, the 
specialty itself). (See the Criteria for Submitting Supplemental 
Practice Expense Survey Data interim final rule with comment period, 
published on May 3, 2000 (65 FR 25664).) Originally, the deadline to 
submit supplementary survey data was through August 1, 2001. This 
deadline was extended in the November 1, 2001 final rule through August 
1, 2003. (See the Revisions to Payment Policies and Five-Year Review of 
and Adjustments to the Relative Value Units Under the Physician Fee 
Schedule for CY 2002 final rule, published on November 1, 2001 (66 FR 
55246).) Then, to ensure maximum opportunity for specialties to submit 
supplementary survey data, we extended the deadline to submit surveys 
until March 1, 2005. (See the Revisions to Payment Policies Under the 
Physician Fee Schedule for CY 2002 final rule, published on November 7, 
2003 (68 FR 63196).)
    The CPEPs consisted of panels of physicians, practice 
administrators, and nonphysicians (registered nurses, for example) who 
were nominated by physician specialty societies and other groups. There 
were 15 CPEPs consisting

[[Page 70122]]

of 180 members from more than 61 specialties and subspecialties. 
Approximately 50 percent of the panelists were physicians.
    The CPEPs identified specific inputs involved in each physician 
service provided in an office or facility setting. The inputs 
identified were the quantity and type of nonphysician labor, medical 
supplies, and medical equipment.
    In 1999, the AMA's Multi-specialty Relative Value Update Committee 
(RUC) established the PEAC. Since 1999, and until March 2004, the PEAC, 
a multi-specialty committee, reviewed the original CPEP inputs and 
provided us with recommendations for refining these direct PE inputs 
for existing CPT codes. Through its last meeting in March 2004, the 
PEAC provided recommendations which we have reviewed and accepted for 
over 7,600 codes. As a result of this scrutiny by the PEAC, the current 
CPEP/RUC inputs differ markedly from those originally recommended by 
the CPEPs. The PEAC has now been replaced by the Practice Expense 
Review Committee (PERC), which acts to assist the RUC in recommending 
PE inputs.
b. Allocation of Practice Expenses to Services
    In order to establish PE RVUs for specific services, it is 
necessary to establish the direct and indirect PE associated with each 
service. Our current approach is to allocate aggregate specialty 
practice costs to specific procedures and, thus, it is often referred 
to as a ``top-down'' approach. The specialty PEs are derived from the 
AMA's SMS survey and supplementary survey data. The PEs for a given 
specialty are allocated to the services performed by that specialty on 
the basis of the CPEP/RUC data and work RVUs assigned to each CPT code. 
The specific process is detailed as follows:

Step 1--Calculation of the SMS Cost Pool for Each Specialty

    The six SMS cost categories can be described as either direct or 
indirect expenses. The three direct expense categories include clinical 
labor, medical supplies and medical equipment. Indirect expenses 
include administrative labor, office expense, and all other expenses. 
We combine these indirect expenses into a single category. The SMS cost 
pool for each specialty is calculated as follows:
    <bullet> The specialty PE per hour (PE/HR) for each of the three 
direct and one indirect cost categories from the SMS is calculated by 
dividing the aggregate PE per specialty by the specialty's total hours 
spent in patient care activities (also determined by the SMS survey). 
The PE/HR is divided by 60 to obtain the PE per minute (PE/MIN).
    <bullet> Each specialty's PE pools (for each of the three direct 
and one indirect cost categories) are created by multiplying the PE/MIN 
for the specialty by the total time the specialty spent treating 
Medicare patients for all procedures (determined using Medicare 
utilization data). Physician time on a procedure-specific level is 
available through RUC surveys of new or revised codes and through 
surveys conducted as part of the 5-year review process. For codes that 
the RUC has not yet reviewed, the original data from the Harvard 
resource-based RVU system survey is used. Physician time includes time 
spent on the case before, during, and after the procedure. The 
physician procedure time is multiplied by the frequency that each 
procedure is performed on Medicare patients by the specialty.
    <bullet> The total specialty-specific SMS PE for each cost category 
is the sum, for each direct and indirect cost category, of all of the 
procedure-specific total PEs.
    Table 1 illustrates an example of the calculation of the total SMS 
cost pools for the three direct and one indirect cost categories 
discussed in step 1. For this specialty, PE/HR for clinical payroll 
expenses is $9.30 per hour. The hourly rate is divided by 60 minutes to 
obtain the clinical payroll per minute for the specialty.
    The total clinical payroll for providing hypothetical procedure 
00001 for this specialty of $3,633,465 is the result of taking the 
clinical payroll per minute of $0.16; multiplying this by the physician 
time for procedure 00001 (56 minutes); and multiplying the result by 
the number of times this procedure was provided to Medicare patients by 
this specialty (418,602). The total amount spent on clinical payroll in 
this specialty is $667,457,018. This amount is calculated by summing 
the clinical payroll expenses of procedure 00001 and all of the other 
services provided by this specialty.
[GRAPHIC] [TIFF OMITTED] TR21NO05.002

Step 2--Calculation of CPEP Cost Pool

    CPEP data provide expenditure amounts for the direct expense 
categories (clinical labor, supplies, and equipment cost) at the 
procedure level. Multiplying the CPEP procedure-level PEs for each of 
these three categories by the number of times the specialty provided 
the procedure, produces a total category cost, per procedure, for that 
specialty. The sum of the total expenses from each procedure results in 
the total CPEP category cost for the specialty.

[[Page 70123]]

    For example, in Table 2, using CPEP data, the clinical labor cost 
of procedure 00001 is $65.23. Under the methodology described above in 
this step, this is multiplied by the number of services for the 
specialty (418,602), to yield the total CPEP data clinical labor cost 
of the procedure: $27,305,408. In this example, the clinical labor cost 
for all other services performed by this specialty is $831,618,600. 
Therefore, the entire clinical labor CPEP expense pool for the 
specialty is $858,924,008. Step 2 is repeated to calculate the CPEP 
supply and equipment costs.
[GRAPHIC] [TIFF OMITTED] TR21NO05.003

Step 3--Calculation and Application of Scaling Factors

    This step ensures that the total of the CPEP costs across all 
procedures performed by the specialty equates with the total direct 
costs for the specialty as reflected by the SMS data. To accomplish 
this, the CPEP data are scaled to SMS data by means of a scaling factor 
so that the total CPEP costs for each specialty equals the total SMS 
cost for the specialty. (The scaling factor is calculated by dividing 
the specialty's SMS pool by the specialty's CPEP pool.)
    The unscaled CPEP cost per procedure value, at the direct cost 
level, is then multiplied by the respective specialty scalar to yield 
the scaled CPEP procedure value. The sum of the scaled CPEP direct cost 
pool expenditures equals the total scaled direct expense for the 
specific procedure at the specialty level.
    In the Step 3 example shown in Table 3, the SMS total clinical 
labor costs for the specialty is $667,457,018. This amount divided by 
the CPEP total clinical labor amount of $858,924,008 yields a scaling 
factor of 0.78. The CPEP clinical labor cost for hypothetical procedure 
00001 is $65.23. Multiplying the 0.78 scaling factor for clinical labor 
costs by $65.23 yields the scaled clinical labor cost amount of $50.69. 
Individual scaling factors must also be calculated for supply and 
equipment expenses. The sum of the scaled direct cost values, $50.69, 
$43.90, and $139.45, respectively, equals the total scaled direct 
expense of $234.04.

                            Table 3.--Calculation and Application of Scaling Factors
----------------------------------------------------------------------------------------------------------------
                                                                                                  Total Scaled
                                                                                                 direct expense
       Standard methodology          Clinical/Labor         Supplies            Equipment      (Sum of A, B, and
                                                                                                       C)
                                               (A)                 (B)                 (C)                   (D)
----------------------------------
(a) Total--SMS Pool..............     $667,457,018        $344,493,945        $531,094,831
(b) Total--CPEP Pool.............      858,924,008         411,894,617       5,929,275,023
(c) Scaling Factor...............                0.78               52.49            1,556.86
Unscaled Value
(e) CPT 00001--Scaled Value......               50.69               43.90              139.45            $234.04
(c) = (a)/(b)
(e) = (c)*(d)
----------------------------------------------------------------------------------------------------------------

Step 4--Calculation of Indirect Expenses

    Indirect PEs cannot be directly attributed to a specific service 
because they are incurred by the practice as a whole. Indirect costs 
include rent, utilities, office equipment and supplies, and accounting 
and legal fees. There is not a single, universally accepted approach 
for allocating indirect practice costs to individual procedure codes. 
Rather allocation involves judgment in identifying the base or bases 
that are the best measures of a practice's indirect costs.
    To allocate the indirect PEs to a specific service, we use the 
following methodology:
    <bullet> The total scaled direct expenses and the converted work 
RVU (the work RVU for the service is multiplied by $34.5030, the 1995 
CF) are added together, and then multiplied by the number of services 
provided by the specialty to Medicare patients.
    <bullet> The total indirect PEs per specialty are calculated by 
summing the indirect expenses for all other procedures provided by that 
specialty.
    For example, in Table 4, the physician work RVU for procedure 00001 
is 2.36. Multiplying the work RVU by the 1995 CF of $34.5030 equals 
$81.43. The physician work value is added to the scaled total direct 
expense from Step 3

[[Page 70124]]

($234.04). The total of $314.47 is a proxy for the indirect PE for the 
specialty attributed to this procedure. The total indirect expenses are 
then multiplied by the number of times procedure 00001 is provided by 
the specialty (418,602), to calculate total indirect expenses for this 
procedure of $132,055,728. The process is repeated across all 
procedures performed by the specialty, and the indirect expenses for 
each service are summed to arrive at the total specialty indirect PE 
pool of $6,745,545,434.

                                    Table 4.--Calculation of Indirect Expense
----------------------------------------------------------------------------------------------------------------
                                                                              Total direct
                 Standard Methodology                    Physician Work*        expense              Total
                                                                      (A)                (B)              (C)
-------------------------------------------------------
(a) CPT 00001.........................................             $81.43            $234.04             $315.47
(b) Allowed Services..................................  .................  .................          418,602
                                                       --------------------
(c) Subtotal..........................................  .................  .................      132,055,728
(d) All Other Services................................  .................  .................    6,613,489,706
                                                       ====================
(e) Total Indirect Expense............................  .................  .................   6,745,545,434
----------------------------------------------------------------------------------------------------------------
* Calculated by multiplying work RVU of 2.36 by 1995 CF of $34.5030.

Step 5--Calculation and Application of Indirect Scaling Factors

    Similar to the direct costs, the indirect costs are scaled to 
ensure that the total across all procedures performed by the specialty 
equates with the total indirect costs for the specialty as reflected by 
the SMS data. To accomplish this, the indirect costs calculated in Step 
4 (Table 4) are scaled to SMS data. The calculation of the indirect 
scaling factors is as follows:
    <bullet> The specialty's total SMS indirect expense pool is divided 
by the specialty's total indirect expense pool calculated in Step 4 
(Table 4), to yield the indirect expense scaling factor.
    <bullet> The unscaled indirect expense amount, at the procedure 
level, is multiplied by the specialty's scaling factor to calculate the 
procedure's scaled indirect expenses.
    <bullet> The sum of the scaled indirect expense amount and the 
procedure's direct expenses yields the total PEs for the specialty for 
this procedure.
    In table 5, to calculate the indirect scaling factor for 
hypothetical procedure 00001, divide the total SMS indirect pool, 
$3,337,285,089 (calculated in Step 1-Table 1)), by the total indirect 
expense for the specialty across all procedures of $6,745,545,434. This 
results in a scaling factor of 0.49. Next, the unscaled indirect cost 
of $315.47 is multiplied by the 0.49 scaling factor, resulting in 
scaled indirect cost of $156.07. To calculate the total PEs for the 
specialty for procedure 00001, the scaled direct and indirect expenses 
are added, totaling $390.12.

                  Table 5.--Calculation of Indirect Scaling Factors and Total Practice Expenses
----------------------------------------------------------------------------------------------------------------
                                                                                                   Specialty
                                                                                               specific practice
                 Standard methodology                     Indirect costs       Direct cost     expenses  (Sum of
                                                                                                     A, B)
                                                                    (A)                   (B)                (C)
-------------------------------------------------------
(a) Total--SMS Indirect Expense.......................   $3,337,285,089
(b) Total Indirect Expense for all Procedures (from       6,745,545,434
 Step 4)..............................................
(c) Scaling Factor....................................                0.49
(d) CPT 00001--Unscaled Value.........................              315.47
(e) CPT 00001--Scaled Value...........................              156.07            $234.04            $390.12
----------------------------------------------------------------------------------------------------------------

Step 6--Weighted Average of RVUs for Procedures Performed by More Than 
One Specialty

    For codes that are performed by more than one specialty, a 
weighted-average PE is calculated based on Medicare frequency data of 
all specialties performing the procedure as shown in Table 6.

             Table 6.--Weight Averaging for All Specialties
------------------------------------------------------------------------
                                     Practice expense   Percent of total
       Standard methodology               value         allowed services
                                                  (A)                (B)
-----------------------------------
(a) Specialty Total Practice                  $390.12                 83
 Expense..........................
(b) Weighted Avg.--All Other                   929.87                 17
 Specialties......................
(c) Weighted Avg.--All Specialties             481.70                100
------------------------------------------------------------------------


[[Page 70125]]

Step 7--Budget Neutrality and Final RVU Calculation

    The total scaled direct and indirect inputs are then adjusted by a 
budget neutrality factor (BNF) to calculate RVUs. Section 
1848(c)(2)(B)(ii)(II) of the Act provides that adjustments in RVUs may 
not cause total PFS payments to differ by more than $20 million from 
what they would have been if the adjustments were not made. Budget 
neutrality for the upcoming year is determined relative to the sum of 
PE RVUs for the current year. Although the PE RVUs for any particular 
code may vary from year-to-year, the sum of PE RVUs across all codes is 
set equal to the current year. The BNF is equal to the sum of the 
current year's PE RVUs, divided by the sum of the direct and indirect 
inputs across all codes for the upcoming year. The BNF is applied to 
(multiplied by) the scaled direct and indirect expenses for each code 
to set the PE RVU for the upcoming year.
    In Table 7, the sum of the scaled direct and indirect expenses for 
hypothetical code 00001 ($481.70) is multiplied by the BNF (0.02 in 
this example) to yield a PE RVU of 10.60.

                                           Table 7.--Calculate PE RVU
----------------------------------------------------------------------------------------------------------------
                                                            Total scaled
                                                             direct and     Budget neutrality     Final PE RVU
                                                          indirect inputs         factor
                                                                (A)                (B)                (C)
--------------------------------------------------------
(a) Code 00001.........................................            $481.70               0.02              10.60
----------------------------------------------------------------------------------------------------------------

c. Other Methodological Issues: Nonphysician Work Pool (NPWP)
    As an interim measure, until we could further analyze the effect of 
the top-down methodology on the Medicare payment for services with no 
physician work (including the technical components (TCs) of radiation 
oncology, radiology and other diagnostic tests), we created a separate 
PE pool for these services. However, any specialty society could 
request that its services be removed from the nonphysician work pool 
(NPWP). We have removed some services from the NPWP if we find that the 
requesting specialty provides the service the majority of the time.

NPWP Step 1--Calculation of the SMS Cost Pool for Each Code

    This step parallels the calculations described above for the 
standard ``top-down'' PE allocation methodology. For codes in the NPWP, 
the direct and indirect SMS costs are set equal to the weighted average 
of the PE/HR for the specialties that provide the services in the pool. 
Clinical staff time is substituted for physician time in the 
calculation. The clinical staff time for the code is from CPEP data. 
Otherwise, the calculation is similar to the method described 
previously for codes with physician time.
    The following example in Table 8 illustrates this calculation for 
hypothetical code 00002. In this example, the average clinical payroll 
PE/HR for all specialties in the NPWP is $12.30 and the clinical staff 
time for code 00002 is 116 minutes.
[GRAPHIC] [TIFF OMITTED] TR21NO05.004

NPWP Step 2--Calculation of Charge-Based PE RVU Cost Pool

    The NPWP calculation uses the 1998 (charge-based) PE RVU value for 
the code, multiplied by the 1995 CF (25.74 x $34.503 = $888.11). The 
percentage of clinical labor, supplies and equipment are the percentage 
that each PE category represents for all physicians relative to the 
total PE for all physicians (calculated from the SMS data) as shown in 
Table 9.

[[Page 70126]]

[GRAPHIC] [TIFF OMITTED] TR21NO05.005

NPWP Step 3--Calculation and Application of Scaling Factors

    After the total cost pools for each code in the NPWP are 
calculated, the steps to ensure the total charge-based PEs for the 
procedure do not exceed the total SMS PEs for the procedure (scaling) 
are the same as those described previously for codes with physician 
work.
    In Table 10, the SMS total clinical labor costs are $2,499,159. 
This amount divided by the charge-based total clinical labor amount of 
$16,613,742 yields a scaling factor of 0.15. The charge-based clinical 
labor cost for hypothetical procedure 00002 is $158.08 (from NPWP Step 
2--Table 9). Multiplying the 0.15 scaling factor for clinical labor 
costs by $158.08 yields the scaled clinical labor cost amount of 
$23.78. Individual scaling factors must be calculated for both supply 
and equipment expenses. The sum of the scaled direct cost values, 
$23.78, $32.57 and $2.72, respectively, equals the total scaled direct 
expense of $59.07.

                      Table 10.--Calculation and Application of Direct Cost Scaling Factors
----------------------------------------------------------------------------------------------------------------
                                                                                                  Total scaled
                                                                                                 direct expense
           NPWP methodology                 Clinical           Supplies          Equipment        (Sum of A, B,
                                                                                                     and C)
                                                  (A)                (B)                (C)                  (D)
--------------------------------------
(a) Total--NPWP Specialty Pool.......      $2,499,159         $1,503,559           $650,188
(b) Total NPWP Charge-based Pool.....      16,613,742          4,386,775          9,986,912
(c) Scaling Factor...................               0.15               0.34               0.06
(d) CPT 00002--Unscaled Value........             158.08              95.03              41.74
(e) CPT 00002--Scaled Value..........              23.78              32.57               2.72            $59.07
----------------------------------------------------------------------------------------------------------------

NPWP Step 4--Calculation of Indirect Expenses

    Because codes in the NPWP do not have work RVUs, indirect expenses 
are set equal to direct expenses (for codes with physician work, 
indirect expenses equal the sum of the scaled direct expenses and the 
converted work RVU). This amount is then multiplied by the number of 
times the procedure is performed.
    In Table 11, the scaled total direct expense from NPWP Step 3 
(Table 10) ($59.07) is also the proxy for the total indirect expense 
attributed to the procedure. The total indirect expense is multiplied 
by the number of services (105,095), to calculate total indirect cost 
for this procedure of $6,207,961.

                                   Table 11.--Calculation of Indirect Expenses
----------------------------------------------------------------------------------------------------------------
                                                                               Total direct
                     NPWP methodology                      Physician work *       expense            Total
                                                                        (A)               (B)             (C)
----------------------------------------------------------
(a) CPT 00002............................................  ................            $59.07             $59.07
(b) Allowed Services--NPWP...............................  ................  ................         105,095
(c) Total NPWP Indirect Expense..........................  ................  ................      $6,207,961
----------------------------------------------------------------------------------------------------------------

NPWP Step 5--Calculation and Application of Indirect Scaling Factors

    Similar to the direct costs, the indirect costs are scaled to 
ensure that the total of the charge-based PE costs across all 
procedures equates with the total indirect costs as reflected by the 
SMS data for the code. To accomplish this, the charge-based indirect 
PEs are scaled to the SMS indirect PEs.
    In Table 12, to calculate the indirect scaling factor for 
hypothetical procedure 00002, the total SMS indirect PE, $9,407,404 
(from NPWP Step 1--Table 8), is divided by the total charge-based 
indirect expense of $6,207,961 (from NPWP Step 4--Table 11). This 
results in a scaling factor of 1.51. Next, the

[[Page 70127]]

unscaled indirect charge-based cost for procedure 00002 of $59.07 (from 
NPWP Step 4--Table 11) is multiplied by the 1.51 scaling factor, 
resulting in scaled indirect costs for this procedure of $89.19.

                     Table 12.--Calculation and Application of Indirect Cost Scaling Factors
----------------------------------------------------------------------------------------------------------------
                                                                                                   Specialty
                 Standard methodology                     Indirect costs       Direct cost      specific PE RVU
                                                                                                (Sum of A and B)
                                                                    (A)                   (B)                (C)
-------------------------------------------------------
(a) Total--NPWP ``SMS'' Pool..........................       $9,407,404
(b) Total NPWP Indirect Expense.......................        6,207,961
(c) Scaling Factor....................................                1.51
(d) CPT 00002--Unscaled Value.........................               59.07
(e) CPT 00002--Scaled Value...........................               89.19             $59.07            $148.26
----------------------------------------------------------------------------------------------------------------

NPWP Step 6--Budget Neutrality and Final RVU Calculation

    Similar to the calculation for codes with physician work, the BNF 
is applied to (multiplied by) the scaled direct and indirect expenses 
for each code to set the PE RVU for the upcoming year.
    In Table 13, the sum of the scaled direct and indirect expenses for 
hypothetical code 00002 ($148.26) is multiplied by the BNF (0.022 in 
this example) to yield a PE RVU of 3.26.

                             Table 13.--Budget Neutrality and Final RVU Calculation
----------------------------------------------------------------------------------------------------------------
                                                            Total scaled
                                                             direct and     Budget neutrality     Final PE RVU
                                                          indirect inputs         factor
----------------------------------------------------------------------------------------------------------------
Code 00002.............................................            $148.26              0.022               2.96
----------------------------------------------------------------------------------------------------------------

d. Facility/Nonfacility Costs
    Procedures that can be performed in a physician's office as well as 
in a hospital have two PE RVUs; facility and nonfacility. The 
nonfacility setting includes physicians' offices, patients' homes, 
freestanding imaging centers, and independent pathology labs. Facility 
settings include hospitals, ambulatory surgery centers, and skilled 
nursing facilities (SNFs). The methodology for calculating the PE RVU 
is the same for both facility and nonfacility RVUs, but each is 
calculated independently to yield two separate PE RVUs. Because the PEs 
for services provided in a facility setting are generally included in 
the payment to the facility (rather than the payment to the physician 
under the fee schedule), the PE RVUs are generally lower for services 
provided in the facility setting.
2. PE Proposals for CY 2006
    The following discussions outline the specific PE related proposals 
for CY 2006.
a. Supplemental PE Surveys
    The following discussions outline the criteria for supplemental 
survey submission as well as information we have received for approval.
(1) Survey Criteria and Submission Dates
    In accordance with section 212 of the BBRA, we established criteria 
to evaluate survey data collected by organizations to supplement the 
SMS survey data normally used in the calculation of the PE component of 
the PFS. In the final rule published November 7, 2003 (68 FR 63196), we 
provided that, beginning in 2004, supplemental survey data had to be 
submitted by March 1 to be considered for use in computing PE RVUs for 
the following year. This allows us to publish our decisions regarding 
survey data in the proposed rule and provides the opportunity for 
public comment on these results before implementation.
    To continue to ensure the maximum opportunity for specialties to 
submit supplemental PE data, we extended until 2005 the period that we 
would accept survey data that meet the criteria set forth in the 
November 2000 PFS final rule. The deadline for submission of 
supplemental data to be considered in CY 2006 was March 1, 2005.
(2) Submission of Supplemental Survey Data
    The following discussion outlines the survey data submitted for CY 
2004 and CY 2005.
(a) Surveys Submitted in 2004
    As discussed in the August 8, 2005 PFS proposed rule (70 FR 45774), 
we had received surveys by March 1, 2004 from the American College of 
Cardiology (ACC), the ACR, and the American Society for Therapeutic 
Radiation Oncology (ASTRO). The data submitted by the ACC and the ACR 
met our criteria. However, as requested by the ACC and the ACR, we 
deferred using their data until issues related to the NPWP could be 
addressed. In the August 8, 2005 proposed rule, we proposed to use the 
ACC and ACR survey data in the calculation of PE RVUs for CY 2006, but 
only as specified in the proposals relating to a revised methodology 
for establishing direct PE RVUs.
    The survey data from ASTRO did not meet the precision criteria 
established for supplemental surveys, therefore, we indicated we would 
not use it in the calculation of PE RVUs for CY 2005. However, we 
proposed to use these data to blend with data submitted by the 
Association of Freestanding Radiation Oncology Centers (AFROC) for CY 
2006, as described below.
(b) Surveys Submitted in 2005
    In 2005 we received surveys from the AFROC, the American Urological 
Association (AUA), the American Academy of Dermatology Association 
(AADA), the Joint Council of Allergy, Asthma, and Immunology (JCAAI), 
the National Coalition of Quality Diagnostic Imaging Services (NCQDIS) 
and a joint survey from the American Gastroenterological Association 
(AGA), the American Society of Gastrointestinal Endoscopy (ASGE), and 
the American College of Gastroenterology (ACG).

[[Page 70128]]

    As explained in the August 8, 2005 proposed rule, we contract with 
the Lewin Group to evaluate whether the supplemental survey data that 
are submitted meet our criteria and to make recommendations to us 
regarding their suitability for use in calculating PE RVUs. (The Lewin 
Group report on the 2005 submissions is available on the CMS Web site 
at http://www.cms.hhs.gov/physicians/pfs/.) The report indicated that, 
except for the survey from NCQDIS, all met our criteria and we are 
proposing to accept these surveys. The survey data submitted by the 
NCQDIS on independent diagnostic testing facilities (IDTFs) did not 
meet the precision criterion of a 90 percent confidence interval with a 
range of plus or minus 15 percent of the mean (that is, 1.645 times the 
standard error of the mean, divided by the mean, is equal to or less 
than 15 percent of the mean). For the NCQDIS survey, the precision 
level was calculated at 16.3 percent of the mean PE/HR (weighted by the 
number of physicians in the practice). However, the Lewin Group has 
recommended that we accept the data from NCQDIS. The Lewin Group points 
out that PE data for IDTFs do not currently exist, and suggests that 
the need for data for the specialty should be weighed against the 
precision requirement.
    We proposed not to accept the NCQDIS data to calculate the PE RVUs 
for services provided by IDTFs. As just noted, the NCQDIS data did not 
meet our precision requirements. We established the minimum precision 
standards because we believe it is necessary to ensure that the data 
used are valid and reliable, and the consistent application of the 
precision criteria is the best way to accomplish that objective.
    Section 303(a)(1) of the MMA added section 1848(c)(2)(I) of the Act 
to require us to use survey data that include expenses for the 
administration of drugs and biologicals submitted by a specialty group 
for which at least 40 percent of the Part B payments are attributable 
to the administration of drugs in 2002 to adjust PE RVUs for drug 
administration services. The provision applies to surveys received by 
March 1, 2005 for determining the CY 2006 PE RVUs. Section 303(a)(1) of 
the MMA also amended section 1848(c)(2)(B)(iv)(II) of the Act to 
provide an exemption from budget neutrality for any additional 
expenditures resulting from the use of this survey data to adjust PE 
RVUs for drug administration services. In the Changes to Medicare 
Payment for Drugs and Physician Fee Schedule Payments for CY 2004 
interim final rule published January 7, 2004 (69 FR 1084), we stated 
that the specialty of urology meets the above criteria, along with 
gynecology and rheumatology (69 FR 1094). Because we proposed to accept 
the new survey data from the AUA, we are required to exempt from the 
budget neutrality adjustment any impacts of accepting these data for 
purposes of calculating PE RVUs for drug administration services.
    In addition, Lewin recommended blending the radiation oncology data 
from this year's AFROC survey data with last year's ASTRO survey data 
to calculate the PE/HR. According to the Lewin Group, the goal of the 
AFROC survey was to represent the population of freestanding radiation 
oncology centers only. In order to develop an overall average for the 
radiation oncology PE pool, the Lewin Group recommended we use the 
AFROC survey for freestanding radiation oncology centers, and the 
hospital-based subset of last year's ASTRO survey. Consistent with that 
recommendation, we proposed to use the new PE/HR calculated in this 
manner for radiation oncology.
    As discussed in the August 8, 2005 PFS proposed rule and also in 
the preamble of this final rule with comment, we proposed to revise our 
methodology to calculate direct PE RVUs from the current top-down cost 
allocation methodology to a bottom-up methodology. Although we would 
continue to use the SMS data and the incorporated supplemental survey 
data for indirect PEs, we did not extend the deadline for submitting 
supplemental survey data but rather requested comments on the most 
appropriate way to proceed to ensure the indirect PEs per hour are 
accurate and consistent across specialties.
b. Revisions to the PE Methodology
    As discussed in the August 8, 2005 proposed rule, since 1997, when 
we first proposed a resource-based PE methodology, we have had several 
major goals for this payment system and have encouraged the maximum 
input from the medical community regarding our PE data and methodology.
    We also have had the following three specific goals for the 
resource-based PE methodology itself, which have also been supported in 
numerous comments we have received from the medical community:
    <bullet> To ensure that the PE payments reflect, to the greatest 
extent possible, the actual relative resources required for each of the 
services on the PFS. This could only be accomplished by using the best 
available data to calculate the PE RVUs.
    <bullet> To develop a payment system for PE that is understandable 
and at least somewhat intuitive, so that specialties could generally 
predict the impacts of changes in the PE data.
    <bullet> To stabilize the PE payments so that there are not large 
fluctuations in the payment for given procedures from year-to-year.
    As we explained in the August 8, 2005 proposed rule, we believe 
that we have consistently made a good faith effort to ensure fairness 
in our PE payment system by using the best data available at any one 
time. The change from the originally proposed ``bottom-up'' to the 
``top-down'' methodology came about because of a concern that the 
resource input data developed in 1995 by the CPEP were less reliable 
than the aggregate specialty cost data derived from the SMS process. 
The adoption of the top-down approach necessitated the creation of the 
NPWP. The NPWP is a separate pool created to allocate PEs for codes 
that have only a technical (rather than professional) component, or 
codes that are not performed by physicians.
    However, the situation has now changed. As we explained in the 
August 8, 2005 proposed rule, refinement of the original CPEP data is 
complete and the refined PE inputs now, in general, accurately capture 
the relative direct costs of performing PFS services. Also, the major 
specialties comprising the NPWP (radiology, radiation oncology, and 
cardiology) submitted supplemental survey data that we proposed to 
accept, which would eliminate the need to treat these technical 
services outside the PE methodology applied to other services.
    Due to the ongoing refinement by the RUC of the direct PE inputs, 
we had expected that the PE RVUs would necessarily fluctuate from year-
to-year. However, it became apparent that certain aspects of our 
methodology exacerbated the yearly fluctuations. The services priced by 
the NPWP methodology have proven to be especially vulnerable to any 
change in the pool's composition. With the CPEP/RUC refinement of 
existing services virtually complete, we indicated this was an 
opportunity for us to propose a way to provide stability to the PE 
RVUs.
    Therefore, consistent with our goals of using the most appropriate 
data, simplifying our methodology, and increasing the stability of the 
payment system, we proposed the following changes to our PE methodology 
and also requested suggestions that would assist us in further 
refinement of the indirect PE methodology.

[[Page 70129]]

(1) Use a Bottom-up Methodology To Calculate Direct PE Costs
    Instead of using the top-down approach to calculate the direct PE 
RVUs, where the aggregate CPEP/RUC costs for each specialty are scaled 
to match the aggregate SMS costs, we proposed to adopt a bottom-up 
method of determining the relative direct costs for each service. Under 
this method, the direct costs would be determined by summing the costs 
of the resources--the clinical staff, equipment and supplies--typically 
required to provide the service. The costs of the resources, in turn, 
would be calculated from the refined CPEP/RUC inputs in our PE 
database.
(2) Eliminate the Nonphysician Work Pool (NPWP)
    Since we proposed to incorporate new survey data for the major 
specialties that comprise the NPWP, we proposed to eliminate the pool 
and calculate the PE RVUs for the services currently in the pool by the 
same methodology used for all other services. This would allow the use 
of the refined CPEP/RUC data to price the direct costs of individual 
services, rather than utilizing the pre-1998 charge-based PE RVUs.
(3) Utilize the Current Indirect PE RVUs, Except for Those Services 
Affected by the Accepted Supplemental Survey Data
    As described previously, the SMS and supplemental survey data are 
the source for the specialty-specific aggregate indirect costs used in 
our PE calculations. We then allocate to particular codes on the basis 
of the direct costs allocated to a code and the work RVUs. Although we 
now believe the CPEP/RUC data are preferable to the SMS data for 
determining direct costs, we have no information that would indicate 
that the current indirect PE methodology is inaccurate. We also are not 
aware of any alternative approaches or data sources that we could use 
to calculate more appropriately the indirect PE, other than the new 
supplemental survey data, which we proposed to incorporate into our PE 
calculations. Therefore, we proposed to use the current indirect PEs in 
our calculation incorporating the new survey data into the codes 
performed by the specialities submitting the surveys.
    We specifically requested suggestions that would assist us in 
further refinement of the indirect PE methodology. For example, we 
noted in the proposed rule that we are considering whether we should 
continue to accept supplementary survey data or whether it would be 
preferable and feasible to have an SMS-type survey of only indirect 
costs for all specialties; or whether a more formula-based methodology 
independent of the SMS data should be adopted, perhaps using the 
specialty-specific indirect-to-total cost percentage as a basis of the 
calculation.
(4) Transition the Resulting Revised PE RVUs Over a 4-Year Period
    We are concerned that, when combined with an expected negative 
update factor for CY 2006, the shifts in some of the PE RVUs resulting 
from our proposals could cause some measure of financial stress on 
medical practices. Therefore, we proposed to transition the proposed PE 
changes over a 4-year period. This would also give ample opportunity 
for us, as well as the medical specialties and the RUC, to identify any 
anomalies in the PE data, to make any further appropriate revisions, 
and to collect additional data, as needed prior to the full 
implementation of the proposed PE changes.
    During this transition period, the PE RVUs would be calculated on 
the basis of a blend of RVUs calculated using our proposed methodology 
described above (weighted by 25 percent during CY 2006, 50 percent 
during CY 2007, 75 percent during CY 2008, and 100 percent thereafter), 
and the current CY 2005 PE RVUs for each existing code.
    Now that the direct PE inputs have been refined, we believe that 
the CPEP/RUC direct input data are generally superior to the specialty-
specific SMS PE/HR data for the purposes of determining the typical 
direct PE resources required to perform each service on the PFS. First, 
we have received recommendations on the procedure-specific inputs from 
the multi-specialty PEAC that were based on presentations from the 
relevant specialties after being closely scrutinized by the PEAC using 
standards and packages agreed to by all involved specialties. Second, 
the refined CPEP/RUC data are more current than the SMS data for the 
majority of specialties. Third, for direct costs, it appears more 
accurate to assume that the costs of the clinical staff, supplies and 
equipment are the same for a given service, regardless of the specialty 
that is performing it. This assumption does not hold true under the 
top-down direct cost methodology, where the specialty-specific scaling 
factors create widely differing costs for the same service.
    We also would argue that the proposed methodology is less confusing 
and more intuitive than the current approach. For instance, the NPWP 
would be eliminated and all services would be priced using one 
methodology, eliminating the complicated calculations needed to price 
NPWP services. Also, any revisions made to the direct inputs would now 
have predictable results. Changes in the direct practice inputs for a 
service would proportionately change the PE RVUs for that service 
without significantly affecting the PE RVUs for unrelated services.
    In addition, the proposed methodology would create a system that 
would be significantly more stable from year-to-year than the current 
approach. We recognized that there are still some outstanding issues 
that need further consideration, as well as input from the medical 
community. For example, although we believe that the elimination of the 
NPWP would be, on the whole, a positive step, some practitioner 
services, such as audiology and medical nutrition therapy (MNT), would 
be significantly impacted by the proposed change. In addition, there 
are still services, such as the end stage renal disease (ESRD) visit 
codes, for which we have no direct input information. Also, as 
mentioned above, we do not have current SMS or supplementary survey 
data to calculate the indirect costs for most specialties. Further, we 
do not yet have accurate utilization for the new drug administration 
codes that were created in response to the MMA provision on drug 
administration. Therefore, we did not propose to change the RVUs for 
these services at this time, but to include them under our proposed 
methodology in next year's rule when we have appropriate data. The 
proposed transition period would give us the opportunity to work with 
the affected specialties to collect the needed survey or other data or 
to determine whether further revisions to our PE methodology are 
needed.
    We requested comments on these proposed changes, particularly those 
concerning additional modifications to the indirect PE methodology that 
might help us further our intended goals.
    Comment: There were 3 main concerns raised in comments we received 
on our overall proposed PE methodology which included: (1) Many of the 
proposed decreases appeared anomalous and were not explained; (2) there 
was insufficient information given to allow specialties to review and 
analyze the proposal and its impact; and (3) the use of the new PE data 
from the seven accepted supplementary surveys caused an inequitable 
redistribution of PE RVUs. As a result of these concerns, many 
commenters also requested a

[[Page 70130]]

delay in the implementation of our proposed methodology.
    The following are examples of the comments detailing the above 
concerns.
    The AMA and the RUC agreed with the goals that we have set for an 
accurate, intuitive and stable methodology to use for the calculation 
of PE RVUs. The RUC added that it looks forward to helping us meet 
these goals. However, the AMA urged us to provide more information, 
such as examples of how the new values were calculated, the PE/HR and 
source of the data for each specialty and the budget neutrality 
adjuster applied at the end of the process, so that the medical 
community would have the opportunity to review the values and impact of 
the proposal.
    Medicare Payment Advisory Commission (MedPAC) stated its agreement 
with the concerns regarding the current PE methodology that motivated 
us to propose a change, but did request that we assess the impact of 
proposed changes by groups of services--evaluation and management 
services, major procedures, other procedures, laboratory tests and 
imaging services, as well as by physician specialty group.
    A specialty society representing obstetrics and gynecology 
commended the goal of the new methodology, but suggested we offer two 
or more examples of how PE is calculated, starting with the inputs that 
are used and moving through the process of developing the final PE RVUs 
for those codes.
    An optometric association expressed regret that the proposed rule 
does not provide service-specific examples of how PE RVUs would be 
calculated using the current and proposed methodologies because this 
made it difficult to provide detailed comments on the proposal. 
Therefore, the commenter concluded that we should issue a final with a 
comment period. Two emergency medicine societies also requested the 
same service-specific examples.
    An ophthalmology society was troubled by our failure to make the 
indirect cost data used in determining the rates of change in PE values 
available to all specialties for review and by the lack of analysis 
explaining the significant impacts caused by the acceptance of the 
supplemental survey data.
    A specialty society representing cardiology urged us to provide 
more data and a more detailed explanation of the methodology, along 
with examples of how RVUs for specific codes were determined, so that 
stakeholders can gain a thorough understanding of our proposal.
    A dermatology association commented that it is pleased that we want 
to transition to a bottom-up approach. The association believes that 
this will result in a more easily understood and stable payment system, 
but it would be helpful to have more information in the final rule on 
the calculation of PE values under the new methodology. For example, 
the association asks for clarification of why the PE RVUs for several 
dermatology procedures decreased.
    A specialty society representing physical medicine expressed 
concern regarding a number of the results with respect to several 
physical medicine and rehabilitation codes and requested that we 
provide a more detailed description of the new methodology and address 
anomalies in the final rule. The commenter suggested that we establish 
a percentage decrease threshold that would trigger an opportunity for 
expedited review to determine whether the direct cost inputs are 
accurate.
    Four organizations representing radiation oncology submitted 
comments stating their concern that several radiation therapy codes, 
including those for intensity modulated radiation therapy, continuing 
medical physics consultation and brachytherapy, have inappropriate 
proposed reductions. Two of the commenters recommended that we examine 
the impact of the methodology on a code-specific basis and, if 
necessary, implement an adjustment factor that limits the reduction to 
no more than 15 percent of the 2005 global RVUs at the end of the 4-
year transition period. Comments from societies representing nuclear 
cardiology and echocardiography also supported a cap on the maximum 
reduction applied to any procedure that resulted from the decision to 
adopt the new methodology.
    A geriatrics society expressed concern that geriatrics will 
experience a 1 percent reduction under the new methodology and stated 
that the transition period is critical, as it will lessen the impact of 
the proposed reduction. The society suggested that, during the 
transition period, we should work with stakeholders to explain the new 
methodology, to identify non-intuitive decreases in payment and to 
identify better ways to pay for indirect expenses.
    An association representing nursing facility medical directors 
expressed concern that the new methodology will reduce the PE RVUs for 
nearly all codes for nursing facility services. If we proceed with the 
changes, the association suggested that we provide a more detailed 
explanation of the new methodology in the final rule, with examples of 
the PE RVU calculations for specific services under the old and new 
methods.
    A consulting company expressed concern that we failed to make 
needed data available, such as the time file, utilization file and 
scaling factors and pools file. The commenter also requested that, in 
the future, we consider making available the same files we use to 
produce the PE RVUs, the assumptions used, such as crosswalks or 
projected utilization for new services and the data needed to evaluate 
the methodology used to go from the survey data to a PE/HR.
    The American Cancer Society expressed concern regarding the 
specific reductions in payment for screening mammography, pap smears, 
pelvic/breast exams and flexible sigmoidoscopies which could 
potentially reduce access to cancer screenings.
    An oncology nursing society strongly urged us to include drug 
administration services in the phase-in of the new methodology and 
exempt them from budget neutrality requirements. A cancer and blood 
disorders center expressed the same concern and stated that this 
omission would skirt the MMA mandate to exempt from budget neutrality 
limits any 2006 fee schedule changes to drug administration codes.
    An association representing medical colleges noted that, together 
with the negative update, the decrease in revenue across faculty 
practice groups will exceed -6 percent. The association recommended 
that this warrants further review by the medical community and CMS 
should make public examples of how the new values were calculated, the 
actual new PE values for each code, the PE per hour and source of the 
data for each specialty and the budget neutrality adjuster applied as a 
final step.
    A medical technology company requested that we explain how we 
intend to scale PE when CPT codes, such as endogenous radiofrequency 
ablation procedures, include a vascular as well as a radiology imaging 
procedure. The commenter recommended we should calculate the costs 
according to the primary group furnishing the procedure. In addition, 
the commenter contended that a deflation factor should not be applied 
to new procedures that have been valued by the RUC and CMS in late 2004 
for establishment of 2005 payment.
    Following are examples of the comments explicitly requesting delay.

[[Page 70131]]

    A comment from specialty societies representing general surgeons, 
anesthesiology, ophthalmology, hematology, emergency medicine, 
neurosurgery, cataract surgery, thoracic surgery, orthopaedic surgery, 
otolaryngology and hand surgery, supported by a letter from a member of 
the Congress, stated agreement with our goals for a PE methodology. 
However, the commenters requested that the implementation of the new 
methodology and data be delayed for 1 year, citing several concerns: 
First, commenters claimed that CMS did not provide sufficient data and 
information or time to allow adequate review of the validity of the new 
methodology, the supplementary survey data or the proposed impact. As a 
result, the comment argued that physicians have not had a reasonable 
opportunity to participate in the rule making process, in compliance 
with the Administrative Procedure Act. In addition, the comment cited 
the Practicing Physician Advisory Committee recommendation that we 
delay implementation of the new data and methodology for 1 year.
    An oncology society commented that a final decision on the proposed 
revision to the PE methodology should be deferred 1 year until 
information is available on how the proposal will affect drug 
administration services. A large provider of oncology services was also 
troubled by the decision to exclude drug administration services from 
revisions to the PE methodology.
    A psychological association stated that its primary concern is 
``the proposed rule's lack of clarity regarding the impacts that the 
change in methodology will have on each health care specialty.'' 
Because of the lack of this data, the Association requested a 1 year 
delay for our proposal.
    A specialty society representing surgeons stated that the proposed 
methodology apparently created many aberrant PE RVUs and gave examples: 
Closely related procedures with proposed RVUs that are inconsistent 
with their actual costs; services that contribute significantly to the 
increases in volume and intensity noted by MedPAC all receive 
significant increases; within specialties that should benefit from the 
higher PE/HR in their surveys, there are increases and decreases that 
cannot be explained; E/M services will be increased in the office 
setting, but decreased in the hospital setting. The college recommends 
that we withdraw the current proposal and republish it in a future PFS 
rule that includes a detailed description of the methodology.
    Two specialty societies representing thoracic and chest physicians 
expressed concern with the significant shifts in the PE that would 
necessitate a 4-year transition and suggested that there should be no 
change in PE until all specialties can complete supplemental PE 
surveys.
    A specialty society representing spine surgeons requested that we 
suspend the proposed PE changes until 2007, not because the methodology 
is flawed, but in order to allow all physicians an equal opportunity to 
submit data relevant to their specialties.
    A specialty society representing anesthesiologists contended that 
lack of information on data and methodology behind the PE changes 
requires a delay in implementation. The Society requested that we 
provide information that clearly breaks out the impact of the proposed 
changes by specialty on the indirect and direct PE payments.
    A medical group practice association fully supported the 4-year 
transition of the new PE values achieved under the new bottom-up 
calculation. However, because it believed that insufficient information 
has been made available, the association recommended that we delay 
implementation until the provider community has time to evaluate the 
methodology used to recalculate the PE RVUs.
    The following commenters requested a delay in calculating the PE 
RVUs for their own specific services under the new methodology.
    Several comments from a specialty society representing heart rhythm 
services, two manufacturers and a manufacturers association, as well as 
a provider of remote cardiac monitoring services expressed concern 
about the proposed cuts for remote cardiac monitoring services and 
requested that we not implement these proposed reductions, pending 
further study.
    Two societies representing audiology and speech language pathology, 
supported by a comment from two senators, expressed concern about the 
large reductions in payment for audiology services and urged us to 
impose a 1 year moratorium on the proposed reductions for these 
services so that an equitable methodology for their services can be 
developed. One commenter suggested that if we do not implement a 
moratorium on payment decreases for audiology services, we should 
consider an alternative, such as assigning proxy work RVUs for indirect 
PE using the otolaryngology PE/HR.
    The following commenters opposed any delay in implementing our 
proposed methodology.
    A gastroenterology association commented that, since all medical 
specialties had equal opportunity to conduct supplemental PE studies, 
there should not be a delay in the implementation of our proposed 
changes.
    A specialty society representing radiation oncology agreed that 
more information on the new methodology should be provided, but is 
opposed to any delay in the implementation of the proposed methodology 
as the transition provides sufficient opportunity for CMS to provide 
this information and resolve identified problems.
    A sonography society commented that we should not delay the 
implementation of the revised TC component services with a 4-year 
transition. An alternative to the zero-work pool has been many years in 
the making and we should fully implement the new values this year.
    An association representing urology disagrees with a 4-year phase 
in of the revised PE RVUs and strongly urged us to consider other 
options that will allow specialties with supplemental survey data to 
realize the full advantages of applying that data in 2006. The 
commenter claimed that a transition will allow specialties that did not 
conduct surveys to unfairly take a portion of the 4-year increases from 
specialties that did.
    A specialty society representing allergists expressed concern that 
the RVUs based on the new accepted data will be phased in over 4 years. 
The commenter contended that we have not provided any rationale for why 
we are breaking with past policy or why we have decided to phase-in the 
specialty survey data. The commenter is concerned in particular about 
the continued applicability of the old and incorrect scaling factors 
which result in the discounting of the specialty's costs.
    A pharmaceuticals company requested that we consider an immediate 
100 percent transition to the 2009 proposed PE values for procedures 
like photodynamic therapy where access has been constrained due to the 
use of scaling factors.
    A society representing family physicians commented that the 
original legislation mandating resource-based PE was enacted in 1994 
and that we delayed the initial implementation by a year before 
entering a 4-year transition under our current methodology. The 
commenter therefore encouraged us to shorten or eliminate the 
transition and finally complete the process of implementing resource-
based PE. However a society representing internists supported our 
proposal to transition PE RVU changes resulting

[[Page 70132]]

from methodological changes in this proposed rule over a 4-year period.
    Response: We very much appreciate all the thoughtful and helpful 
comments we received on our proposal to revise our PE methodology. In 
addition, we are pleased that so many commenters stated their agreement 
with the goals that we outlined for our PE methodology in order to 
implement a payment system for physician and practitioner practice 
costs that is accurate, understandable, and stable. We also still 
believe, despite all the concerns pointed out by commenters, that the 
implementation of a methodology that bases the PE calculations on the 
latest available data, that uses the PEAC-refined CPEP data to create a 
bottom-up approach for direct costs and that values all services using 
the same method will help us achieve those goals.
    However, based on the comments we received, it appears that our PE 
proposal was not as clear and intuitive as we had intended. We continue 
to believe that the proposal for direct costs was straightforward; this 
proposal would do away with costs pools and scaling factors and merely 
add up the costs of the PEAC-refined input data assigned to each code 
to arrive at the direct PE RVUs (pre-PE budget neutrality). We had not 
anticipated that our indirect PE calculation would create difficulties 
since we intended that, except for those services for which the 
acceptance of the new supplementary survey data produced direct 
increases, to utilize the current indirect PE RVUs to develop the pre-
PE budget neutrality indirect PE RVUs for 2006. However, due to an 
error in our indirect PE program, the indirect costs were not 
calculated as intended. As a result, almost all of the PE RVUs 
published in the August 8, 2005 proposed rule were incorrect.
    Therefore, we are concerned that interested parties were not 
provided notice of the actual effect of the proposed changes in the PE 
RVU methodology and were not given the sufficient opportunity to submit 
meaningful comments on the proposal.
    As a result, we are withdrawing our entire PE methodology proposal 
and instead, with only three exceptions, we will use the current 2005 
PE RVUs to value all services for CY 2006. First, as we usually do each 
year, we will value the work and PE on an interim basis for all codes 
that are new in 2006. Second, as required by section 1848(c)(2)(I) of 
the Act, we will apply the PE/HR data from the urology supplementary 
survey to the calculation of the PE RVUs for all the drug 
administration codes performed by urology. Third, we will apply the 
savings from the implementation of the multiple procedure payment 
reduction for certain imaging services across all the PE RVUs that are 
discussed later in the preamble of this rule.
    We understand that the withdrawal of this proposal will be welcomed 
by some and will be a disappointment to others, especially those 
specialties that undertook PE surveys that are not being used for 2006. 
We want to work with the medical community beginning now through the 
next proposed rule to exchange thoughts on all of the issues raised, to 
answer any questions and to provide additional data and corrected 
information. We hope to hold meetings on these topics early next year 
so that we can obtain maximum input from all interested parties to 
ensure that our next proposal does meet the goals we have set for our 
PE methodology.

Acceptance of Supplementary Surveys for 2006

    Comment: Many commenters indicated their strong support for our 
proposal to accept the PE data from 7 supplementary surveys. Several 
specialty societies representing radiation therapy expressed approval 
for the proposal to blend the survey data submitted by ASTRO and AFROC 
to calculate a revised PE/HR for radiation oncology services. A 
specialty society representing interventional radiology stated support 
for the proposed use of the ACR's supplemental PE data for purposes of 
PE RVU determination. The ACC is pleased that we proposed to 
incorporate their supplemental PE survey data submitted for cardiology 
and other specialties that submitted data consistent with the 
acceptance criteria. The ACC commented that, given the rigorous and 
detailed analysis conducted by our contractor, these data are very 
likely superior to the SMS data that were used to calculate PE RVUs and 
that our acceptance of the supplemental PE data has been an important 
component of efforts to refine the resource-based PE RVUs. An 
echocardiography society and a commenter representing cardiovascular 
angiography also stated its support for use of the cardiology data. Two 
societies representing gastroenterology commented that they are pleased 
with our acceptance of the supplemental PE survey data for 
gastroenterology. The AUA strongly urged us to finalize our proposal to 
accept the AUA's supplemental survey data, as they believe language in 
the section 303(a)(1)(I) of the MMA requires us to accept supplemental 
data submitted by urology. In addition, the AUA stated that we are 
required by the MMA to update the 2006 PE RVUs for urology drug 
administration, applying the exemption from budget neutrality. A 
commenter representing prosthetic urology also agreed that we should 
use the urology supplemental data to allocate the indirect PE costs to 
each urology procedure.
    However, other commenters had concerns with the proposal. An 
otolaryngology specialty society questioned the validity of the 
dramatic increases in the PE/HR for the specialties that have submitted 
surveys because this could create a two-tiered system between those 
specialties that have submitted surveys and those which have not. 
Therefore, the society recommended that use of this new PE data be 
delayed until such time as a multispecialty PE survey can be conducted. 
A comment from an occupational therapy association recognized the need 
to use SMS aggregate data in the indirect calculations, but questioned 
the impact on specialties who did not participate in the survey and 
suggested that the transition period be used to examine the atypical 
impact of this change. Two thoracic surgery groups commented that the 
PE fluctuations and disparities caused by the acceptance of these 
surveys are counter-intuitive and advantage those for whom we have 
accepted data at the expense of those from whom we have not. The 
specialty society representing surgeons stated that the dramatic 
increase in the proposed PE/HR figures could cause significant 
distortions in the relativity of PE payments across specialties and 
urged that we delay implementation of the new data until a multi-
specialty PE survey, similar to the AMA's SMS survey can be conducted. 
However, the society also recommended that we use the urology PE/HR 
data because it would be required by the MMA. A provider group 
representing remote cardiac services recommended that we should refrain 
from incorporating any additional survey data until all supplemental 
data is submitted.
    Conversely, a society representing echocardiographers stated that 
it is crucial for us to use the submitted survey meeting our criteria 
in order to retain the type of trust necessary for physician specialty 
groups to conduct this type of survey in the future. The commenters 
from the gastroenterology groups stated that use of these data should 
not be transitioned, but should be treated consistently with the manner 
in which all other supplemental data have been treated. Further, the 
commenter contended that, even if we agree to a delay in the 
implementation

[[Page 70133]]

of our proposed methodology, the accepted supplemental PE/HR data 
should be implemented immediately for both direct and indirect 
expenses.
    Response: We understand the considerable effort, time and money 
expended by the specialty societies that submitted surveys that met our 
criteria and are aware that there will be considerable disappointment 
that the new data will not be used for 2006. We also understand the 
concern of those specialties that have not undertaken a supplementary 
survey that now fear that they could be relatively disadvantaged if the 
accepted surveys are used. We would point out that for the last five 
years there has been an equal opportunity for all specialties to submit 
supplementary data and it could be presumed that those specialties that 
did not avail themselves of the opportunity believed the effort was not 
worth the probable result. In addition, all specialties had the 
opportunity to comment on our proposed criteria for acceptance of 
survey data and the medical community at large did not comment that the 
criteria needed to be more stringent. However, we will not be using the 
accepted supplementary data in our indirect PE calculations for 2006, 
with the exception of the urology PE/HR data that we are applying to 
the drug administration codes performed by urology as required by 
section 1848(c)(2)(I) of the Act. We are not using the other accepted 
supplementary PE data because, as explained above, we are not adopting 
the proposed changes to our PE methodology, we did not propose to use 
the survey data for calculating the direct PE RVUs and the use of the 
survey data would have caused significant changes in the PE RVUs for 
which there would have been no opportunity for comment.
    Comment: We also received several comments with specific concerns 
regarding our handling of the submitted PE survey data. A specialty 
society representing radiation oncology asserted that the approach to 
blending survey data has inadvertently lowered the values for certain 
radiation oncology services by under-weighting the PE expenses for 
freestanding facilities from the AFROC survey and by overestimating the 
hours in the denominator of the PE/HR calculation. In addition, three 
commenters questioned an apparent discrepancy with the PE/HR for 
radiology, radiation oncology and cardiology recommended by the Lewin 
Group and the PE/HR in the proposed rule and the subsequent correction 
notice. The commenters requested a clarification on how we applied the 
deflators in order to ensure that all specialties submitting surveys 
were evaluated in the same way. A comment from specialty societies 
representing most major surgical groups, as well as emergency medicine 
and anesthesia, contended that over the years we have treated 
supplemental survey data with different standards and have blended some 
while not blending others. A medical technology company requested that 
we explain how the data were evaluated, especially because we did not 
accept some recommendations presented by the Lewin Group.
    Response: Because we are not utilizing the new supplementary data 
for indirect PE calculations for 2006, we plan to discuss all of these 
issues with the relevant specialties in order to determine if 
adjustments are needed to our calculations of the PE/HR data. However, 
we do not believe that we have treated supplemental data with different 
standards, but would request specific information from the commenters. 
Currently, we are not using any blended data for any supplementary 
survey that we have accepted and used. Although we rely heavily on the 
analysis and evaluation of the survey data done by the Lewin Group, we 
are responsible for the final decision on whether or not to accept the 
data from a given survey. The Lewin Group did recommend that we accept 
the data from the NCQDIS survey, which did not meet our precision 
criteria, because we currently have no survey data for them. However, 
we believe that it is more equitable to apply the same standards to all 
who submit surveys and we proposed not to accept the survey data at 
this time.
    Comment: The NCQDIS expressed concern that we did not accept their 
PE survey data for diagnostic imaging services in IDTFs because the 
precision criteria was not met. NCQDIS pointed out that the Lewin Group 
recommended that we accept the data in spite of the precision level 
because PE data for IDTFs do not currently exist. The commenter stated 
that, after further analysis of the data, NCQDIS determined that 
inclusion of one inaccurate record skewed the findings outside the 
acceptable precision range. Therefore, NCQDIS recommended that we 
accept the revised analysis from the Lewin Group that includes updated 
PE information for the record in question and that we allow the updated 
data to be used in development of PE RVUs for 2006. The NCQDIS 
recommendation was supported by a comment from a society representing 
diagnostic medical sonography that contended that no alternative data 
is available for these entities and the current PE data used 
understates their PE.
    Response: There have been further discussions between NCQDIS and 
our contractor. We will be discussing this with the specialty in order 
to resolve the issue for a future proposal.
    Comment: A nuclear medicine society stated that it cannot respond 
to our use of the radiology and cardiology surveys because it has not 
seen the data as it relates to nuclear medicine. The commenter 
requested that we make the nuclear medicine supplementary survey 
information and impact available. A specialty society representing 
radiation oncology expressed the belief that the new survey data do not 
reflect the costs of brachytherapy because providers of this service 
were not adequately represented in the sample.
    Response: We would be willing to discuss the societies' concerns to 
determine an appropriate resolution.
    Comment: A long term care association urged us to use the data from 
the ACR supplementary survey as the PE/HR proxy for the portable x-ray 
set-up code (Q0092) to prevent inconsistencies in the application of 
the new payment methodology.
    Response: We do not believe it would be appropriate to use the same 
indirect costs associated with a free-standing radiology center, which 
incurs costs for such requirements as lead shielding and structural 
reinforcements for heavy equipment, as the costs for setting up a 
portable x-ray machine. Therefore, we will not apply the data from the 
radiology supplementary survey to the calculations of the PE RVUs for 
Q0092.
    Comment: Because we had proposed to accept the supplementary survey 
data for radiology, radiation oncology and cardiology, the specialties 
that make up the bulk of the NPWP, we also proposed eliminating the 
pool and pricing all of the services in the NPWP under the new proposed 
PE methodology. We received comments from several organizations 
including those representing diagnostic sonography, urology, medical 
physicists, allergy geriatrics and a blood disorder center supporting 
this proposal. However, the specialty society representing audiology 
urged that, before we dismantle the protection provided by the NPWP, a 
reasonable formula should be developed to fairly and adequately 
reimburse audiologists for their services. The societies representing 
audiology, speech language pathology and medical nutrition all 
commented that we should assign work RVUs to their services, rather 
than treating their professional work as PE.
    Response: We are pleased that most commenters approved of our 
proposal to

[[Page 70134]]

eliminate the NPWP. However, because we will not be using the accepted 
new supplementary survey data in the calculation of PE RVUs for 2006, 
we believe it would be more equitable to defer the elimination of the 
pool as well. Therefore, we will not be implementing this proposal for 
2006. This will also give us the additional time to work with audiology 
and other specialties to ensure that our future proposal will be 
equitable to all. Because we are maintaining the NPWP for 2006, we are 
deferring our decision regarding work RVUs for audiology, speech 
language pathology and medical nutrition pending further discussions 
with the specialties.

Bottom-up for Direct PE

    Comment: We received many comments on our proposal to value the 
direct PE for all services by the bottom-up method, using the PEAC 
refined staff, supply and equipment costs associated with each 
procedure as the basis for calculating the direct PE RVUs. Almost all 
of these comments favored our proposal to modify our PE methodology. 
This support was expressed whether the commenter also requested a delay 
in the implementation of our proposed methodology or recommended 
immediate implementation with no transitioning of the new PE RVUs. 
Commenters who were pleased with the resulting PE RVUs and those 
concerned with specific reductions also showed support. Below are some 
specific examples of the supporting comments.
    Two comments from specialty societies representing family 
physicians and internists agreed that the bottom-up approach will 
produce a more accurate, intuitive and stable PE methodology. One of 
the commenters contended that the proposed methodology would be more 
accurate because the bottom-up methodology assumes that the costs of 
the clinical labor, supplies and equipment are the same for a given 
service, regardless of the specialty performing it.
    A urological association supported switching to a bottom-up 
methodology for calculating PE RVUs and believed it meets our stated 
goals of using the most appropriate data, simplifying the PE 
methodology and increasing the stability of the PE payments.
    A major oncology center applauded our decision to implement a 
bottom-up approach because of the inequities that result when PE RVUs 
are set using a top-down approach which allows the frequent ``leakage'' 
of a specialty's costs to other specialties. This rationale was also 
stated by a society representing anesthesiologists and by a patient 
advocate foundation.
    An oncology nursing society commented it has long advocated a 
bottom-up modification to help ensure that PE payments reflect the 
actual relative resources required for each service provided by 
oncology nurses.
    An organization representing allergy supported our proposal to 
change to a bottom-up methodology for determining PE values because 
this is a more rational approach. This view was shared in a comment 
from a physical medicine and rehabilitation society, which added that a 
bottom-up approach would result in a more direct relationship between 
PE RVUs and direct costs.
    A spine society commented that it welcomed the change to a 
``bottom-up methodology because any movement in the direction of 
stability and uniformity will have positive effects across providers.''
    A specialty society representing neurology supported the proposed 
change to a bottom-up methodology for calculating direct costs. The 
society asserted that the top-down method is flawed as it unfairly 
raises the expenses for high-end procedures. The commenter also stated 
that the excellent work of the PEAC, and now the PERC, has produced 
reliable data for all the codes, making CPEP complete for all the codes 
and must be given primacy in any method we would chose to implement.
    Two radiation therapy societies stated their strong support of the 
proposed bottom-up methodology and the proposed implementation for 
January 1, 2006. One society commented that eliminating the scaling 
factors, at least for direct costs, is a step in the right direction 
toward a simpler and more transparent PE methodology.
    A respiratory care association stated support for our proposed 
bottom-up approach because this methodology would minimize aberrations 
that might inadvertently appear in the calculations, providing a more 
accurate representation of direct PE incurred by pulmonary physicians.
    A psychological association commented that the refinements approved 
by the PEAC may allow CMS to utilize a more simplified PE methodology 
which will make PE more understandable.
    An organization representing radiology contended that using the 
bottom-up methodology seems to be a simpler and easier way to make the 
transition with minimal impact. A medical sonography society stated 
that our efforts to help ensure a more accurate payment for healthcare 
services and create more year-to-year stability are to be commended.
    An occupational therapy association and a physical therapy 
association both agreed that the bottom-up method would be a preferable 
methodology. First, because it would rely on actual inputs from the 
specialties providing each service and second because it would create a 
more stable and predictable system and would reflect the actual 
relative resources required for each service.
    A specialty society representing hematology agreed that the top-
down method for calculating the direct PE is extremely complex and not 
at all intuitive and stated that the bottom-up method will simplify the 
system and reduce the complexity of the calculations.
    Other organizations that supported the adoption of the bottom-up 
approach to valuing direct costs included specialty societies 
representing podiatry, prosthetic urology, geriatrics, infectious 
diseases, chest physicians, a pharmaceutical company, and medical group 
practices.
    Response: We are very pleased that so many in the medical community 
approve of the concept of using a bottom-up methodology to value the 
direct PE RVUs. We believe, along with these commenters, that the use 
of the bottom-up approach in the future would allow us to calculate 
more accurately the relative direct costs for each service in the PFS. 
The bottom-up approach would be simple to understand--we merely sum the 
costs of the PEAC-refined clinical staff, supply and equipment inputs 
that are assigned to each service. The bottom-up approach would be 
intuitive--any change in direct inputs would lead to a commensurate 
change in the direct PE RVUs. The bottom-up methodology should also be 
more stable--with no cost pools or scaling factors to complicate the 
computation, direct PE RVUs for a service would only change if there 
was a revision to the inputs assigned. It was the hard work put forth 
by the AMA, the PEAC, the RUC and specialty societies in refining the 
CPEP inputs that made it possible to propose using a bottom-up 
methodology. However, for reasons discussed in this section, we are not 
implementing the bottom-up methodology for direct costs for 2006. 
However, we will be working with the RUC and the medical community to 
ensure that the inputs assigned to each service are correct and that 
the overall methodology works as intended so that we can propose this 
improvement in the future.

[[Page 70135]]

    Comment: Several commenters expressed concern regarding the future 
refinement of the direct PE inputs that would ensure that a bottom-up 
methodology continues to lead to appropriate PE RVUs. A radiation 
oncology specialty society recommended that the bottom-up methodology 
be reviewed to ensure that the full input amounts are recognized 
accurately. A specialty society representing podiatry commented that 
the codes refined in the early stages of the PEAC may have inputs not 
consistent with codes refined later and that they should be looked at 
again by PEAC or PERC. The specialty society representing allergy 
suggested that there needs to be a continuing mechanism, such as the 
PEAC and PERC, for addressing changes in PE. A physical medicine 
society asserted that it is essential that we establish a system for 
updating or revising direct cost inputs based on new data or changes in 
technology. A thoracic medicine society supported the bottom-up 
methodology for creating direct PE inputs with continued refinement by 
the PEAC or the PERC. A pharmaceutical company supported the bottom-up 
method of determining the relative direct costs of each service, but 
requested that we establish a system to accept and review external data 
during the notice and comment period to update the direct cost inputs 
as needed. A specialty society representing prosthetic urology 
recommended that we adopt the bottom-up method and establish a method 
to review external data to ensure that the inputs are updated 
appropriately.
    Response: We agree with the commenters that there needs to be a 
continuing review process for the direct PE inputs to reflect changes 
in practice or new technology. In addition, it will be necessary to 
ensure that the clinical staff time standards and supply and equipment 
packages that have been developed through the refinement process are 
applied appropriately to all services. We are hopeful that the RUC will 
continue to play a role in this further review and will be discussing 
this with RUC staff. In addition, we will continue to encourage input 
from the medical community in general regarding the accuracy of the 
direct inputs and their pricing.
    Comment: There were a few specific concerns raised by commenters 
regarding the bottom-up methodology. A specialty society representing 
radiation oncology stated that the bottom-up methodology may be 
unintentionally compressing higher-cost technology. A health care 
provider supported the bottom-up approach conceptually, but expressed 
concerns that aggregate budget neutrality would be more difficult to 
control using a bottom-up approach than using the top-down. A medical 
group practice association, as well as a large multi-specialty clinic, 
had concerns that the RUC recommendations we have accepted for new 
technical procedures have, because of budget neutrality, eroded the 
value attributed to cognitive services. MedPAC had concerns about 
dealing with overvalued services and with the assumptions we use to 
allocate the cost of equipment to a specific service. For example, 
MedPAC questioned whether our assumption of 50 percent utilization for 
all equipment is valid.
    Response: We are not sure how the bottom-up methodology would 
compress higher cost technology, but would be willing to discuss this 
with the commenter as we develop our next proposal. For budget 
neutrality, we are not certain that it is harder to control under a 
bottom-up approach; it would depend on which data source--the aggregate 
SMS-type data or the PEAC-refined input data--produces the most 
accurate estimate of direct costs. We understand, in a budget neutral 
system, the concern about the effect that adding inputs for expensive 
technology has on cognitive services, but under a bottom-up methodology 
there would not be the issue of scaling factors exaggerating this 
effect. We would like very much to discuss the issue raised by MedPAC 
as we endeavor to improve our PE methodology.

Future Indirect PE Refinement

    Comment: Although we did not propose any major change to the 
indirect PE methodology, other than incorporating the new PE survey 
data, we did indicate our interest in receiving suggestions on ways to 
continue to refine the indirect PE calculations. Most commenters 
focused on the need for us to acquire up-to-date survey information for 
all specialties so that the PE data for all specialties is as current 
as possible. Specialty societies representing infectious disease 
physicians, orthopaedists, remote cardiac services, chest physicians 
and physical medicine commented that we should extend the deadline to 
allow specialty societies to conduct supplemental PE surveys. A 
commenter representing otolaryngologists stated this would not be a 
preferred option since the high cost involved with conducting surveys 
would disadvantage smaller specialties.
    Other specialty societies representing cataract surgeons, 
anesthesiologists, emergency medicine and otolaryngology recommended 
that an unbiased SMS-type survey that cuts across all specialties would 
be most appropriate for use in the future, instead of having data from 
different time periods. In arguing for this multi-specialty approach, 
an emergency medicine association commented that, as MedPAC reports 
have indicated, only specialty societies who are likely to gain ground 
have incentive to produce new surveys. The specialty society 
representing otolaryngology cited the discussion in the Lewin Group 
report, ``Recommendations Regarding Supplemental Practice Expense Data 
Submitted for 2006,'' that suggests that the increase in the surveyed 
PE/HR could indicate a ``secular trend in rising physician PEs,'' and 
the need for a multi-specialty PE survey. The commenter also suggested 
that a universal survey could be paid for by using funds reallocated 
from the oncology demonstration. A specialty society representing spine 
surgeons commented that all physicians should have the opportunity to 
submit data relevant to their specialties because it would be unfair to 
reduce PE reimbursement for providers such as neurosurgeons and 
orthopedic surgeons without allowing those providers that opportunity 
to submit accurate data. The society suggested that, as we have 
established a model for survey data, we could allow societies to survey 
their membership and submit the results, either directly to CMS or 
through the RUC. An association representing medical group practices 
recommended that a comprehensive study be initiated to accurately 
balance the relativity of overhead costs of practice for each service 
on a nationwide basis and that this include the costs of information 
technology (IT) implementation. An emergency medicine commenter 
recommended including survey questions on uncompensated care.
    Response: We agree with all the commenters that, for the PE RVUs to 
reflect accurately the relative indirect costs for all services, it 
would be most preferable to have current data for all specialties. 
However, section 212 of the BBRA required that we establish a process 
to use data developed by entities and organizations to supplement the 
data we normally collect in determining the PE component. We 
established this process and set criteria and a timeline for submission 
of this data. Although we twice extended the period during which we 
would accept these supplemental data, we are not proposing to extend 
this period beyond this year. We believe

[[Page 70136]]

that there has been sufficient time for individual specialties that had 
sufficient member support to do a survey, and that had reason to 
believe that the results of a survey would be helpful, to submit 
supplementary PE data to us. Therefore, we agree with the commenters 
who suggest that a multi-specialty survey done for a uniform time 
period would be most helpful. We are now planning to work with the AMA 
and the medical community to develop a strategy for funding and 
fielding a multi-specialty indirect PE survey that will help ensure 
that our PE methodology treats all specialties equitably.
    Comment: Several commenters offered the following suggestions for 
revisions to the indirect methodology.
    Comments from two associations representing speech language 
pathologists and audiologists argued that the current method of 
assigning indirect costs to their services results in a gross 
underestimation of these costs for both audiology and speech-language 
pathology services. One association suggested an alternative method of 
basing indirect costs on the ratio of the refined direct costs to the 
total costs for all physicians or for otolaryngologists.
    A specialty society representing allergy expressed concern that the 
indirect costs of an allergy practice are not properly accounted for in 
the current methodology because most either are not assigned work RVUs 
or have very low work RVUs, but may have high actual indirect costs. 
The society recommended that we should either establish a mechanism for 
adjusting the indirect PE when the existing formula yields an 
inequitable result, or revise the direct costs to include 
administrative staff time.
    A comment from a manufacturer stated that we should not use the 
``All Physician'' indirect cost data for IDTFs and recommended using 
the radiology PE/HR figure for IDTF radiological services and the 
cardiology PE/HR for IDTF cardiology services, with the exception of 
the cardiac remote monitoring services which should be paid at current 
levels, pending the collection of additional data.
    A comment from a clinical oncology society recommended that any 
revision in the methodology for direct costs should be accompanied by a 
revision in the methodology for allocating indirect costs. The society 
stated that both the Lewin Group and the Government Accountability 
Office have found that the current methodology for indirect costs is 
biased against services that lack a physician work component.
    A family physician association questioned why we use physician 
work, rather than physician time, in our formula for allocating 
indirect expenses. The commenter stated that there is no evidence that 
PE would vary with physician intensity and recommended that we use 
physician time rather than work in the allocation of indirect expenses.
    A group representing cardiac services providers recommended that if 
and when the new methodology is applied to remote cardiac monitoring, 
indirect costs for these services should be based on a survey of their 
group and not on the ``All Physician'' average PE/HR, which fails to 
reflect the actual practice costs incurred. The group also recommended 
that we allocated indirect costs solely on the basis of direct costs, 
without regard to physician work.
    Response: We thank all the above commenters for their suggestions 
on improvements to our indirect PE methodology. We will certainly 
consider all of the above recommendations, as we work with the medical 
community to develop our next proposal for indirect PE.
    Comment: The American College of Surgeons recommends that we 
convene a multi-stakeholder process to address indirect PE 
methodological issues so that we can make further changes before final 
implementation of our new methodology.
    Response: As we have mentioned previously, we agree wholeheartedly 
with the above recommendation. We plan to initiate an open process with 
the medical community to exchange ideas, answer questions and provide 
information regarding changes to all aspects of our PE methodology 
before publication of the next PFS proposed rule. We recognize that in 
any payment system based on costs, indirect costs are always the most 
difficult to allocate fairly and accurately. Therefore, we will welcome 
all suggestions, including those recommended, to improve our indirect 
PE methodology.

Other Issues

    Comment: A group representing community cancer centers requested 
that we review the PE RVUs for drug administration services as soon as 
the needed data are available to ensure that they accurately reflect 
all the costs associated with these services. The National Patient 
Advocate Foundation agreed because of concern that use of the current 
indirect PE RVUs will not be sufficient to reimburse oncologists for 
drug administration costs.
    Response: We should have the utilization data needed for the 2006 
proposed rule and plan to include the drug administration services in 
whatever PE methodology is proposed.
    Comment: Several commenters recommended that we maintain budget 
neutrality for PE RVU changes by adjusting the CF proportionately, 
rather than decreasing only PE RVUs.
    Response: Though there could be operational difficulties with 
adjusting the CF to account for PE budget neutrality, we would like to 
solicit comments on how best to reflect the budget neutrality for PE.
3. PE Recommendations on CPEP Inputs for CY 2006
    Since 1999, the PEAC, an advisory committee of the AMA's RUC, 
provided us with recommendations for refining the direct PE inputs 
(clinical staff, supplies, and equipment) for existing CPT codes. The 
PEAC held its last meeting in March 2004 and the AMA established a new 
committee, the PERC, to assist the RUC in recommending PE inputs.
    With the PERC's assistance, the RUC completed refinement of 
approximately 200 remaining codes at its meetings held in September 
2004 and February 2005. A list of these codes appeared in Addendum C of 
proposed rule.
    We reviewed the RUC-submitted PE recommendations and proposed to 
adopt nearly all of them. We worked with the AMA staff to correct any 
typographical errors and to make certain that the recommendations are 
in line with previously accepted standards.
    As stated in the proposed rule, we revised the PE database to 
reflect these RUC recommendations which can be found on our web site. 
(See the ``Supplementary Information'' section of this rule for 
directions on accessing our web site.)
    We disagreed with the RUC's recommendation for clinical labor time 
for CPT code 36522, Extracorporeal Photopheresis. In the CY 2005 final 
rule (69 FR 66236), we assigned, on an interim basis, 223 minutes of 
total clinical labor for the service period based on the typical 
treatment time of approximately 4 hours. The RUC, however, recommended 
122 minutes total clinical labor time for the service period, which 
allowed for 90 minutes of nurse ``intra service'' time for the 
performance of the procedure (the society originally proposed 180 
minutes). We believe that 135 minutes is a more appropriate estimation 
of the clinical staff time actually needed for the intra time, as it 
more closely approximates the time assigned to the other procedures in 
this family of codes, including CPT codes 36514, 36515, and 36516. 
Therefore, we proposed a total

[[Page 70137]]

clinical labor time of 167 minutes for the service period. We did not 
receive specific comments for this revision and are finalizing this 
change to the clinical labor time. While we have made the change in the 
PE database, the PE RVUs for 2006 will not reflect the adjustment due 
to the decision concerning the PE methodology to maintain all PE RVUs 
at the 2005 level as discussed previously.
    The RUC also recommended that no inputs be assigned to several 
codes because the services were not performed in the office setting. 
However, our utilization data shows that 4 of these codes (CPT codes 
15852, 76975, 78350, and 86585) are currently priced in the office and 
are performed with sufficient frequency in the office to warrant this. 
Therefore, we proposed not to accept the RUC recommendations for these 
services at this time, but requested comments from the relevant 
specialties as to whether the recommendations should be accepted.
    Comment: We received comments from one specialty society 
disagreeing with the RUC's recommendation for CPT 78350, single photon 
bone densitometry, as they believe this procedure is being performed in 
the office. They expressed their intentions to work with CMS as they 
develop appropriate PE inputs for this procedure in the nonfacility 
setting. The specialty society also expressed their agreement with the 
RUC's recommendation to eliminate the nonfacility PE RVUs for 76975 
because virtually all of these exams are performed in the facility 
setting. In addition, a national organization representing medical 
directors of respiratory care, supported the retention of nonfacility 
PE RVUs for CPT 86585, TB tine test, because they believe it to be a 
legitimate office-based procedure. We did not receive comments on the 
appropriateness of nonfacility RVUs for CPT 15852.
    Response: We will maintain the nonfacility setting PE RVUs for 
78350 and look forward to working with the specialty society in their 
initiative to develop inputs for this procedure. We will remove the PE 
inputs for the nonfacility setting for CPT codes 76976 and 15852, 
although for the 2006 PFS these codes will reflect the 2005 PE RVU 
amounts. CPT 86585 has been deleted from CPT 2006 and will not appear 
on Addendum B.
4. Payment for Splint and Cast Supplies
    In the Physician Fee Schedule (CY 2000); Payment Policies and 
Relative Value Unit Adjustment final rule, published November 2, 1999 
(64 FR 59379) and the Physician Fee Schedule (CY 2002); Payment 
Policies and Relative Value Units Five-Year Review and Adjustments 
final rule, published November 1, 2000 (66 FR 55245), we removed cast 
and splint supplies from the PE database for the CPT codes for fracture 
management and cast/strapping application procedures. Because casting 
supplies could be separately billed using Healthcare Common Procedure 
Coding System (HCPCS) codes that were established for payment of these 
supplies under section 1861(s)(5) of the Act, we did not want to make 
duplicate payment under the PFS for these items.
    However, in limiting payment of these supplies to the HCPCS codes 
Q4001 through Q4051, we unintentionally prohibited remuneration for 
these supplies when they are not used for reduction of a fracture or 
dislocation, but rather, are provided (and covered) as incident to a 
physician's service under section 1861(s)(2)(A) of the Act.
    Because these casting supplies are covered in sections 1861(s)(5) 
or 1861(s)(2)(A) of the Act, we proposed to eliminate the separate 
HCPCS codes for these casting supplies and to again include these 
supplies in the PE database. This would allow for payment for these 
supplies whether based on section 1861(s)(5) or 1861(s)(2)(A) of the 
Act, while ensuring that no duplicate payments are made. In addition, 
by bundling the cost of the cast and splint supplies into the PE 
component of the applicable procedure codes under the PFS, physicians 
would no longer need to bill Q-codes in addition to the procedure codes 
to be paid for these materials.
    Because these supplies were removed from the PE database prior to 
the refinement of these services by the PEAC, we proposed to add back 
the original CPEP supply data for casts and splints to each applicable 
CPT code and we requested that the relevant medical societies review 
the ``Direct Practice Expense Inputs'' on our web site and provide us 
with feedback regarding the appropriateness of the type and amount of 
casting and splinting supplies. We also requested specific information 
about the amount of casting supplies needed for the 10-day and 90-day 
global procedures, because these supplies may not be required at each 
follow-up visit; therefore, the number of follow-up visits may not 
reflect the typical number of cast changes required for each service.
    We reincorporated the following cast and splint supplies as direct 
inputs: fiberglass roll, 3 inch and 4 inch; cast padding, 4 inch; 
webril (now designated as cast padding, 3 inch); cast shoe; 
stockingnet/stockinette, 4 inch and 6 inch; dome paste bandage; cast 
sole; elastoplast roll; fiberglass splint; ace wrap, 6 inch; and kerlix 
(now designated as bandage, kerlix, sterile, 4.5 inch) and malleable 
arch bars. The cast and splint supplies were added, where applicable, 
to the following CPT codes: 23500 through 23680, 24500 through 24685, 
25500 through 25695, 26600 through 26785, 27500 through 27566, 27750 
through 27848, 28400 through 28675, and 29000 through 29750.
    Because we proposed to pay for splint and cast through the PE 
component of the PFS, we would no longer make separate payment for 
these items using the HCPCS Q-codes.
    Comment: We received a comment on behalf of the American 
Osteopathic Academy of Orthopedics (AOAO) that provided specific 
information for the type and number of casts needed for the 10 or 90-
day global period for each code in the relevant fracture management 
series. The AOAO also noted the type and amount of casting supplies, 
including stockinette, cast padding, fiberglass and post-op cast shoe, 
as appropriate.
    We also received a comment from the RUC expressing their 
appreciation for the proposal to make coding and billing for fracture 
management and casting/strapping supplies easier by reducing the number 
of codes for physicians to submit. In addition, the RUC expressed 
interest in reviewing the data submitted in response to our proposal so 
that the resulting casts and strapping PE inputs can ``enjoy the same 
level of scrutiny and cross-specialty refinement that all of the other 
PE inputs have''.
    Other specialty societies supported our proposal to include casting 
material in the fracture care codes and the elimination of the Q codes. 
However, some of these societies expressed concerns about bundling all 
of the necessary casting/strapping supplies for the global period into 
the fracture management codes. These commenters related that only the 
initial cast/strapping supplies should be bundled into the relevant 
fracture care code series and that physicians should be able to 
continue to submit separate claims for the CPT codes for the 
application of casts and strapping procedures during the global period.
    Many commenters, primarily from orthopedic practices, expressed 
concern about the proposal, but misunderstood that this proposal was 
separate from the anticipated negative update for 2006 based on the SGR 
methodology.
    Response: We thank AOAO for submitting the information we requested 
in the proposed rule. The society submitted a clear,

[[Page 70138]]

comprehensive and beautifully prepared spreadsheet detailing each CPT 
code in the various fracture management series. We commend them on 
their efforts to submit such a thorough and meticulous document in 
response to our proposed rule request.
    For the 2006 fee schedule, based on the decision concerning PE 
methodology to maintain all PE RVUs at the 2005 level previously 
discussed, we have removed the CPEP inputs for casts and splints from 
the PE database and CMS will retain use of the Q-code fee schedule as 
done in the past. In addition, we will use the interim time period 
before the notice of proposed rulemaking for the 2007 fee schedule to 
work with the affected specialties and the RUC to clarify issues 
related to Medicare payment policy and establish more appropriate 
amounts of casting/strapping materials for the relevant series of 
fracture management codes and the casts and strapping application 
codes. Due to the temporary status and intended limited use of the Q-
code fee schedule, it is our intention to resolve these important 
payment issues in the near future. A detailed discussion of the SGR and 
the update for 2006 is found later in this final rule with comment.
5. Miscellaneous PE Issues
    In this section, we discuss our specific proposals related to PE 
inputs.
a. Supply Items for CPT Code 95015
    We proposed to change the supply inputs for CPT code 95015, 
intracutaneous (intradermal) tests, sequential and incremental, with 
drugs, biologicals or venoms, immediate type reaction, specify number 
of tests, based on comments received from the JCAAI. JCAAI reported 
that ``venom'' is the most typical test substance used when performing 
this service and that ``antigen'', currently listed in the PE database, 
is never used. They also suggested that the appropriate venom quantity 
should be 0.3 ml (instead of the 0.1 ml listed for CY 2005) because of 
the necessity to use all 5 venoms (honey bee, yellow jacket, yellow 
hornet, white face hornet and wasp) to perform this sensitivity 
testing; that is, 1 ml of each venom type for a total of 5 ml of venom. 
The diluted venoms are sequentially administered until sensitivity is 
shown, beginning with the lowest concentration of venom and 
subsequently administering increasing concentrations of each venom. We 
accepted the specialty's argument and proposed to change the test 
substance in CPT code 95015 to venom, at $10.70 (from single antigen, 
at $5.18) and the quantity to 0.3 ml (from 0.1 ml).
    Comment: JCAAI expressed their appreciation for our proposal to 
change the supply item input for CPT 95015 from 0.1 ml antigen to .3 ml 
of venom.
    Response: The appropriate changes have been made to our PE 
database. However, as discussed above, because we are making only 
limited, necessary changes to PE RVUs for the 2006 PFS, the PE RVUs for 
this code will continue to reflect the 2005 PE RVU amounts.
b. Flow Cytometry Services
    In the CY 2005 final rule (69 FR 66236), we solicited comments on 
the interim RVUs and PE inputs for new and revised codes, including 
flow cytometry services. Based on comments received and additional 
discussions with representatives from the society representing 
independent laboratories, we proposed to revise the PE inputs for the 
flow cytometry CPT codes 88184 and 88185.
    Based on information from the specialty society, we proposed to 
change the direct inputs used for PE as follows:
    <bullet> Clinical Labor: Change the staff type in the service 
(intra) period in both CPT codes 88184 and 88185 to cytotechnologist, 
at $0.45 per minute (currently lab technician, at $0.33 per minute).
    <bullet> Supplies: Change the antibody cost for both CPT codes 
88184 and 88185 to $8.50 (from $3.544).
    <bullet> Equipment: Add a computer, printer, slide strainer, 
biohazard hood, and FACS wash assistant to CPT code 88184. Add a 
computer and printer to the equipment for CPT code 88185.
    Comment: We received comments from several organizations including 
those representing professional services in clinical laboratories, 
manufacturers, clinical laboratories, and clinical pathologists. These 
commenters all supported our proposal to revise the PE inputs outlined 
above for the flow cytometry CPT codes 88184 and 88185.
    Response: We appreciate the support extended to us by these 
national organizations in regards to the revision of direct inputs for 
the CPT codes for flow cytometry. The PE changes have been made, as 
indicated above, to the database. However, because we are making only 
limited, necessary changes to PE RVUs for the 2006 PFS, the PE RVUs for 
these codes will continue to reflect the 2005 PE RVU amounts.
c. Low Osmolar Contrast Media (LOCM) and High Osmolar Contrast Media 
(HOCM)
    HOCM and LOCM are used to enhance images produced by various types 
of diagnostic radiological procedures. In the CY 2005 final rule (69 FR 
66356), we eliminated the criteria for the payment of LOCM that had 
been included at Sec.  414.38. Effective April 1, 2005, providers can 
receive separate payment for LOCM when used with procedures requiring 
contrast media through the use of separate Q-codes. Payment for HOCM is 
currently included as part of the PE component under the PFS. We 
proposed, effective January 1, 2006, to no longer include payment for 
HOCM under the PFS and to establish Q-codes for the separate payment of 
HOCM.
    As noted in the proposed rule we reviewed the PE database and 
proposed to remove the following two supply items which we have 
identified as HOCM from the PE database:
    <bullet> Conray inj. iothalamate 43 percent(supply item 
<greek-i>SH026, deleted from 64 procedures).
    <bullet> Diatrizoate sodium 50 percent (supply item 
<greek-i>SH0238, deleted from 74 procedures).
    We also identified 5 CPT codes (specifically CPT codes 42550, 
70370, 93508, 93510 and 93526) that included omnipaque as a supply 
item, and proposed to remove this supply item from these 5 CPT codes 
since omnipaque is actually a type of LOCM.
    Comment: We received several comments from organizations 
representing radiology physicians and manufacturers on our proposal to 
delete HOCM from the PE database. The commenters supported our proposal 
for separate payment for both HOCM and LOCM to ensure beneficiaries 
access to all the various types of medical imagining contrast media. 
The commenter representing the manufacturers requested that we notify 
carriers that separate payment for LOCM and HOCM is available.
    Response: We thank the organizations for their comments in support 
of our proposal which would permit separate payment for HOCM in 2006. 
We have removed HOCM from the direct inputs in the PE database and also 
deleted LOCM from the 5 procedures as noted above. However, because we 
are not implementing the bottom-up methodology which utilizes the 
direct inputs to determine the PE RVUs, these imaging codes will again 
be valued in the NPWP where the PE RVUs are established using an 
appropriate crosswalked charge-based RVU containing HOCM as an inherent 
supply cost. We will delay separate payment for HOCM until such time 
the direct inputs are used to determine PE RVUs. For 2006, the PE RVUs 
will be retained at the 2005 level. We remind the commenters that the 
average sales price

[[Page 70139]]

(ASP) quarterly values are published on our Web site at the following 
address: http://www.cms.hhs.gov/providers/drugs/asp.asp.
d. Imaging Rooms
    We include standardized ``rooms'' for certain services in our PE 
equipment database, rather than listing each item separately. We 
received pricing information from the ACR for the following rooms that 
are included in the database. We accepted most of the proposed items 
that met the $500 threshold for equipment and proposed to include the 
items in each specific room, as follows:
    <bullet<ls-thn-eq> Basic Radiology Room: $127,750 (x-ray machine @ 
$125,550 and camera @ $2,200). The recommended viewbox was not included 
because most codes assigned this room have also been assigned an 
alternator (automated film viewer) or a 4-panel viewbox.
    <bullet<ls-thn-eq> Radiographic-Flouroscopic Room: $367,664 
(Radiographic machine @ $365,464 and camera @ $2,200). The recommended 
viewbox was not included because most codes assigned this room have 
also been assigned an alternator (automated film viewer) or a 4-panel 
viewbox.
    <bullet<ls-thn-eq> Mammography Room: $168,214 (mammography unit @ 
$124,900; reporting system @ $16,690; mammography phantom @ $674; 
densitometer @ $3,660; sensitometer @ $2,750; desktop PC for monitoring 
@ $1,840; and processor @ $17,700. Separately listed equipment items 
(densitometer, mammography reporting system, sensitometer, mammography 
phantom, desktop computer, and the film processor) that duplicated 
items included in the mammography room were removed from the codes 
assigned the room, eliminating the reporting system, sensitometer and 
phantom from the PE database.
    <bullet<ls-thn-eq> Computed tomography (CT) Room: $1,284,000 (16-
slice CT scanner with power injector and monitoring system)
    <bullet<ls-thn-eq> Magnetic Resonance Imaging (MRI) Room: 
$1,605,000 (1.5T MR scanner with power injector and monitoring system)
    Comment: We received comments from one specialty society requesting 
that we add 4 cassettes to the composition and cost of the mammography 
room although each cassette does not meet the $500 equipment threshold. 
Another commenter representing a large radiology group practice agreed 
that our cost allowance for the mammography room was appropriate for 
the standard analog mammography room. However, this commenter asked us 
to develop a separately identified cost for a digital mammography room, 
costing approximately 3 to 4 times as much as the analog room, citing 
this digital system provides better diagnostic services.
    Response: We appreciate the comments regarding the cost and 
composition of the mammography room. We are sympathetic to the 
commenter's request for the creation of a separate digital mammography 
room. However, the direct PE inputs for labor, supplies and equipment 
that are included in physicians' services reflect the costs involved in 
the typical procedure or service provided in the nonfacility setting. 
We believe that the mammography room we proposed represents the 
equipment used to provide the typical mammography service and was based 
on information provided by the specialty society.
    We disagree with the specialty society in regards to adding the 
cost of the 4 cassettes to the room's price. The threshold for the 
inclusion of equipment for PE purposes remains at $500. For this 
reason, we will finalize the value of the mammography room as proposed, 
at $168,214.
    In addition we will finalize the proposed values for all of the 
above imaging rooms in this final rule with comment. However, because 
we are adopting only limited, necessary changes to PE RVUs for CY 2006, 
and will continue to utilize the NPWP to value these services, the RVUs 
will remain the same as those for 2005.
e. Equipment Pricing for Select Services and Procedures From the CY 
2005 Final Rule (69 FR 66236)
    In the August 8, 2005 proposed rule, we presented information on 
pricing of equipment for select services and procedures based on 
specialty information and stated we would be accepting the prices. The 
specific equipment was as follows:
    <bullet> Equipment pricing for certain radiology services received 
from the ACR were presented in table 15 of the proposed rule.
    <bullet> Equipment pricing on the Ultrasound color Doppler 
transducers and vaginal probe received from the American College of 
Obstetrics and Gynecology was presented.
    <bullet> For CPT 36522, extracorporeal photopheresis, we discussed 
equipment pricing information specific to this procedure.
    <bullet> Pricing of EMG botox machine used in CPT code 92265 as 
presented by the American Academy of Ophthalmology.
    No comments were received on these items, therefore, the prices 
discussed in the proposed rule will be used in the PE database. 
However, we will continue to use the 2005 PE RVUs for each of these 
codes for CY 2006.
f. Supply Item for In Situ Hybridization Codes (CPT 88365, 88367, and 
88368)
    As discussed in the August 8, 2005 proposed rule, we received 
comments in response to the CY 2005 final rule from the College of 
American Pathologists regarding the number of DNA probes assigned to 
the in situ hybridization codes, CPT codes 88365, 88367, and 88368. 
Currently, CPT codes 88365 and 88368 have 1.5 probes assigned, while 
CPT code 88367 has only 0.75 of a probe assigned. The College of 
American Pathologists requested that we assign 1.5 probes to CPT code 
88367, and provided justification for this request. We accepted the 
College of American Pathologists' rationale and proposed to change the 
probe quantity for CPT code 88367 to 1.5.
    Comment: A society representing clinical pathologists supports the 
proposed change to the probe quantity for CPT 88367.
    Response: We have entered the number of probes, at 1.5, to our PE 
database. This change will not be expressed in the 2006 PE RVUs because 
as discussed above, we will retain the 2005 PE RVUs.
g. Supply Item for Percutaneous Vertebroplasty Procedures (CPT Codes 
22520 and 22525)
    The Society for Interventional Radiology (SIR) provided us with 
documentation for the price of the vertebroplasty kit used in CPT codes 
22520 and 22525. We proposed to accept a new price of $696 for this 
supply, currently listed as $660.50, a placeholder price from the CY 
2005 final rule.
    Comment: Commenters supported the proposed $696 cost estimate for 
the vertebroplasty kit.
    Response: We are finalizing our proposal to value the 
vertebroplasty kit price at $696 in the supply database, although, as 
discussed previously, this will not be reflected in the 2006 PE RVUs 
because we will retain the 2005 PE RVUs.
h. Clinical Labor for G-codes Related to Home Health and Hospice 
Physician Supervision, Certification and Recertification
    As discussed in the August 8, 2005 PFS proposed rule, 4 G-codes 
related to home health and hospice physician supervision, certification 
and

[[Page 70140]]

recertification, G0179, 180, 181, and 182, are incorrectly valued for 
clinical labor. These codes are cross-walked from CPT codes 99375 and 
99378, which underwent PEAC refinement in January 2003 for the 2004 fee 
schedule. However, we did not apply the new refinements to these 
specific G-codes. This was an oversight on our part and we proposed to 
revise the PE database to reflect the new values in the 2006 physician 
fee schedule.
    Comment: Commenters, including those representing the specialty 
societies for home care physicians and internists, expressed concern 
about the decrease in PE RVUs for the G-codes for hospice and home 
health supervision and care plan oversight services. One commenter 
requested that we elaborate on the sequence of events that lead to this 
decrease.
    Response: We appreciate the concern expressed by the commenters and 
are providing additional information outlining the reason for this 
change. For the 2001 PFS, these G-codes were created in order to 
provide payment for these specific services. Changes made to the CPT 
codes (CPT codes 99375 and 99378) for 2001 did not enable us to 
recognize the CPT codes for Medicare payment purposes. Therefore, the 
PE inputs that had been applied to these CPT codes were cross-walked 
and used to establish the PE RVUS for the G codes that we established 
for these services. Subsequent to this, the CPT codes underwent 
refinement by the PEAC at its January 2003 meeting where a majority of 
the other E/M services were refined. CMS accepted these PE 
recommendations from the PEAC that included only a total of 36 minutes 
for clinical labor. The PEAC recommendations did not include supplies 
and equipment because they did not believe these were utilized in the 
typical services represented by these codes. These PE inputs were 
intended to be crosswalked to the G-codes for 2004, however, due to an 
oversight, this did not occur. We apologize to the specialties that 
this refinement was not done in a timely manner. Thus, we are 
finalizing the direct inputs for these G-codes in this rule and have 
changed the PE database accordingly. However in 2006, the PE RVUs for 
these 4 G-codes will remain at the 2005 level, as explained above.
i. Programmers for Implantable Neurostimulators and Intrathecal Drug 
Infusion Pumps
    Subsequent to the CY 2005 final rule, we received comments from a 
manufacturer of programmers for implantable neurostimulators and 
intrathecal drug infusion pumps. The commenter indicated that the 
equipment costs for these programmers are not a direct expense for the 
physicians performing the programming of these devices and that the 
manufacturer furnishes these devices without cost because the 
programming device is considered a ``necessary, ancillary item to the 
neurostimulator and drug pump and can only be used to program these 
devices.'' Therefore, we proposed to remove the 2 programmers from the 
PE database: EQ208 for medication pump from 2 codes (CPT 62367 and 
62368) and EQ209 for the neurostimulator from 8 codes (CPT 95970-
97979). We also requested comments from the specialty societies 
performing these services as to whether this reflects typical practice.
    Comment: Several commenters disagreed with this proposal indicating 
that not all programmers are provided without cost. Specifically, for 
the one manufacturer, the practice of providing physicians with these 
programmers free of charge is just a recent occurrence. In addition, 
one commenter informed us that there are other PE items that are not 
accounted for, including a printer, for 62367 and 62368. The RUC 
commented that several specialty societies conducted an email-based 
survey finding that the majority of the respondents reported paying for 
these programmers. The RUC asked us to reconsider our decision to 
delete the programmers from the PE direct inputs because it was based 
solely on the recommendation of one manufacturer.
    Response: We are sympathetic to the commenters' concerns about the 
programmers used by pain medicine physicians. We have carefully 
reviewed our decision to delete the programmers from the PE database in 
light of the comments we received. Therefore, based on the uncertainty 
as to which brand product is typical, the survey results presented to 
us by the RUC, and the life, 7 years, of each programmer, we have 
determined that we will retain these programmers in the database. In 
addition, we have added ``with printer'' to the description of EQ208 to 
match that of EQ209 in order to assuage the commenter's concern that 
the price listed in the database, $1975, correctly reflects the cost of 
both the programmer and the printer. Because the PE RVUs for 2005 
contained the price for these programmers, the PE RVUs for 2006 will 
continue to reflect their costs.
j. Pricing of New Supply and Equipment Items
    As part of the CY 2005 final rule process, we reviewed and updated 
the prices for equipment items in our PE database and assigned a unique 
identifier to each equipment item with the first 2 elements 
corresponding to one of 7 categories. It was brought to our attention 
that we assigned the same category identifier (ELXXX) for both ``lanes/
rooms'' as well as ``laboratory equipment''. To correct this, we 
proposed assigning laboratory equipment items the new category 
identifier ``EPXXX'', but the specific numbers associated with each 
item would remain the same. In addition, supply items were reviewed and 
updated in the rulemaking process for the 2004 PFS. During subsequent 
meetings of both the PEAC (now referred to as the PERC) and the RUC, 
supply and equipment items were added that were not included in the 
pricing updates. In the proposed rule we included 2 tables (Table 16: 
Proposed Practice Expense Supply Items and Table 17: Proposed Practice 
Expense Equipment Items) that listed the additional supply and 
equipment items for 2006 and the proposed associated prices that we 
would use in the PE calculation. The listing of new supplies and 
equipment in the proposed rule does not guarantee that the price listed 
for each item has been accepted. Rather, the new supply and equipment 
tables are to make specialties aware of the descriptors and assigned 
supply or equipment codes that can be used in future proposals to the 
RUC and HCPAC. As discussed below, the addition of an item to the 
tables for new supplies or equipment does not preclude the inclusion of 
the same item on the tables that require more detailed information and 
documentation from the specialty organization.
k. Supply and Equipment Items Needing Specialty Input
    We also identified certain supply and equipment items for which we 
were unable to verify the pricing information, reflected in Table 18: 
Supply Items Needing Specialty Input for Pricing and Table 19: 
Equipment Items Needing Specialty Input for Pricing of the proposed 
rule. We stated that the items listed in these tables represent the 
outstanding items from last year and new items added from the RUC 
recommendations. Therefore, we requested that commenters, particularly 
specialty organizations, provide pricing information on items in these 
tables along with documentation to support the recommended price.
    Tables 14 and 15 reflect the comments and documentation we received 
for each item. Specialty societies are asked to review these supplies 
and equipment, as

[[Page 70141]]

appropriate, to assure that the item status is accurate and forward any 
necessary documentation. We would also like to reinforce the types of 
documents that meet the acceptable category. The following list 
includes examples of acceptable documentation:
    <bullet> Photocopy or actual vendor catalog listing, indicating 
price, accessories or components (if applicable), available quantity, 
company name, brand name, and catalog date. Scanned versions, if 
readable, can also be emailed.
    <bullet> Photocopy of web page with specific supply or equipment 
including the necessary information listed in above bullet.
    <bullet> Photocopy of invoice indicating the price paid for 
specific supply or equipment, as well as the specific contents of kit, 
pack or tray for supplies and component or accessory parts for the 
equipment item.
    <bullet> Letter, FAX or e-mail from manufacturer, vendor or 
distributor noting the ASP of the supply or equipment. The description 
of the item must list all contents, accessories or component parts that 
are included in the price.
    The following information is not considered acceptable 
documentation, including:
    <bullet> Web site addresses.
    <bullet> Vendor, manufacturer, or distributor phone number and 
address.
    <bullet> Approximated values.
BILLING CODE 4121-01-U

[[Page 70142]]

[GRAPHIC] [TIFF OMITTED] TR21NO05.006


[[Page 70143]]


[GRAPHIC] [TIFF OMITTED] TR21NO05.007


[[Page 70144]]


[GRAPHIC] [TIFF OMITTED] TR21NO05.008


[[Page 70145]]


[GRAPHIC] [TIFF OMITTED] TR21NO05.009


[[Page 70146]]


[GRAPHIC] [TIFF OMITTED] TR21NO05.010


[[Page 70147]]


[GRAPHIC] [TIFF OMITTED] TR21NO05.011

BILLING CODE 4120-01-C

[[Page 70148]]

l. Additional PE Issues Raised by Commenters
    Comment: We received a comment from an equipment distributor and 
multiple comments from physicians asking us to add more clinical labor, 
supplies and equipment to CPT codes 78481 and 78483 for cardiac blood 
pool imaging using the first pass technique. The commenters emphasized 
that the labor costs are understated, and that additional supplies and 
equipment are necessary to perform these services. In particular, the 
commenters requested we add a nuclear medicine gamma camera to the 
equipment inputs or cross-walk the equipment listed for CPT 78465. The 
distributor presented supply and equipment tables for both codes, using 
direct PE inputs currently listed in the PE database, most of these are 
found in the PE for CPT 78465.
    Response: The direct inputs for these ``First Pass'' services were 
presented by the specialty society to the PEAC at its January 2004 
meeting. The RUC forwarded the PEAC's recommendations to CMS for 
consideration during the rulemaking process for the 2004 fee schedule 
at which time these recommendations were accepted. We do not believe 
that we are in a position to make the type of changes to the PE inputs 
for these 2 codes that the commenters have requested. We recommend that 
the commenters and the specialty society whose members perform these 
procedures, work together so that necessary changes can be considered 
through the usual RUC process.
    Comment: We received comments from a specialty society and a 
manufacturer asking us to replace a supply item, a Tesio type dual 
catheter, with the Lifesite system in CPT 36566--a procedure described 
as the insertion of tunneled catheter with subcutaneous port(s). The 
specialty society explained that when the RUC valued this service in 
2003, the incorrect catheter was included with their PE 
recommendations. The manufacturer asks for our assistance in correcting 
a ``clerical error'' in our database. The commenters explain that CPT 
codes 36565 and CPT 36566 are nearly identical in procedure, although 
CPT 36566 requires the insertion of ``subcutaneous port(s)'' and that 
the Tesio-type catheter, priced at $355, is currently listed for both 
of these procedures. The Lifesite system, containing a subcutaneous 
port, is priced at $1750. Both commenters noted that 2 Lifesite systems 
are necessary to perform this procedure instead of one for a total 
supply cost of $3500.
    Response: We appreciate the commenters concerns about the specific 
supplies they believe are needed to perform this service. The work and 
PE values for CPT 36566 were forwarded by the RUC and accepted in our 
final rule, for the 2004 fee schedule. We believe that the RUC is the 
appropriate avenue to address correction of inputs to the PE database, 
particularly due to the expensive nature of this replacement, and are 
not revising the PE database to reflect this price change.
    Comment: A specialty society commented that it believes the 
nonfacility PE RVUs were mistakenly deleted from CPT codes 59812, 
59840, and 59841. The specialty also requested that nonfacility PE RVUs 
be added for CPT 58558.
    Response: We have reviewed the specialty's request regarding 
nonfacility PE RVUs for the 4 codes noted above. The ``NA'' indicator 
for PE RVUs in the nonfacility setting is listed incorrectly for CPT 
codes 59840 and 59841 in Addendum B of our proposed rule. Both of these 
CPT codes should have PE RVUs listed in the nonfacility setting. The 
specialty society is mistaken, however, regarding the appropriateness 
of nonfacility PE RVUs for CPT 59812 and 58558. These codes have both 
undergone refinement by the PEAC at least once and the recommendations 
forwarded by the RUC clearly indicated that these procedures were not 
valued in the nonfacilty setting. We have changed our database, as 
appropriate, to reflect the changes for CPT 59840 and 59812.
    Comment: We received comments from a specialty organization citing 
that the total RVUs for CPT 19298 are too low in comparison to those 
for CPT 19296--both new CPT codes for CY 2005. The specialty believes 
this difference is likely due to the supply PE inputs necessary to 
perform each procedure. The specialty states that the catheter supply 
expenses should be similar between the 2 services, yet the nonfacility 
PE RVUs for CPT 19298 (39.56) are significantly lower than those listed 
for CPT 19296 (117.96). The specialty stated that while the average 
number of catheters used for CPT 19298 is 25, ranging from 15-30, this 
cost should be comparable to the catheter required for CPT 19296. 
Finally, the specialty requests that we crosswalk the total RVUs for 
the nonfacility setting from CPT 19296 to CPT 19298 for 2006 while they 
gather detailed information to present to us.
    Response: We have researched the specialty's concern about the 
supply cost differences between the 2 new CPT codes for 2005. Whereas 
the specialty contends that the catheter expenses are similar, or only 
somewhat greater for CPT 19296, we found that the differences between 
these 2 supply costs is significant. The mammosite tray, containing the 
catheter used for CPT 19296, is priced at $2,550 while the button-end 
implant catheters used for CPT 19298 are priced at $18.50 each. The PE 
database indicates that the RUC-recommended typical procedure would 
require 30 such catheters, opposed to 25 noted by the specialty, for a 
total cost of $555. Consequently, we will not change the PE RVUs for 
either procedure, although we remain puzzled as to the commenters' 
specific concerns. We look forward to the specialty's clarification 
regarding this issue and would urge them to address their concerns 
through the usual RUC process. We would also like to remind commenters 
that interim RVUs are published, for new and revised CPT codes, in our 
final rule each year and are subject to a 60-day comment period at that 
time. We encourage commenters to observe and utilize the respective 
comment periods during our annual rulemaking process in order that we 
may respond timely to issues and concerns.
    Comment: We received many comments regarding the use of ``NA'' in 
Addendum B when used for the ``Nonfacility PE RVUs'' column, the 
``Facility PE RVUs'' column, and the occasional code with NA noted in 
both PE RVU columns. These commenters asked us to provide a clear 
definition of how the service is paid when the NA is affixed to either 
PE RVU column in Addendum B which our rule for 2005 fee schedule had PE 
RVUs listed for the nonfacility. One commenter stated that private 
payors believe that payment is not made when the NA indicator is listed 
in Addendum B.
    Response: We appreciate the commenters remarks regarding the 
uncertainty involved with interpreting Addendum B, particular regarding 
the use of the ``NA'' indicator for the PE RVUs nonfacility and 
facility columns. Due to the confusion expressed by the commenters 
surrounding the NA designations, we have added explanations to Addendum 
A in order to assist the readers of Addendum B. We are also including 
these definitions here because of this issue's importance. The 
following 2 explanations also appear in Addendum A of this rule:
    <bullet> An ``NA'' in the ``Non-facility PE RVUs'' column of 
Addendum B means that CMS has not developed a PE RVU in the nonfacility 
setting for the service because it is typically performed in the 
hospital (that is, for example, an open heart surgery is generally 
performed in

[[Page 70149]]

the hospital setting and not a physician's office).
    <bullet> Services that have an ``NA'' in the ``Facility PE RVUs'' 
column of Addendum B are typically not paid using the PFS when provided 
in a facility setting. These services (which include ``incident to'' 
services and the technical portion of a diagnostic tests) are generally 
paid under either the outpatient hospital prospective payment system or 
bundled into the hospital inpatient prospective payment system payment.
    Comment: Other commenters, including specialty organizations, 
device manufacturers and physicians, noted that CMS had either 
mistakenly removed PE RVUs in the nonfacility setting or that we had 
made a decision to stop paying for services where, in Addendum B, an 
``NA'' appeared in the proposed rule in the PE RVUs nonfacility column. 
Another commenter believes that a series of codes for E/M services were 
incorrectly marked as ``NA'' in the facility setting. These commenters 
requested that the PE RVUs be restored to these codes.
    Response: We apologize to those commenters who found that where, 
due to the use of a new PE methodology, some of the codes listed in 
Addendum B of the proposed rule were mistakenly marked with an ``NA'' 
in either the nonfacility or facility PE RVU column when the service is 
actually valued in this setting and PE RVUs were listed previously. 
These mistakes were corrected for Addendum B in this final rule with 
comment. Most of the commenters requesting the restoration of 
``missing'' PE RVUs in the nonfacility setting, though, were mistaken 
because, in fact, we have not developed nonfacility PE RVUs for these 
services and Addendum B continues to properly reflect the ``NA'' for 
the nonfacility PE RVU column.
    Comment: Several commenters asked us to create PE RVUs for their 
services by cross-walking the direct inputs from other services.
    Response: All of the requests we received to establish PE RVUs in 
the nonfacility setting were for services that the PEAC/RUC had either 
refined or developed without recommendations for PE nonfacility inputs. 
We would like to remind the specialty organizations that the RUC has a 
long standing process for the establishment and refinement of PE inputs 
and encourage all organizations to follow this process.
    Comment: A manufacturer requested that we add 15 minutes of 
clinical labor and a tilt table to the PE database for CPT codes 36475 
and 36476--both new codes for CPT 2005.
    Response: We agree that the tilt table, for Trendelenberg, is 
needed for these procedures and are adding this equipment, for the 
respective service period minutes for each code. However, the 
commenter's request for additional clinical labor is not timely because 
the RVUs for these new codes were published as interim in the CY 2005 
PFS final rule with comment at that time. As stated in the response 
above, we remind commenters to observe and utilize the comment period 
for new and revised codes at the time they are issued in our final rule 
or utilize the established RUC process, as appropriate.
    Comment: We received a comment from an organization representing 
radiation oncology informing us that equipment for CPT codes 77333 and 
77470 was missing.
    Response: For CPT 77470, we disagree with the commenter that this 
service should be assigned equipment. At the January 2004 PEAC meeting, 
this code was valued specifically to compensate for the clinical labor 
costs involved with certain high-intensity radiation procedures, such 
as combined chemotherapy and radiation treatment. CPT 77470 was valued 
to be billed once throughout the course of treatment, that is typically 
comprised of 25 fractions. On the other hand, we agree with the 
commenter that the lack of equipment for CPT codes 77333 and CPT 77332 
appears to be an oversight. We believe that the PEAC, at their 
September 2002 meeting, when considering equipment inputs for CPT code 
77334, intended to cross-walk this equipment to the other 2 codes in 
the family, CPT code 77332 and 77333. Therefore, we are adding this 
equipment to 77332 and 77333, on an interim basis, and have changed the 
PE database to reflect this addition for the correlating service period 
time for each service. However, as explained above, because these codes 
will be valued in the NPWP and the 2005 PE RVUs will be retained in 
2006, this addition will be transparent until such time as the direct 
inputs are used to establish the PE RVUs for the NPWP services.
    Comment: We received comments from several organizations, a 
specialty society, device manufacturers, IDTFs and physicians regarding 
concerns about the remote cardiac event monitoring services, including 
CPT codes 93012, 93226, 93232, 93271, 93733 and 93736, based on the 
significant reduction in PE RVUs for these services published in our 
proposed rule using the bottom-up methodology and the elimination of 
the NPWP. Two of these services, CPT codes 93012 and 90271, were 
reviewed by the RUC in April 2005 and forwarded as part of the PERC/RUC 
recommendations in the proposed rule. The commenters noted that these 
services are typically provided by IDTFs that are equipped for 
continuous monitoring capabilities 24 hours a day, 7 days a week and 
require highly trained staff to perform the monitoring of 
transmissions. The commenters all agreed that the uniqueness of these 
services makes a poor fit with the usual accounting for direct practice 
expenses in the physician office. A specialty society requested CMS to 
work with the involved provider community, that is, the specialty 
IDTFs, to ensure that the direct and indirect costs of providing these 
services are adequately reflected in the nonfacility PE RVUs.
    Response: We are pleased that the commenters are in agreement that 
these cardiac event monitoring services may not fit the usual PE model. 
We are also happy that the specialty society has requested our 
assistance to work with the specialized provider community in order to 
ensure more appropriate PE inputs for these services. We look forward 
to working with the provider organizations before the issuance of our 
next proposed rule.
    Comment: A manufacturer requested that we increase the work and PE 
values for G0166, external counterpulsation (ECP), because of the 
significant decrease in PE RVUs for the nonfacility setting in the 
proposed rule. Specifically, the commenter asked that the labor time be 
increased to include pre and post service time in addition to the 60 
minutes allotted for actual ECP treatment time.
    Response: We agree with the commenter that the 60 minutes is 
inadequate to account for the other activities that the RN performs in 
relationship to each ECP service. We have assigned some of the 
standardized times for the activities previously identified by the PEAC 
as appropriate to this service, as follows: 3 minutes for meet and 
greet; 2 minutes to prepare the room; 2 minutes to position the 
patient; 3 minutes for vitals; and 3 minutes for cleaning the room. 
This extra 13 minutes has been added to the service period in the PE 
database yielding a total of 73 minutes for the ECP service--although, 
as discussed previously, this increase will not take effect in 2006 
because, with limited exceptions, we will retain the 2005 PE RVU values 
for existing codes.
    Comment: Many commenters, including physicians and a device 
manufacturer, requested that we increase labor, supplies, and equipment 
PE values for CPT code 93701, thoracic

[[Page 70150]]

electrical bioimpedance (TEB). Their concerns arose from the proposed 
reduction in PE RVUs in the proposed rule for this service. Some of the 
commenters told us that the average cost of the equipment from one 
manufacturer is $38,000, the electrodes are 10.95 ($8.95 with discount) 
and that the labor time for the TEB procedure ranges from 15-20 
minutes. The commenters requested that we adjust the PE values 
accordingly.
    Response: We are sympathetic to the commenters concerns regarding 
the decrease in PE RVUs reflected in the proposed rule that reflected 
both the elimination of the NPWP and the bottom-up methodology. For the 
labor time request, the PE database does contain 20 minutes, although 
this time was incorrectly cross-walked to the equipment time. We 
apologize to the commenters regarding this error, and have changed the 
equipment time to 20 minutes, from 10, in the database. We disagree 
with the commenters about the inaccuracy of the equipment cost. During 
the rulemaking process for the CY 2005 fee schedule, at which time we 
revalued all equipment in the PE database, we identified 2 different 
brands of equipment used for the TEB service. When the 2 prices are 
averaged (using $38,000 as noted above by the commenters), the cost of 
the TEB equipment is $28,625 which is the price listed in the database. 
We also repriced our supply database during rulemaking for the 2004 fee 
schedule. The TEB electrodes or sensors are listed at $9.95 in the 
database and that amount is based solely on a phone quote from the 
commenting manufacturer. TEB sensors from the other equipment 
manufacturer range from $4.43 to $6.00 for each patient application. 
Based on current valuation of the supplies and equipment in the PE 
database, we are not changing the price of equipment or supplies for 
the TEB service.
m. Additional PE Issues Raised by Commenters
    Comment: We received 2 comments from specialty organizations 
requesting CMS to re-evaluate the lack of physician work value for the 
3 G-codes (G0237, G0238, and G0239) CMS created to describe services to 
improve respiratory function to reflect the physician's work in 
overseeing these incident to services. The commenters contend that the 
addition of CPT 99755, assistive technology assessment, in 2004 created 
a rank-order anomaly for the respiratory function G-codes. The 
commenters requested that CMS ask the RUC to evaluate the work for 
these G-codes.
    Response: We disagree with the commenter's contention that a rank 
order anomaly exists between the respiratory function G-codes and CPT 
97755. We were clear when we created these codes during rulemaking for 
the 2002 fee schedule that the G-codes would make billing of CPT codes 
97000-97799 inappropriate for professionals involved in treating 
respiratory conditions, unless these services are delivered by physical 
therapists (PTs) and occupational therapists (OTs) and meet other 
requirements for physical and occupational therapy services. We also 
disagree that these services are always provided incident to a 
physician's service because in the CORF setting, where respiratory 
therapy services are statutorily delineated as a CORF service, the 
physician's direct supervision is not a requirement and the incident to 
provisions do not apply. The G-codes enable us to distinguish CORF 
respiratory therapy and incident to services from the services provided 
by PTs and OTs under the therapy benefit. Consequently, these G-codes 
cannot be used to bill for services provided under the physical and 
occupational benefit category at section 1861(P) of the Act and, as 
such, cannot create a rank order anomaly with the 97000 series of CPT 
codes. Although we have not assigned any work values for this final 
rule with comment, we are still considering the merits of this request 
and are happy to meet with the commenters prior to the issuance of our 
next proposed rule to discuss this issue in greater detail. We remind 
the specialty societies that they can make requests to the RUC to 
review the G-codes with respect to work values. However, we believe the 
appropriate review entity would be the HCPAC.
    Comment: Several commenters expressed their concern regarding the 
high-priced supply items in our practice expense database. In their 
comments, the RUC requested that we consider a different approach for 
payment of high-priced disposable medical supplies, particularly with 
respect to new technology supply items--where prices commonly decrease 
within 6-12 months after being distributed into a wider market--as 
these services move into the physician's office. As an alternative, the 
RUC strongly encourages CMS to review and re-price medical supplies, 
priced at or above $200, on an annual basis. Another commenter noted 
that our listed price of $677 for the endovenous laser kit used for CPT 
36478 is apparently in error because it is readily available at $250-
$350 and listed four suppliers who distribute this supply in the noted 
price range.
    Response: We appreciate comments and remarks. The RUC's comments 
regarding high cost medical supplies and the need to review these 
prices on a more frequent basis than every 5 years. Because we are 
committed to ensuring that the prices for supplies and equipment in the 
PE database are accurate, we also want to account in some way for the 
volatile nature of prices for new technology. We will consider options 
for revaluing these high cost ``new tech'' supply items and include a 
discussion of this issue in the next proposed rule
    Comment: We received a comment from an organization representing 
services of audiologists noting that the salary for audiologists and 
the equipment for their services are too low or out of date.
    Response: During the rulemaking process for the 2005 fee schedule, 
we revalued all equipment in the PE database, and requested specialty 
input at that time. To the extent that there have been changes since 
last year, we recommend that the organization utilize the establish RUC 
process. We would also encourage the commenter to supply us with 
updated salary information so that we may better address their other 
concern.

Revisions to CPT Code Series 21076 Through 21087

    We also want to note that, at the request of the RUC, we have been 
working directly with representatives of maxillofacial prosthetics to 
refine the PE inputs for the CPT code series 21076 through 21087. They 
have submitted spreadsheets to us for labor, supplies and equipment, 
and much of this information has been entered in the PE database 
although, as discussed above, the 2005 PE RVUs will be retained for 
2006. We will continue to work with the specialty to refine these 
inputs, verifying prices and quantities, prior to the issuance of our 
next proposed rule.

B. Geographic Practice Cost Indices (GPCIs)

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

[[Page 70151]]

    As discussed in the August 8, 2005 proposed rule (70 FR 45783), 
section 1848(e)(1)(E) of the Act, as amended by section 412 of the MMA, 
established a floor of 1.0 for the work GPCI for any locality where the 
GPCI would otherwise fall below 1.0. This 1.0 work GPCI floor was used 
for purposes of payment for services furnished on or after January 1, 
2004 and before January 1, 2007. This 1.0 floor will remain in effect 
in 2006.
    Section 602 of the MMA added section 1848(e)(1)(G) of the Act, 
which sets a floor of 1.67 for the work, PE, and malpractice GPCIs for 
services furnished in Alaska between January 1, 2004 and December 31, 
2005 for any locality where the GPCI would otherwise fall below 1.67. 
Effective January 1, 2006, this provision will end. In the proposed 
rule, we indicated the 2006 GPCIs for Alaska will be 1.017 for 
physician work, 1.103 for PE, and 1.029 for malpractice.

Payment Localities

    In the August 8, 2005 proposed rule (70 FR 45783), we stated that 
we look for the support of a State medical society as the impetus for 
changes to existing payment localities. Because the GPCIs for each 
locality are calculated using the average of the county-specific data 
from all of the counties in the locality, removing high-cost counties 
from a locality will result in lower GPCIs for the remaining counties. 
Because of this redistributive impact, we have refrained, in the past, 
from making changes to payment localities unless the State medical 
association provides evidence that any proposed change has Statewide 
support.
    After the publication of the CY 2005 final rule, the California 
Medical Association (CMA) submitted a proposal for a demonstration 
project that was the same as its proposal submitted in response to the 
August 5, 2004 PFS proposed rule. The CMS proposed removing ten 
counties from the existing ``Rest of California'' payment locality and 
creating ten new payment localities. Additionally, reductions to the 
payments to the Rest of California locality, would be balanced by 
payment contributions from the other payment localities in the State.
    There were several aspects of the proposal that made implementation 
problematic for us under our demonstration authority. For example, 
physicians whose payments would decrease under the demonstration could 
challenge the validity of a new locality configuration established 
without providing them the opportunity to comment through the 
regulatory process (as is our normal process for making locality 
changes). In particular, physicians who are not members of county 
medical societies or the CMA, or did not agree to participate in the 
proposed demonstration may have challenged its implementation.
    Also, the Medicare PFS currently uses identical GPCIs to pay for 
services provided in an area by both physicians and nonphysician 
providers (such as podiatrists, optometrists, physical therapists, and 
nurse practitioner). Changing the locality configuration for medical 
doctors and doctors of osteopathic medicine, but not for other 
professionals, would have some peculiar results that were not addressed 
in the CMA proposal. For example, in areas where the GPCIs would be 
reduced under the demonstration, some practitioners not participating 
under the demonstration (such as physical therapists) could be paid 
more than physicians in the same locality. Conversely, where the GPCIs 
would be increased under the demonstration, there would likely be 
complaints from the nonphysician practitioners not included in the 
demonstration.
    Nonetheless, we do recognize the potential impact of wide 
variations in the practice costs within a single payment locality. In 
the CY 2005 final rule, we noted that we received many comments from 
physicians and individuals in Santa Cruz County expressing the opinion 
that Santa Cruz County should be removed from the Rest of California 
payment locality and placed in its own payment locality. The county-
specific GAF of Santa Cruz County is 10 percent higher than the Rest of 
California locality GAF. Santa Cruz County is adjacent to Santa Clara 
County and San Mateo County. Santa Clara and San Mateo Counties have 
two of the highest GAFs in the nation. The published 2006 GAF for the 
Rest of California payment locality is 24 percent less than the GAFs of 
Santa Clara and San Mateo.
    Sonoma County is also part of the Rest of California payment 
locality. The county-specific GAF of Sonoma County is 8 percent higher 
than the Rest of California locality GAF. Sonoma County is bordered by 
Marin County and Napa County. Using published 2006 values, the payment 
locality that includes Marin and Napa counties has the fourth highest 
GAF in the nation, and is 13 percent higher than the GAF of the Rest of 
California payment locality.
    We recognize that changing demographics over time may lead to 
significant payment disparities in particular circumstances. We rely 
upon State medical societies to identify and propose consensus 
approaches to resolving these disparities, because there are 
redistributive impacts in the ``budget neutral'' process within a State 
when new localities are created (or existing ones reconfigured). Yet we 
also recognize our responsibility for establishing fee schedule areas. 
In the proposed rule, to assure the maximum opportunity for public 
discussion and comment to identify a consensus approach, we listed 
alternative locality configurations that we had examined, including:
    <bullet> The CMA demonstration approach comparing county-specific 
GAFs to the payment locality GAF, and designating any county with a 
county-specific GAF at least 5 percent higher than its locality GAF as 
a new locality;
    <bullet> An approach that sorts counties by descending GAFs and 
compares the highest county to the second highest county. If the 
difference between these two counties is 5 percent or less, they are 
included in the same locality. The third highest county GAF is then 
compared to the highest county GAF and so on, until the next county GAF 
is not within 5 percent of the highest county GAF. At that point, the 
county GAF that is more than 5 percent lower than the highest county 
GAF becomes the comparison for the next lowest county GAF, to create a 
second locality. This process is repeated down throughout all of the 
counties;
    <bullet> An approach that compares the county with the highest GAF 
to the Statewide average, removing counties that are 5 percent or more 
than the Statewide average; and
    <bullet> An approach that bases GPCI payment localities on 
Metropolitan Statistical Areas as defined by the Office of Management 
and Budget.
    However, because these reconfigurations would result in significant 
redistributions across most California counties, we simply proposed the 
approach that would have the least impact on other counties. We 
proposed that Santa Cruz and Sonoma Counties (the two counties with the 
most significant disparity between the assigned Rest of California GAF 
and the county-specific GAF) be removed from the Rest of California 
payment locality and that each would be its own payment locality. We 
invited and received comments regarding this proposal and possible 
alternative approaches to address this issue. We were particularly 
interested in whether the CMA supported this approach. Those comments 
and our responses are discussed below.
    The issue of payment locality designation in light of changing 
economic and population trends will be

[[Page 70152]]

of importance to us for the foreseeable future. We also indicated in 
the proposed rule that we are interested in other solutions to the 
problem, and with any ideas or suggestions that will help resolve the 
problems associated with the designation and revision of payment 
localities. We would use those ideas and suggestions in developing any 
future proposal that would be subject to comment through the rulemaking 
process.
    Comment: Numerous comments from the beneficiaries and health care 
providers in Santa Cruz and Sonoma Counties, and from several members 
of the Congress, including a U.S. Senator from California, supported 
our proposed change. These comments focused on the high costs of 
practicing in Santa Cruz and Sonoma Counties and were appreciative of 
the proposal. Most supporters referred to studies that have shown the 
high costs of working in Santa Cruz and Sonoma Counties have resulted 
in physicians restricting their practices or withdrawing from practice 
altogether. According to the commenters, this has made it more 
difficult for Medicare beneficiaries to find doctors in those counties. 
These commenters feel that our proposed change will encourage 
physicians to continue to treat Medicare patients in their Santa Cruz 
and Sonoma County practices.
    Response: These two counties currently have the most significant 
disparities between their present GAFs and their county-specific GAFs. 
They are also bordered by counties with significantly higher GAFs. As 
we stated earlier in this section and in the proposed rule, we have 
received many comments in the past expressing concern that these 
disparities have led some practitioners to relocate their practices out 
of these counties, creating potential access problems.
    The proposal was an attempt to balance the interests of physicians 
and nonphysician practitioners and their patients in Santa Cruz and 
Sonoma Counties with the interests of providers and patients in the 
other counties in the Rest of California. We noted in the proposed rule 
that the 2006 Rest of California GAF would be 1.011, compared to the 
2005 GAF of 1.012. Absent this proposal, the 2006 Rest of California 
GAF would be 1.017 (2006 is the second year of the transition to the 
new GPCIs and GAFs incorporating updated data).
    Comment: We also received comments opposing the proposal from 
numerous providers and medical associations in the current Rest of 
California payment locality. In addition, several members of the 
Congress wrote letters opposing the proposed change.
    The CMA pointed to the fact, which is the result of the budget 
neutrality requirement for administrative actions to modify GPCIs, that 
the Rest of California locality would be negatively impacted. The CMA 
also notes that the proposal does not address the other localities it 
identified in its demonstration proposal. These views were echoed by 
the other commenters objecting to the proposal.
    Response: It is indicative of the difficult nature of this issue 
that many of the same commenters who expressed disappointment that our 
proposal did not address all of the other counties that CMA identified 
in its demonstration proposal were also concerned that the proposal 
would simultaneously result in a reduction of the GPCIs for the Rest of 
California payment locality. Under our current statutory authority, it 
is well known that changes to the payment localities must be 
implemented in a budget neutral manner. Therefore, it is not possible 
to fully meet both objectives without legislation to provide additional 
funding for physician payments in California.
    While we appreciate the situation of practitioners in Santa Cruz 
and Sonoma Counties as described above, we also acknowledge the 
concerns of those in the Rest of California payment locality about the 
negative payment impact of removing the GPCI data for Santa Cruz and 
Sonoma Counties, and the lack of support from the CMA for an 
administrative solution to these payment concerns. As we mentioned 
earlier in this section, our proposal was designed to balance these two 
interests.
    As we have stated repeatedly in the past, we believe payment 
locality reconfigurations should be supported broadly across the State. 
It was our belief that the proposal we presented, which actually would 
have had the smallest possible negative impact on the Rest of 
California's GAF, might meet that criterion. However, based on the 
comments we received opposing the proposal, particularly those from the 
CMA, it is apparent that this proposed change is not acceptable to the 
majority of commenters at this time.
    Comment: The CMA indicated that it supports a nationwide 
legislative solution that would provide additional funding for 
physicians in counties adversely affected by locality reconfigurations. 
The CMA states ``this is the only GPCI solution that we are supporting 
at this time.''
    The Medicare Payment Advisory Commission (MedPAC) comments that the 
locality boundaries have not had a complete review since 1997 and that 
economic and population trends are likely to have changed since that 
time. MedPAC is studying these issues, and encourages CMS to do so as 
well, with the goal of revisiting the boundaries of all payment 
localities nationwide.
    We also received a comment from a member of the Congress urging us 
to conduct a national examination of the definitions of payment 
localities. The commenter recommended that we propose a method to 
reconfigure payment localities to be effective January 1, 2008. The 
commenter also recommended that we develop a process for periodically 
reviewing payment localities.
    Response: As we stated earlier in this section and in the proposed 
rule, we are interested in all ideas that will help resolve the 
problems associated with the designation and revision of payment 
localities. Clearly, as illustrated by the situation discussed earlier 
in this section, one of the most significant issues to be addressed is 
the redistributive nature of changes to the payment localities in a 
budget neutral context.
    There are currently 89 separate payment localities. Of these, 34 
are Statewide localities. Our last comprehensive evaluation of the 
definition and composition of the payment localities was discussed in 
the July 2, 1996 proposed rule (61 FR 34615) and the November 22, 1996 
final rule (61 FR 59494). The localities existing at that time, which 
were developed by the local Medicare contractors, served as building 
blocks for the current localities (at the time, there were 210 separate 
localities, 22 of them were Statewide localities).
    We stated at the time that our major goals were to simplify payment 
areas and payment differences among adjacent geographic areas while 
maintaining accuracy in tracking input price differences among areas. 
There is an inherent trade-off between these two goals. Thus, at one 
extreme is a set of Statewide localities with no intra-state geographic 
adjustments; very simple, but less descriptive of input price 
differences. At the other extreme is a separate locality for each 
county; maximum input price adjustment for geographic variation, but 
operationally very cumbersome, expensive to develop and maintain, and 
potentially very confusing for providers.
    We do not disagree with the view that a comprehensive evaluation of 
the current payment localities is due, and we look forward to working 
cooperatively with MedPAC in that regard. We are examining all viable

[[Page 70153]]

options that will meet the general objectives discussed above. We would 
note, however, that our goals for this analysis are very similar to 
those we expressed in 1996.
    Comment: A private insurer is opposed to our proposal because it 
increases the number of payment localities which increases commercial 
payer administrative costs. The insurer suggests we reduce the number 
of California payment localities from 10 to 3.
    Response: While we appreciate and, as a matter of general policy, 
agree that it would be preferable to minimize the number of separate 
payment localities wherever possible, we do not believe that reducing 
the number of payment localities would resolve the issues discussed 
above.
    Comment: We received comments from a medical clinic in Wisconsin 
and a research and management organization in Colorado. These 
commenters stated that CMS is using improper data to create the GPCIs. 
The commenters suggest we change the wage proxy categories to include 
physicians and remove physician work from the GPCI calculation. They 
further state that ``Medicare payments are a primary stimulus in 
attracting greater numbers of physicians to high payment localities''. 
The commenters also suggest we look for alternative data sources for 
rent data.
    Response: The CY 2005 final rule contained responses to commenters 
raising the same issues related to the data used to calculate the GPCIs 
as those noted above (69 FR 66260). Because the data used to calculate 
the GPCIs was not part of the proposed rule, we refer the commenter to 
that document rather than repeat that discussion here. We also note 
that we continue to evaluate other potential sources of data to use to 
calculate the GPCIs.
    We are disappointed that there was limited support for the proposal 
to create new, separate payment localities for Santa Cruz and Sonoma 
Counties. As we noted above, the proposal was designed to balance 
concerns of practitioners in higher-cost Santa Cruz and Sonoma Counties 
with the concerns of those in the Rest of California payment locality 
about the negative payment impact resulting from removal of the GPCI 
data for Santa Cruz and Sonoma counties from the Rest of California 
GPCI calculation. Because of the nearly complete lack of support for 
this proposal outside the two positively impacted counties, we have 
decided to withdraw this proposal at this time. As noted above, we 
intend to work with MedPAC and other interested parties toward a more 
comprehensive evaluation of potential refinements of the payment 
localities.
    Under section 1848(e)(1)(E) of the Act, the floor of 1.67 for the 
work, PE, and malpractice GPCIs for services furnished in Alaska ends 
as of January 1, 2006. Therefore, as of that date, the GPCIs for Alaska 
will be 1.017 for physician work, 1.103 for PE, and 1.029 for 
malpractice costs.

C. Malpractice Relative Value Units (RVUs)

    We discussed several proposed technical changes and other issues 
related to the calculation of the malpractice RVUs in the proposed 
rule. These are summarized below, along with discussions of the 
comments we received and our responses.
1. Five Percent Specialty Threshold
    We are concerned that the malpractice RVUs could be inappropriately 
inflated or deflated due to irregular data based upon incorrectly 
reported specialty classifications and have examined the impact of 
establishing a minimum percentage threshold for any procedure performed 
by any specialty before the risk factor of that specialty is included 
in the malpractice RVU calculation of a particular code. We proposed 
excluding data for any specialty that performs less than 5 percent of a 
particular service or procedure from the malpractice RVU calculation 
for that service or procedure and discussed the code-specific impact of 
implementing this proposed threshold. Our assumption was that the 
infrequent instances of these specialties in our data represent 
aberrant occurrences and removing the associated risk factor from the 
malpractice RVU calculation would improve the accuracy and stability of 
the RVUs. This was based on our belief that removing data attributable 
to specialties that occur in our data less than 5 percent of the time 
would most appropriately balance the objective to identify irregular 
data (claims with a specialty identified that is highly unlikely to 
have performed a particular procedure) while including specialties that 
perform a procedure a small percentage (but at least 5 percent)of the 
time.
    We excluded evaluation and management (E&M) services from the 
analysis. Medicare claims data show that E&M services are performed by 
virtually all physician specialties. Therefore, in the case of E&M 
codes, it is likely that even the low relative percentages of 
performance by some specialties would accurately represent the 
provision of the service by those specialties.
    For all services other than E&M services, we stated our belief that 
removing data attributable to specialties that occur in our data less 
than 5 percent of the time would most appropriately balance the 
objective to identify irregular data (claims with a specialty 
identified that is highly unlikely to have performed a particular 
procedure) while including specialties that perform a procedure a small 
percentage of the time. The higher the threshold, the more likely it 
would result in the removal of data for specialties actually performing 
the procedure, while a lower threshold would be more likely to fail to 
remove some irregular data, particularly for low-volume codes (fewer 
than 100 occurrences, where each claim represents 1 or more percentage 
points).
    The overall impact of removing the risk factor for specialties that 
occur less than 5 percent of the time in our data for a procedure is 
minimal. There is no impact on the malpractice RVUs for over 5,280 
codes, and there is an impact of less than 1 percent on the malpractice 
RVUs for over 1,300 additional codes. Only 16 codes decrease by at 
least 0.1 RVUs, with the biggest decrease being a negative 0.28 impact 
on the malpractice RVU for CPT code 17108, Destruction of skin lesions, 
from a current RVU of 0.82 to a proposed RVU of 0.54.
    Conversely, there are 219 codes for which RVUs increase by at least 
0.1, the largest increase being a positive 0.81 RVU increase for CPT 
code 61583, Craniofacial approach, skull, from a current RVU of 8.32 to 
a proposed RVU of 9.13. Among codes whose malpractice RVUs would 
increase under our proposal, 646 have increases of less than 1 percent. 
The impact analysis section of this proposed rule examines the effects 
of this proposed change by specialty.
    Comment: Numerous commenters supported the 5 percent specialty 
threshold. Several commenters suggested that we apply the threshold to 
the E&M codes.
    Response: We appreciate the commenters' support of this change to 
our methodology. Regarding the exclusion of E&M codes from our 
analysis, we note our rationale as stated above in this section. The 
comments we received did not address our concern that all specialties 
use these codes. Therefore, we still believe it is appropriate not to 
apply the 5 percent specialty threshold to the E&M codes.
    Comment: We received a comment recommending the threshold be 
lowered to 1 percent. The commenter is concerned that a 5 percent 
threshold inappropriately removes some

[[Page 70154]]

specialties actually performing interventional radiology services. The 
example of CPT code 35476 (percutaneous venous angioplasty) was 
provided. The commenter noted that CMS's proposed 5 percent threshold 
removed the risk factors for general surgeons and vascular surgeons, 
resulting in a decrease in the malpractice RVUs for this code. The 
commenter states this was contrary to our objective to remove irregular 
data because both of these specialties actually perform this procedure, 
and that a 1 percent threshold would better retain those specialties 
actually providing the service while still removing irregular data.
    Response: In the case of CPT code 35476, the risk factors for the 
two specialties that were removed resulted in a decrease in the RVUs 
for this code; however, we review these data on a regular basis and if, 
in the future, the data support it, we will change the RVUs 
accordingly. We note that the majority of commenters supported a 5 
percent threshold as reasonable. We do not believe a 1 percent 
threshold, as suggested by the commenter, is reasonable as this 
threshold would not be an effective screen for claims with a specialty 
identified that is highly unlikely to have performed a particular 
procedure. However, we will continue to assess whether a different 
threshold may ensure irregular data are removed without also removing 
data for specialties that actually perform the service.
2. Specialty Crosswalk Issues
    Malpractice insurers generally use five-digit codes developed by 
the Insurance Services Office (ISO), an advisory body serving property 
and casualty insurers, to classify physician specialties into different 
risk classes for premium rating purposes. ISO codes classify physicians 
not only by specialty, but in many cases also by whether or not the 
specialty performs surgical procedures. A given specialty could thus 
have two ISO codes, one for use in rating a member of that specialty 
who performs surgical procedures and another for rating a member who 
does not perform surgery.
    Medicare uses its own system of specialty classification for 
payment and data purposes. Therefore, to calculate the malpractice 
RVUs, it was necessary to map Medicare specialties to ISO codes and 
insurer risk classes, and in some instances to crosswalk unassigned 
specialties to the most approximate existing ISO codes and risk 
classes.
    We stated in the CY 2005 final rule that we would continue to work 
with the AMA RUC's Professional Liability Insurance (PLI) Workgroup to 
address any potential inconsistencies that may still exist in our 
methodology. Based upon this commitment, the RUC PLI Workgroup 
forwarded various recommendations for our consideration. The RUC 
developed its recommendations based upon comments submitted to them by 
physician specialty organizations.
    As discussed in the August 8, 2005 proposed rule, the Workgroup 
believes the risk factors assigned to certain professions overestimate 
the insurance premiums for these professions and, based on its 
recommendations, we proposed revising the risk factor for the following 
specialties to a risk factor of 1.00: clinical psychology; licensed 
clinical social work; psychology; occupational therapy; opticians and 
optometrists; chiropractic and physical therapy. We invited comment 
from representatives of the affected specialties and others regarding 
the appropriateness of this proposal, as well as other specialty 
crosswalks and suggestions for reliable sources of actual malpractice 
premium data for nonphysician groups.
    The RUC PLI Workgroup also believed that a number of professions 
that were assigned to the average for all physicians risk factor should 
be removed from the calculation of malpractice RVUs altogether and 
recommended excluding data from the following professions: Certified 
clinical nurse specialist; clinical laboratory; multispecialty clinic 
or group practice; nurse practitioner; physician assistant; and 
physiological laboratory (independent). We agreed with this 
recommendation and proposed to establish malpractice RVUs based upon 
the mix of specialties exclusive of the above specialties and 
professions.
    The PLI Workgroup also made recommendations for changing the 
crosswalks for risk factors for the following specialties which we did 
not accept: Certified registered nurse anesthetists; colorectal 
surgeons; gynecologists; and oncologists. We did not propose changes to 
the current crosswalks for these specialties and professions because we 
believe the current crosswalks we are using for these specialties 
appropriately reflect the types of services they provide.
    Comment: One commenter objected to our proposed change in the 
crosswalk to the lowest current risk factor of 1.00 for opticians and 
optometrists. The commenter stated that the recommendation from the RUC 
was not based on examination of the premium data or any other objective 
evidence. However, another commenter supported the proposal to 
crosswalk optometrists and opticians to the lowest current risk factor 
of 1.00, arguing this more appropriately reflects the actual level of 
risk assumed during the performance of procedures.
    A commenter objected to the proposed crosswalk change to 1.00 for 
clinical psychologists, licensed clinical social workers, and 
psychologists because the commenter believes that the malpractice 
insurance costs for these nonphysician practitioners are well below 
those paid by psychiatrists.
    Response: The proposed changes to the risk adjustment factor 
crosswalks were based on our agreement with the RUC PLI Workgroup's 
assertion that these nonphysician professionals incur costs most 
similar to the lowest cost physician specialty. Because we do not have 
actual premium data for these professional groups, it is necessary to 
select an appropriate crosswalk category. We proposed to change the 
crosswalks for these specialties because, absent actual premium data, 
we agree with the RUC that these groups very likely do not incur 
malpractice costs on par with the average physician specialty.
    In its comments, the RUC points out that each of the professions 
for which we proposed to change the malpractice crosswalk is 
represented on the RUC's Health Care Professional Advisory Committee 
(HCPAC). The HCPAC agreed that these professions should review their 
premium data and report back to the HCPAC at its September 29, 2005 
meeting. Subsequently, on October 6, 2005 (after the close of the 
public comment period), the RUC submitted the results of these reviews.
    The RUC submitted to us after the close of the public comment 
period malpractice insurance premium data from many of these 
nonphysician professional groups. Because these data were received 
after the close of the comment period, and we believe it is important 
to allow the affected specialties the opportunity to comment on changes 
to the crosswalks, we are not incorporating these data in this final 
rule with comment. However, we would note that the data suggest that 
the annual premiums paid by these groups are below the average amounts 
paid by allergists and immunologists, the lowest premium cost physician 
specialties.
    We plan to continue to examine this issue in conjunction with the 
RUC's PLI Workgroup before the 2007 proposed rule. Based on the fact 
that commenters did not provide any alternative data to suggest the 
crosswalks we proposed

[[Page 70155]]

were inappropriate, we will adopt our proposals for 2006 without 
change.
    Comment: One commenter supported our proposal to change the 
crosswalk for services of occupational therapists to 1.00, but suggests 
that the crosswalk should not be to allergy and immunology. Instead, 
the commenter recommended a crosswalk to physical medicine and 
rehabilitation.
    Response: We appreciate the commenter's support of our proposal. 
With regard to the commenter's recommendation to crosswalk to the 
specialty of physical medicine and rehabilitation, we would note that 
the risk factor for this specialty is 1.26 rather than 1.00. As noted 
above, because the comments we received did not contain any alternative 
data to suggest the crosswalks we proposed were inappropriate, we are 
adopting our proposals for 2006.
    Comment: Several commenters urged us to reconsider our proposal to 
not accept the RUC PLI's recommendations to crosswalk: the specialty of 
gynecologist/oncologist to surgical oncology; certified registered 
nurse anesthetists (CRNAs) to anesthesiology; and, colorectal surgery 
to general surgery.
    Commenters also suggested separate surgical and nonsurgical risk 
factors for urology, and that hand surgery be crosswalked to orthopedic 
surgery (without spine).
    Response: With respect to the commenters' recommendation to 
crosswalk gynecologist/oncologist to surgical oncology, the commenters 
did not substantially justify the argument that the professional 
liability premiums of the specialty are similar to those of surgical 
oncologists; however, we will analyze the data for this suggestion for 
possible future consideration. Commenters noted that CRNAs are 
currently crosswalked to general surgery, which means that CRNAs have a 
higher risk factor than anesthesiologists. These commenters recommended 
that CRNAs be crosswalked to anesthesiology and we accept this 
recommendation.
    For the request to crosswalk colorectal surgery to general surgery, 
the specialty of colorectal surgery was not crosswalked. Instead, we 
used actual premium liability insurance data collected for this 
specialty. Consequently, we disagree that this specialty should be 
crosswalked to another specialty. As stated previously and in the 
proposed rule, we only crosswalked specialties for which no premium 
data were collected.
    With regard to the comments regarding separate surgical and 
nonsurgical risk factors for urology, we would be interested in further 
information regarding the appropriateness of this change.
    For the request to crosswalk hand surgery to orthopedic surgery, we 
note that, similar to colorectal surgery above, we used actual premium 
liability insurance data collected for this specialty. Consequently, we 
disagree that this specialty should be crosswalked to another 
specialty.
    Comment: The RUC supported our proposal to remove the risk 
adjustment data for the following professions and providers: certified 
clinical nurse specialist; clinical laboratory; multispecialty clinic 
or group practice; nurse practitioners, physician assistants; and 
physiological laboratory (independent).
    Response: We appreciate these supportive comments for this proposed 
change.
3. Cardiac Catheterization and Angioplasty Exception
    In the November 2, 1999 final PFS rule (64 FR 59384), we applied 
surgical risk factors to the following cardiology catheterization and 
angioplasty codes: 92980 to 92998 and 93501 to 93536. This exception 
was established because these procedures are quite invasive and more 
akin to surgical than nonsurgical procedures.
    In the CY 2005 (69 FR 66275), we discussed changes to the list of 
codes that would fall under the exception. In response to a request 
from the RUC's PLI Workgroup, we proposed to add the following CPT 
codes to the existing list of codes under the exception: 92975; 92980 
to 92998; and 93617 to 93641.
    Comment: Several commenters supported the changes made for the 
cardiac catheterization and angioplasty exception.
    Response: We appreciate the supportive comments for this proposed 
change.
4. Dominant Specialty for Low-Volume Codes
    The final recommendation from the PLI Workgroup was to use the 
dominant specialty approach for services or procedures with fewer than 
100 occurrences, and to apply this approach to the list of 1,844 
services supplied by the workgroup. The PLI Workgroup worked in 
conjunction with various specialty organizations to identify the 
dominant specialty that performs each service.
    We did not propose to adopt this methodology and noted that low 
volume procedures or services are not necessarily performed by only one 
specialty. As noted previously, we would distinguish between excluding 
data presumed to be erroneous from data reflecting utilization by 
specialties that perform a service but are not the dominant specialty. 
However, we acknowledge that there may be instances where irregular 
data exist that would not be identified and removed by our proposed 5 
percent threshold discussed previously. We will continue to work with 
the RUC PLI Workgroup examine this issue in the future.
    Comment: Numerous commenters opposed our policy to use actual 
specialty data rather than dominant specialties and suggested that we 
adopt the RUC recommendations.
    Response: As we stated in the PFS proposed rule (70 FR 45786), we 
believe that basing payment on all specialties that perform a 
particular service ensures that the actual professional liability 
insurance costs of all specialties are included in the calculation of 
the malpractice RVUs. Therefore, we do not believe it would be 
appropriate, even for these low-volume services, to include only the 
dominant specialty if other specialties regularly provide the service.
5. Collection of Premium Data
    Although this issue was not part of the proposed rule, many 
commenters suggested that we use alternative sources for our premium 
data.
    Comment: Some commenters suggested we used data supplied by the 
Physicians Insurers Association of America (PIAA) or directly from 
physician providers.
    Response: We are currently investigating the usefulness of the PIAA 
data and once our evaluation of the data is complete we will make a 
decision. We are not considering using physician provider self-reported 
premium costs.

Final Decision

    We are implementing the proposed 5 percent threshold and specialty 
crosswalk changes discussed in the proposed rule. After considering all 
of the other comments received, we are not making other changes to the 
calculation of the malpractice RVUs.

D. Medicare Telehealth Services

1. Requests for Adding Services to the List of Medicare Telehealth 
Services
    As discussed in the August 8, 2005 PFS proposed rule (70 FR 45786), 
section 1834(m) of the Act defines telehealth services as professional 
consultations, office and other outpatient visits, and office 
psychiatry services identified as of July 1, 2000 by CPT codes 99241 
through 99275, 99201

[[Page 70156]]

through 99215, 90804 through 90809, and 90862. In addition, the statute 
requires us to establish a process for adding services to or deleting 
services from the list of telehealth services on an annual basis.
    In the December 31, 2002 Federal Register (67 FR 79988), we 
established a process for adding or deleting services to the list of 
Medicare telehealth services. This process provides the public an 
ongoing opportunity to submit requests for adding services. We assign 
any request to make additions to the list of Medicare telehealth 
services to one of the following categories:
    <bullet> Category <greek-i>1: Services that are similar to office 
and other outpatient visits, consultations, and office psychiatry 
services. In reviewing these requests, we look for similarities between 
the proposed and existing telehealth services for the roles of, and 
interactions among, the beneficiary, the physician (or other 
practitioner) at the distant site and, if necessary, the telepresenter. 
We also look for similarities in the telecommunications system used to 
deliver the proposed service (for example, the use of interactive audio 
and video equipment.)
    <bullet> Category <greek-i>2: Services that are not similar to the 
current list of telehealth services. Our review of these requests 
includes an assessment of whether the use of a telecommunications 
system to deliver the service produces similar diagnostic findings or 
therapeutic interventions as compared with the face-to-face ``hands 
on'' delivery of the same service. Requestors should submit evidence 
showing that the use of a telecommunications system does not affect the 
diagnosis or treatment plan as compared to a face-to-face delivery of 
the requested service.
    Since establishing the process, we have added the psychiatric 
diagnostic interview examination and ESRD services with 2 to 3 visits 
per month and 4 or more visits per month to the list of Medicare 
telehealth services (although we require at least one in-person visit a 
month by a physician, clinical nurse specialist, nurse practitioner, or 
physician assistant to examine the vascular access site).
    Requests for adding services to the list of Medicare telehealth 
services must be submitted and received no later than December 31st of 
each year to be considered for the next proposed rule. For example, 
requests submitted before the end of CY 2004 are considered for the CY 
2006 proposed rule. For more information on submitting a request for an 
addition to the list of Medicare telehealth services, visit our web 
site at www.cms.hhs.gov/physicians/telehealth.
    We received the following public requests for additional approved 
services in CY 2004: (1) Individual medical nutritional therapy (MNT) 
as described by HCPCS codes G0270, 97802 and 97803; (2) group MNT 
(HCPCS codes G0271 and 97804); (3) individual diabetes outpatient self-
management training (DSMT) services (HCPCS code G0108); (4) Group DSMT 
(HCPCS code G0109); and (5) modification of the definition of an 
interactive telecommunications system for purposes of furnishing a 
telehealth service.
    After reviewing the public requests, we proposed to add individual 
MNT as represented by HCPCS codes G0270, 97802 and 97803 to the list of 
Medicare telehealth services. We also proposed to add individual MNT to 
the list of Medicare telehealth services at Sec.  410.78 and Sec.  
414.65. Moreover, because a certified registered dietitian or other 
nutrition professional are the only practitioners permitted by law to 
furnish MNT, we proposed to revise Sec.  410.78 to add a registered 
dietitian and nutrition professional as defined in Sec.  410.134 to the 
list of practitioners who may furnish and receive payment for a 
telehealth service.
    We did not propose to add any additional services to the list of 
Medicare telehealth services or to make any changes to the definition 
of an interactive telecommunications system for CY 2006.
    For further information on our proposals, see the Federal Register 
dated August 8, 2005 (70 FR 45786).

Individual MNT

    Comment: Many commenters supported our proposal to approve 
individual MNT for telehealth and to add a registered dietitian and 
nutrition professional to the list of practitioners authorized to 
furnish and receive payment for Medicare telehealth services. 
Commenters stated that adding MNT to the list of Medicare telehealth 
services would improve access and services for patients in remote areas 
where traditional MNT services may not be readily available. For 
example, a State dietetic association mentioned that in many cases, 
patients need to drive for more than an hour to receive MNT services 
and that the ability to furnish individual MNT as a telehealth service 
will provide great benefit to rural Medicare beneficiaries. 
Furthermore, a renal association stated that limited access to 
nutritional therapists is problematic for patients with stage 3 and 4 
kidney disease who are located in rural or isolated areas. The 
commenter explained that nutritional counseling is an important tool 
for helping beneficiaries improve their nutritional status and in 
controlling levels of key electrolytes such as potassium and 
phosphorous. Several MNT practices also urged us to adopt our proposal 
to approve individual MNT for telehealth. Another commenter supported 
the addition of individual MNT, however stated that more conclusive 
data regarding efficacy is needed before further expansion.
    Response: We agree with the commenters that approving individual 
MNT for telehealth would help provide greater access to registered 
dietitians and other nutritional professionals for beneficiaries in 
rural and or isolated areas.
    Comment: A few commenters believe that MNT should not be approved 
as a Medicare telehealth service. For instance, a certified diabetes 
educator (CDE) stated that it would be very difficult to accurately 
assess cognitive and literacy levels, emotional state and motivation 
without seeing the patient. The commenter also believes that face-to-
face interaction for assessment, establishment of goals, and reviewing 
written materials is essential. The commenter expressed support for 
using telehealth to furnish MNT in very limited circumstances, for 
example if there was no access to an educator within 50 miles or if the 
patient was homebound. One commenter contends that it would be 
difficult to assess a patient's understanding of the dietary 
prescription, nutrient content of each food group, portion control and 
information provided by food labels, especially for beneficiaries who 
cannot read and or have a vision impairment that prevents them from 
reading fine print. Moreover, another commenter believes that 
individual MNT includes skill-based training beyond an individual 
assessment, not unlike teaching insulin administration or blood glucose 
monitoring. The commenter stated that the skills taught in MNT cannot 
be verbally assessed through distance education.
    Response: As discussed in the proposed rule, we believe that 
individual MNT is similar in nature to an office or other outpatient 
visit (which is defined in the law as a Medicare telehealth service). 
We believe that the components of an E/M office visit involve a similar 
level of patient counseling for following a treatment plan as compared 
to individual MNT. We also believe that a registered dietitian at the 
distant site, along with an appropriate medical professional

[[Page 70157]]

with the beneficiary at the originating site, could adequately assess 
and adjust to the beneficiary's ability to understand and follow his or 
her nutritional plan.
    We do not agree with the commenter that the same level of physical, 
skill-based training that is required in an individual DSMT session, 
(for example, teaching a Medicare beneficiary the skills necessary for 
the self-injection of insulin), is a requirement for individual MNT.
    Comment: One commenter requested that we clarify whether we would 
pay a physician practice for individual MNT furnished as a telehealth 
service when a registered dietitian or other nutrition professional 
reassigns his or her right to bill for payment to the physician 
practice as an employer.
    Response: As discussed in the CMS claims processing manual (Pub. 
100-04, chapter 1, section 30.2.6), if the employer/employee 
reassignment exception is met, and the person furnishing the service 
and the entity wishing to bill are both enrolled in Medicare and each 
have their own billing number, then we could make payment to the 
physician practice for the MNT service.

Group Medical Nutritional Therapy (MNT) and Diabetes Self-Management 
Training Services (DSMT)

    Comment: Some commenters agreed with our proposal not to add DSMT 
to the list of Medicare telehealth services. For instance, one 
commenter wrote that DSMT can not be done as a telehealth service 
because in-person interaction with the client is crucial for assessing 
the skill development necessary for managing diabetes. Additionally, 
two certified diabetic educators (CDE) stated that DSMT can not be 
adequately furnished as a telehealth service and agreed with our 
proposal not to add DSMT to the list of Medicare telehealth services. 
Furthermore, another commenter stated that face-to-face interaction for 
assessment, establishment of goals, and reviewing written materials is 
essential for DSMT.
    Response: As discussed in the proposed rule, we believe that DSMT 
is not similar to the current list of Medicare telehealth services and 
requires conclusive evidence showing that the use of a 
telecommunications system is an adequate substitute for the in-person 
delivery of DSMT.
    Comment: A few commenters believe group MNT and group DSMT are 
similar in nature to the current list of Medicare telehealth services 
and therefore should be approved for telehealth under category 1 
criteria. The commenters contend that the same presentation material, 
text books, manuals, DVD's and on site support staff are used whether 
group DSMT or group MNT is furnished in-person or through an 
interactive audio and video telecommunications system. The commenters 
stated that the practitioner would conduct the same training session 
for a telehealth service as they would in-person, and they believe that 
the interactive differences between group MNT and group DSMT and the 
current Medicare telehealth services should not be used as a basis for 
denying these services. The commenters believe that the criteria for 
approving group MNT and group DSMT should be based on whether the use 
of a telecommunications system is equivalent to the in-person delivery 
of the requested service. Moreover, commenters argue that no group 
services would ever be approved if we base approval upon whether the 
interactive dynamic of the requested service is similar to existing 
telehealth services and requested us to add group MNT and group DSMT as 
a precedent by which other future group service requests could be 
measured.
    Response: Category 1 requests are reviewed to ensure that the roles 
of, and interaction among, the beneficiary and physician (or other 
practitioner) of the requested service are similar to the current 
telehealth services, for example office and other outpatient visits and 
consultation services. In other words, the roles of, and interaction 
among, the beneficiary and physician (or practitioner) is the criterion 
used to determine whether the requested service is similar to the 
current telehealth services.
    Since the interactive dynamic of group MNT and group DSMT is not 
similar to the current list of telehealth services, the request to add 
these services was assigned to category 2. For category 2 services, we 
assess whether the use of an interactive audio and video 
telecommunications system to deliver the requested service is 
equivalent to the in-person delivery of the service. To that end, we 
review any comparative analyses submitted by the requestor illustrating 
that the use of a telecommunications system is an adequate substitute 
for the in-person delivery of the requested service. If the requestor 
were to submit studies indicating that beneficiaries receiving group 
MNT and group DSMT comprehend and apply the training material as well 
by telehealth as in person, we would reconsider approving group MNT and 
group DSMT for telehealth.
    Comment: The same group of commenters also believe that individual 
DSMT is similar to the existing list of telehealth services and should 
be approved as a category 1 request. The commenters contend that a 
telepresenter would be able to facilitate the ``hands on'' aspects of 
training a patient how to inject insulin. For example, a telepresenter 
with a patient at the originating site (who is not a certified CDE) 
could assist with filling syringes, mixing doses, and showing the 
injection site location through illustration or pointing to areas on 
the body. Commenters also argue that the use of a large video monitor 
to show gradient markings on a syringe could be beneficial for patients 
with poor vision.
    Response: As discussed in the proposed rule, we considered 
individual DSMT as a category 2 request because the components included 
in training a Medicare beneficiary to administer insulin injections are 
typically not part of the services currently on the list of telehealth 
services. We did not propose to add individual DSMT because the 
requestors did not submit any comparative analyses illustrating that 
the use of an interactive audio and video telecommunications system is 
an adequate substitute for individual DSMT furnished in-person.
    Comment: Several commenters submitted summaries of studies and or 
articles regarding group psychiatry, individual psychotherapy, and 
medication management furnished as telehealth services. Additionally, 
an individual practitioner mentioned a study that compared diabetes 
education furnished through telemedicine with diabetes education 
furnished in-person.
    Response: For category 2 services, we require evidence showing that 
the requested telehealth service is equivalent to the in-person 
delivery of the same service. The articles regarding mental health 
services and pharmacologic management do not address whether the use of 
a telecommunications system is an adequate substitute for the in-person 
delivery of MNT or DSMT. Additionally, individual psychotherapy and 
pharmacologic management are already on the list of Medicare telehealth 
services.
    The comparison study regarding diabetes education focused on 
certain aspects of individual DSMT (but, as noted below, not on 
training patients to inject insulin), and therefore is irrelevant to 
the request to add group DSMT. The study conclusions mentioned that the 
``diabetes nurse educator was even successful in

[[Page 70158]]

teaching insulin administration via telemedicine to a patient who had 
very high blood glucose levels''. However, training patients on the 
self-administration of injectable drugs (which typically occurs during 
an individual training session) was not the focus of this study and no 
conclusive evidence was provided showing that insulin administration 
can routinely be taught as a telehealth service.
    Comment: Some commenters suggested that we approve the majority of 
DSMT for telehealth and require selected aspects of the training such 
as the instruction of insulin injections to be furnished in person by a 
CDE. For instance, one CDE stated that the use of telehealth would not 
be appropriate for teaching selected skills (such as the administration 
of self-injectable drugs, glucometer testing, or insulin pump therapy), 
and should not replace the initial assessment or all follow-up visits. 
Some CDE's and DSMT programs stated that a combination of in-person and 
telehealth training works well for their patients. However, commenters 
stated that the majority of the curriculum for an American Diabetes 
Association (ADA) recognized DSMT program can be successfully provided 
as a telehealth service. For instance, a CDE stated that curriculum 
components such as nutritional management, foot care, ketone testing, 
sick day management, use of a supplemental insulin scale, and treatment 
of hypoglycemia or hyperglycemia could be furnished as a telehealth 
service.
    Response: DSMT is furnished either as an individual or group 
service as described by HCPCS codes G0108 and G0109 respectively. As 
many commenters mentioned, teaching a patient how to inject insulin is 
typically furnished as part of an individual DSMT session rather than 
in a group setting. Additionally, as discussed at Sec.  410.141(c)(1), 
Medicare payment for initial DSMT may not exceed 10 hours of 
beneficiary training in which 9 hours of the training are usually 
furnished as a group service. Since teaching a patient how to inject 
insulin is typically an integral component of an individual training 
session, and comprises only 1 hour of a maximum of 10 hours of initial 
training, we do not believe that it would be appropriate to carve out 
selected skill-based training from an individual DSMT service.
    We agree that skill-based training such as teaching patients how to 
inject insulin would be difficult to accomplish without the physical 
in-person presence of the teaching practitioner and believe this is not 
a common aspect of the current list of telehealth services. Given that 
teaching patients the skills required for insulin injection and blood 
glucose monitoring are typically furnished during an individual DSMT 
session we assigned the request to add individual DSMT to category 2. 
Moreover, as discussed previously, since the interactive dynamic of 
group DSMT is not similar to the current list of telehealth services, 
it does not meet the criteria for category 1. Therefore, we require 
evidence showing that the use of an interactive audio and video 
telecommunications system in furnishing DSMT is an adequate substitute 
for DSMT furnished in-person.
    Comment: Some commenters believed that we compared group MNT to 
group psychiatric therapy or mental health counseling. The commenters 
suggest this is not a fair comparison because patients participating in 
a group MNT session typically do not discuss specific personal health 
information with the nutrition professional because the group 
``therapy'' is a discussion of nutrition and is centered on a specific 
medical disease topic (for example, diabetes). Commenters contend that 
in the case of group MNT, the dietitian presents educational material 
to many beneficiaries at once and that the level of intense personal 
interaction found in group mental health services is not necessary in 
group MNT.
    Response: As discussed previously, we compared the roles of, and 
interaction among, the beneficiary and physician (or other 
practitioner) in furnishing MNT and DSMT to the existing telehealth 
services. We did not compare group MNT to group psychiatric therapy or 
to group mental health counseling.
    Comment: A few commenters stated that furnishing MNT for a diabetic 
patient is intended to be an adjunct to DSMT. For example, one group of 
commenters stated that without receiving DSMT, patients would not have 
an overall understanding of diabetes, how the disease develops and 
changes, and would not be taught additional methods for controlling 
glucose beyond those presented in MNT.
    Response: Approving individual MNT for telehealth is one step along 
the way to helping more beneficiaries gain access to a collaborative 
skill-based DSMT program. As discussed earlier, we believe there should 
be conclusive evidence showing that DSMT can be as effective when 
furnished as a telehealth service as in a face-to-face encounter before 
we approve this service for telehealth.
    Additionally, we conduct and sponsor a number of innovative 
demonstration projects to test and measure the effect of potential 
program changes. Our demonstrations study the likely impact of new 
methods of service delivery, coverage of new types of service, and new 
payment approaches on beneficiaries, providers, health plans, states, 
and the Medicare Trust Funds. We would encourage the commenters to take 
advantage of other programs that the agency has set up to increase 
medical quality and reduce cost. For more information on demonstration 
projects visit our web site at www.cms.hhs.gov/researchers/demos.
    Comment: A few commenters requested that we pay for DSMT education 
provided to patients over the phone. One commenter submitted several 
studies and articles regarding telephone-based interventions for 
diabetes care, (for example, telephone counseling).
    Response: Patient education provided over the phone is beyond the 
scope of this provision. Telephone calls do not meet the definition of 
an interactive telecommunications system and are not on the list of 
Medicare telehealth services. Additionally, as discussed in the 
Medicare benefits policy manual, publication 100-2, chapter 15, section 
30, no separate payment is made for phone calls under the Medicare 
program.
    Comment: One commenter requested us to recognize CDE's as a 
Medicare practitioner and allow them to bill the Medicare program 
directly.
    Response: The statute does not permit a CDE to bill and receive 
direct payment for Medicare services. The statute defines a certified 
DSMT provider as a physician, other individual, or entity who, in 
addition to providing DSMT services, provides other items or services 
for which direct payment may be made. We do not have the statutory 
authority to establish a separate CDE benefit category.

Definition of an Interactive Telecommunications System

    We received many comments regarding the use of an interactive audio 
and one-way video telecommunications system for delivering a Medicare 
telehealth consultation. Several commenters expressed qualified support 
for the use of an interactive audio and one-way video telecommunication 
for purposes of furnishing a telehealth consultation. For instance, 
some commenters believe that allowing one-way video would be 
appropriate in situations when it enables the consulting physician to 
add value to the

[[Page 70159]]

diagnosis and decision making capabilities of the patient care team at 
the originating site which includes, at a minimum, a treating 
physician; and where observation of the consulting physician by the 
patient is either unnecessary or not possible (for example, when the 
patient is unconscious).
    Some commenters also suggested that we allow one-way video 
specifically for assessing suitability for stroke thrombolytic tissue-
type plasminogen activator (tPA) therapy and compared the remote 
evaluation of a stroke patient for purposes of determining tPA 
treatment to a confirmatory consultation. For instance, the treating 
physician at the originating site would make a determination regarding 
the use of tPA and request a consultation to confirm his or her 
decision to use tPA therapy. Another commenter, who currently provides 
stroke consultation as a Medicare telehealth service, believes this 
service is an outpatient or inpatient consultation (where the 
neurologist at the distant site determines the treatment plan rather 
than offering a second or third opinion). The commenter also explained 
that they use an interactive audio and video telecommunications system 
that allows two-way real time video interaction between the consulting 
physician at the distant site and the originating site medical team.
    One organization stated that payment should be made for physicians' 
services that are safe, effective, medically appropriate, and provided 
under accepted standards of medical practice. The commenter believes 
that the critical factor in determining whether to pay for a service 
should be medical necessity rather than the technology used to furnish 
the service. The commenter also compared the use of one-way video and 
two-way audio to a physician furnishing a visit to a blind patient. The 
commenter contends that we would not deny payment for a face-to-face 
consultation on the basis that the patient could not see the physician, 
and therefore we should not deny a telehealth consultation on the same 
basis.
    Another commenter requested that we allow the use of one-way video 
equipment for delivering infectious disease telehealth consultations 
for ICU patients. The commenter explained that the hospital ICU is 
currently equipped with a one-way video, two-way audio 
telecommunications system and contends that moving interactive audio 
and video teleconferencing equipment to the ICU patient is very 
cumbersome and is only possible if appropriate technical staff are 
available.
    We received a few comments regarding the added clinical value of 
two-way video versus one-way video and whether one-way video is 
appropriate for a broad range of specialty consultations. One commenter 
made the point that two-way video would allow the patient to see the 
physician or practitioner at the distant site when a greater degree of 
interaction is necessary. One organization believes that two-way video 
may add value to a telehealth consultation by allowing the patient and 
presenting practitioner (if necessary) to see the body language and 
other non-verbal communication of the physician or practitioner at the 
distant site. However, the commenter stated that payment should not be 
denied for using a one-way video telecommunications system. Another 
commenter supported using one-way video in limited emergent 
circumstances, but also stated that additional research should be 
conducted to determine whether the use of one-way video is appropriate 
for a broad range of specialty consultations.
    Some commenters did not support the use of one-way video for 
furnishing a telehealth consultation. For instance, one commenter 
stated that face-to-face (interactive video) is a better method for 
obtaining patient compliance and results in a higher level of patient 
confidence with the health care team.
    Response: We appreciate the comments on the use of an interactive 
audio and one-way video telecommunications system for purposes of 
furnishing a telehealth consultation. We intend to consider the 
suggestions raised by the commenters as we continue to evaluate 
conditions of payment for Medicare telehealth services. We continue to 
believe that the interaction between the consulting physician and the 
clinical staff at the originating site is important and it is not clear 
to us that one-way video is as effective in that regard as two-way 
video. With regard to the commenter who stated that the critical factor 
in determining whether to pay for a telehealth service should be based 
on medical necessity, we believe that the method used to furnish the 
service, for example the use of an appropriate telecommunications 
system, is just as critical as whether the service itself is medically 
necessary.
2. Definition of an Originating Site
    As discussed in the August 8, 2005 proposed rule, section 418 of 
the MMA required the Health Resources Services Administration (HRSA) 
within HHS, in consultation with CMS, to conduct an evaluation of 
demonstration projects under which SNFs, as defined in section 1819(a) 
of the Act, are treated as originating sites for Medicare telehealth 
services. The MMA also required HRSA to submit a report to the Congress 
that would include recommendations on ``mechanisms to ensure that 
permitting a SNF to serve as an originating site for the use of 
telehealth services or any other service delivered via a 
telecommunications system does not serve as a substitute for in-person 
visits furnished by a physician, or for in-person visits furnished by a 
PA, NP or CNS, as is otherwise required by the Secretary.'' We 
indicated that this report was currently under development and that if 
the Secretary concludes in the report that it is advisable to include a 
SNF as a Medicare telehealth originating site under section 1834(m) of 
the Act, we would consider the recommendations of the report to 
determine whether to add SNFs to the list of approved originating 
sites. We also solicited comments on this topic.
    Comment: We received many comments supporting the use of telehealth 
in a SNF. The commenters noted that adding a SNF to the definition of 
an originating site would provide increased access to specialty 
physicians and practitioners, most notably mental health services, and 
decrease unnecessary travel for both the beneficiary and nursing 
facility staff.
    For example, one mental health practitioner stated that research 
studies indicate a critical shortage of psychiatrists in non-MSA areas 
and a lack of appropriate mental health care in rural SNF's as compared 
to their urban counterparts. As such, the commenter believes that many 
rural SNFs do not provide professional psychiatric or mental health 
care and that telehealth is one method that could be used to meet the 
mental health needs of the rural SNF population. Furthermore, the 
commenter stated that the lack of appropriate mental health care 
results in higher rates of psychiatric hospitalizations and the 
inability to effectively manage medications.
    Another commenter believes that allowing telehealth services to be 
furnished in a SNF would increase access to follow-up care and would 
result in cost savings. For example, the commenter contends that 
addressing acute medical conditions earlier before they develop into a 
crisis could save money by reducing transportation costs and decrease 
the number of hospital admissions. The commenter also mentioned that 
traveling and waiting in an unfamiliar waiting room is often

[[Page 70160]]

confusing and uncomfortable for the patient. The use of telehealth for 
SNF residents could result in less travel hardships for both the 
patient and SNF staff.
    Response: We appreciate the comments regarding the addition of SNFs 
to the definition of an originating site. At this time the telehealth 
report to the Congress, as required by section 418 of the MMA, is under 
development within HHS. As discussed previously, we have the authority 
to approve telehealth furnished in a SNF if the Secretary concludes in 
the report that it is advisable to include a SNF as a Medicare 
telehealth originating site under section 1834(m) of the Act.
    Comment: A few commenters requested us to add other facilities in 
addition to a SNF to the definition of an originating site. For 
example, one organization requested that we expand the definition of an 
originating site to include domiciliary care facilities and other 
congregate-living arrangements if SNFs are approved as an originating 
site. Another commenter requested that we expand the definition of an 
originating site to allow all community hospitals regardless of their 
location (for purposes of furnishing a telehealth consultation for 
stroke patients). The commenter noted that a timely evaluation of a 
stroke patient is crucial for effective stroke treatment and argued 
that beyond three hours after onset, resuscitation of injured brain 
cells becomes increasingly unlikely. The commenter contends that timely 
access to a critical care neurologist remains a concern for the 
majority of community hospitals. Moreover, a national society of 
nephrology requested that we add a dialysis facility to the list of 
originating sites.
    Response: The statute defines an originating site facility as a 
physician's or practitioner's office, hospital, critical access 
hospital, rural health clinic, or FQHC. Additionally, the statute only 
permits telehealth services to be furnished at an originating site 
located in a rural health professional shortage area as defined in 
section 332(a)(1)(A) of the Public Health Service Act or within a 
county that is not included in a metropolitan statistical area. We do 
not have the legislative authority (except for SNFs as indicated 
previously) to expand the definition of an originating site facility or 
to allow telehealth services to be furnished in a hospital regardless 
of geographic location.
3. Other Issues
    Comment: One association urged us to pay for asynchronous ``store 
and forward'' dermatology consultations. The commenter explained that a 
store and forward consultation involves the transmission of 
dermatological photographs and other medical information to the 
consulting practitioner without interaction between the patient and 
practitioner at the distant site; the patient is not present for the 
consultation. The commenter contends that store and forward 
consultation is more convenient for the patient, originating site and 
consulting physician.
    Response: Medicare telehealth services include office and other 
outpatient visits (99201 through 99215), professional consultations 
(99241 through 99275), individual psychotherapy (90804 through 90809), 
pharmacologic management (90862), psychiatric diagnostic interview 
examination (90801), and ESRD-related services included in the MCP 
(except for one visit per month to examine the access site). As a 
condition of payment under Medicare, these services require an in-
person patient encounter. We believe that the patient's presence, and 
the use of an interactive audio and video telecommunications system 
permitting the distant site practitioner to interact with the patient, 
provides a reasonable substitute for an in-person encounter. The 
statute provides for the use of asynchronous, store and forward 
technologies for delivering telehealth services only for Federal 
telemedicine demonstration programs conducted in Alaska or Hawaii. We 
do not have the authority to expand the use of store and forward 
technology in delivering telehealth services.
    Comment: Two commenters urged us to consider adding speech-language 
pathologist and audiologists as practitioners allowed to furnish and 
receive payment for telehealth services and noted that we have not 
submitted the telehealth report to the Congress on additional sites, 
geographic areas and practitioners that may be appropriate for Medicare 
telehealth payment. The commenters also mentioned that the American 
Speech-Hearing Association (ASHA) previously submitted a request for 
consideration in the CY 2005 physician rule to add various speech and 
audiology services to the list of Medicare telehealth services. The 
commenters believe that we have not responded specifically to ASHA's 
request to approve speech and audiology services for telehealth.
    Response: The report to the Congress (as required by section 223(d) 
of the Medicare, Medicaid and State Child Health Insurance Program 
Benefits Improvement and Protection Act of 2000 (BIPA) (Pub. L. 106-
554)) on additional sites and settings, practitioners, and geographic 
areas that may be appropriate for Medicare telehealth payment is under 
development. We are considering the suggestions raised by the commenter 
as we formulate our recommendations to the Congress. Moreover, since 
speech language pathologists and audiologists are not permitted under 
current law to provide and receive payment for Medicare telehealth 
services at the distant site, we can not fully consider ASHA's request 
to add speech and audiology services to the list of Medicare telehealth 
services.
    Comment: One commenter requested that we replace the term face-to-
face with ``in-person''. The commenter believes that the term ``in-
person'' is a better description of an encounter where the patient and 
practitioner are in the physical presence of each other.
    Response: The commenter's suggestion to use the term ``in-person'' 
to describe an encounter where the physician or practitioner and the 
beneficiary are physically in the same room has been noted. We will 
consider the commenter's suggestion as we discuss Medicare telehealth 
payment policy.

Result of Evaluation of Comments

    We will add individual MNT as represented by HCPCS codes G0270, 
97802 and 97803 to the list of Medicare telehealth services. We also 
will add individual MNT to the list of Medicare telehealth services at 
Sec.  410.78 and Sec.  414.65. Moreover, since a certified registered 
dietitian or other nutrition professional are the only practitioners 
permitted by statute to furnish MNT, we will revise Sec.  410.78 to add 
a registered dietitian and nutrition professional as defined in Sec.  
410.134 to the list of practitioners that may furnish and receive 
payment for a telehealth service.

E. Contractor Pricing of Unlisted Therapy Modalities and Procedures

    We recognize that there may be services or procedures performed 
that have no specific CPT codes assigned. In these situations, it is 
appropriate to use one of the CPT codes designated for reporting 
unlisted procedures. These unlisted codes do not typically have RVUs 
assigned to them.
    For services coded using these unlisted codes, the provider 
includes a description of the specific procedure(s) that was furnished. 
The contractor uses this information to determine an appropriate 
valuation.
    As explained in the August 8, 2005 PFS proposed rule (70 FR 45788), 
currently, there are two unlisted CPT

[[Page 70161]]

codes with assigned RVUs, CPT 97039, Unlisted modality (specify and 
time if constant attendance), and 97139 Unlisted therapeutic procedure.
    To make the pricing methodology consistent with our policy for 
other unlisted services, and to more appropriately match payments with 
the actual resources expended to deliver the services provided, we 
proposed to have our contractors value CPT codes 97039 and 97139.
    We received several comments on this proposal and provide the 
following summary of the comments and our response below.
    Comment: Two commenters were opposed to the proposal. These 
commenters stated they were concerned that contractor pricing would 
create inconsistencies in the payment for these services or would lower 
payment resulting in the services no longer being provided, potentially 
increasing the administrative burden and resulting in delayed payments. 
One of these commenters suggested that we work with interested 
specialties to better understand the services billed under these codes. 
Another commenter expressed concern that obtaining new CPT codes 
requires a good deal of research and investigation to ensure accurate 
payment.
    Other commenters supported this proposed change, indicating that 
because these codes are used for widely different services they should 
be evaluated separately and there is no basis for assigning the code a 
set fee schedule rate.
    Response: While it is true that having these codes priced by the 
contractors may result in some increase in administrative burden and 
impact the timeliness of payments, it will not necessarily result in 
lower payments. Our goal is to ensure appropriate payment for the 
actual services provided and we believe that our contractors will work 
with the provider community to make certain that this occurs. To the 
extent that providers believe that new codes are needed they might want 
to work with the specialty organizations to achieve this objective.
    Final Decision: We are finalizing our proposal and our contractors 
will value CPT codes 97039 and 97139. We are assigning a status 
indicator of ``C'' to these two CPT codes.

F. Payment for Teaching Anesthesiologists

    In the August 8, 2005 PFS proposed rule (70 FR 45789), we 
summarized the current policy for the payment for services provided by 
teaching anesthesiologists, including the revisions to the policy 
published November 7, 2003 (68 FR 63196 through 63395), where we 
revised Sec.  414.46 of our regulations to allow teaching 
anesthesiologists to bill in a similar manner to teaching certified 
registered nurse anesthetists (CRNAs) for the teaching 
anesthesiologist's involvement in two concurrent cases involving 
residents. This policy took effect for services furnished on or after 
January 1, 2004 and was intended as an alternative to the ``medical 
direction'' payment policy applicable to concurrent cases involving 
teaching anesthesiologists and residents.
    As noted in the August 8, 2005 proposed rule, despite the higher 
level of payment available under this policy, the American Society of 
Anesthesiologists (ASA) has informed us that it is not aware of any 
teaching anesthesia programs that have arranged their practices to meet 
the conditions necessary to bill under the revised policy. The ASA 
suggests that the teaching physician regulations for teaching 
anesthesiologists should be similar to those for teaching surgeons for 
overlapping complex surgery procedures. The ASA thinks that anesthesia 
is similar to complex surgery in terms of critical periods, overlap, 
and availability of teaching physicians. However, as we noted in the 
August 8, 2005 proposed rule, the critical portions of the teaching 
anesthesia service and the critical portions of the teaching surgeon 
service are not the same. The ASA believes that inadequate payment 
levels have contributed to the loss of teaching anesthesiologists and 
an inability to recruit new faculty.
    In the August 8, 2005 proposed rule, we requested comments on a 
teaching physician policy for anesthesiologists that could build on the 
policy announced in the November 7, 2003 PFS final rule, but could 
provide the appropriate revisions that would allow it to be more 
flexible for teaching anesthesia programs. We also indicated we would 
be interested in receiving data and studies relevant to this issue as 
well as any offsetting savings that could be made to account for any 
potential costs that could be incurred if there was a policy change.

Discussion of Comments Received

    As discussed previously in this section, we did not present a 
formal proposal, but asked for comments from interested stakeholders on 
these issues. While we have not fully analyzed all the relevant 
information and data, we have been provided anecdotal evidence that 
some anesthesiologists may be leaving academic practice for better 
compensated positions in private practice. While we recognize that 
Medicare payment policies are an important consideration in these 
decisions, they are not the only factor.
    In contrast, as pointed out by a commenter, there has been an 
increase in the number of nurse anesthesia programs from 83 programs in 
2000 to 105 programs projected for 2006. The number of nurse anesthesia 
graduates has surged from 1075 nurse anesthetists in 2000 to 2035 
projected for 2006. Despite these increases, nurse anesthesia programs 
had reported similar financial problems, such as levels of teachers' 
salaries, in recruiting faculty to teaching nurse anesthetists.
    In terms of anesthesia manpower, we did not receive any information 
from surgical groups indicating difficulty in getting anesthesiologists 
or CRNAs to provide anesthesia services. Additionally, we did not 
receive any comments identifying areas of offsetting savings that might 
be used to fund any change in the teaching anesthesia payment policy.
    We will continue to review the information and relevant data 
presented by the commenters and consult with the stakeholders before we 
move forward with any proposal.

G. End Stage Renal Disease (ESRD) Related Provisions

    On August 8, 2005, we published the Revisions to Payment Policies 
Under the Physician Fee Schedule for CY 2006 proposed rule in the 
Federal Register (70 FR 45789), revising payments to ESRD facilities 
under the provisions of the MMA. The proposed rule implements section 
1881(b) of the Act, as amended by section 623 of the MMA, which directs 
the Secretary to make a number of revisions to the composite rate 
payment system, as well as payment for separately billable drugs 
furnished by ESRD facilities.
    Under section 1881(b)(12) of the Act, the add-on adjustment must 
reflect both the effect of the new payment methodology and estimate 
growth in ESRD drug expenditures. We proposed an add-on adjustment of 
8.1 percent to the composite payment rate to account for the difference 
between previous payments for separately billed drugs and biologicals 
and the revised pricing that will take effect January 1, 2006.
    We updated that add-on adjustment to reflect estimated growth in 
ESRD drug expenditures of 0.7 percent. We combined the add-on 
adjustment of 8.1 percent that reflects the payment methodology we will 
be using for ESRD drugs with the 0.7 percent increase for expenditures 
in 2006 to produce one

[[Page 70162]]

proposed drug add-on adjustment for CY 2006 of 8.9 percent.
    Following publication of the proposed rule, it came to our 
attention that 3 codes had been omitted in our analysis of drug 
payments and utilization for the top ten ESRD drugs that affected our 
calculation of the proposed add-on adjustment. On September 1, 2005, we 
issued a correction notice on the CMS Web site, to correct our omission 
of the 3 J Codes in the estimation of the market shares for the top ten 
ESRD drugs used in our calculation of the proposed drug add-on 
adjustment for 2006. The ``Correction to the Proposed ESRD Drug Add-on 
Adjustment: Revised Table 22'' is available at http://www.cms.hhs.gov/providers/esrd/090105_ESRD_Correction.pdf. The corrected table shows 
the revised weights compared to the weights included in the proposed 
rule and resulted in a revised proposed total drug add-on adjustment to 
the composite payment rate of 11.3 percent for 2006.
    We also proposed to revise the drug pricing for ESRD drugs to ASP+6 
percent for the top ten drugs furnished by independent facilities and 
EPO furnished by hospital-based facilities.
    In addition, section 1881(b)(12) of the Act as amended by section 
623 of the MMA provided authority to the Secretary to revise the 
geographic index applied to the composite payment rate and phase in any 
changes to the index over a multi-year period. Accordingly, we proposed 
to revise the geographic classifications and wage indexes currently in 
effect for adjusting composite rate payments and to implement these 
changes over a 2-year transition period.
    We also proposed to revise the regulations applicable to the 
composite rate exceptions process to reflect section 623 of the MMA 
provisions that restricts exceptions to pediatric facilities.
    No changes to the current case-mix adjustments were proposed.
    We received a total of 37 comments from the ESRD community that 
represented major organizations, pharmaceutical companies, 
beneficiaries, and concerned individuals. The comments and responses 
are summarized in the following sections.
1. Revised Pricing Methodology for Separately Billable Drugs and 
Biologicals Furnished by ESRD Facilities
    In the August 8, 2005 proposed rule, we proposed that payment for 
drugs furnished in connection with renal dialysis services and 
separately billed by independent renal dialysis facilities would be 
based on payment amounts determined under section 1847A of the Act 
which are 106 percent of the ASP. We proposed to update the payment 
allowances quarterly, based on the ASP reported to us by drug 
manufacturers. We also proposed to pay for EPO in hospital-based 
facilities at the ASP+6 percent. We stated that we are interested in 
moving to the ASP+6 percent methodology for all separately billed drugs 
and solicited comments on a drug add-on estimation methodology that 
would allow us pay hospital-based facilities ASP+6 percent for all 
separately billable drugs.
    In this final rule with comment, we are implementing payment of 
ASP+6 percent for all ESRD drugs furnished by both independent and 
hospital-based ESRD facilities. A discussion of the final drug payment 
methodology and related comments and responses can be found in section 
II.H.2.
2. Adjustment to Account for Changes in the Pricing of Separately 
Billable Drugs and Biologicals, and the Estimated Increase in 
Expenditures for Drugs and Biologicals
    Section 1881(b)(12) of the Act, as added by section 623(d) of the 
MMA, contains two provisions that describe how the drug add-on 
adjustment will be implemented in the ESRD payment system. First, the 
add-on adjustment must reflect the difference between the payment 
methodology for separately billed drugs under the drug price in effect 
in CY 2004 and current drug pricing and, second, the aggregate payments 
for CY 2005 must equal aggregate payments absent this MMA provision.
    Prior to 2005, separately billable ESRD drugs and biologicals other 
than EPO furnished in independent facilities were paid under the 
average wholesale price (AWP) methodology. In 2005, section 
1881(b)(13)(A)(ii) of the Act required that we pay the acquisition cost 
for separately billable ESRD drugs (including EPO) as determined by the 
Office of the Inspector General (OIG). If the OIG did not determine an 
acquisition cost for a separately billable drug or biological, then the 
Secretary was given discretion to determine the payment rate. In the CY 
2005 final rule (69 FR 66322-66323), we described the methodology that 
we used for developing the drug add-on adjustment to the composite rate 
to account for the difference between estimated drug payments under the 
AWP payment system and the acquisition costs as determined by the OIG. 
This adjustment was developed so that aggregate spending for composite 
rates plus separately billed drugs would remain budget neutral for CY 
2005.
    Section 1881(b)(12) of the Act, as added by section 623 (d) of the 
MMA, also contains two provisions related to adjustments to payments 
for drugs and biologicals for CY 2006. Section 1881(b)(12)(C)(ii) of 
the Act requires that we recalculate the 2005 add-on adjustment to 
reflect the difference between estimated payments using the AWP payment 
methodology and the payment methodology for 2006 which we proposed to 
be ASP+6 percent.
    In addition, section 1881(b)(12)(F) of the Act requires that, 
beginning in 2006, we establish an annual update adjustment to reflect 
estimated growth in expenditures for separately billable drugs and 
biologicals furnished by ESRD facilities. This update would be applied 
only to the drug add-on portion of the composite payment rate. In order 
to meet both requirements, we proposed to develop the CY 2006 drug add-
on adjustment in two steps.
    First, we proposed to recalculate the CY 2005 add-on adjustment to 
reflect the difference in drug payments using 95 percent AWP pricing 
and payments using ASP+6 pricing. The result of this calculation would 
replace the current 8.7 percent adjustment and would be budget neutral 
to CY 2005 payments. Next, we proposed to develop a proposed annual 
update methodology that we would first use in CY 2006 to reflect the 
estimated growth in drug expenditures each year. As stated previously, 
this update would be applied only to the drug add-on portion of the 
composite payment rate. For specific details regarding the proposed 
adjustments, see the August 8, 2005 Federal Register (70 FR 45793 
through 45800).
    As noted previously, we issued a correction to the proposed ESRD 
drug add-on adjustment contained in the proposed rule. In this notice 
we acknowledged that our estimation of the market shares for the top 
ten ESRD drugs that we used in the calculation of the proposed drug 
add-on for 2006 was incorrect. After further analysis of the 2003 
expenditure data used to assign weights to the top ten ESRD drugs, we 
determined that our data did not account for 3 new ``J'' codes that 
were implemented in 2003. As a result, the weights for Iron Sucrose, 
Sodium Ferric Gluconate and Paricalcitol were understated.
    In addition, we noted that the weight for EPO incorrectly included 
expenditures for hospital-based facilities. Since the purpose of the 
weighting was to allocate the drug spread to all other drugs paid using 
the

[[Page 70163]]

proposed ASP+6 percent pricing, hospital-based data should not have 
been included because we paid for other hospital-based drugs based on 
cost. Table 16 shows the revised weights compared to the weights 
included in the proposed rule.

                Table 16.--Revised to Reflect Correction
------------------------------------------------------------------------
                                        Published       Revised proposed
               Drugs                 proposed weights       weights
------------------------------------------------------------------------
Epogen............................              78.83              69.33
Calcitriol........................               0.13               0.84
Doxercalciferol...................               1.74               1.48
Iron dextran......................               0.38               0.23
Iron sucrose......................               0.71               7.03
Levocarnitine.....................               0.89               0.77
Paricalcitol......................              17.37              14.61
Sodium ferric glut................               0.53               4.96
Alteplase, Recombinant............               0.18               0.56
Vancomycin........................               0.24               0.19
------------------------------------------------------------------------

    We note that as a result of these data corrections, the top ten 
drugs account for 98 percent of total ESRD drug expenditures, rather 
than 92 percent as stated in the proposed rule.
    Using these revised weights, the proposed recalculated 2005 drug 
add-on adjustment was corrected to 10.4 percent, and the proposed 2006 
update was corrected to 0.8 percent. The corrected total drug add-on 
adjustment proposed for 2006 was 11.3 percent.
    The proposed rule also discussed a method to estimate the drug 
spread applicable to hospital-based facilities for non-EPO drugs if we 
decided to implement ASP+6 percent pricing for all hospital-based 
drugs. This methodology would use the weighted average drug spread 
percent for independent facilities to estimate the drug spread for non-
EPO drugs furnished by hospital-based ESRD facilities.
    The following sections discuss the comments we received on these 
issues and provide a detailed description of the final drug add-on 
adjustment to the ESRD composite payment rate that will be implemented 
January 1, 2006.
    Comment: We received a number of comments advocating that drug 
payments to hospital based facilities should be the same as to 
independent facilities. However, most of these comments raised no 
concerns regarding our proposed methodology for computing the drug 
spread applicable to hospital-based facilities. Two comments 
specifically supported our proposal to use the drug pricing drug spread 
from independent facilities to estimate the spread for hospital-based 
facilities. Two comments stated we should follow MedPAC's suggestion 
that we collect data to estimate hospital-based facilities' cost and 
Medicare payment per unit for ESRD drugs, but did not raise concerns 
with our proposed alternative method for estimating the drug spread 
applicable to hospital-based facilities if we implemented ASP+6 percent 
pricing. MedPAC recommended that we use the same methodology to pay for 
all drugs (regardless of setting) and suggested that we could use 
dosing data from independent facilities to estimate ASP+6 payments for 
hospital-based facilities to compute the drug spread related to 
hospital-based facility drug payments.
    Response: Given both the MedPAC recommendation that ASP should be 
the basis of payment for all separately billable ESRD drugs and the 
overall support for providing consistent drug payments for both 
hospital-based and independent facilities, we have decided, in light of 
section 1881(b)(13)(A)(iii) of the Act, to implement ASP+6 percent 
pricing for hospital-based facilities beginning January 1, 2006. See 
section II.H.2 for a more detailed discussion of this issue. We are 
adopting the methodology outlined in the proposed rule to determine the 
drug spread applicable to hospital-based facilities and to calculate a 
drug add-on adjustment. We are also adopting the proposed methodology 
which would permit us to implement a change in payment to ASP+6 percent 
for all non-EPO drugs provided by hospital-based ESRD facilities.
    While we agree that the ideal approach would be to collect data 
from hospital-based facilities, this data collection would 
significantly delay implementation of a consistent ESRD drug payment 
policy. Absent the collection of data, we believe that using the 
estimation methodology described in the proposed rule brings us closer 
to the actual price of hospital drugs (ASP+6 percent) than does the 
policy of continuing to rely on reasonable costs.
    In response to MedPAC's suggestion, we did an analysis of drug 
dosing units from the billing data of independent facilities and were 
unable to determine accurate monthly average units from those bills, 
because facilities do not bill individual line items by date of 
service. As a result, the average monthly dose we computed for some 
drugs was significantly below the FDA expected monthly dose. In other 
words, the average monthly dose for the top ten ESRD drugs from 
independent facility data that we could use as a proxy for pricing the 
hospital-based bills was problematic. We believe the statute 
contemplates a single payment approach for separately billable ESRD 
drugs. Therefore, using our estimation proposal is a start towards 
MedPAC's principle that the same prices should be paid for the same 
services across all settings which we believe is consistent with the 
statute. Furthermore, moving to ASP+6 percent pricing for hospital-
based facilities evens out the effect of the drug add-on adjustment 
between independent and hospital-based facilities.
    Therefore, we have computed the drug spread for non-EPO hospital 
based drugs using the weighted average drug spread percentage from 
independent facilities. We applied that percentage to the total 
hospital-based drug payments in order to estimate the amount of the 
drug spread as a result of revising the drug pricing methodology to 
ASP+6 percent for hospital-based facilities.
    We believe this method provides a reasonable estimation of the drug 
spread because, as explained previously, all drugs in both settings are 
based on ASP+6 pricing. Moreover, we believe that the benefits of 
implementing a consistent drug payment methodology outweighs any 
potential drawbacks that may result from estimating the drug spread 
without more precise data. We intend to pursue options for obtaining 
additional data to more accurately

[[Page 70164]]

compute and update the drug add-on adjustment. Once more complete 
hospital-based ESRD drug data become available, we will re-examine the 
computation of the drug add-on adjustment and make any necessary 
revisions to our estimations.
    Comment: We received comments from two associations representing 
ESRD facilities that expressed concern about our interpretation of the 
statutory provision related to the drug add-on adjustment. These 
comments presented legal arguments challenging our decision to apply a 
single drug add-on adjustment that is applicable to both hospital-based 
and independent ESRD facilities. Both comments indicated that as long 
as separate drug payment methodologies are in place for hospital-based 
facilities and independent facilities, the statutory text, structure, 
and legislative history requires that we establish distinct drug add-on 
adjustments. Another commenter recommended that the add-on adjustment 
should be directly linked to hospital-based and independent facilities 
based on the actual loss of revenue due to changes in reimbursement for 
separately billed drugs.
    Response: We continue to believe that our interpretation of this 
statutory provision represents the best reading of the statute as we 
explained, for reasons, discussed, in the CY 2005 final rule (see 69 FR 
66319 through 66320). Accordingly, rather than adopting separate add-on 
adjustments for independent and hospital-based ESRD facilities, we are 
addressing the payment inequities expressed in the comments and pointed 
out in the MedPAC report that result from differential drug payment 
methodologies for hospital-based and independent facilities. As 
discussed previously, we are implementing a consistent drug payment 
methodology for all ESRD provider settings. In this way, we believe we 
have resolved the concerns expressed by these commenters in a manner 
consistent with the statute.
a. Recalculation of the CY 2005 Drug Add-on Adjustment
    For CY 2006, we proposed to use the same method that we used to 
develop the drug add-on adjustment for CY 2005 to recalculate the 2005 
adjustment to reflect the proposed revision to the ESRD drug payment 
methodology from acquisition costs to ASP+6 percent. That is, we 
proposed to calculate the spread based on the difference in aggregate 
payments between estimated payment based on AWP pricing and estimated 
payment based on ASP+6 pricing. Although we proposed to use pricing 
data from the second quarter of CY 2005, we indicated that all of the 
data used to develop the proposed add-on adjustment would be updated 
for the final rule with comment, as more current data would be 
available.
(1) Historical Drug Expenditure Data
    To develop the drug add-on adjustment for this final rule with 
comment, we used historical total aggregate payments for separately 
billed ESRD drugs for calendar years 2001, 2002, 2003, and 2004. For 
EPO, these payments were broken down according to type of ESRD facility 
(hospital-based versus independent). We also used the number of 
dialysis treatments performed by these two types of facilities over the 
same period.
(2) ASP+6 Percent Prices
    In the proposed rule we used the ASP+6 percent prices for the 
second quarter of CY 2005. However, we indicated that we would use all 
four quarters of CY 2005 prices to develop the CY 2005 ASP payments.
    Comment: One commenter raised concerns regarding using four 
quarters of the ASP to determine an annual average. This commenter 
indicated that the most recent available quarter, specifically, the 
fourth quarter ASP prices of any CY represents the ASP for the entire 
year. This commenter recommended that, instead of using all four 
quarter of CY 2005, we use only the fourth quarter of CY 2005 ASP to 
calculate the difference in the aggregate payments based on 95 percent 
AWP pricing and the estimated payment based on ASP+6 percent.
    Response: We do not agree with this recommendation and have used 
the average of ASP prices in all four quarters of 2005 to calculate the 
add-on adjustment. The fourth quarter of the ASP represents only the 
most current ASP prices, and does not represent an aggregate annual 
average. Therefore, our calculation for ASP+6 percent includes not only 
the most current quarter (that is, the fourth quarter ASP) but also the 
previous three quarters of ASP pricing data for 2005). We believe this 
calculation provides the most accurate estimation of 2005 actual ASP+6 
percent payments.
    We used four quarters of 2005 ASP+6 percent prices for the drugs 
listed in Table 17. We averaged these to develop prices representing 
the average 2005 ASP payments.

                                Table 17
------------------------------------------------------------------------
                                                         Average sales
                         Drug                            price plus 6%
                                                              2005
------------------------------------------------------------------------
Epogen...............................................              $9.30
Calcitriol...........................................               0.75
Doxercalciferol......................................               2.19
Iron dextran.........................................              11.21
Iron sucrose.........................................               0.36
Levocarnitine........................................              12.30
Paricalcitol.........................................               3.92
Sodium ferric glut...................................               4.74
Alteplase, Recombinant...............................              30.61
Vancomycin...........................................               2.95
------------------------------------------------------------------------

(3) Estimated Medicare Payments Using 95 Percent of AWP
    In the proposed rule, we used the first quarter 2005 AWP prices and 
updated them to the second quarter by applying, for drugs other than 
EPO, an estimated AWP quarterly growth of approximately 0.74 percent. 
In order to estimate AWP payments for this final rule with comment, we 
used 4 quarters of 2005 AWP prices and averaged them to obtain prices 
representative of 2005 payment amounts. This methodology was not 
applied to the price for Epogen since payment was maintained at $10.00 
per thousand units prior to MMA (see Table 18).

                                Table 18
------------------------------------------------------------------------
                                                          2005 average
                                                           estimated
                        Drugs                          medicare payments
                                                        using 95% of AWP
------------------------------------------------------------------------
Epogen...............................................             $10.00
Calcitriol...........................................               1.36
Doxercalciferol......................................               3.98
Iron dextran.........................................              17.91
Iron sucrose.........................................               0.65
Levocarnitine........................................              36.48
Paricalcitol.........................................               5.32
Sodium ferric glut...................................               8.17
Alteplase, Recombinant...............................              31.89
Vancomycin...........................................               3.79
------------------------------------------------------------------------

(4) Dialysis Treatments
    In the proposed rule, using the most complete data available at the 
time, we estimated total dialysis treatments for 2005 at 34.5 million.
    Comment: We received comments suggesting that our estimate of 
dialysis treatments was overstated.
    Response: Using more recent data that has become available since we 
issued the proposed rule, we increased our projection of total number 
of dialysis treatments based on actuarially projected growth in the 
number of ESRD beneficiaries. Since Medicare covers a maximum of three 
treatments per week, utilization growth is limited, and, therefore, any 
increase in the number of

[[Page 70165]]

treatments should be due to beneficiary enrollment. The actual 2004 
data we used in this final rule with comment, showed higher treatment 
counts than we had projected for 2004 in the proposed rule. Therefore, 
for CY 2005, we estimate there will be a total of 34.7 million 
treatments performed.
(5) Drug Payments
    In the proposed rule, we updated drug payments for both EPO and 
non-EPO drugs using the estimated trend factor for EPO of 9.0 percent. 
We proposed using the EPO 9.0 percent trend factor for all drugs (not 
just for EPO) because EPO constitutes the largest proportion of drugs 
furnished by ESRD facilities and because we determined that the 
extremely varied growth in spending for non-EPO drugs between 2000 and 
2003 prohibited a reliable trend analysis. As we indicated we would do 
in the proposed rule, we used later 2004 drug payment data for the 
final rule with comment and trended those data forward to 2005.
    Comment: We received a number of comments concerning our use of the 
EPO trend factor to update drug payments to 2005. These comments 
expressed concern that this resulted in understating the growth in ESRD 
drug payments. We also received comments that we should correlate the 
growth of EPO and other separately billable ESRD drugs.
    Response: Since we now have 2004 data, we have modified the trend 
factor to more accurately reflect the growth in drug payments. In 
addition, we have calculated trend factors for non-EPO drugs 
independently of those for EPO.
    We updated the total aggregate EPO drug payments for both hospital-
based and independent facilities by using historical trend factors 
using data from 2001 through 2004. For CY 2005, the CY 2004 payment 
level was increased by a trend factor of 11.0 percent.
    Similarly, we updated the aggregate spending for separately 
billable drugs, other than EPO, for both hospital-based and independent 
facilities by using a historical trend factor of 15 percent.
    In addition, we deducted 50 cents for each administration of EPO 
from the total EPO spending for both hospital-based and independent 
facilities to account for payment for syringes that were included in 
the EPO payments prior to the implementation of the MMA drug payment 
provisions.
    In the proposed rule, we estimated the cost of syringes at $1.6 
million for hospital-based facilities and $26.8 million for independent 
facilities.
    Comment: We received comments that the proposed $26.8 million 
dollars estimated for syringe payments to independent facilities was 
too high, because the estimated number of administrations of EPO 
exceeded the number of treatments.
    Response: We have re-estimated the syringe payments to take into 
account problems we encountered related to the administrations field on 
the dialysis bills. Thus for the final rule with comment, we are 
calculating syringe payments as 50 cents multiplied by 90 percent of 
estimated treatments for 2005. The 90 percent represents the percent of 
dialysis patients that receive EPO. Since we only pay for one 
administration per treatment we applied this 90 percent to total 
treatments in order to estimate the number of EPO administrations.
    Using this methodology, for CY 2005, we estimate payments for these 
syringes will amount to $1.8 million for hospital-based facilities and 
$13.8 million for independent facilities.
    For CY 2005, we estimate that total spending for separately 
billable drugs will reach $462 million for drugs provided in hospital-
based facilities ($217 million for EPO and $245 million for other 
drugs), and $3.102 billion for drugs provided in independent facilities 
($2.082 billion for EPO and $1.019 billion for other drugs).
    Comment: One comment indicated that we were eliminating separate 
payments for syringes.
    Response: We believe the commenter misunderstood our payment 
policy. We currently pay separately for syringes used to administer 
ESRD drugs, and will continue to do so. We began paying separately for 
the syringes associated with administration of EPO when EPO payment was 
revised from payment at $10 per 1,000 units in 2005. While the previous 
$10 payment included payment for syringes, the new payment methodology 
does not. We have not modified our approach to paying for syringes in 
general, but now also pay separately for syringes associated with the 
administration of EPO.
(6) Add-On Calculation and Budget Neutrality
    In the August 8, 2005 proposed rule (70 FR 45789), we acknowledged 
a mistake in our calculation of the proposed drug add-on adjustment. 
The proposed 2005 recalculated add-on adjustment was 10.4 percent. In 
addition, we indicated in the proposed rule that we intended to include 
more recent 2004 billing data in the calculation of the final drug add-
on adjustment.
    Comment: We received a number of comments commending us for 
responding to industry concerns by making the corrections to the 
proposed add-on calculation and urging us to use the most accurate, up-
to-date data and trends available to compute the 2005 budget-neutral 
add-on adjustment.
    Response: We have taken these comments into consideration and have 
updated all of the data and assumptions used to calculate the add-on 
adjustment as described below.
    For each of the top ten drugs, we calculated the percent by which 
ASP+6 percent is projected to be less than payment amounts under the 95 
percent of AWP pricing system for 2005. We then calculated a weighted 
average of the percentages by which ASP+6 percent would be below 95 
percent of AWP payment amounts, for the top 10 ESRD drugs for 
independent facilities. We weighted these percentages by using the 2005 
estimated Medicare payment amounts for the top ten drugs. This 
procedure resulted in a weighted average payment difference of 16 
percent.

                                Table 19
------------------------------------------------------------------------
                                      2005 estimated
                                     medicare payment   Percent by which
                                       weights as a    ASP+6% prices are
               Drugs                  percentage of     below 95% of AWP
                                        total drug           prices
                                       expenditures
------------------------------------------------------------------------
Epogen............................              67.96               7.03
Calcitriol........................               0.45              44.74
Doxercalciferol...................               3.62              44.94
Iron dextran......................               0.11              37.40
Iron sucrose......................               7.79              44.50

[[Page 70166]]

 
Levocarnitine.....................               1.11              66.27
Paricalcitol......................              13.38              26.44
Sodium ferric glut................               4.64              41.96
Alteplase, Recombinant............               0.75               4.00
Vancomycin........................               0.20              22.20
------------------------------------------------------------------------

    Since we estimate that these 10 drugs represent nearly 98 percent 
of total 2005 drug payments to both hospital-based and independent 
facilities, we applied the weighted average to 100 percent or all of 
aggregate drug spending projections for hospital-based and independent 
facilities, producing a projected difference of $585 million (the sum 
of $76 million for hospital-based and $509 for independent facilities). 
Since we do not currently have reliable data on dosing units from 
hospital-based bills, we believe it is reasonable, as discussed above, 
to proxy the drug spread for hospital-based facilities using the spread 
for independent facilities. The weighted average is applied to 100 
percent of drug spending projections for hospital-based and independent 
facilities.
    Distributing the total 2005 figure of $585 million over a total 
projected 34.7 million treatments results in a revised 2005 add-on to 
the per treatment composite rate of 13.1 percent. This compares to the 
proposed adjustment of 10.4 percent. By making this adjustment to the 
composite rate, we estimate that the aggregate payments to ESRD 
facilities would be budget neutral for drug payments for 2005, as 
required by the MMA. We note that, beginning January 1, 2006, this 13.1 
percent adjustment replaces the 8.7 percent adjustment currently in 
effect for CY 2005.
b. Calculation of the Proposed CY 2006 Inflation Update to the Drug 
Add-On Adjustment
    The proposed rule described the approach we proposed to use to 
update the drug add-on adjustment to account for the estimated growth 
in drug expenditures between 2005 and 2006. Based on the most recent, 
complete data that was available at the time, we proposed a 2006 
inflation adjustment of 0.8 percent to the drug add-on to the composite 
payment to reflect the estimated growth in drug expenditures between 
2005 and 2006. While we received no comments specific to the add-on 
inflation adjustment, we did receive comment about our growth 
projections used to calculate the adjustment. Those comments were 
addressed in the previous section.
(1) Drug Payments and Dialysis Treatments
    Similar to the above mentioned process, we updated the total 
aggregate EPO drug spending for hospital-based and independent 
facilities using historical trend factors. For 2006, the EPO payment 
level was increased from 2005 by a trend factor of 11.0 percent. We 
also updated aggregate spending for separately billable drugs, other 
than EPO, for both hospital-based and independent facilities by a trend 
factor of 15 percent. This procedure resulted in projected drug 
expenditures of $523 million for drugs provided in hospital based 
facilities ($240 million for EPO and $283 million for other drugs) and 
$3.481 billion for drugs provided in independent facilities ($2.306 
billion for EPO and $1.175 billion for other drugs). These numbers 
include an estimated reduction for the 50 cent payment for syringes of 
$1.9 million for hospital-based facilities and $14.1 million for 
independent facilities. We also updated the projected number of 
dialysis treatments using actuarial enrollment projections. This 
resulted in total of 35.6 million treatments for 2006.
(2) Adjustment to Composite Rate Add-On
    The proposed computation of the 2006 inflation adjustment to the 
composite rate was 0.8 percent. We have updated our projected inflation 
adjustment for the drug add-on and have included data for non-EPO 
hospital-based drugs into the computation.
    Since EPO is updated at an average trend of 11 percent and other 
separately billable drugs are updated by a trend factor of 15 percent, 
for both hospital-based and independent facilities, for 2006 we 
computed a combined weighted average growth in total drug expenditures 
of 12.3 percent, based on the relative proportions of EPO and non-EPO 
drugs. We then applied the 12.3 percent projected growth in aggregate 
drug expenditures between 2005 and 2006 to the 2005 drug add-on figure 
of $585 million. This resulted in a projected incremental increase in 
the drug spread for 2006 of $72 million ($9 million for drugs furnished 
by hospital-based facilities and $63 million for drugs furnished by 
independent facilities). We distributed the $72 million over 35.6 
million projected treatments, resulting in a 1.4 percent increase to 
the 2005 composite payment rate.
    Comment: We received a number of comments regarding an annual 
update factor. Several comments recommended that we should provide an 
annual update to the composite rate. The specific recommendation 
suggested an annual market basket update in the composite rate 
equivalent to the MedPAC recommendation of an increase to the composite 
payment rate of 2.5 percent in 2006. The comments further acknowledged 
that the creation of an annual market basket update requires 
Congressional action.
    Response: Because Congressional action is required, there is no 
specific provision in the current statute or regulations for an annual 
update for the composite payment rate based on the ESRD market basket 
rate of increase. However, the statute does, in effect, provide for an 
annual update to the drug add-on to the composite payment rate. As 
discussed previously, the statute requires that we annually update the 
amount of the drug spread included in the composite payment rate, based 
on the projected growth in drug expenditure between 2005 and 2006. We 
are providing an inflation adjustment to the composite payment rate of 
1.4 percent. Even though this inflation adjustment is part of the 
overall add-on adjustment, the overall effect for 2006 is equal to an 
update of 1.4 percent.

[[Page 70167]]

    In addition, we note that as part of our work on the development of 
a fully bundled prospective payment system (PPS) for ESRD facilities, 
we will be developing an update framework that would include an ESRD 
market basket factor. We expect to include a discussion of this update 
framework as part of a Report to Congress on a fully bundled PPS for 
outpatient ESRD facilities. This report is still under development.
    Comment: One comment stated that the add-on adjustment to the 
composite rate should be reflected as an absolute dollar amount rather 
than a percentage, stating that there is no logical reason why the drug 
add-on component should be adjusted by a wage index.
    Response: Section 1881(b)(12)(A) of the Act which was added by the 
MMA, required the establishment of a ``case-mix adjusted prospective 
payment system for dialysis services'' that included: (1) The composite 
rate; (2) case-mix adjustment for a limited number of patient 
characteristics; and (3) a drug add-on adjustment to the composite rate 
to account for the difference in drug payments compared to the previous 
drug pricing methodology. Section 1881(b)(12)(D) requires that payments 
under this system be adjusted by a geographic index. Therefore, we are 
required to apply the wage index to all components of the case-mix 
adjusted composite rate system.
c. Drug Add-On Adjustment for 2006
    With the CY 2005 add-on to the per treatment composite rate being 
13.1 percent and the additional increment for expenditures in CY 2006 
being 1.4 percent, the combined drug add-on adjustment for 2006 is 14.7 
percent (1.131 x 1.014).
3. Revisions to Geographic Designations and Wage Indexes Applied to the 
ESRD Composite Payment Rate
    Section 1881(b)(12)(D) of the Act, as added by section 623(d) of 
the MMA, gave the Secretary the discretionary authority to revise the 
current wage index incorporated in the ESRD composite payment rates. 
That provision also requires that any revised wage index be phased in 
over a multiyear period. We proposed to adopt OMB's revised geographic 
definitions (announced in OMB Bulletin No. 03-04, issued June 6, 2003) 
to determine urban and rural locales for purposes of calculating ESRD 
composite payment rates, beginning January 1, 2006. In conjunction with 
using OMB's geographic designations, we proposed to recalculate the 
ESRD wage index based on acute care hospital wage and employment data 
for FY 2002, as reported to us in connection with development of the 
wage index used in the inpatient hospital prospective payment system 
(IPPS). We also proposed to update the labor portion of the ESRD 
composite rate to which the wage index is applied. Below we discuss 
comments we received on these proposals and our final determinations 
regarding CY 2006 revisions to the wage index adjustment as it is 
applied to the ESRD composite payment rate.
a. Use of Revised OMB Geographic Area Designations To Determine Urban 
and Rural Locales for ESRD Composite Payment Rates
    In the August 8, 2005 proposed rule, we proposed to use OMB's 
revised core-based statistical area (CBSA)-based definitions for 
Metropolitan Statistical Areas, New England County Metropolitan Areas, 
and Micropolitan Statistical Areas, announced in OMB Bulletin 03-04 
(June 6, 2003) as the basis for revising the urban/rural locales and 
corresponding wage index values reflected in the composite payment 
rates. The definitions we proposed are the same urban and rural 
definitions used for the Medicare IPPS, but without regard to 
geographic reclassifications authorized under section 1886(d)(8) and 
(d)(10) of the Act. In conjunction with adopting OMB's geographic 
classifications, we proposed replacing the current weighted wage index 
based on a 60/40 blend of Bureau of Labor Statistics (BLS) and hospital 
wage index values with one developed exclusively from acute care 
hospital wage and employment data obtained from the Medicare hospital 
cost reports. We proposed to update the wage index annually. For a full 
discussion of our proposals, see the August 8, 2005 proposed rule (70 
FR 45793 through 45800). The following section contains a summary of 
the comments that we received on the proposed wage index revisions.
    Comment: Several commenters, generally those representing 
independent ESRD facilities located in rural areas, opposed 
implementation of the CBSA based wage index. The commenters expressed 
concern that the proposed wage index would jeopardize beneficiary 
access to care, and left little protection for rural facilities. Some 
commenters pointed out the amount of the reduction in composite 
payments that specific providers would incur based on the proposed 
urban/rural definitions and revised wage index values.
    Response: The current urban/rural definitions reflected in the 
composite payment rates have been in effect for over 20 years, and 
needed to be updated. By revising those definitions to conform with the 
latest available OMB geographic designations as explained in the August 
8, 2005 proposed rule, we believe that we are complying with the 
express intent of the Congress permitting revision of those 
designations, as set forth in section 1881(b)(12)(D) of the Act. While 
our authority to revise the current ESRD wage index is discretionary, 
we believe this revision is essential if the composite rates are to 
reflect accurately the costs of providing ESRD services.
    None of the commenters proposed an alternative to our proposed 
geographic classification system. Because we must have a national 
classification system built on clear objective standards, we are 
adopting the CBSA based urban/rural definitions, as described in our 
proposed rule. As to commenters' concerns about any reductions in the 
base composite payment rates, we have taken these concerns into 
consideration and have adopted a transition policy concerning the wage 
index. We address commenter's comments and provide a more detailed 
discussion of our transition policy in section II.3.c. of this final 
rule with comment.
    Comment: While several commenters supported the implementation of 
the new CBSA based wage index, they expressed concern over the 
potential impact on independent ESRD facilities, particularly those 
located in rural areas. The most frequent recommendations to reduce the 
impact of any payment reductions were to extend the proposed transition 
period from 2 to 5 years, and provide annual updates of the wage index 
in each of those years.
    Response: We agree that the new CBSA based wage index should be 
revised periodically to account for not only changes in labor market 
conditions, but also any future revisions in the definitions of the 
Metropolitan Statistical Areas and other geographic designations which 
may be announced by OMB. We will revise the ESRD wage index annually 
using the most recent Medicare cost report data as is used in the 
Medicare hospital IPPS. We also agree that the proposed transition 
period of 2 years may not be sufficiently long to provide ESRD 
facilities with enough time to adapt to the new wage index and have 
extended the transition period to 4 years. For a more complete 
discussion of our policies to help ESRD facilities adapt to the OMB 
geographic designations and wage index revisions

[[Page 70168]]

we have adopted for ESRD purposes (see section C of this preamble).
    Comment: Several commenters endorsed our adoption of the proposed 
wage index based on the revised OMB definitions. However, the 
commenters were critical of what they perceived to be a lack of 
transparency in the data and methodology used to develop the new wage 
index, especially the budget neutrality adjustment. The commenters 
requested that we provide the data and methodology used to calculate 
the new wage index values and BNF.
    Response: For purposes of adjusting the labor-related portion of 
the CY 2006 ESRD composite rate, we are using the most recent hospital 
wage data applicable to FY 2006 payments as discussed previously in 
this section. We start with the wage index used by the Skilled Nursing 
Home Prospective Payment System (SNF PPS) and multiply this index by a 
numeric factor, which is the budget neutrality adjustment. We use the 
SNF PPS wage index because we believe it reflects the most recent data, 
and is consistent with all other non-acute care facility payment 
systems.
    As explained earlier in this section, we begin with the same wage 
index values as those used by the SNF and multiply those values by the 
BNF (See Tables 21 and 22). The methodology for creating this wage 
index BNF is explained in further detail below.
    The wage index measures relative differences in the average hourly 
wage for the hospitals in each labor market area compared to the 
national average hourly wage. As stated previously, for ESRD payment 
purposes the wage index values are based on wage data as reported by 
hospitals on their Medicare cost reports. The wage data used to 
construct the wage index are updated annually, based on the most 
current data available. Accordingly, 2002 wage data were used to 
construct the wage index values used in this final rule with comment 
and 2003 wage data will be used to construct the wage index that we 
intend to use for the ESRD composite rate for CY 2007.
    For each geographic area, wage data for all providers in that area 
are combined. The sum of all wages for all providers in that geographic 
area is divided by the total hours for all providers in that geographic 
area. The result is the average hourly rate for that geographic area. 
This data can be found at the following link: http://www.cms.hhs.gov/providers/hipps/ippswage.asp.
    The data will be found under the section labeled, ``FY 2006 Wage 
Index Public Use Files'', and contains average hourly rate data and 
wage index. The index is computed by dividing the average hourly rate 
for each geographic area within the CBSA by the national average hourly 
wage.
    As we noted earlier, for the ESRD wage index we are using hospital 
wage data without regard to any approved geographic reclassification 
authorized under sections 1886(d)(8) and (d)(10) of the Act or other 
provision that only applies to hospitals paid under the IPPS. For 
purposes of the ESRD wage index methodology, the data we use is pre-
reclassified, pre-floor hospital data and unadjusted by occupational 
mix.
    The final step is to multiply each wage index value by the wage 
index budget neutrality factor (BNF) (see section 4 for details about 
this adjustment).
    Comment: One commenter strongly objected to our proposed 
implementation of the CBSA based wage index. The commenter maintained 
that we have failed to examine the entire dialysis patient delivery 
system taken as a whole. Specifically, we have not recognized that 
rural facilities generally have lower utilization, and consequently 
higher costs per treatment, especially for overhead and supplies, 
compared to urban facilities. The commenter offered three options for 
consideration-the establishment of one composite rate for all dialysis 
facilities, the creation of a special composite rate adjustment factor 
that compensates rural facilities for their higher overhead costs due 
to lower utilization, or the creation of an explicit exception for 
higher rural facility overhead costs.
    Response: We recognize that large chain dialysis providers operate 
with the benefit of economies of scale, and may be better able to adapt 
to the impact of policy changes to the composite payment rates. 
However, we have no evidence to indicate that rural facilities have 
higher overhead and supply costs per treatment. Payments to rural 
facilities are lower compared to urban facilities because rural 
facility composite rate costs, including labor costs, are generally 
lower. We do not believe our use of a CBSA-based wage index would 
change our conclusion, however, as noted below, we will continue to 
monitor provider cost data.
    Moreover, section 623(b) of the MMA and section 422(a)(2) of BIPA 
prohibit the granting of new exceptions for the composite rate, except 
for pediatric ESRD facilities.
b. Revised Labor-Related Portion
    The current composite rate wage index is applied to two different 
labor-related shares, 40.65 percent for independent facilities and 
36.78 percent for hospital-based facilities. Given the age of the cost 
data used to develop these shares, we proposed revising the labor-
related portion of the composite rate based on the ESRD composite rate 
market basket contained in our May 2003 Report to Congress on 
developing a bundled outpatient ESRD payment system. We proposed the 
use of a single labor-related share of 53.711 percent that would apply 
to both hospital-based and independent facilities. This proportion was 
based on the sum of the labor-related categories of costs that comprise 
the ESRD market basket. (70 FR 45796 through 45798). We received the 
following comments on this proposal.
    Comment: One commenter criticized our use of the ESRD composite 
rate market basket developed from CY 1997 data to revise the labor 
related-portion of composite rate costs subject to wage index 
adjustment. The commenter maintained that the use of more recent cost 
report data to develop a revised labor-related share would be more 
reflective of current economic realities. Another commenter recommended 
that we use the hospital market basket, which was developed from fiscal 
year 2002 data, instead. The commenter reasoned that the hospital 
market basket would be a more appropriate measure, not only because it 
reflects more recent data, but also because ESRD facilities compete 
with hospitals for labor and use the same vendors for supplies.
    Response: Calendar year 1997 was the most recent year for which 
relatively complete data were available when the ESRD composite rate 
market basket was developed in 2003. Until the ESRD market basket is 
rebased to incorporate later data, we believe it is proper to use the 
1997-based ESRD composite rate market basket to determine the labor-
related share because it reflects the cost structures of ESRD 
facilities serving Medicare beneficiaries. We will continue to evaluate 
the available data on ESRD facilities and expect to periodically rebase 
the ESRD market basket when appropriate.
    We disagree with the commenter's recommendation to use the 2002-
based hospital market basket to determine the labor-related share for 
ESRD facilities. We believe the 1997-based ESRD market basket best 
reflects the types of medical services and cost structures used by ESRD 
facilities. This is consistent with other payment systems that use 
individually tailored market baskets to determine their labor-related 
share.
    Comment: One commenter attempted to replicate the basic composite 
payment rate (that is, the payment rate

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prior to application of the drug add on and patient specific case-mix 
adjustments) for the Orlando, Florida MSA. The commenter inquired 
whether the proposed revised wage index for each urban/rural area is 
applied to 40 percent or 100 percent of the wage adjustment reflected 
in the current composite payment rates.
    Response: The published wage index applicable to each urban/rural 
area is neither applied to 40 percent nor 100 percent of the composite 
payment rate's current wage adjustment. We currently multiply the 
current wage index by one of two different labor-related portions of 
the composite payment rates, depending on the type of ESRD facility. 
The portion is 40.65 percent for independent facilities and 36.78 
percent for hospital-based facilities. However, the composite rate wage 
index itself is a blend of two separate wage index values. Of the 
current measure, 40 percent, is based on the hospital wage index 
calculated from fiscal year 1986 data, and 60 percent is based on the 
hospital wage index calculated from 1980 BLS data.
    However, in our August 8, 2005 proposed rule, we proposed making 
the labor-related portion the same for both hospital-based and 
independent ESRD facilities. That proportion (53.711 percent) was 
developed from the labor-related components of the ESRD composite rate 
market basket. Moreover, the proposed wage index is not a blended 
measure. It was developed exclusively from hospital wage and employment 
data for fiscal year 2002 obtained from the Medicare hospital cost 
reports. We proposed to apply the proposed wage index values to 100 
percent of the 53.711 percent labor-related share. The revised labor-
related shares applicable to hospital-based and independent ESRD 
facilities were contained in Table 26 of our proposed rule. Using data 
contained in Table 26 in our proposed rule, we calculated that the 
basic composite payment rate for hospital-based ESRD facilities in the 
Orlando MSA would have been $71.12 x 0.9677 + $61.29 or $130.11. For 
independent facilities the rate would have been $68.94 x 0.9677 + 
$59.41 or $126.12.
c. Adoption of Floor/Ceiling Wage Index Values and Transition Policies 
for Implementation of Revised Wage Index
    The wage index values in the current composite payment rates 
reflect a floor of 0.90 and a cap of 1.30. In the August 8, 2005 rule, 
we proposed eliminating the cap because of the effect it has had on 
restricting payments in high wage areas. While we stated that we would 
like to remove the floor as well, we were concerned that its immediate 
elimination could adversely affect beneficiary access to dialysis. To 
mitigate any potential adverse impact, we proposed a gradual reduction 
in the floor to 0.85 for 2006 and 0.80 in 2007, with a reevaluation of 
continued need for the floor in 2008.
    We also proposed a 2-year transition for implementation of the new 
composite payment rates, but only for those facilities whose CBSA based 
payment decreased. Under the proposed transition, facilities would be 
paid the higher of the new wage adjusted composite rate, or a 50-50 
blend of the current wage adjusted rate and the new wage adjusted rate 
(70 FR 45798 through 45799). We received the following comments 
regarding the proposed ceiling and floor wage index values and the 2-
year transition period.
    Comment: Several commenters representing facilities whose payment 
rates would increase as a result of the revised urban/rural definitions 
and wage index values, endorsed the immediate introduction of the new 
basic composite payment rates. Other commenters either supported the 
proposed 2-year transition period, or recommended longer transitions of 
varying duration to mitigate further the impact of reduced composite 
payments.
    Response: Most commenters endorsed our proposal to provide for a 
transition period to mitigate the impact of the revised CBSA based 
composite payment rates, but believed that a 2-year transition was too 
short. The recommended transition periods, generally ranged from 3 to 5 
years, with several commenters supporting a transition period of 5 
years. We agree that a longer transition period is appropriate to allow 
ESRD facilities sufficient time to adjust to the new CBSA based wage 
index, and have selected 4 years as a reasonable compromise among the 
recommended alternatives. While a 4-year transition is longer than the 
transition in other payment systems, we believe it is justified in the 
case of ESRD facilities because the wage data currently used for the 
wage index is over 20 years old. Thus, facilities need more than the 
usual transition. However, we will apply the 4-year transition period 
to all ESRD facilities, those whose base composite payment rates 
compared to those currently in effect increase as well as decrease. 
This represents a change from our proposed policy of applying a 
transition period only to those facilities whose composite payment 
rates decreased. We believe that a transition period of 4 years applied 
to all ESRD facilities achieves a reasonable balance between cushioning 
the impact for providers whose CBSA based composite payment rates 
decrease, and implementing the CBSA based wage index as quickly as 
possible.
    Comment: We received several comments on our proposal to reduce 
gradually the wage index floor from its current level of 0.90, to 0.85 
in 2006 and 0.80 in 2007. The comments included keeping the floor at 
0.90, maintaining the floor at 0.90 but simultaneously increasing the 
ceiling from its current level of 1.30 to 1.40, and phasing out the 
floor as proposed, but also extending the phase out to the wage index 
ceiling as well.
    Response: We recognize that only immediate elimination of the 0.90 
floor could substantially reduce composite payments in locales where 
prevailing labor costs are lower. Although ESRD facilities in areas 
with wage levels below 0.90 have benefited from the application of the 
floor, we are concerned that its sudden elimination could adversely 
affect ESRD beneficiary access to care.
    In the August 8, 2005 rule, we proposed lifting the wage index cap 
of 1.30 entirely in 2006 because it has restricted payments in areas 
with high labor costs. Under our proposal ESRD facilities whose base 
composite payment rate increased would receive the full payment amount 
per treatment without regard to the cap.
    We have carefully reconsidered our proposal in light of concerns 
over the potential impact of the use of new CBSA-based geographic 
designations and wage index values on ESRD facilities that will 
experience a decrease in their composite payments. We believe that it 
would be more consistent and equitable for all ESRD facilities if we 
phased out the wage index floor and eliminated the ceiling. 
Accordingly, we are implementing a 4-year transition period that will 
apply to all ESRD facilities, those experiencing either an increase or 
decrease in their base composite payment rate for 2006. Although the 
present wage index ceiling of 1.30 will be eliminated in 2006, 
facilities whose payments have been restricted by the ceiling would not 
receive 100 percent of their otherwise applicable base composite 
payment per treatment without the ceiling until 2009. This occurs as a 
result of blending the proportion of old MSA and new CBSA based wage 
adjusted composite rates over the 4-year transition period as shown in 
Table 20. By applying blended shares during the 4-year transition 
period to all ESRD facilities, we believe we can achieve a balance 
between our goals of preserving access to care in low

[[Page 70170]]

wage areas and the ultimate elimination of constraints on the wage 
index. The wage index floors, caps, and blended shares of the base 
composite payment rates applicable to all ESRD facilities for CYs 2006 
through 2009 are detailed in Table 20.

                                     Table 20.--Wage Index Transition Blend
----------------------------------------------------------------------------------------------------------------
            CY payment                      Floor                 Ceiling             Old MSA        New CBSA
----------------------------------------------------------------------------------------------------------------
2006..............................  0.85 *...............  None.................              75              25
2007..............................  0.80 *...............  None.................              50              50
2008..............................  Reassess.............  None.................              25              75
2009..............................  Reassess.............  None.................               0            100
----------------------------------------------------------------------------------------------------------------
* Each wage index floor is multiplied by a budget neutrality adjustment factor. For CY 2006 the budget
  neutrality adjustment is 1.045287 resulting in an actual wage index floor of .8885.

    We plan to reassess the continuing application of the wage index 
floor in connection with the 2008 update to the composite payment 
rates.
    An example of how the base composite payment rates would be blended 
during the 4 year transition period to reflect the old MSA and new CBSA 
based geographic designating follows.
    Assume an ESRD facility whose base composite payment rate (that is, 
without regard to any case-mix adjustments) is $135.00 per treatment in 
2005. Based on the new CBSA wage index designations, its base composite 
payment rate is $145.00 for 2006. This facility's blended rate during 
each year of the 4 year transition period would be as follows:

CY 2006--.75 x $135.00 + .25 x $145.00 = $137.50
CY 2007--.50 x $135.00 + .50 x $145.00 = $140.00
CY 2008--.25 x $135.00 + .75 x $145.00 = $142.00
CY 2009--0 x $135.00 + 1.0 x $145.00 = $145.00

    Of course, this hypothetical assumes that the calculated rate of 
$145.00 for 2006 will not change in 2007 and the following years. In 
actuality, it would because of annual revisions to the wage index. 
However, the example serves to illustrate how the new CBSA-based 
composite payment rates will be phased-in during the 4 year transition 
period, regardless of whether an ESRD facility's base composite payment 
increases or decreases in 2006 compared to 2005.
    Comment: One commenter endorsed our proposed elimination of the 
wage index cap, but was concerned that isolated rural ESRD facilities, 
whose wage levels are generally lower than those prevailing in urban 
locales, could be adversely affected, even with the proposed floor wage 
index values. The commenter recommended that these facilities continue 
to be permitted to receive the isolated essential facility exception to 
their otherwise applicable composite payment rate under Sec.  413.186.
    Response: ESRD facilities which have been granted exceptions to 
their composite payment rates, including those granted under the 
authority of Sec.  413.186, have the option of either retaining their 
exceptions, or becoming subject to the case-mix adjusted composite 
payments, at any time. Beyond this option, we have no discretion to 
grant new exceptions under Sec.  413.186. Section 422(a)(2) of BIPA, as 
amended by section 623(b) of the MMA, eliminated the granting of new 
exceptions to the composite payment rates except for ESRD facilities 
qualifying as pediatric facilities. We believe that the wage index 
floors of 0.85 for 2006 and 0.80 for 2007, the extension of the 
transition period from 2 to 4 years, and affording facilities the 
option of retaining previously granted exceptions, should help cushion 
any potential adverse impact to ESRD facilities located in isolated 
rural areas.
    Comment: Several commenters expressed particular concern over the 
relatively large reduction in payment rates for dialysis facilities in 
certain rural areas and in certain States. While most of these locales 
were unspecified, some commenters used Ohio out as an example, noting 
that implementation of the revised wage index would reduce payment 
rates in Ohio by more than $14.00 per treatment. The commenters 
requested that we provide a State specific impact analysis, delay 
implementation of the proposed revised composite payment rates for a 6-
month period, and engage in dialysis community discussions to determine 
whether changes to the proposed wage index floor values and 
modification of the proposed 2-year transition period, would be 
necessary.
    Response: We strive to engage in discussions with the dialysis 
community concerning ESRD payment policies, such as our open door 
forums where the dialysis community can provide input to CMS on ESRD 
issues. Moreover, as noted previously, based in part on the comments 
received we are implementing revisions to our proposed policies 
regarding continuation of the wage index floor and ceiling, and the 
duration of the transition period. These changes should lessen the 
impact of our adoption of CBSA-based geographic designations and 
revised wage index values for ESRD services. We believe that no 6-month 
delay in implementing the revised composite payment rates is necessary. 
To respond to the commenter's suggestion that we provide a State-
specific impact analysis, we have provided this information in Table 
52. We are extending the proposed 2-year transition to a 4-year 
transition to allow affected facilities to adjust to the revised wage 
indices.
    Comment: We received several comments which endorsed a phase in of 
the new CBSA based wage index based on a 50/50 split, similar to the 
wage index adopted in connection with the FY 2006 SNF PPS.
    Response: The FY 2006 SNF PPS, published in the Federal Register on 
August 4, 2005 (70 FR 45026), adopted a wage index consisting of a 
blend of 50 percent of the FY 2006 MSA-based wage index, and 50 percent 
of the FY 2006 CBSA-based wage index, both of which were developed from 
FY 2002 hospital wage data (70 FR 45041). This blended wage index is 
effective for a 1 year period. As the current ESRD wage index is 
obsolete, we see no reason to use it as a part of a blended measure 
which would then reflect an outdated wage index as part of a transition 
mechanism.
4. ESRD Wage Index Budget Neutrality
    Section 623(d) of MMA added section 1881(b)(12)(E)(i) to the Act 
which requires that any revisions to the ESRD composite rate payment 
system as a result of the MMA provision (including the geographic 
adjustment) be made in a budget neutral manner. This means that 
aggregate payments to ESRD facilities in CY 2006 should be the same 
aggregate payments that would have

[[Page 70171]]

been made if we had not made any changes to the geographic adjusters. 
We proposed to apply a budget neutrality adjustment factor directly to 
the revised ESRD wage index values, rather than applying the adjustment 
to the base composite payment rates. We believe this is the simplest 
approach since it allows us to maintain a base composite rate for 
hospital-based facilities and one for independent facilities during the 
transition from the current wage adjustments to the revised wage 
adjustments. The proposed budget neutrality adjustment was 1.023024.
    For CY 2006, we will apply the budget neutrality adjustment factor 
directly to the revised ESRD wage index values. Since we will be 
transitioning to the new wage index over a 4-year period, the 
computation of the adjustment factor varies slightly from our proposal. 
However, the basic method and concept is still the same as we proposed.
    In order to compute the proposed wage index BNF, we used treatment 
counts from CY 2004 billing data and facility-specific CY 2005 
composite payment rates. For purposes of adjusting the labor-related 
portion of the CY 2006 ESRD composite rate, we are using the most 
recent hospital wage data applicable to FY 2006 payments as discussed 
previously in this section.
    Using treatment counts from the 2004 claims and facility-specific 
CY 2005 composite payment rates, we computed the estimated dollar 
amount each ESRD provider would have received had there been no changes 
to the ESRD wage index. This becomes the target amount of expenditures 
for all ESRD facilities. Then we computed the estimated dollar amount 
that would have been paid to the same ESRD facilities using the revised 
ESRD wage index (including the 4-year transition). In the first year of 
the transition, ESRD facilities receive 25 percent of the CBSA wage 
adjusted composite rate and 75 percent of the current composite rate. 
This becomes the first year new amount of expenditures for all ESRD 
facilities.
    After comparing these two dollar amounts (target amount divided by 
first year new amount), we calculate an adjustment factor that, when 
multiplied by the ESRD wage index, will result in the target amount of 
expenditures for all ESRD facilities. Since the ESRD wage index is only 
applied to the labor-related portion of the composite rate payment, we 
computed the adjustment based on that proportion (53.711 percent). We 
apply the estimated budget neutrality adjustment factor to the revised 
wage index values for CY 2006 to ensure that estimated aggregate 
payments to ESRD facilities would remain budget neutral. The final wage 
index BNF adjustment factor is 1.045287.
    Applying this budget neutrality to the wage index floor of 0.8500, 
results in a wage index floor for 2006 of 0.8885.
    As stated earlier, the data used to compute the BNF are the wage 
index values in Table 21 and 22, the 2004 100 percent Outpatient 
Standard Analytic File (SAF) Claims, and geographic location 
information for each facility which may be found through Dialysis 
Facility Compare.
    Comment: Several commenters requested that we provide the data and 
methodology used to compute the wage index BNF.
    Response: The purpose of the wage index BNF is to achieve budget 
neutrality as required by section 623(d) of the MMA, which added 
section 1881(b)(12)(E)(i) to the Act. That provision of the Act 
requires that any revisions to the ESRD composite rate payment system 
(including the geographic adjustment) must be made in a budget neutral 
manner. This means that aggregate payments to ESRD facilities in CY 
2006 should be the same as aggregate payments that would have been made 
if we had not made any changes to the geographic adjusters. The 
methodology for computing the wage index BNF is described earlier in 
this section.
    The data used to compute the BNF are the wage index values in 
Tables 21 and 22, the 2004 100 percent Outpatient Standard Analytic 
File (SAF) Claims, and geographic location information for each 
provider which may be found through Dialysis Facility Compare. Dialysis 
Facility Compare can be found by going to the following link: http://www.medicare/Download/DOWNLOADDB.asp.
d. Wage Index Table
    The following two tables show the ESRD wage indexes for urban areas 
(Table 21) and rural areas (Table 22).
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4. Miscellaneous Comments on ESRD Issues
    We propose to make no changes to the existing case-mix adjustment 
system. We proposed to maintain the existing system as established in 
the CY 2005 final rule (69 FR 66238) and implemented on April 1, 2005.
    Comment: One commenter recommended that we stop the implementation 
of the basic case-mix adjustment. The commenter was critical of the 
case-mix adjustment because this commenter could not calculate the 
impact on their payment of one of the case-mix variables, specifically, 
weight. This commenter did not want to report weight as a case-mix 
variable because of the fluctuations in this variable, that is, weight 
changes.
    Response: Section 623(d)(1) of the MMA added section 1881(b)(12)(A) 
of the Act requiring that the outpatient dialysis services included in 
the composite rate be case-mix adjusted. Case-mix variables are 
characteristics of the patients served that enable payment systems to 
reflect the resources needed by patients. The statute required 
adjustments to the composite payment rate for a limited number of 
patient characteristics. We implemented the case-mix adjustments 
required by the statute in April 2005, using research on case-mix 
variables to support our selection of a limited number of case-mix 
adjusters. A report on that research, entitled, ``Methodology for 
Developing a Basic Case-mix Adjustment for the Medicare ESRD 
Prospective Payment System'' is available on www.sph.umich.edu/kecc. 
The selected case-mix adjusters are age, low body mass index (BMI), and 
body surface area (BSA). BSA and low BMI were selected because they are 
a better predictor of cost of care than using weight alone. Height and 
weight are the case-mix variables that we use to calculate BMI and BSA 
adjusters. For this reason, and because we think that facilities should 
be easily able to report a case-mix variable that should be part of 
each patient's ongoing care plan, we will continue to require reporting 
of the patient's weight for purposes of calculating the case-mix 
adjusters.
    Comment: There were several comments recommending that we explore 
the option of adding variables to the existing basic case-mix 
adjustments. Commenters recommended including variables that measured 
improved survival rates, creating a new code for ESRD patients with 
diabetes, and adding measures that reflect improvements in the quality 
of life for ESRD patients. Comments indicated that the current case-mix 
adjustments do not adequately compensate providers for resources used 
or the intensity of care that is required to provide services to the 
frail elderly, and patients with ambulatory limitations or selected 
comorbid conditions. In addition, commenters recommended that we should 
consider a variable that adjusts for time in treatment; specifically 
recommending that we consider the potential predictive power of a 
variable that exported the interval following the initial 6 months of 
ESRD treatments because the intensity of care and resources could 
increase.
    Response: We indicated in the proposed rule that we anticipated 
maintaining the basic case-mix adjustment as established in the CY 2005 
final rule (69 FR 66238) and implemented on April 1, 2005. Although we 
understand the comments that we explore additional case-mix variables, 
we do not currently have the data that would be necessary to analyze 
the current case-mix adjustment variables and refine the basic system. 
Therefore, we believe that it is premature at this time to add 
additional variables to the basic case-mix adjustment system. Several 
of the variables recommended, including intensity of care, survival 
rates and quality of life improvement, are excellent recommendations as 
variables for exploration.
    As we stated in the CY 2005 final rule, the basic case-mix system 
is adjusts for a limited number of patient characteristics, consistent 
with the provisions of section 1881(b)(12)(A) of the Act as added by 
section 623 of the MMA. The MMA legislation anticipated that work would 
continue toward the development of a more fully bundled case-mix 
payment system for ESRD. We are continuing to work towards a more fully 
bundled case-mix system through ongoing research and development of a 
demonstration project required by the MMA.
    We have a contract with the University of Michigan to continue the 
research that was initiated in 2001 to explore a number of variables 
that could be predictive of resource use in a fully bundled case-mix 
adjusted system. This research will include exploring the predictive 
potential of variables available from existing data sources, including 
assessing the potential impact of comorbid conditions to predict 
payments. Several of the suggestions, specifically, survival rates, 
assessing improvements in the quality of life for ESRD patients, 
developing frailty/ambulatory limitation measures, require the 
construction of classification measures of functioning for disability 
and health. These are beyond the scope of our existing research 
efforts; however, over time, HHS may include efforts to develop 
classifications of functioning for disability and health measures, as 
well as add quality measurements as part of our payment systems.
    In addition, we will be assessing the data submitted under the 
existing basic case-mix system. As the analysis of this data 
progresses, we will consider potential refinements to the basic case-
mix system.
    We are also working on a demonstration project that will assess the 
use of a fully case-mix adjusted payment system. Both the demonstration 
and the ongoing research will examine the impact of comorbid conditions 
on case-mix and payment.
    Regarding the comment that we should create a reimbursement code 
for ESRD patients with diabetes, we note that we did analyze comorbid 
conditions as part of the research for the basic case-mix system. At 
that time diabetes was not found to be a significant predictor. In 
addition, our staff found that the reporting of comorbid conditions, 
including diabetes, was frequently limited. Therefore, as part of our 
training effort, we have encouraged facilities to report all comorbid 
conditions, and plan to use the reported data in our ongoing research 
related to refining the basic case-mix system. Thus, we will continue 
to assess the impact of diabetes as a case-mix variable and a predictor 
of resource use, but we will not be requesting, at this time, the 
creation of a new code for diabetic ESRD patients for payment.
    Comment: One commenter expressed concern regarding the reporting of 
height and weight for individuals who are double amputees. The comments 
indicated because of the case-mix adjustments for these individuals, 
the average reimbursement was reduced by an average of $20 per 
treatment even though these patients generally require the same or 
additional treatment because they could be in a wheel chair or possibly 
transported by stretcher.
    Response: We concur that there may be issues surrounding the 
reporting of the height and weight variables associated with double 
amputees. We have explored a number of reporting options for these 
patients in an attempt to resolve both clinical and operational issues 
related to the reporting of these values. We agree that requiring that 
the height for double amputees be measured ``as they present'' may not 
accurately measure the necessary dialysis dose, we also believe that 
the reported weight for

[[Page 70214]]

these patients would require adjusting if we instructed facilities to 
report height ``pre-amputation.''
    Based on the available literature related to height and weight 
measurements for double amputees, we believe there is sufficient data 
from which to appropriately adjust weight if height is reported pre-
amputation. We relied on the methodology in the K-DOQI ``Guidelines for 
Peritoneal Dialysis Adequacy.'' Appendix E, Guideline 9 contains 
instructions related to adjustments to weight for amputees. Based on 
those guidelines, we are adopting the following formula for adjusting 
weight using the adjustment factor for below the knee (BKA) double 
amputees which is the most common type of double amputation:

    Pre-Amputation Weight = Actual Weight x 1.15

    Therefore, for dialysis treatments provided on or after January 1, 
2006, we will revise our claims processing instructions related to the 
reporting of height and weight for double amputee dialysis patients. 
Height would be reported ``pre-amputation'' and weight would be 
adjusted by 1.15 to reflect the ``pre-amputation'' weight.
    Comment: We received a number of comments from ESRD patients 
expressing concern regarding the impact that any reductions in payment 
could have on their care. One ESRD patient expressed concern that if 
there were payment cuts, the facilities could be adversely impacted 
resulting in facilities closing.
    Response: The intent of the changes in payments to ESRD facilities 
was to appropriately pay facilities based on the characteristics of the 
patients they treat, as well as the wage levels for the areas in which 
they are located. We note that all of the changes in payments as a 
result of the MMA legislation were done in a budget neutral manner. 
That is, aggregate payments to ESRD facilities remain constant. While 
the result of the changes we have made to the wage adjustment will 
result in redistributing payments to individual facilities, these 
changes more accurately pay facilities based on local wage levels. We 
understand the concerns expressed by these patients and have provided 
for a transition from the old, outdated wage adjustment to the revised 
adjustment to help mitigate any adverse impact to individual 
facilities. In addition, we have provided a 1.4 percent increase to the 
payment facilities receive for 2006 based on the projected increase in 
drug expenditure between 2005 and 2006.
5. Revisions to the Composite Payment Rate Exceptions Process
    In response to the changes made by section 422 of BIPA and section 
623 of MMA, in the August 8, 2005 proposed rule (70 FR 45840 through 
45842), we proposed changes to the existing regulations at Sec.  
413.180 through Sec.  413.192 (42 CFR Part 413, Subpart H) regarding 
criteria and application procedures for requesting an exception to the 
ESRD composite rate payment. We also proposed to revise Sec.  
413.170(b) to specify that subpart H provides procedures and criteria 
under which only a pediatric ESRD facility as specified in the statute 
may receive an exception.
a. Pediatric ESRD Facility Exception
    Existing exception rates are protected under section 422(a)(2)(C) 
of BIPA. The ``protection'' clause for existing exception rates 
provides that exception rates in effect on December 1, 2000 (or 
approved based on an application by July 1, 2001) remain in effect as 
long as the facility's exception rate is higher than the updated 
composite rate. Pediatric ESRD facility exception rates granted under 
the provisions of section 623 of the MMA (hereinafter referred to as 
``pediatric facility exception rates'') are not subject to the 
``protection'' clause for existing exception rates. However, we 
proposed to change our regulations to continue pediatric facility 
exception rates in the same way as existing nonpediatric exception 
rates. Specifically, we proposed that both nonpediatric and pediatric 
facility exception rates would remain in effect until the facility 
notifies its fiscal intermediary that it wishes to give up its rate 
because its case-mix adjusted composite rate is higher. As section 
422(a)(2)(B) of BIPA allows existing nonpediatric exception rates to 
continue in effect as long as the exception rate exceeds the facility's 
updated composite payment rate, we expected that each facility would 
compare its existing exception rates to its basic case-mix adjusted 
composite rates to determine which is the higher rate. We believe the 
determination as to whether an ESRD facility's exception rate per 
treatment will exceed its average case-mix adjusted composite rate per 
treatment is best left to the affected entity.
    In the past, an ESRD facility could request an exception to its 
prospective composite payment rate within 180 days of the effective 
date of its new composite rate (s) or the date on which we opened a 
specific exception window. We proposed to revise Sec.  413.180(d) to 
remove the requirement that an application for an exception must be 
filed within the 180-day window because we believe that the small 
volume of applications will make it feasible for us to accept 
applications on a rolling basis. Therefore, we proposed to revise Sec.  
413.180(d) to state that a pediatric ESRD facility may request an 
exception to its composite payment rate at any time after it has been 
in operation for at least 12 consecutive months. For a full discussion 
of our proposal, see the August 8, 2005 proposed rule (70 FR 45840 
through 45842). We received the following comments on these issues:
    Comment: Several commenters asked for clarification that CMS will 
continue to recognize the exceptions status of non pediatric ESRD 
facilities. The commenters stated that the proposed rule presents 
conflicting statements about the continuing validity of these 
exceptions.
    Response: We agree, and we are revising proposed Sec.  413.180(i) 
to include the statement that ``ESRD facilities electing to retain 
their nonpediatric or pediatric exception rates (including self-
dialysis training) do not need to notify their intermediaries.'' An 
ESRD facility may notify its fiscal intermediary at any time if it 
wishes to give up its nonpediatric or pediatric exception rate. Thirty 
days after written notice is received by the intermediary, the facility 
will become subject to the new basic case-mix adjusted composite 
payment rate methodology. A facility's decision to give up its 
exception rate can not be subsequently rescinded or reversed.
    Comment: One commenter is concerned that the composite rate as 
modified by the MMA will be maintained for patients under age 18 in 
many facilities that do not qualify for a pediatric exception because 
the pediatric population is below 50 percent of all patients dialyzed. 
Patients under age 18 require additional resources. The commenter 
recommends that a facility should qualify for a pediatric exception if 
25 percent of its patients are under 21 years of age.
    Response: Section 623 of the MMA amended BIPA to allow a pediatric 
ESRD facility that did not have an approved exception rate as of 
October 1, 2002, to file for an exception to its updated prospective 
payment rate. To apply for the exception rate, the MMA requires that 
the pediatric facility has to demonstrate that at least 50 percent of 
its patients are individuals under 18 years of age.
    We believe the statute is very specific regarding the criteria a 
pediatric ESRD facility must satisfy in order to apply for

[[Page 70215]]

an exception rate. We have incorporated these statutory provisions in 
our proposed regulatory changes to Sec.  413.170, Sec.  413.182, and 
Sec.  413.184. However, we note, that regardless of whether the 
pediatric exception is available to a facility, pediatric ESRD patients 
(defined as those under the age of 18) receive a specific case-mix 
adjustment factor when the composite payment rate is determined. None 
of the other case-mix adjustors that apply to nonpediatric patients 
(that is, the five age groups, low BMI, and BSA) is applicable to 
pediatric ESRD patients.
    Comment: We received two comments supporting the proposed change to 
allow pediatric ESRD facilities to file an exception at anytime after 
it is in operation for at least 12 consecutive months.
    Response: Previously, a pediatric ESRD facility that has been 
denied its exception would have to wait until a subsequent exception 
request. We have revised Sec.  413.180(d) to provide that a pediatric 
ESRD facility that has been denied an exception may immediately file 
another exception request. However, a subsequent exception request must 
address the deficiencies cited in our determination letter.
b. Pediatric Facility Exception Request Process
    Section 422 of BIPA prohibited CMS from providing exceptions to 
ESRD facilities on or after December 31, 2000. Section 623 of the MMA 
amended BIPA by restoring the exception process, but only for pediatric 
facilities that that did not have an approved exception rate as of 
October 1, 2002. To file for an exception, the pediatric facility would 
have to demonstrate that at least 50 percent of its patients are 
individuals under 18 years of age. Since the MMA restored the exception 
process only for pediatric facilities, we proposed to remove existing 
exception criteria that are not applicable to the newly defined 
pediatric facilities, including exceptions for isolated essential 
facilities, extraordinary circumstances, and frequency of dialysis as 
specified in regulations at Sec.  413.182(b), (c), and (e). However, we 
proposed to retain the exception criterion for self-dialysis training 
costs under Sec.  413.182(d) because some pediatric facilities may 
qualify for an exception on that basis. For a full discussion of our 
proposal, see the August 8, 2005 proposed rule (70 FR 45841). The 
comments received on these issues and our response to those comments 
are as follows:
    Comment: Several commenters asked that we retain the exceptions 
process for all five previous exception criteria in order to preserve 
access to care for dialysis patients and to foster evolution in the 
patterns of dialysis care. Commenters pointed out that the recent 
experience with Hurricane Katrina underscores the need for an exception 
process to provide for continuity of dialysis care during extraordinary 
circumstances. Commenters included a recommendation that self-dialysis 
and more frequent dialysis should be preserved as exception options, 
noting that patients with congestive heart failure may require four 
dialysis treatments per week, and this is a growing segment of the ESRD 
population. Finally, the commenters stated that the exception for 
isolated essential facilities should be retained because of the 
potential impact on access to care resulting from the proposed changes 
in the composite payment rate wage index and reimbursement for ESRD 
drugs.
    Response: We have determined that pediatric facilities would not 
qualify for an exception under most of the existing exception criteria 
because of the uniqueness of their patient population (at least 50 
percent under age 18). In the past, ESRD facilities with high 
percentages of pediatric patients only qualified for exceptions under 
the ``atypical patient mix'' criterion specified at Sec.  413.182(a) 
and Sec.  413.184. We have, therefore, proposed to replace the 
``atypical patient mix'' criteria with a more specific ``pediatric 
patient mix'' criteria and to retain this exception at proposed 
Sec. Sec.  413.182 and 413.184. We proposed to eliminate the exception 
criteria that we believe do not apply to facilities with large numbers 
of pediatric patients (that is, exceptions on the basis of isolated 
essential facilities, extraordinary circumstances, and frequency of 
dialysis). Based on our experience in granting ESRD exceptions, we do 
not believe that a situation exists where any newly defined pediatric 
facility with the required volume of pediatric patients would qualify 
for an exception under the isolated essential facilities criterion. 
Further, we note that previous exception requests for ``frequency of 
dialysis'' were granted to ESRD facilities that dialyzed their patients 
less frequently than 3 times a week and not more frequently as 
suggested by the commenter. However, we proposed to retain the 
exception criterion for self-dialysis training costs under Sec.  
413.182(d) because we have found that some pediatric facilities may 
qualify for an exception on that basis.
    With respect to Hurricane Katrina, we have taken into consideration 
that, in this type of emergency (an extraordinary circumstance), 
alternatives exist to ensure that ESRD patients will have continuing 
access to services in other ESRD facilities. Any ESRD facility that has 
adequate treatment capacity, and is located close to a displaced 
patient's home, would be glad to offer its dialysis services. However, 
if there are no remaining ESRD facilities nearby to voluntarily accept 
displaced patients, dialysis service will be made available to these 
patients that have been temporarily relocated to a local shelter or to 
another town. Displaced patients relocated to another town that are 
healthy enough to drive or to be driven to a dialysis facility, will 
receive dialysis services there. Displaced patients in temporary 
shelters will receive dialysis from providers or suppliers that will 
send the necessary equipment, personnel, and supplies to the shelter.
    We are finalizing the changes to Sec.  413.180 through Sec.  
413.192 as proposed. However, we have added language to Sec.  413.180 
regarding the intermediary notification discussed above. In addition, 
we are adding a technical clarification to proposed Sec.  413.170 to 
cross-reference Sec.  413.184 which specifies pediatric patient-mix 
requirements that pediatric ESRD facilities must meet to qualify for an 
exception.

H. Payment for Covered Outpatient Drugs and Biologicals

    Medicare Part B covers a limited number of prescription drugs and 
biologicals. For the purposes of this rule, the term ``drugs'' will 
hereafter refer to both drugs and biologicals. Medicare Part B covered 
drugs not paid on a cost or prospective payment basis generally fall 
into three categories:
    <bullet> Drugs furnished incident to a physician's service.
    <bullet> DME drugs.
    <bullet> Drugs specifically covered by statute (immunosuppressive 
drugs, for example).
    Beginning in CY 2005, the vast majority of Medicare Part B drugs 
not paid on a cost or prospective payment basis are paid under the ASP 
methodology. The ASP methodology is based on data submitted to us 
quarterly by manufacturers. In addition to the payment for the drug, 
Medicare currently pays a dispensing fee for inhalation drugs, a 
furnishing fee for blood clotting factors, and a supplying fee for 
certain Part B drugs.
    In this section of the preamble we discuss the August 8, 2005 (70 
FR 45843) proposed changes and issues related to the determination of 
the payment amounts for covered Part B drugs and the separate payments

[[Page 70216]]

allowable for dispensing inhalation drugs, furnishing blood clotting 
factor, and supplying certain other Part B drugs. We also discussed 
proposed changes in how manufacturers calculate the ASP and in the ASP 
data reported to us.
1. ASP Issues
    Section 303(c) of the MMA amended Title XVIII of the Act by adding 
new section 1847A. This new section establishes the use of the ASP 
methodology for payment for most drugs and biologicals not paid on a 
cost or prospective payment basis furnished on or after January 1, 
2005. The ASP reporting requirements are set forth in section 1927(b) 
of the Act. Manufacturers must submit ASP data to us quarterly. The 
manufacturers' submissions are due to us not later than 30 days after 
the last day of each calendar quarter. The methodology for developing 
Medicare drug payment allowances based on the manufacturers' submitted 
ASP data is specified in the regulations in part 414, subpart K. Based 
on the data we receive, we update the Part B drug payment amounts 
quarterly.
    In this section of the preamble, we discuss: Our proposed changes 
related to the methodology manufacturers use to calculate the ASP and 
apply the estimate of lagged price concessions in the ASP calculation; 
the reporting of ASP data; the weighting methodology we follow to 
establish the Medicare payment amounts using the ASP data; the comments 
received and our responses; and our final policy with respect to these 
issues.
a. Estimation Methodology for Lagged Price Concessions
    Section 1847A(c)(5)(A) of the Act states that the ASP is to be 
calculated by the manufacturer on a quarterly basis. As a part of that 
calculation, manufacturers are to take into account price concessions 
such as--
    <bullet> Volume discounts.
    <bullet> Prompt pay discounts.
    <bullet> Cash discounts.
    <bullet> Free goods that are contingent on any purchase 
requirement.
    <bullet> Chargebacks.
    <bullet> Rebates (other than rebates under the Medicaid drug rebate 
program).
    If the data on these price concessions are lagged, then the 
manufacturer is required to estimate costs attributable to these price 
concessions. Specifically, the manufacturer sums the price concessions 
for the most recent 12-month period available associated with all sales 
subject to the ASP reporting requirements. The manufacturer then 
calculates a percentage using this summed amount as the numerator and 
the corresponding total sales data as the denominator. This results in 
a 12-month rolling average price concession percentage that is applied 
to the total in dollars for the sales subject to the ASP reporting 
requirement for the quarter being submitted to determine the price 
concession estimate for the quarter. The methodology is specified in 
Sec.  414.804(a)(3).
    We identified a refinement of the ASP calculation and lagged price 
concession estimation methodology related to chargebacks that we 
believe improves the accuracy of the estimate. As a result, we proposed 
to clarify the ASP calculation in the August 8, 2005 proposed rule (70 
FR 5843).
b. Price Concessions: Wholesaler Chargebacks
    Wholesaler chargebacks are a type of price concession, generally 
paid on a lagged basis, that apply to sales to customers (for example, 
physicians) via a wholesaler (or distributor). Wholesaler chargeback 
arrangements may vary in scope and complexity. Under the current 
estimation methodology for lagged price concessions, total lagged price 
concessions, including lagged wholesaler chargebacks, for the 12-month 
period are divided by total sales for that same period to determine a 
ratio that is applied to the total sales for the reporting period. The 
ratio of lagged price concessions to sales is calculated over all 
sales, both indirect sales (sales to wholesalers and distributors and 
other similar entities that sells to others in the distribution chain) 
and direct sales (sales directly from manufacturer to providers, such 
as hospitals or HMOs). To the extent that the relationship between 
total dollars for indirect sales and total dollars for all sales is 
different for the reporting quarter and the 12-month period used, the 
current ratio methodology for estimating lagged price concessions may 
overstate or understate wholesaler chargebacks expected for the 
reporting period. A more accurate estimation of lagged price 
concessions would minimize the effect of quarter to quarter variations 
in the relationship between indirect sales and all sales. As a result, 
we proposed to revise Sec.  414.804 to require manufacturers to 
calculate the ASP for direct sales independently from the ASP for all 
other sales subject to the ASP reporting requirement (indirect sales). 
Then, the manufacturer would calculate a weighted average of the direct 
sales ASP and the indirect sales ASP to submit to us.
    We believed that the weighted average of direct sales ASP and 
indirect sales ASP would improve the overall accuracy of the ASP 
calculation, particularly for NDCs with significant fluctuations in the 
percentage of sales that are direct sales.
    We proposed conforming changes to Sec.  414.804 for the methodology 
for calculating the lagged price concessions percentage. We also 
proposed to revise the regulation to clarify that the estimation ratio 
methodology relates to lagged price concessions and also define 
``direct sales'' and ``indirect sales'' in Sec.  414.802. In addition, 
we requested comments about the advisability and potential effects of 
requiring manufacturers to calculate the ASP for direct sales, 
including price concessions, independently from the ASP for indirect 
sales and then calculating a weighted average of these ASPs to submit 
to us, as well as the proposed definitions of direct sales and indirect 
sales.
    Comment: We received many comments on our proposed refinement to 
the ASP calculation. Nearly all of these commenters opposed this 
proposal and many asked for clarification of the proposed terminology.
    All but one of the comments received from drug manufacturers stated 
that the proposed change to the ASP calculation would require 
significant modifications to manufacturers' accounting and reporting 
data systems while resulting in minimal change or benefit to the ASP-
based payment. Many commenters stated that the proposed modification to 
the ASP calculation would not result in more accurate payments. 
Further, comments from groups representing drug and biological 
manufacturers stated that they do not believe the proposed methodology 
will have a material impact on the overall ASP or the accuracy of the 
calculation. Many of the commenters opposing the proposal stated that 
the expense and burden of implementing the proposed change to the ASP 
calculation would be unjustified because direct and indirect sales and 
price concessions for a given product are stable over time, 
particularly for generic products, and further breakdown of the 
calculation would not have a significant impact on the ASP calculation. 
Many commenters also noted that implementing the proposed weighted 
average approach would increase both the complexity of the ASP 
calculation and the potential for calculation error.
    We received comments from manufacturers of oncology, inhalation, 
contrast media, and other drugs and biologicals that included estimates 
of the potential impacts of the proposed

[[Page 70217]]

modification to the ASP calculation for a limited number of NDCs chosen 
as examples. These estimates ranged from a slight decrease (less than 
one half of a percent) to a 4.3 percent increase in the overall ASP for 
the NDC. One manufacturer estimated that sales would have to vary 20 
percent from the 12-month lag period to change the ASP by more than 1 
percent. Notwithstanding the potential change in the overall ASP, all 
but one manufacturer, which reports ASP for a single product, 
recommended that we not adopt the proposed change. However, some of 
these commenters suggested that the weighted average approach be 
voluntary or applicable only in cases where significant fluctuations 
exist in the proportion of sales that are direct and indirect and there 
is a compelling need to apply the proposed methodology. Other 
commenters from the manufacturing community were concerned about 
consistency across manufacturers and recommended that we not leave it 
up to each manufacturer to choose whether to use the proposed 
methodology or not. One commenter suggested that the proposed 
methodology be mandatory for a manufacturer that has at least one NDC 
with direct sales of 33 percent or more of gross sales for the prior 
year. The manufacturer would then be required to calculate the ASP for 
all of its NDCs using the proposed methodology.
    Several commenters expressed concern that the proposed definitions 
of direct and indirect sales were unclear and required further 
clarification to ensure consistent application across manufacturers. 
Several commenters noted that our use of the term supplier was 
confusing; that it was unclear whether GPO sales would be considered 
direct or indirect; and it was unclear how utilization rebates to PBMs 
should be categorized. Several commenters noted that certain purchasers 
(for example, specialty pharmacies) may purchase both directly and 
indirectly during a given reporting period. Similarly, we received a 
comment from a drug manufacturer requesting greater clarification on 
how to allocate price concessions across direct and indirect sales when 
a customer purchases under both of these channels. Several 
manufacturers noted that their current data systems were not capable of 
capturing data at the level of detail necessary to accurately segregate 
sales into the direct and indirect categories. Other commenters noted 
that, in general, manufacturers do not track price concessions 
associated with direct or indirect sales. As a result, several 
commenters recommended that, if the proposed methodology is adopted, we 
implement the change prospectively to allow for a phase-in period and 
to delay implementation until April 2006 or later to provide time for 
systems changes to be implemented and tested.
    We received a few comments from drug manufacturers expressing their 
belief that other market issues cause fluctuation in the ASP, and that 
it would be more beneficial to receive guidance on how to resolve these 
issues.
    A few commenters were concerned with the time frame for 
implementation of the proposed modification of the ASP calculation. 
These commenters recommended that we consider delaying implementation 
until after a trial period or at least until April 2006.
    We also received comments from providers who have experienced 
difficulty acquiring drugs at or below the payment amount. These 
commenters, as well as comments from physician organizations, support 
changes to the ASP calculation insofar as they will result in more 
appropriate reimbursements for Part B drugs.
    Response: Our goal is to ensure continued beneficiary access to 
care through implementation of accurate and sufficient payment systems. 
To this end, we proposed to refine the ASP calculation because the 
weighted average of direct sales ASP and indirect sales ASP could 
potentially improve the overall accuracy of the ASP calculation. We 
greatly appreciate the efforts undertaken by commenters to examine the 
potential impacts of the proposed method on the overall ASP 
calculation. Based on the comments received, we find compelling the 
commenters' concerns about the challenges and increased burden 
associated with calculating the ASP independently for direct and 
indirect sales and then calculating the weighted average ASP. Although 
we continue to have interest in the potential impacts of quarter to 
quarter variations in estimates of price concessions, we will not adopt 
the proposed change at this time.
    In reaching our decision, we noted that all of the drug 
manufacturers that submitted comments reported that the impact of the 
proposed refinement of the ASP calculation would be minimal or not 
material. We note that these commenters are in a position to assess the 
impacts of the proposed methodology on their customers and to weigh the 
potential benefits and burdens inherent with the proposed change. In 
all but one case (a manufacturer which reports ASP for only one 
product), they did not support the proposal because they believe the 
burden would outweigh the benefit.
    Among the comments received that specified potential percentage 
changes in the overall ASP, a range of potential impacts was reported. 
One of the examples submitted suggested that the impact could extend to 
upwards of a 4 percent increase in the ASP for an NDC, while another 
example showed a slight decrease. We cannot determine whether the 
reported examples are representative of other or all NDCs subject to 
the ASP reporting requirements.
    We also noted the concerns expressed by manufacturers regarding the 
significant additional burdens associated with the proposed 
methodology, the potential for inconsistent application of the proposed 
methodology across manufacturers, and the potential effects of the 
proposed methodology on manufacturers' systems. In addition, we 
carefully considered the comments from the physician community in 
support of refinements to the ASP calculation that would increase 
payments.
    Although we are not implementing the proposed refinement to the ASP 
calculation at this time, we will continue to work with manufacturer to 
better understand the instances in which the proposed methodology may 
benefit the program and the potential for appropriate use of that 
methodology for certain or all NDCs, and whether such an approach would 
be sustainable.
    We did not receive any comments on our proposal to revise the 
regulations at Sec.  414.804 to clarify that the estimation ratio 
methodology published on September 16, 2004 (69 FR 55763), relates to 
lagged price concessions; therefore, we will implement the revised 
regulatory language as proposed.
c. Determining the Payment Amount Based on ASP Data
    As explained in the August 8, 2005 proposed rule (70 FR 45844) in 
response to inquiries we have received related to the formula we use to 
calculate the payment amount for each billing code we posted 
information on our web site (http://www.questions.cms.hhs.gov) earlier 
this year. We included this information (which follows) in the proposed 
rule to ensure greater public access to this information.
    <bullet> For each billing code, we calculate a weighted ASP using 
the ASP data submitted by manufacturers.
    <bullet> Manufacturers submit ASP data at the 11-digit NDC level.
    <bullet> Manufacturers submit the number of units of the 11-digit 
NDC sold and the ASP for those units.

[[Page 70218]]

    <bullet> We convert the manufacturers' ASP for each NDC into the 
ASP per billing unit by dividing the manufacturer's ASP for that NDC by 
the number of billing units in that NDC. For example, a manufacturer 
sells a box of 4 vials of a drug. Each vial contains 20 milligrams 
(mg). The billing code is per 10 mg. The conversion formula is: 
manufacturer's ASP/[(4 vials x 20 mg)/10 mg = 8 billable units per 
NDC].
    <bullet> Then, the ASP per billing unit and the number of units 
(11-digit NDCs) sold for each NDC assigned to the Billing Code are used 
to calculate a weighted ASP for the billing code. We sum the ASP per 
billing unit times the number of 11-digit NDCs sold for each NDC 
assigned to the billing code, and then divide by the total number of 
NDCs sold. The ASP per billing unit for each NDC is weighted equally 
regardless of package size.
    Comment: Several manufacturers and other commenters representing 
the manufacturing community recommended that the formula be revised so 
that the payment limit is calculated based on the weighted ASP of the 
number of billing units sold rather than the number of NDCs sold. These 
commenters noted that products are available in different package sizes 
and that a billing code may encompass multiple NDCs. As a result, these 
commenters contend that weighting the ASP payment amount by NDCs sold 
does not reflect the true weighted average price per billing unit. 
Several commenters, including manufacturers and their trade 
associations, noted that altering the formula to weight by the number 
of billing units sold may increase or decrease the overall ASP. 
Nonetheless, these commenters recommend adoption of their recommended 
alternative formula. One commenter suggested that the alternative 
formula be adopted along with an exception process that would be 
applicable to billing codes that represent therapies of differing 
weights or dosage. We also received comments from manufacturers that 
supported continued use of the current formula.
    Response: In establishing the formula used to calculate the payment 
amounts based on the manufacturers' ASP data, we considered various 
approaches, including the alternative approach recommended by some 
commenters. For the initial implementation of the ASP methodology, we 
operationalized the calculation of ASP by weighting the formula by the 
number of NDCs sold. As we gain more experience with the ASP data and 
other sources of information become available about the purchasing 
patterns of providers and their acquisition costs, we may consider 
altering the methodology or establishing exceptions, if we find good 
reason to do so. If we decided such a change is warranted, we would 
implement the change at the next quarterly update.
    Comment: Although not directly related to the formula used to 
calculate the ASP payment amounts, we received several comments from 
oncology physician practices and other commenters related to the 
adequacy of the ASP+6 percent payment methodology and other topics. We 
received several comments from oncology and other providers contending 
that the Medicare payment amount does not always cover their 
acquisition costs for certain drugs. A mid-sized oncology practice 
reported that it is unable to obtain nearly half of the drugs it 
administers at a price below the Medicare reimbursement rate. This 
commenter believes that larger practices may not face drug acquisition 
costs that exceed ASP+6 percent. One oncology practice reported that 
the ASP+6 percent payment would cover its drug costs if beneficiaries 
could always afford their cost sharing amounts. A large oncology 
practice stated that its average Medicare reimbursement, which is 2 
percent more than its acquisition costs, was insufficient and would 
cause it to discontinue treatment for beneficiaries.
    On the topic of price concessions, several commenters, including a 
drug manufacturer, suggested that prompt pay and other discounts given 
to wholesalers and distributors should not be included in the 
calculation of the manufacturers' ASP so that the payment amounts would 
be increased.
    Response: It is true for all payment systems based on averages that 
the payment amount may not equal a specific provider's cost for every 
service. Section 1847A of the Act specifies that the Medicare payment 
is at 106 percent of ASP for the majority of Part B drugs and 
biologicals not paid on a cost or prospective payment basis. The 
statute requires use of the ASP+6 percent payment methodology except in 
limited instances. Although several commenters (most of which represent 
oncology practices) reported that the ASP+6 percent methodology was 
insufficient to cover their drug acquisition costs for certain drugs, 
these commenters also acknowledged that the Medicare payment exceeds 
their drug acquisition costs for other drugs. This is consistent with 
the findings of recent studies by the General Accountability Office 
(GAO) (GAO-05-142R), Office of Inspector General (OIG) (``Adequacy of 
Medicare Part B Drug Reimbursement to Physician Practices for the 
Treatment of Cancer Patients'', (A-06-05-00024), and MedPAC (October 6, 
2005, public meeting report on oncology site visits). These studies 
have found that physicians generally can obtain oncology drugs for 
prices below Medicare reimbursement.
    We did not propose a change to the price concessions manufacturers 
must include in the ASP calculation. Section 1847A(c)(3) of the Act 
specifically identifies prompt pay discounts as a type of price 
concession that must be included in the manufacturer's calculation of 
the ASP.
    Comment: We received comments from a few drug manufacturers 
requesting clarification and more detailed guidance on the treatment of 
administrative fees, service fees, and data fees in the ASP 
calculation.
    Response: These issues are beyond the scope of this rule. We will 
continue to work with manufacturers to more fully understand these 
issues. We expect to publish a final rule on the ASP reporting 
requirements and will consider these comments in the course of 
preparing that rule.
    Comment: We received comments from oncology practices, ESRD 
facilities and retail pharmacies, as well as IVIG manufacturers and 
stakeholders, indicating that manufacturer price increases are not 
reflected timely in the ASP+6 percent payment amounts due to the 
necessary lag time for calculating the rates and updating the payment 
systems. One commenter suggested that we implement a ``true up'' 
mechanism that immediately reconciles the historic reimbursement rate 
to reflect manufacturer price increases. Several IVIG stakeholders 
suggested that we issue payment rates on a retroactive basis.
    Response: Section 1847A(c)(5)(B) specifies a prospective update in 
the payment amounts. We agree with the commenters' observations that 
there is a necessary time frame after the close of a calendar quarter 
for manufacturers to calculate and submit the ASP data to CMS, for CMS 
to prepare and issue the payment rates, and for the claims processing 
contractors to implement the updated payment files. As we stated in the 
CY 2005 final rule (69 FR 66300), we implement these new prices through 
program instructions or otherwise at the first opportunity after we 
receive the data, which is the calendar quarter after receipt.
    Comment: Several commenters, including patient and industry 
representatives and physicians as well as manufacturers, requested that 
we take steps to improve the availability of IVIG. Many of these 
commenters noted their

[[Page 70219]]

ongoing collaboration with the Congress, HHS, CMS and others to better 
understand the market forces and dynamics influencing the current IVIG 
situation. These commenters reported that numerous patients and 
physician practices have been adversely impacted by the change in 
reimbursement to the ASP+6 percent methodology. These impacts include 
postponed infusions, increasing intervals between infusions, having to 
receive treatment in the hospital setting rather than in the physician 
office, possible unintended reactions as a result of switching brands 
of IVIG, and increased level of effort to obtain product and schedule 
services. Several commenters restated suggestions previously 
communicated to us, including concerns about our proposed changes for 
IVIG reimbursement in the outpatient setting. Comments from an industry 
group referenced its new study that it is conducting to help clarify 
the marketplace and provide insight into the costs for providing IVIG 
services. The study will examine IVIG acquisition costs and related 
services. Citing the adverse effects of patients migrating from 
physician offices to hospitals for treatment, several commenters 
requested that we consider an interim add-on payment for the complex 
activities related to furnishing IVIG until the industry study is 
completed. These commenters noted that the add-on payment would ensure 
that providers are paid sufficiently for IVIG under Part B so that 
their provision of IVIG remains viable and beneficiaries' access to 
IVIG is not reduced.
    Response: We will continue to work with the IVIG community, 
manufacturers, the Congress, and other entities to seek better 
understanding of the supply and market issues influencing the current 
IVIG market. We look forward to learning of the industry's study 
findings as that work progresses. We have discussed the accuracy of the 
ASP data with the manufacturers and have been assured by these 
manufacturers that their ASPs have been developed in accordance with 
applicable guidance and that the resulting price reflects the current 
IVIG market in aggregate. At the same time, the IVIG manufacturers' 
association, the Plasma Protein Therapeutics Association, reports that 
the overall supply of IVIG is adequate and has improved in the past 
several months. However, based on the comments received and our ongoing 
work with manufacturers, patient groups, and other stakeholders, we 
continue to be concerned about reports of patients experiencing 
difficulties in accessing timely IVIG treatments and reports of 
providers experiencing difficulties in obtaining adequate amounts of 
IVIG products on a consistent basis to meet their patients' needs in 
the current marketplace. Most brands of IVIG have been put on 
allocation by manufacturers and some manufacturers have reported 
allocating products to a smaller number of distributors and reducing 
the size of inventories. In addition, there have been reports of 
diversion of products to the secondary market and secondary 
distributors raising prices markedly. The Secretary's Advisory 
Committee on Blood Safety and Availability has recommended immediate 
steps be taken to ensure access to IVIG so that patients' needs are 
being met. However, the complexity of the IVIG marketplace makes it 
unclear what particular systematic approaches would be most effective 
in addressing the many individual circumstances that have been shared 
with us while not exacerbating what appears to be a temporary 
disruption in the marketplace.
    IVIG is a complicated biological product that is purified from 
human plasma obtained from human plasma donors. Its purification is a 
complex process that occurs along a very long timeline, and only a 
small number of manufacturers provide commercially available products. 
Historically, numerous factors, including decreased manufacturing 
capacity, increased usage, more sophisticated processing steps, and low 
demand for byproducts from IVIG fractionation have affected the supply 
of IVIG. For CY 2006, there are 2 HCPCS codes that describe all IVIG 
products, based on their lyophilized versus liquid preparation.
    The recent patterns of utilization of IVIG also are unusual in 
comparison with most other drugs and biologicals. Different IVIG 
products are FDA-approved in a number of therapeutic areas for various 
specific conditions which include: anti-infective therapy (bone marrow 
transplant); immune globulin replacement therapy (primary immune 
deficiencies and chronic lymphocytic leukemia); anti-inflammatory 
therapy (Kawasaki disease); and immunomodulation therapy (idiopathic 
thrombocytopenic purpura). IVIG therapy, which has been available for 
about 25 years, was initially reserved for the treatment of these FDA-
approved indications. More recently, IVIG has been increasingly used 
off-label so that off-label uses now significantly exceed on-label 
uses. Many of these off-label uses are for autoimmune, neurological, or 
systemic inflammatory conditions. Some off-label uses of IVIG are 
supported by a robust evidence base, while for other medical conditions 
the evidence has not demonstrated that IVIG infusions are of 
significant therapeutic benefit. There are also new emerging 
indications for IVIG treatment, including those based on 
recommendations from various professional associations and advisory 
groups. In addition, despite the growing uses of IVIG there are 
definite risks associated with IVIG treatment, including both early 
inflammatory reactions and more rare but serious renal and 
thromboembolic complications, as well as the inherent risk associated 
with receipt of any biological product even with the ongoing 
improvements in the safety of these types of products.
    Medicare currently has one national coverage determination in place 
since CY 2002 regarding IVIG infusions to treat autoimmune blistering 
diseases, and there are numerous local coverage policies that describe 
Medicare coverage for specific off-label indications. In the context of 
these national and local coverage policies, IVIG use in hospital 
outpatient departments has climbed steeply over the most recent years 
for which data are available, from about 40,000 infusion days in CY 
2002, to 60,000 days in CY 2003, and again to over 70,000 days in CY 
2004. The infusion of IVIG in physician offices increased from about 
2.3 million grams in CY 2003 to 4.0 million grams in CY 2004. In the 
face of growing demand for IVIG in the absence of significant changes 
in the prevalence of medical conditions for which there is high quality 
evidence regarding the effectiveness of IVIG therapy, we are concerned 
that all patients with medical need for IVIG continue to have access to 
this expensive and valuable therapy. Over the upcoming year, we will be 
using our historical claims databases to study the epidemiology of IVIG 
treatment of Medicare beneficiaries in outpatient settings. We expect 
that the health system as a whole should encourage an accountable and 
scientifically-grounded use of IVIG, and we welcome discussions with 
industry, providers, and other interested entities regarding efforts to 
ensure that IVIG is responsibly utilized for evidence-based clinical 
indications so that optimal benefit is obtained.
    Commenters have indicated to us that the infusion of IVIG in 
physician offices is more complex and resource intensive, particularly 
during the actual infusion, than many other types of infusions 
currently reported using the same drug administration CPT codes. They 
have described the specific resources

[[Page 70220]]

required for initiating and monitoring infusions of IVIG for patients 
under various clinical circumstances. We encourage commenters to 
discuss their concerns with the CPT Editorial Panel to assess whether 
alternative coding or additional CPT guidance would be appropriate. In 
addition, they may wish to discuss their resource concerns with the 
AMA/Specialty Society RVS Update Committee that provides advice 
regarding the resources associated with physician services.
    Based on the potential access concerns, the growing demand for 
IVIG, and the unique features of IVIG detailed above, as we seek to 
gain improved understanding of the contemporary volatile IVIG 
marketplace, we will employ a two-pronged approach during CY 2006 to 
help ensure the availability of IVIG to physicians and hospital 
outpatient departments who care for Medicare beneficiaries and will be 
paid ASP+6 percent for the IVIG products.
    First, in addition to the ongoing monitoring and outreach 
activities within the HHS, the Office of the Inspector General (OIG) is 
studying the availability and pricing of IVIG as part of its monitoring 
of market prices pursuant to section 1847A(d)(2)(A) of the Act. We 
expect the OIG's work to provide a significant contribution to the 
analysis of the current situation with respect to the specific 
activities of manufacturers and distributors that may be contributing 
to possible access problems for IVIG as we move to the ASP methodology 
in both physician office and hospital outpatient settings. We hope to 
understand those particular market behaviors that may have led to such 
public alarm about the availability of IVIG and the adequacy of our 
payment rate of ASP+6 percent, concerns that have been particularly 
strong and persistent for IVIG in comparison with other drugs paid 
under the same ASP methodology.
    Second, we will provide additional payment in CY 2006. Presently 
the IVIG marketplace is a dynamic one, where a significant portion of 
IVIG products previously available in CY 2005 are being discontinued 
and other products are expected to enter the market over the next year. 
In light of this temporary market instability, we understand that 
manufacturers have continued allocation procedures aimed at stabilizing 
the supply of IVIG. Even so, we understand that providers may face 
purchasing whichever brand of IVIG is available, even if it is not a 
brand the patient is known to tolerate. Many patients treated with IVIG 
receive regular infusions on a predictable schedule. To meet this need, 
physicians' office staff must conduct significant preadministration 
services prior to IVIG infusions to monitor and manage their inventory, 
locate available IVIG products, reschedule infusions according to 
product availability and patients' needs, and implement physicians' 
determinations regarding whether the available formulations are 
appropriate for patients and whether specific dosing adjustments are 
required. Product-specific factors must be evaluated in light of 
patients' clinical indications for the IVIG infusions, their underlying 
medical conditions, and their past reactions to various IVIG products, 
and office staff must locate appropriate doses of IVIG products in 
light of these considerations. If the appropriate IVIG product 
formulations were more widely and reliably available, we do not believe 
that routine IVIG infusions would require these extensive 
preadministration-related services prior to each infusion.
    To continue to ensure appropriate patient access to IVIG in CY 2006 
during this short-term period of market instability for IVIG, beginning 
for dates of service on or after January 1, 2006 through December 31, 
2006, we will temporarily allow a separate payment to physicians to 
reflect the substantial additional resources that are associated with 
locating and acquiring adequate IVIG product and preparing for an 
office infusion of IVIG in the current environment. We expect that 
making separate payment for these additional necessary services will 
help insure that physicians are able to continue to provide IVIG 
infusions to their patients who depend upon them. We will also provide 
an additional payment to hospital outpatient departments for these 
special services, to ensure that patients continue to have access to 
IVIG infusions in the most medically appropriate settings, without 
undesirable shifts in sites of service for their care.
    Because the resources associated with the preadministration-related 
services for intravenous infusion of immunoglobulin are not accounted 
for in the physician office practice expense associated with the CY 
2006 drug administration codes that will be billed for IVIG infusions, 
we are creating a temporary G-code to describe these additional 
preadministration services related to the intravenous infusion of 
immunoglobulin. We have established the following G-code for physician 
office billing for CY 2006:
    G0332; Preadministration-related services for intravenous infusion 
of immunoglobulin, per infusion encounter (This service is to be billed 
in conjunction with administration of immunoglobulin).
    Physicians may bill this service once per day in association with a 
patient encounter for administration of IVIG, in addition to billing 
for the appropriate drug administration service(s) and for appropriate 
units of the HCPCS code that describes the IVIG product infused. In 
addition, physicians may also bill for any significant and separately 
identifiable evaluation and management (E/M) service they perform at a 
level 2 through 5 in association with the infusion encounter, appending 
modifier -25 to the E/M service. We have established the payment level 
for this service in physician offices by cross-walking the RVUs for the 
new G-code to the practice expense RVUs of 1.90 for G0319, ESRD related 
services during the course of treatment, for patients 20 years of age 
and over; with 1 face-to-face physician visit per month. We do not 
believe there is increased preadministration physician work associated 
with preparation for intravenous infusion of immunoglobulin, so we have 
not allocated the physician work RVUs assigned to G0319 to G0332. 
Physician work associated with preparation for the intravenous infusion 
of immunoglobulin is already included in the physician work allocated 
to the drug administration services associated with the infusion and to 
the evaluation and management services (including the pre- and post-
work already included in the relative values for evaluation and 
management services) provided to patients receiving intravenous 
immunoglobulin treatments. However, we think G0332 requires additional 
resources from the physician practice, particularly clinical labor, 
that are comparable to the practice expense for the ESRD management 
code. We expect that in many cases IVIG infusions will be provided once 
per month, with activities in preparation for the infusion, including 
consulting with patients and distributors, conducted over the course of 
a month as are the ESRD related services described by G0319. In 
addition, preparation for the IVIG infusion will generally not require 
a face-to-face visit with the patient prior to the infusion, so we have 
selected the ESRD related services G code that includes only one 
physician visit for the practice expense crosswalk.
    We believe that this temporary separate payment provided through 
G0332 in CY 2006 for the physician office and hospital outpatient 
resources associated with additional IVIG preadministration-related 
services due to the present significant fluctuations in

[[Page 70221]]

the IVIG marketplace will ensure that Medicare beneficiaries depending 
on IVIG experience no adverse health consequences from the market 
instability for IVIG products. In the meantime, we will continue to 
evaluate the market factors affecting the pricing and availability of 
IVIG products in the context of our ASP+6 percent payment methodology 
and our separate payment for G0332 in CY 2006. We expect that in CY 
2006 with continued collection of updated ASP data for IVIG; improved 
understanding of the IVIG marketplace; more focused attention on the 
medical necessity of the utilization of IVIG; ongoing collaboration 
between CMS, the IVIG community, manufacturers, providers, and other 
interested entities; and this temporary separate payment for hospital 
and physician office resources required for the intensive 
preadministration services related to IVIG infusion, the IVIG 
marketplace should stabilize over the upcoming year. Substantial 
preadministration-related services for IVIG infusions should no longer 
be required of physician offices and hospital outpatient departments 
that provide IVIG infusions to patients who need them. Therefore, this 
additional payment for G0332 is effective for CY 2006 only. Thus, we 
will be closely monitoring this issue once again in the context of our 
rulemaking for CY 2007.
    Comment: Several commenters representing providers of community 
cancer care and manufacturers noted that physicians do not receive 
separate payment for pharmaceutical management and related pharmacy and 
handling costs (such as drug inventory, disposal of toxic waste, and 
spillage and breakage), and that in the 2006 proposed rule for HOPD we 
proposed a 2 percent add-on payment to the ASP+6 percent payment for 
drugs. These commenters stated the costs for handling pharmaceuticals 
are similar across settings and that physicians should receive the same 
add-on.
    Response: The costs for handling pharmaceuticals are paid through 
the PE RVUs for the drug administration code.
d. Reporting WAC
    As explained in the August 8, 2005 proposed rule (70 FR 45844) we 
have provided information on our web site (http://www.questions.cms.hhs.gov) concerning reporting WAC. We state that 
manufacturers must report the WAC for a single source drug or 
biological if it is less than the ASP for a quarter and in cases where 
the ASP during the first quarter of sales is unavailable. Upon further 
review, we have determined that the WAC must be reported each quarter 
if required for payment to be made under section 1847A of the Act, in 
addition to the ASP, if available.
    Section 1927(b)(3)(A)(iii) of the Act specifies the ASP data 
manufacturers must report. Section 1927(b)(3)(A)(iii)(II) of the Act 
specifies that the manufacturer must report the WAC, if it is required 
in order for payment to be made under section 1847A of the Act. Under 
section 1847A of the Act, the payment is based on WAC (as opposed to 
ASP) in the following cases:
    <bullet> For a single source drug or biological, when the WAC-based 
calculated payment is less than the ASP-based calculated payment for 
all NDCs assigned to such drug or biological product. (See section 
1847A(b)(4) of the Act.)
    <bullet> During an initial period in which data on the prices for 
sales for the drug or biological is not sufficiently available from the 
manufacturer to compute an ASP. (See section 1847A(c)(4) of the Act.)
    In these instances, we must make the determination of whether the 
payment amount is based on ASP or WAC. Therefore, WAC is required for 
payment in all of these instances.
    As explained in the August 8, 2005 proposed rule (70 FR 45844), we 
had previously published a template which manufacturers must use to 
report ASP data to us; however, the WAC was not included in that 
template. Therefore, because of the requirement to report the WAC and 
the confusion manufacturers have experienced in submitting the WAC data 
we proposed, in a separate information collection notice published 
August 19, 2005 (70 FR 48770), to revise the reporting template to 
include a place to report WAC.
    To clarify the instances when manufacturers are required to report 
the WAC, in the August 8, 2005 proposed rule (70 FR 45844), we stated 
that manufacturers are required to report quarterly both the ASP and 
the WAC for NDCs assigned to a single source drug or biological billing 
code. Manufacturers are also required to report the WAC for use in 
determining the payment during the initial period under section 
1847A(c)(4) of the Act. That is, the WAC is reported for the reporting 
period prior to reporting the ASP based on a full quarter of sales.
    Because the WAC could change during a reporting period, we proposed 
that in reporting the WAC, manufacturers would be required to report 
the WAC in effect on the last day of the reporting period.
    Comment: Some commenters noted that requiring manufacturers to 
report WAC for all single source drugs each quarter encompasses the 
requirement for manufacturers to report WAC for new drugs during the 
initial period. Separately specifying these instances in the preamble 
led some commenters to request clarification of how the proposed policy 
differs from the existing requirements posted on our web site. Several 
manufacturers requested that we clarify in the final rule with comment 
that the WAC in effect on the last day of the reporting period is the 
value to be submitted for that reporting period.
    Response: We agree with the commenters who noted that new drugs are 
a subset of single source drugs. We separately specified the 
requirements for reporting WAC in these two instances so that 
manufacturers would be aware of the reporting requirement and because 
we have discussed these instances separately in past rulemaking.
    The proposed change is different from existing guidance previously 
posted on our web site in that we clarify that submission of the WAC in 
these instances is always necessary for payment to be made. The 
manufacturer does not decide if the WAC is to be submitted and the WAC 
is not submitted only if it is less than the ASP as previously posted 
on our web site. We interpret section 1927(b)(3)(A)(iii)(II) of the Act 
to apply to all NDCs of single source drugs.

Final Decision

    Manufacturers must report WAC for all single source drugs 
(including new drugs) each reporting period. In submitting the WAC, 
manufacturers must report the WAC in effect on the last day of the 
reporting period. We will update our web site to include this decision.
e. Revised Format for Submitting ASP Data
    The August 8, 2005 proposed rule (70 FR 45845) included a 
discussion of the format manufacturers are required to use to report 
the ASP data to us. However, as discussed above, the current template 
does not provide adequate instructions for manufacturers to report both 
the ASP and the WAC. Therefore, we published a separate information 
collection notice on August 19, 2005 (70 FR 48770) and proposed to 
revise the ASP reporting format to accommodate submission of both, the 
ASP and the WAC as well as collect the following additional 
information:
    <bullet> Drug name.

[[Page 70222]]

    <bullet> Package size (strength of product, volume per item, and 
number of items per NDC).
    <bullet> Expiration date for last lot manufactured.
    <bullet> Date the NDC was first marketed (for products first 
marketed on or after October 1, 2005).
    <bullet> Date of first sale for products first sold on or after 
October 1, 2005.
    Comment: We received several comments in response to the proposed 
rule related to our separate information collection notice on the 
proposed changes to the ASP reporting format (CMS-10110; see 70 FR 
48770). The commenters generally supported inclusion of the WAC and 
drug name within the reporting format. Some commenters expressed 
concerns related to the level of burden that would be necessary to 
report some of the proposed additional data elements, particularly the 
date the NDC was first marketed. Some commenters suggested refinements 
to the definitions of the proposed data elements and the frequency of 
their collection. In addition, commenters suggested that we consider 
using data elements collected by Medicaid in lieu of the proposed data 
elements pertaining to first marketing date, first date of sale, and 
expiration date. In addition, commenters stated that they were 
uncertain when the proposed changes to the reporting requirements would 
be effective.
    Response: We appreciate receiving the comments on the proposed 
additional data elements and the proposed revisions to Addendum A used 
to report ASP data. To be considered timely, comments on the proposed 
modification to ASP reporting format must have been mailed within 60 
days of that notice (by October 18, 2005). All timely comments were not 
available for consideration at the time of the preparation of this 
final rule with comment. Changes to the ASP information collection 
(CMS-10110; OMB control number 0938-0921), if adopted by CMS and 
approved by the OMB, would be effective as of the approval date of the 
information collection submission Manufacturers would begin reporting 
the additional data elements with the next reporting deadline.
f. Limitations on ASP
    Section 1847A(d)(1) of the Act states that ``the Inspector General 
of HHS shall conduct studies, which may include surveys to determine 
the widely available market prices (WAMP) of drugs and biologicals to 
which this section applies, as the Inspector General, in consultation 
with the Secretary determines to be appropriate.'' Section 1847A(d)(2) 
of the Act states that ``Based upon such studies and other data for 
drugs and biologicals, the Inspector General shall compare the ASP 
under this section for drugs and biologicals with--
    <bullet> The widely available market price (WAMP) for these drugs 
and biologicals (if any); and
    <bullet> The average manufacturer price (AMP) (as determined under 
section 1927(k)(1) of the Act for such drugs and biologicals.''
    Section 1847A(d)(3)(A) of the Act states that ``The Secretary may 
disregard the ASP for a drug or biological that exceeds the WAMP or the 
AMP for such drug or biological by the applicable threshold percentage 
(as defined in subparagraph (B)).'' The applicable threshold is 
specified as 5 percent for CY 2005. For CY 2006 and subsequent years, 
section 1847A(d)(3)(B) of the Act establishes that the applicable 
threshold is ``the percentage applied under this subparagraph subject 
to such adjustment as the Secretary may specify for the WAMP or the 
AMP, or both.''
    For CY 2006, we proposed to specify an applicable threshold 
percentage of 5 percent for both the WAMP and AMP. We did not receive 
the OIG's final report in time for consideration before developing the 
proposed rule. Thus, we believe that continuing the CY 2005 threshold 
percentage applicable to both the WAMP and AMP is most appropriate.
    Comment: One commenter stated its support of credible drug rates 
that are based upon widely accepted health care industry standards, and 
that are established using methodologies that are clear and readily 
understood by persons with health care industry knowledge. In this 
context, the commenter expressed concern about how well the terms WAMP 
and AMP are understood across the health care industry. Several 
commenters supported our proposal to retain 5 percent as the applicable 
threshold for 2006, while strongly urging that we not implement the 
provisions relating to substitution of the ASP until notice and comment 
rulemaking is conducted. Many commenters referred to the language in 
the Conference Report accompanying the MMA that discusses rulemaking in 
connection with this issue and requested that we follow the intent of 
that language and provide the public the opportunity to evaluate the 
validity of the processes used and the data obtained by OIG.
    Response: We appreciate the commenter's acknowledgement that we are 
required to specify the threshold percentage applicable in 2006. 
Section 1847A(d)(3)(B)(i) of the Act specified the applicable threshold 
percentage for 2005. Section 1847A(d)(1) of the Act requires that the 
OIG conduct studies to determine the WAMPs, and the OIG began its study 
activities shortly after the passage of the MMA. Upon completion, the 
OIG's findings and methodology will be available to the public. We are 
aware of the Conference Report language; however, given the statutory 
requirements in section 1847A(d), we do not believe rulemaking is 
appropriate at this time.

Final Decision

    We will establish 5 percent as the applicable threshold for 2006.
2. Payment for Drugs Furnished During CY 2006 in Connection With the 
Furnishing of Renal Dialysis Services if Separately Billed by Renal 
Dialysis Facilities
    Section 1881(b)(13)(A)(iii) of the Act indicates that payment for a 
drug furnished during CY 2006 and subsequent years in connection with 
the furnishing of renal dialysis services, if separately billed by 
renal dialysis facilities, will be based on the acquisition cost of the 
drug as determined by the OIG report to the Secretary as required by 
section 623(c) of the MMA or, the amount determined under section 1847A 
of the Act for the drug, as the Secretary may specify. In the report 
entitled, ``Medicare Reimbursement for Existing End Stage Renal Disease 
Drugs,'' the OIG obtained the drug acquisition costs for the top 10 
ESRD drugs for the 4 largest ESRD chains as well as a sampling of the 
remaining independent facilities. Based on the information obtained 
from this report, for CY 2005, payment for the top 10 ESRD drugs billed 
by freestanding facilities and payment for EPO billed by hospital-based 
facilities was based on acquisition costs as determined by the OIG. Due 
to the lag in the data obtained by the OIG, we updated the acquisition 
costs for the top 10 ESRD drugs to 2005 by the PPI. The separately 
billable ESRD drugs not contained in the OIG report were paid at the 
ASP+6 percent for freestanding facilities. The payment allowances for 
these remaining drugs were updated on a quarterly basis during 2005.
    Section 1881(b)(13)(A)(iii) of the Act gives the Secretary the 
authority to establish the payment amounts for separately billable ESRD 
drugs beginning in 2006 based on acquisition costs or the amount 
determined under section 1847A of the Act. As discussed in the proposed 
rule, we do not believe that it is appropriate to continue to use

[[Page 70223]]

2002 acquisition costs updated by the PPI for another year as the basis 
for payment. The acquisition costs are based on 2002 data which, 
despite updates by the PPI do not necessarily reflect current market 
conditions. Thus, the chances increase that Medicare payments will 
either overpay or underpay for drugs resulting in payments that are 
inconsistent with the goal of making accurate payments for drugs. We 
also considered whether actual acquisition cost data could be 
periodically updated. However, we do not believe that it would be 
feasible to base Medicare payments over the long term on continually 
acquiring data on actual acquisition costs from ESRD facilities. This 
approach would provide incentives for manufacturers and facilities to 
increase acquisition costs without constraint. It also would not 
necessarily provide data regarding current market rates. Therefore, we 
proposed that the payment methodology for all ESRD drugs when 
separately billed by freestanding ESRD facilities during CY 2006 be the 
amount determined under section 1847A of the Act. This payment amount 
is the ASP+6 percent rate.
    Based on an analysis of the 2002 acquisition costs for the top 10 
separately billable ESRD drugs, when updated by the PPI for CY 2006, it 
is our contention that relying on 2002 acquisition cost data updated 
for a number of years as would be necessary to establish a payment 
amount for 2006 is not the most appropriate option for determining 
Medicare payment rates when other drug-specific pricing is available. 
Further, we contend that relying on the ASP+6 percent as the payment 
rate for all separately billable ESRD drugs when billed by freestanding 
ESRD facilities for CY 2006 is a more reliable indicator of the market 
transaction prices for these drugs. The ASP is reflective of 
manufacturer sales for specific drug products and is more indicative of 
market and sales trends for those specific products than the 2002 OIG 
acquisition cost data.
    We also note MedPAC's recommendation in its June 2005 report that 
the ASP be the basis of payment for all separately billable ESRD drugs 
provided by both freestanding and hospital-based facilities in CY 2006 
(MedPAC, ``Report to the Congress: Issues in a Modernized Medicare 
Program,'' June 2005). In making this recommendation, MedPAC states 
that the ASP data are more current (updated quarterly) and more likely 
to reflect actual transaction prices when compared with acquisition 
cost data which are not regularly collected by the OIG or CMS. 
Furthermore, the report indicated that utilizing the same payment 
policy for both freestanding and hospital-based facilities would ensure 
uniformity across the various settings irrespective of the site of 
care. In addition, MedPAC recommends in its report that we obtain, ``* 
* * data to estimate hospitals'' costs and Medicare's payment per unit 
for these drugs. No published source identifies the unit payment for 
these drugs because Medicare pays hospitals their reasonable costs.'' 
MedPAC further states: ``We attempted to calculate the unit payment 
from 2003 claims data, but the accuracy of the data fields we needed to 
make this calculation was unclear, particularly the number of units 
furnished and Medicare's payment to the hospital.'' MedPAC also 
recommends that CMS or the OIG collect acquisition cost data 
periodically in the future to gauge the appropriate percentage of ASP 
for the payment amount.
    We acknowledged MedPAC's recommendations regarding uniformity 
across the various settings irrespective of the site of care and 
believe it is more appropriate to pay for separately billed drugs 
furnished in hospital-based facilities under the ASP+6 percent 
methodology rather than on a reasonable cost basis.
    Therefore, for CY 2006, we proposed that payment for a drug 
furnished in connection with renal dialysis services and separately 
billed by freestanding renal dialysis facilities and EPO billed by 
hospital-based facilities be based on section 1847A of the Act. We 
proposed to update the payment allowances quarterly based on the ASP 
reported to us by drug manufacturers. We sought comment on our proposed 
decision to revise the payment methodology for separately billable ESRD 
drugs and about the potential method we have discussed in other 
sections of this final rule with comment which would permit us to pay 
hospital-based facilities under the ASP+6 percent methodology for 2006. 
We also sought comment on how this proposed decision could affect 
beneficiaries' or providers' access to these drugs.
    We received numerous comments regarding our proposal to pay for 
drugs furnished in connection with renal dialysis services and 
separately billed by free-standing renal dialysis facilities as well as 
EPO billed by hospital-based facilities at the ASP+6 percent payment 
methodology. We also received comments on our proposal to continue to 
pay hospital-based facilities reasonable cost for separately billable 
ESRD drugs. Those comments and responses are provided below.
    Comment: Several commenters agreed with our proposal to use the 
ASP+6 percent methodology as the basis for payment for drugs furnished 
in connection with renal dialysis services and separately billed by 
free-standing renal dialysis facilities as well as EPO billed by 
hospital-based facilities and our decision to update the payment 
allowances on a quarterly basis. These commenters viewed the ASP+6 
percent payment methodology as superior to the average acquisition 
payment methodology as the ASP+6 percent methodology enables payment to 
reflect the actual market transaction prices for ESRD drugs. Commenters 
stated that reliance on the ASP+6 percent methodology will lead to a 
more uniform payment policy across care settings. These commenters 
strongly recommended that we finalize our proposal to pay all ESRD 
drugs when separately billed by freestanding ESRD facilities, as well 
as EPO when furnished in hospital-based facilities at ASP+6 percent. It 
was noted that the ASP+6 percent methodology is easier for us to 
administer as we already collect and update ASP data on a quarterly 
basis. Other commenters were cautious in regards to the ASP system, 
indicating that although the shift from average acquisition cost to 
ASP+6 percent appeared rational, the ASP would be largely influenced by 
the lower large provider price. As a result, the ASP prices would not 
reflect the acquisition costs for all providers. Small dialysis 
facilities would be unable to purchase ESRD drugs at the proposed 
prices and would be at risk of being paid well below their acquisition 
costs, as they lack the same buying power or economics of scale that 
larger facilities possess. Some commenters focused on statements we 
made in the past in which we stated that we expected smaller providers 
to join buying groups in order to reduce acquisition costs. These 
commenters stated that although almost all small dialysis providers 
belong to such buying groups, such arrangements have not reduced the 
disparity between the large providers' acquisition prices and the small 
providers' acquisition prices. Commenters suggested that this ``market 
dynamic'' with extremely different buying power among providers does 
not exist in any other market where we have established drug payment 
policies.
    Response: We agree with the commenters who suggested that we 
establish the 2006 payment rates for drug furnished in connection with 
renal dialysis services and separately billed

[[Page 70224]]

by freestanding renal dialysis facilities and EPO billed by hospital-
based facilities using the ASP, rather than use the 2002 average 
acquisition costs updated by the PPI. We also agree for 2006 to apply 
the quarterly update of ASP data to payment for drugs furnished by 
freestanding renal dialysis facilities and EPO billed by hospital-based 
facilities.
    After consideration of the feasibility of continuing to use 2002 
acquisition costs updated by the PPI for another year, we have 
determined that the ASP+6 percent methodology is the most accurate 
measure for paying for EPO furnished in hospital-based facilities and 
for separately billable ESRD drugs provided in freestanding dialysis 
facilities.
    Implemented in 2005 by the MMA of 2003, the ASP methodology is 
based on data submitted by manufacturers of Medicare Part B drugs. The 
ASP for all drug products included within the same billing and payment 
code is the volume-weighted average of the manufacturers' ASPs reported 
to us across all the NDCs assigned to the billing or payment code. 
Therefore, the ASP is a more accurate indicator of market trends for 
specific drugs.
    We do not agree with commenters who suggest that varying buying 
power only exists among providers of ESRD drugs. Other purchasers of 
Part B drugs have expressed concerns to us regarding a variation in 
buying power. We will continue to support groups representing Medicare 
Part B drug purchasers, especially small and rural purchasers, to help 
them identify the most favorable drug prices possible.
    Comment: Many commenters requested that if we implemented the ASP-
based methodology for separately billable ESRD drugs, we should utilize 
the most recently available ASP data and update that data quarterly. 
These commenters expressed concern about the significant lag time 
apparent in the current ASP methodology, indicating the lag time 
results in a decrease in payment that no dialysis facility has the 
ability to make up. Commenters encouraged us to provide retrospective 
payments to dialysis facilities, particularly small or independent 
dialysis providers to prevent such facilities from reducing services or 
from closing. One large drug manufacturer suggested that we consider an 
alternative drug payment option for small providers and we assure that 
these providers are not negatively affected by changes in the payment 
policy for drugs. Commenters suggested that we utilize a methodology 
that uses average acquisition price for small providers as the marker 
for ESRD drug reimbursement, citing section 1881(b)(13)(A)(ii) of the 
Act as the authority. Under this system, we would collect acquisition 
cost data from small providers, update the data for the current year 
and establish payment rates on these acquisition costs. Other 
commenters suggested that we consider establishing an exception process 
whereby rural or inner city ESRD facilities could request an alternate 
payment based on their actual drug acquisition costs as a result of 
unique economic circumstances. Some commenters suggested that we 
exclude EPO from the ASP payment methodology, stating that EPO has only 
one manufacturer and accounts for a large proportion of drug payment to 
independent dialysis facilities. Some commenters suggested that 
contracts of large providers are able to influence the ASP for EPO and 
for these providers; the acquisition price will be close to ASP. The 
inclusion of EPO in the ASP methodology will create disparity in 
patient care.
    Response: In response to concerns regarding the significant lag 
time apparent in the ASP methodology, the ASP methodology is based on 
ASPs reported by manufacturers quarterly. Manufacturers must report to 
us no later than 30 days after the close of the quarter. We implement 
these new prices through program instructions or otherwise at the first 
opportunity after we receive the data, which is the calendar quarter 
after receipt.
    We do not agree with commenters who suggested that we permit small, 
rural, or inner city ESRD facilities to request an alternate payment 
based on their actual drug acquisition costs, or that we exclude EPO 
from the ASP payment methodology. We do not have that authority. 
Section 1881(b)(13)(A)(iii) of the Social Security Act states that the 
Secretary chooses the methodology to determine payment rates for all 
drugs separately billed by ESRD facilities. The language refers to the 
choice of acquisition costs as determined by the Inspector General of 
the ASP rates. Section 1881(b)(13)(A)(ii) does not provide authority 
for individual providers to choose whether to be paid on the basis of 
costs or the ASP method.
    Comment: Several organizations stated that payment differences 
should be eliminated for separately billable drugs furnished in 
independent and hospital-based facilities and the ASP payment 
methodology should be used for all drugs provided in hospital-based 
facilities. One commenter agreed with our concerns regarding the lack 
of available data from hospital claims and recommended that the 
Secretary collect data on the acquisition cost and payment per unit for 
drugs furnished by hospital-based providers, or consider using the unit 
dosing information obtained from claims submitted by freestanding 
dialysis facilities and consult with clinical experts regarding the 
appropriateness of the dose data.
    Response: We agree with commenters who suggested that we utilize 
the same payment methodology for separately billable drugs furnished in 
independent facilities and hospital-based facilities. For reasons 
discussed in the ESRD section of this final rule with comment, we 
believe it is appropriate to implement the ASP payment methodology for 
all drugs provided in hospital-based facilities.
    Comment: Prompt pay discounts are included in the calculation of 
the ASP; however, commenters stated that small customers do not 
normally receive such discounts. Rather, these customers are charged an 
additional service fee to the price of the product. Thus, by including 
prompt pay discounts in the calculation of the ASP, the ASP is lowered, 
but the small providers are not privy to such discounts. Commenter also 
stated that sales to cutomers outside of independent dialysis 
facilities are included in the calculation of the ASP and thus, 
contribute to the difference between manufacturer-provided ASPs and 
provider acquisition costs. They stated that we have established a 
distinct methodology for drug payment for hospital-based dialysis 
facilities, and therefore, it is inappropriate to include such 
customers in the ASP payment system for independent dialysis 
facilities.
    Response: In the calculation of the ASP, as specified in Section 
1847A(c)(3), a manufacturer should include volume discounts, prompt pay 
discounts, cash discounts, free goods that are contingent on any 
purchase requirements, chargebacks, and rebates (other than rebates 
under the Medicaid rebate statute). We lack the statutory authority to 
permit manufacturers to exclude prompt pay discounts from the 
calculation of the ASP. Further, the statute does not permit the 
exclusion of or differentiation by classes of trade in the calculation 
of the ASP payment rates, except for the specific statutory exceptions 
described in the Medicaid best price calculation under sections 
1927(c)(1)(C)(i) and 1927(c)(1)(C)(ii)(III) of the Act.
    Comment: Several commenters stated that the ASP methodology does 
not take into consideration provider costs for storage, handling, and 
wastage. Small

[[Page 70225]]

providers will be disadvantaged as they have less efficient and more 
costly systems for storage and handling.
    Response: The ASP+6 percent payment methodology was not intended to 
cover the handling and storage of drugs.
3. Clotting Factor Furnishing Fee
    Section 303(e)(1) of the MMA added section 1842(o)(5) of the Act 
which requires the Secretary, beginning in CY 2005, to pay a furnishing 
fee in an amount the Secretary determines to be appropriate to 
hemophilia treatment centers and homecare companies for the items and 
services associated with the furnishing of blood clotting factor. In 
the CY 2005 final rule (69 FR 66236), we established a furnishing fee 
of $0.14 per unit of clotting factor for CY 2005. Section 1842(o)(5) of 
the Act specifies that the furnishing fee for clotting factor for years 
after CY 2005 will be equal to the fee for the previous year increased 
by the percentage increase in the consumer price index (CPI) for 
medical care for the 12-month period ending with June of the previous 
year. The percent increase for the 12 months ending June 2005 is 4.2 
percent. Consequently, the furnishing fee will be $0.146 per unit 
clotting factor for CY 2006. While the furnishing fee payment rate is 
calculated at 3 digits, the actual amount paid to providers and 
suppliers is rounded to 2 digits. The requests to publish the 2006 
furnishing fee in the final rule with comment were the only comments we 
received on the clotting factor section in the proposed rule.
4. Payment for Inhalation Drugs and Dispensing Fee
    Medicare Part B pays for inhalation drugs administered via a 
nebulizer, a covered item of DME. Beginning in CY 2006, coverage for 
inhalation drugs administered through metered dose inhalers will 
generally be available through the Medicare Part D benefit. This 
represents an important expansion in the options available to 
beneficiaries for inhalation drug coverage under Medicare. We expect 
that both modes of inhalation drug delivery will play an important role 
in the Medicare program in the years to come.
    Prior to CY 2004, most Medicare Part B covered drugs, including 
inhalation drugs administered by a nebulizer (hereafter referred to as 
inhalation drugs), were paid at 95 percent of the AWP. Numerous studies 
by the OIG and GAO indicated that 95 percent of AWP substantially 
exceeded suppliers' acquisition costs for Medicare Part B drugs, 
particularly for the high volume inhalation drugs, albuterol and 
ipratropium bromide.\1\ The MMA changed the Medicare payment 
methodology for many Part B covered drugs, including inhalation drugs. 
As an interim step, in CY 2004, Medicare paid a reduced percentage of 
AWP, 80 percent of AWP in the case of albuterol and ipratropium 
bromide. Beginning with CY 2005, Medicare paid for inhalation drugs at 
106 percent of the average sales price (ASP+6 percent).
---------------------------------------------------------------------------

    \1\ GAO, ``Medicare Payment for Covered Outpatient Drugs Exceed 
Providers' Costs,'' September 2001. OIG, ``Excessive Medicare 
Reimbursement for Albuterol,'' March 2002.
---------------------------------------------------------------------------

    In addition to making payment for the drug itself, Medicare also 
pays a dispensing fee to suppliers of inhalation drugs. Prior to CY 
2005, Medicare paid a monthly $5 dispensing fee for each covered 
inhalation drug or combination of drugs used. In the August 5, 2004 
proposed rule (69 FR 47488), we sought comment on an appropriate 
dispensing fee level to cover the shipping, handling, compounding, and 
other pharmacy activities required to get these medications to 
beneficiaries. We received many comments asserting that a substantial 
fee was needed to compensate suppliers for a wide range of costs 
associated with dispensing drugs to beneficiaries, with many citing a 
2004 report prepared by a consultant for the American Association for 
Homecare (AAH) that recommended a $68 fee.\2\ The 2004 AAH report 
provided information for 10 cost categories: clinical intake; 
establishing/revising the plan of care; delivery of services; 
compliance monitoring/refill calls; billing/collections; other direct 
costs; patient education; caregiver training; care coordination; and 
in-home visits. In addition, as discussed in the August 8, 2005, 
proposed rule, a 2004 study by the GAO showed substantial variation in 
supplier costs of dispensing inhalation drugs.\3\ With the wide 
variation in the reported costs and services provided by inhalation 
drug suppliers suggested by the comments and the GAO study, we stated 
in the CY 2005 final rule (69 FR 66338) that we would establish an 
interim dispensing fee for inhalation drugs applicable for CY 2005 and 
reconsider the issue for CY 2006. The 2005 dispensing fee for a 30-day 
supply of inhalation drugs was based on the industry recommended $68 
fee from the 2004 AAH study, excluding certain costs that Medicare 
generally does not reimburse regardless of the Medicare Part B benefit 
category (that is, sales and marketing, bad debt, and an explicit 
profit margin). The resulting fee established for a 30-day supply of 
inhalation drugs was $57 for CY 2005. Because the 2004 AAH study did 
not establish a fee for a 90-day supply, we applied the methodology 
used in the 2004 GAO report to convert the 30-day fee to a 90-day fee. 
Accordingly, the 2005 fee established for a 90-day supply was $80. In 
establishing the dispensing fee rates for 2005, we indicated in the CY 
2005 final rule that although the AAH study contained costs related to 
services that may be of potential benefit to our beneficiaries, we were 
concerned that these services may be outside the scope of a dispensing 
fee. We indicated that we would consider this issue further in order to 
establish an appropriate dispensing fee for CY 2006.
---------------------------------------------------------------------------

    \2\ Muse & Associates Report for the American Assoication for 
Homecare, ``The Cost of Delivering Inhalation Drug Services to 
Medicare Beneficiaries,'' August 2004.
    \3\ GAO, ``Appropriate Dispensing Fee Needed for Suppliers of 
Inhalation Therapy Drugs,'' GAO-050-72, October 2004.
---------------------------------------------------------------------------

    As discussed in the August 8, 2005 proposed rule (70 FR 45847), we 
indicated that we intend to establish a dispensing fee amount for 2006 
that is appropriate to cover the costs of those services that fall 
within the scope of a dispensing fee. Furthermore, we indicated that we 
thought this fee amount likely would be lower than the current fee of 
$57 per 30-day period in 2005. In the proposed rule we solicited public 
comments and information on a number of issues including the following:
    <bullet> What services appropriately fall within the scope of a 
dispensing fee; the cost of providing those services; and, whether any 
of the services being provided by inhalation drug suppliers may be 
covered through another part of the Medicare program, such as the PFS 
or the DME benefit.
    <bullet> An appropriate dispensing fee level for 2006 as well as 
data and information on the various services inhalation drug suppliers 
are currently providing to Medicare beneficiaries and the associated 
costs, and typical dispensing costs for an efficient, high-quality 
supplier.
    <bullet> The extent to which inhalation drug suppliers have 
utilized the newly available 90-day scripts in order to reduce unit 
shipping costs and any reasons as to why 90-day supplies may not have 
been utilized.
    <bullet> How revised guidelines regarding the timeframe for 
delivery of refills has affected the need for overnight delivery 
services as well as the extent to which suppliers have shifted their 
shipping to ground services.
    <bullet> Comments on the potential impact on beneficiaries and 
providers of possible changes to the inhalation drug dispensing fee in 
2006, as well as the

[[Page 70226]]

impact of the new drug benefit on inhalation drug access.
    Comment: Many commenters suggested that dispensing inhalation drugs 
to Medicare beneficiaries involves a wide range of services that should 
be compensated through the dispensing fee. A number of commenters 
referenced a 2005 report by an industry consultant sponsored by the 
AAH.\4\ The 2005 AAH report indicated that suppliers provide services 
in seven broad categories: Intake; compounding, dispensing, and 
pharmacy assessment; delivery, set-up, and patient education; follow-up 
and compliance monitoring; quality assurance, accreditation, licensing, 
and regulatory compliance; Medicare billing and compliance; and other 
direct and indirect costs and expenses. Within these seven categories, 
the 2005 AAH report indicated that there were ``117 discrete services'' 
provided to or on behalf of Medicare beneficiaries. The 2005 report 
surveyed 82 homecare pharmacies. The vast majority of survey 
respondents thought the 117 discrete services outlined by the 
consultant fell within the scope of a dispensing fee, and the vast 
majority of respondents indicated they were providing these services. 
Several commenters suggested that the survey demonstrated there was 
widespread agreement that the standard of care for inhalation drug 
suppliers involved a wide range of services. In addition, one commenter 
asserted that the 117 services identified in the 2005 AAH report 
encompassed all of the functions identified in the 2004 AAH report 
prepared by the same consultant, which formed the basis of the 2005 
fee.
---------------------------------------------------------------------------

    \4\ Muse Associates Report Prepared for the American Association 
for Homecare, ``Examination of Inhalation Drug Services to Medicare 
Beneficiaries Under the Average Sales Price Reimbursement 
Methodology In Response to the CMS Notice of Proposed Rule Making 
(CMS-1502-P),'' September 2005.
---------------------------------------------------------------------------

    Response: We established the interim dispensing fee for 2005 based 
on cost data from the 2004 AAH report. That report provided cost data 
for 10 service categories: Clinical intake; establishing/revising the 
plan of care; delivery of services; compliance monitoring/refill calls; 
billing/collections; other direct costs; patient education; caregiver 
training; care-coordination; and in-home visits. In using this data to 
establish the 2005 fee in the CY 2005 final rule, we indicated that we 
were concerned that some of the services in the industry cost data may 
be outside the scope of a dispensing fee and we would revisit this 
issue further in order to establish an appropriate dispensing fee for 
CY 2006. As discussed in the August 8, 2005, proposed rule, we continue 
to have concerns with respect to what services should be included 
within the dispensing fee payment.
    Authority for a dispensing fee for inhalation drugs is based on 
section 1842(o)(2) of the Act, which provides that if payment is made 
to a licensed pharmacy for a drug or biological under Medicare Part B, 
the Secretary may pay a dispensing fee (less the applicable deductible 
and coinsurance) to the pharmacy. The statute did not define the term 
dispensing fee or set parameters as to what activities should be 
included within the scope of that definition. However, as discussed 
below, we do not believe the Congress intended us to adopt the broad 
reading of dispensing fee suggested by commenters.
    We are not persuaded by suggestions that Medicare should broadly 
define the definition of dispensing fees for inhalation drugs to 
include pharmacy care management services such as patient education, 
caregiver training, care coordination, and in-home visits. A number of 
commenters suggested the dispensing fee be based on the total costs of 
supplying inhalation drugs indicated by the 2004 AAH report data. That 
data indicated that suppliers expend on average 63.5 minutes per new 
patient and 50 minutes per established patient per month on patient 
education, caregiver training, care coordination, and in-home visits. 
Such services represent pharmacy care management services, which (if 
included in dispensing fee payments) would extend the definition of 
dispensing fee beyond what we believe should be reasonably included 
within the scope this benefit. As an initial matter, we do not believe 
that there is any indication that the Congress intended these care 
management activities to be included in the definition of dispensing 
fees. Where the Congress wished for us to cover the costs of such 
training and management services under Medicare, it specifically 
directed us to do so (for example, by amending the statute to recognize 
diabetes outpatient self management training under Medicare Part B and 
medication therapy management programs under Medicare Part D (see 
sections 1861(qq) and 1860D-4(c) of the Social Security Act). 
Therefore, in accordance with our interpretation of the statute, we do 
not believe it is reasonable for us to define the term dispensing fee 
under Medicare Part B to include the costs of such services.
    In addition, we also believe that the inclusion of beneficiary 
education and training about use of nebulizers would raise duplicate 
payment issues. Payment for DME is based on fee schedule amounts which 
include, in part, amounts for training beneficiaries on the use of 
nebulizer equipment. Thus, the equipment supplier is responsible for 
educating the beneficiary on the use of the DME or ensuring that 
``another qualified party'' has done so as specified in Sec.  
424.57(c)(12). In addition, under the physician fee schedule Medicare 
makes a separate payment for beneficiary training by a physician or 
physician's staff regarding use of a nebulizer (CPT code 94664, 
demonstration and/or evaluation of patient utilization of an aerosol 
generator, nebulizer, metered dose inhaler or IPPB device). We believe 
that physicians can play an important role in beneficiary training 
concerning the use of nebulizers, as they are ultimately responsible 
for directing beneficiary care, and determining what drug treatment 
regimen is most effective for an individual patient. Accordingly, 
because payment for education, training, and management concerning use 
of nebulizer equipment may be separately recognized under Medicare, we 
are concerned that the inclusion of such services within the definition 
of dispensing fee would increase the potential for double billing.
    We are also not persuaded by commenters' suggestions that the 2005 
AAH report demonstrates that the standard of care for supplying 
inhalation drugs includes a broad range of services. The 2005 AAH 
report presented results from a survey of homecare companies, in which 
the companies were asked whether 117 activities or overhead items 
should be included in the dispensing fee and whether the companies 
currently provide or undertake each activity/item (although the 
frequency and extent to which each activity/item was provided was not 
asked). The 2005 report identified services provided but failed to 
provide any information on the proportion of beneficiaries actually 
receiving various services (for example, patient education, caregiver 
training, in-home visits). It also did not provide any information on 
the cost of various services (other than delivery), or the amount of 
time involved in providing these services to the typical beneficiary. 
Consequently, the 2005 AAH report fails to demonstrate that the 117 
activities/overhead items outlined in the 2005 report translate into an 
average of 63.5 minutes per new patient and 50 minutes per established 
patient each month for the care management services of patient 
education, caregiver training, in-home visits, and care coordination in 
the 2004 AAH report. Since the 2005 report did

[[Page 70227]]

not include information on costs, the 2004 AAH report is the only 
information we have on average cost and time per activity. However, 
even the 2004 AAH report does not contain information on the proportion 
of beneficiaries that actually receive the care management services. 
Accordingly, given the data identified in the reports, we are not 
persuaded by the AAH reports that the standard of care for supplying 
inhalation drugs includes extensive care management services for 
patient education, caregiver training, in-home visits, and care 
coordination.
    Furthermore, a September 2005 OIG study entitled ``Review of 
Services Provided by Inhalation Drug Suppliers'' \5\ found little 
evidence that inhalation drug suppliers provide care management 
services to many beneficiaries. The OIG report sought to ascertain the 
nature and extent of services provided by inhalation drug suppliers. 
The OIG examined services such as clinical intake, revising the plan of 
care, patient/caregiver education, responding to patient/caregiver 
inquiries about the drug, contacting the physician's office, contacting 
a patient for a refill, reviewing medication compliance, and other 
certain services. The OIG did not focus on certain core activities such 
as filling prescriptions, delivery, and billing that they indicated 
were necessary for suppliers to dispense drugs and receive 
reimbursement. They also indicated that they excluded equipment related 
services because Medicare pays suppliers separately for equipment.
---------------------------------------------------------------------------

    \5\ Office of the Inspector General, ``Review of Services 
Provided by Inhalation Drug Suppliers,'' September 2005, OEI-01-05-
00090.
---------------------------------------------------------------------------

    The OIG report concluded that beneficiaries receive few services 
from their inhalation drug supplier beyond calls to ask if they need a 
drug refill. The OIG report found that among beneficiaries with at 
least 2 months of claims in 2003, 16 percent received no services (that 
is, no educational services, refill calls, or other adjunct services 
the OIG examined) from their inhalation drug supplier during the entire 
year. The OIG found that refill calls accounted for the majority of 
services provided by inhalation drug suppliers. In addition, the OIG 
found that only 16 percent of beneficiaries received an educational 
service from their drug supplier, 8 percent made a non-billing inquiry 
to their drug supplier, 8 percent received an in-home visit, 5 percent 
had a care plan revision, and 3 percent received a respiratory 
assessment from their drug supplier at least once during 2003. 
Furthermore, the OIG report indicated that only 27 percent of 
beneficiaries had their medication compliance reviewed by drug supplier 
at least once in 2003, with 89 percent of these reviews occurring 
during refill calls. Accordingly, in light of the OIG findings 
regarding services actually provided, we remain unconvinced regarding 
the standard of care contentions set forth in comments concerning the 
2004 and 2005 AAH reports.
    As mentioned previously, we do not believe it is appropriate to 
include care management services such as patient education, caregiver 
training, care coordination, and in-home visits in the inhalation drug 
dispensing fee. Furthermore, the OIG found that few care management 
services were actually provided to a typical beneficiary. While it is 
possible that some types of care management services may be of 
potential benefit to some beneficiaries, at this time there is not 
clear evidence that such services are widely provided to beneficiaries 
nor have there been studies evaluating the effect of such services on 
beneficiary outcomes. Given such concerns, we do not believe it is 
appropriate for us to define dispensing fee under Medicare Part B to 
include care management services. However, we believe it is very 
important that the Medicare program support better patient care 
outcomes, particularly for beneficiaries with chronic respiratory 
conditions. We plan to explore how the Medicare program can engage 
physicians and their partners on issues of quality and performance to 
foster high quality of care for Medicare beneficiaries using 
respiratory drugs. For example, we believe there may be an opportunity 
under our demonstration authority to implement a demonstration program 
to test whether care management and care coordination services by 
physicians and their partners can improve health outcomes and reduce 
Medicare costs for beneficiaries who use inhalation drugs.
    Comment: Some commenters criticized the OIG report as being too 
narrow in scope. A few commenters suggested that the OIG study excluded 
many essential services such as drug deliveries and billing activity 
that account for the bulk of services and costs. Another commenter 
suggested that the study did not capture all the services inhalation 
drug suppliers provide, including many that are required by State and 
Federal regulations (for example, Food and Drug Administration and 
State Pharmacy Boards), and standards of care for pharmacy practice. 
The commenters also criticized the OIG report for excluding billing 
services and not taking into account the substantial amounts of time 
spent doing the following: Collecting and processing the relevant 
billing information from the beneficiary and beneficiary's physician, 
which the commenter indicated often requires multiple on-site visits to 
doctors offices; verifying eligibility and processing reimbursement 
from secondary insurers responsible for payment of coinsurance; and 
researching and on-site verification of beneficiary financial and 
living circumstances in order to validate a waiver of coinsurance for 
hardship. The commenters also criticized the OIG report for not taking 
into account non-payment of coinsurance by Medicaid, the costs of 
Medicare billing requirements, and costs of oversight by multiple 
carriers. Furthermore, several commenters suggested that the OIG study 
undercounted services because the OIG survey instrument requested 
documentation for each service provided and the report focused on 
documented services. Some commenters suggested that this approach left 
out those services for which suppliers did not have documentation, 
either because they had discarded the documentation after it was no 
longer useful or because they had not documented services since there 
was no requirement to do so. Some commenters indicated that the 
mandatory refill calls require two telephone contacts on average before 
contact is made with the beneficiary. One commenter indicated that it 
maintains documentation of failed call attempts only for several 
months, and is not required to maintain long-term documentation of 
repeated calls and visits to patient homes and physicians' offices to 
gather documentation and information. In addition, one commenter noted 
that the OIG report expanded the categories of services it analyzed in 
its report based on information submitted by respondents in the survey 
instrument's ``other'' category. The commenter believed that this meant 
participants in the OIG report may not have always been explicitly 
asked about certain types of services. This commenter also criticized 
the OIG report for not conducting field work to observe the activities 
of inhalation drug suppliers, and indicated its belief that the GAO and 
2004 AAH report included a more thorough analysis. Another commenter 
stated that the OIG report does not address the issue that the costs of 
dispensing drugs are higher than the current $57 fee for high quality 
suppliers in compliance with applicable requirements. Furthermore, the 
commenter stated that

[[Page 70228]]

the service levels suggested in the OIG report are not representative 
of high quality suppliers. The commenter also stated that the behavior 
of noncompliant suppliers should not serve as a basis for reducing the 
fee because they contend the various services are required to comply 
with the regulations of Medicare, other government entities, and 
accrediting or quality assurance organizations.
    Response: We do not find the criticisms of the OIG report 
persuasive. While a number of commenters criticized the methodology and 
findings of the OIG study, we believe that the results of the OIG study 
are credible. The OIG study examined the extent to which certain 
services such as patient/caregiver education, responding to patient/
caregiver inquiries about drugs, revising the plan of care, contacting 
the physician's office, contacting a patient for a refill, reviewing 
medication compliance, and certain other services were actually being 
provided to beneficiaries by inhalation drug suppliers. The OIG failed 
to find evidence that many beneficiaries received such services from 
their inhalation drug suppliers, with the exception of drug refill 
calls.
    Although some commenters criticized the OIG report for not 
including core dispensing activities such as filling the prescription 
and billing, the OIG report indicated that it did not focus on those 
activities because it did not have cause to question that they are 
necessary to dispense drugs and be reimbursed. The OIG instead focused 
on those services where less was known about the extent to which the 
services were actually being provided to beneficiaries. The OIG report 
examined a set of services that accounted for 60 percent of costs 
included in the 2004 AAH data. In addition, some costs cited by one 
commenter as being improperly excluded from the OIG study, such as non-
payment of coinsurance by Medicaid, costs associated with waivers of 
coinsurance for indigent beneficiaries, and assessment of the 
beneficiary's situation for coinsurance waiver, are not generally 
reimbursed under Medicare Part B as a matter of general policy.
    We are not persuaded by those commenters who suggested that the OIG 
study should be disregarded because the OIG undercounted the number of 
services suppliers actually provide due to the OIG's focus on 
documented services. Although the OIG focused its analysis on 
documented services, the OIG report indicated that if they had included 
undocumented services reported by suppliers in their analysis, the 
average number of services per beneficiary would still have been low 
(increasing from an average of 1.2 to 1.59 services per beneficiary per 
month). In addition, if various services are essential to dispensing 
these drugs to beneficiaries as some have suggested, we would have 
expected that suppliers would have documented the content and frequency 
of the services in patient records in order to track patient progress 
and maintain continuity of care. Furthermore, although some contend 
that the OIG study suggests that some suppliers are non-compliant in 
their provision of required services, as commenters pointed out, the 
OIG study did not generally collect information on the core services 
required to furnish inhalation drugs, with the exception of refill 
recalls. The OIG report found that not all beneficiaries who should 
have received a refill call actually got one. We plan to study the 
issue of refill call compliance further, and we believe it is important 
to reflect the costs of refills call in the dispensing fee.
    In terms of the comment that the OIG study added several service 
categories based on information submitted by commenters, the survey 
instrument included an ``other'' category under which suppliers could 
report any services that were not captured by the categories provided. 
We do not view the opportunity for suppliers to elaborate on the types 
of services provided to be a weakness but rather a strength of the 
study. Although the OIG study was criticized by some for not conducting 
field work, the OIG adopted a methodology that was designed to provide 
information on a representative sample of beneficiaries receiving 
inhalation drugs.
    While the OIG report does not provide information on supplier 
costs, that was not the objective of the OIG study. The OIG report 
provides information on the percent of beneficiaries that received 
various services from their drug suppliers, and as a result, and we 
believe it offers helpful information in our consideration of the 
inhalation drug dispensing fee.
    Comment: We received a number of comments recommending either an 
increase or no reduction in the dispensing fee for 2006. Several 
commenters suggested the 2005 AAH report provided an appropriate fee 
for 2006. For that report, a consultant surveyed homecare pharmacies 
about what fee level they thought was appropriate for 2006. Survey 
respondents on average suggested a fee of $66.55 for a 30-day supply 
and a fee of $138.80 a 90-day supply. Suggested fees from other 
commenters ranged from $57 to $68, with a few commenters suggesting an 
inflation adjustment on top of those levels. One insurer commented that 
the current dispensing fee appears high.
    Some commenters provided cost information as part of their 
contention that the fee should not be reduced or should be increased. 
One large supplier indicated that its costs were about $75 per 
beneficiary for a 30-day period, with the 3 cost categories accounting 
for the largest share being delivery, setup, and patient education 
($20); clinical intake ($15); and compounding, dispensing, and 
assessment ($14). Another supplier indicated its costs broke out as 
follows: delivery, set-up, and patient education (27.3 percent); 
compounding, dispensing, pharmacy assessment (19.0 percent); patient 
intake (17.8 percent); follow-up and compliance monitoring (11.6 
percent); quality assurance, accreditation, licensing and regulatory 
compliance (9.1 percent), other direct and indirect costs (4.2 
percent). The supplier indicated that its costs were largely for 
salaries, freight and other delivery charges, and business 
infrastructure.
    A number of commenters stated that the dispensing fee should not be 
based on retail pharmacy costs, stating that retail pharmacies do not 
provide the array of services that homecare pharmacies do. One retail 
pharmacy clarified its comments from the prior year cited in the 
proposed rule. By suggesting a fee of 5 to 6 times the current fee last 
year, the retail pharmacy said they meant 5 to 6 times the $10 proposed 
supplying fee (for immunosuppressive, oral anticancer, and oral anti-
emetic drugs) for 2005 (that is, $50 to $60). In addition, a 
respiratory company stated that a comment received on the August 5, 
2004 proposed rule from another retail pharmacy, which was cited in the 
August 8, 2005 proposed rule, may have been intended to mean $25 per 
prescription rather than $25 per 30-day period. Also, the commenter 
stated that the prior cost data was irrelevant because it preceded 
experience with the ASP system. Comments from retail pharmacies and a 
pharmacy association indicated support for the dispensing fee level 
urged by the 2005 AAH report.
    A number of commenters stated there would be adverse effects on 
beneficiary access to inhalation drugs if the fee were reduced. Some 
suppliers asserted that they would reduce the services offered to 
beneficiaries or cease supplying inhalation drugs to Medicare 
beneficiaries. A number of commenters pointed to the 2005 AAH survey, 
which indicated that 45 percent of providers

[[Page 70229]]

would not accept Medicare patients if the dispensing fee were reduced 
more than a nominal amount, while 50 percent indicated they would 
reduce services provided to beneficiaries, and 2.5 percent indicated 
they would close. One commenter maintained that some providers had 
already closed or are seeking acquisition by other companies under 
current reimbursement rates. Another commenter speculated that a 
reduction in the dispensing fee would cause a shift away from small 
home care pharmacies to retail pharmacies, and asserted that these 
pharmacies would have to gear up by increasing inventories or directing 
patients to their mail order pharmacies. Some commenters suggested that 
a fee reduction could lead to adverse health effect for beneficiaries, 
reduced quality, or use of more intensive Medicare services. Others 
raised concerns that a reduction could create adverse incentives for 
substituting MDIs for nebulizers, even for patients where nebulizers 
are the preferred delivery mechanism.
    Some commenters suggested that it is premature to reduce the 
dispensing fee. Some of these commenters asserted that CMS did not 
provide any new cost data in the proposed rule that would warrant a 
reduction. Several commenters stated costs had increased due to higher 
fuel prices, unforeseen natural disasters, and wage inflation. Several 
commenters pointed to the 2005 AAH study which indicated that the 
average cost of shipping increased from $12.13 in 2004 to $14.41 in 
2005. One commenter indicated that its overnight shipping costs were 
between $27 to $40 per shipment. Another commenter cited a 12.5 percent 
increase in the fuel surcharge cap for one large shipping company, 
which they indicated would cause their delivery costs to increase an 
additional 4 percent on top of prior increases. One commenter indicated 
that its cost per shipment had increased by $0.40 due to increased fuel 
costs in 2005, and it expected additional future increases. In urging 
an increase in the fee to take into account inflation, another 
commenter mentioned that it had consolidated the number of pharmacies 
it operated to increase efficiency, but indicated that the number of 
costs that could be reduced was limited. Another commenter stated that 
we should not reduce the fee because the agency indicated in a October 
8, 2004 letter to GAO that a fee of $55 to $64 was a reasonable range 
for a 2005 fee. Other commenters asserted that experience with the ASP 
system and the current dispensing fee is too limited to conclude there 
are overpayments. One commenter stated that the payment reduction in 
2005 was greater than the Congressional Budget Office or the CMS 
Actuaries Office had projected prior to passage of the Medicare 
Modernization Act. This commenter suggested actual levels in 2005 
claims data be compared to original estimates before taking any action.
    Response: As noted previously, we established the 2005 dispensing 
fee using data from the 2004 AAH report. That report included costs for 
a wide range of services beyond basic dispensing, such as patient 
education, caregiver training, care coordination, and in-home visits. 
As discussed previously, we believe these activities represent care 
management services that should not fall within the scope of a 
dispensing fee. Furthermore, the September 2005 OIG report found little 
evidence that many beneficiaries receive these care management 
services. Consequently, we are establishing a dispensing fee for 2006 
using the 2004 AAH cost data excluding separable costs for care 
management services. We believe this interpretation represents an 
appropriate reading of the statute. Based on the 2004 AAH data for 
homecare pharmacies, excluding costs for care coordination, in-home 
visits, patient education, and caregiver training (as well as sales, 
marketing, bad debt and profit which were also excluded last year 
because Medicare does not generally reimburse those costs with respect 
to Part B services), we are establishing a dispensing fee of $33 for a 
30-day supply of inhalation drugs. Because greater levels of effort may 
be involved in dispensing inhalation drugs when a patient begins these 
drugs for the first time, we have decided to maintain the current $57 
dispensing fee for the first 30-day period in which an individual uses 
inhalation drugs as a Medicare beneficiary. Thus, beginning in 2006, we 
will pay a dispensing fee of $57 for the first month an individual uses 
inhalation drugs as a Medicare beneficiary, and $33 for a 30-day supply 
of inhalation drugs for all other months.
    Although some commenters urged an inflation adjustment, we do not 
believe it is warranted for 2006 because we do not believe it is clear 
that total dispensing costs have increased since the 2004 industry cost 
data was collected. Although data from the 2004 industry report may not 
reflect wage inflation or increased delivery costs due to fuel price 
increases, it would also not include any efficiencies that providers 
may have achieved as they have adjusted to the new payment system in 
2005. The 2005 AAH report did not provide updated cost data for the 
service categories included in the 2004 AAH report. Given that the 2004 
AAH cost data would not reflect inflationary pressures, nor increased 
efficiencies in business operations, it is uncertain whether an upward 
or downward adjustment to the 2004 cost data should be made. As a 
result, we believe it is best to use the 2004 AAH data as is. We will 
consider the appropriateness of an inflation adjustment for the future.
    Regarding concerns raised by some commenters about beneficiary 
access, we believe, as discussed previously, that the fee level we are 
establishing is appropriate to cover suppliers' dispensing costs, and 
beneficiaries will maintain good access to inhalation drugs. The fee 
amount is based on the 2004 AAH cost data for clinical intake, 
establishing/revising the plan of care, delivery of services, refill 
calls/compliance monitoring, billing/collections, ``other'' direct 
costs, and indirect costs, excluding sales, marketing, bad debt, and 
profit which are not reimbursed by Medicare. Having based the 2006 
dispensing fee on industry cost data for those activities that we 
believe fall within the scope of a dispensing fee, we believe the fees 
are appropriate to cover providers' costs and will not impair access. 
In addition, we will continue to monitor access to care.
    Regarding concerns raised by some commenters about CMS lowering the 
fee without the benefit of new cost data, we believe it is our 
fiduciary responsibility to establish an appropriate payment for 2006. 
As discussed previously, our decision is based on our determination 
that certain services should not fall within the scope of the 
dispensing fee and the OIG report which found that these services are 
furnished infrequently to beneficiaries. We believe our decision to 
lower the fee for 2006 is consistent with our October 8, 2004 letter to 
the GAO, in which we stated that a dispensing fee in the range of $55 
to $64 would be appropriate for the interim 2005 fee. Regarding the 
comment that the savings from the ASP system are greater for inhalation 
drugs than the savings projected by CBO or the CMS actuaries prior to 
enactment of the MMA, we recognize the concerns regarding the shift 
from a payment system based on AWP; however, we do not believe such 
concerns are an appropriate consideration in determining the dispensing 
fee for 2006. Medicare does not generally establish payment rates based 
on budget projections. Rather, we use the most reliable cost data 
available to establish

[[Page 70230]]

a payment rate that is consistent with the statute and appropriate for 
Medicare covered services.
    Comment: In response to our request for comments on providers' 
experience with the dispensing fee for a 90-day supply, we received a 
number of comments. One commenter pointed to the 2005 AAH survey, which 
found that most respondents (77 percent) do not provide a 90-day 
supply, and among those that do it represents 3 percent of their 
business. Reasons cited by survey respondents for non-use of a 90-day 
supply included--(1) 30-day supply promotes more contact with patients 
and compliance monitoring; (2) patient prescriptions often change; and 
(3) many suppliers believed the 90-day dispensing fee ($80 in 2005) was 
not adequate to cover costs. Less than 1 percent indicated they do not 
provide a 90-day supply because it is less profitable than a 30-day 
supply. A few other commenters raised concerns about the 90-day 
dispensing fee and provided similar reasons for non-use of the 90-day 
supply as the 2005 AAH survey. In addition, one commenter cited 
Medicare's refund requirements for unused drugs as being another reason 
for non-use of the 90-day supply. However, one commenter suggested that 
the 90-day supply is not used because it receives less reimbursement 
overall than using the 30-day supply. A physician specialty group 
supported the 90-day prescription because it reduces paperwork and 
redundant efforts by patients, physicians, and DME suppliers.
    Response: We agree with the physician specialty group that 
dispensing a 90-day supply has merit; thus, we have continued the 90-
day dispensing fee for 2006. As cited by respondents to the 2005 AAH 
study, a 30-day supply may be most appropriate for certain 
beneficiaries such as those with changing prescriptions. However, for 
those situations where it is medically appropriate, we believe it is 
important to have a 90-day option available.
    In the CY 2005 final rule, we calculated the 90-day dispensing fee 
by taking direct costs for the 30-day fee and tripling indirect costs 
(which was based on the methodology used in the October 2004 GAO 
report). However, as discussed, some commenters voiced concern about 
the adequacy of the 2005 90-day dispensing fee. Some commenters 
supported the reimbursement amounts suggested by respondents in the 
2005 AAH survey. In that survey, respondents suggested an average fee 
for a 90-day supply ($138.80) that was roughly twice the amount they 
suggested for a 30-day supply ($66.55). For 2006 using a 2 to 1 ratio 
for the 90-day versus 30-day fee would yield a 90-day fee about 40 
percent higher than our previous methodology. We believe it is 
important that adequate reimbursement be available for the 90-day 
option, as well as, the 30-day option. Therefore, using the 2 to 1 
ratio recommended by commenters for the 90-day versus 30-day supply 
payment rates, we are establishing a fee of $66 for a 90-day supply of 
inhalation drugs for 2006.
    Although we established two levels of dispensing fees for a 30-day 
supply, an initial 30-day fee of $57 and a 30-day fee of $33 for all 
other months, we do not believe a higher initial fee is warranted for a 
90-day supply given that we do not believe a 90-day supply is generally 
used when a beneficiary first begins inhalation drugs. A number of 
commenters noted that the 90-day supply is not well-suited for patients 
whose prescriptions are likely to change. We recognize that 
beneficiaries who begin using inhalation drugs for the first time are 
more likely than established patients to experience changes in drugs or 
dosages, or to discontinue use altogether. Accordingly, we do not 
believe it is appropriate to encourage use of a 90-day supply when a 
beneficiary first begins using inhalation drugs by establishing a 
higher initial 90-day fee. Consequently, given such concerns, we have 
not provided two levels of dispensing fees with the 90-day option.
    Comment: Some commenters noted that refill calls are a service 
required by Medicare.
    Response: We agree that Medicare requires that a supplier confirm 
that a beneficiary needs a refill before sending a new shipment, and we 
have included the costs of refill calls from the 2004 AAH report within 
the dispensing fee.
    Comment: A few commenters suggested that many of the activities 
they carry out are required to maintain compliance with FDA, Medicare, 
and State regulations, and with standards imposed by accrediting bodies 
such as JCAHO. Some commenters noted that CMS has issued draft supplier 
quality standards, and that they are required to provide certain 
services as part of those standards. The commenters suggested that the 
dispensing fee should accommodate their costs in these areas.
    Response: With the exception of certain guidelines concerning 
compounding, we do not believe that the requirements applicable to 
inhalation drug suppliers are in general substantially different from 
the requirements applicable to pharmacies dispensing other drugs. 
Furthermore, we view costs such as regulatory compliance and quality 
assurance as part of overhead, which we have included in the dispensing 
fee based on the 2004 AAH cost data for overhead and other direct 
costs. We also do not believe that the costs associated with regulatory 
requirements applicable to equipment suppliers should be compensated 
through the inhalation drug dispensing fee. The Medicare program makes 
separate payments to equipment suppliers for rental/purchase of 
nebulizers and maintenance, and regulatory requirements applicable to 
equipment suppliers would be covered through the basic payment rates 
for the equipment, not the Medicare payment rate for drugs or 
dispensing.
    Regarding the draft supplier quality standards that have been 
released for comment, we note that the agency has adopted a two-step 
process for developing those standards. An initial document with draft 
quality standards for suppliers of several types of durable medical 
equipment has been released for public comment. We expect to release a 
second document that will clarify which quality standards apply to 
inhalation drug suppliers. We expect that the standards applying to 
inhalation drug suppliers will be consistent with accepted quality 
standards for pharmacies. Furthermore, the standards will establish 
minimum requirements for being a supplier, which we consider to be part 
of the standard cost of doing business that is covered through our 
basic payment rates. As with conditions of participations (COP) for 
providers, we do not increase our payment rate as a result of a change 
in COP requirements.
    Comment: One commenter stated that section 1842(b)(3) of the Act 
requires Medicare payments be reasonable. The commenter asserted that 
the agency has established in Sec.  405.502(a) criteria for determining 
what is reasonable, and stated that Medicare has a history of 
recognizing and reimbursing services related to patient care.
    Response: We recognize the commenter's concern regarding the 
reasonableness of Medicare payments. We have based the dispensing fee 
payment rates on industry cost data from the 2004 AAH report, which was 
submitted as part of comments by AAH on the CY 2005 proposed rule, and 
used in the CY 2005 final rule, to establish the 2005 dispensing fee. 
To establish the 2006 dispensing fee, we have used the 2004 AAH cost 
data excluding those services that fall outside the scope of a 
dispensing fee.

[[Page 70231]]

    Comment: Some commenters cited Medicare's drug payment rates (ASP+6 
percent) as a reason the dispensing fee should remain the same or be 
increased. One homecare pharmacy indicated that it could not obtain 
drugs at ASP+6 percent. A few commenters stated that their costs exceed 
reimbursement for drugs in cases where a physician writes brand 
medically necessary and the drug is in a billing code that contains 
both brand and generic drugs. An inhalation drug supplier indicated 
that for three inhalation drugs its acquisition costs exceeded Medicare 
reimbursement. Some commenters indicated Medicare drug payments (ASP+6 
percent) were inadequate for a variety of reasons such as exclusion of 
wholesaler markup from ASP, the lag time between sales for a quarter 
and the inclusion of such information in the Medicare ASP+6 drug 
payment rates, volatility in ASP+6 reimbursement from quarter to 
quarter, and class of trade differences in pricing. One commenter 
suggested that Medicare had addressed concerns about the adequacy of 
ASP+6 percent reimbursement for oncology patients by implementing the 
Demonstration of Improved Quality of Care for Cancer Patients 
Undergoing Chemotherapy. They also suggested that the ASP+6 percent cap 
on reimbursement for the upcoming Part B drug competitive acquisition 
program (CAP) was a reason for its delay, because they asserted vendors 
did not want to commit to a program where ASP+6 percent was the 
reimbursement limit. The commenter stated that the issues it has 
encountered with ASP+6 percent are similar to the issues faced by 
oncologists and vendors under CAP program and therefore should be 
addressed through the inhalation drug dispensing fee.
    In addition, a few commenters suggested that Medicare payments for 
equipment were inadequate, necessitating a substantial dispensing fee.
    Response: Although some commenters stated that the dispensing fee 
should account for drug acquisition costs in excess of the ASP+6 
percent payment, we disagree. Section 1847A of the Act specifies that 
the Medicare payment for inhalation drugs is at 106 percent of the ASP. 
We believe the Congress established the ASP based payment for 
inhalation drugs and separate authority for dispensing of these drugs 
for good reason, namely to pay appropriately for each service and to 
eliminate cross subsidization of services. Similarly, we believe 
payment for nebulizer equipment is a distinct policy separate from the 
dispensing fee, and one should not cross subsidize the other. In 
establishing the dispensing fee of $33 for a 30-day supply of 
inhalation drugs (and higher first month payment), we are focusing on 
what we believe is the appropriate scope and payment for the dispensing 
fee.
    Although one commenter suggested that we had addressed perceived 
issues about ASP+6 percent payment adequacy by implementing the 
Demonstration of Improved Quality of Care for Cancer Patients 
Undergoing Chemotherapy, we disagree. The purpose of the demonstration 
program is to promote improvements in quality by measuring patient 
outcomes in several areas of concern often cited by patients undergoing 
chemotherapy, which can then be traced to treatments and outcomes. In 
addition, we believe that the commenter's statement that the change in 
the timeframe for implementation of the Medicare Part B drug CAP was a 
result of the ASP+6 percent cap on vendor reimbursement is not accurate 
and not related to the inhalation drug dispensing fee.
    Comment: A few commenters expressed concern that the 30-day 
dispensing fee is the same regardless of the number of prescriptions 
dispensed. They noted that if a prescription is changed in the middle 
of the 30-day period they do not receive an additional fee. They 
suggested CMS consider a per script fee.
    Response: The dispensing fee amount we have established is based on 
the 2004 AAH report data, which presented average costs for a month. 
Consequently, we believe our payment rate should be adequate to cover 
situations where multiple prescriptions are provided. We will consider 
the suggestion of a per script fee in future rulemaking, as necessary.
    Comment: Several commenters indicated that our revised guidelines 
concerning the timeframe for shipping refills had not reduced their 
need to use of overnight shipping. An industry association indicated 
that several factors often force overnight shipping such as hospitals 
giving beneficiaries only a one or two dose supply and beneficiaries 
waiting until they are out of medication to reorder. The 2005 AAH 
survey indicated that the percent of shipments that were overnight 
increased slightly from 56.3 percent in 2004 to 56.9 percent in 2005. 
One commenter indicated that 60 percent of its shipments occur on an 
overnight basis because of several factors such as needing multiple 
calls to reach a beneficiary and new prescriptions reportedly needing 
to be shipped overnight. The commenter urged us to permit refill calls 
as needed to be ready to ship refill orders at least 7 days before the 
patient's medication runs out. The commenter believes that this would 
allow for ground shipping in most cases, including refill dates that 
fall on weekends and 3-day holidays. One commenter suggested that the 
30-day dispensing fee reimbursement guideline had reduced the amount of 
drugs that they could ship in a month, necessitating more use of 
overnight shipping. In addition, one commenter asserted if 
beneficiaries come in for a refill before the end of the month, then 
the pharmacy would receive no fee. While most commenters indicated that 
the revised delivery timeframes had not had a substantial impact on 
their delivery practices, one commenter indicated that 70 percent of 
its shipment through the third quarter of 2005 were ground deliveries, 
and they hoped to transition an additional 20 percent of shipments to 
ground delivery in the fourth quarter of 2005 as a result of Medicare's 
extension of the patient notification and shipment window.
    Response: In the CY 2005 final rule, we made several administrative 
changes aimed at reducing inhalation drug supplier costs, including 
providing more flexible refill timeframes. We currently allow refills 
to be sent up to approximately 5 days before the end of the current 
usage period. To further facilitate the use of ground delivery, we are 
in the process of working to expand this timeframe to allow refills to 
be sent up to 7 days before the end of the current usage period. Under 
this new delivery timeframe, we will allow a dispensing fee to be paid 
up to 7 days before the end of current usage period, with up to 12 
months of dispensing fees payable per year per beneficiary.
    In addition, we note that for 2006, we are establishing a 
dispensing fee of $57 for the first month an individual uses inhalation 
drugs as a Medicare beneficiary because greater levels of effort may be 
involved in dispensing inhalation drugs when a patient begins these 
drugs for the first time, for example, following hospital discharge.
    Comment: Many commenters responded to our request for comments on 
the impact of Medicare Part D coverage of metered dose inhalers on 
beneficiary access to care. A number of commenters asserted that they 
did not believe there would be a substantial shift to MDIs when they 
become covered under Medicare Part D. One commenter said that MDIs are 
not a substitute for nebulizers, as many patients require nebulizers 
due to inability to use MDIs properly, or physicians' experience has 
shown nebulizers are more effective than MDIs.

[[Page 70232]]

Another commenter said that although research has not been able to 
demonstrate the superiority of nebulizers to MDIs, nebulizers are the 
standard of care for COPD and chronic lung diseases in the moderate to 
severe stages. Other reasons commenters cited for their belief that 
there would not be a substantial shift to MDIs include: Physician 
inability to properly train patients on MDIs; patient familiarity with 
nebulizer use gained during hospital stays; research suggesting patient 
preference for nebulizers; potential use of nebulizers and MDIs by the 
same patient; and potential differences in cost-sharing across Medicare 
Part B and Part D. However, one physician specialty group said that it 
anticipates many Medicare beneficiaries will migrate to MDIs, and those 
that remain on nebulizers will be more frail and in need of more 
personalized service.
    Response: We believe expansion of Medicare coverage of inhalation 
drugs to include MDIs under Medicare Part D will provide additional 
options for treatment and positively impact access to care. As we 
indicated in the proposed rule, we recognize that nebulizers are 
required by many beneficiaries because of their individual 
circumstances. We believe that physicians will choose the treatment 
option that best meets a beneficiary's needs, and both nebulizers and 
MDIs will play an important role in the Medicare program in the years 
to come.
    Comment: A health professional association asserted that 
individuals that provide patient education on use of nebulizers, MDIs, 
and dry powder inhalers (DPIs) should be qualified by virtue of 
education, training, and competency testing. It also urged CMS to pay a 
separate education fee to physicians when prescribing an MDI or dry 
powder inhaler. The commenter also proposed various levels of fees for 
initial and follow-up services.
    Another commenter raised concerns about what it asserts is a trend 
toward drop shipping respiratory related devices. The commenter 
expressed concern that contact between a respiratory patient and 
provider may disappear, raising potential concerns about correct usage 
of the respiratory device.
    Response: We agree that it is important that beneficiaries are 
properly trained in the use of nebulizers. The Medicare program 
provides that equipment suppliers either directly train the beneficiary 
in the use of the nebulizer or ensure that the beneficiary has been 
trained by other qualified individuals (Sec.  424.57(c)(12)). In 
addition, under the physician fee schedule, Medicare will pay 
physicians to train the beneficiary in the use of a nebulizer, MDI, or 
inhalation device (CPT code 94664, demonstration and/or evaluation of 
patient utilization of an aerosol generator, nebulizer, metered dose 
inhaler or IPPB device).
    Comment: One commenter stated that CMS evaded its notice and 
comment rulemaking obligations under the Administrative Procedures Act 
(APA) to collect meaningful data in support of an appropriate 
dispensing fee. The commenter urged us to publish data in a subsequent 
rule, and seek comment, before publishing a final payment rate for 
2006.
    Response: In the August 8, 2005 proposed rule, we identified and 
reviewed available studies and data on the cost of providing inhalation 
drugs, sought comment as well as additional data and information 
concerning an appropriate payment amount and scope, and indicated that 
we thought it likely that the payment amount for 2006 would be lower 
than the current amount. Furthermore, in establishing the 2006 
dispensing fee, we analyzed the available studies and data in response 
to comments received on the proposed rule and based on that analysis 
have continued to use the 2004 AAH data that was identified in the 
proposed rule and also used to establish the 2005 fee. Furthermore, as 
discussed previously, it is our opinion that the rates established in 
this rule are appropriate in light of the statute and our understanding 
of Congressional intent. We believe, therefore, this met our 
obligations under the APA.
    Comment: One commenter took issue with our description in the 
proposed rule of inhalation drugs as supplies.
    Response: Medicare coverage of inhalation drugs is derived from 
their use in covered nebulizers. For Medicare coverage purposes, they 
are considered covered supplies.
    Comment: A few commenters expressed concern about precedents 
Medicare Part B will set for Medicare Part D. They asserted that 90-day 
scripts are not appropriate for nursing home patients.
    Response: The Medicare Part B policy concerning a 90-day dispensing 
fee does not carry over to Medicare Part D.
    Comment: Although the assignment of benefits form (AOB) has been 
eliminated, one commenter noted that the requirement to obtain a 
payment authorization signed by the beneficiary before submitting the 
claim diminishes the benefit of eliminating the AOB. The commenter 
urged CMS to eliminate the requirement for signed payment authorization 
for providers and those reimbursed based on assignment only.
    Response: We thank the commenter for the comment. CMS is reviewing 
the beneficiary signature requirement for claims submission in light of 
the elimination of the AOB form in instances of mandatory assignment. 
However, CMS currently requires a beneficiary signature for claims 
submission.
    Comment: One drug manufacturer suggested that compounding that 
attempts to mimic production of commercially available products 
threatens patient safety. The commenter urged CMS to structure the 
dispensing fee to reduce the likelihood of inappropriate compounding. 
The commenter also suggested code modifiers for pharmacy-compounded 
medications to help identify their occurrence. Another drug 
manufacturer suggested that reducing the dispensing fee could spur 
suppliers to provide compounded versions of commercially available 
products without physician or patient authorization. The commenter 
suggested that we review supplier documentation to ensure compounded 
solutions are only furnished where documentation supports medical 
necessity of a customized product.
    Response: The inclusion of costs for pharmacy compounding in the 
dispensing fee is not in any way an endorsement of compounding that is 
inconsistent with FDA guidelines. Furthermore, Medicare expects that 
pharmacies comply with FDA guidelines irrespective of the dispensing 
fee payment amount established. We understand the concerns the 
commenters raised and will consider the issues further.
    Comment: One commenter urged us to require code modifiers for 
claims associated with patient compounding of inhalation drugs. The 
commenter asserts that when a physician writes a prescription for a 
compounded drug, the inhalation drug supplier has an incentive to 
dispense the drugs separately in order to obtain two dispensing fees. 
The commenter asserts that implementing the modifiers would allow us to 
pay only one dispensing fee, instead of two, under these circumstances.
    Response: Medicare pays only one dispensing fee per 30-day (or 90-
day) period, regardless of the number of drugs dispensed. As a result, 
these modifiers would not affect Medicare expenditures.
    Comment: We received some comments in response to our request for 
information about why there is substantial variation in costs across

[[Page 70233]]

suppliers. A few commenters suggested that many beneficiaries receive 
services from small providers who may have higher costs.
    Response: We appreciate the comments. We note that the GAO report, 
which showed wide cost variation, found that larger suppliers did not 
necessarily have lower costs than small suppliers. We continue to 
believe that this is an issue that might benefit from further study.
5. Supplying Fee
    Section 303(e)(2) of the MMA added section 1842(o)(6) of the Act 
which requires the Secretary to pay a supplying fee (less applicable 
deductible and coinsurance) to pharmacies for certain Medicare Part B 
drugs and biologicals, as determined appropriate by the Secretary. The 
types of Medicare Part B drugs and biologicals eligible for a supplying 
fee are immunosuppressive drugs described in section 1861(s)(2)(J) of 
the Act, oral anticancer chemotherapeutic drugs described in section 
1861(s)(2)(Q) of the Act, and oral anti-emetic drugs used as part of an 
anticancer chemotherapeutic regimen described in section 1861(s)(2)(T) 
of the Act.
    Beginning with CY 2005, Medicare established a supplying fee of $24 
per prescription for these categories of drugs, with a higher fee of 
$50 for the initial oral immunosuppressive prescription supplied in the 
first month after a transplant. When multiple drugs are supplied to a 
beneficiary, a separate supplying fee is paid for each prescription, 
except when different strengths of the same drug are supplied on a 
single day. When we established the $24 supplying fee in the CY 2005 
final rule (69 FR 66236), we indicated that we were establishing a rate 
higher than that of other payers due to the additional costs associated 
with Medicare Part B's lack of online claims adjudication.
    As part of the August 8, 2005 proposed rule (70 FR 45848), we 
proposed changes to the supplying fee for multiple prescriptions 
supplied during the same month. We proposed to continue paying $24 for 
the first prescription supplied during a month (or $50 for the first 
oral immunosuppressive prescription supplied in the first month after a 
transplant) and a supplying fee of $8 for each additional prescription 
the pharmacy supplied to the beneficiary during the same month. Each 
pharmacy supplying these drugs to a beneficiary during a month would be 
entitled to one $24 supplying fee per beneficiary during that month. In 
making this proposal, we indicated that when a pharmacy supplies 
multiple drugs to a beneficiary during the same month, many of which 
are likely to be supplied on the same day, we were concerned that we 
were overpaying for the costs associated with our lack of online claims 
adjudication. Furthermore, we indicated that we believe that the $24 
supplying fee for the first prescription would adequately compensate a 
supplier for the billing costs associated with the lack of on-line 
claims adjudication, and that the cost of supplying additional 
prescriptions in the same month should be comparable to that of other 
payers.
    We also proposed to expand the circumstances under which we pay 
supplying fees for multiple prescriptions filled on the same day. 
Currently, we pay a supplying fee for each prescription supplied on the 
same day as long as the prescriptions are for different drugs. We 
proposed to pay a supplying fee for each prescription, even if the 
prescriptions are for different strengths of the same drug.
    We requested comments about the appropriateness of our proposed 
supplying fee for multiple prescriptions supplied during a single month 
along with data and information about the incremental costs of 
supplying additional prescriptions to a Medicare beneficiary during a 
single month. We also asked for comments about how pharmacy costs and 
reimbursement for supplying oral drugs under Medicare compares to that 
of other payers.
    We received numerous comments regarding our supplying fee 
proposals. Those comments and responses are provided below.
    Comment: Numerous commenters were supportive of our proposal to 
expand the circumstances under which we pay a supplying fee to include 
paying separate fees when multiple strengths of the same drug are 
supplied on the same day. However, many commenters expressed concern 
about our proposal to pay a supplying fee of $24 to a pharmacy for the 
first prescription and $8 for all subsequent prescriptions supplied in 
a 30-day period. Commenters generally urged no reduction in the 
supplying fee when multiple prescriptions are provided in the same 
month, and a few urged a payment increase. In opposing the $8 
subsequent fee, some commenters stated that the agency had included no 
new cost data in the proposed rule to support a reduction. At the same 
time, some commenters provided cost information as part of their 
comments.
    A few commenters indicated that the cost of supplying a drug for an 
insurer with online claims adjudication had increased from $8 (as cited 
in the proposed rule) to $9 to $10 based on new studies. An association 
representing chain drug stores provided information from a few large 
chains indicating that the average cost to supply a Medicare Part B 
prescription was between $19 and $21, noting that small chains or 
independent pharmacies may have higher costs. The association asserted 
that the current $24 fee was reasonable considering the fact that 
Medicare currently does not pay separate supplying fees for different 
strengths of the same drug supplied on the same day. The association 
urged us to consider an increase in the $24 fee to take into account 
inflation, and an increase in the $50 fee for the first prescription 
after a transplant to compensate for the intense patient monitoring 
that the association indicated was needed. A large chain pharmacy 
indicated its average cost of supplying a Medicare prescription was 
$19.02, which included $5.54 for bad debt.
    An association for specialty transplant pharmacies submitted data 
suggesting that Medicare's reimbursement (combined payment for the drug 
and supplying fee) to these pharmacies for 2 large volume 
immunosuppressive drugs is comparable or lower than that of Medicaid or 
private payers. This association pointed to a 2004 report prepared by a 
consultant, which indicated that specialty pharmacy costs for 
immunosuppressive drugs for Medicare patients averaged about $35. This 
association also indicated that transplant pharmacies have higher costs 
because they offer more extensive services, routinely stock specialty 
medicines and maintain regular and consistent contact with their 
Medicare clients. The association suggested that these services should 
be compensated through the supplying fee. In addition, this association 
also claimed that chain pharmacy data collected in a similar manner to 
the specialty pharmacy data yield costs of $21. The group asserted that 
the chain costs appear lower than the specialty pharmacy costs in part 
because chains supply items such as diabetic test-strips, which they 
indicate cost less to supply.
    In opposing a reduction in the supplying fee for subsequent 
prescriptions in a month, a number of commenters took issue with the 
rationale provided in the proposed rule for the reduction, saying that 
there are not economies of scale in processing Medicare claims when 
multiple prescriptions are provided in the same month. Many commenters 
outlined costs associated with billing Medicare.

[[Page 70234]]

Because of the lack of online claims adjudication, some stated that 
there was more bad debt associated with Medicare Part B claims. Other 
commenters indicated that it takes longer to process a Medicare claim 
because of the requirement of a signed order from the physician as well 
as the lack of online claims adjudication. Some commenters indicated 
that without online claims adjudication, pharmacies must call the DMERC 
to check the beneficiary's deductible as well as verify whether the 
beneficiary is still enrolled in traditional Medicare as opposed to 
Medicare Advantage. Other commenters indicated that the lack of online 
claims adjudication and automatic cross over claims means that they may 
have to refund a beneficiary's coinsurance if it is later determined 
that the beneficiary has supplemental insurance. Other billing 
activities and requirements that commenters cited as creating added 
costs include: contracting with a special entity to convert Medicare 
Part B claims from the NCPDP format to ANSI X837; working with 
physicians to determine whether oral anticancer or anti-emetic drugs 
are being prescribed for Medicare Part B covered indications; having to 
submit the unique physician identifying number (UPIN) on the claim; and 
Medicare's requirement that the date of service and date of 
prescription be the same.
    Although most commenters did not support the proposal for a reduced 
fee when multiple prescriptions are supplied in a month, one health 
insurer commented that the current supplying fee payment amounts appear 
high, and put upward pressure on commercial rates.
    Response: As we indicated in the CY 2005 final rule (69 FR 66236), 
we recognize that the cost of supplying Medicare Part B drugs is 
somewhat higher than that of other payers because of the lack of on-
line claims adjudication for Medicare Part B claims. We believe it is 
appropriate for Medicare's supplying fee to compensate for the Medicare 
billing costs associated with the lack of online claims adjudication. 
However, as we indicated last year, we do not believe the supplying fee 
for these drugs should be higher than other payers for reasons other 
than the lack of on-line claims adjudication.
    The comments included information on the costs of supplying 
Medicare Part B drugs for some chain pharmacies. One chain reported 
Medicare costs of $14.48 ($19.02 - $5.54 non-reimbursed bad debt). A 
retail pharmacy association commented that a few chains had indicated 
that their costs of supplying a Medicare Part B prescription were 
between $19-$21 per prescription (without indicating whether bad debt 
was included). Furthermore, as we indicated in the August 14, 2004 
final rule (69 FR 66236), our analysis of data from a 2004 survey of 
specialty pharmacies yields a supplying fee in the range of $13-$27 
depending on the proportion of personnel costs assumed to be associated 
with Medicare billing. This range was developed by using a figure of $5 
or $10 for the payment rates of payers with on-line adjudication, and 
adding to that Medicare claims processing costs from the specialty 
pharmacy data ($8), and a portion of personnel costs from the specialty 
pharmacy data (total was $9) assumed to be related to Medicare billing. 
This results in supplying fee between $13 ($5 + $8) and $27 ($10 + $8 + 
$9), depending on the portion of personnel costs associated with 
Medicare billings.
    Based on this information from chains and specialty pharmacies, we 
agree that an $8 fee for subsequent prescriptions is too low. However, 
as discussed in more detail subsequently, our analysis of the cost 
information from the comments has led us to believe that a subsequent 
prescription supplying fee that is slightly lower than $24 would be 
appropriate. Based on our analysis, we believe that a $24 fee for the 
first prescription in a 30-day period, and a $16 fee per prescription 
for all subsequent prescriptions in the 30-day period would be 
consistent with the cost information included in the comments. Under 
this fee structure, reimbursement to a pharmacy for the supplying fee 
would average $24 for a patient with 1 prescription in a 30-day period, 
$20 per prescription for patients with 2 prescriptions, $18.67 per 
prescription for a patient with 3 prescriptions, and $18 per 
prescription for a patient with 4 prescriptions, for example. Our 
claims data currently indicate that beneficiaries receiving 
immunosuppressive, oral anticancer, or oral anti-emetic drugs under 
Medicare Part B average 2.2 prescriptions per month, with a majority 
receiving 4 or fewer. We believe average supplying fee payments ranging 
from $18 to $24 are consistent with the chain drug store costs 
indicated in the comments and falls within the mid-range of the 
potential supply fee amounts we calculated based on the specialty 
pharmacy data survey.
    Because we continue to believe that there are some economies of 
scale for Medicare billing costs when multiple prescriptions are 
supplied in the same month, particularly when they are billed on the 
same claim form, we believe it is appropriate to pay a higher fee for 
the first prescription in a 30-day period, and the somewhat lower fee 
for all subsequent prescriptions in the 30-day period. For example, 
several activities related to Medicare billing that commenters cited as 
being costly including calling the DMERC to verify the beneficiary's 
Medicare fee for service eligibility, locating the physician's UPIN to 
include on the Medicare Part B claim form, handling coinsurance refunds 
for crossover claims, and completing other information on the claim 
form would only have to be performed once, rather than twice, when 
multiple prescriptions are submitted on the same claim. Moreover, 
following through on our proposal to expand payment of the supplying 
fee to include paying separate fees when multiple strengths of the same 
drug are supplied on the same day, we believe it is important that the 
subsequent prescription supplying fee reflect lower incremental costs.
    Consequently, beginning in 2006, we are establishing a supplying 
fee of $24 for the first prescription in a 30-day period, and $16 for 
each subsequent prescription in the period. Each pharmacy will be 
eligible for one $24 fee per beneficiary per 30-day period. As 
mentioned previously, beginning in 2006 we are also expanding the 
circumstances under which we pay the supplying fee to include paying 
separate fees for different strengths of the same drug that are a 
supplied on the same day. We are not altering the current policy of 
paying a $50 supplying fee for the first immunosuppressive prescription 
after a transplant. If a supplier receives a $50 supplying fee for the 
initial prescription after a transplant, a supplying fee of $16 will be 
paid for all subsequent prescriptions, after the initial prescription, 
furnished by that supplier to the beneficiary during that 30-day 
period.
    We are making conforming changes to Sec.  414.1001(b) to reflect 
this policy concerning subsequent prescriptions supplied during the 
same 30-day period as the initial immunosuppressive prescription after 
a transplant.
    Comment: A number of commenters expressed concerns about 
beneficiary access if the supplying fee were reduced. Some suggested 
that pharmacies may stop providing these drugs to beneficiaries if the 
supplying fee is lowered. Others believe that a reduction in the fee 
could lead specialty pharmacies to stop providing support services to 
transplant patients, which they assert could adversely impact 
transplant success for some patients.

[[Page 70235]]

    Response: We believe the supplying fee payment amounts we have 
established are appropriate based on the cost information available 
from the comments, and beneficiaries will continue to have good access 
to these drugs. Furthermore, we note that the reduction in Medicare 
payments resulting from the supplying fee changes are expected to 
represent at most 1 percent of Medicare total payments to pharmacies 
for these drugs.
    Comment: Some commenters expressed concern about the reduction in 
reimbursement that would result from the subsequent prescription 
supplying fee in certain situations (for example, for drugs that have a 
3-week prescription cycle or for patients with 3 prescriptions per 
month).
    Response: Under the supplying fee rates established for 2006, 
Medicare reimbursement for the supplying fee would in the majority of 
cases average from $24 (patient with 1 Medicare Part B prescription) to 
$18 (patient with 4 Medicare Part B prescriptions). As mentioned 
previously, we believe this range of average reimbursement is 
consistent with the chain pharmacy cost information in the comments and 
falls near the mid-range of the potential supplying fee payment amounts 
we calculated based on the 2004 survey data for specialty pharmacies. 
Furthermore, we believe the supplying fee payment rates appropriately 
reflect the potential for economies of scale when multiple 
prescriptions are supplied in the same month.
    Comment: A few commenters stated that a lower subsequent 
prescription fee may encourage pharmacies to send patients to affiliate 
locations in order to receive the $24 fee.
    Response: We disagree. As mentioned previously, we believe that the 
supplying fee payment rates established are adequate to cover 
pharmacies' supplying costs based on the cost information included in 
the comments. We do not believe that these reimbursement changes would 
spur pharmacies to take actions that would cause inconvenience to the 
beneficiaries they serve.
    Comment: Some commenters maintained Medicare's drug payment rates 
(the average sales price + 6 percent) were below their acquisition 
costs for certain drugs, and stated that the current $24 per 
prescription supplying fee should be unchanged or increased to 
compensate for this.
    Response: Although some commenters stated that the supplying fee 
should account for drug acquisition costs in excess of the ASP+6 
percent payment, we disagree. Section 1847A of the Act specifies that 
the Medicare payment for these drugs is at 106 percent of the ASP. We 
believe the Congress established the ASP based payment for these drugs 
and separate payment for the supplying of these drugs for good reason, 
namely to pay appropriately for each distinct service. In expanding the 
circumstances under which we pay a supplying fee and establishing the 
supplying fee payment amounts ($24 for the first prescription in a 30-
day period and $16 for all subsequent prescriptions in a 30-day period, 
as well as the $50 fee for first immunosuppressive prescription after a 
transplant), we are focusing on the appropriate scope and payment for 
the supplying fee.
    Comment: A few commenters suggested that for 2006 the current 
supplying fee payment amounts ($50 for initial prescription after a 
transplant, and $24 per prescription otherwise) be increased for 
inflation or to ensure adequate reimbursement for services provided by 
suppliers.
    Response: We believe that the supplying fee payment amounts we have 
established for 2006 are consistent with the cost information from the 
comments this year. We will consider an inflation adjustment for the 
future.
    Comment: Some commenters raised concern that if a beneficiary 
sought a refill before the end of the month, the pharmacy would not be 
eligible for a $24 fee for that refill.
    Response: We understand the commenters' concern. We are taking 
several steps to address this potential issue. First, we have decided 
to use a 30-day period rather than a calendar month as the basis for 
determining whether a $24 or $16 supplying fee is payable. Thus, we 
will pay a $24 supplying fee for the first prescription supplied by a 
pharmacy in a 30-day period (or a $50 supplying fee for the first 
immunosuppressive prescription after a transplant), and a $16 supplying 
fee for each subsequent prescription supplied by that pharmacy to the 
beneficiary in the 30-day period. We believe using a 30-day period 
avoids arbitrary fluctuations in payment that might otherwise occur as 
a result of variation in the number of days per month. In addition, in 
our instructions to implement the 2006 supplying fee, we will allow a 
$24 supplying fee to be paid for a refill prescription up to 7 days 
before the end of the 30-day period for which the last $24 supplying 
fee was paid to that pharmacy, with up to twelve $24 supplying fees 
payable per beneficiary per year.
    Comment: A number of commenters expressed concern that the 
assignment of benefits (AOB) forms, which the August 14, 2004 final 
rule indicated would be eliminated, has not yet been eliminated.
    Response: The requirement that a pharmacy obtain an AOB form when 
supplying drugs to a beneficiary was eliminated for dates of services 
on or after January 1, 2005. Because of technical issues, the claims 
processing contractors did not immediately implement this change. We 
published a change request in August 2005 clarifying that the 
requirement for an AOB form was eliminated effective January 1, 2005 
for pharmacies supplying Medicare Part B drugs to beneficiaries (as 
well as in other circumstances where assignment is mandatory). This 
change request will be implemented on November 14, 2005. The change 
request can be found at: http://www.cms.hhs.gov/manuals/pm_trans/R643CP.pdf.
    Comment: Several commenters expressed concern that the DMERC 
Information Form (DIF), which the August 14, 2004 final rule indicated 
would be eliminated, had not been eliminated yet. A commenter also 
mentioned some suppliers having difficulty with the rejection of claims 
for immunosuppressives for ``DIFs not on file,'' when they are on file. 
In addition, one commenter urged us to not only eliminate the DIF, but 
also to eliminate the requirement that pharmacies collect and submit 
the DIF information with each claim. The commenter suggests that most 
of this information can be obtained by information submitted to 
Medicare by the transplant facility or transplant physician, and the 
requirement for pharmacies to submit the information is duplicative.
    Response: The elimination of the DIF will be implemented with the 
quarterly systems release that occurs April 2006. A number of systems 
issues makes the elimination of the DIF more involved than anticipated. 
We regret the delay in the elimination of this requirement, and remain 
committed to implementing the change in April 2006. Regarding the other 
issues concerning the DIF raised in the comments, these billing issues 
are outside the scope of this final rule; however, we encourage 
commenters to continue to bring these concerns to our attention.
    Comment: A specialty pharmacy group indicated that some pharmacies 
had encountered situations where Medicaid or other third party payers 
were not covering the beneficiary's coinsurance on the supplying fee. 
The commenter requested that the final rule include an explanation of 
these parties'

[[Page 70236]]

responsibilities concerning beneficiary coinsurance on the supplying 
fee.
    Response: The supplying fee is covered under Medicare Part B. Like 
all other Medicare Part B benefit categories, standardized Medigap 
plans are responsible for paying all (plans A-J) or a specified 
proportion (plans K and L) of a beneficiary's Part B coinsurance once 
the Part B deductible has been met.
    With some exceptions, State Medicaid programs are responsible for 
beneficiary cost-sharing for the supplying fee for beneficiaries who 
are dually eligible for both Medicare and Medicaid. State Medicaid 
programs can limit coinsurance payments to the extent that any payment, 
when combined with Medicare payments, equals the amount of 
reimbursement payable under the State Medicaid program. A State 
Medicaid program may deem a pharmacy to be paid in full even if it has 
received either no coinsurance payment or a reduced payment from the 
State. Beneficiaries have no liability beyond the State's payment 
amount as set forth in section 1902(n)(2) of the Act.
    Comment: One commenter suggested that physicians be allowed to bill 
for the supplying fee for immunosuppressive, oral anti-cancer, and oral 
anti-emetic drugs. The commenter suggested we could define a pharmacy, 
for the purposes of the supplying fee, to include physicians acting as 
pharmacists. As another approach, they suggested we could use our 
inherent reasonableness authority to extend the supplying fee to 
physicians.
    Response: As we indicated in the CY 2005 final rule, given our 
understanding of Congressional intent, we do not believe it would be 
appropriate to pay a supplying fee to physicians. In addition, at this 
time, we do not have sufficient data to determine if our inherent 
reasonableness authority would apply in this instance.
    Comment: A specialty pharmacy group requested that we include 
clarification in the final rule concerning whether temporary billing 
codes for the supplying fee G0369 and G0370 will be replaced with 
permanent codes.
    Response: Effective January 2006, we intend to replace the G-codes 
for the supplying fee with Q-codes.
6. Competitive Acquisition of Outpatient Drugs and Biologicals Under 
Part B
    In this section of the preamble, we discuss the Competitive 
Acquisition Program (CAP) for Part B drugs; summarize the requirements 
established in the July 6, 2005 interim final rule with comment titled 
``Competitive Acquisition of Outpatient Drugs and Biologicals Under 
Medicare Part B'' (70 FR 39022); respond to comments on selected issues 
in that rule and finalize the associated policies; and discuss the next 
steps in the implementation of the CAP program. We are addressing the 
issue of inclusion of CAP drug units in the ASP calculation in separate 
rulemaking.

General Overview of CAP

    Section 303(d) of the MMA amended the Act by adding a new section 
1847B, which establishes a program for the acquisition of and payment 
for competitively biddable Part B covered drugs and biologicals 
furnished on or after January 1, 2006. Implementation of the CAP will 
provide physicians with a choice between--
    <bullet> Obtaining these drugs from entities selected to 
participate in the CAP in a competitive bidding process; or
    <bullet> Acquiring and billing for Part B covered drugs under the 
ASP drug payment methodology.
    In our July 6, 2005 interim final rule with comment, we finalized 
provisions set forth in the Competitive Acquisition of Outpatient Drugs 
and Biologicals Under Part B proposed rule published on March 4, 2005 
in the Federal Register (70 FR 10746), but also provided the public an 
additional opportunity to comment on the final provisions established 
for the CAP. We codified the requirements and provisions for the CAP in 
regulations at 42 CFR part 414, subpart K, with Sec.  414.906 through 
Sec.  414.920 containing requirements for payment under the CAP as 
follows:
    <bullet> Section 414.906 (Competitive acquisition program as the 
basis for payment). This section specifies how payment for CAP drugs is 
determined, including vendor responsibilities for billing, shipment and 
delivery; computation of the payment amount; substitution of CAP drugs 
and resupply of a participating CAP physician's drug inventory.
    <bullet> Section 414.908 (Competitive acquisition program). This 
section specifies the process for a physician to select an approved CAP 
vendor and the responsibilities of a participating CAP physician, 
including the specific information that must be included on the 
prescription order as well as notification and the timeframe for 
submission of claims. This section also specifies the process for 
selecting approved CAP vendors, as well as factors that are considered 
in the selection process such as exclusion under section 1128 of the 
Act from participation in Medicare or other Federal health care 
programs.
    <bullet> Section 414.910 (Bidding process). This section outlines 
the specific criteria for submission of a bidding price for a CAP drug, 
and specifies what costs should be included in the bid price.
    <bullet> Section 414.912 (Conflicts of interest). This section 
discusses requirements and standards for conflict of interest that 
applicants that bid to participate and approved CAP vendors must meet.
    <bullet> Section 414.914 (Terms of contract). This section outlines 
the contract provisions between CMS and the approved CAP vendor 
including contract length and termination, and specific requirements 
the approved CAP vendor must comply with.
    <bullet> Section 414.916 (Dispute resolution for vendors and 
beneficiaries). This section discusses the process available to an 
approved CAP vendor and beneficiaries for resolution of denied drug 
claims, outlining the steps, timeframes and requirements that must be 
met.
    <bullet> Section 414.917 (Dispute resolution and process for 
suspension or termination of approved CAP contract). This section 
discusses the process available to participating CAP physicians for 
resolution of quality or service issues concerning an approved CAP 
vendor, including steps and timeframes that are to be followed.
    <bullet> Section 414.918 (Assignment) and Sec.  414.920 (Judicial 
review). Application of assignment and administrative and judicial 
review for the CAP are discussed in these sections of the regulation, 
respectively.
    In the July 6, 2005, interim final rule with comment for the CAP 
published as CMS 1325-IFC, we also defined terms used for the CAP in 
Sec.  414.902. We also established that for initial implementation, the 
competitive acquisition area, in which approved CAP vendors supply 
drugs, will be on a national level and include all 50 States, the 
District of Columbia, Puerto Rico, and the U.S. territories. In 
addition, we established a single drug category consisting of 
approximately 180 drugs commonly provided ``incident to'' a physician's 
service and included these in the addenda to the July 6, 2005 interim 
final rule with comment. These drugs represent about 40 percent of the 
approximately 440 drugs that may be billed ``incident to'' physician 
services and about 85 percent of physicians' Part B drugs by billed 
charges, as reflected in our Part B billing data.
    Effective August 3, 2005, we suspended the vendor bidding process 
that began with publication of the July

[[Page 70237]]

6, 2005 interim final rule with comment to allow us more time to fully 
review public comments on the interim final rule with comment and also 
to further refine the bidding process. We provided notification of the 
suspension on the CMS Web site http://www.cms.hhs.gov/providers/drugs/compbid/ and through the pharmacy and physician Listservs. We also 
announced the suspension of the bid process in the Competitive 
Acquisition of Outpatient Drugs and Biologicals Under Part B: 
Interpretation and Correction interim final rule with comment, 
published on September 6, 2005 in the Federal Register (70 FR 52930). 
In that document, we stated we would publish a final rule for 
implementing the CAP after we analyzed the additional comments on the 
July 6, 2005 interim final rule with comment and determined the best 
manner for improving the efficiency of the CAP and increasing potential 
participation of both vendors and physicians in the program. We also 
indicated that we would announce the dates for the new vendor bidding 
period as well as a special physician election period with the 
publication of the final rule. As noted earlier in this section of the 
preamble and as discussed in more detail below, in this final rule with 
comment, we are addressing certain issues raised by commenters 
responding to the July 6, 2005 interim final rule with comment. We 
believe it is critical to address these specific concerns we have 
identified through review of the comments and finalize or clarify 
specific policy issues raised to allow us to effectively implement the 
CAP. Other issues raised by commenters that are not addressed in this 
final rule with comment will be addressed in future rulemaking, once we 
have fully reviewed all of the comments not addressed in this 
rulemaking. Specific information concerning implementation of the CAP, 
including vendor bidding and physician election are discussed later in 
this section.

Analysis of and Response to Public Comments

    We received a total of 225 timely comments in response to the July 
6, 2005 interim final rule with comment (70 FR 39022). Commenters 
included trade associations, medical societies and organizations, a 
health insurance company, pharmaceutical manufacturers and wholesalers, 
specialty pharmacies and pharmacy benefits management groups, as well 
as practitioners, private citizens and patient advocates, and a member 
of the Congress. All public comments were reviewed and grouped by 
related topics and focused on various aspects of the CAP interim final 
rule with comment. In this final rule with comment, we are responding 
to comments related to certain aspects of the CAP, and making 
modifications to the regulation text where necessary so that an 
improved implementation can be achieved. We will be responding to the 
remaining comments and issues raised in future rulemaking after we have 
had the opportunity to fully review those comments and issues. The 
specific areas being addressed are discussed below.
a. Design of the Program
    In this section, we discuss the policy and process for changes to 
the original CAP Single Drug Category List (Addendum A) and changes in 
the original New Drugs for the CAP Bidding for 2006 (Addendum B). These 
changes are reflected in Addendum F and Addendum G of this final rule 
with comment. We also clarify issues related to drugs included in the 
CAP and updated certain requirements for bidding. We discuss the 
process for when and how an approved CAP vendor may request that we 
approve a change to its CAP drug list. Finally we discuss CAP drug 
weighting for the single drug category.
(1) Changes to the List of Drugs Supplied Under the CAP
    The CAP is intended to provide beneficiaries with access to 
Medicare Part B drugs and maintain physician flexibility when 
prescribing medications. In the July 6, 2005 interim final rule with 
comment, we described how the single drug category list was developed 
and how newer agents and substitute products could be incorporated into 
the CAP. In this section of the preamble, we will respond to comments 
relating to drugs supplied under the CAP.
    We developed the single drug category list by developing criteria 
based on Part B drug utilization. This list was published in Addendum A 
of the July 6, 2005 interim final rule with comment and contains the 
majority of drugs that a prospective CAP vendor will bid on. Newer 
drugs without utilization data were listed in Addendum B--New Drugs for 
CAP Bidding in 2006 in the July 6, 2005 interim final rule with 
comment. Development of these lists began with the statutory definition 
of competitively biddable drugs and biologicals (section 1847B(a)(2) of 
the Act) and then the application of specific steps described in the 
July 6, 2005 interim final rule with comment (70 FR 39030) to narrow 
the list of possible drugs based on utilization and other factors, as 
described in the interim final rule with comment, that we believe made 
inclusion of the drug in the CAP drug category appropriate for the 
initial implementation stage of the CAP. Section 1847B(a)(1)(B) of the 
Act requires that the Secretary establish categories of drugs that will 
be included under the CAP, and requires the Secretary to phase-in the 
program with respect to these categories. The statute also defines 
``competitively biddable drugs and biologicals'' for the purposes of 
the CAP by referring to section 1842(o)(1)(C) of the Act.
    Relying on our authority to phase in the CAP drug categories as 
appropriate, we narrowed our focus to drugs furnished ``incident to'' a 
physician's service. In response to comments, and in an effort to offer 
the CAP to as many physicians as possible, we chose not to phase-in the 
CAP on the basis of drugs typically used by any one particular 
specialty; however, we realized that certain types of drugs may be 
better suited for inclusion in early stages of the CAP than others. 
During our review of comments on the July 6, 2005 interim final rule 
with comment and subsequent review of the single drug category list 
published in Addendum A, we became aware of supply issues with one 
specific drug. These issues have prompted us to make changes to the 
Single Drug Category List in Addendum A of the interim final rule with 
comment (included with this rule as Addendum F). We have deleted a 
HCPCS code (J1710) for a drug that is being phased out of the market 
and revised the addenda that comprise the CAP drug category to account 
for upcoming changes to HCPCS codes. Also, before the CAP is 
implemented, several new permanent HCPCS codes will be approved and 
several others modified. A number of these newly approved codes would 
have been included in the CAP drug category identified in our July 6, 
2005 interim final rule with comment, had permanent HCPCS codes been 
available at that time. Therefore, we are amending the list of drugs 
published in the New Drugs for CAP Bidding for 2006 in Addendum B of 
the interim final rule with comment to account for drugs in the new 
HCPCS codes, and to account for HCPCS codes that appeared in Addendum A 
of the July 6, 2005 interim final rule with comment that have since 
been split into separate HCPCS codes for which we are unable to 
calculate new weights. Updated lists of drugs that are included in the 
initial CAP drug category appear

[[Page 70238]]

in Addendum F and Addendum G of this rule.
(a) Changes to the Single Drug Category List--Addendum A of the July 6, 
2005 Interim Final Rule With Comment
    The July 6, 2005 interim final rule with comment discussed criteria 
for developing the Single Drug Category List (Addendum A of the interim 
final rule with comment). In the following section, we describe factors 
that led us to revise this list.
    After suspending the bidding process, we reviewed the drugs 
included in the Single Drug Category List that was published in 
Addendum A of the July 6, 2005 interim final rule with comment (70 FR 
39101). During this process, we found that the brand name product under 
HCPCS code J1710 (hydrocortisone sodium phosphate injection) was 
withdrawn from the market and that generic products for this code are 
not reliably available. This drug's weight in the CAP's Single Drug 
Category List as published in Addendum A is 0.000060285401. Because of 
the availability issue associated with this drug we will remove J1710 
from the Single Drug Category List and recalculate weights for the 
remaining drugs. The impact on other drugs' weights will be minimal 
because of J1710's very low weight.
    Yearly updates to the HCPCS codes also impacted the CAP drug lists 
in several ways. One code J7051 Sterile saline or water up to 5cc (CAP 
weight = 0.006953978284) was modified to A4218 Sterile saline or water, 
metered dose dispenser, 10 ml. ``A codes'' are primarily medical and 
surgical supplies, and we believe that the change reflects usage that 
is primarily through a means other than incident to a physician's 
service. Therefore, we will remove this code from the Single Drug 
Category list and recalculate weights for the remaining drugs.
    Revisions to the Single Drug list also reflect modifications to 
several HCPCS codes. These modifications will not affect the weighting 
calculation because they are either changes in names or consolidation 
of multiple codes into one. The previous codes' utilization data will 
be used in the updated calculation. Table 23 illustrates the affected 
HCPCS codes.

                                Table 23
------------------------------------------------------------------------
         New HCPCS code             New description      Old HCPCS code
------------------------------------------------------------------------
J0881...........................  Injection,                       J0880
                                   darbepoetin alfa,               Q0137
                                   1 microgram (non-
                                   esrd use).
J0885...........................  Injection, epoetin               Q0136
                                   alfa, (for non-
                                   esrd use), 1000
                                   units.
J7318...........................  Hyaluronan (Sodium               J7317
                                   Hyaluronate) or                 J7320
                                   derivative, intra-
                                   articular
                                   injection, 1 mg.
------------------------------------------------------------------------

    The changes to the HCPCS codes also affected iron dextran. A 
discussion of iron dextran's removal from the single drug category list 
and the addition of the two new iron dextran HCPCS codes to the Revised 
New Drugs for CAP Bidding For 2006 appears in the following section.
(b) Changes to New Drugs for CAP Bidding for 2006--Addendum B of July 
6, 2005 Interim Final Rule With Comment (See Addendum G in This Final 
Rule With Comment)
    Addendum B, published in the July 6, 2005 interim final rule with 
comment (70 FR 39102), was developed in response to comments on the 
proposed rule that urged us to provide a means to include newer drugs. 
We are updating Addendum B with drugs that have been recently assigned 
new HCPCS codes, and drugs that were previously listed in Addendum A of 
the July 6, 2005 interim final rule with comment, but because of HCPCS 
code changes, cannot be re-weighted. These changes appear in Addendum G 
of this rule. Further details are provided below.
    Comment: We received numerous comments asking that individual drugs 
that were recently approved and introduced to the United States market 
be included in the CAP. Improving the selection of products that could 
be supplied through the CAP was commonly given as a reason for the 
request.
    Response: We agree that it is desirable for the CAP to include a 
wide variety of drugs and to maintain the flexibility to adapt to a 
rapidly changing marketplace. Therefore, we are adding additional 
procedures to the CAP that will allow approved CAP vendors to adjust 
and update their drug lists. These changes are described below.
    In the July 6, 2005 interim final rule with comment, we stated that 
we intended to provide the physician with choice and flexibility within 
groups of drugs that might be used by different specialties for the 
treatment of various conditions. The drugs available under the CAP are 
intended to accommodate a variety of physician practice patterns and a 
variety of specialties. As discussed in other sections of this rule, 
the CAP also seeks to provide access to new drug therapies.
    As a part of the annual HCPCS code update, several new permanent 
HCPCS codes were issued. Billing with these codes will begin on January 
1, 2006. In order to keep the CAP list of drugs as comprehensive and 
complete as possible, we have updated the New Drugs for CAP Bidding 
that was originally published in Addendum B of the July 6, 2005 interim 
final rule with comment to account for the coding changes. This list of 
newly issued HCPCS codes provided us with an opportunity to add drugs 
to the CAP drug category; the additions include several recently 
approved drugs. Examination of the new HCPCS codes also revealed that 
several codes for drugs listed in Addendum A of the July 6, 2005 
interim final rule with comment had undergone modification. For 
example, beginning in January 2006, the HCPCS code for iron dextran 
will be split into two codes, and the HCPCS code for darbepoetin alfa 
when used for non-end stage renal disease will be revised.
    We are unable to recalculate the weights for these split HCPCS 
codes because it is not possible to estimate the new codes' 
utilization. Therefore, we are including these drugs in a revised 
version of Addendum B--New Drugs for CAP Bidding 2006, which was 
published in the July 6, 2005 in the interim final rule with comment. 
The list of New Drugs for CAP Bidding 2006 is now Addendum G of this 
rule. We believe this change is appropriate because we had already 
decided to include these drugs in the CAP drug category, and adding 
them to Addendum G will avoid a recalculation of the other CAP drugs' 
weights based on an imprecise estimate of utilization. Addenda F and G 
published in this final rule with comment supersede Addenda A and B 
from the July 6, 2005 interim final rule with comment. Note that HCPCS 
code modifications as they

[[Page 70239]]

relate to the Single Drug Category list were discussed in section 
II.H.6.a.(1).(a) of this final rule with comment.
    In order to be included in Addendum G--Revised List of New Drugs 
for CAP Bidding for 2006, we determined that a drug must not appear in 
the Revised Single Drug Category List (Addendum F of this rule) and 
must meet at least one of the following three criteria:
    <bullet> Criterion 1: The drug must have been listed in Addendum B 
of the July 6, 2005 interim final rule with comment, ``New drugs for 
CAP Bidding for 2006''.
    <bullet> Criterion 2: The drug must have a new J or Q HCPCS code 
effective January 1, 2006, and meet the three following conditions:
    + Be administered incident to a physician's service.
    + Have had a previous C, S or ``NOC'' (Not Otherwise Classified or 
Miscellaneous) code.
    + Have one national published ASP payment price and not meet either 
of the following two conditions:
    ++ Be primarily billed through the DME process.
    ++ Be primarily used as a diagnostic agent.
    <bullet> Criterion 3: The drug must be listed in Addendum A--Single 
Drug Category List published in the July 6, 2005 interim final rule 
with comment, but had its HCPCS code terminated effective January 1, 
2006 and split into J or Q Codes that become effective January 1, 2006.
    Criterion 1 describes drugs listed in Addendum B of the July 6, 
2005 interim final rule with comment. Tables 24 and 25 list drugs that 
meet criteria 2 and 3. Table 24 lists drugs that will have new HCPCS 
codes beginning January 1, 2006 and Table 25 is a list of drugs that 
were previously included in Addendum A but whose HCPCS codes were 
split. Combining these three lists will yield Addendum G--Revised New 
Drugs for CAP Bidding for 2006, which is published in this rule.

   Table 24.--CAP Drugs With New HCPCS Codes Effective January 1, 2006
------------------------------------------------------------------------
       HCPCS  (effective  1/1/2006)               Long description
------------------------------------------------------------------------
J0128.....................................  Abarelix injection.
J0180.....................................  Agalsidase beta injection.
J0878.....................................  Daptomycin injection.
J1931.....................................  Laronidase injection.
J2357.....................................  Omalizumab injection.
J2469.....................................  Palonosetron HCl.
J2794.....................................  Risperidone, long acting.
J9035.....................................  Bevacizumab injection.
J9041.....................................  Bortezomib injection.
J9055.....................................  Cetuximab injection.
J9305.....................................  Pemetrexed injection.
J9264.....................................  Paclitaxel protein bound
                                             particles.
J2503.....................................  Pegaptanib.
J0278.....................................  Amikacin.
J9225.....................................  Histrelin implant.
------------------------------------------------------------------------


       Table 25.--HCPCS Codes From Addendum A That Have Been Split
------------------------------------------------------------------------
                                       2006 Long          Discontinued
  HCPCS  (effective  1/1/2006)        description            HCPCS
------------------------------------------------------------------------
J1751...........................  Iron Dextran 165...              J1750
J1752...........................  Iron Dextran 267...              J1750
------------------------------------------------------------------------

    The drugs identified in Addendum G will be bid and paid for as 
described in the July 6, 2005 interim final rule with comment (70 FR 
39072). In the July 6, 2005 interim final rule with comment, we stated 
that we will require that prospective vendors include bids for all of 
these drugs in their submissions and provide these drugs to physicians 
who elect to participate in the CAP. However, we will not incorporate 
the bids for these drugs into the composite bid methodology, because we 
lack sufficient utilization data to compute appropriate weights for 
these drugs. Instead, we will consider these bids separately from, but 
parallel to, evaluation of the composite bid for the other drugs for 
which we have adequate utilization data. Specifically, we will require 
bidders to submit a separate bid for each drug in the list. We will 
also impose a ceiling on acceptable bids. As in the case of the 
composite bids, that ceiling will be tied to the ASP payment 
methodology. Specifically, we will not accept any bid for a drug listed 
in Addendum G that is higher than 106 percent of the ASP for that drug 
(as determined at the time when the bidding begins). In order to be 
eligible for selection as an approved CAP vendor, a bidder must meet 
all of the criteria outlined in Sec.  414.908 of the regulation text 
and must submit acceptable bids on each of the drugs listed in Addenda 
F and G of this final rule with comment.
(c) Process for Adding NDCs Within a HCPCS Code in an Approved CAP 
Vendor's Drug List
    We acknowledge that given the 3-year CAP contract duration, some 
changes to the approved CAP vendors' CAP drug lists are anticipated 
during the life of the contract. In the July 6, 2005 interim final rule 
with comment (70 FR 39075), we described a mechanism where approved CAP 
vendors could request CMS approval to add new drugs to their CAP drug 
lists once the drug had a permanent HCPCS code. We also described a 
mechanism (70 FR 39044 and Sec.  414.906(f)(2)(i)) where, if a 
particular NDC becomes unavailable or goes through a period of short 
supply an approved CAP vendor could substitute a different NDC within 
the HCPCS code for the NDC currently supplied by the approved CAP 
vendor for an extended period of time (2 weeks or longer) if the 
approved CAP vendor identifies the replacement product, CMS approval 
for the substitution is obtained, and all participating CAP physicians 
who have selected the approved CAP vendor are notified of the change.
    Comment: Numerous commenters recommended that we develop a 
mechanism to allow approved CAP vendors to add drug products 
(identified by an NDC) to those already supplied within a HCPCS code 
during the CAP contract period. Potential vendors indicated in their 
comments that they would like the flexibility to add NDCs because, as 
experience with the CAP grows, they may encounter situations where the 
addition of certain drugs supplied under a HCPCS code may improve 
beneficiary access, reduce waste, and improve the vendor's cost 
efficiency.
    Response: We agree that additional mechanisms to expand an approved 
CAP vendor's drug list at the NDC level are desirable. The current 
requirements state that an approved CAP vendor must offer at least one 
NDC within each HCPCS code in the CAP drug category. We encourage 
potential vendors to bid more than the minimum of one NDC per HCPCS 
code. However, we also understand that, as the 3-year contract period 
progresses, opportunities to modify the initial list of NDCs supplied 
under a HCPCS code will occur. Examples of these opportunities could 
include introduction of a new package size, the introduction of a new 
manufacturer's products (including new multisource products), and price 
changes in existing NDCs.
    We believe that in order for an approved CAP vendor to continue to 
meet participating CAP physicians'

[[Page 70240]]

needs, it is in the approved CAP vendor's best interest to provide and 
maintain a satisfactory range of products, and to improve the range of 
available products as experience with the program increases. We agree 
that a mechanism to increase the number of CAP drugs offered by an 
approved CAP vendor is expected to improve access to Part B drugs and 
to improve prescribing flexibility for physicians who obtain drugs 
through the CAP. We believe that the process to add NDCs to the 
existing list of NDCs supplied by an approved CAP vendor is 
appropriate, provided that the additions to the approved CAP vendor's 
list undergo an approval process.
    In the July 6, 2005 interim final rule with comment, in Sec.  
414.906(f)(2), we stated that the designated carrier's medical director 
will approve long-term substitutions to the list of drugs supplied by 
an approved CAP vendor ``on behalf of CMS.'' As described in the 
following sections of this rule and based on comments on the interim 
final rule with comment, we have expanded this request and approval 
process for incorporating changes into the list of drugs supplied by 
the CAP vendor to include new NDCs, and new HCPCS codes. In addition, 
beginning in 2007, approved CAP vendors will be able to request 
approval to add newly approved drugs to their CAP drug list before the 
drug is assigned a HCPCS code.
    In order to provide flexibility for managing this task and 
consistency for these processes, we are amending Sec.  414.906 to allow 
CMS or its designee to approve long-term substitutions and additions to 
approved CAP vendors' CAP drug lists. We are also revising Sec.  
414.906(f)(4)(iii) to specify that substitutions that are due to a drug 
shortage, or other exigent circumstance, may become effective 
immediately provided that the approved CAP vendor's participating CAP 
physicians are notified of the substitution immediately following CMS 
approval.
    We are modeling the process of adding new NDCs within a HCPCS code 
on the substitution mechanism described in the July 6, 2005 interim 
final rule with comment (70 FR 39044) and specified in Sec.  
414.906(f). We note that because this is a mechanism for the addition 
of drugs to an approved CAP vendor's CAP drug list, the approved CAP 
vendor will be required to continue supplying all NDCs from its most 
recently updated CAP drug list. (The substitution process should be 
used if the approved CAP vendor is seeking approval to remove an NDC 
from its CAP drug list and replace it with another NDC.) In order to 
add a new NDC within a HCPCS code being offered in the approved CAP 
vendor's CAP drug list, the approved CAP vendor must make a written 
request to CMS or its designee. Requests for approval must include a 
rationale and discussion of impact on the CAP, including safety, waste, 
and potential for cost savings. The requests will be reviewed and, if 
approved, changes will become effective as of the beginning of the next 
quarter.
    Like the substitution procedure, the addition of new NDCs to an 
approved CAP vendor's CAP drug list will not affect the CAP payment 
amount for that particular HCPCS, as the payment amount will have been 
set during the initial bidding (or approval process for adding an 
additional HCPCS code) and, if applicable, updated as outlined in Sec.  
414.906. This application process is reflected in the amended Sec.  
414.906(f)(2)(ii).
    Participating CAP physicians who have selected the approved CAP 
vendor must be notified of additions to the approved CAP vendor's CAP 
drug list at least on a quarterly basis (at least 30 days or earlier 
before the approved changes are due to take effect). Both the approved 
CAP drug vendor and CMS (or its designee) will be responsible for 
maintaining this information and disseminating it. Approved CAP vendors 
must provide direct (for example, mail or e-mail) notification of 
updates to the participating CAP physicians enrolled with them on a 
quarterly basis. The entire list of drugs supplied by the approved CAP 
vendor should be disseminated at least once yearly; and approved CAP 
vendors must make a complete list that incorporates the most recent 
updates available to participating CAP physicians on an ongoing basis. 
We will post the updated drug lists on our web site. The approved CAP 
vendor may also post the complete, updated, and approved list on its 
web site. We have added these requirements to new Sec.  414.914(f)(15). 
We will issue additional instructions for this process at a later date.
(d) Process for Expediting the Addition of Newly Approved Drugs to the 
CAP (``NOC'' Codes)
    The July 6, 2005 interim final rule with comment outlined a process 
that approved CAP vendors can use to add new drugs to the list of drugs 
supplied under the CAP once the new drug has been assigned a permanent 
HCPCS code, provided the drug would have been properly assigned to the 
single drug category and that CMS determines that the drug is 
appropriate for inclusion. This mechanism was intended to provide an 
opportunity for vendors to supply drugs that were introduced too late 
to be incorporated into the Addendum B--New Drugs for CAP bidding for 
2006 published in the July 6, 2005 interim final rule with comment.
    Comment: Several commenters have requested that we develop a 
process to further expedite the addition of newly approved or marketed 
drugs to an approved CAP vendor's drug list. Commenters stated that 
access to newly approved drugs should be immediate. These commenters 
further stated that participating CAP physicians should not have to go 
outside of the CAP to acquire new drugs. Several commenters suggested a 
mechanism that uses the miscellaneous (``NOC'') HCPCS codes for 
physicians and vendors to bill CAP drugs that do not have a permanent 
HCPCS code. Certain commenters also suggested that approved CAP vendors 
be required to offer the new drugs as soon as they are on the market.
    Response: We agree with the commenters that the earlier addition of 
newly approved or newly marketed drugs to the CAP is desirable, to the 
extent these drugs are appropriate for inclusion in the CAP. The tight 
timeframe for CAP implementation and the requirement for additional 
system changes prevent us from implementing the process suggested by 
the commenters at this time. In 2007, approved CAP vendors will be able 
to request CMS approval to add new drugs without a permanent HCPCS code 
to their CAP drug lists. This process will be similar to the process 
established in the July 6, 2005 interim final rule with comment that 
allows approved CAP vendors to add new drugs that are assigned a 
permanent HCPCS code to their CAP drug lists. Approved CAP vendors will 
submit a request to add these drugs, and CMS or its designee will 
determine whether the particular drugs are appropriate for inclusion in 
the CAP using a process that parallels the development of the Single 
Drug Category List and the List of New Drugs for CAP bidding for 2006. 
Updates to the approved CAP vendors' CAP drug lists will be made on a 
quarterly basis; we anticipate that all approved CAP vendors' updates 
will be posted on the CMS Web site simultaneously.
    Payment for new CAP drugs approved for inclusion in the approved 
CAP vendor's CAP drug list before they are assigned a HCPCS code would 
be at the price published in the ASP's ``not otherwise classified'' 
(NOC) price file consistent with the next quarterly update. And we note 
that these drugs would be considered for inclusion in the CAP only if 
CMS is able to identify

[[Page 70241]]

a single ASP payment amount for the drug. At a future date, we will 
issue additional guidance to approved CAP vendors on the application 
procedures for requesting approval to add these changes to the approved 
CAP vendor's CAP drug list, and we will issue additional guidance to 
participating CAP physicians on how to order these particular drugs 
once they are added to the approved CAP vendor's CAP drug list.
    We do not believe that requiring approved CAP vendors to add all 
new drugs to their CAP lists is advisable. Instead, we believe that a 
request and approval process as described for other changes to an 
approved CAP vendor's drug list would be appropriate because it would 
allow for flexibility while ensuring that only those that are 
appropriate for inclusion in the CAP are added to an approved CAP 
vendor's CAP drug list. As discussed in the July 6, 2005 interim final 
rule with comment (70 FR 39027 through 39031) some drugs may not be 
good candidates for the CAP, for instance, some new drugs are not 
typically administered ``incident to'' a physician's services, some new 
drugs may have very low utilization, and some may have special storage, 
distribution, or handling requirements that would make these drugs 
inappropriate for inclusion in the CAP. The existing procedures for 
adding new NDCs within the HCPCS codes that are on an approved CAP 
vendor's CAP drug list, and the new procedures for adding new HCPCS 
codes to an approved CAP vendor's CAP drug list also rely on approved 
CAP vendors' voluntary requests and our approval of these requests. 
Simply put, we want to expand the number of CAP drugs that approved CAP 
vendors offer, but we do not believe that all new drugs should be added 
to the CAP, or that addition of certain drugs should be mandatory, 
especially at the beginning of this program. As we gain experience with 
the program we may consider other approaches to the addition of drugs 
that a vendor supplies under the CAP.
    Beginning in 2007, approved CAP vendors will be able to request 
approval to add new ``NOC'' drugs to their CAP drug lists. The 
procedures will parallel those for addition of new HCPCS codes and new 
NDCs within a HCPCS code, as specified in Sec.  414.906(f)(2)(iv). In 
each case, the approved CAP vendor must make a written request to CMS 
(or its designee). Requests for approval must include a rationale and 
discussion of impact on the CAP, including safety, waste, and potential 
for cost savings. The requests will be reviewed and, if approved, 
changes will become effective on a quarterly basis.
    We remind physicians that an approved CAP vendor's CAP drug list is 
subject to change over the contract period. Upon electing to 
participate in the CAP and selecting an approved CAP vendor, 
participating CAP physicians are agreeing to accept, in most cases, the 
particular NDCs listed and shipped by the selected approved CAP vendor 
for the duration of the participating CAP physician's election period 
with the approved CAP vendor. By electing to participate with a 
particular approved CAP vendor, the participating CAP physician also is 
agreeing to accept the approved changes to the approved CAP vendor's 
CAP drug list and drugs supplied under the updated and approved lists. 
We believe that the changes in the approved CAP vendor's CAP drug list 
will improve (or at least maintain) a participating CAP physician's 
selection of available drugs and will likewise improve (or maintain) 
Medicare beneficiaries' access to drugs supplied under the CAP. We are 
revising Sec.  414.908(a)(3)(vi) to state this requirement.
    We remind physicians that routine orders for CAP drugs should be 
placed at the HCPCS level, unless the participating CAP physician 
determines that a particular product that is on the approved CAP 
vendor's CAP drug list is medically necessary for a patient. In this 
case, a participating CAP physician may order that specific NDC from 
the approved CAP vendor under the ``furnish as written'' process. 
Documentation of medical necessity in the medical record is also 
required; this information may be subject to medical review. We are 
revising Sec.  414.908(a)(3)(vii) to reflect this requirement.
(e) Process for Adding Drugs With a New HCPCS Code to the CAP
    In the July 6, 2005 interim final rule with comment (70 FR 39075), 
we stated that we would allow approved CAP vendors to petition CMS to 
add drugs with a new HCPCS code to their CAP drug lists; however, we 
did not include regulation text to implement this section. In order to 
implement this process we are amending regulation text at Sec.  
414.906(f)(2)(iii).
(f) Process for Adding Single Indication Orphan Drugs to the CAP
    Table 26 is a brief summary of methods that an approved vendor may 
use to amend the list of drugs it supplies under the CAP. Please note 
that all of these methods require approval from CMS or its designee.
    Comment: We received several comments from manufacturers requesting 
inclusion of their single indication orphan drugs in the CAP. Most 
commenters stated that these low volume products were quite suitable 
for the CAP because availability through the CAP would minimize the 
associated administrative burden for physicians who choose to 
administer them. Inclusion of one product (thyrotropin alfa) was also 
requested by a number of physicians who treat patients with thyroid 
cancer and by patients who had been treated for thyroid cancer. One 
manufacturer specifically requested that its orphan drug (azacitidine) 
not be included in the CAP, citing concern about timely access to the 
drug.
    Response: We appreciate the comments that we received regarding 
single indication orphan drugs. Improving access to Part B drugs is a 
desirable quality for this program. For example, we have endeavored to 
improve access by allowing the addition of new NDCs and new HCPCS codes 
to a drug vendor's list. During this initial stage of the CAP, as 
described in the July 6, 2005 interim final rule with comment (70 FR 
39032), we also have sought to strike a balance that would allow for a 
sufficiently sized market volume for approved CAP vendors, while making 
the CAP a meaningful alternative for most physician specialties. In 
order to decrease the inventory burden for approved CAP vendors, we 
wanted to minimize the number of drugs included in the CAP drug 
category that are billed in very low volumes, so we applied dollar 
value thresholds to the CAP.
    As noted by commenters, the addition of the single indication 
orphan drugs to the CAP drug category may decrease administrative 
burden on the participating CAP physicians, and we agree that a 
decreased burden is desirable. We are persuaded by the number of 
commenters that asked us to include single indication orphan drugs in 
the CAP drug category that a mechanism for their addition to an 
approved CAP vendor's CAP drug list is desirable. However, for the 
reasons that prompted us not to include single indication orphan drugs 
in the initial drug category (as described in the July 6, 2005 interim 
final rule with comment), we continue to believe that we should not 
require approved CAP vendors to supply these drugs.
    Therefore, we are specifying that approved CAP vendors may request 
CMS approval to add single indication orphan drugs (as described in the 
July 6, 2005 interim final rule with comment) to their CAP drug lists. 
The

[[Page 70242]]

single indication drugs covered by this provision are the following: 
J0205, J0256. J9300, J1785, J2355, J3240, J7513, J9010, J9015, J9017, 
J9160, J9216 and their successor codes. Payment for single indication 
orphan drugs that vendors voluntarily add to the CAP will be based on 
ASP+6 percent.

 Table 26.--Methods for Changing an Approved CAP Vendor's CAP Drug List
------------------------------------------------------------------------
                Description                        Regulation text
------------------------------------------------------------------------
Substitution: Approved CAP vendor may       Sec.   414.906(f)(2)(i).
 request approval to replace one or more
 NDCs in a HCPCS code supplied by the
 approved CAP vendor with one or more
 other NDCs.
Add newly issued HCPCS Codes: Approved CAP  Sec.   414.906(f)(2)(iii).
 vendor may request that CMS allow it to
 supply additional HCPCS codes under the
 CAP.
Additional NDCs: Approved CAP vendor may    Sec.   414.906(f)(2)(ii).
 request that CMS allow it to supply
 additional NDCs under a HCPCS code that
 the approved CAP vendor already supplies
 under the CAP.
Newly approved drugs without HCPCS codes    Sec.   414.906(f)(2)(iv).
 (``NOC'' dugs''): Beginning in 2007,
 approved CAP vendor may request that CMS
 allow it to supply a newly approved drug
 under the CAP before a permanent HCPCS
 code is assigned to the drug.
Single Indication Orphan Drugs: Approved    Sec.   414.906(f)(2)(iii).
 CAP vendor may request that CMS allowed
 it to supply single indication orphan
 drugs under the CAP.
------------------------------------------------------------------------

(g) Other Issues Related to Drugs Supplied Under the CAP
(i) Addition of Other Specific Drugs
    We received comments regarding the addition of low volume drugs, 
and dermal tissue biologicals to the CAP. Specific comments and 
responses for each type of drug follow.
    Comment: One commenter asked whether we would allow approved CAP 
vendors to voluntarily supply drugs with low utilization volumes 
through the CAP. The commenter was specifically referring to drugs that 
were not included in the CAP category because of utilization criteria 
described in the interim final rule with comment (70 FR 39031-39032).
    Response: Drugs included in the initial CAP drug category account 
for about 85 percent of Part B drugs billed by physicians. In other 
sections of this rule we have described methods that an approved CAP 
vendor may use to request the addition of new NDCs or new HCPCS codes 
to the CAP. Although we appreciate the request to add drugs with low 
utilization volumes to the CAP drug category, we believe it is 
appropriate to allow additions to an approved CAP vendor's CAP drug 
list through the case-by-case approval process we have described above 
and specified in Sec.  414.906. Once we gain experience with the CAP, 
we anticipate being able to consider broadening the scope of drugs 
included in future CAP drug categories.
    Comment: The manufacturers of two dermal tissue products expressed 
concern about language in the July 6, 2005 interim final rule with 
comment that stated ``tissues are not considered drug products.'' One 
manufacturer asked that its product be included in the CAP, while the 
other stated other reasons for excluding its product were appropriate 
and did not ask that its product be included in the CAP.
    Response: We thank the commenters for providing us with the 
opportunity to clarify the discussion about dermal tissue found in the 
July 6, 2005 interim final rule with comment (70 FR 39031). During 
development of the criteria used to create Addendum A--Single Drug 
Category List of the July 6, 2005 interim final rule with comment, we 
attempted to allow for a sufficiently sized market for approved CAP 
vendors, while making the CAP a meaningful alternative for most 
physician specialties. The statement that the commenter references 
above was intended to explain why we did not include dermal tissue 
products in the initial CAP drug category and was not intended to 
reflect overall Medicare policy for dermal tissue products. We are not 
including tissues in the initial CAP drug category at this time because 
the products do not have sufficient documented utilization, and some 
products may require specialized handling. As we gain experience with 
the CAP, we anticipate reevaluating exclusion criteria applied to 
bidding for the initial phase of this program.
(ii) Formularies and the CAP
    In the July 6, 2005 interim final rule with comment, we responded 
to comments on the subject of formularies. We respond to additional 
comments on the subject from the July 6, 2005 interim final rule with 
comment below.
    Comment: We received several comments that encouraged us to refrain 
from creating formularies in the CAP and to avoid situations where a 
formulary-like process could be created. Commenters raised concerns 
about a formulary's likelihood to limit beneficiaries' access to a wide 
selection of drugs and the impact on a physician's choice in 
prescribing medications.
    Response: In the July 6, 2005 interim final rule, we stated that we 
were not accepting the recommendation that vendors be permitted to 
establish formularies because the statute expressly requires that for 
multiple source drugs, a competition be conducted for the acquisition 
of at least one drug per billing code within that category (70 FR 
39034). We agree that in an effort to provide physicians with maximum 
flexibility in prescribing, we should avoid the use of formularies in 
the CAP. Furthermore, we believe that making the CAP less restrictive 
will increase physician interest and, therefore, improve vendor 
participation.
    In the July 6, 2005 interim final rule with comment (70 FR 39033 
through 39034 and 39068), we stated that ``we do not expect there to be 
a creation of a drug formulary,'' and we further discussed our belief 
that vendors would find it prudent to structure their bids in a way to 
supply more than one NDC per HCPCS code. We wish to emphasize that this 
is still our position on formularies in the CAP. It is our opinion that 
approved CAP vendors who offer more than one product per HCPCS code 
would be selected by a greater number of participating CAP physicians.
(iii) Physicians Regulatory Issues Team Drugs
    The July 6, 2005 interim final rule with comment also discussed 
issues regarding drugs that have posed acquisition problems for some 
physicians under the ASP system. We received additional comments on 
this topic.
    Comment: Commenters asked whether drugs included on the Physicians 
Regulatory Issues Team (PRIT) list (drugs reported to be difficult for 
physicians to obtain for less than ASP+6 percent) have been included in 
the CAP. Commenters also asked that

[[Page 70243]]

the PRIT list be made available to the public.
    Response: The PRIT is a group of CMS subject matter experts who 
work to reduce the regulatory burden on Medicare physicians. Since the 
inception of the ASP payment system, individual physicians have 
reported difficulty in acquiring certain drugs for less than ASP+6 
percent. At the request of the Physicians Practice Advisory Committee, 
the PRIT began compiling reports of these situations. More information 
about the PRIT may be found at the following web site: http://www.cms.hhs.gov/physicians/prit/.
    Because the PRIT list is based on voluntary reporting, and 
information is received on an ad-hoc, nonrepresentative basis, the PRIT 
list may not fully describe overall drug pricing or availability 
patterns; therefore, we have chosen not to use the PRIT list as a 
specific criterion for the CAP. However, as stated in of the July 6, 
2006 interim final rule with comment (70 FR 39033), we did review drugs 
that had been associated with access problems under the ASP payment 
system during the development of the CAP single drug category and we 
have subsequently examined the PRIT list during the writing of this 
rule. We have found that the CAP includes most drugs reported to the 
PRIT. PRIT list drugs not in the CAP are drugs that were not included 
for specific reasons described in the July 6, 2005 interim final rule 
with comment, such as -single indication orphan drugs, drugs without 
permanent HCPCS codes, oral medications, and drugs with low 
utilization.
(iv) Discussion of Intrathecal Pain Management
    The July 6, 2005 interim final rule with comment's discussion of 
specific drugs contained a comment and response on ziconotide 
(Prialt[supreg]).
    Comment: One commenter stated that, in our discussion of 
intrathecal pain management, we mischaracterized ziconotide as an 
opioid analgesic. The commenter points out our inconsistency in 
referring to ziconotide as an opioid, but following with a discussion 
that demonstrates understanding that ziconotide is not an opiate. The 
commenter asked if non-opiate pain medications administered 
intrathecally through an implanted pump or external infusion device 
would be suitable for inclusion in the CAP. The commenter also asked 
whether ziconotide could be added to Addendum B--New Drugs for CAP 
Bidding for 2006 of the drug bidding list if a permanent HCPCS code 
were assigned in the Fall of 2005. The commenter also noted that 
baclofen and clonidine, two other medications that can be administered 
intrathecally through a pump, are included in the CAP drug category.
    Response: We appreciate the opportunity to clarify our discussion. 
Ziconotide is not an opiate analgesic and it is not a controlled 
substance. Neither the comment nor the corresponding response were 
intended to describe ziconotide as an opioid or to limit the discussion 
to intrathecally administered opioids.
    Our response to the comment in the interim final rule with comment 
was intended to address two points. First, we did not consider opioids 
and ziconotide for inclusion into the bid list for different reasons. 
Opioids are controlled substances and are subject to extra record 
keeping requirements as stated in the July 6, 2005 interim final rule 
with comment (70 FR 39028); ziconotide was not included in the CAP drug 
category because it had not yet been assigned a HCPCS code. Second, we 
agreed in principle that opioid medications administered intrathecally 
through implanted variable-rate infusion devices could be included 
under the CAP, when they are administered by physicians in their 
offices incident to their services. Although we specifically referred 
to opioid medications in this discussion, the statement applies to non-
opioid medications as well. However in the interim final rule with 
comment, we described our methodology for determining whether a drug 
would be included in the initial CAP drug category. (70 FR 39028 and 
39031 through 39032).
    Although ziconotide generally appears to meet the criteria for 
inclusion in the initial CAP drug category, we have become aware of an 
unresolved payment methodology issue with this drug resulting in the 
lack of a consistent ASP for ziconotide. It is important that drugs 
included in the CAP drug category have an ASP that we can determine, 
because a drug's ASP is used to calculate the overall price ceiling for 
the composite bid and the maximum payment amount for CAP drugs not 
included in the composite bidding process. For this reason, we are not 
including this drug in the CAP at this time.
(v) Leuprolide and Related Drugs
    During the development of the Single Drug Category List published 
in Addendum A of the July 6, 2005 interim final rule with comment, we 
chose not to include injectable forms of leuprolide acetate (J9217 and 
J9218) in the initial CAP drug category. We provide a discussion of 
local coverage determinations (LCDs) and LCA policy as it relates to 
the CAP in the July 6, 2005 interim final rule with comment (70 FR 
39039). We note that leuprolide acetate implant (J9219) remains in the 
CAP's Single Drug Category List.
    Comment: We received several comments about leuprolide and other 
luteinizing hormone-releasing hormone (LHRH) analogues, which include 
goserelin, triptorelin, and histrelin. Commenters acknowledged the 
complexity of applying LCA policies to the CAP for both physicians and 
vendors. They also questioned whether all regions of the United States 
were subject to LCA policies for this leuprolide, and commenters 
expressed concern that the policies may extend to LHRH other than 
leuprolide and goserelin, such as histrelin and triptorelin. Two 
commenters suggested that the CAP not use LCA policies, and failing 
that the commenter suggested that drugs covered by LCA policies be 
``carved out'' of the CAP. Another commenter stated that LCA policies 
varied so much that not including leuprolide in the CAP drug category 
was an incomplete solution to the LCA issue because the entire group of 
LHRH analogues was in the process of becoming affected by LCAs, and 
that continuing price changes could not guarantee that goserelin would 
remain the least costly alternative drug among the LHRH analogues.
    Response: We appreciate the concerns raised by the commenters. 
However, we do not believe that we have the authority to specify that 
CAP prices supersede an LCA policy. As we stated in the July 6, 2005 
interim final rule with comment, nothing in this rule is intended to 
disrupt the longstanding ability of contractors to apply an LCA policy 
under section 1862(a)(1)(A) of the Act. Section 1862(a)(1)(A) of the 
Act provides that notwithstanding any other provision in the Medicare 
statute (that is, including section 1847B of the Act), no payment may 
be made under Part A or Part B for any expenses incurred for items and 
services that are not medically necessary. As a result, if a carrier 
applies an LCA policy to a particular drug, a claim submitted to the 
carrier for that drug is subject to LCA.
    After considering the comments, we continue to believe that the 
decisions outlined in the July 6, 2005 interim final rule with comment 
pertaining to which drugs are included in the CAP drug category 
maintain a balance between physician access to LHRH analogues

[[Page 70244]]

and vendor risk associated with the application of LCAs for these 
drugs.
(h) Drug Weighting
    In the July 6, 2005 interim final rule with comment (70 FR 39069), 
we finalized our proposal to employ a ``composite bid'' for selecting 
bidders. The composite bid will be constructed by weighting each HCPCS 
bid by the HCPCS code's share of volume (measured in HCPCS units) of 
drugs in our single drug category during the prior year. Within the 
single category, the drugs weights will sum to one.
    Comment: Some commenters suggested that instead of using only 
utilization data to derive weights, we should use both utilization and 
allowed charges data so that products with high utilization, but low 
charges, are not over weighted.
    Response: We appreciate the suggestion of an alternative weighting 
methodology, and we recognize that the weighting methodology could be 
developed in a number of ways. We are also aware that changing the 
weighting methodology from utilization volume to dollar volume could 
impact overall weighting.
    For the initial bidding cycle, we chose to use a relatively simple 
weighting methodology based on claims volume, but corrected for the 
appearance of multiple identical claim lines on a given day of service. 
We also believe that the creation of a single drug category further 
minimizes some effects associated with using utilization data as the 
only weighting parameter. We do not believe that a change in weighting 
methodology would result in significantly different weights than those 
derived under the current weighting methodology for the majority of 
drugs in the single drug category list. Therefore, we will implement 
CAP using the same weighting methodology described in the July 6, 2005 
interim final rule with comment (70 FR 39069 through 39071) and will 
consider alternatives for future bidding cycles.
    Earlier in this section we have discussed the need to make changes 
to the Single Drug Category List published in Addendum A of the July 6 
2005 interim final rule with comment. The resulting change in the 
composition of the Single Drug List required us to recalculate the drug 
weights. A complete discussion of the reasons for this revision is 
included in section II.H.6.a.(1)(a), Changes to the Single Drug 
Category List--Addendum A of the July 6, 2005 interim final rule with 
comment.
b. Vendor/Bidding Issues
    In this section we discuss issues related to vendor bidding such as 
drug quality, vendor subcontracting, confidentiality of the bids, 
vendor call center requirements, the inclusion of prompt pay discounts 
in vendor net acquisition costs, and the mechanics of the bidding 
process.
(1) Quality/Product Integrity
    In the July 6, 2005 interim final rule with comment (70 FR 390660 
through 390662), we discussed product integrity and the requirement to 
comply with existing State and Federal laws regarding adulteration, 
misbranding, spoilage, contamination, expiration, and counterfeiting of 
products. We stated that although we do not propose to require 
applicants or potential CAP vendors to employ measures beyond those 
required for licensure and regulatory compliance, we believe these 
measures set a minimum standard, and we requested that applicants 
discuss any additional measures they have taken to ensure product 
integrity. We also provided examples of additional measures that pose 
minimal burden but enhance the ability to detect adulterated, 
misbranded, or counterfeit drugs. We further stated that the approved 
CAP vendor application process, the maintenance of appropriate 
licensure, and Medicare supplier status form the framework for product 
integrity. We also noted that potential CAP vendors are required to 
submit a compliance plan as part of the bidding process that contains 
policies and procedures for the prevention of fraud, waste, and abuse, 
and provides detailed information on steps to ensure product integrity 
as specified in Sec.  414.914.
    Comment: Many commenters supported the steps outlined in the July 
6, 2005 interim final rule with comment to ensure quality and product 
integrity. There were some commenters, however, who expressed concern 
that the provisions in the interim final rule with comment will not be 
adequate to prevent fraud and abuse and ensure product integrity. One 
commenter believed that patient health and safety could be compromised 
by the imposition of a third party (the approved CAP vendor) for drug 
acquisition, preparation, and delivery. This commenter was also 
concerned about the possibility that certain drugs could be 
reconstituted in their vials by the approved CAP vendor. Another 
commenter suggested that the Verified-Accredited Wholesale Distributors 
\TM\ Program could play a key role in adherence to quality and 
performance standards among approved CAP vendors. This is a program 
developed by the Task Force on Counterfeit Drugs and Wholesale 
Distributors that was convened in 2003 by the National Association of 
Boards of Pharmacy to ensure that a wholesale distribution facility is 
licensed and operating under best practices for drug distribution.
    Response: We appreciate and share the commenters' concerns about 
ensuring quality and product integrity. However, we do not agree that 
the approved CAP vendor's role in drug acquisition, preparation, and 
delivery will compromise patient health and safety. We addressed the 
issue of reconstituted vials in the July 6, 2005 interim final rule 
with comment (70 FR 39061) by stating that approved CAP vendors may 
split vial trays, but cannot ship opened vials.
    As we gain more experience with the CAP, we will explore the 
Verified-Accredited Wholesale Distributors \TM\ Program and other 
options to further protect product integrity.
    Comments: Several commenters recommended that CMS establish 
standards and survey procedures for approved CAP vendors and their 
subcontractors to inspect the chain of custody of the drugs delivered 
to participating CAP physicians. These commenters also requested that 
CMS establish and disseminate information about the procedure that 
participating CAP physicians should follow to report a suspected 
delivery of counterfeit drugs, and suggested that a web-based quality 
reporting system be available on various aspects of the approved CAP 
vendor's performance. These commenters also wanted clarification that 
one substantiated instance of purchase or distribution of a counterfeit 
drug by an approved CAP vendor will result in the automatic termination 
of the vendor's Part B supplier contract and the CAP contract.
    Response: We continue to believe that existing Federal and State 
requirements, along with the specific requirements for approved CAP 
vendors outlined in the bidding and selection process, provide an 
adequate framework for protecting product integrity. Participating CAP 
Physicians should notify the approved CAP vendor immediately if there 
are any questions regarding the integrity of a CAP drug, and report any 
violations to the appropriate Federal and State authorities, as well as 
to the designated carrier's dispute resolution staff. In addition, the 
designated carrier will act promptly to investigate CAP quality 
complaints under the process outlined for dispute resolution as 
described in Sec.  414.916.

[[Page 70245]]

    As we gain experience with the CAP, we will assess whether 
additional steps are needed to ensure product quality. We are committed 
to ensuring that approved CAP vendors ship only high quality products 
and any reports of compromised quality will be addressed promptly.
(2) Subcontracting
    In the July 6, 2005 interim final rule with comment (70 FR 39060, 
39064, and 39065), we stated that a vendor could subcontract with 
another entity as long as that entity met all of our approved CAP 
vendor requirements, is in compliance with all applicable laws and 
regulations, has a demonstrable record of integrity regarding fraud and 
abuse and conflict of interest, and has adequate administrative 
arrangements in place to ensure effective operations. Information on 
specific requirements for subcontractors was provided in the July 6, 
2005 interim final rule with comment and is a required part of the 
vendor's CAP application.
    In Sec.  414.914(f)(9), we also stated that it is the approved CAP 
vendor's responsibility to determine that subcontractors remain 
compliant with these standards. It was further noted that we intend 
that subcontractors or other entities associated with furnishing CAP 
drugs under an approved CAP vendor's contract maintain the same 
standards as the approved CAP vendor for the role that they play in 
supplying CAP drugs.
    Comment: Many commenters expressed support that we intend to hold 
any subcontractors to the same standards as the approved CAP vendors. 
However, some commenters requested clarification on certain aspects of 
subcontracts or requested more stringent requirements. Two commenters 
requested that approved CAP vendors include in their subcontractor 
agreements a covenant binding on the subcontractor to comply with all 
rules applicable to approved CAP vendors, including those rules 
regarding product integrity and drug pedigree, and that HHS be a third 
party beneficiary to these agreements with the right to enforce any of 
the provisions relating to CAP compliance. One commenter wanted 
assurance that a contract between a large distributor and a specialty 
pharmacy would not be considered a conflict of interest.
    Another commenter requested that we require full disclosure of a 
potential CAP vendor's corporate relationships and specifically 
prohibit potential CAP vendor subsidiaries from bidding against their 
parent company or other subsidiaries with the same parent company.
    Response: We appreciate the commenters' interest in maintaining 
quality of the CAP by ensuring integrity in all aspects of the approved 
CAP vendor and subcontractor relationship. We believe that we have 
stated clearly our intention to hold all subcontractors to the same 
rigorous standards that we require of approved CAP vendors. We also 
believe that we have the necessary authority to review, enforce, and 
take any needed action to ensure that quality and integrity of the 
subcontractor relationship is maintained.
    Because an approved CAP vendor is ultimately responsible for any 
activity of its subcontractor and risks termination of its CAP contract 
if quality or integrity are compromised, we believe that the approved 
CAP vendor will take adequate steps to ensure compliance with all 
requirements. Therefore, we will not require a binding covenant between 
approved CAP vendors and subcontractors, although we would expect that 
an approved CAP vendor may want to include this type of provision in 
its subcontracts for its own protection.
    Contracts between a distributor and a specialty pharmacy are not 
automatically problematic. However, these arrangements would be subject 
to the same requirements as specified in the CAP statute and 
regulations that apply to all other subcontracting arrangements. 
Approved CAP vendors may wish to consult with legal counsel to 
determine whether there exists unique circumstances that could present 
a conflict of interest.
    We also appreciate the commenters' concern about corporate 
relationships and the possibility of a potential CAP vendor's 
subsidiaries bidding against their parent company or other subsidiaries 
with the same parent company. However, because of the complexity of 
many corporate relationships, we believe that rejecting bids based on a 
test such as the commenter suggests could exclude some legitimate and 
qualified entities from participating in the CAP. We will not prohibit 
any qualified bidder from submitting a bid to be an approved CAP 
vendor, but we expect applicants to submit any relevant information, 
including information about their corporate relationships. We will 
review all this information as part of the application and bidding 
process described in this final rule with comment and the July 6, 2005 
interim final rule with comment.
(3) Confidentiality of the Bids (Potential CAP Vendor Information)
    In both the March 4, 2005 proposed rule (70 FR 10746) and the July 
6, 2005 interim final rule with comment (70 FR 39065), we affirmed that 
all cost information will be confidential and not made available for 
public display, and that bid prices will be kept confidential in 
accordance with section 1927(b)(3)(D) of the Act.
    We also stated that section 1847B(a)(1)(C) of the Act provides 
that, in implementing the CAP, the Secretary may waive provisions of 
the Federal Acquisition Regulation (FAR), ``other than provisions 
relating to the confidentiality of information.'' The confidentiality 
provisions of the FAR apply to the data submitted by bidders and 
potential CAP vendors under the CAP.
    However, we noted that what is confidential for FAR purposes may 
not necessarily be protected under the provisions of the Freedom of 
Information Act (FOIA), and that if a FOIA request is received for 
pricing information, the request will be processed in accordance with 5 
U.S.C section 552(b) and 45 CFR part 5, subpart F to determine whether 
any of the FOIA's exemptions to mandatory disclosure may apply to 
protect the information.
    Comment: One commenter expressed concern that drug pricing 
information may be subject to disclosure under FOIA and suggested that 
it is protected from disclosure under FOIA exemption (b)(4). This 
commenter also suggested that drug pricing information provided under 
the CAP be treated the same as the drug pricing information provided 
for Hospital Outpatient Prospective Payment System (OPPS) and the 
Medicare Part D prescription drug benefit. Another commenter wanted 
assurance that all potential CAP vendor cost data will be protected as 
proprietary and will remain confidential and unidentifiable by 
manufacturer or wholesaler.
    Response: We again affirm that, to the extent permitted by law, all 
cost information submitted during the bidding process and as part of 
the contract's price adjustment process will remain confidential and 
not made available, and that potential CAP vendor pricing information 
will be kept confidential. The FAR directly addresses the government's 
obligation to protect contractor information submitted in response to a 
solicitation for competitive bids. If a FOIA request is received 
seeking disclosure of a bidder's pricing data, that request would

[[Page 70246]]

be forwarded to the CMS FOIA officer for review in accordance with FOIA 
requirements. To the extent allowed by Federal law, we will assert 
applicable FOIA exemptions to protect confidential cost and pricing 
information. The FOIA exemptions are set forth in Department of Health 
& Human Services Freedom of Information regulations at 45 CFR part 5, 
subpart F.
(4) Approved CAP Vendor Requirements/Call Center Hours of Operation
    In the July 6, 2005 interim final rule with comment (70 FR 39065), 
we stated that the approved CAP vendor would be required to--
    <bullet> Maintain the operation of a grievance process so that 
participating CAP physician, beneficiary, and beneficiary caregiver 
complaints can be addressed;
    <bullet> Provide a prompt response to any inquiry as outlined in 
the vendor application form;
    <bullet> Maintain business hours on weekdays and weekends with 
staff available to provide customer assistance for the disabled, 
including the hearing impaired, and to Spanish speaking inquirers; and
    <bullet> Provide toll-free emergency assistance when the call 
center is closed.
    We also required that approved CAP vendors maintain a formal 
mechanism for responding to complaints from participating CAP 
physicians, beneficiaries, and their caregivers (if applicable) (70 FR 
39065). Additionally, we stated that customer service is of primary 
importance and approved CAP vendors must demonstrate the ability to 
respond to inquiries on both weekdays and weekends (70 FR 39085).
    Comment: We received no objections to any of the requirements. A 
commenter noted that although vendors are required to have procedures 
to resolve complaints and inquiries about CAP drug shipments, there 
were no clear standards for systems or procedures that approved CAP 
vendors must maintain. This commenter supported the establishment of a 
call center or other patient support center to answer patients' 
questions about billing, payment schedules, and other matters.
    Response: We believe that customer service is of primary importance 
and that approved CAP vendors must demonstrate the ability to respond 
promptly and satisfactorily to inquiries from providers, beneficiaries, 
and caregivers. We believe that approved CAP vendors should have the 
flexibility to develop standards and systems that meet our 
requirements. However, we note that an approved CAP vendor will be 
required to respond to inquiries from a wide variety of sources, 
including beneficiaries and physician office staff, and that inquiries 
could come from a variety of time zones. Therefore, we are finalizing 
this policy and revising Sec.  414.914 to reflect that an approved CAP 
vendor will be required to--
    <bullet> Maintain the operation of a grievance process so that 
participating CAP physician, beneficiary, and beneficiary caregiver 
complaints can be addressed.
    <bullet> Respond within 2 business days to any inquiry, or sooner 
if the inquiry is related to drug quality.
    <bullet> Staff a toll-free line from 8:30 a.m. or earlier and until 
5 p.m. or later for all time zones served in the continental United 
States by the approved CAP vendor on business days (Monday through 
Friday excluding Federal holidays) to provide customer assistance, and 
establish reasonable hours of operation for Hawaii, Alaska, Puerto 
Rico, and the other U.S. territories.
    <bullet> Staff a toll-free emergency line for weekend and evening 
access when the call center is closed, and determine which hours on 
Saturdays and Sundays the call center will be staffed and which hours a 
toll-free emergency line will be activated.
    <bullet> Include assistance for the disabled, the hearing impaired, 
and Spanish speaking inquirers in all customer service operations.
    We also recommend that all approved CAP vendors have arrangements 
in place to obtain translation services in other languages if serving a 
sizable population of beneficiaries or caregivers whose language is 
other than English or Spanish and who do not have access to translator 
assistance.
    When a beneficiary has a question about a coinsurance bill from an 
approved CAP vendor, the beneficiary is directed to contact the 
approved CAP vendor or his or her supplemental insurance provider (if 
applicable). If the beneficiary has no supplemental insurance, and 
believes he or she is not liable for the coinsurance bill, but is 
unable to resolve the situation on their own, the beneficiary may 
contact the designated carrier's customer service staff for assistance. 
The dispute resolution process is described in Sec.  414.916(d) and in 
the July 6, 2005 interim final rule with comment (70 FR 39098).
(5) Prompt Pay Discounts
    In the July 6, 2005 interim final rule with comment, we stated that 
prompt pay discounts should be disclosed by the approved CAP vendor and 
included in determining reasonable, net acquisition costs for purposes 
of section 1847B(c)(7) of the Act, and that we were interested in 
receiving comments about how these discounts are arranged and whether 
they are indeed different from other price concessions and discount 
arrangements.
    Comment: Some commenters questioned the inclusion of prompt pay 
discounts in the determination of approved CAP vendors' reasonable net 
acquisition costs. They argued that so long as prompt pay discounts 
truly represent the time value of money and the fair market value of 
the distribution and financial services that are provided and are not 
passed on to providers, they should not be included in the approved CAP 
vendor's net acquisition costs. The commenters also raised issues with 
the treatment of prompt pay discounts under the ASP system.
    Response: We disagree that prompt payment discounts should be 
excluded from the determination of an approved CAP vendor's reasonable, 
net acquisition costs. Section 1847B(c)(7) of the Act makes reference 
to an approved CAP vendor's ``reasonable, net acquisition costs''. The 
statute's use of the word ``net'' indicates these costs should reflect 
discounts the approved CAP vendor has received. Further, we believe it 
is appropriate that ``net acquisition costs'' be calculated in a manner 
consistent with the calculation of ASP. Prompt pay discounts are price 
concessions that must be included in a manufacturer's calculation of 
ASP. Please see section II.H.1 of this preamble, ASP Issues, for 
further discussion of prompt pay discounts under the ASP payment 
methodology.
(6) Bidding Process
    In the July 6, 2005 interim final rule with comment, we stated that 
the composite bid ceiling will be determined on the basis of ASP prices 
in effect during the quarter in which the bids are generated, and that 
the single price for each drug (HCPCS code) will be initially 
determined on the basis of the median of the bids submitted during the 
second quarter of CY 2005 for that drug. We further stated that the 
price of each drug will then be updated to the mid-point of CY 2006 
(five quarter increase) Producer Price Index (PPI) for prescription 
preparations.
    Given the 6 month delay in implementation and the corresponding 
change in the bidding period, we will be making certain adjustments to 
the bidding process to account for more recent data. In general, we 
will retain the process described in the July 6, 2005

[[Page 70247]]

interim final rule with comment (Sec.  414.904). However, we will 
require bidders to base their bid on the October ASP file which 
accounts for the most recent ASP data available and can be found at 
http://www.cms.hhs.gov/providers/drugs/asp. As a result of the use of 
the updated drug pricing data and the delay in the implementation, we 
will no longer need to update the bid price by 5 quarters of PPI. 
Instead, we will update prices by 4 quarters of PPI. This allows the 
data to be trended forward from the period in which bidding is 
conducted (the fourth quarter of CY 2005) to the period in which the 
single prices will actually be in effect (second half of CY 2006). 
Specifically, the price of each CAP drug will be updated to the mid-
point of the 2006 payment period on the basis of projecting the overall 
change in PPI prices for prescription preparations.
    Bidding for potential CAP vendors will commence upon publication of 
this final rule with comment. Bidders will have at least 30 days to 
submit an application. Upon publication of the final rule, CAP bidding 
forms and additional information regarding bidding timelines, and other 
related material, can be found at http://www.cms.hhs.gov/providers/drugs/compbid/bid_form_announ.asp.
c. Operational Issues
    In this section, we address drug product waste and returns, and 
when unused portions of single-use drugs may be billable to Medicare 
under the CAP. We address billing issues and timing of claims 
processing and payment. We address comments regarding coinsurance and 
collection of Advanced Beneficiary Notice forms (ABNs) and arrangements 
between approved CAP vendors and participating CAP physicians for 
services relating to the CAP.
    We also address several CAP drug-ordering issues. We describe the 
resupply option and emergency use within the CAP. We clarify when a 
Medicare beneficiary's height and weight are needed for ordering a CAP 
drug. We also clarify the ``furnish as written'' option. Finally, we 
address patient confidentiality.
(1) Unused Drug Product (Waste and Returns)
    In the July 6, 2005 interim final rule with comment (70 FR 39062), 
we responded to commenters asking for specific guidance on how to 
manage drug waste and returns as follows:
    Although a variety of situations may create quantities of unused 
drugs at the place of administration, we believe the unused CAP drugs 
will come in the following 3 forms:
    <bullet> An unopened vial (or vial package) as shipped by the 
approved CAP vendor.
    <bullet> An opened vial (that may or may not be reconstituted or 
partly used).
    <bullet> A drug that has been removed from a vial or package and is 
in a syringe, IV bag, or other device or container used for drug 
administration.
    Unused quantities of a drug may increase the risk of waste, fraud 
and abuse, and attempts to use the excess drug may violate applicable 
pharmacy law or may compromise product integrity. We expect that 
approved CAP vendors will furnish drugs in a manner that will minimize 
unused drugs. We also expect that participating CAP physicians and 
approved CAP vendors will both make an effort to label, ship, and store 
CAP drugs in a manner that will allow the legally permissible reuse of 
an unopened and intact container of a CAP drug. Returns of unused 
products through a distribution system may be acceptable, but many 
States prohibit reusing drugs that have been dispensed by a pharmacy 
(For further information, see FDA Office of Regulatory Affairs (ORA) 
Compliance Policy Guides Manual Sec. 460.300, Return of Unused 
Prescription Drugs to Pharmacy Stock, CPG 7132.09). We are aware of 
situations when an approved CAP vendor may label a vendor-supplied 
outer container for prescriptions to keep the actual manufacturer's 
packaging intact and unlabelled. We further expect approved CAP vendors 
to offer and ship units of a drug that match the beneficiary's dosing 
requirements and HCPCS billing amount as closely as practical. In this 
way, a degree of waste will be prevented. Specific details, including 
how waste, returns, and their cost burden are handled, will depend on 
State law and regulation as well as the individual situations. Approved 
CAP vendors should establish policies on these issues (making sure that 
they comply with applicable laws and regulations) and make the policies 
available for physicians to review during the election period and 
through the term of the approved CAP vendor's participation in the CAP.
    Approved CAP vendors will supply CAP drugs to participating CAP 
physicians' offices in unopened vials. However, in situations where a 
CAP drug is dosed by body weight or BSA, the amount of drug in vials 
may not match the Medicare patient's actual dose, and the approved CAP 
vendor will be forced to ship excess drug. In certain States, pharmacy 
law may prevent the use of excess CAP drug for another Medicare 
beneficiary if the order must be labeled as a prescription. The return 
process is guided by the following:
    <bullet> Federal Law and guidelines (such as the FDA/ORA CPG 
460.300), State law, Medicare requirements (such as the Claims 
Processing Manual), drug stability, and appropriate standards (such as 
United States Pharmacopoeia Chapter 797, Pharmaceutical Compounding--
Sterile Preparations) will be used to determine how an extra drug 
product(s) may be used for subsequent dosing on the same beneficiary or 
for use on another beneficiary.
    <bullet> If excess drug product remaining in a vial shipped by an 
approved CAP vendor must be returned, the approved CAP vendor is 
expected to accept excess CAP drugs for disposal and is expected to pay 
for shipping. The participating CAP physician is responsible for 
appropriately packing the drug. Consolidating shipping into larger and 
less frequent packages by the participating CAP physician would be 
encouraged. We do not intend for this process to be used as a vehicle 
for routine disposal of empty or nearly empty vials, disposal of any 
drug product not shipped by an approved CAP vendor, or disposal of 
drugs mixed in IV bags, syringes, associated needles and tubing, or 
other devices used in the administration of the drug product to a 
beneficiary.
    The approved CAP vendor bills Medicare only for the amount of CAP 
drug administered to the Medicare beneficiary and the beneficiary's 
coinsurance amount will be calculated from the quantity of drug that is 
administered. Because the CAP statute authorizes us to pay the approved 
CAP vendor only upon administration of the CAP drug, any discarded drug 
(or drug that is considered waste) will not be eligible for payment.
    We also stated that the CAP dispute resolution process will be 
available to resolve any associated disputes.
    Comment: Most commenters objected to our payment policy for the 
unused portion of drugs. Most commenters perceived that the payment 
policy for the unused portion of a drug under the CAP was more 
restrictive than the payment policy for the unused portion of a drug 
under the ASP payment system. Many, but not all, commenters on this 
issue supported the general concept of payment for the unused portion 
of drugs contingent upon good faith efforts on the part of the 
participating CAP physician and approved CAP vendor to minimize unused 
drugs. However, some commenters indicated that payment to

[[Page 70248]]

the approved CAP vendor for the unused portion of CAP drugs should not 
be contingent on good faith efforts by the participating CAP physician, 
but only good faith efforts by the approved CAP vendor in furnishing 
the drug.
    Response: Under the ASP payment system, physicians may bill the 
program for the unused portion of a drug remaining in an opened single-
use vial if the physician made good faith efforts to minimize the 
unused portion of the drug in how he or she scheduled patients and how 
he or she ordered, accepted, stored, and used the drug. This policy 
does not apply to the unused portion of drugs from multiple use vials.
    We expect that approved CAP vendors and participating CAP 
physicians will act and interact in a manner that will minimize unused 
drugs. Section 1847B(a)(3)(A)(iii) of the Act states that payment for 
CAP drugs is conditioned upon the administration of these drugs. We are 
clarifying that we consider the unused portion of a drug remaining in 
an opened single-use vial to be administered for the limited purpose of 
section 1847B(a)(3)(A)(iii)(II) of the Act, but only if the 
participating CAP physician has made good faith efforts to minimize the 
unused portion of the CAP drug in how he or she scheduled patients and 
how he or she ordered, accepted, stored, and used the drug, and only if 
the approved CAP vendor has made good faith efforts to minimize the 
unused portion of the drug in how it supplied the drug. This policy 
does not apply to the unused portion of drugs from multiple use vials.
    We disagree with commenters who indicated that payment for the 
unused portion of drugs should not be contingent on good faith efforts 
by the participating CAP physician, but only on good faith efforts by 
the approved CAP vendor in supplying the drug. The program should not 
pay for the unused portion of a drug resulting from circumstances that 
were avoidable through good faith efforts. However, in response to 
these comments, we are including a new obligation in participating CAP 
physicians' CAP election agreement that requires the participating CAP 
physician to make good faith efforts to minimize the unused portion of 
CAP drugs in how he or she schedules patients and how he or she orders, 
accepts, stores, and uses the drugs. The requirement stated in the July 
6, 2005 interim final rule with comment (70FR 39048) still applies, 
that when a participating CAP physician does not administer a CAP drug 
during the time frame specified on the prescription order, or 
administers a smaller amount of the drug than was originally ordered, 
the participating CAP physician must contact the approved CAP vendor to 
discuss what to do. If it is permissible under State law, and if the 
CAP drug is unopened and both the participating CAP physician and the 
approved CAP vendor are in agreement, then the participating CAP 
physician may retain the drug for administration to another Medicare 
beneficiary. However, before the drug could be administered to another 
Medicare beneficiary, the participating CAP physician would need to 
provide the approved CAP vendor with a new prescription order for the 
drug, and the approved CAP vendor would need to provide the 
participating CAP physician with a new beneficiary-specific 
prescription order number.
    If the unused portion of the CAP drug is from a single-use vial, 
and all of the other conditions are met, the approved CAP vendor may 
bill for the unused portion of the CAP drug in the single-use vial. 
However, if the unused portion of the CAP drug is from a multi-use vial 
or an unopened vial, the participating CAP physician and approved CAP 
vendor must come to an arrangement on what to do with the unused CAP 
drug consistent with statute, the CAP regulations, and all applicable 
State and Federal laws and regulations. We note that unused CAP drugs 
are the property of the approved CAP vendor.
    Comment: Some commenters asked for clarification of wastage, 
spillage or spoilage.
    Response: Any drug or portion of a CAP drug that is not 
administered to a Medicare patient is considered wastage, spillage or 
spoilage. We note that if the other conditions described in the 
previous response are met, the unused portion of a CAP drug from a 
single-use vial is considered to have been administered for purposes of 
section 1847B(a)(3)(A)(iii)(II) of the Act, and, therefore, would not 
be considered wastage, spillage, or spoilage.
    Comment: One commenter indicated that totally unopened or unused 
vials or packages ordered by the participating CAP physician should be 
purchased by the participating CAP physician for his or her own 
inventory.
    Response: We expect participating CAP physicians will make good 
faith efforts to minimize unused CAP drugs. One of the goals of the CAP 
program is to allow physicians a choice between obtaining CAP drugs 
from approved CAP vendors selected in a competitive bidding process or 
acquiring and billing for Part B covered drugs under the ASP drug 
payment methodology. We do not believe that requiring participating CAP 
physicians to purchase totally unopened or unused vials or packages for 
their own inventory is consistent with this goal.
    Comment: One commenter stated that many neurology practices that 
administer botox infusions split vials of the medication between two 
patients in cases where the patient does not need the full vial. The 
commenter indicated that the interim final rule with comment would 
prohibit this practice.
    Response: We indicated in the interim final rule with comment that 
unused quantities of a drug may increase the risk of waste, fraud and 
abuse, and attempts to use the excess drug may violate pharmacy law and 
may compromise product integrity. However, we also indicated that 
specific details will depend on State law and regulation as well as the 
individual situations. Approved CAP vendors will establish policies on 
these issues (making sure that they comply with applicable laws and 
regulations) and make the policies available for physicians to review 
during the election period and through approved CAP vendor's 
participation in the CAP. Note also our policy regarding unused 
portions of a CAP drug from a single-use vial, which is described 
above.
(2) Timing of Approved CAP Vendor Billing/Payment of Claims
    In the July 6, 2005 interim final rule with comment, we stated the 
participating CAP physician must file his or her drug administration 
claim within 14 days of administration (70 FR 39050 and 39095), and 
that the approved CAP vendor could not bill the beneficiary for drug 
product coinsurance until the claims matched and the approved CAP 
vendor received payment from the designated carrier (70 FR 39052 and 
39097).
    Comment: Potential vendors have proposed ways to shorten the time 
frame of the approved CAP vendor's payment window. One suggested that 
approved CAP vendors should be permitted to bill and be paid for drugs 
upon delivery to a participating CAP physician. Another suggested that 
the participating CAP physician be deemed to have ``purchased'' the 
drug if the participating CAP physician has not filed his or her claim 
within 14 days of delivery. These potential vendors are concerned about 
the viability of the CAP from a cash flow perspective.
    Response: In most cases, assuming the participating CAP physician 
and the approved CAP vendor have promptly and properly submitted their 
claims, the approved CAP vendor should be paid by CMS within two to 
three weeks from the

[[Page 70249]]

date of drug administration. The anticipated sequence of events for the 
majority of CAP claims that are in compliance with local coverage 
determinations (LCDs) is described in the timeline in Diagram 1.
    This timeline (diagram 1) is offered as an illustration of how the 
approved CAP vendor's drug claim and the participating CAP physician's 
administration claim would travel through the Medicare claims 
processing system using the month of October as an example. The claims 
depicted here are assumed to have passed ``front end edits'' and been 
considered ``clean claims.''
BILLING CODE 4120-01-U

[[Page 70250]]

[GRAPHIC] [TIFF OMITTED] TR21NO05.053

BILLING CODE 4120-01-C

[[Page 70251]]

    In the July 6, 2005 interim final rule with comment, we asked the 
approved CAP vendor to submit its drug claim to the designated carrier 
no earlier than the first day of the anticipated week of administration 
as indicated on the drug order (70 FR 39040). After performing initial 
``front end'' edits to validate the claim, the designated carrier will 
forward the approved CAP vendor's claim to the CMS central claims 
processing system. If there is not an immediate match between the 
approved CAP vendor's drug product claim and the participating CAP 
physician's drug administration claim in the CMS central claims system 
on the day the approved CAP vendor's claim is received, then the 
approved CAP vendor's claim goes into a recycling phase and will be 
reviewed for a match regularly thereafter. Section 1842(c)(3)(A) of the 
Act requires that no payment on an electronic claim shall be issued in 
less than 13 days. We add one day for mailroom and check handling and 
refer to this 14-day period as the ``payment floor.'' The payment floor 
clock starts on the day the approved CAP vendor's claim is received by 
the designated carrier as long as the claim passes all edits and is 
classified as a ``clean claim''.
    In the July 6, 2005 interim final rule with comment, we stated that 
participating CAP physicians are required to file their claims for drug 
administration services within 14 days of the date of administration 
(70 FR 39050). Statistics obtained from Medicare claims filing data 
indicate that 75 percent of physician claims are filed within 14 days 
of the date of service, and that 95.6 percent of all Part B claims are 
considered clean when first filed. Within 3 days of receipt of a 
participating CAP physician's clean claim that has not been suspended 
for medical review, the CMS central claims processing system will 
generate a match between the participating CAP physician's claim and 
the approved CAP vendor's claim and permit payment of the approved drug 
vendor's drug product claim, provided the 14-day payment floor has been 
satisfied.
    In the July 6, 2005 interim final rule with comment, we stated that 
drug administration claims will undergo electronic medical review for 
compliance with LCDs (70 FR 39038). Historically, approximately 5 
percent of Part B drug claims are suspended for manual review, and 
approximately 7 percent of all claims (that is, not just those for Part 
B drugs) are denied. We expect that a small number of CAP drug claims 
will be reviewed for off-label use.
    As for the 20 percent coinsurance portion of the bill, about 80 
percent of Medicare beneficiaries have a supplemental insurance policy 
that covers the beneficiary's cost sharing obligation. Approved CAP 
vendors will know which beneficiaries have a supplemental policy 
because that information is required to be included on the prescription 
order. Approved CAP vendors will also be able to verify the 
beneficiary's supplemental coverage by contacting the supplemental 
insurer.
    If the supplemental insurer has an arrangement with CMS as part of 
the automatic coordination of benefits process, the approved CAP 
vendor's claim will automatically cross over to the supplemental 
insurer after Medicare has paid its 80 percent share of the claim. In 
addition, under the mandatory Medigap crossover process, claims will be 
forwarded to the supplemental insurers for their use calculating their 
financial liability after Medicare if the approved CAP vendor properly 
coded the claim with the trading partner (for example, supplemental 
insurers) information. In both of these situations, after the 
supplemental insurer receives the claim it will issue applicable 
payment to the approved CAP vendor.
    When an approved CAP vendor has supplied a CAP drug for 
administration to a beneficiary without supplemental insurance, the 
approved CAP vendor may bill the beneficiary upon receipt of Medicare's 
payment from the designated carrier or upon administration of the drug, 
if the approved CAP vendor has received notice of administration from 
the participating CAP physician. The approved CAP vendor may enter into 
a voluntary arrangement with a participating CAP physician to receive 
notification that the drug has been administered. The approved CAP 
vendor may also enter into a voluntary arrangement with the 
participating CAP physician to arrange for the collection of the 
beneficiary's coinsurance after the drug is administered, or to deliver 
information and notices on coninsurance assistance.
(3) Arrangements Between Approved CAP Vendors and Participating CAP 
Physicians for the Collection of Coinsurance and ABNs
    In the July 6, 2005 interim final rule with comment, we stated that 
nothing in the CAP statute or regulations prohibited an approved CAP 
vendor and a participating CAP physician from entering into an 
agreement governing their arrangements for the provision of CAP drugs 
or other items or services (70 FR 39050). We added that parties to 
these agreements must ensure that the arrangements do not violate the 
physician self-referral (``Stark'') prohibition (section 1877 of the 
Act), the Federal anti-kickback statute (section 1128B(b) of the Act), 
or any other Federal or State law or regulation governing billing or 
claims submission.
    Comment: Some commenters requested that we state explicitly that 
approved CAP vendors and participating CAP physicians are allowed to 
enter into these arrangements. They suggested that drug industry 
relationships commonly include supplier/physician arrangements. These 
commenters believed that approved CAP vendor/participating CAP 
physician arrangements will promote more participation in the CAP, 
stimulate greater cooperation between the parties, and generate fiscal 
efficiencies.
    Physician and manufacturer commenters requested that we implement 
the CAP with safeguards that preserve the participating CAP physician's 
prescribing authority in the presence of these arrangements. They asked 
us to ensure that approved CAP vendors have no incentive and no 
regulatory pathway by which to restrict, limit, or change a 
participating CAP physician's access to specific drug and biological 
therapy.
    Response: We are stating explicitly that nothing in the CAP statute 
or regulations prohibits approved CAP vendors and participating CAP 
physicians from entering into voluntary written arrangements that 
include--
    <bullet> An arrangement between a participating CAP physician and 
an approved CAP vendor to notify the approved CAP vendor after the CAP 
drug has been administered to the beneficiary;
    <bullet> An arrangement between a participating CAP physician and 
an approved CAP vendor to communicate with the beneficiary about 
coinsurance for CAP drugs on behalf of the approved CAP vendor;
    <bullet> An arrangement between a participating CAP physician and 
an approved CAP vendor to issue an ABN on behalf of the approved CAP 
vendor;
    <bullet> An arrangement between a participating CAP physician and 
an approved CAP vendor to collect applicable coinsurance and deductible 
on behalf of the approved CAP vendor from the beneficiary with no 
supplemental insurance coverage after the drug has been administered; 
and
    <bullet> Any other appropriate and legal arrangement between a 
participating CAP physician and an approved CAP vendor. (We note that 
the provisions of Sec.  414.914(h) also allow the participating CAP 
physician and the approved CAP vendor to enter into an arrangement for

[[Page 70252]]

the participating CAP physician to deliver notices related to the 
vendor's coinsurance assistance program.)
    We will not dictate the breadth of use or the specific obligations 
contained in these arrangements, other than to note that they must 
comply with applicable law and to prohibit approved CAP vendors from 
coercing participating CAP physicians into entering any of these 
arrangements, as noted below. All written arrangements between approved 
CAP vendors and participating CAP physicians must comply with the 
requirements discussed below.
    These arrangements should be carefully scrutinized by the parties 
to ensure that these arrangements are not disguised payments for 
referrals for items or services payable by a Federal health care 
program. These arrangements are subject to the physician self-referral 
(``Stark'') prohibition, the Federal anti-kickback statute or any other 
Federal or State law or regulation governing billing or claims 
submission. Arrangements should be at fair market value for actual 
services provided and should not take into account the volume or value 
of referrals. Percentage compensation arrangements or per item 
arrangements for billing and collection services between participating 
CAP physicians and approved CAP vendors would be highly suspect under 
the fraud and abuse laws.
    Approved CAP vendors who enter into these arrangements with 
participating CAP physicians remain subject to liability for improper 
waivers of deductibles and coinsurance, including violations of the 
Federal anti-kickback statute and liability under section 1128A(a)(5) 
of the Act. Cost-sharing waivers are permitted under certain conditions 
for financially needy beneficiaries as specified in section 1128A(i)(6) 
of the Act. Parties should monitor these arrangements to ensure that 
waivers are made appropriately and create safeguards to ensure that 
these arrangements are not used by approved CAP vendors or 
participating CAP physicians as inappropriate marketing tools.
    A participating CAP physician's decision to enter into an 
arrangement with an approved CAP vendor must be completely voluntary. 
An approved CAP vendor may not refuse to do business with a 
participating CAP physician because the participating CAP physician has 
declined to enter into an arrangement with the approved CAP vendor. 
Approved CAP vendors must accept all participating CAP physicians who 
choose to enroll with that approved CAP vendor.
    Comment: Some commenters proposed that approved CAP vendors should 
have authority to obtain beneficiary credit card authorization before 
shipping drugs for them. One commenter suggested that Medicare withhold 
the approved CAP vendor's 20 percent coinsurance from the participating 
CAP physician's drug administration claim payment. The participating 
CAP physician would then collect both the administration coinsurance 
together with the drug product coinsurance from the beneficiary and/or 
the beneficiary's supplemental insurer. The approved CAP vendor would 
be paid the full amount.
    Response: The CAP statute requires that we develop a process for 
the sharing of information between the participating CAP physician and 
the approved CAP vendor related to the payment of deductible and 
coinsurance (section 1847B(a)(3)(C) of the Act). In the July 6, 2005 
interim final rule with comment, we interpreted this to mean 
beneficiary contact information, Medicare information, and third party 
insurance information (70 FR 39041). In the interim final rule with 
comment, we stated that we will not ask the participating CAP physician 
to collect the beneficiary's credit card information and share it with 
the approved CAP vendor because this information is not necessary to 
complete the drug ordering process, nor is it part of any supplemental 
insurance coverage that the beneficiary may have. We maintain that 
position in this final rule with comment. We do not ask the 
participating CAP physician to collect and forward credit card 
information to a third party supplier in any other Medicare setting. 
The beneficiary will have supplemental insurance approximately 80 
percent of the time, rendering beneficiary payment information 
unnecessary in most cases.
    We do not believe it is appropriate to require participating CAP 
physicians to secure drug coinsurance payment information from 
beneficiaries with no supplemental insurance, since provisions of 
section 1847B(a)(3)(A)(ii) of the Act make the collection of 
coinsurance the responsibility of the approved CAP vendor. However, as 
discussed previously, the participating CAP physician and the approved 
CAP vendor may enter into a voluntary arrangement, whereby the 
participating CAP physician, on the approved CAP vendor's behalf, would 
collect coinsurance from beneficiaries with no supplemental insurance 
coverage.
(4) Resupply Option/Definition of Emergency
    As stated in the July 6, 2005 interim final rule with comment (70 
FR 39037 and 39047), the four criteria that govern the resupply option 
are contained in section 1847B(a)(5) of the Act, which says that a 
participating CAP physician may acquire drugs under the CAP to resupply 
his or her private inventory if all of the following requirements are 
met:
    <bullet> The drugs were required immediately.
    <bullet> The participating CAP physician could not have anticipated 
the need for the drugs.
    <bullet> The approved CAP vendor could not have delivered the drugs 
in a timely manner.
    <bullet> The participating CAP physician administered the drugs in 
an emergency situation.
    As we also stated in the July 6, 2005 interim final rule with 
comment, these criteria are set forth in the CAP statute, and, 
therefore, we do not have the authority to change them, or to allow 
that some of them be optional.
    In the July 6, 2005 interim final rule with comment, we defined 
``delivery in a timely manner'' for the resupply provisions of the CAP 
as the ability to meet emergency delivery standards for timely delivery 
as defined in Sec.  414.902. We also defined ``emergency situation'' 
for the purposes of the resupply provisions of the CAP in Sec.  414.902 
as an unforeseen occurrence or situation determined by the 
participating CAP physician, in his or her clinical judgment, to 
require prompt action or attention for purposes of permitting the 
participating CAP physician to use a drug from his or her own stock, if 
the other requirements of Sec.  414.906(e) are met.
    In the July 6, 2005 interim final rule with comment, we stated that 
we anticipated that the local carrier would, at times, conduct a post-
payment review of claims for emergency drug replacement in order to 
determine whether participating CAP physicians were complying with 
conditions for emergency drug replacement. The local carrier would use 
the emergency replacement modifier code to identify claims for 
emergency drug replacement for random post-payment review.
    Comment: Numerous commenters expressed concern that the emergency 
resupply provisions were too restrictive and would have a negative 
impact on patient care. These commenters stated that, particularly for 
oncology treatment, health status changes are common, resulting in 
frequent changes in drug

[[Page 70253]]

dosage or medication(s). These commenters believe that the requirements 
regarding emergency resupply would result in delayed treatment for 
patients already ill, and increase the burden on the patient and their 
caregivers. The impact on people in rural areas who may live several 
hours from where they receive treatment was mentioned by many 
commenters, and it was suggested that the patient's driving distance be 
considered in the ability of a participating CAP physician to provide 
drugs out of office supply and be resupplied by the approved CAP 
vendor. One commenter also noted that acute and infectious disease 
patients could be at risk if there was any delay in treatment.
    Some commenters expressed concern that participating CAP physicians 
who use the emergency resupply option might be subjected to unwarranted 
audits. Others expressed concern that frequent use of the emergency 
resupply option would result in adverse consequences for the 
participating CAP physician. There were also questions about the 
approved CAP vendor's ability to withhold shipment if the approved CAP 
vendor did not agree that an emergency existed or if they believe the 
drug that was used in the emergency situation would not be covered.
    Response: As stated in the July 6, 2005 interim final rule with 
comment, we believe that the definition of emergency used in this 
situation should be one that enables the participating CAP physician to 
use his or her clinical judgment to determine when his or her patient 
needs immediate treatment. We have defined emergency for purposes of 
this provision as a situation determined by the participating CAP 
physician's clinical judgment to be an unforeseen situation that 
requires prompt action or attention. If the approved CAP vendor's 
emergency delivery timeframe would result in delivery of the drug after 
the time necessary to meet the patient's clinical need, it would be 
considered that the CAP drug could not have been delivered in a timely 
manner.
    We are firm in our view that the determination of clinical need 
rests with the participating CAP physician and we leave it to the 
participating CAP physician to determine the scope of the clinical 
need. As previously stated, the participating CAP physician will assess 
whether all of the criteria are applicable and will document the 
patient's medical record accordingly. However, we do not believe that 
driving distance in itself should be a determining factor in the use of 
the emergency supply provision. Rather, the participating CAP physician 
should evaluate the entire clinical situation of the patient and make 
an appropriate determination based on all relevant information.
    Approved CAP vendors do not have the authority to override a 
participating CAP physician's determination of what constitutes an 
emergency situation for purposes of the resupply provision. Policies 
regarding the shipment of CAP drugs are the same for the emergency 
resupply provision as they are for routine ordering and shipping of CAP 
drugs and for the ``furnish as written'' procedures. In all of these 
cases, the approved CAP vendor is required to deliver CAP drug(s) upon 
receipt of a prescription order, ensuring that the participating CAP 
physician's judgment about the appropriate treatment is the final 
determining factor in the decision-making process. The same principle 
applies to the emergency replacement process. If a participating CAP 
physician orders a CAP drug to resupply inventory on the basis of an 
emergency administration, the approved CAP vendor must ship it, unless 
the conditions of Sec.  414.914(h) are met.
    As stated in the July 6, 2005 interim final rule with comment, we 
anticipate that at times the local carrier would conduct a post payment 
review of emergency drug replacement in order to determine whether 
participating CAP physicians were complying with conditions for 
emergency drug replacement. We acknowledge that there may be some 
participating CAP physicians that may have legitimate reasons for more 
frequent use of the emergency resupply option. The post payment review 
process will also provide us with information on participating CAP 
physicians' use of the emergency resupply provision and help to 
distinguish between appropriate and inappropriate use of this 
provision. As we gain more experience with the CAP, we will assess 
whether the emergency resupply provision is working as intended, and 
whether further refinement is necessary.
(5) Order Form Information on Patient's Height and Weight
    In the July 6, 2005 interim final rule with comment (70 FR 39095), 
we stated that the participating CAP physician would agree to provide 
specific information to the approved CAP vendor from whom he or she has 
elected to receive drugs information. The specific information required 
included the Medicare beneficiary's height and weight. We also stated 
that abbreviated information could be sent for repeat patient orders. 
We received comments regarding the patient's height and weight.
    Comment: Some commenters stated that including the patient's height 
and weight on the CAP order form should not be required.
    Response: It is possible for an approved CAP vendor to be a 
wholesaler distributor, a specialty pharmacy or a combination of both. 
State and Federal laws that govern specialty pharmacy operations may be 
different from those that govern wholesale distributor operations. For 
example, State laws, regulations, and recognized professional practice 
standards may require that specialty pharmacy services be provided by a 
qualified pharmacist. If the approved CAP vendor is a specialty 
pharmacy or distributor with an arrangement with a specialty pharmacy 
to supply drugs to a participating CAP physician, then information on 
patient height and weight may be required in order for a pharmacist to 
check a dispensed dose. If the approved CAP vendor operates solely as a 
drug wholesaler this information may not be necessary. To reflect the 
different requirements that may apply to different potential types of 
approved CAP vendors, we are amending Sec.  414.908(a)(3)(v)(M) to 
specify that height and weight should be provided only if necessary.
(6) Furnish as Written
    In the July 6, 2005 interim final rule with comment (70 FR 39043), 
we stated that we would allow the participating CAP physician to obtain 
a drug and bill Medicare under the ASP system using the ``furnish as 
written'' (FAW) option when medical necessity requires that a specific 
formulation of a drug be furnished to the patient, and that formulation 
is not provided by the approved CAP vendor. Documentation of the 
medical necessity must be maintained in the Medicare patient's medical 
record. The participating CAP physician would use a FAW modifier to 
identify that he or she was allowed to bill Medicare under the ASP 
system in this limited circumstance.
    Comment: One commenter stated the examples given under the 
description of FAW were very narrow and would keep a participating CAP 
physician from using the FAW option proactively.
    Response: If the approved CAP vendor does not carry a specific NDC 
that is medically necessary for a patient, the participating CAP 
physician may purchase the drug, bill for it and use the FAW modifier 
on the drug claim. In this situation, the local carrier will pay the 
participating CAP physician under the ASP payment system. We remind 
physicians that the FAW process

[[Page 70254]]

requires documentation of medical necessity.
    Although the July 6, 2005 interim final rule with comment contained 
several examples of when the FAW process may be used, we did not intend 
to imply that these were exhaustive. The examples were meant to be 
illustrative, and were not meant to exclude other situations where FAW 
could legitimately be used in order to furnish a patient with the most 
appropriate therapy. Rather, we wished to indicate two points--(1) 
Participating CAP physicians who use FAW must appropriately document 
clinical judgment in support of the use of FAW; and (2) FAW is not 
intended to provide participating CAP physicians with an ``end run'' 
around their decision to participate in the CAP. The CAP is in no way 
intended to bar access to a medically necessary therapy. However, where 
medical necessity is served by the drug formulation supplied by the 
approved CAP vendor, coverage is available only if the participating 
CAP physician obtains the drug from the approved CAP vendor.
    We again remind physicians that routine orders for CAP drugs should 
be placed at the HCPCS level. Specific products not on an approved CAP 
vendor's drug list that are medically necessary for the beneficiary may 
be obtained through the ASP system. Please note that the approved CAP 
vendor has the ability to request CMS approval to add new drugs to its 
CAP drug list. This process was discussed in the July 6, 2005 interim 
final rule with comment (70 FR 39075) and further described previously 
in this section.
(7) Patient Data Confidentiality
    In the July 6, 2005 interim final rule with comment (70 FR 39065), 
we stated that approved CAP vendors would be required to comply with 
the HIPAA Administrative Simplification Rules, including the Privacy 
Rule.
    Comment: One commenter requested that CMS explicitly prohibit 
approved CAP vendors from using, sharing, or selling patient 
information for any purpose other than that which is strictly related 
to fulfilling CAP orders. Another commenter wanted assurance that 
approved CAP vendor subcontractors would be subject to the same 
confidentiality requirements as the approved CAP vendor.
    Response: We concur with the commenters that patient information 
must be protected from misuse, and believe that this requirement is 
adequately addressed by the requirement that approved CAP vendors 
comply with the HIPAA Privacy and Security rules. We also note that 
subcontractors are held to the same requirements and standards as the 
approved CAP vendor, including those pertaining to confidentiality.
d. Beneficiary Issues
    In this section we discuss the policy permitting an approved CAP 
vendor to stop supplying drugs for a beneficiary who is not meeting 
their coinsurance obligations.
    We also discuss the ABN process as it pertains to the CAP. Finally, 
we respond to comments about the financial liability of a Medicare/
Medicaid dual eligible beneficiary who receives a CAP drug.
(1) Coinsurance
    In the July 6, 2005 interim final rule with comment, we specified 
requirements at Sec.  414.914(g) to include a provision requiring 
approved CAP vendors to provide information on sources of cost-sharing 
assistance available to beneficiaries on request (70 FR 39096). We 
noted that routine waiver of deductibles and coinsurance could violate 
the Federal anti-kickback statute, as well as, the civil prohibition on 
offering inducements to beneficiaries at section 1128A(a)(5) of the Act 
(70 FR 39050). However, cost-sharing waivers are permitted under 
certain conditions for beneficiaries who are experiencing financial 
hardship.
    We also stated in the July 6, 2005 interim final rule with comment 
that we would not require an approved CAP vendor to continue to supply 
CAP drugs for beneficiaries who do not pay their deductible or 
coinsurance. Rather, we would allow the approved CAP vendor to refuse 
to make further shipments to the participating CAP physician for that 
beneficiary as long as the requirements of Sec.  414.914(h) are met. In 
instances where a beneficiary failed to meet his or her obligation to 
pay coinsurance or deductible for a CAP drug, and the approved CAP 
vendor refused to continue providing the drug, we stated that we would 
permit the participating CAP physician to opt out of that drug category 
for the CAP.
    Comment: Commenters from the community of potential CAP vendors 
expressed support for the approved CAP vendor's right to refuse to ship 
drugs for beneficiaries who do not meet their deductible and 
coinsurance obligations. They recommend removal of the requirement that 
the approved CAP vendor wait up to 60 days before discontinuing 
shipment of drugs on behalf of beneficiaries who do not meet their 
coinsurance obligations. The commenters offer that their exposure for 
additional uncollected coinsurance during the waiting period represents 
a risk so great that it renders participation in CAP untenable, and 
they should be permitted to collect coinsurance amounts on the day they 
ship the drugs.
    Physicians and some drug manufacturers commented that the 45 to 60 
day waiting period is too short, suggesting the period after the 
vendor's referral to a specific, bona fide charitable organization 
should be extended to permit the beneficiary sufficient time to apply 
for the aid, and the charitable organization time to process the 
request. A longer period was requested for cognitively impaired 
beneficiaries.
    Response: Approved CAP vendors who become concerned about 
additional drug coinsurance exposure during the waiting period may make 
reasonable contact with the beneficiary for assurance that he or she is 
making timely and meaningful efforts to secure additional sources of 
funding. The additional 15-day waiting period after the specific, bona 
fide charitable organization referral represents a safety valve, and is 
not suggested as the starting point for the beneficiary's effort to 
secure alternative funding. The regulatory time periods set up a 
framework for an enforceable remedy. However, in light of the comments, 
and to reflect our policy change that an approved CAP vendor may make 
an arrangement with a participating CAP physician to collect 
coinsurance on its behalf, we are making modifications to Sec.  
414.914(h) to reflect that the 45-day period will begin on the date 
that the bill for coinsurance is delivered to the beneficiary whether 
it is mailed by the approved CAP vendor or delivered by the 
participating CAP physician on the behalf of the approved CAP vendor. 
We are also clarifying that the delivery of the coinsurance bill need 
not be subsequent to Medicare payment if the approved CAP vendor has 
received notice of drug administration from the participating CAP 
physician and the beneficiary lacks supplemental insurance. Because we 
believe the regulatory provision with this technical modification 
appropriately balances the interests of all involved, we are not going 
to change the length of the waiting period in Sec.  414.904(h).
    Comment: Some physician commenters have indicated that they waive 
coinsurance for indigent beneficiaries in some cases and expect that 
vendors should do likewise as a matter of routine.
    Response: Approved CAP vendors and participating CAP physicians 
must conduct their business in compliance

[[Page 70255]]

with the requirements of sections 1128A(a)(5) and 1128A(i)(6) of the 
Act. In the July 6, 2005 interim final rule with comment (70 FR 39053) 
we stated that we were modifying the program requirements at Sec.  
414.914(g) to include a provision requiring approved CAP vendors to 
provide information on sources of cost-sharing assistance available to 
beneficiaries on request. It is important to note that routine waiver 
of deductibles and coinsurance can violate the Federal anti-kickback 
statute, as well as the civil prohibition on offering inducements to 
beneficiaries at section 1128A(a)(5) of the Act. However, cost-sharing 
waivers are permitted under certain conditions for beneficiaries who 
are experiencing financial hardship. The assistance offered by the 
approved CAP vendor must take the form of one of the following: A 
referral to a bona fide and independent charitable organization, 
implementation of a reasonable payment plan, or a full or partial 
waiver of the cost-sharing amount based on the individual financial 
need of the patient, provided that the waiver meets all of the 
requirements in Sec.  1003.101(1) (Definition of ``Remuneration''). The 
availability of waivers may not be advertised or be made as part of a 
solicitation; however, approved CAP vendors may inform beneficiaries 
generally of the various categories of assistance noted in the 
preceding sentence. In no event may the approved CAP vendor include or 
make any statements or representations that promise or guarantee that 
beneficiaries will receive cost-sharing waivers. We will evaluate the 
procedures that applicant vendors propose to implement to make cost-
sharing assistance referrals as part of the approved CAP vendor 
application review process.
    Comment: Some physician commenters opposed the vendor's right to 
refuse further shipment because they believe it will fall to the 
physician to communicate to the beneficiary that his or her drugs are 
not being delivered, even though the decision to refuse shipment was 
the approved CAP vendor's.
    Response: We understand the commenters' concern. However, when 
notifying the beneficiary of the approved CAP vendor's refusal to ship 
CAP drugs, the participating CAP physician need not justify the 
approved CAP vendor's decision. Instead, the participating CAP 
physician need only direct the beneficiary to the approved CAP vendor's 
grievance process. We believe it is the responsibility of the approved 
CAP vendor to notify the beneficiary about the conditions (specified in 
Sec.  414.914(h)) under which the approved CAP vendor could permissibly 
cease delivery of CAP drugs for a beneficiary.
    Comment: A few physician commenters expressed concern that an 
approved CAP vendor could use the refusal to ship for nonpayment of 
coinsurance as a way to influence the participating CAP physician's 
treatment plan, such as forcing the participating CAP physician to 
admit the beneficiary to a hospital.
    Response: In order to preserve the flexibility of the participating 
CAP physician as required by the statute we have significantly limited 
the instances in which an approved CAP vendor can refuse to ship. 
However, we have a very specific process to provide the approved CAP 
vendor with some economic protection, and we will monitor the instances 
where an approved CAP vendor refuses to ship for nonpayment of 
coinsurance to ensure it is not being abused. The participating CAP 
physician may seek assistance from the CAP designated carrier in 
working out disputes where the participating CAP physician believes the 
approved CAP vendor is abusing the process under Sec.  414.917.
    Comment: One physician group commented that the regulation should 
be revised to require that the approved CAP vendor must provide 
information on cost sharing assistance to needy beneficiaries. The 
commenter stated that because the regulation at Sec.  414.914(g)(3) and 
Sec.  414.914(h)(3) state that the approved CAP vendor may inform 
beneficiaries that they generally make available categories of 
assistance such as referral to a bona fide charitable organization, 
implementation of a payment plan, or a full or partial waiver of the 
cost sharing amount that they were not required to do so.
    Response: In the July 6, 2005 interim final rule with comment (70 
FR 39086), we stated that the approved CAP vendor would be required on 
request, to provide information to beneficiaries on sources of 
coinsurance assistance. The regulations at Sec.  414.914(g) state that 
the ``approved CAP vendor must provide assistance to beneficiaries 
experiencing financial difficulty in paying their cost sharing amounts 
* * *'' However, Sec.  414.914(g)(3) and Sec.  414.914(h)(3) state that 
approved CAP vendors may inform beneficiaries that they generally make 
cost sharing assistance available. It was our intention as reflected in 
the language in the preamble and Sec.  414.914(g) and Sec.  
414.914(h)(3) to require approved CAP vendors to have a cost sharing 
assistance program available if the beneficiary expressed a need for 
one.
    Section 14.914(g)(3) and Sec.  414.914(h)(3) were intended to 
convey that approved CAP vendors may generally inform beneficiaries of 
the existence of this program rather than waiting for the beneficiary 
to request assistance. It was not our intention to convey that the 
approved CAP vendor had the option not to provide this assistance. In 
order to resolve any confusion we are revising Sec.  414.914(g)(3) and 
Sec.  414.914(h)(3) to reflect our original intent. The revision now 
reads, ``Approved CAP vendors must inform beneficiaries,'' that they 
generally make available the categories of assistance described in 
paragraphs Sec.  414.914(g)(1), (g)(2), and (g)(3) of this section.''
    Comment: One manufacturer commented that the vendor should be 
required to document ``reasonable collection efforts'' before being 
allowed to cut off a beneficiary.
    Response: Because approximately 80 percent of beneficiaries have a 
Medicare supplemental policy that includes coverage for Part B cost 
sharing, their coinsurance and deductible payments should be made 
automatically in most cases by their supplemental insurer under the 
coordination of benefits process. Some beneficiaries without 
supplemental insurance may have difficulty making their coinsurance and 
deductible payments at times, and may seek assistance from the approved 
CAP vendor or some other third party. As we stated previously in this 
final rule and in the July 6, 2005 interim final rule with comment and 
consistent with the requirements of section 1128A(a)(5) of the Act and 
Sec.  414.914(g) of the regulations, at the time of billing, the 
approved CAP vendor must inform the beneficiary generally of the types 
of cost-sharing assistance that may be available. If the beneficiary is 
unable to pay the coinsurance or deductible, he or she may request 
assistance from the approved CAP vendor as described above. The 
approved CAP vendor has an obligation to provide the information 
requested, and to take one of the actions specified in Sec.  
414.914(g). However, if the beneficiary has not requested financial 
assistance and if after a period of 45 days from delivery date of the 
approved CAP vendor's bill to the beneficiary whether by the approved 
CAP vendor or by the participating CAP physician on the behalf of the 
approved CAP vendor, the beneficiary's coinsurance obligation remains 
unpaid, the approved CAP vendor may refuse to make further shipments of 
drugs to the participating CAP physician for that

[[Page 70256]]

beneficiary. (We note that these provisions assume that the approved 
CAP vendor bills the beneficiary after payment is received from 
Medicare and his or her supplemental insurance provider (if 
applicable).)
    If the beneficiary requests cost-sharing assistance and the 
approved CAP vendor refers the beneficiary to a bona fide independent 
charitable organization for assistance or offers a payment plan, the 
approved vendor must wait an additional 15 days from the date of 
delivery (which would be the postmark date when mailed and received 
date when hand delivered) of the approved CAP vendor's response to the 
beneficiary's request for cost-sharing assistance. If at the end of the 
15-day time period, the approved CAP vendor has not received a cost-
sharing payment (either from the charitable organization or from the 
beneficiary under the payment plan), the approved CAP vendor may refuse 
to ship additional drugs to the physician on behalf of that 
beneficiary. Further, if the approved CAP vendor implements a 
reasonable payment plan, it must continue to ship CAP drugs for the 
beneficiary, so long as the beneficiary remains in compliance with the 
payment plan.
    Finally, if the approved CAP vendor waives the cost-sharing in 
accordance with section 1128A(i)(6)(A) of the Act and Sec.  1003.101 
and Sec.  414.914(g)(3) of the regulations, it may not refuse to ship 
CAP drugs for the beneficiary. At this time, we believe that sufficient 
safeguards are built into the system to protect the beneficiary. 
Beneficiaries who believe that the approved CAP vendor is not adhering 
to these standards may use the vendor's grievance process. If that does 
not resolve the issue to their satisfaction they may request assistance 
from the designated carrier under the dispute resolution process. We 
will monitor the implementation of this provision to see whether a 
requirement that the approved CAP vendor document collection efforts 
should be implemented at a later date.
    Comment: A beneficiary advocacy group requested that the approved 
CAP vendor be required to assess the beneficiary's financial condition 
and waive coinsurance for beneficiaries who meet a prescribed poverty 
test.
    Response: Any beneficiary who is unable to meet his or her cost-
sharing obligations is free to request assistance from the approved CAP 
vendor. We assume that if the approved CAP vendor administers its own 
plan rather than referring the beneficiary to a charitable organization 
for assistance, it will develop eligibility guidelines for the plan. We 
do not require any provider to waive coinsurance on a routine basis.
(2) Advance Beneficiary Notices (ABNs)
    In the July 6, 2005 interim final rule with comment, we stated that 
the approved CAP vendor could issue an ABN to the beneficiary if the 
approved CAP vendor and the participating CAP physician did not agree 
about whether the drug administration service claim would be paid as a 
medically necessary service (70 FR 39058). We also stated that the 
approved CAP vendor may ask the participating CAP physician to deliver 
an ABN. If the participating CAP physician agrees to do so, he or she 
will describe both the administration of the drug and the drug product 
on the ABN, together with the estimated cost for each that the 
beneficiary must pay if he or she receives the drug and Medicare does 
not pay. We also noted that if the participating CAP physician declined 
to issue the ABN, then the approved CAP vendor could issue the ABN to 
the beneficiary before the drug was administered. In the July 6, 2005 
interim final rule with comment, we used the phrase ``signed ABN'' 
where we meant to say ``enforceable ABN'' (70 FR 39039 and 39051). We 
wish to clarify this point because there are circumstances under which 
an ABN issued via telephone can be enforced. The requirements for 
delivery of ABNs can be found in the Medicare Claims Processing Manual, 
Pub. 100-4, Chapter 30, Section 40.3.4. These requirements may be 
accessed electronically at http://cms.hhs.gov/manuals/104_claims/clm104c30.pdf.
    Comment: Some physicians commented that an obligation to collect an 
ABN on behalf of the approved CAP vendor represented an unwelcomed 
administrative burden. Others expressed concern that approved CAP 
vendors would overuse the ABN process, issuing ABNs even when the 
approved CAP vendor had no reasonable belief that the physician's drug 
administration claim or the vendor's claim for the drug would be 
denied. A commenter stated that it would be a logical anomaly for the 
approved CAP vendor to ask a participating CAP physician to collect an 
ABN in cases where the physician believes the drug administration 
services and, consequently, the drug product will be covered. The 
commenter believes this puts the participating CAP physician in an 
untenable situation and will serve to confuse the beneficiary 
unnecessarily.
    Commenters from the community of potential vendors requested that 
we allow the approved CAP vendor to refuse to ship the CAP drug if the 
approved CAP vendor believes the applicable coverage policy prohibits 
payment and the participating CAP physician refuses to collect an ABN 
for the CAP drug on behalf of the vendor, suggesting that, in this 
case, the participating CAP physician should be allowed to use the 
furnish as written process. One commenter requested that we allow the 
approved CAP vendor to terminate CAP business with a participating CAP 
physician who refused to issue an ABN on behalf of the approved CAP 
vendor when the underlying claim was not paid.
    Response: In response to the commenters' concerns, we reemphasize 
that the participating CAP physician's decision to issue an ABN on 
behalf of the approved CAP vendor is completely voluntary. An approved 
CAP vendor is always free to contact the beneficiary and issue an ABN 
on its own. Because the participating CAP physician's decision to issue 
an ABN is voluntary, the approved CAP vendor may not penalize the 
participating CAP physician who refuses to do so by refusing to ship 
the drug or attempting in some other way to force the participating CAP 
physician to obtain it. We note that, approved CAP vendors will have a 
disincentive to abuse the ABN process. Should an approved CAP vendor 
issue an ABN that is not consistent with CMS requirements, and the 
claim for the drug is denied and appealed to an Administrative Law 
Judge (ALJ), the ALJ could review the case and determine that the use 
of the ABN was inappropriate or invalid, thereby shifting liability to 
the approved CAP vendor. In addition, if an approved CAP vendor 
frequently seeks ABNs in cases where the participating CAP physician's 
local carrier routinely determines a particular drug to be covered, the 
approved CAP vendor may not be seen as a good business partner by the 
participating CAP physician and could lose his or her business at the 
next CAP election period. After careful consideration of the comments 
we have received, and balancing all the policy implications we have 
decided to maintain the policy with respect to ABNs set forth in the 
July 6, 2005 interim final rule with comment.
(3) Dual Eligibles
    In the July 6, 2005 interim final rule with comment, we addressed 
the situation of beneficiaries who are dually eligible for the Medicare 
and Medicaid programs. We stated that Medicaid coinsurance payments 
would vary by State and that we had no authority to change the 
coinsurance amount based

[[Page 70257]]

on who was responsible for payment of the coinsurance (70 FR 39054).
    Comment: Several commenters requested that we specifically state 
that dual eligible, Medicare/Medicaid beneficiaries may not be held 
responsible for more coinsurance than what the Medicaid State Agency 
pays. They have asked us to make clear that approved CAP vendors may 
not balance bill the beneficiary for that portion of the 20 percent 
Medicare coinsurance that is above the given State's Medicaid upper 
payment limit.
    Response: State Medicaid programs can limit coinsurance payments to 
the extent that any payment for a covered Medicaid benefit, when 
combined with Medicare payments, equals the amount of reimbursement 
payable under the Medicaid program. A State Medicaid program may deem 
an approved CAP vendor to be paid in full even if it has received 
either no coinsurance payment or a reduced payment from the State. Dual 
eligible beneficiaries have no liability for a covered Medicaid benefit 
beyond the State's payment amount as set forth in section 1902(n)(2) of 
the Act.
e. Physician Election Issues and Education
    In the July, 6, 2005 interim final rule with comment (70 FR 39079), 
we stated that section 1847B(a)(1)(A) of the Act specifies that each 
physician be given the opportunity annually to elect to participate in 
the CAP. Physicians who do not elect to participate in the CAP would 
continue to buy the drugs they provide to beneficiaries ``incident to'' 
their service and bill the Medicare program for them under section 
1847A of the Act, the ASP system. Section 1847B(a)(5)(A) of the Act 
requires that we develop a process that physicians who wish to 
participate in the CAP may use to select an approved CAP vendor. This 
election is to occur on an annual basis. The statute requires that we 
coordinate this process with the Medicare Participating Physician 
Process described in section 1842(h) of the Act. Additionally, we 
stated that physicians who elect to participate in the CAP would be 
required to complete a CAP election agreement and would agree to the 
participating CAP physician requirements as established in the July 6, 
2005 interim final rule with comment (70 FR 39079 through 39083).
    In the July 6, 2005 interim final rule with comment, we also stated 
that the participating CAP physician election process would operate 
from October 1 to November 15 of each calendar year. In the September 
6, 2005 interim final rule with comment interpretation and correction 
notice (70 FR 52930), we announced a delay in CAP implementation to 
approximately July 1, 2006. We anticipate that the bidding for the 
initial round of CAP will commence upon the publication of this rule. 
Thus, for this first CAP year the participating CAP physician election 
process will occur for approximately 6 weeks in early to mid-spring. 
Exact dates and election procedures will be announced on our web site. 
Later in 2006, we will conduct the annual participating CAP physician 
election for CY 2007. The election period for 2007 will occur from 
October 1, 2006 to November 15, 2006, with subsequent annual 
participating CAP physician election periods running from October 1 to 
November 15 of each calendar year thereafter.
    In the July 6, 2005 interim final rule with comment, we stated that 
participating CAP physicians who wish to continue their participation 
in the CAP into subsequent years would do so by executing an 
abbreviated agreement, which would, if applicable, indicate a 
preference to change approved CAP vendors or, if applicable, CAP drug 
category. We also described specific instances in which participating 
CAP physicians will be permitted to select another approved CAP vendor 
or leave the CAP mid-year. These instances are when the selected 
approved CAP vendor ceases to participate in the CAP because its 
contract is terminated or suspended or if the participating CAP 
physician leaves the group practice that had selected the given 
approved CAP vendor or relocates to another competitive area (if 
multiple CAP competitive areas are implemented). Additionally, 
physicians newly enrolled in Medicare have 90 days from the date of 
enrollment to elect to participate in the CAP. The election process was 
summarized in the July 6, 2005 interim final rule with comment (70 FR 
39083).
    We also stated that when a physician bills as a member of a group 
using the group's Provider Identification Number (PIN), he or she must 
follow the group's election to participate or not to participate in the 
CAP. Thus, members of a group practice would elect to participate in 
the CAP as a group when billing under the group PIN. We also stated 
that if a group practice physician maintains a separate solo practice, 
he or she could make a separate determination of whether to participate 
in the CAP for the solo practice if using his or her individual PIN for 
the solo practice.
(1) Group vs. Individual Participation in CAP
    We received several comments on the CAP participation of physicians 
who are in a group practice.
    Comment: Several commenters suggest that when a physician is part 
of a group practice that the choice to elect the CAP should be made by 
the individual physician or by the physician specialty. Commenters 
sought clarification on the ability of physicians to be able to make 
their own, independent decisions related to the CAP so as not to affect 
the continuity of the group practices. One commenter specifically 
sought clarification on whether a physician within a group practice 
could opt out of CAP while his partners within the group opted in. The 
commenter believed that the language allows one physician within a 
group to continue with the ``buy and bill'' method while the others 
within the group opt to elect the CAP as long as the physician bills 
all of his or her professional services rendered to group patients 
under his or her own individual PIN.
    Response: In the July 6, 2005 interim final rule with comment (70 
FR 39082), we stated that we were required to coordinate the selection 
of the approved CAP vendor with agreements entered into under section 
1842(h) of the Act (agreements to become a Medicare participating 
physician). The Medicare participating physician enrollment process 
coordinates the Medicare payment for the health care services delivered 
to a Medicare beneficiary. When payments for services are made to a 
health care provider, they are made based on the PIN. In order for a 
physician to ``buy and bill'' separately from the group he or she must 
not have reassigned his or her benefits to the group. By reassigning 
his or her benefits to the group practice, the physician will be 
billing Medicare using the group's PIN. Thus, the group will make the 
choice about whether to participate in the CAP.
    Comment: Another commenter sought clarification on whether a non-
participating physician who joined the CAP will be able to accept 
assignment for CAP drug administration.
    Response: When a Medicare physician is a non-participating 
physician, he or she may still accept assignment on a case-by-case 
basis for his or her services. However, he or she must agree to accept 
assignment for all Medicare Part B drug payment as specified in section 
1842(o)(3)(A) of the Act. If the non-participating physician elects to 
participate in the CAP he or

[[Page 70258]]

she will no longer be billing Medicare for the Part B drugs that he or 
she obtains through CAP, but he or she will still be able to bill 
Medicare for the administration of those drugs. Thus, if a non-
participating physician elects to participate in the CAP, he or she 
must agree to accept assignment for drug administration for all CAP 
drugs to allow for the Medicare beneficiary's and approved CAP vendor's 
appeal rights.
(2) Practitioners in CAP-Clarification
    In the July, 6, 2005 interim final rule with comment, we stated 
that physicians would have a choice to participate in the CAP or 
continue to buy the drugs they provide to beneficiaries ``incident to'' 
their service and bill the Medicare program for them under the ASP 
system as specified in section 1847A of the Act. We would like to 
clarify that for the purposes of the CAP, a physician includes all 
practitioners that meet the definition of a ``physician'' in section 
1861(r) of the Act.
(3) Physician Choice of Approved CAP Vendor
    Comment: One commenter believes that approved CAP vendors will be 
entirely dependent on physicians for various actions including--filing 
claims, appealing a denial, obtaining beneficiary information, and, 
where necessary, obtaining an ABN. The commenter asserts that approved 
CAP vendors should be allowed the right to decline to work with a 
participating CAP physician who has--
    <bullet> Previously failed to pay for drugs on a timely basis.
    <bullet> Materially breached his or her contractual obligations to 
the approved CAP vendor or his or her CAP election agreement with CMS.
    <bullet> Acted in a manner that obstructs the purpose or intent of 
the CAP, or otherwise hinders its effectiveness.
    <bullet> Otherwise acted in bad faith.
    The commenter is concerned that as long as a participating CAP 
physician is not currently suspended, the participating CAP physician 
may select any approved CAP vendor he or she wishes, including an 
approved CAP vendor that might have generated a suspension request for 
that participating CAP physician. The commenter further asserts that 
because of the critical reliance of approved CAP vendors on 
participating CAP physician's compliance with CAP requirements that in 
the event of the participating CAP physician's noncompliance the 
approved CAP vendors should have the right not to work with a 
participating CAP physician if it has a reasonable basis for concern. 
The commenter also believes it is important for the approved CAP vendor 
to have some recourse when it will potentially be selling drug products 
to the physician, and, thus, potentially be owed significant amounts by 
a physician in certain situations.
    Response: The commenter's reference to a vendor ``selling'' drugs 
to a physician appears to be expressing concern about an approved CAP 
vendor's relationship with a participating CAP physician outside the 
scope of the CAP. These relationships are beyond the scope of this 
rule. Currently, physicians purchase the drugs they administer to their 
Medicare beneficiary patients and are reimbursed for those drugs 
through the ASP payment system. The CAP is an alternative way for 
physicians to obtain drugs. In the CAP, the participating CAP physician 
does not purchase CAP drugs, but rather orders them. Because 
participating CAP physicians will not own the CAP drugs they order from 
the approved CAP vendor, the approved CAP vendor will not be 
``selling'' the drug to the participating CAP physician. Instead, the 
approved CAP vendor will ship CAP drugs to the participating CAP 
physician and bill Medicare for them upon administration. In addition, 
as we have stated in this final rule with comment and the July 6, 2005 
interim final rule with comment, an approved CAP vendor must accept any 
participating CAP physician who selects it. However, in developing the 
CAP, we recognized that the approved CAP vendor, as the owner of the 
CAP drugs, would have significant financial risk. We developed a 
dispute resolution process to assist the approved CAP vendor if there 
were occurrences of participating CAP physician noncompliance within 
the program. In the July 6, 2005 interim final rule with comment (70 FR 
39054), we detailed the dispute resolution process for addressing 
participating CAP physician's non-compliance with CAP obligations. We 
believe the dispute resolution process is the appropriate forum for 
addressing these concerns.
(4) Participating CAP Physician Mid Year Opt-Out
    In this section, we discuss the comments received concerning the 
ability of a participating CAP physician to opt-out of the CAP prior to 
the end of the year and our responses to those comments.
    Comment: We received a number of comments requesting that 
participating CAP physicians have the ability to opt-out of CAP for any 
approved CAP vendor issues, including quality and delivery issues.
    Response: We understand the commenters' concerns. We believe that 
we have provided for a sound method to ensure the quality of the CAP 
and to resolve these issues. As discussed in the July 6, 2005 interim 
final rule with comment (70 FR 39058), we established financial and 
quality standards to ensure that we choose reputable and experienced 
vendors to participate in the CAP.
    Participating CAP physicians will have the option of changing 
approved CAP vendors or opting out of the CAP program on an annual 
basis. We also provided the circumstances, as specified in Sec.  
414.908(a)(2), under which a participating CAP physician may choose a 
different approved CAP vendor mid-year or opt-out of the CAP. These 
circumstances are: (1) If the selected approved CAP vendor ceases to 
participate in the CAP; (2) if the participating CAP physician leaves 
the group practice that had selected the approved CAP vendor; (3) if 
the participating CAP physician relocates to another competitive 
acquisition area (once multiple CAP competitive areas are developed); 
or, (4) for other exigent circumstances defined by CMS. We identified a 
separate exigent circumstance relating to instances in which an 
approved CAP vendor declines to ship CAP drugs (when the conditions of 
Sec.  414.914(h) are met) in Sec.  414.908(a)(5). We note that in all 
these cases, while there is only one drug category for CAP, the 
participating CAP physician would be allowed to opt-out of the CAP 
altogether.
    In the July 6, 2005 interim final rule with comment, we also 
discussed how the participating CAP physician would use the approved 
CAP vendor's grievance process for drug quality and service issues and 
turn to the designated carrier for assistance in developing solutions 
(70 FR 39057). If a participating CAP physician is dissatisfied with 
the drug quality or drug delivery performance of an approved CAP 
vendor, we expect the participating CAP physician to attempt to resolve 
the issue with the approved CAP vendor informally, and then to use the 
approved CAP vendor's grievance procedure. The next step is to ask for 
the designated carrier's assistance in developing a solution with 
cooperation from both parties. The designated carrier will act promptly 
to investigate quality and service issues. If these are not resolved, 
the designated carrier may recommend to CMS the suspension or 
termination of the approved CAP vendor's contract. We will act on that

[[Page 70259]]

recommendation after gathering any necessary, or additional information 
from the participating CAP physician and approved CAP vendor. If the 
approved CAP vendor is suspended from the program, that vendor will be 
unable to participate in the CAP for the remainder of that year. The 
ultimate sanction for service and quality issues is termination of the 
approved CAP vendor's 3-year contract upon exhaustion of the 
reconsideration process as specified in Sec.  414.917. If the approved 
CAP vendor contract is suspended or terminated, the participating CAP 
physician would be able to choose another approved CAP vendor or leave 
the CAP altogether.
(5) Participating CAP Physician Opt-Out for Non-Payment of Coinsurance
    In the July 6, 2005 interim final rule with comment (70 FR 39053), 
we stated that in instances where a beneficiary has failed to meet his 
or her obligation to pay the coinsurance or the deductible for a drug, 
the conditions of Sec.  414.914(h) were met, and the approved CAP 
vendor has refused to continue shipping CAP drugs to the participating 
CAP physician for the beneficiary, we will permit the participating CAP 
physician to opt-out of that drug category for the CAP. We noted that 
for the initial implementation of the CAP, there is only one CAP drug 
category. Thus, a participating CAP physician exercising this option 
will be opting out of the entire CAP program until the next opportunity 
to elect to participate.
    We are making a technical change to Sec.  414.908(a)(5) to state 
that if the approved CAP vendor refuses to ship to the participating 
CAP physician because the conditions of Sec.  414.914(h) have been met; 
the participating CAP physician can withdraw from the applicable CAP 
drug category for the remainder of the year immediately upon notice to 
CMS and to the approved CAP vendor. We note again, that for the initial 
implementation of the CAP, there is only one CAP drug category. Thus, a 
participating CAP physician exercising this option will, in effect, be 
opting out of the entire CAP program until the next opportunity to 
elect to participate.
    Comment: We received numerous comments on the exigent circumstance 
that allows a participating CAP physician to opt-out of CAP if an 
approved CAP vendor were to stop providing a drug to a Medicare 
beneficiary due to non-payment of the coinsurance to the approved CAP 
vendor. Commenters requested that we allow the participating CAP 
physician to opt-out of CAP for only that one Medicare beneficiary 
allowing the participating CAP physician to continue in CAP for the 
other Medicare beneficiaries.
    Response: We do not believe that allowing a participating CAP 
physician to opt-out of CAP on a beneficiary-by-beneficiary basis is 
consistent with the CAP statute. When a physician elects to obtain 
drugs through the CAP that physician will no longer be able to bill 
Medicare for drugs under the ASP methodology that is available from the 
approved CAP vendor unless permitted under the ``furnish as written'' 
option. The approved CAP vendor will bill Medicare for the CAP drugs 
administered by the participating CAP physician. Therefore, if an 
approved CAP vendor has refused to ship the CAP drug as specified in 
Sec.  415.914(h), we will permit the participating CAP physician to 
opt-out of CAP for that category. However, we note that for the initial 
implementation of CAP there is only one drug category.
(6) Physician Education
    In the July 6, 2005 interim final rule with comment, we stated that 
we would instruct the Medicare carriers to use various communication 
channels at the local and national levels to disseminate information 
about the CAP and assist approved CAP vendors and participating CAP 
physicians in understanding the Medicare program's operations, policy, 
and billing and administration procedures regarding the CAP in 
conjunction with use (70 FR 39084). The Medicare carriers will be 
instructed to use data analyses in tailoring their outreach and 
educational efforts for potential vendors and physicians regarding 
identified areas of confusion about the CAP. Additionally, we specified 
that the Medicare carriers would be instructed to use mass media, as 
well as educational and outreach products, services, forums, and 
partnerships in an effort to disseminate information about, and provide 
assistance regarding, the CAP to potential vendors and healthcare 
practitioner communities. We stated that the goal of our outreach and 
education would be to ensure that those who provide services to 
Medicare beneficiaries receive the information they need to understand 
the Medicare program so that they can administer it and bill it 
correctly.
    Comment: There were comments requesting assistance and education 
for the CAP. One commenter was concerned with the availability of 
assistance and education to the participating CAP physician discussed 
in the July 6, 2005 interim final rule with comment. The commenter 
asserted that we have not elaborated on how physicians would be able to 
obtain education and assistance on CAP throughout the year. The 
commenter believed that physicians will have questions related to the 
CAP processes or other technical aspects not clear at the beginning of 
the program. The commenter also believed that we might make changes 
during the course of the year once the program is implemented and 
improvements are instituted. The commenter encouraged us to anticipate 
the need for on-going, real-time assistance to the participating CAP 
physician utilizing the CAP, particularly in the first year and 
implement a proactive education strategy. Another commenter requested 
that given the short time frame allowed for the CAP election, we ensure 
that physicians are properly educated and informed about CAP before 
they make an election. They suggested that we require approved CAP 
vendors to provide participating CAP physicians with a disclosure form 
and to certify that they have accurately disclosed all program features 
including administrative requirements, technical/software requirements, 
penalties, restrictions on delivery and transporting of drugs.
    Response: The commenter is correct to note that there will be 
changes in the CAP during the course of the year. As we previously 
discussed, approved CAP vendors will have the opportunity to request 
approval to change their drug lists in several ways. Physicians should 
be aware of this before electing to participate in the CAP, but CMS and 
approved CAP vendors will inform participating CAP physicians of these 
and other changes on a timely basis, as described in a previous section 
of this preamble.
    In the July 6, 2005 interim final rule with comment, we stated that 
we would post on our Web site, the approved CAP vendors we have 
selected for the CAP, their categories of drugs (and specific NDCs), 
and the geographic areas within which they would operate (70 FR 39081). 
(See http://www.cms.hhs.gov/providers/drugs/compbid/). We stated that 
we would publicize the participating CAP physician election information 
on our Web site, listservs, Medicare fee-for-service contractors' Web 
sites, and newsletters. We stated our intention to coordinate with 
physician specialty organizations to inform their members that the 
participating CAP physician election information is available. We also 
stated that we would provide a CAP fact sheet so that the carriers can 
disseminate it to their physicians and that there would be an education 
campaign to inform

[[Page 70260]]

physicians about the CAP Web site and the election process. We 
described our plan to make available, the participating CAP physician 
election agreement forms with instruction on how to download, complete, 
and sign them and return them to the local carrier. The local carrier 
will note the physician's decision to participate in the CAP, the 
approved CAP vendor and the selected categories of drugs (when multiple 
categories of drugs become available). The local carrier will forward 
information from the participating CAP physician election agreement to 
the CAP designated carrier. The designated carrier will compile a 
master list of all participating CAP physicians' approved CAP vendor 
and drug category selections. In addition, the designated carrier will 
notify each approved CAP vendor of the participating CAP physicians who 
have elected to enroll with that approved CAP vendor.
    Throughout the year we will continue to provide participating CAP 
physician assistance through the participating CAP physician's local 
carrier and the designated carrier. Both the participating CAP 
physician's local carrier and the designated carrier will have toll 
free numbers for participating CAP physicians to use in requesting 
assistance.
f. Brief Summary of Comments We Are Not Addressing
    In response to the July 6, 2005 interim final rule with comment, we 
received comments on a wide variety of issues related to the CAP. This 
final rule with comment addresses those issues that are most urgent to 
begin CAP implementation. Other issues raised in the comments will be 
fully considered and addressed at a later time.
    Among the comments we are not addressing at this time are comments 
related to rural operational issues, the impact of CAP delivery times 
on satellite clinics, restrictions on transporting drugs, the 14 day 
participating CAP physician billing requirement, impact on clinical 
research, and licensure requirements for CAP pharmacies and 
distributors.

I. Private Contracts and Opt-Out Provision

    Section 4507 of the BBA of 1997 amended section 1802 of the Act to 
permit certain physicians and practitioners to opt-out of Medicare if 
certain conditions were met, and to provide through private contracts 
services that would otherwise be covered by Medicare.
    When a physician or practitioner fails to maintain the conditions 
necessary for opt-out and does not take good faith efforts to correct 
his or her failure to maintain opt-out, current regulations at Sec.  
405.435(b) specify the consequences to that physician or practitioner 
for the remainder of that physician's or practitioner's 2-year opt-out 
period. However, Sec.  405.435(b) describes a situation where the 
Medicare carrier notifies the physician or practitioner that he or she 
is violating the regulations and the statute. As explained in the 
August 8, 2005 proposed rule, the current regulations do not address 
the consequences to physicians and practitioners in situations when a 
condition resulting in failure to maintain opt-out occurs during the 2-
year opt-out period, but a Medicare carrier does not discover or give 
notice of a physician's or practitioner's failure to maintain opt-out 
during the 2-year opt-out period. We proposed to amend Sec.  405.435 in 
order to clarify that the consequences specified in Sec.  405.435(b) 
for the failure on the part of a physician or practitioner to maintain 
opt-out will apply regardless of whether or when a carrier notifies a 
physician or practitioner of the failure to maintain opt-out. We also 
proposed to add a new paragraph (d) to clarify that in situations where 
a violation of Sec.  405.435(a) is not discovered by the carrier during 
the 2-year opt-out period when the violation actually occurred, then 
the requirements of Sec.  405.435(b)(1) through (b)(8) would be 
applicable from the date that the first violation of Sec.  405.435(a) 
occurred until the end of the opt-out period during which the violation 
occurred (unless the physician or practitioner takes good faith efforts 
to restore opt-out conditions, for example, by refunding the amounts in 
excess of the charge limits to beneficiaries with whom he or she did 
not sign a private contract). These good faith efforts must be made 
within 45 days of any notice by the carrier that the physician or 
practitioner has failed to maintain opt-out (where the carrier 
discovers the failure after the 2-year opt-out period has expired), or 
within 45 days after the physician or practitioner has discovered the 
failure to maintain opt-out, whichever is earlier.
    Comment: One commenter stated that having physicians suffer 
regulatory consequences for failure to maintain opt-out status, even 
when they are not notified of their status, would be unfair and 
discouraging. They recommended that Medicare carriers be required to 
notify physicians of their opt-out status 60 days before any actions 
are taken against them.
    Response: The revision to Sec.  405.435 does not instruct Medicare 
carriers to take action against physicians without sufficient notice to 
the physician. In situations where a physician or practitioner fails to 
maintain opt-out and the carrier discovers that violation either during 
the physician's or practitioner's opt-out period or after it expires, 
carriers will notify the physician or practitioner of the violation and 
the physician or practitioner will have 45 days from the date of the 
carrier's notice to correct that violation. Similarly, in the situation 
where the physician or practitioner discovers that he or she has failed 
to maintain opt-out, the physician or practitioner will be on notice 
that unless he or she takes corrective action within 45 days the 
provisions of Sec.  405.435(b)(1)-(b)(8) are applicable. We do not 
agree with the commenter's suggestion that the 45-day period for taking 
corrective action should begin in all cases until the carrier sends a 
notice, that is, including situations in which the physician or 
practitioner discovers the failure to maintain opt-out. If physicians 
and practitioners were permitted to intentionally violate their opt-out 
responsibilities, or ignore unintentional violations that they 
discovered subsequently, until the carrier notifies the physician or 
practitioner of the violation, harm to both beneficiaries and the 
program could result. For example, beneficiaries could enter into 
private contracts that do not meet the notice requirements of Sec.  
405.415 or the Medicare program could make mistaken payments due to the 
physician or practitioner billing Medicare in violation of Sec.  
405.425. In order to minimize these harms when a physician or 
practitioner discovers a failure to maintain opt-out, we believe the 
45-day period should begin on the date the failure to maintain opt-out 
is discovered, not at some later date when a carrier discovers the 
failure and gives notice.
    Comment: One commenter stated that the proposed rule would 
establish regulations that address situations where a physician or 
practitioner that has opted out of the Medicare program fails to 
maintain the requirements of their status. In particular, the proposed 
regulatory language would provide physicians or practitioners that have 
opted out of the Medicare program 45 days to correct the violation. The 
commenter believes these regulations are reasonable as proposed. 
However, the commenter urges the agency to establish standardized 
language for the violation notice and clear guidelines for carriers to 
execute timely notice of opt-out violation.

[[Page 70261]]

    Response: The CMS Internet-Only Manual (Publication 100-2, chapter 
15, section 40.12) currently provides Medicare's carriers with 
standardized guidelines regarding the notice to physicians and 
practitioners, and the actions to take, in cases of failure to maintain 
opt out status.
    We are finalizing our proposed changes to Sec.  405.435 (b) and 
adding new paragraph (d) as proposed.

J. Multiple Procedure Payment Reduction for Diagnostic Imaging

    As explained in the August 8, 2005 proposed rule (70 FR 45849), 
diagnostic imaging procedures are priced in the following three ways:
    <bullet> The professional component (PC) represents the physician 
work, that is, the interpretation.
    <bullet> The technical component (TC) represents PE, that is, 
clinical staff, supplies, and equipment.
    <bullet> The global service represents both PC and TC.
    Under the resource-based PE methodology, specific PE inputs of 
clinical labor, supplies, and equipment are used to calculate PE RVUs 
for each individual service. We do not believe these same inputs are 
needed to perform subsequent procedures. When multiple images are taken 
in a single session, most of the clinical labor activities and most 
supplies are not performed or furnished twice. In addition, equipment 
time and indirect costs are allocated based on clinical labor time; 
therefore, these inputs should be reduced accordingly. Excluding these 
PE inputs, which we believe are duplicative, supports a 50 percent 
reduction in the payment for the TC of subsequent procedures. A 
reduction of 50 percent is also currently used in the multiple 
procedure payment reduction for surgery, which has been a longstanding 
policy.
    Therefore, we proposed extending the multiple procedure payment 
reduction to the TC of specific procedures listed in Table 29 of the 
August 8, 2005 proposed rule (70 FR 45850). Table 29 identified 11 
families of imaging procedures by imaging modality (ultrasound, CT and 
computed tomographic angiography (CTA), MRI and magnetic resonance 
angiography (MRA)), and contiguous body area (for example, CT and CTA 
of Chest/Thorax/Abdomen/Pelvis). We proposed applying the reduction 
only to procedures involving contiguous body areas within a family of 
codes, not across families, and to those multiple procedures that were 
provided in one session. We also proposed only to apply the multiple 
procedure payment reduction to the TC of certain procedures because, 
while we believe there may be some reduction in physician work 
associated with the performance of multiple diagnostic imaging 
procedures on contiguous body areas, we have no specific plans to 
extend the proposal to the PC. In addition, since the global service 
payment equals the combined PC and TC components, when the global 
service code is billed for these procedures, the TC would be reduced to 
the same as above, but the PC would be paid in full. We proposed making 
full payment for the TC of the highest priced procedure and payment at 
50 percent of the TC for each additional procedure.
    Comment: Several commenters supported our proposal, and described 
it as appropriate, reasonable, justified, rational, and consistent with 
the private sector. One commenter suggested extending the proposal to 
the professional component. Two other commenters stated that it should 
not be applied to the professional component. One commenter suggested 
applying the reduction to noncontiguous body areas imaged using the 
same modality. Another commenter indicated an understanding of the 
rationale for the proposal but did not want it extended to traditional 
radiographs.
    Response: We appreciate the commenters' support. We currently have 
no plans to extend our proposal to incorporate the commenters' 
suggestions (that is, to include noncontiguous body areas, other 
radiologic examinations, or the professional component of imaging 
services). We are not certain whether and to what degree a multiple 
procedure payment reduction policy would be appropriate in these types 
of situations.
    Comment: Several commenters opposed our proposal on the basis that 
diagnostic imaging is not comparable to surgery. For example, they 
noted that diagnostic imaging is not paid as part of a global package 
of services; its pre and post activities and resources are typically 
not as extensive as those required for surgery, and so should comprise 
a much smaller portion of the payment than for surgery; and it is 
highly capital intensive compared to surgery. One commenter stated that 
nuclear medicine procedures were inappropriately discounted and should 
not serve as precedent for discounting diagnostic imaging procedures.
    Response: We agree that diagnostic imaging procedures are not 
comparable to surgical procedures and did not base the development of 
the multiple imaging procedure payment reduction policy on specific 
comparisons with the reductions applicable to multiple surgical 
procedures. Instead, with findings from the MedPAC recommendation about 
a multiple imaging procedure reduction, detailed information regarding 
current imaging reduction payment policies in the private insurance 
industry, and our analysis of PE data, we believe that the rationale 
for the proposed reduction is sound. The 50 percent reduction was 
specifically founded upon well-established and professionally accepted 
data we examined from the PEAC, as described below, and was not based 
simply on the fact that a 50 percent reduction is applied to multiple 
surgical procedures. In addition, the reduction for six nuclear 
medicine procedures has been in effect for 11 years. During that time, 
we have received no evidence to indicate that it is not appropriate. 
Nevertheless, we did not base our multiple imaging procedure reduction 
policy on comparisons with nuclear medicine procedures.
    Comment: Numerous commenters agreed that some clinical labor 
activities, supplies, and equipment are not duplicated for subsequent 
procedures. Other commenters indicated exactly the opposite (that is, 
that these items, including some portion of scanning time, are 
duplicated). In addition, some commenters indicated that where 
equipment adjustments are required between studies, clinical labor time 
could actually increase when multiple imaging procedures are performed 
on the same patient during a single session.
    The majority of commenters agreed that there are some efficiencies 
when multiple procedures are performed but disagreed that all the 
activities we listed above are never duplicated. Therefore, they 
disagreed that the efficiencies achieved in subsequent procedures 
support a 50 percent reduction. Many commenters indicated that a 50 
percent reduction is arbitrary and that we provided no supporting data. 
Several commenters suggested that the reduction should be somewhere 
between 5 and 25 percent. The ACR offered several suggestions on the 
relative level of reduction among families of procedures, for example, 
that the reduction for the procedures in family four should be less 
than for family two; and that the reduction for procedures in family 
seven should be less than for family two, but greater than for family 
four. However, they provided no specific percentages for the reductions 
in each family.
    A few commenters recommended varying the percentage reduction by 
modality because efficiencies are not

[[Page 70262]]

uniform across all families of procedures. Two commenters indicated 
that the proposal was inconsistent with the mandate to make resource-
based PE payments. Specific comments included the following:
    <bullet> For ultrasound procedures, all clinical labor activities 
except for greeting the patient, are duplicated.
    <bullet> For some CTs, repositioning the patient is necessary. Some 
CTs require multi-phasic contrast injections that are separately 
scanned.
    <bullet> For CTs, MRIs and MRAs, the number of prior exams for 
review before the studies are performed has increased significantly.
    <bullet> Some CTs, CTAs, MRIs, and MRAs require more images, slices 
or pulse sequences.
    <bullet> For brain MRIs and neck MRAs, it is necessary to remove 
the patient; change from a head coil to a neurovascular coil; retune 
the coil; enter multiple new scan parameters; reposition the patient; 
and run a new set of pulse sequences. The patient often requests a 
break between procedures.
    Several commenters recommended delaying implementation of the 
proposal for 1 year pending further study. Their reasons included: 
postponing until the PE inputs are fully implemented and clearly 
defined; deferring until the entire PFS methodology is reassessed; and 
delaying until MedPAC's other imaging study recommendations are 
implemented. Two commenters suggested that we phase-in the reduction. 
The ACR offered to work with CMS to reexamine the procedures subject to 
the reduction; reconfigure the families of procedures; and, determine 
appropriate reductions based on modality family.
    Response: We indicated in the proposed rule that the following 
activities are not duplicated for subsequent procedures:
    <bullet> Greeting the patient.
    <bullet> Positioning and escorting the patient.
    <bullet> Providing education and obtaining consent.
    <bullet> Retrieving prior exams.
    <bullet> Setting up the IV.
    <bullet> Preparing and cleaning the room.
    In addition, we consider supplies, with the exception of film, are 
not duplicated for subsequent procedures. Therefore, the 50 percent 
reduction for subsequent procedures is based on eliminating the time 
for the clinical labor activities noted above, plus supplies, with the 
exception of film. We do not assume any reduction in procedure 
(scanning) time or equipment for subsequent procedures. However, as 
noted in the proposed rule, equipment, time, and indirect costs are 
allocated based on clinical labor time; therefore, these inputs were 
reduced accordingly.
    The 50 percent reduction was determined based on the examination of 
multiple pairs of procedure codes from the families representing all 
modalities (that is, ultrasound, CT/CTA, and MRI/MRA studies) that were 
frequently performed on a single day based on historical claims data. 
Using PE input data provided by the RUC, we factored out the clinical 
staff minutes for the activities we indicated are not duplicated for 
subsequent procedures, and the supplies, other than film, which we 
consider are not duplicated for subsequent procedures. As noted 
previously, equipment time and indirect costs are allocated based on 
clinical labor time; therefore, these inputs were reduced accordingly. 
Removing the PE inputs for activities that are not duplicated, and 
adjusting the equipment time and indirect costs for the individual 
pairs of procedures studied, supports payment reductions ranging from 
40 to 59 percent for the subsequent services. Because we found a 
relatively narrow range of percentage payment reductions across 
modalities and families, and taking into consideration that we did not 
eliminate any duplicative image acquisition time for subsequent 
procedures in our analysis, we decided that an across-the-board 
reduction for all 11 families of 50 percent (which is approximately the 
midpoint of the range established through our analysis) was both 
justified and conservative. We believe this payment reduction policy 
represents an appropriate reduction for the typical delivery of 
multiple imaging services in all 11 families. Because the reduction is 
based on eliminating the specific practice expense inputs that are not 
duplicated, we believe the proposal is consistent with the resource-
based practice expense methodology.
    While various alternative reduction percentages were suggested, no 
evidence was presented to support specific alternative percentages. 
However, we recognize that many commenters raised significant 
objections and we appreciate their comments indicating their specific 
concerns regarding the appropriate reductions for each family and 
specific combinations of services within families.
    To allow for a transition of the changes in payments for these 
services attributable to this reduction policy, and provide a further 
opportunity for comment, we have decided to phase-in the policy over 2 
years. We will implement a 25 percent payment reduction in CY 2006 and 
a 50 percent reduction for all 11 families in CY 2007 for all code 
families, unless we find upon further review during the upcoming year 
that modifications to this policy are appropriate. To enhance our 
review, we are soliciting, from providers of diagnostic imaging 
services, comprehensive data regarding the efficiencies associated with 
different combinations of imaging services in the 11 families. We 
welcome the opportunity to have other discussions with the physician 
community on these issues.
    Comment: One commenter noted that a patient having both a pelvic 
and transvaginal ultrasound often needs a break between procedures and 
requires repositioning, along with the use of a different probe for the 
second study. The commenter also noted that breast and pelvic 
ultrasounds are often performed in different locations and by different 
physicians.
    Response: The commenter has raised some serious questions 
concerning whether any payment reduction is appropriate for the 
procedures indicated. Therefore, we have decided to delete transvaginal 
ultrasound and ultrasound of the breast(s) (CPT codes 76830 and 76645, 
respectively) from the list of procedures in family one subject to the 
payment reduction, pending further study. We believe there may be 
common clinical scenarios where these services are provided in 
combination with other ultrasound studies where payment reduction may 
not be appropriate. These typical efficiencies associated with these 
services when provided in combination with other studies in family one 
require further study.
    Comment: Many commenters asked how ``single session'' is defined 
and what mechanism will be used to distinguish single and multiple 
sessions. One commenter indicated that multiple procedures are 
frequently performed in separate rooms within the radiology department 
or in different areas within the hospital. In these cases, the patient 
must be transported from one room to another and the process restarted. 
One commenter noted the potential for abuse by self-referring 
physicians writing separate prescriptions for studies on different 
days. Another commenter indicated that the proposal will force 
providers to schedule further studies on additional days.
    Response: We consider a single session to be one encounter where a 
patient could receive one or more radiological studies. If more than 
one of the imaging services in a single family

[[Page 70263]]

is provided to the patient during one encounter, then this would 
constitute a single session and the lower-priced procedure(s) would be 
reduced. On the other hand, if a patient has a separate encounter on 
the same day for a medically necessary reason and receives a second 
imaging service from the same family, we consider these multiple 
studies in the same family on the same day to be provided in separate 
sessions. In the latter case, we have established that the physician 
should use modifier -59 to indicate multiple sessions, and that the 
multiple procedure reduction does not apply. Medicare carriers will 
establish edits to ensure that separate sessions are not 
inappropriately scheduled for contiguous body area imaging in attempts 
to bypass the reduction. Use of the modifier where not medically 
necessary in order to bypass the payment reduction constitutes fraud.
    Comment: One commenter suggested that the proposal required 
multiple body area imaging whenever a procedure in a particular family 
was performed, resulting in unnecessary imaging. Another commenter 
stated that grouping procedures to justify lower reimbursement provides 
no medical or monetary benefit and is detrimental to patient care.
    Response: It appears the commenters have misinterpreted our 
proposal. The proposal in no way requires the performance of 
unnecessary multiple imaging procedures when only a single study is 
medically necessary. The families of procedures are based on claims 
data indicating that these procedures are often done in combination, 
most likely in a single session. We believe that the payment reduction 
for the lower-priced imaging procedures from one family performed on 
contiguous body areas provides the most appropriate payments for the 
services provided.
    Comment: A few commenters recommended that we apply the budget 
neutrality adjustment only to PE RVUs and not to work RVUs.
    Response: The commenters are correct that, because the payment 
reduction applies only to PE RVUs, the savings should likewise only 
apply to PE RVUs. We agree with this comment and have made the 
necessary adjustment.
    Comment: One commenter indicated that we should request a statutory 
change to exempt the proposal from budget neutrality.
    Response: We believe it is up to the Congress to decide whether it 
wants to make adjustments to the application of budget neutrality. We 
have no plans to request this change.

Final Decision

    We have revised our proposal as follows:
    <bullet> Phase in the payment reduction, with a 25 percent 
reduction in CY 2006 and a 50 percent reduction in CY 2007. Our review 
of the multiple imaging payment reduction policy will be ongoing.
    <bullet> Deleting CPT codes 76830 and 76645 from the list of 
procedures in family one subject to the reduction, pending further 
study.
    <bullet> Applying the budget neutrality adjustment only to PE RVUs, 
rather than to both work and PE RVUs.
    An example of the current and CY 2006 payments is summarized in 
Table 26, and the revised lists of procedures subject to the reduction, 
are set forth in Table 27:

                                                             Table 26.--Example of Payments
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                                  Current total      CY 2006 total
                                          Procedure 1 74183  Procedure 2 72196       payment            payment           CY 2006 payment calculation
--------------------------------------------------------------------------------------------------------------------------------------------------------
PC......................................            $117.00             $90.00            $207.00            $207.00                       no reduction.
TC......................................             978.00             529.00           1,507.00           1,374.75                 978 + (.75 x $529).
Global..................................           1,095.00             619.00           1,714.00           1,581.75        $207 + $978 + (0.75 x $529).
--------------------------------------------------------------------------------------------------------------------------------------------------------

BILLING CODE 4120-01-U

[[Page 70264]]

[GRAPHIC] [TIFF OMITTED] TR21NO05.054


[[Page 70265]]


[GRAPHIC] [TIFF OMITTED] TR21NO05.055

BILLING CODE 4120-01-C

[[Page 70266]]

K. Therapy Cap

    As discussed in the August 8, 2005 proposed rule, section 
1833(g)(1) of the Act applies an annual, per beneficiary combined cap 
on outpatient physical therapy and speech-language pathology services, 
and a similar separate cap on outpatient occupational therapy services 
under Medicare Part B. While Section 624 of the MMA placed a moratorium 
on the application of these caps from December 8, 2003 through December 
31, 2005, the caps will become effective again beginning January 1, 
2006. (The caps were last implemented from September 1, 2003 through 
December 7, 2003.) Section 1833(g)(2) of the Act provides that, for 
1999 through 2001, the caps were $1500, and for years after 2001, the 
caps are equal to the preceding year's cap increased by the percentage 
increase in the MEI (except that if an increase for a year is not a 
multiple of $10, it is rounded to the nearest multiple of $10).
    All of the comments we received questioned the use of therapy caps 
as a way to ensure beneficiaries get needed service while constraining 
the growth in spending. The large majority also pointed out the 
negative effects the therapy caps had on beneficiaries and providers 
when they were last implemented. However, most of the commenters 
recognized that we do not have the authority to change the caps. 
Commenters also wrote in support of an extended moratorium; separating 
physical therapy and speech-language pathology into two caps; a 
condition-based payment system; a pay-for-performance system; and a 
demonstration to assess one or more alternative limitation methods.
    We will implement therapy caps on January 1, 2006 according to the 
statute. We note that significant progress has been made toward the 
challenging goal of establishing a payment policy ``based on the 
classification individuals'' as required by the Congress in the BBA 
section 4541(d)(2) and again in the BBRA section 221(c)(2)(B). First, 
in order to evaluate Medicare payments for therapy services, we 
developed a method of identifying therapy services and their individual 
costs on Medicare claim lines. Then, we identified classification 
groups and conducted initial analyses of the type and amount of 
treatment utilized by each group. These 21 classification groups 
consisted of patients whose conditions were similar based on ICD-9 
diagnosis codes, utilization patterns, published research and clinical 
opinion that indicated they may have similar health risk and require 
similar level of care and expenditures for service. For example, spinal 
cord injury, hip fracture, and musculoskeletal disorders form 
classifications that include many similar diagnoses. This demonstrated 
that if the expected need for service can be determined for subsets of 
each classification group, system edits that limit spending based on 
expected needs are feasible and would result in cost savings. To 
implement a payment method based on the conditions described by 
classification groups, additional information is needed on the claim 
about the patient's need for therapy services. Indicators or 
measurements that represent need, such as severity and acuity of a 
patient's condition, are not available on the current Medicare claim 
form and are not consistently gathered or reported by therapists. In 
order to be useful, these factors must be obtained from a sufficiently 
large database of patients to predict patients' needs with statistical 
validity and reliability. We currently have studies underway to extend 
the progress made in prior studies to explore the potential for using 
patient condition information to predict therapy needs and likely 
outcomes. We expect these studies to be completed in 2006.
    After issuance of this rule, we will issue instructions to 
contractors related to the implementation of therapy caps. We will 
consider comments received in response to the August 8, 2005 proposed 
rule as we develop those instructions. Since 2003, we have maintained, 
and we recently updated, a web site that describes therapy caps. We 
encourage providers and beneficiaries to review that information at 
www.cms.hhs.gov/medlearn/therapy (Therapy Cap Status).
    Based on the formula established in 1883(g)(2) of the Act, the 
therapy caps will be implemented January 1, 2006. The dollar amount for 
the therapy caps for CY 2006 is $1,740.

L. Chiropractic Demonstration Discussion

    Section 1861(r)(5) of the Act limits current Medicare coverage for 
chiropractic treatment by means of the manual manipulation of the spine 
for the purpose of correcting a subluxation, defined generally as a 
malfunction of the spine. Specifically, Medicare covers three CPT Codes 
provided by chiropractors: 98940 (manipulative treatment, 1-2 regions 
of the spine); 98941 (manipulative treatment, 3-4 regions of the 
spine); and 98942 (manipulative treatment, 5 regions of the spine). 
Treatment must be provided for an active subluxation only, and not for 
prevention or maintenance. Additionally, treatment of the subluxation 
must be related to a neuromusculoskeletal condition where there is a 
reasonable expectation of recovery or functional improvement.
    In the August 8, 2005 proposed rule, we included a discussion of 
the 2-year demonstration authorized by Section 651 of the MMA to 
evaluate the feasibility and advisability of covering additional 
chiropractic services under Medicare. These services extend beyond the 
current coverage for manipulation to care for neuromusculoskeletal 
conditions typical among eligible beneficiaries, and cover diagnostic 
and other services that a chiropractor is legally authorized to perform 
by the State or jurisdiction in which the treatment is provided. 
Physician approval will not be required for these services. The 
demonstration is being conducted in four sites, two rural and two 
urban. One site of each area type must be a health professional 
shortage area (HPSA). The demonstration must also be budget neutral. 
The statute requires the Secretary to ensure that aggregate payments 
made under the Medicare program do not exceed those that would be paid 
in the absence of this demonstration.
    Ensuring budget neutrality requires that the Secretary develop a 
strategy for recouping funds should the demonstration result in costs 
higher than would occur in the absence of the demonstration. In this 
case, we would make adjustments in the national chiropractor fee 
schedule to recover the costs of the demonstration in excess of the 
amount estimated to yield budget neutrality. We will assess budget 
neutrality by determining the change in costs based on a pre/post 
comparison of costs and the rate of change for specific diagnoses that 
are treated by chiropractors and physicians in the demonstration sites 
and control sites. We will not limit our analysis to reviewing only 
chiropractor claims, because the costs of the expanded chiropractor 
services may have an impact on other Medicare costs.
    Any needed reduction would be made in the CY 2010 and CY 2011 fee 
schedules as it will take approximately 2 years to complete the claims 
analysis. If we determine that the adjustment for budget neutrality is 
greater than 2 percent of spending for the chiropractor fee schedule 
codes (comprised of the 3 currently covered CPT codes 98940, 98941 and 
98942), we will implement the adjustment over a 2-year period. However, 
if the adjustment is less than 2 percent of spending under the 
chiropractor fee schedule codes, we will implement the adjustment over 
a 1-year period. We will include the detailed

[[Page 70267]]

analysis of budget neutrality and any proposed offset in the CY 2009 
Federal Register publication of the PFS.
    We also noted in the proposed rule that PT services performed by 
chiropractors under the demonstration will be included under the PT cap 
described in section II.K. of the preamble to this final rule with 
comment. These services are included under the cap because 
chiropractors are subject to the same rules as medical doctors for 
therapy services under the demonstration.
    The following is a summary of the comments received and our 
responses.
    Comment: Several commenters expressed concern regarding specific 
aspects of the demonstration project, including PT services being 
provided by chiropractors and including the PT services provided by 
chiropractors under the demonstration under the therapy cap.
    Response: A discussion of the chiropractic demonstration was 
included in the PFS proposed rule because of the potential for a budget 
neutrality adjustment that will be discussed in the CY 2009 Federal 
Register publication of the PFS. Issues concerning the demonstration 
project itself were outside the scope of the proposed rule. We are 
including PT services provided by chiropractors under the therapy cap 
because under the demonstration, we are subjecting chiropractors to the 
same rules as physicians for therapy services.
    Comment: One commenter suggested that in the calculation of the 
budget neutrality of the demonstration project that the therapy 
rendered by the chiropractors or their therapists is a ``trade off'' of 
associated costs that would have required evaluation, order and 
recertification by a medical doctor. They also suggested that the 
management of neuromuscular conditions is more efficient when all 
contributing factors are identified and addressed simultaneously by the 
combined skills of each specialty. The patient would normally learn to 
function more rapidly through concurrent multidisciplinary management 
than with any limited single approach. In addition, the commenters 
noted that to accurately assess the demonstration a variety of 
variables, such as medical services that were not required or services 
directly replaced by another provider, need to be considered.
    Response: Section 651(a)(1) specified that the chiropractic 
services provided under the demonstration should include diagnostic and 
other services that a chiropractor is legally authorized to perform by 
the State or jurisdiction in which the treatment is provided. There is 
no requirement for concurrent multidisciplinary management of 
neuromuscular conditions. We recognize that covering additional 
services by chiropractors could have an impact on currently covered 
Medicare services. For this reason, we plan to assess budget neutrality 
by examining the total Medicare costs for specific diagnoses, and not 
just the chiropractor costs. As we noted previously, we will provide a 
detailed analysis of budget neutrality and any proposed offset in the 
CY 2009 Federal Register publication of the PFS.
    Comment: Commenters requested that we clarify plans for making 
reductions to maintain budget neutrality and identify claims we will 
analyze. The commenters also requested that we provide information on 
how this will impact the SGR, particularly if the chiropractic 
demonstration results in increased spending on physicians' services, 
since this could result in reductions in reimbursement for all 
physicians, not just chiropractors. Another commenter opposed the 
application of any adjustments to the national chiropractic fee 
schedule instead of an adjustment to the overall fee schedule. This 
commenter believes that the totality of funds under part B and not 
subset of services within it should finance the demonstration program 
and that this is reflected in section 651(f)(A)of the MMA.
    Response: Section 651(f)(A) requires that ``* * * the Secretary 
shall ensure that the aggregate payment made by the Secretary under the 
Medicare program do not exceed the amount which the Secretary would 
have paid under the Medicare program if the demonstrations projects 
under this section were not implemented.'' The legislation does not 
specify a specific methodology for ensuring budget neutrality. Our 
methodology meets the legislative intent, and appropriately impacts the 
profession that is directly affected by the demonstration.
    Because the demonstration is located in only four sites in which 
the expansion of services is permitted, we anticipate that the impact 
on the SGR would be negligible.

M. Supplemental Payments to Federally Qualified Health Centers (FQHCs) 
Subcontracting With Medicare Advantage (MA) Plans

    Section 237 of the MMA amended section 1833(a)(3) of Act to provide 
supplemental payments to FQHCs that contract with Medicare Advantage 
(MA) organizations to cover the difference, if any, between the payment 
received by the FQHC for treating enrollees in MA plans offered by the 
MA organization and the payment that the FQHC is entitled to receive 
under the cost-based all-inclusive payment rate as set forth in part 
405, subpart X. The supplemental payment for covered Medicare FQHC 
services furnished to MA enrollees augments the direct payments made by 
MA plans to FQHCs for covered Medicare FQHC services.
    In order to implement this new payment provision, we must determine 
whether the Medicare cost-based payments to which the FQHC would be 
entitled exceed the amount of payments received by the center from the 
MA organization and, if so, pay the difference to the FQHC.
    The proposed supplemental payment for FQHC covered services 
rendered to MA enrollees is equal to the difference between 100 percent 
of the FQHC's all-inclusive cost-based per-visit rate and the average 
per-visit rate received by the FQHC from the MA plan in which the 
enrollee is enrolled, less any amount the FQHC may charge as described 
in section 1857(e)(3)(B) of the Act.
    A supplemental payment will be made every time a face-to-face 
encounter occurs between an MA enrollee and any one of the FQHC's core 
practitioners: physician, nurse practitioner, physician assistant, 
clinical nurse midwife, clinical psychologist, or clinical social 
worker. The supplemental payment is made directly to each FQHC through 
the Medicare Fiscal Intermediary (FI).
    In the August 8, 2005 proposed rule, we proposed conforming changes 
to our regulations to add Sec.  405.2469 to provide a supplemental 
payment, based on a per-visit calculation, to FQHCs under contract 
(directly or indirectly) with MA organizations.
    We received comments on the portion of the proposed rule addressing 
the FQHC supplemental payment provision of section 237 of the MMA. A 
summary of those comments and our responses follows:
    Comment: One commenter asked how the Medicare contractor will know 
the amount the health plan paid when FQHCs bill the Medicare contractor 
for the supplemental payment.
    Response: The Medicare contractor will know the amount paid by the 
MA plan based on the required MA payment estimate furnished by the FQHC 
to the contractor. The payment amount difference between the interim 
FQHC all-inclusive cost based rate and the average interim MA rate will 
be reported on the FQHC claim form every time the FQHC submits a bill 
to the

[[Page 70268]]

contractor to collect an FQHC supplemental payment. The Medicare 
contractor will pay FQHCs the difference between the interim FQHC all-
inclusive rate and the interim MA rate on a per-visit basis.
    Comment: A commenter requested clarification regarding cost sharing 
rules for MA enrollees as referenced in Sec.  405.2469(a)(ii), which 
stipulates that FQHCs may charge Medicare patients as described in 
section 1857(e)(3)(B) of the Act.
    Response: Section 1857(e)(3)(B) of the Act provides that a FQHC 
must accept the MA payment and the Federal supplemental payment (that 
is, the payment decribed in section 1833(a)(3)(B)) as payment in full 
for services covered by the agreement, except that the FQHC may collect 
any amount of cost-sharing permitted under the MA contract, so long as 
the amounts of any deductible, coinsurance, or co-payment comply with 
the requirements under section 1854(e) of the Act. In general, an MA 
plan offered by an MA organization satisfies section 1854(e) of the Act 
beginning in 2006 if the monthly basic MA premium and the actuarial 
value of the cost sharing charged to enrollees for services covered 
under Parts A and B of original Medicare do not exceed the actuarial 
value of cost sharing charged to beneficiaries in original Medicare. MA 
plans must also disclose cost sharing amounts to their members.
    Comment: Two commenters urged us to deduct from the supplemental 
payment calculation only the amount of cost-sharing actually collected 
by the FQHC. Furthermore, the commenters asked that we recognize any 
uncollected cost-sharing amounts as ``bad debt'' on the FQHC cost 
report.
    Response: The supplemental payment calculation shall deduct the 
cost sharing amounts set forth in the formal contract between the FQHC 
and MA plan, not the actual amounts collected by the FQHC. Section 
1833(a)(1)(B) states that the supplemental payment is to be calculated 
net of any amount the FQHC ``may charge'' as described in section 
1857(e)(3)(B) of the Act. Thus the language of the statute plainly 
states that the supplemental payment is to be based on what the FQHC 
could charge as cost sharing, not cost sharing amounts that the FQHC 
actually collects.
    Rules regarding what may constitute ``bad debt'' for purposes of a 
FQHC's cost report are beyond the scope of this final rule with 
comment. Furthermore, the rules we are finalizing pertain to section 
237 of the MMA which addresses a supplemental payment to FQHCs that 
contract, directly or indirectly, with an MA organization. Thus, 
arrangements pertaining to ``bad debt'' for uncollected cost sharing 
owed by an MA plan enrollee, if any, would be governed by the contract 
between the FQHC and the MA organization.
    Comment: A commenter questioned whether the upper payment limit 
would apply in determining the supplemental payment.
    Response: For FQHCs operating below the FQHC national payment 
limit, we will use their actual per-visit all-inclusive rate to 
determine the FQHC supplemental. For FQHCs operating at or above the 
national payment limit, we will use the applicable national FQHC urban 
or rural upper limit to calculate the FQHC supplemental payment. The 
amount of the supplemental payment will be the amount by which the 
original FQHC payment exceeds the MA plan payment. Section 237 of the 
MMA clearly requires the use of a cost-based rate or based on other 
tests of reasonableness as the Secretary may prescribe in regulations. 
The longstanding national FQHC payment limit is an integral part of the 
FQHC payment methodology as set forth in regulations.
    Comment: A commenter questioned whether the provider types listed 
on page 45853 (Proposed Payment Methodology Section) of the August 8, 
2005 proposed rule is broader than the original FQHC benefit.
    Response: In the proposed rule, we explained that an FQHC 
supplemental payment is made only when a face-to-face encounter occurs 
between a core FQHC practitioner and an MA enrollee. This list of core 
FQHC practitioners is identical to the practitioner list for the 
original FQHC Medicare benefit. Furthermore, these FQHC practitioners 
must meet all applicable qualification requirements as set forth in 
section 405 and 491 of the CFR in order to qualify for the supplemental 
payment.
    Comment: A commenter requested that we amend the regulatory 
definition of eligible centers for the FQHC supplemental payments to 
allow payments for health centers for the homeless. The preamble of the 
proposed rule states that eligible FQHCs include all centers receiving 
grants under Section 330 except those centers that receive funds 
pursuant to Section 330(h) of the Public Health Service Act (that is, 
Health Care for the Homeless grantees). The commenter specifically 
requested that we recognize these centers for supplemental payments, or 
at a minimum, be prepared to do so as soon as legislation is passed.
    Response: We currently do not have the statutory authority to 
recognize as Medicare FQHCs any entity that does not meet statutory 
requirements for designation as an FQHC. Consequently, we cannot 
provide centers that are not FQHCs with Medicare FQHC supplemental 
payments for treating MA enrollees. If changes were made to the 
statute, we would implement regulations, as necessary, consistent with 
statutory requirements.
    Comment: A commenter asked for clarification regarding the 
statement in the rule that FQHCs under contract (indirectly or 
directly) with MA organizations are eligible for supplemental payments. 
The commenter requested specific confirmation that the term 
``indirect'' is intended to include arrangements under which the health 
center contracts with another organization, which in turn, contracts 
with the MA organization in order to provide Medicare services.
    Response: We interpreted section 237 of the MMA to mean that any 
Medicare FQHC furnishing covered FQHC services to MA plan enrollees 
would be eligible for supplemental payments regardless of whether they 
have a direct contract with an MA organization or contract with another 
entity (for example, a medical group) that has a direct contract with 
the MA organization to treat its enrollees.
    Comment: A commenter asked whether a health center with an MA 
contract can bill Medicare directly on a fee-for-service basis if the 
center provides services to plan enrollees that are not FQHC services. 
For example, can they directly bill for services the FQHC could 
otherwise bill as Part B services if it were not providing the service 
to an MA plan enrollee? A commenter requested clarification whether a 
health center will be allowed to bill original Medicare for extended 
hours of operation not included under the center's MA arrangement. 
Another commenter asked whether a health center that utilizes a 
specialist, who is not included in the MA plan's specialty panel, to 
provide an FQHC core service will be permitted to bill Medicare for 
these services.
    Response: The FQHC should bill original Medicare only for covered 
services rendered to original Medicare beneficiaries that are ``not'' 
enrolled in an MA plan. In accordance with section 1851(i) of the Act, 
with limited exceptions, only the MA organization is entitled to 
receive Medicare payments for services furnished to its enrollees. 
Therefore, FQHCs under direct or indirect contract with an MA 
organization must look to the MA

[[Page 70269]]

organization for payment. The additional payment permitted by section 
1833(a)(3)(B) of the Act applies only to FQHC services described in 
section 1832(a)(2)(D)(ii) of the Act.
    Comment: A commenter questioned whether services not covered under 
original Medicare, but offered and paid for by the MA plan, such as 
dental, are included in determining the CMS wrap-around payment to the 
center.
    Response: Only services meeting the definition of an FQHC service 
as defined under section 1832(a)(2)(D) of the Act are included in the 
determination of the FQHC supplemental payment. Thus, services other 
than those defined under section 1832(a)(2)(D), such as dental 
services, are not included in the determination of the supplemental 
payment.
    Comment: A commenter requested that we modify our proposed FQHC 
supplemental payment methodology to include Medicare FQHC covered 
services that are not necessarily performed as a face-to-face 
encounter.
    Response: All covered Medicare FQHCs services are eligible for 
supplemental payments regardless of whether these services trigger a 
billable FQHC visit. For purposes of consistency, we adopt the 
longstanding FQHC visit definition under original Medicare, which would 
provide a supplemental payment every time there is a face-to-face 
encounter between an MA enrollee and one or more of the following FQHC 
covered core practitioners: physicians, nurse practitioners, physician 
assistants, clinical nurse midwives, clinical psychologists, or 
clinical social workers. The costs of services incidental to the 
professional services of the above core FQHC practitioners would be 
bundled into the calculation of the supplemental payment. In light of 
the fact that all incidental services and costs are recognized, we 
believe that the use of the FQHC encounter definition for the 
supplemental payment provision is reasonable and appropriate.
    Comment: A commenter requested clarification regarding the interim 
rate that should be utilized for these health centers in light of the 
fact that centers have yet to have their annual reconciliation from 
2004 performed.
    Response: The interim rate for MA payments will be based on 
estimates from the contracting FQHC until actual MA payments and visits 
are captured on the FQHC cost report. We will use these estimates until 
actual MA payments and visits are captured on the FQHC cost reports. At 
that point, payments will be adjusted accordingly.
    Comment: A commenter asked for clarification regarding which fiscal 
year would apply to the rate calculation methodology for services 
rendered on or after January 1, 2006--the Federal fiscal year, the 
health center, or the MA plan. Furthermore, clarification was requested 
regarding the transition process for reconciling differences between 
centers' fiscal year and the MA contract year.
    Response: The FQHC supplemental payment calculation shall be based 
on the FQHC's cost report year. For the initial year, if the MA plan's 
contract year and the FQHC's fiscal year do not coincide, the FQHC 
supplemental payment calculation shall be based on a weighted average 
of MA payments based on the number of MA visits expected in each 
respective MA contract year. In subsequent FQHC cost report years, 
actual MA payments and visits will be used to calculate final FQHC 
supplemental payments as well as the interim supplemental payments for 
the following year. Since actual payments and visits already reflect 
the differences between the FQHC fiscal year and the MA contract year, 
no transition process is necessary.
    Comment: A commenter requested clarification whether payments will 
be aggregated across multiple MA plans or whether the payments will be 
plan specific.
    Response: In cases where an FQHC has multiple arrangements in place 
with different MA plans, payments will be aggregated across multiple 
plans to determine final Medicare program liability. In other words, at 
cost settlement MA payments will be aggregated for all MA enrollees 
treated by the FQHC.
    Comment: A commenter expressed concern that the required detailed 
MA payment estimates from FQHCs will result in a significant increase 
in administrative time. In light of this new requirement, they 
suggested that we develop standard forms and information requests to 
ease the burden as much as possible.
    Response: Each eligible FQHC seeking the supplemental payment is 
required to submit (for the first two rate years) to the Medicare 
Fiscal Intermediary (FI) an estimate of the average MA payments (per-
visit basis) for covered FQHC services provided to MA enrollees. Every 
eligible FQHC seeking the supplemental payment is required to submit a 
documented estimate of its average per-visit payment for MA enrollees 
in each MA plan offered by the MA organization and any other 
information as may be required to enable the FI to accurately establish 
an interim supplemental payment. Expected payments from the MA 
organization would be used only until actual MA revenue and visits 
collected on the FQHC's cost report can be used to establish the amount 
of the supplemental payment. Until we modify the FQHC cost report form 
to identify and capture MA payments and visits, each eligible FQHC 
requesting supplemental payments will be required to submit estimates 
to CMS.
    Comment: A commenter urged us to calculate and provide supplemental 
payments on a per-visit basis to ensure adequate cash flow to 
contracting FQHCs.
    Response: Under the proposed rule, we added Sec.  405.2469 to 
specify that the FQHC supplemental payment methodology is on a per-
visit basis.
    Comment: A commenter requested timely annual system reviews of cost 
reports to ensure that the health centers are provided with a 
continuous cash flow of Medicare funding.
    Response: The Medicare contractors responsible for processing FQHC 
claims and reviewing cost reports will use all available resources for 
timely cost report settlement.
    Comment: A commenter requests that we provide guidance under this 
rule regarding the methods of enforcing the statutory requirement that 
MA plan payments to contracting FQHCs must be comparable to other 
contracting health care providers furnishing similar services.
    Response: Generally, we will examine contracts and attendant fee 
schedules between MA organizations and FQHCs and between MA 
organizations and other providers to ensure that payment levels for 
similar services are comparable.
    Comment: A commenter requested clarification regarding how our 
cross-over system will work for MA enrollees who are dually-eligible 
for the Medicare and Medicaid programs. They asked if claims for 
dually-eligible patients will be forwarded to the Medicaid agency by 
the MA plan or by CMS.
    Response: Our crossover processes do not apply to MA claims but 
rather to claims that are processed under original Medicare, fee-for-
service contractor operations. Therefore, claims for persons who have 
enrolled in an MA plan will not be crossed over by CMS. The MA plan 
would need to coordinate with Medicaid.
    Comment: A commenter expressed concern about the appeals process 
for circumstances under which the MA plan denies a claim, which would 
result in our denial of the supplemental payment. They asked what 
procedures

[[Page 70270]]

the health center should follow when faced with this situation.
    Response: If an FQHC signs a waiver of liability, the FQHC may 
utilize the MA appeals process at 42 CFR part 422, subpart M to contest 
an MA organization's payment denial. If the MA organization's claim 
denial is overturned upon appeal, CMS will make a supplemental payment 
to a FQHC.
    Comment: A commenter requested that we work with MA plans on 
establishing an expedited credentialing process to ensure that all 
health center providers are credentialed on a timely basis, preferably 
prior to January 1, 2006.
    Response: The requirements related to credentialing MA plan 
providers are found in subpart E the Part 422. Note that with limited 
exceptions, the credentialing process that MA organizations follow for 
providers is at the MA organization's discretion (see Sec.  422.204).
    Comment: A commenter requested clarification that supplemental 
payments are available for Medicare-covered services provided by FQHCs 
under non-traditional managed care approaches, such as Preferred 
Provider Organization (PPOs).
    Response: FQHCs contracting with any MA organization are eligible 
for supplemental payments. MA organizations can offer various types of 
MA plans, including PPOs.
    We are revising Sec.  405.2469 as proposed with one change, the 
first use of the term ``Medicare Advantage plans'' is revised to read 
``Medicare Advantage organizations.''

N. National Coverage Decisions Timeframes

    We have established requirements concerning the administrative 
review of local coverage determinations (LCDs) and National Coverage 
Determinations (NCDs) at 42 CFR part 426, with subpart C specifically 
addressing the general provisions for the review of LCDs and NCDs. We 
are updating these requirements as they apply to NCDs to reflect 
changes in the statute.
    Under our existing regulations in part 426, Subpart C, the 
Departmental Appeals Board may stay the adjudicatory proceedings in 
certain circumstances to allow CMS to consider significant new evidence 
that is submitted in the context of a challenge to an NCD. Our previous 
regulations at Sec.  426.340(e), permitted a brief stay of the 
adjudicatory proceedings (not more than 90 days), for CMS to complete 
its reconsideration of the NCD. Those timeframes, although short, were 
consistent with the previous process for making NCDs that did not 
require publication of a proposed decision memorandum and an 
opportunity for public comment on the proposed decision memorandum.
    As discussed in the August 8, 2005 proposed rule (70 FR 45853), 
based on the provisions of section 731 of the MMA of 2003, we proposed 
to amend Sec.  426.340 to state that if the CMS informs the Board that 
a revision or reconsideration was or will be initiated, then the Board 
will stay the proceedings and set appropriate timeframes by which the 
revision or reconsideration will be completed, that reflects sufficient 
time for the publication of a proposed determination, a 30-day public 
comment period, and time for CMS to prepare a final determination that 
responds to public comments as specified in section 1862(l) of the Act. 
We also proposed to eliminate the reference to the 90-day 
reconsideration period in Sec.  426.340(e)(3) for NCD appeals to 
reflect the new timeframes in the MMA.
    Comment: We received 7 comments regarding the proposed NCD 
timeframes. All commenters supported the change. However, a few 
commenters raised concerns about the delays regarding a specific NCD 
that was initiated before the December 8, 2003 effective date for the 
statutory change.
    Response: We will finalize the changes to Sec.  426.340 as proposed 
with minor technical edits, and will continue to work diligently to 
assure that all NCDs submitted after the December 8, 2003 effective 
date for the statutory change are developed within the set timeframes.

O. Coverage of Screening for Glaucoma

    On January 1, 2002, we implemented regulations at Sec.  
410.23(a)(2), Conditions for and limitations on coverage of screening 
for glaucoma, requiring that the term ``eligible beneficiary'' be 
defined to include individuals in the following high risk categories: 
Individuals with diabetes mellitus; individuals with a family history 
of glaucoma; or African-Americans age 50 and over. As discussed in the 
August 8, 2005 proposed rule (70 FR 45853) based on our review of the 
current medical literature, we believe that there are other 
beneficiaries who are at risk for glaucoma and should be included in 
the definition of eligible beneficiary for purposes of the glaucoma 
screening benefit.
    We believe the evidence is adequate to conclude that Hispanic 
persons age 65 and older are at high risk and could benefit from 
glaucoma screening.
    Therefore in Sec.  410.23(a)(2), we proposed to revise the 
definition of an eligible beneficiary to include Hispanic Americans age 
65 and over. In view of the possibility that it may be appropriate to 
include other individuals in the definition of those at ``high risk'' 
for glaucoma, we also requested comments on this issue, including 
documentation from the peer-reviewed medical literature in support of 
suggested changes.
    We received seven comments on the proposal to expand coverage of 
the glaucoma screening benefit to include Hispanic Americans within the 
category of those individuals at ``high risk'' for glaucoma. The 
following is a summary of the comments received and our responses.
    Comment: One commenter stated that it might be appropriate to 
include other individuals (and not only Hispanic-Americans over age 65) 
in the definition of those at ``high risk'' for glaucoma. The commenter 
cited the Los Angeles Latino Eye Study and the research conducted by 
the Eye Diseases Prevalence Research Group as illustrating a sharp rise 
in the prevalence of glaucoma among Hispanic-Americans beginning at age 
60 (Archives of Ophthalmology 2004; 122:532-538). The commenter 
indicated that according to the latter research, the risk of developing 
glaucoma among Hispanics between the ages 50-59 is 2.92 percent, and 
that this number increases significantly to 7.36 percent for Hispanics 
between the ages 60-69. In view of this increase in the prevalence of 
glaucoma in the Hispanic population between the ages 60-69, the 
commenter recommended that CMS reduce the proposed screening coverage 
age from 65 to 60 years of age, suggesting that this lowering of the 
age would allow for medical intervention at an earlier stage during 
this critical period for glaucoma development.
    Response: We note that the commenter relied on the results of a 
major study (See the Archives Ophthalmology 2004; 122:532-538) in 
offering their suggestion for revising the proposal. That, in turn, 
relied on the results of another major study (See Archives of 
Ophthalmology 2001; 119:1819-1826) for data on incidence and prevalence 
of primary open angle glaucoma in Hispanic-Americans. The latter study 
(Quigley, et al.) contains a graph on page 1822 which, in addition to 
stating the same data that the commenter referenced, shows an 
acceleration in prevalence of open angle glaucoma in Hispanic-Americans 
as compared to White persons beginning at age 65. This study by Quigley 
et al.

[[Page 70271]]

yields data supporting a higher incidence of open angle glaucoma in 
Hispanics as compared to Whites beginning at age 65 (Quigley, HA et 
al). The prevalence of glaucoma in a population based study of Hispanic 
subjects: proyecto VER. (Annals of Ophthalmology 2001; 119:1819-1825). 
Though they are not statistically significant in that age group, the 
data strongly favors our conclusion. However, for ages under 65 years, 
the evidence is poor for any differences in these 2 groups for an 
incidence of open angle glaucoma. Therefore, we have chosen a coverage 
baseline for the glaucoma screening benefit of age 65 and older for 
Hispanic-Americans.
    Comment: One commenter stated that they did not support the 
proposal to expand the definition of those individuals at ``high risk'' 
for glaucoma because they do not believe there is sufficient evidence 
in the medical literature to recommend for or against screening adults 
for glaucoma, including Hispanic-Americans age 65 and older. The 
commenter cited the United States Preventive Services Task Force 
(USPSTF) recommendation that concluded that there is insufficient 
evidence to recommend for or against screening adults for glaucoma. The 
commenter also noted that while the USPSFT clinical considerations 
section of its recommendation states that increased ocular pressure, 
family history, older age, and being of African-American descent place 
an individual at risk for glaucoma, it makes no mention of Hispanic-
Americans. Therefore, the commenter concluded that CMS should not make 
any changes to the current definition.
    Response: As stated previously, the articles in Archives of 
Ophthalmology, show that the prevalence of glaucoma in Hispanics begins 
to increase at age 65 markedly when compared to Whites. While the 
USPSTF concluded that there is insufficient evidence to recommend 
either for or against screening any adult for glaucoma, section 
1861(s)(2)(K) of the Act mandates coverage of screening for glaucoma 
for individuals determined to be at high risk for glaucoma, individuals 
with a family history of glaucoma and individuals with diabetes. Based 
on our review of the two published studies, we believe that the 
evidence is adequate to conclude that Hispanics age 65 and older meet 
the definition of individuals at high risk for glaucoma and could 
benefit from glaucoma screening. Further, since glaucoma is prevalent 
in Hispanics, we would rather be inclusive rather than exclusive for 
the screening benefit.
    Comment: Two commenters urge CMS to help educate providers and 
Hispanic beneficiaries to ensure that they are aware of the benefits 
associated with the new coverage when it is included in the final rule.
    Response: We agree and will release appropriate manual and 
transmittal instructions and information from our educational 
components for the medical community, including a MedLearn Matters 
article and fact sheets. We also encourage the medical community to 
join this effort in educating physicians and beneficiaries by 
distributing their own communications, bulletins, or other 
publications. In addition, we have specifically included information on 
the expanded glaucoma screening benefit in the 2006 English and Spanish 
versions of the Medicare and You Handbook, and we plan to revise the 
booklet, Medicare's Preventive Services, and the bilingual brochure for 
Hispanic beneficiaries, to reflect the expanded benefit as well.
    Comment: One commenter expressed concern that at the present time, 
if a glaucoma screening is performed and a disease or condition other 
than glaucoma is discovered the screening examination will no longer be 
considered to be a covered service, which may leave providers open to 
additional financial liability unless they ensure that the patient sign 
an ABN. The commenter recommends that Medicare should cover screening 
examinations without regard to the diagnosis that is determined as a 
result of the screening in a particular case.
    Response: The availability of coverage under the screening benefit 
does not depend on whether or not a disease condition is discovered 
during the annual screening examination. Medicare covers the screening 
examination regardless of the findings at the time of the screening 
examination, but if the provider decides to perform and bill Medicare 
for the more comprehensive eye exam, the cost of the screening 
examination is considered bundled into the Medicare payment for the 
more expensive comprehensive eye examination. For example, if a 
disease, cataract, or a macular degeneration condition is discovered at 
the time of the glaucoma screening, the provider may decide to perform 
a medically necessary comprehensive eye examination and bill Medicare 
Part B for that more expensive covered service. In this example, it 
would be inappropriate for the provider to bill Medicare for the less 
expensive glaucoma screening service as well as the more comprehensive 
and expensive service because it would be duplicative for Medicare to 
pay for both services. In this situation, the only eye service that may 
be billed Medicare is the comprehensive eye examination and it would be 
presumed that the glaucoma screening service is bundled into the 
Medicare payment for the comprehensive eye service.
    Comment: One commenter suggested that CMS work with the Secretary 
of HHS to add on beneficiary eligibility for all Medicare covered 
screening tests to the ASC X12N 270/271 eligibility transaction.
    Response: This issue does not fall within the scope of the Medicare 
PFS regulations; and therefore, we are unable to address it in this 
final rule with comment.
    Comment: Two commenters expressed concern about the statement in 
the Regulatory Impact Analysis (70 FR 45870) of the proposed rule that 
stated that the expansion of the benefit to include Hispanic persons 
age 65 and older ``is not expected to have a significant cost impact on 
the Medicare program.'' The commenters urge CMS to make available to 
the public it's calculation of the impact on spending that would result 
from the proposed increase in glaucoma screening coverage and to 
reflect these spending increases in the SGR, including increases due to 
the initial test and all related and follow-up care.
    Response: Based on the projected utilization of the expanded 
glaucoma screening coverage to include Hispanic persons age 65 and 
older, we estimated in the proposed rule that the expanded benefit 
would result in an increase in Medicare payments to ophthalmologists or 
optometrists who will provide these screening tests and related follow-
up tests and treatment. However, we noted that this change was not 
expected to have a significant cost impact on the Medicare program. 
Based on Medicare Part B carrier claims processing data, we estimate 
that the program paid for about 1,100 glaucoma screening services in CY 
2004 at a cost of about $47,000 for the same time period. While it is 
not possible to predict how many Hispanic-Americans might take 
advantage of the new coverage that will be available to them, judging 
from the impact of the present glaucoma screening benefit on the 
Medicare costs in CY 2004, we do not believe the expansion will have a 
significant impact on program costs in CY 2005 and subsequent years.
    Comment: One commenter suggested that CMS seek to improve its 
coverage web site in the future to reflect all changes being considered 
by the agency--both regulatory and NCD developments--that relate to 
Medicare

[[Page 70272]]

coverage of various preventive services. The commenter stated that 
providing references to all matters affecting Medicare coverage in one 
place would provide the pubic with a better understanding of the extent 
of the agency's efforts in this area.
    Response: We note that the regulation and the NCD processes are two 
separate methods specified in the Medicare statute for developing and 
publishing national coverage policies. However, we plan to review the 
commenter's suggestion for providing references on the CMS Coverage web 
site to all matters--both regulatory and NCD developments--affecting 
Medicare coverage in the preventive services area.

Final Decision

    We are revising the definition of an eligible beneficiary who is at 
``high risk'' for glaucoma to include Hispanic-Americans age 65 and 
older as proposed.

P. Additional Issues

1. Corrections to Conditions for Medicare Payment (Sec.  424.22)
    Two typographical errors in 42 CFR 424.22 were discovered. First, 
Sec.  424.22(d) erroneously refers to the definition of ``financial 
relationship'' in ``Sec.  411.351'' instead of ``Sec.  411.354''. In 
addition, footnote 1 of Sec.  424.22(a)(1)(iv) contains an error in the 
spelling of the word ``hospital.'' Therefore, we are revising Sec.  
424.22 to correct these errors.
2. Chemotherapy Demonstration Project
    CMS seeks to encourage quality care in all facets of cancer 
treatment and care by encouraging best clinical practices and quality 
care. In the CY 2005 final rule, we announced the initiation of a 1 
year demonstration project for CY 2005 for office-based oncology 
services. The authority for this demonstration is based on sections 
402(a)(1)(B) and 402(b) of the Social Security Act Amendments of 1967 
(Pub. L. 90-248). These provisions allow the Secretary to develop and 
engage in experiments and demonstration projects to provide incentives 
for economy while maintaining or improving quality in the provision of 
health services.
    This CY 2005 project focused on three areas of concern often cited 
by patients undergoing chemotherapy: controlling pain; minimizing 
nausea and vomiting; and reducing fatigue. Participating practitioners 
are reporting standardized assessments of patient symptoms at the time 
of chemotherapy encounters. We are collecting data based on these 
assessments over the course of chemotherapy treatment to trace changes 
in patient symptoms, quality of life, and medical responses associated 
with standardized physician assessment of these important areas.
    To facilitate the collection of information, we established new 
Billing Codes, that is, G-codes, to be reported by practitioners in the 
demonstration. The codes correspond to four patient assessment levels 
for each of the three patient symptom areas: Nausea and vomiting; pain; 
and fatigue. These levels, based on the Rotterdam scale, have already 
proven effective in measuring patient symptoms associated with cancer 
care, are easily understood by patients, and are in widespread use. 
Practices reporting data on all three factors to Medicare qualify for 
an additional payment of $130 per encounter. By billing the designated 
codes, the practitioner self-enrolls in the project.
    Although we did not include a discussion item or demonstration 
proposal in the August 8, 2005, proposed physician fee schedule rule, 
we did release a fact sheet on August 1, 2005, titled, ``Demonstration 
of Improved Quality of Care for Cancer Patients Undergoing 
Chemotherapy'' which was posted on our web site. The fact sheet 
provided background on the demonstration project, shared preliminary 
data on the results of the demonstration, and indicated that we would 
continue to consult with its stakeholders about the merits of the 
program and the utility of the data captured.
    We received comments on the proposed rule on the demonstration 
itself and the specific items in the fact sheet. Some commenters 
pointed out what they perceived as limitations of the demonstration 
itself, such as the application of the Part B coinsurance to the 
demonstration codes. Almost all commenters urged CMS to extend the 
demonstration project in its current form or revise it to capture 
better data on quality and outcomes. Several commenters favored 
extending the demonstration to services provided by other physician 
specialties, such as rheumatology, gastroenterology, urology, or 
infectious disease; or to those services currently not included in the 
framework of the demonstration, such as chemotherapy administration to 
hospital outpatients or chemotherapy services provided through oral 
anti-cancer drugs.
    One major specialty group opposed the continuation of the 
demonstration project stating that it is inconsistent with current 
efforts to build evidence-based medicine into the delivery of high 
quality care to Medicare patients.
    Following extensive discussions with various groups representing 
the interests of oncologists and advocates for patient care, we have 
decided to retain the demonstration project for one more year, but we 
will revise the G-codes for reporting in order to take a further step 
toward encouraging quality care and promoting best clinical practices 
that should lead to improved patient outcomes. We will eliminate the CY 
2005 G-codes specific to the assessment of patient symptoms, while 
maintaining our focus on quality cancer care, including the management 
of debilitating symptoms, to assure the best possible quality of life 
for cancer patients.

Reconfiguration of the Demonstration for CY 2006

    The new 1 year oncology demonstration, applicable to services 
furnished in CY 2006, will build on the use of G codes to gather more 
specific information relevant to the quality of care for cancer 
patients, their treatments, and the spectrum of care they receive from 
their doctors, and whether or not the care follows clinical guidelines. 
The project will emphasize evidence-based practice guidelines that have 
been shown to lead to better patient outcomes as the source for 
standard of care, permitting us to monitor and encourage quality care 
to cancer patients. Reporting will no longer be specific to 
chemotherapy administration services, but instead will be associated 
with physician E/M visits for established patients with cancer, visits 
that are frequent and essential to assuring quality of care and life 
for patients.
    The demonstration is available to office-based hematologists/
oncologists who provide an E/M service of level 2, 3, 4, or 5 to an 
established patient, when the service is delivered to a patient with a 
primary diagnosis of cancer belonging to one of the following major 
diagnostic categories:
    <bullet> Breast cancer (invasive).
    <bullet> Colon cancer.
    <bullet> Rectal cancer.
    <bullet> Prostate cancer.
    <bullet> Lung cancer (either non-small cell or small cell).
    <bullet> Stomach cancer.
    <bullet> Esophageal cancer.
    <bullet> Pancreatic cancer.
    <bullet> Ovarian cancer.
    <bullet> Non-Hodgkins Lymphoma.
    <bullet> Chronic myelogenous leukemia.
    <bullet> Multiple myeloma.
    <bullet> Cancer of the head and neck.
    E/M services furnished by hematologists/oncologists for patients 
with other cancers as the principal

[[Page 70273]]

diagnosis will not qualify under the demonstration.
    We are establishing a 2006 payment amount of $23 for the 1 year 
oncology demonstration payment. To qualify for the $23 oncology 
demonstration payment, the physician must submit one G-code from each 
of the following three categories when an E/M service of level 2, 3, 4, 
or 5 is billed: (1) The primary focus of the E/M service; (2) the 
current disease state; and (3) whether current management adheres to 
clinical guidelines.
    We will inform the public on more details of this demonstration 
through a fact sheet and information on our Web site at 
www.cms.hhs.gov/.

III. Refinement of Relative Value Units for Calendar Year 2006 and 
Response to Public Comments on Interim Relative Value Units for 2005

    [If you choose to comment on issues in this section, please include 
the caption ``Interim Relative Value Units'' at the beginning of your 
comments.]

A. Summary of Issues Discussed Related to the Adjustment of Relative 
Value Units

    Section III.B. and III.C. of this final rule with comment describes 
the methodology used to review the comments received on the RVUs for 
physician work and the process used to establish RVUs for new and 
revised CPT codes. Changes to codes on the PFS reflected in Addendum B 
are effective for services furnished beginning January 1, 2006.

B. Process for Establishing Work Relative Value Units for the 2005 
Physician Fee Schedule

    Our CY 2005 final rule (69 FR 66236) contained the work RVUs for 
Medicare payment for existing procedure codes under the PFS and interim 
RVUs for new and revised codes beginning January 1, 2005. We considered 
the RVUs for the interim codes to be subject to public comment under 
the annual refinement process. In this section, we summarize the 
refinements to the interim work RVUs published in the CY 2005 final 
rule and our establishment of the work RVUs for new and revised codes 
for the 2006 PFS.

C. Work Relative Value Unit Refinements of Interim Relative Value Units

1. Methodology (Includes Table Titled ``Work Relative Value Unit 
Refinements of the 2004 Interim and Related Relative Value Units'')
    Although the RVUs in the CY 2005 PFS final rule were used to 
calculate 2005 payment amounts, we considered the RVUs for the new or 
revised codes to be interim. We accepted comments for a period of 60 
days. We received substantive comments for 7 CPT codes with interim 
work RVUs.
    To evaluate these comments, we used a process similar to the 
process used since 1997. (See the October 31, 1997 final rule (62 FR 
59084) for the discussion of refinement of CPT codes with interim work 
RVUs.) We convened a multispecialty panel of physicians to assist us in 
the review of the comments. The comments that we did not submit to 
panel review are discussed at the end of this section, as well as those 
that were reviewed by the panel, which are contained in Table 28, Codes 
Reviewed Under the Refinement Process. We invited representatives from 
the organizations from which we received substantive comments to attend 
a panel for discussion of the code on which they had commented. The 
panel was moderated by our medical staff, and consisted of the 
following voting members:
    <bullet> One or two clinicians representing the commenting 
organization.
    <bullet> One primary care clinician nominated by the American 
Academy of Family Physicians.
    <bullet> Three carrier medical directors.
    <bullet> Two clinicians with practices in related specialties who 
were expected to have knowledge of the service under review.
    The panel discussed the work involved in the procedure under review 
in comparison to the work associated with other services under the PFS. 
We assembled a set of 75 reference services and asked the panel members 
to compare the clinical aspects of the work of the service a commenter 
believed was incorrectly valued to one or more of the reference 
services. In compiling the set, we attempted to include: (1) Services 
that are commonly performed whose work RVUs are not controversial; (2) 
services that span the entire spectrum from the easiest to the most 
difficult; and (3) at least three services performed by each of the 
major specialties so that each specialty would be represented. The 
intent of the panel process was to capture each participant's 
independent judgment based on the discussion and his or her clinical 
experience. Following the discussion, each participant rated the work 
for the procedure. Ratings were individual and confidential, and there 
was no attempt to achieve consensus among the panel members.
    We then analyzed the ratings based on a presumption that the 
interim RVUs were correct. To overcome this presumption, the inaccuracy 
of the interim RVUs had to be apparent to the broad range of physicians 
participating in each panel.
    Ratings of work were analyzed for consistency among the groups 
represented on each panel. In addition, we used statistical tests to 
determine whether there was enough agreement among the groups of the 
panel and whether the agreed-upon RVUs were significantly different 
from the interim RVUs published in Addendum C of the final rule. We did 
not modify the RVUs unless there was a clear indication for a change. 
If there was agreement across groups for change, but the groups did not 
agree on what the new RVUs should be, we eliminated the outlier group 
and looked for agreement among the remaining groups as the basis for 
new RVUs. We used the same methodology in analyzing the ratings that we 
first used in the refinement process for the 1993 PFS. The statistical 
tests were described in detail in the November 25, 1992 final rule (57 
FR 55938). Our decision to convene multispecialty panels of physicians 
and to apply the statistical tests we described was based on our need 
to balance the interests of those who commented on the work RVUs 
against the redistributive effects that would occur in other 
specialties.
    Table 28 lists those interim codes reviewed under the refinement 
panel process described in this section. This table includes the 
following information:
    <bullet> CPT Code. This is the CPT code for a service.
    <bullet> Description. This is an abbreviated version of the 
narrative description of the code.
    <bullet> 2005 Work RVU. The work RVUs that appeared in the CY 2005 
final rule are shown for each reviewed code.
    <bullet> Requested Work RVU. This column identifies the work RVUs 
requested by commenters.
    <bullet> 2006 Work RVU. This column contains the final RVUs for 
physician work.

[[Page 70274]]



                          Table 28.--Codes Reviewed Under the Refinement Panel Process
----------------------------------------------------------------------------------------------------------------
                                                                                         Requested    2006 work
        CPT code*              Mod           Descriptor             2005 work RVU         work RVU       RVU
----------------------------------------------------------------------------------------------------------------
97605....................  ...........  Neg press wound tx,   Bundled.................         0.55         0.55
                                         < 50 cm.
97606....................  ...........  Neg press wound tx,   Bundled.................         0.60         0.60
                                         > 50 cm.
----------------------------------------------------------------------------------------------------------------
* All CPT codes and descriptions copyright 2005 AMA. All rights reserved and applicable FARS/DFARS clauses
  apply.

2. Interim 2005 Codes
    CPT codes 97605 Negative pressure wound therapy (e.g., vacuum 
assisted drainage collection), including topical application(s), wound 
assessment, and instruction(s) for ongoing care, per session; total 
wound(s) surface area less than or equal to 50 square centimeters and 
97606 Negative pressure wound therapy (e.g., vacuum assisted drainage 
collection), including topical application(s), wound assessment, and 
instruction(s) for ongoing care, per session; total wound(s) surface 
area greater than 50 square centimeters.
    The RUC HCPAC review board recommended 0.55 work RVUs for CPT code 
97605 and 0.60 work RVUs for CPT code 97606, which we did not accept. 
We disagreed with their recommendation that these services contained 
physician work and did not assign work RVUs. Further, when the negative 
pressure wound therapy service does not encompass selective 
debridement, we consider the service to represent a dressing change and 
will not make separate payment. When the negative pressure wound 
therapy service includes the need for selective debridement, we 
consider the services represented by CPT codes 97605 and 97606 to be 
bundled into CPT codes 97597 or 97598. We assigned a status indicator 
of ``B'' to CPT code 97605 and 97606, meaning that we would not make 
separate payment for these services.
    Comment: Commenters disagreed with our decision not to accept the 
RUC HCPAC recommended work RVU of 0.55 for CPT code 97605 and 0.60 work 
RVU for CPT code 97606 and with our decision not to make separate 
payment for these services. Based on these comments, we referred these 
codes to the multispecialty validation panel for review.
    Response: As a result of the statistical analysis of the 2005 
multispecialty validation panel ratings, we have assigned 0.55 work 
RVUs to CPT code 97605 and 0.60 work RVUs to CPT code 97606.
    CPT codes 32855 Backbench standard preparation of cadaver donor 
lung allograft prior to transplantation, including dissection of 
allograft from surrounding soft tissues to prepare pulmonary venous/
atrial cuff, pulmonary artery, and bronchus; unilateral; 32856 
Backbench standard preparation of cadaver donor lung allograft prior to 
transplantation, including dissection of allograft from surrounding 
soft tissues to prepare pulmonary venous/atrial cuff, pulmonary artery, 
and bronchus; bilateral; 33933 Backbench standard preparation of 
cadaver donor heart/lung allograft prior to transplantation, including 
dissection of allograft from surrounding soft tissues to prepare aorta, 
superior vena cava, inferior vena cava, and trachea for implantation; 
Backbench standard preparation of cadaver donor heart allograft prior 
to transplantation, including dissection of allograft from surrounding 
soft tissues to prepare aorta, superior vena cava, inferior vena cava, 
pulmonary artery, and left atrium for implantation; 44715 Backbench 
standard preparation of cadaver or living donor intestine allograft 
prior to transplantation, including mobilization and fashioning of the 
superior mesenteric artery and vein; 47143 Backbench standard 
preparation of cadaver donor whole liver graft prior to 
allotransplantation, including cholecystectomy, if necessary, and 
dissection and removal of surrounding soft tissues to prepare the vena 
cava, portal vein, hepatic artery, and common bile duct for 
implantation; without trisegment or lobe split; 47144 Backbench 
standard preparation of cadaver donor whole liver graft prior to 
allotransplantation, including cholecystectomy, if necessary, and 
dissection and removal of surrounding soft tissues to prepare the vena 
cava, portal vein, hepatic artery, and common bile duct for 
implantation; with trisegment split of whole liver graft into two 
partial liver grafts (ie, left lateral segment (segments II and III) 
and right trisegment (segments I and IV through VIII)); 47145 Backbench 
standard preparation of cadaver donor whole liver graft prior to 
allotransplantation, including cholecystectomy, if necessary, and 
dissection and removal of surrounding soft tissues to prepare the vena 
cava, portal vein, hepatic artery, and common bile duct for 
implantation; with lobe split of whole liver graft into two partial 
liver grafts (ie, left lobe (segments II, III, and IV) and right lobe 
(segments I and V through VIII)); 48551 Backbench standard preparation 
of cadaver donor pancreas allograft prior to transplantation, including 
dissection of allograft from surrounding soft tissues, splenectomy, 
duodenotomy, ligation of bile duct, ligation of mesenteric vessels, and 
Y-graft arterial anastomoses from iliac artery to superior mesenteric 
artery and to splenic artery; 50323 Backbench standard preparation of 
cadaver donor renal allograft prior to transplantation, including 
dissection and removal of perinephric fat, diaphragmatic and 
retroperitoneal attachments, excision of adrenal gland, and preparation 
of ureter(s), renal vein(s), and renal artery(s), ligating branches, as 
necessary; and 50325 Backbench standard preparation of living donor 
renal allograft (open or laparoscopic) prior to transplantation, 
including dissection and removal of perinephric fat and preparation of 
ureter(s), renal vein(s), and renal artery(s), ligating branches, as 
necessary. These codes, all of which were approved in 2004 for 
inclusion in the 2005 CPT, were designated by us as carrier-priced.
    Comment: Commenters believed these codes describe services which 
are not payable under the Medicare PFS because they are hospital organ 
acquisition costs reimbursed under Part A of Medicare. The commenters 
requested that we change the designation of the standard backbench 
services from carrier priced to ``excluded by law'', to be consistent 
with deceased donor procurement codes thereby indicating that they are 
not included in the definition of physician services for PFS purposes. 
Commenters also requested that we clarify that these services are 
included in the definition of hospital organ acquisition costs.
    Response: The backbench standard preparation codes describe 
procedures that are performed by physicians to prepare donor organs for 
implantation. The procedure is usually performed at the same hospital 
by the same surgical transplant team where the recipient transplant 
operation occurs, often in the same or adjacent operating room. It is 
usually completed shortly prior to or during the recipient transplant 
operation (especially for the heart and

[[Page 70275]]

lung) although more time is available to complete the transplant 
operations for the liver, kidney, and pancreas. This procedure is a 
necessary component for completion of the recipient transplant 
operation. With the exception of living donors, these services are 
rarely rendered at the hospital where the donor organs are procured. 
Hospital organ acquisition costs primarily consist of charges for 
services rendered by the hospital, Organ Procurement Organization 
(OPO), and the physicians related to retrieving the cadaveric donor 
organs at the ``donor hospital'' location.
    By virtue of its proximate timing and spatial association with the 
recipient transplant operation, this group of backbench standard 
preparation procedures are similar to other transplant surgery 
procedures that are performed by physicians and paid under the Medicare 
PFS. Therefore, we do not see how they would be considered as hospital 
organ acquisition costs (as suggested by the commenter). Since the 
codes for these backbench procedures do not represent deceased donor 
procurement codes, they would not appropriately be designated as 
``excluded by law'' as requested by the commenter. It would be more 
appropriate to pay for these services under the PFS.
    In the specific case of living donors, both the ``donor hospital'' 
and the ``recipient hospital'' are obviously the same, although both 
operations are performed simultaneously by different surgical teams. In 
these cases, the backbench standard preparation procedures may be 
performed by physician members of either the donor team, the recipient 
team, or even a third surgical team.
    It is recognized that on occasion a donor organ will not be used 
for transplant at the facility where the backbench standard preparation 
procedure is performed (often because the intended recipient is found 
to be medically unsuitable after completion of the backbench work). In 
these situations, the donor organ may be sent to a different facility 
for another potential transplant recipient. Even in these situations, 
the physician performing the backbench procedure has no particular 
association with the initial donor procurement operation, the OPO, or 
the ``donor hospital'' site. Therefore, this physician's work is still 
a physician service that should be paid under the Medicare PFS.
    CPT codes 36475 Endovenous ablation therapy of incompetent vein, 
extremity, inclusive of all imaging guidance and monitoring, 
percutaneous, radiofrequency; first vein treated and 36476 Endovenous 
ablation therapy of incompetent vein, extremity, inclusive of all 
imaging guidance and monitoring, percutaneous, radiofrequency; second 
and subsequent veins treated in a single extremity, each through 
separate access sites. We accepted the RUC recommendation of 6.72 work 
RVUs for 36475 and 3.38 work RVUs for 36476.
    Comment: We received a comment expressing concerns that we assigned 
endovenous radiofrequency (RF) ablation procedures (CPT code 36475 and 
36476) the same work RVUs as were assigned to endovenous laser 
procedures (CPT codes 36478 and 36479). The commenter strongly urged us 
to reevaluate the work RVUs for RF ablation procedures. The commenter 
also noted that the vignette developed for the RF procedure was used 
for the laser procedure with one modification--the word radiofrequency 
was changed to ``laser'' and as a result, the vignette for the laser 
procedure was inaccurate, misleading, and created the impression that 
the work for the laser procedure is as intense as the work for the RF 
procedure. The commenter believed the mistaken description likely 
blurred the distinctions between the two procedures in terms of work 
and procedure time. The commenter also believed the flawed survey is 
evidence that the work RVUs for RF procedures were not appropriate and 
should be reexamined.
    Response: We believe the RUC appropriately valued these codes based 
upon the information that was provided to them during the RUC survey 
process and suggest the commenter contact the specialty society to have 
these codes reexamined by the RUC.
    In the CY 2005 final rule (69 FR 66370), we also responded to the 
RUC recommendations on the PE inputs for the new and revised CPT codes 
for 2005. Comments received on the PE inputs were addressed earlier in 
this preamble in the PE proposals for CY 2006 with the exception of 
comments received on CPT codes 36475 and 36476. As noted in the 
previous discussion concerning refinement of interim work RVUs, the 
commenter indicated the vignette was incorrect and therefore we believe 
the concerns about PE should also be handled through the RUC process by 
the specialty society.

D. Establishment of Interim Work Relative Value Units for New and 
Revised Physician's Current Procedural Terminology (CPT) Codes and New 
Healthcare Common Procedure Coding System Codes (HCPCS) for 2006 
(Includes Table titled ``American Medical Association Specialty 
Relative Value Update Committee and Health Care Professionals Advisory 
Committee Recommendations and CMS's Decisions for New and Revised 2006 
CPT Codes'')

    One aspect of establishing RVUs for 2006 was to assign interim work 
RVUs for all new and revised CPT codes. As described in our November 
25, 1992 notice on the 1993 PFS (57 FR 55951) and in section III.B. of 
the November 22, 1996 final rule (61 FR 59505), we established a 
process, based on recommendations received from the AMA's RUC, for 
establishing interim work RVUs for new and revised codes.
    This year we received work RVU recommendations for 175 new and 
revised CPT codes from the RUC. Our staff and medical officers reviewed 
the RUC recommendations by comparing them to our reference set or to 
other comparable services for which work RVUs had previously been 
established. We also considered the relationships among the new and 
revised codes for which we received RUC recommendations and agreed with 
the majority of the relative relationships reflected in the RUC values. 
In some instances, although we agreed with the relationships, we 
nonetheless revised the work RVUs to achieve work neutrality within 
families of codes. That is, the work RVUs were adjusted so that the sum 
of the new or revised work RVUs (weighted by projected frequency of 
use) for a family will be the same as the sum of the current work RVUs 
(weighted by projected frequency of use) for the family of codes. We 
reviewed all the RUC recommendations and accepted approximately 94 
percent of the RUC recommended values. For approximately 6 percent of 
the recommendations, we agreed with the relativity established by the 
RUC, but needed to adjust work RVUs to retain budget neutrality.
    We received 9 recommendations from the Health Care Professional 
Advisory Committee (HCPAC). We agreed with seven of these 
recommendations and disagreed with two of them.
    Table 29, titled ``AMA RUC and HCPAC Recommendations and CMS 
Decisions for New and Revised 2006 CPT Codes,'' lists the new or 
revised CPT codes, and their associated work RVUs, that will be interim 
in 2006. This

[[Page 70276]]

table includes the following information:
    <bullet> A ``<greek-i>'' identifies a new code for 2006.
    <bullet> CPT code. This is the CPT code for a service.
    <bullet> Modifier. A ``26'' in this column indicates that the work 
RVUs are for the professional component of the code.
    <bullet> Description. This is an abbreviated version of the 
narrative description of the code.
    <bullet> RUC recommendations. This column identifies the work RVUs 
recommended by the RUC.
    <bullet> HCPAC recommendations. This column identifies the work 
RVUs recommended by the HCPAC.
    <bullet> CMS decision. This column indicates whether we agreed or 
we disagreed with the RUC recommendation. Codes for which we did not 
accept the RUC recommendation are discussed in greater detail following 
this table. An ``(a)'' indicates that no RUC recommendation was 
provided.
    <bullet> 2006 Work RVUs. This column establishes the interim 2006 
work RVUs for physician work.
BILLING CODE 4120-01-U

[[Page 70277]]

[GRAPHIC] [TIFF OMITTED] TR21NO05.056


[[Page 70278]]


[GRAPHIC] [TIFF OMITTED] TR21NO05.057


[[Page 70279]]


[GRAPHIC] [TIFF OMITTED] TR21NO05.058


[[Page 70280]]


[GRAPHIC] [TIFF OMITTED] TR21NO05.059

BILLING CODE 4120-01-C
    Table 30, which is titled ``AMA RUC ANESTHESIA RECOMMENDATIONS AND 
CMS DECISIONS FOR NEW AND REVISED 2006 CPT CODES'', lists the new or 
revised CPT codes for anesthesia and their base units that will be 
interim in 2006. This table includes the following information:
    <bullet> CPT code. This is the CPT code for a service.
    <bullet> Description. This is an abbreviated version of the 
narrative description of the code.
    <bullet> RUC recommendations. This column identifies the base units 
recommended by the RUC.
    <bullet> CMS decision. This column indicates whether we agreed or 
we disagreed with the RUC recommendation. Codes for which we did not 
accept the RUC recommendation are discussed in greater detail following 
this table.
    <bullet> 2006 Base Units. This column establishes the 2006 base 
units for these services.

[[Page 70281]]



          Table 30.--AMA RUC Anesthesia Recommendations and CMS Decisions for New and Revised CPT Codes
----------------------------------------------------------------------------------------------------------------
                                                           RUC                                       2006 base
         * CPT CODE                Description       recommendation          CMS decision              units
----------------------------------------------------------------------------------------------------------------
<greek-i>01965.............  ANESTH, INC/MISSED AB             4.00  Agree......................            4.00
                              PROC.
<greek-i>01966.............  ANESTH, INDUCED AB                4.00  Agree......................            4.00
                              PROCEDURE.
----------------------------------------------------------------------------------------------------------------
* All CPT codes copyright 2005 AMA.
<greek-i> New CPT code.

E. Discussion of Codes for Which There Were No RUC Recommendations or 
for Which the RUC Recommendations Were Not Accepted

    The following is a summary of our rationale for not accepting 
particular RUC work RVUs, base unit recommendations, or for accepting 
RUC recommendations with an intention to continue to monitor and 
reexamine the code(s) in the near future. It is arranged by type of 
service in CPT order. This summary refers only to work RVUs or Base 
Units.

New and Revised Codes for 2006

    CPT codes 61630 Balloon angioplasty, intracranial (e.g., 
atherosclerotic stenosis), percutaneous; 61635 Transcatheter placement 
of intravascular stent(s), intracranial (e.g., athersosclerotic 
stenosis), including balloon angioplasty if performed; 61640 Balloon 
dilatation of intracranial vasospasm, percutaneous, initial vessel; 
61641 Balloon dilatation of intracranial vasospasm, percutaneous, 
initial vessel; each additional vessel in same vascular family; and 
61642 Balloon dilatation of intracranial vasospasm, percutaneous, 
initial vessel; each additional vessel in different vascular family.--
The RUC recommended 21.08 work RVUs for 61630, 23.08 work RVUs for 
61635, 12.32 work RVUs for 61640, 4.33 work RVUs for 61641 and 8.66 
work RVUs for 61642. We are assigning a status indicator of N for these 
services because they are noncovered under Medicare due to a National 
Coverage Decision.
    CPT codes 76376 3D rendering with interpretation and reporting of 
computed tomography, magnetic resonance imaging, ultrasound or other 
tomographic modality; not requiring image post-processing on an 
independent workstation and 76377 3D rendering with interpretation and 
reporting of computed tomography, magnetic resonance imaging, 
ultrasound or other tomographic modality; requiring image post 
processing on an independent workstation.--The CPT Editorial Panel 
created CPT codes 76376 and 76377 to describe the new technology of 
volumetric acquisition of advanced cross-sectional imaging. The RUC 
recommended 0.20 work RVUs for CPT code 76376 and 0.79 work RVUs for 
CPT code 76377. These services were previously reported using CPT code 
76375 Coronal, sagittal, multiplanar, oblique, 3-dimensional and/or 
holographic reconstruction of computed tomography, magnetic resonance 
imaging, or other tomography modality. --According to the specialty 
society of the services reported for 76375, 80 to 90 percent reflected 
two-dimensional multiplanar reformatting and only 10 to 20 percent 
reflected three-dimensional rendering described in codes 76376 and 
76377. Although we are accepting the utilization crosswalks recommended 
by the specialty society and the work RVUs recommended by the RUC, we 
will continue to evaluate the work and utilization associated with 
these services over the next year and reexamine these codes in the 
future.
    CPT code 88334 Pathology consultation during surgery; cytologic 
examination (e.g., touch prep, squash prep), each additional site.--The 
RUC recommended a work RVU of 0.80 for this service based on a 
comparison of this procedure to CPT code 88332 Pathology consultation 
during surgery; each additional tissue block, with frozen section(s). 
The RUC reviewed the specialty society's survey data and noted that the 
surveyed code 88334, when compared to the reference code 88332 has 
higher intensity/complexity measures and an additional five minutes of 
intra-service time, 20 minutes and 15 minutes, respectively. Although 
88334 has an additional five minutes of intra-service time, we believe 
that 88334 is very similar in work to 88332 and, therefore, should be 
valued the same. We have assigned 0.59 work RVUs to 88334.
    CPT codes 88384 Array-based evaluation of multiple molecular 
probes; 11 through 50 probes, 88385 Array-based evaluation of multiple 
molecular probes; 51 through 250 probes and 88386 Array-based 
evaluation of multiple molecular probes; 251 through 500 probes.--The 
RUC recommended that the base code (88384) be carrier priced and 
recommended 1.50 work RVUs for 88385 and 1.88 work RVUs for 88386. We 
will allow the base code to be carrier priced and are accepting the RUC 
recommended values for 88385 and 88386. We will continue to evaluate 
the work and utilization associated with all of these services over the 
next year and reexamine these codes in the future.
    CPT code 90773 Therapeutic, prophylactic or diagnostic injection 
(specify substance or drug); intra-arterial.--We did not receive a 
final RUC recommendation for this code. This code replaces CPT code 
90783 Therapeutic, prophylactic or diagnostic injection (specify 
material injected); intra-arterial, which has been deleted and was 
assigned 0.17 work RVUs. On an interim basis, we have assigned 0.17 
work RVUs to 90773 since it replaces 90783.
    CPT code 92630 Auditory rehabilitation, pre-lingual hearing loss 
and 92633 Auditory rehabilitation, post-lingual hearing loss.--CPT 
codes 92630 and 92633 represent speech language pathology and audiology 
services. These CPT codes describe rehabilitative or therapeutic 
services. When speech-language pathologists (SLPs) provide these 
services, they may bill for them by using CPT code 92507 Treatment of 
speech, language, voice, communication, and/or auditory processing 
disorder; individual, as appropriate. According to the Medicare 
statute, section 1861(ll)(2) of the Act, audiologists are recognized 
for purposes of providing diagnostic testing services to Medicare 
beneficiaries. Therefore, we will not recognize CPT codes 92630 and 
92633 under Medicare and have assigned a status indicator of I because 
these services represent therapeutic services rather than diagnostic 
tests.
    CPT code 95251 Ambulatory continuous glucose monitoring of 
interstitial tissue fluid via a subcutaneous sensor for up to 72 hours; 
physician interpretation and report.--The RUC recommended a work RVU of 
0.85 for this service. We disagree with the RUC's recommendation 
because we believe the work for this service is similar to CPT code 
93268 Patient demand single or multiple event recording with presymptom 
memory loop, 24-hour attended monitoring, per 30 day period of time; 
includes

[[Page 70282]]

transmission, physician review and interpretation, which involves the 
review of data over a 30 day period. Therefore, we have assigned 0.52 
work RVUs to 95251.
    CPT codes 95873 Electrical stimulation for guidance in conjunction 
with chemodenervation (List separately in addition to code for primary 
procedure) and 95874 (Needle electromyography for guidance in 
conjunction with chemodenervation (List separately in addition to code 
for primary procedure).--The RUC recommended a work RVU of 0.56 for CPT 
codes 95873 and 95874. The RUC examined reference code 95860 (Needle 
electromyography; one extremity with or without related paraspinal 
areas) and determined that the intensity for the new procedures and the 
reference procedure were the same so a proper value for both new codes 
should be based on the ratio of time with the reference code. We 
believe that the work involved with 95873 and 95874 is very similar to 
95870 and therefore should be valued the same. We have assigned 0.37 
work RVUs to CPT codes 95873 and 95874.
    CPT codes 96116 Neurobehavioral status exam (clinical assessment of 
thinking, reasoning and judgment, e.g., acquired knowledge, attention, 
language, memory, planning and problem solving, and visual spatial 
abilities); per hour of the psychologist's or physician's time, both 
face-to-face time with the patient and time preparing the report and 
96118 Neuropsychological testing (e.g., Halstead-Reitan 
Neuropsychological Battery, Wechsler Memory Scales and Wisconsin Card 
Sorting Test); per hour of the psychologist's or physician's time, both 
face-to-face time with the patient and time preparing the report.--The 
HCPAC recommended 2.05 work RVUs for CPT codes 96116 and 96118. We 
disagree with the HCPAC's recommendation and believe the physician work 
associated with these services is similar to 96101, as reflected by the 
technical skill, judgment and complexity of these services. Therefore, 
we have assigned 1.86 work RVUs to 96116 and 96118.
    CPT codes 98960 Education and training for patient self-management 
by a qualified, nonphysician health care professional using a 
standardized curriculum, face-to-face with the patient (could include 
caregiver/family) each 30 minutes; individual patient; 98961 Education 
and training for patient self-management by a qualified, nonphysician 
health care professional using a standardized curriculum, face-to-face 
with the patient (could include caregiver/family) each 30 minutes; 2-4 
patients; and 98962 Education and training for patient self-management 
by a qualified, nonphysician health care professional using a 
standardized curriculum, face-to-face with the patient (could include 
caregiver/family) each 30 minutes; 5-8 patients.--We are assigning a 
status indicator of N for these services because they are noncovered 
under Medicare.
    CPT codes 99143 Moderate sedation services (other than those 
services described by codes 00100-01999) provided by the same physician 
performing the diagnostic or therapeutic service that the sedation 
supports, requiring the presence of an independent trained observer to 
assist in the monitoring of the patient's level of consciousness and 
physiological status, under 5 years of age; first 30 minutes intra-
service time, 99144 Moderate sedation services (other than those 
services described by codes 00100-01999) provided by the same physician 
performing the diagnostic or therapeutic service that the sedation 
supports, requiring the presence of an independent trained observer to 
assist in the monitoring of the patient's level of consciousness and 
physiological status, age 5 years or older; first 30 minutes intra-
service time, 99145 Moderate sedation services (other than those 
services described by codes 00100-01999) provided by the same physician 
performing the diagnostic or therapeutic service that the sedation 
supports, requiring the presence of an independent trained observer to 
assist in the monitoring of the patient's level of consciousness and 
physiological status, age 5 years or older; each additional 15 minutes 
intra-service time, 99148 Moderate sedation services (other than those 
services described by codes 00100-01999) provided by a physician other 
than the health care professional performing the diagnostic or 
therapeutic service that the sedation supports, under 5 years of age; 
first 30 minutes intra-service time, 99149 Moderate sedation services 
(other than those services described by codes 00100-01999) provided by 
a physician other than the health care professional performing the 
diagnostic or therapeutic service that the sedation supports, age 5 
years or older; first 30 minutes intra-service time, 99150 Moderate 
sedation services (other than those services described by codes 00100-
01999) provided by a physician other than the health care professional 
performing the diagnostic or therapeutic service that the sedation 
supports, each additional 15 minutes intra-service time.--The CPT 
Editorial Panel created six new codes to accurately report 2 separate 
families of moderate sedation. One family describes the provision of 
moderate sedation services by the physician who is performing the 
diagnostic or therapeutic service and supervising an independent 
trained observer while the other family describes moderate sedation 
services performed by a physician (other than an anesthesiologist) 
other than the physician performing a diagnostic or therapeutic 
service. These new codes replace CPT codes 99141 Sedation with or 
without analgesia (conscious sedation); intravenous, intra-muscular or 
inhalation and 99142 Sedation with or without analgesia (conscious 
sedation); oral, rectal and/or intranasal, which were bundled under the 
PFS. The RUC recommended 0.70 work RVUs for 99143, 0.66 work RVUs for 
99144, 0.23 work RVUs for 99145, 1.75 work RVUs for 99148, 1.65 work 
RVUs for 99149 and 0.47 work RVUs for 99150. We are uncertain whether 
the RUC assigned values are appropriate and have carrier priced these 
codes in order to gather information for utilization and proper 
pricing.
    F. Establishment of Interim PE RVUs for New and Revised Physician's 
Current Procedural Terminology (CPT) Codes and New Healthcare Common 
Procedure Coding System (HCPCS) Codes for 2006.
    We have developed a process for establishing interim PE RVUs for 
new and revised codes that is similar to that used for work RVUs. Under 
this process, the RUC recommends the PE direct inputs (the staff time, 
supplies and equipment) associated with each new code. We then review 
the recommendations in a manner similar to our evaluation of the 
recommended work RVUs. The RUC recommendations on the PE inputs for the 
new and revised 2006 codes were submitted to us as interim 
recommendations.
    We have accepted, in the interim, the PE recommendations submitted 
by the RUC for the codes listed in the table titled ``AMA RUC and HCPAC 
RVU Recommendations and CMS Decisions for New and Revised 2006 CPT 
Codes.''
    CPT code 28890 Extracorporeal shock wave, high energy, performed by 
a physician, requiring anesthesia other than local, including 
ultrasound guidance, involving the plantar fascia.--We accepted the 
work RVUs for CPT 28890. However, we disagree with the RUC's 
recommendation to value this procedure only in the facility setting. We 
believe that this procedure is being performed in the nonfacility 
setting and are assigning the following PE inputs based on information 
that the RUC

[[Page 70283]]

provided for informational purposes: (a) Total clinical labor time of 
133 minutes consisting of 16 minutes for pre-service, 36 minutes for 
the service period, and 81 minutes for the post-service period; (b) 
supplies consist of 4 multispecialty supply packages (1 each for the 
procedure and each of the 3 post visits), 1 fenestrated drape, 3 18-24 
gauge needles, 1 10cc syringe, 5cc of lidocaine 1 percent, 5cc of 
marcaine 0.5 percent, and 2 alcohol swabs; and (c) equipment includes 
ESW machine used for the procedure for 36 minutes and a power table and 
an exam lamp each for 117 minutes (includes the 36 minute procedure and 
81 minutes for the post visits).
    CPT 89049 Caffeine halothane contracture test (CHCT) for malignant 
hyperthermia susceptibility, including interpretation and report.--
While we accepted the work RVUs for this procedure, we disagreed with a 
PE recommendation regarding 30 minutes clinical labor--provided by a 
staff blend comprised of a combination laboratory technician and 
histotechnologist--that was requested to prepare the registry report. 
Because we do not pay for the clinical labor necessary to prepare 
registry reports in any other procedure codes, we have deleted the 30 
minutes report preparation time from the total service period time in 
the practice labor expense database. The net result for the clinical 
labor service period is 274 minutes for CPT 89049.

IV. Five-Year Refinement of RVUs--Status Update

    In the CY 2005 final rule (69 FR 66236), we solicited comments on 
the work RVUs that may be inappropriately valued. Since we recognized 
that this process generally elicits comments focusing on undervalued 
codes, we also indicated that we would identify codes (especially high-
volume codes across specialties) that:
    <bullet> Are valued as being performed in the inpatient setting, 
but that are now predominantly performed on an outpatient basis; and
    <bullet> Were not reviewed by the RUC, (that is, Harvard RVUs are 
still being used, or there is no information).
    We received comments on potentially misvalued services from 
approximately 35 specialty organizations and individuals involving over 
500 codes. We shared these comments with the RUC and also identified 
approximately 160 additional codes for review. As explained in the CY 
2005 final rule (69 FR 66236), we proposed to utilize a process similar 
to that established for the assignment of RVUs for new and revised CPT 
codes where the RUC makes recommendations on work RVUs for services. 
This process was used during the last 5-year review, and we believe 
that it was beneficial. The RUC's perspective is helpful because of its 
experience in recommending RVUs for new and revised CPT codes since we 
implemented the PFS. Furthermore, the RUC, by virtue of its 
multispecialty membership and consultation with approximately 65 
specialty societies, involves the medical community in the refinement 
process.
    We will consider all comments on all work RVUs in the development 
of a proposed rule that we will publish 2006. In that rule, we will 
propose the revisions to work RVUs that we believe are needed. We will 
then review and analyze the comments received in response to our 
proposed revisions and publish our decisions in the final rule for CY 
2007.

V. Physician Self-Referral Prohibition: Nuclear Medicine and Annual 
Update to the List of CPT/HCPCS Codes

A. General

    Section 1877 of the Act prohibits a physician from referring a 
Medicare beneficiary for certain designated health services (DHS) to a 
health care entity with which the physician (or a member of the 
physician's immediate family) has a financial relationship, unless an 
exception applies. Section 1877 of the Act also prohibits the DHS 
entity from submitting claims to Medicare or billing the beneficiary or 
any other entity for Medicare DHS that are furnished as a result of a 
prohibited referral.
    As specified in our regulations at Sec.  411.351, the following 
services are DHS:
    <bullet> Clinical laboratory services.
    <bullet> Physical therapy, occupational therapy, and speech-
language pathology services.
    <bullet> Radiology and certain other imaging services.
    <bullet> Radiation therapy services and supplies.
    <bullet> Durable medical equipment and supplies.
    <bullet> Parenteral and enteral nutrients, equipment, and supplies.
    <bullet> Prosthetics, orthotics, and prosthetic devices and 
supplies.
    <bullet> Home health services.
    <bullet> Outpatient prescription drugs.
    <bullet> Inpatient and outpatient hospital services.

B. Nuclear Medicine

    In the August 8, 2005 rule, we proposed to include diagnostic and 
therapeutic nuclear medicine procedures under the DHS categories for 
radiology and certain other imaging services and radiation therapy 
services and supplies, respectively. The DHS categories of radiology 
and certain other imaging services and radiation therapy services and 
supplies are defined by a list of CPT and HCPCS codes that is updated 
annually and posted on our web site. In the August 8, 2005 proposed 
rule (70 FR 45764), we stated that we would revise the list of CPT and 
HCPCS codes (List of CPT/HCPCS Codes) that identifies the items and 
services that are included in each of these DHS categories. Addendum G 
of the proposed rule set forth a list of codes for all diagnostic 
nuclear medicine procedures, all therapeutic nuclear medicine 
procedures, and the radiopharmaceuticals used in diagnostic and 
therapeutic nuclear medicine procedures. Additionally, we stated our 
intention to include diagnostic nuclear medicine services on the 
revised List of CPT/HCPCS Codes under ``Radiology and Certain Other 
Imaging Services'' and to include therapeutic nuclear medicine services 
on the revised List of CPT/HCPCS Codes under ``Radiation Therapy 
Services and Supplies''. We stated that some radiopharmaceuticals may 
be included in both categories.
    We requested comments concerning whether the list was accurate and 
complete. In addition, we requested comments as to whether, or how, to 
minimize the impact on physicians who are currently parties to 
arrangements that involve nuclear medicine services and supplies (that 
is, by specifying a delayed effective date or by grandfathering certain 
arrangements).
1. Response to Comments
    We received many comments in response to our proposal to add 
diagnostic and therapeutic nuclear medicine services and supplies to 
the list of designated health services subject to the physician self-
referral prohibition. Comments were submitted by or on behalf of 
numerous specialty societies, individual physicians, physician group 
practices, manufacturers, hospitals, the AMA and other trade 
associations, diagnostic imaging centers, and the Medicare Payment 
Advisory Commission (MedPAC). We received a few general comments, but 
the vast majority of comments centered on five specific issues. We 
address the comments in the following order:
    <bullet> General Comments.
    <bullet> Authority to Include Nuclear Medicine Services and 
Supplies as Designated Health Services.
    <bullet> Overutilization or Abuse.
    <bullet> Beneficiary Access to Care.

[[Page 70284]]

    <bullet> Quality of Care.
    <bullet> Grandfathering Existing Arrangements or Delaying the 
Effective Date.
a. General Comments
    Comment: One commenter questioned how our proposal would affect a 
physician's ability to refer patients to a positron emission tomography 
(PET) center that purchases radiopharmaceuticals (which are DHS under 
our proposal) from a company with which the referring physician has a 
financial relationship.
    Response: The effect of this final rule with comment on a physician 
who has a financial relationship with a company that produces and 
supplies radiopharmaceuticals for PET scanning will depend on the 
nature of the physician's financial relationship with the supplying 
company and the supplying company's financial relationship with the PET 
center to which the physician wishes to refer. Depending on the facts, 
the arrangement described by the commenter could constitute an indirect 
compensation arrangement (as defined in Sec.  411.354(c)(2). If an 
indirect compensation arrangement exists between the referring 
physician and the PET center, the physician may not refer to the PET 
center unless the arrangement complies with the indirect compensation 
arrangement exception at Sec.  411.357(p).
    Comment: One commenter expressed concern about our proposal and 
requested that we maintain the ability of radiation oncologists to 
order, perform and use as needed, diagnostic and therapeutic nuclear 
medicine services for radiation treatment planning and treatment 
delivery.
    Response: We do not believe this final rule with comment will 
prohibit a radiation oncologist from ordering or performing diagnostic 
and therapeutic nuclear medicine services for purposes of radiation 
treatment planning and delivery. A ``referral'' does not include the 
request by a radiation oncologist for radiation therapy, including 
therapeutic nuclear medicine, if the request results from a 
consultation initiated by another physician and the services are 
furnished by or under the supervision of the radiation oncologist, or 
under the supervision of another radiation oncologist in the same group 
practice. In the March 26, 2004 final rule (69 FR 16065), we stated 
that the radiation oncologist exception in the definition of 
``referral'' would also protect ``necessary and integral ancillary 
services requested, and appropriately supervised, by the radiation 
oncologist.'' We believe that diagnostic nuclear medicine procedures 
that are necessary and integral to the provision of radiation therapy 
fall within the scope of this protection. Accordingly, we are modifying 
the definition of ``Referral'' in Sec.  411.351.
    Comment: Two commenters suggested that the in-office ancillary 
services exception be modified or amended to prevent referring 
physicians from circumventing the physician self-referral law and its 
provisions.
    Response: We understand the commenter's viewpoint, but the 
commenter's request goes beyond the scope of this rulemaking. We 
believe the in-office ancillary services exception strikes an 
appropriate balance between preventing program abuse without unduly 
interfering with the practice of medicine. However, we will continue to 
monitor the potential for abuse with respect to existing exceptions.
    Comment: One commenter requested that we create a new exception for 
a physician's investment or ownership in a health care entity which 
provides nuclear medicine services and supplies, if the physician who 
refers patients to these entities directly supervises (on-site) the 
technicians or other personnel performing the nuclear medicine 
procedures on patients referred by that physician.
    Response: Under section 1877(b)(4) of the Act, we may create a 
regulatory exception only if we determine that the exception would pose 
no risk of program or patient abuse. The commenter seems to believe 
that the potential for program and patient abuse would be eliminated by 
having an owner physician on-site when a technician performs a nuclear 
medicine procedure that the physician has ordered. We do not see how 
this requirement would eliminate the risk of overutilization or other 
program or patient abuse that arises when a physician self-refers to an 
entity with which he or she has a financial relationship.
b. Authority To Include Nuclear Medicine Services and Supplies as a 
Designated Health Services (DHS)
    The physician self-referral statute, at section 1877(h)(6) of the 
Act, includes within the list of DHS, ``radiology services, including 
magnetic resonance imaging, computerized axial tomography, and 
ultrasound services,'' and ``radiation therapy services and supplies.'' 
We proposed to include diagnostic and therapeutic nuclear medicine as 
DHS because we believe they are within the statute's meaning of 
radiology services and radiation therapy services and supplies. We did 
not receive any comments disputing the assertion that therapeutic 
nuclear medicine services are radiation therapy services and supplies. 
However, regarding diagnostic nuclear medicine services, we received 
some comments that disagreed with our interpretation of the statute as 
well as some that agreed with our interpretation.
    Comment: Three commenters noted that we proposed to include 
diagnostic nuclear medicine procedures within our definition of 
``radiology and certain other imaging services'' in Sec.  405.351. 
These commenters stated that ``other imaging services'' does not appear 
in the statute, and they asserted that the Congress rejected virtually 
identical (in their view) statutory phrasing. The commenters noted that 
when the Congress initially included radiology as a DHS in the Omnibus 
Budget Reconciliation Act of 1993, the language read ``radiology and 
other diagnostic services'' and that the Congress amended the statute 
in the Social Security Amendments of 1994 to delete the phrase ``and 
other diagnostic services.'' The commenters also asserted that if the 
Congress had meant to include nuclear medicine within the DHS category 
of radiology, it would have specifically mentioned diagnostic nuclear 
medicine, as it did magnetic resonance imaging (MRIs), computerized 
axial tomography (CT scans), and ultrasound services.
    Response: We are including diagnostic nuclear imaging services in 
our definition of ``radiology and certain other imaging services'' 
because we believe they are radiology services within the meaning of 
section 1877(h)(6)(D) of the Act. We disagree with the commenter's 
assertion that we lack statutory authority to include certain imaging 
services in the DHS category described at section 1877(h)(6)(D) of the 
Act. We believe that the Congress meant to include all forms of 
radiology, that is, those that have traditionally been considered to be 
radiology, as well as certain other imaging services, such as 
ultrasound that may or may or not be considered to be radiology in the 
traditional sense. Further, we believe the Congress meant to include 
all forms of radiology, regardless of whether the particular form 
existed or was covered by Medicare on the date the statutory language 
was enacted or became effective. We believe that, by describing the DHS 
category as ``[r]adiology services, including [MRI, CAT scans], and 
ultrasound services,'' the Congress merely provided examples (rather 
than an exhaustive list) of some of the most

[[Page 70285]]

common forms of radiology other than x-rays.
    Comment: Three commenters stated that nuclear medicine should not 
be considered a DHS because it is clinically and technically distinct 
from the services that the Congress enumerated when it defined the 
scope of radiology services. The commenters noted that the American 
Board of Nuclear Medicine defines nuclear medicine as ``the medical 
specialty that employs radionuclides to evaluate metabolic, physiologic 
and pathologic conditions of the body for purposes of diagnosis, 
therapy and research.'' According to the commenters, the introduction 
of radiolabeled, biologically active compounds into patients 
distinguishes nuclear medicine from radiology, which may involve the 
administration of biologically inert contrast agents, such as barium 
sulfate, iodine or gadolinium. One of these commenters stated that the 
mere use of radioactive material does not render a service radiology 
because radioactive materials are used in non-radiology services such 
as the performance of radioimmunoassay and irradiation of blood 
products.
    Response: We are not persuaded that the common definitions of 
``radiology'' cited in our proposed rule (70 FR 45854-55) are incorrect 
or do not include diagnostic nuclear imaging. As we stated in the 
proposed rule (70 FR 45855-56), radiology is ``that branch of the 
health sciences dealing with radioactive substances and radiant energy 
and with the diagnosis and treatment of disease by means of both 
ionizing (that is, x-rays) and non-ionizing (that is, ultrasound) 
radiations.'' (quoting Dorland's Illustrated Medical Dictionary). We 
noted in the proposed rule (70 FR 45855-56) that, ``[i]n more recent 
years, radiology has come also to embrace diagnosis by a method of 
organ scanning with the use of radioactive isotopes and non-ionizing 
radiation, such as ultrasound and nuclear magnetic resonance.'' 
(quoting Encyclopaedia Britannica outline). Diagnostic nuclear medicine 
services involve the use of radioactive substances and ionizing 
radiation for purposes of diagnosis. Like the other services the 
Congress identified in describing ``radiology services,'' the final 
product is an image used for purposes of diagnosis. We believe that the 
Congress intended to include as ``radiology services'' all forms of 
radiological imaging, regardless of whether exposure to radioactive 
materials or radiation is achieved through ingestion or eternal 
application and regardless of whether the form of radiation is ionizing 
or non-ionizing. We also note that certain professional medical 
organizations such as the AMA and the ACR consider diagnostic nuclear 
imaging to be a subspecialty of radiology.
    We agree that the use of radioactive substances to perform a 
particular service does not, by itself, render that service 
``radiology'' within the meaning of section 1877(h)(6)(D). We are not 
including as ``radiology and certain other imaging services'' any 
diagnostic nuclear medicine services that are not imaging services. We 
note that radioimmunoassay is a clinical laboratory service for 
purposes of section 1877, and irradiation of blood products is not a 
DHS.
    Comment: We received several comments addressing whether nuclear 
medicine is a subspecialty of radiology. MedPAC stated that it strongly 
supports the proposal to include nuclear medicine services in the 
definition of ``radiology and certain other imaging services.'' MedPAC 
further stated its belief that the proposal is justified because 
physician groups such as the ACR and the AMA consider nuclear medicine 
to be a subspecialty of radiology. (We note that although the AMA 
objected to our proposal on the grounds that overutilization has not 
been shown for nuclear medicine services, the AMA did not assert that 
diagnostic nuclear medicine is not a subspecialty of radiology.) 
Another commenter stated that it is reasonable to include nuclear 
medicine as a DHS, but took exception to our statement in the proposed 
rule that diagnostic nuclear medicine is a subset of radiology. This 
commenter stated that the Nuclear Regulatory Commission (NRC) 
recognizes multiple alternative pathways to becoming a medical 
authorized user of isotopes in addition to certification from the 
American Board of Radiology. The commenter also noted that many 
different subspecialties, in addition to radiology, are recognized 
stakeholders with voting rights at the NRC Advisory Committee on the 
Medical Use of Isotopes. Two other commenters stated that according to 
the American Board of Medical Specialties, nuclear medicine and 
radiology are separate medical specialties, and that each is one of 
only 26 distinct medical disciplines subject to Primary Board 
Certification. These commenters stated that, although it is true that 
some nuclear medicine training is incorporated into the diagnostic 
radiology training program, and that the American Board of Radiology 
does include questions on nuclear medicine in its certification 
examination, physicians become eligible to take the American Board of 
Nuclear Medicine examination only after successfully completing a 
nuclear medicine residency program. Finally, one commenter objected to 
the proposal to include nuclear medicine as a DHS insofar as the 
proposal relates to the subspecialty of nuclear cardiology. According 
to this commenter, nuclear cardiology is the science of performing 
cardiac stress testing with the interpretation of nuclear images for 
purposes of determining a patient's diagnosis and prognosis; therefore, 
nuclear cardiology is not simply the interpretation of images, which 
the commenter stated is the case in nuclear medicine. The commenter 
asserted that the great majority of physicians certified by the 
Certification Board of Nuclear Cardiology are cardiologists rather than 
radiologists.
    Response: We recognize that there is some difference of opinion, 
including among competing certification organizations, as to whether 
nuclear medicine is a subspecialty of radiology or whether it: (1) Is a 
subspecialty of both radiology and some other area of medicine; or (2) 
has achieved some type of independent status. However, even if nuclear 
medicine has achieved some type of independent status, it, 
nevertheless, is a form of radiology (as that term is commonly defined) 
and that therapeutic nuclear medicine is a form of radiation therapy. 
Likewise, the fact that cardiologists have found nuclear imaging to be 
particularly useful for evaluating heart disease and have developed a 
subspecialty in nuclear cardiology does not alter the essential fact 
that nuclear imaging employs radioactive material and is a form of 
radiology.
    Comment: One commenter stated that our January 4, 2001 final rule 
clearly and permanently established the principle that nuclear medicine 
services are not radiology services. The commenter believes that the 
January 2001 rule fairly interpreted the law and that it is 
inappropriate to change the regulation in the absence of specific 
direction from the Congress in the form of a statutory change.
    Response: We disagree with the commenter's belief that our 
regulations remain fixed for all time absent a change in the statute. 
As stated in the August 8, 2005 proposed rule, we believe that a better 
reading of the statute is that the radiology and radiation therapy DHS 
categories, as set forth in section 1877(h)(6) of the Act, encompass 
diagnostic and therapeutic nuclear medicine services, respectively. 
Therefore, we believe it is appropriate to

[[Page 70286]]

amend our regulations to include diagnostic and therapeutic nuclear 
medicine services within the respective DHS categories of radiology 
services and radiation therapy services and supplies.
c. Overutilization or Abuse
    In the August 8, 2005 proposed rule, we cited several studies that 
suggest that a physician's referral patterns and utilization of nuclear 
medicine services and supplies closely correlate to whether the 
physician has a financial interest in the entity providing the services 
and supplies. We received several comments representing divergent views 
as to whether nuclear medicine services and supplies are at risk for 
abuse and overutilization when physicians have financial interests in 
the entities that provide the services and supplies.
    Comment: One commenter supported our proposal to include nuclear 
medicine as a DHS and believed that there has been significant 
overutilization and abuse of this imaging modality in his State. The 
commenter believes that the problems have become more acute with the 
proliferation of PET and PET/CT imaging centers set up as joint 
ventures between select groups of referring physicians and venture 
capitalists in the State and requested that we prohibit these types of 
ventures.
    Response: We welcome the commenter's observations regarding the 
impact on the utilization of PET and PET/CT imaging when physicians 
enter into arrangements with non-physician investors to own these 
imaging centers. Inclusion of nuclear medicine services and supplies as 
DHS likely will have an impact on these ventures (and potentially the 
utilization of PET and PET/CT imaging). However, whether or not PET 
joint ventures are abusive is not a determinative factor in our 
decision to include diagnostic and therapeutic nuclear medicine as DHS. 
Rather, our decision is based on our belief that these services and 
supplies properly are categorized as ``radiology and certain other 
imaging services'' and ``radiation therapy services and supplies'' 
within the meaning of the statute.
    Comment: One commenter provided a summary of the findings from its 
own clinical and financial database regarding the incidence of 
physician self-referral for nuclear medicine services. The commenter 
asserted that the data show that self-referring providers are much more 
likely to order these types of services than those who do not self-
refer.
    Response: We appreciate the commenter's willingness to share its 
data regarding the incidence of physician self-referral for one 
specific type of nuclear imaging service (nuclear cardiology). The 
commenter's findings are consistent with the information we already 
have, including the studies cited in the August 8, 2005 proposed rule, 
that nuclear medicine services and supplies pose the same risk of abuse 
that the Congress intended to eliminate for other types of radiology, 
imaging and radiation therapy services and supplies.
    Comment: Two commenters supported the expansion of the physician 
self-referral provisions to include nuclear medicine services and 
supplies. One of the commenters stated his or her belief that the 
proliferation of imaging units in non-hospital environments has 
contributed significantly to the increase in diagnostic imaging costs. 
This commenter urged that, although the advancement of PET technology 
has proven to be a clinically effective diagnostic imaging tool, the 
physician self-referral law should have equal extension and universal 
application to all imaging providers. The other commenter stated that 
recent studies of the effects of physician self-referral have shown 
that, when physicians have an investment interest in imaging equipment 
and have the opportunity to self-refer, their utilization is 
significantly higher than among physicians who refer their patients to 
a provider in which the referring physician has no financial interest. 
This commenter added that nuclear medicine services and supplies should 
have been included in the original listing, because the potential for 
abuse is no different than for CT scans or MRI scans. Both this 
commenter and MedPAC contend that our policy change will help limit 
referrals for nuclear medicine services that are based on financial, 
rather than clinical, reasons.
    Response: We believe that the position advocated by these 
commenters is consistent with the studies we cited in the August 8, 
2005 proposed rule. As we stated in the proposed rule, although we 
believe that diagnostic and therapeutic nuclear medicine services are 
radiology and radiation therapy services and supplies within the 
meaning of the statute, we would resolve any doubt as to this matter in 
favor of including them as DHS. After careful review of the information 
available to us currently, we believe it is appropriate to include 
diagnostic and therapeutic nuclear medicine services and supplies as 
DHS.
    Comment: One commenter asserted that the risk of anti-competitive 
behavior would increase by limiting the parties that may provide 
nuclear medicine services, which is contrary to our rationale of 
protecting against abuse and ensuring quality patient care. In 
contrast, MedPAC referred to the 1994 GAO report (GAO/HEHS-95-2) and 
supported the inclusion of nuclear medicine as DHS. MedPAC contended 
that physician self-referral to nuclear medicine facilities undermines 
fair competition among these facilities because physician investors 
have a financial incentive to refer patients to the facility they own.
    Response: We agree with MedPAC regarding potential anti-competitive 
behavior. Moreover, we do not agree with the other commenter's 
assertion that the inclusion of nuclear medicine services and supplies 
as DHS would limit the types of entities that may provide nuclear 
medicine services. Rather, the inclusion of these services and supplies 
as DHS merely limits the type of investors in the entities providing 
nuclear medicine services and supplies (that is, except for investors 
in either rural providers (as defined at Sec.  411.356(c)(1) or 
entities that furnish the services in compliance with the in-office 
ancillary services exception, our proposal would limit physician 
investors to those who will not refer patients to the entity).
    Comment: Several commenters asserted (but did not provide data or 
other proof) that nuclear medicine services are not at risk for the 
kind of overutilization that the physician self-referral law is 
designed to prevent. Other commenters disagreed with the proposal to 
include nuclear medicine services and supplies (and, in particular, 
nuclear cardiology) as DHS. The commenters stated that it is not 
possible to know if the rise in utilization of nuclear medicine 
services is due to abuse and believed that we must show evidence that 
these services are currently being abused before including nuclear 
medicine services and supplies as DHS.
    Response: In the August 8, 2005 proposed rule, we referenced 
several studies concerning overutilization and increases in imaging 
services being performed in physician offices. We received comments, 
both data-driven and anecdotal, to support our belief that nuclear 
medicine services are subject to overutilization when physician self-
interest is present, as is the case in many (but not all) office-based 
(or non-hospital) imaging procedures. We must emphasize, however, that 
our decision to include nuclear medicine as a DHS is based upon our 
current knowledge of nuclear medicine. We believe it is appropriate to 
interpret the DHS

[[Page 70287]]

categories described in section 1877(h)(6)(D) and (E) of the Act to 
include diagnostic nuclear medicine services and supplies and 
therapeutic nuclear medicine services and supplies, respectively.
    Although we are conscious of a possible correlation between 
increased utilization and a showing of abuse, in the January 4, 2001 
final rule with comment (66 FR 860), we stated that we did not believe 
the Congress intended us to review every possible service within a DHS 
category to determine its potential for overutilization. The Congress 
has already made the determination that the services in each of the 
eleven DHS categories are potentially subject to overutilization or 
other abuse. The risk of abuse and the potential for anti-competitive 
behavior inherent in physician self-referrals for nuclear medicine 
services simply provide additional support in favor of including 
nuclear medicine as DHS.
    Comment: One commenter claimed that the increase in utilization of 
nuclear imaging services and supplies is due, at least in part, to the 
shift in site of service from the hospital setting to the physician 
office as well as a change in the standard of care in the treatment of 
patients due to improved technology and its applications. The commenter 
asserted that physician self-referral does not appear to be the primary 
driver of growth in imaging services, citing a study that shows that 
access to imaging technology, even in the absence of financial 
incentives, will result in increased utilization. The commenter 
contended that ``eliminating the ability of specialty physicians to 
perform and interpret imaging tests in their offices is not protection 
against the growth in utilization.''
    Response: We are aware of the apparent shift in the site of 
service. However, we do not believe that the change in site of service 
accounts for all, or even most, of the increase in Medicare payments 
for nuclear medicine services. In fact, in its March 2005 ``Report to 
the Congress: Medicare Payment Policy'', MedPAC indicated that about 80 
percent of the increase in the volume and intensity of imaging 
services, including nuclear medicine, between 1999 and 2002, was 
unrelated to any shift in service setting. We disagree with the 
commenter that inclusion of nuclear medicine services and supplies as 
DHS necessarily will prohibit physicians from performing and 
interpreting imaging tests in their offices. Certain arrangements and 
referrals may qualify for protection under existing provisions of the 
physician self-referral law and regulations (for example, the in-office 
ancillary services exception). In addition, even if we assume the 
commenter's sources are correct and utilization will increase with 
access to technology regardless of financial incentives for the 
referring physician, this does not affect the definition of radiology 
and radiation therapy, nor does it affect the proper inclusion of 
nuclear medicine services and supplies in these categories of DHS. We 
also note that, even if not the main ``driver'' of overutilization, 
self-interested referrals that cause any overutilization are 
problematic.
d. Beneficiary Access
    We received numerous comments regarding the impact of our provision 
on beneficiary access to care. Our responses to these comments follow.
    Comment: Several commenters expressed concern that our proposal 
would limit beneficiary access to nuclear medicine services. The AMA 
expressed concern about the potential impact of our proposal with 
regard to disruption of patient care, as well as access to these 
services. One of the commenters believes that our proposal will have a 
negative impact on the availability of PET scans, which constitute an 
important share of Medicare-covered nuclear imaging. In addition, 
another commenter raised concerns about where physicians would send 
patients for PET/CT scans.
    Response: We recognize that the inclusion of nuclear medicine as a 
DHS may cause some changes in physician ownership of, or investment 
interests in PET centers; however, we do not agree with the commenters' 
assertions that our proposal would disrupt patient care and limit 
access to nuclear medicine services such as PET scans. We believe that 
most patients will continue to receive nuclear medicine services in the 
same location or vicinity where those services had been provided 
before. We see no reason why other providers or entities in the 
vicinity of existing PET centers would not be available or become 
available to furnish these services should a physician choose to divest 
any ownership or investment interest in an entity that furnishes 
nuclear medicine services. Alternatively, by restructuring their 
arrangements to comply with an existing exception, physicians may be 
able to continue referring patients to the same location for nuclear 
medicine services. In other words, whereas this rule may affect a 
physician's ability to refer to a PET center with which he or she has a 
financial relationship, there should be either alternative entities 
available to provide the services in the same setting or alternative 
business structures that would permit the physician to continue 
furnishing the services to his or her own patients. Other commenters, 
such as MedPAC, have also noted that there are a large number and 
variety of settings in which nuclear medicine services are available 
(such as hospitals, freestanding centers that are not owned by 
physicians, and physician offices). Therefore, we believe there would 
be no decrease in beneficiary access to care. Nevertheless, we have 
taken steps, as described in our discussion of the delayed effective 
date, to minimize any potential disruption of patient care or access to 
these services.
    Comment: One commenter stated that there were not many PET scanners 
in the State of Oklahoma, and thus, patients would have to travel long 
distances for testing.
    Response: We do not believe that this regulatory change will cause 
any significant disruption in patient care. The only referrals for PET 
scans that our proposal would prohibit are those made by physicians 
whose financial relationship with the entity furnishing the PET scans 
does not satisfy an exception such as the in-office ancillary services 
exception or the rural provider exception. If the financial 
relationship is an ownership interest in a non-rural provider, the 
physician may: (1) Divest the interest; (2) restructure the financial 
relationship so that it complies with an exception; or (3) maintain the 
interest and refer his or her patients to another entity for PET scans. 
If the physician chooses to divest or appropriately restructure his 
interest in the PET center, the physician's subsequent referrals to the 
PET center would not be prohibited under section 1877 of the Act, 
provided that the physician has no other financial relationship with 
the entity that fails to comply with an exception. We believe that the 
rural provider exception will ensure that beneficiaries in rural areas 
have continued access to nuclear medicine services.
    Comment: One commenter expressed concern that if PET services are 
reclassified as DHS, physicians will be prevented from performing this 
service in mobile coaches due to the exclusion of mobile settings from 
the in-office ancillary exception. The commenter contended that 
beneficiary access will be limited where physicians cannot afford to 
operate PET services at fixed locations. The commenter requested that 
the final rule exclude PET services from DHS, or, in the alternative, 
create an exemption for physician ownership arrangements of PET units 
that contain

[[Page 70288]]

certain intrinsic checks against over-utilization.
    Response: The commenter is correct that nuclear medicine services 
such as PET furnished in mobile coaches would not satisfy the ``same 
building'' element of the in-office ancillary services exception. 
However, if the entity furnishing the mobile services furnishes at 
least 75 percent of all the DHS it furnishes is to residents of a rural 
area (as defined in Sec.  411.356(c)(c)(1)), it could meet the 
requirements of the rural provider exception. The commenter did not 
specify the nature of any intrinsic checks against overutilization and 
as we noted in Phase I (66 FR 861), medical necessity reviews and other 
efforts may not be sufficient to control overutilization. The statute 
permits us to create an exception only when there is no risk of fraud 
or program abuse. We have concluded that internal controls or medical 
necessity reviews are not necessarily effective controls on over-
utilization, unfair competition, or other abuse. Therefore, we decline 
to adopt the requested exception. Additionally, we do not agree with 
the commenter's assertion that where physicians cannot afford to 
operate PET centers at fixed locations, the result will be to limit 
access to beneficiaries. As we have noted above, PET services are 
furnished in various settings other than physician-owned entities. 
Therefore, we do not believe our proposal will have a negative impact 
on beneficiary access.
e. Quality of Care
    Comment: Two physicians disagreed with the proposal to include 
nuclear medicine services because they believed that the inclusion of 
nuclear medicine would reduce quality of care to patients. One of the 
physicians expressed specific concern about the timeliness of diagnosis 
and initiation of therapy. The physician recommended that we 
disseminate evidence-based guidelines on the appropriate use of nuclear 
medicine procedures for diagnosis and treatment, and measurement of the 
quality of the service provided. Additionally, the commenter suggested 
that Medicare reimbursement should be site-neutral, ownership-neutral, 
and based on the clinical appropriateness, safety, and quality of the 
service provided.
    Response: We do not believe that the inclusion of nuclear medicine 
as a DHS would reduce quality of care. We have no data, and the 
commenter furnished no data or anecdotal evidence, to support the 
physician's contention that nuclear medicine facilities owned by non-
physicians furnish lower quality of care, as may be evidenced by delays 
in diagnosis and the initiation of treatment. Regarding the commenter's 
other recommendations, this regulation is not the appropriate vehicle 
for addressing the development of evidence-based guidelines, 
measurement of the quality of the service, and changes in Medicare 
reimbursement.
    Comment: One commenter stated that the increased referrals and 
physician investment may not be attributable to financial incentives 
but rather may be attributable to improved services and diagnosis 
achieved by utilizing better equipment. The commenter expressed concern 
that the adoption of this provision could have a negative impact on the 
future provision of quality health care as physicians may hesitate to 
invest in new technology or services. The commenter contended that 
patient care has improved due to physician investment in entities 
providing nuclear medicine and PET services. Specifically, the 
commenter stated that the ability to invest in new technology has led 
to improved diagnostic and treatment ability, and lower costs and 
improved patient care.
    In addition, the commenter stated that physician investment has led 
to increased access to these services. According to the commenter, 
nuclear medicine and PET scan services require more expensive equipment 
than traditional radiology services and therefore physician investment 
in this equipment fills a necessary gap where large care providers have 
been unable to afford such equipment or choose not to acquire such 
equipment.
    Response: We recognize that in some instances, new technology has 
led to improved diagnostic and treatment lower costs, and improved 
patient care; however, this final rule with comment does not prevent 
physicians from furnishing nuclear medicine services or utilizing 
better nuclear medicine equipment. Rather, and consistent with the 
purposes of the statute, the provisions of this final rule with comment 
restrict the circumstances under which physicians can financially 
benefit from DHS they order. Moreover, we believe that many non-
physician owned entities will invest in new technology or new services 
and that quality of care will not be affected because most physicians 
will continue to refer patients for medically necessary services even 
where there is no potential for personal profit. Finally, we note that 
the commenters offered no evidence to support their claim that 
physician ownership of nuclear medicine facilities results in improved 
quality of care.
    Comment: Some commenters opposed our proposal as it related to 
nuclear cardiology services, which the commenters asserted are integral 
to the diagnosis of heart disease and are performed primarily by 
cardiologists. One commenter stated that our proposal would prevent 
cardiologists from referring their patients for these services, thus 
causing primary care practitioners to refer these same patients 
directly to radiologists for nuclear testing, effectively bypassing a 
cardiologist's input on the appropriate approach to cardiac testing. 
The commenter asserted that nuclear medicine services performed in 
hospitals will be interpreted by radiologists who do not possess the 
specialized skills of cardiologists, and that our proposal would, 
therefore, negatively affect patient care.
    Response: We are not persuaded by the commenters' concerns. First, 
our proposal would not prohibit a cardiologist from referring patients 
for nuclear medicine services; it would merely prohibit the physician 
from referring patients for these services to entities with which the 
physician has a financial relationship if that financial relationship 
does not comply with an existing exception. Second, we do not believe 
that patient care would be negatively affected if a cardiologist had to 
refer patients to a hospital for nuclear cardiology tests that would be 
interpreted by a radiologist. We are not convinced that cardiologists 
are the only individuals qualified to interpret these tests. Moreover, 
we believe that hospitals have every incentive to ensure that such 
tests are interpreted by qualified physicians (including cardiologists, 
if necessary).
    Comment: Another commenter suggested that the inclusion of nuclear 
medicine as a DHS will limit the development of diagnostic testing 
facilities and thereby make the hospital setting the only permissible 
setting for nuclear cardiology.
    Response: We do not agree that the effect of this rule will be to 
make the hospital setting the only permissible setting for nuclear 
cardiology. Physician-owned diagnostic testing facilities are not 
prohibited if the physician owners do not refer patients to the 
facilities or if the financial relationship complies with another 
exception, such as the rural provider or in-office ancillary services 
exceptions. Additionally, as MedPAC noted, there are numerous other 
types of non-hospital entities or non-physician owned entities that 
currently furnish these services.

[[Page 70289]]

f. Grandfathering Existing Arrangements or Delaying the Effective Date
    In the August 8, 2005 proposed rule, we requested comments as to 
whether, or how, to minimize the impact on physicians who are currently 
parties to arrangements that involve nuclear medicine services and 
supplies (that is, by grandfathering certain arrangements, or by 
specifying a delayed effective date). Most commenters addressed this 
aspect of the proposed rule and either requested that current financial 
arrangements be grandfathered or recommended a delay in the effective 
date of our proposal.
    Comment: Many commenters supported a delayed effective date for our 
proposal. Commenters suggested various lengths of delay in implementing 
our proposal. Several commenters favored delaying the effective date 
for three to six months. One of the commenters suggested that 
physicians should have at least five years to divest themselves of 
existing ownership or investment interests. This commenter believed 
that this would be the minimum period for physicians to recover a fair 
share of their capital investments and dispose of their assets without 
having to resort to ``bargain basement'' sales. The Society of Nuclear 
Medicine strongly encouraged a phased-in implementation over two to 
three years to decrease the chances that patient access would be 
compromised. The ACR recommended an effective date of January 1, 2006 
with a 1-year ``grace period'' prior to enforcement.
    Response: We have carefully considered the impact of our proposal 
on both beneficiaries and physicians. We have also considered our duty 
to implement the statute. Given our conclusion that nuclear medicine 
services and supplies are radiology and radiation therapy services and 
supplies, we do not believe we can delay the effective date beyond a 
reasonable period of time. After weighing these considerations, we have 
decided to delay the effective date of this regulatory change until 
January 1, 2007. We believe this delay provides adequate notice to the 
general public and a reasonable length of time for physicians to divest 
any existing ownership interests or to restructure their financial 
relationships with nuclear medicine entities so that they comply with a 
statutory or regulatory exception (if that is the course of action they 
choose to take), without unduly delaying our statutory duty to 
implement the statute. We are aware that many of the financial 
arrangements concerning nuclear medicine entities are complex and 
involve ownership, investment, and leasing arrangements. Accordingly, 
we are rejecting commenters' suggestions for a shorter or longer delay 
in implementation as being impractical or unreasonable.
    Comment: Many commenters recommended that current financial 
arrangements be grandfathered and that the process be clearly 
implemented with as little administrative burden as possible. For 
example, some commenters urged us to grandfather existing PET joint 
ventures. The AMA stated its belief that CMS has the authority to 
implement a grandfather clause, and urged us to use it to avoid ``fire 
sales'' wherein physicians may not be able to recover the initial costs 
of their investment due to much greater supply than demand. Another 
commenter expressed a similar belief that the sales prices will reflect 
the forced nature of an immediate need to sell and be significantly 
below the prices that could be obtained in the absence of a grandfather 
provision. The commenter stated that ``even if CMS allowed a three to 
five year period to divest, investors may still not receive the full 
value of their investment.'' A physician stated that he and other 
physicians took risk by investing in nuclear medicine entities and 
believed that they should not have to divest their interest. Therefore, 
the physician advocated that we grandfather existing establishments and 
present ownership structures. Another commenter suggested that we 
grandfather financial relationships that were established prior to the 
effective date of the proposed rule.
    A few commenters objected to grandfathering for several reasons 
including--(1) There was no precedent for grandfathering; (2) the 
statute does not permit grandfathering; and (3) to do so would negate 
the intent of the proposal.
    Response: After reconsidering the issue, we question whether we 
have the authority to grandfather existing arrangements. Grandfathering 
existing arrangements would essentially require the creation of a new 
exception for physician financial relationships with certain nuclear 
medicine facilities. We have authority to create exceptions only for 
arrangements that pose no risk of patient or program abuse. We believe 
that physician self-referrals for diagnostic and therapeutic nuclear 
medicine services and supplies pose a risk of abuse, and we do not 
believe this risk is mitigated or eliminated simply because financial 
relationship was acquired before a particular date. Therefore, we have 
decided not to grandfather existing financial relationships between 
physicians and nuclear medicine facilities. However, we believe our 
decision to specify a delayed effective date will provide physicians 
with sufficient time to divest their ownership interests or to 
restructure appropriately existing financial arrangements.
2. Revisions to the List of Codes Identifying Nuclear Medicine Services
    We have carefully reviewed the list of codes identifying nuclear 
medicine services and supplies (Nuclear Medicine Code List), as 
published in Addendum G of the August 8, 2005 PFS proposed rule. We 
have identified various additions and deletions.
    Table 31 reflects the addition of new CPT and HCPCS codes that 
become effective January 1, 2006 or that became effective since the 
publication of the proposed rule. Table 31 also reflects the addition 
of codes that will be recognized by Medicare for payment purposes 
effective January 1, 2006.
    Table 31 reflects the deletions necessary to conform the Nuclear 
Medicine Code List to the most recent publications of CPT and HCPCS 
codes. We have also deleted all C codes listed in the proposed rule 
because these are hospital outpatient services and are thus included in 
a different DHS category.
    Table 31 identifies the nuclear medicine codes that will be 
included (effective January 1, 2007) in the DHS categories of radiology 
and certain other imaging services and radiation therapy services and 
supplies.
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C. Annual Update to the Code List

    In Sec.  411.351, we specify that the entire scope of four DHS 
categories is defined in a list of CPT/HCPCS codes (the Code List), 
which is updated annually to account for changes in the most recent CPT 
and HCPCS publications. The DHS categories defined and updated in this 
manner are:
    <bullet> Clinical laboratory services.
    <bullet> Physical therapy, occupational therapy, and speech-
language pathology services.
    <bullet> Radiology and certain other imaging services.
    <bullet> Radiation therapy services and supplies.
    The updated Code List appears as Addendum H in this PFS final rule 
with comment and is available on our Web site at http://cms.hhs.gov/medlearn/refphys.asp. We also include in the Code List those items and 
services that may qualify for either of the following two exceptions to 
the physician self-referral prohibition:
    <bullet> EPO and other dialysis-related drugs furnished in or by an 
ESRD facility (Sec.  411.355(g)).
    <bullet> Preventive screening tests, immunizations or vaccines 
(Sec.  411.355(h)).
    The Code List was last updated in the CY 2005 PFS final rule (69 FR 
66236). The updated all-inclusive Code List effective January 1, 2006 
(except as otherwise noted for specific nuclear medicine codes) is 
presented in Addendum H of this final rule with comment.
1. Response to Comments
    We received the following comment:
    Comment: One commenter suggested incorporating the Code List in the 
National Physician Fee Relative Value File as discussed in the CY 2005 
PFS final rule (69 FR 66373).
    Response: We have decided not to incorporate the Code List into the 
National Physician Fee Relative Value File as suggested by the 
commenter. That file is updated quarterly and would entail a quarterly 
update to the PFS. In discussions with the commenter (an association 
representing medical group practices), we learned that its primary goal 
was to have the Code List in a format that could be downloaded. The 
previous Code Lists were generally posted on our web site as PDF files 
that could not be downloaded. Therefore, we will be posting the updated 
Code List on our physician self-referral Web site in an Excel 
spreadsheet that may be downloaded.
2. Revisions Effective for 2006
    Tables 32 and 33, in this section, identify the additions and 
deletions, respectively, to the comprehensive Code List published in 
Addendum L of the CY 2005 PFS final rule. Tables 32 and 33 also 
identify the additions and deletions to the lists of codes used to 
identify the items and services that may qualify for the exceptions in 
Sec.  411.355(g) (regarding EPO and other dialysis-related outpatient 
prescription drugs furnished in or by an ESRD facility) and in Sec.  
411.355(h) (regarding preventive screening tests, immunizations and 
vaccines).
    We will consider comments for the codes listed in Tables 32 and 33, 
if we receive them by the date specified in the DATES section of this 
final rule with comment. We will not consider any comment that 
advocates a substantive change to any of the DHS defined in Sec.  
411.351.
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    The additions specified in Table 32 generally reflect new CPT and 
HCPCS codes that become effective January 1, 2006 or that became 
effective since our last update. Table 32 also reflects the addition of 
codes that will be recognized by Medicare for payment purposes 
effective January 1, 2006. It does not reflect the addition of the 
nuclear medicine codes that were discussed in section V.B.2 of this 
preamble. For the convenience of physicians and DHS entities, nuclear 
medicine codes appear on Addendum H with an asterisk to indicate that 
they will become effective on January 1, 2007 for physician self-
referral purposes.
    As a result of reviewing nuclear medicine codes as set forth in the 
CPT, we are adding CPT 78267 and 78268 for urea breath tests and 
analyses to the DHS category of clinical laboratory services. Although 
these codes appear under the nuclear medicine subheading in the CPT, 
they do not represent imaging services. Therefore, we do not consider 
CPT 78267 and 78268 radiology or other imaging services. We are adding 
these codes to the Code List under the clinical laboratory services 
category. This is consistent with our payment policy, since these codes 
are reimbursed under the clinical laboratory fee schedule. We note that 
there are other tests involving the use of radiopharmaceuticals (for 
example, CPT 83519) that are identified by the Code List as clinical 
laboratory services.
    Additionally, we are adding CPT code 92506 for the evaluation of 
speech, language, voice, communication, and/or auditory processing. We 
had deleted this code in the Phase II physician self-referral interim 
final rule published on March 26, 2004 (69 FR 16054) because it 
represented an audiology service. However, Medicare does not provide 
reimbursement for CPT code 92506 as an audiology service. Under 
Medicare, that code is only reimbursed as a speech-language pathology 
service and therefore must be added to the Code List.

VI. Physician Fee Schedule Update for CY 2006

A. Physician Fee Schedule Update

    The PFS update is determined using a formula specified by statute. 
Under section 1848(d)(4) of the Act, the update

[[Page 70299]]

is equal to the product of 1 plus the percentage increase in the 
Medicare Economic Index (MEI) (divided by 100) and 1 plus the update 
adjustment factor (UAF). For CY 2006, the MEI is equal to 2.8 percent 
(1.028). The UAF is -7.0 percent (0.930). The product of the MEI 
(1.028) and the UAF (0.930), equals the CY 2006 update of -4.4 percent 
(0.95604).
    Our calculations of these figures are explained in this section.

B. The Percentage Change in the Medicare Economic Index (MEI)

    The MEI measures the weighted-average annual price change for 
various inputs needed to produce physicians' services. The MEI is a 
fixed-weight input price index, with an adjustment for the change in 
economy-wide multifactor productivity. This index, which has 2000 base 
year weights, is comprised of two broad categories: physician's own 
time and physician's PE.
    The physician's own time component represents the net income 
portion of business receipts and primarily reflects the input of the 
physician's own time into the production of physicians' services in 
physicians' offices. This category consists of two subcomponents: (1) 
Wages and salaries; and (2) fringe benefits.
    The physician's PE category represents nonphysician inputs used in 
the production of services in physicians' offices. This category 
consists of wages and salaries and fringe benefits for nonphysician 
staff and other nonlabor inputs. The physician's PE component also 
includes the following categories of nonlabor inputs: Office expense; 
medical materials and supplies; professional liability insurance; 
medical equipment; and other expenses. The components are adjusted to 
reflect productivity growth in physicians' offices by the 10-year 
moving average of productivity in the private nonfarm business sector. 
Table 34 presents a listing of the MEI cost categories with associated 
weights and percent changes for price proxies for the 2006 update. For 
CY 2006, the increase in the MEI is 2.8 percent, which includes a 1.0 
percent productivity offset based on the 10-year moving average of 
multifactor productivity. This is the result of a 3.2 percent increase 
in physician's own time and a 4.4 percent increase in physician's PE. 
Within the physician's PE, the largest increase occurred in 
professional liability insurance, which increased 13.7 percent.
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C. The Update Adjustment Factor

    Section 1848(d) of the Act provides that the PFS update is equal to 
the product of the MEI and the UAF. The UAF is applied to make actual 
and target expenditures (referred to in the statute as ``allowed 
expenditures'') equal. Allowed expenditures are equal to actual 
expenditures in a base period updated each year by the sustainable 
growth rate (SGR). The SGR sets the annual rate of growth in allowed 
expenditures and is determined by a formula specified in section 
1848(f) of the Act.
1. Calculation Under Current Law
    Under section 1848(d)(4)(B) of the Act, the UAF for a year 
beginning with 2001 is equal to the sum of the following--
    <bullet> Prior Year Adjustment Component. An amount determined by--
    + Computing the difference (which may be positive or negative) 
between the amount of the allowed expenditures for physicians' services 
for the prior year (the year prior to the year for which the update is 
being determined) and the amount of the actual expenditures for those 
services for that year;
    + Dividing that difference by the amount of the actual expenditures 
for those services for that year; and
    + Multiplying that quotient by 0.75.
    <bullet> Cumulative Adjustment Component. An amount determined by--
    + Computing the difference (which may be positive or negative) 
between the amount of the allowed expenditures for physicians' services 
from April 1, 1996, through the end of the prior year and the amount of 
the actual expenditures for those services during that period;
    + Dividing that difference by actual expenditures for those 
services for the prior year as increased by the SGR for the year for 
which the UAF is to be determined; and
    + Multiplying that quotient by 0.33.
    Section 1848(d)(4)(E) of the Act requires the Secretary to 
recalculate allowed expenditures consistent with section 1848(f)(3) of 
the Act. Section 1848(f)(3) specifies that the SGR (and, in turn, 
allowed expenditures) for the upcoming CY (2006 in this case), the 
current CY (2005) and the preceding CY (2004) are to be determined on 
the basis of the best data available as of September 1 of the current 
year. Allowed expenditures are initially estimated and subsequently 
revised twice. The second revision occurs after the CY has ended (that 
is, we are making the final revision to 2004 allowed expenditures in 
this final rule with comment). Once the SGR and allowed expenditures 
for a year have been revised twice, they are final.
    Table 35 shows annual and cumulative allowed expenditures for 
physicians' services from April 1, 1996 through the end of the current 
CY, including the transition period to a CY system that occurred in 
1999. Also shown is the SGR corresponding with each period. The 
calculation of the SGR is discussed in detail below.
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[[Page 70304]]

    Consistent with section 1848(d)(4)(E) of the Act, Table 35 includes 
our final revision of allowed expenditures for 2004, a recalculation of 
allowed expenditures for 2005, and our initial estimate of allowed 
expenditures for 2006. To determine the UAF for 2006, the statute 
requires that we use allowed and actual expenditures from April 1, 1996 
through December 31, 2005 and the 2006 SGR. Consistent with section 
1848(d)(4)(E) of the Act, we will be making further revisions to the 
2005 and 2006 SGRs and 2005 and 2006 allowed expenditures. Because we 
have incomplete actual expenditure data for 2005, we are using an 
estimate for this period. Any difference between current estimates and 
final figures will be taken into account in determining the UAF for 
future years.
    We are using figures from Table 35 in the statutory formula 
illustrated below:
[GRAPHIC] [TIFF OMITTED] TR21NO05.000

UAF = Update Adjustment Factor
Target<INF>05</INF> = Allowed Expenditures for 2005 or $80.4 billion
Actual<INF>05</INF> = Estimated Actual Expenditures for 2005 = $93.3 
billion
Target <INF>4/96-12/05</INF> = Allowed Expenditures from 4/1/1996-12/
31/2005 = $611.8 billion
Actual <INF>4/96-12/05</INF> = Estimated Actual Expenditures from 4/1/
1996-12/31/2005 = $642.5 billion
SGR<INF>06</INF> = 1.7 percent (1.017)
[GRAPHIC] [TIFF OMITTED] TR21NO05.001

    Section 1848(d)(4)(D) of the Act indicates that the UAF determined 
under section 1848(d)(4)(B) of the Act for a year may not be less than 
-0.070 or greater than 0.03. Since -0.210 is less than -0.070, the UAF 
for 2005 will be -0.070.
    Section 1848(d)(4)(A)(ii) of the Act indicates that 1 should be 
added to the UAF determined under section 1848(d)(4)(B) of the Act. 
Thus, adding 1 to -0.070 makes the UAF equal to 0.930.

VII. Allowed Expenditures for Physicians' Services and the Sustainable 
Growth Rate

A. Medicare Sustainable Growth Rate

    The SGR is an annual growth rate that applies to physicians' 
services paid by Medicare. The use of the SGR is intended to control 
growth in aggregate Medicare expenditures for physicians' services. 
Payments for services are not withheld if the percentage increase in 
actual expenditures exceeds the SGR. Rather, the PFS update, as 
specified in section 1848(d)(4) of the Act, is adjusted based on a 
comparison of allowed expenditures (determined using the SGR) and 
actual expenditures. If actual expenditures exceed allowed 
expenditures, the update is reduced. If actual expenditures are less 
than allowed expenditures, the update is increased.
    Section 1848(f)(2) of the Act specifies that the SGR for a year 
(beginning with 2001) is equal to the product of the following four 
factors:
    (1) The estimated change in fees for physicians' services;
    (2) The estimated change in the average number of Medicare fee-for-
service beneficiaries;
    (3) The estimated projected growth in real gross domestic product 
(GDP) per capita; and
    (4) The estimated change in expenditures due to changes in statute 
or regulations.
    In general, section 1848(f)(3) of the Act requires us to publish 
SGRs for 3 different time periods, no later than November 1 of each 
year, using the best data available as of September 1 of each year. 
Under section 1848(f)(3)(C)(i) of the Act, the SGR is estimated and 
subsequently revised twice (beginning with the FY and CY 2000 SGRs) 
based on later data. (There were also provisions in the Act to adjust 
the FY 1998 and FY 1999 SGRs. See the February 28, 2003 Federal 
Register (68 FR 9567) for a discussion of these SGRs). Under section 
1848(f)(3)(C)(ii) of the Act, there are no further revisions to the SGR 
once it has been estimated and subsequently revised in each of the 2 
years following the preliminary estimate. In this final rule with 
comment, we are making our preliminary estimate of the 2006 SGR, a 
revision to the 2005 SGR, and our final revision to the 2004 SGR.

B. Physicians' Services

    Section 1848(f)(4)(A) of the Act defines the scope of physicians' 
services covered by the SGR. The statute indicates that ``the term 
`physicians' services' includes other items and services (such as 
clinical diagnostic laboratory tests and radiology services), specified 
by the Secretary, that are commonly performed or furnished by a 
physician or in a physician's office, but does not include services 
furnished to a Medicare+Choice plan enrollee.'' We published a 
definition of physicians' services for use in the SGR in the Federal 
Register (66 FR 55316) on November 1, 2001. We defined physicians' 
services to include many of the medical and other health services 
listed in section 1861(s) of the Act. For purposes of determining 
allowed expenditures, actual expenditures, and SGRs, we have specified 
that physicians' services include the following medical and other 
health services if bills for the items and services are processed and 
paid by Medicare carriers (and those paid through intermediaries where 
specified):
    <bullet> Physicians' services.
    <bullet> Services and supplies furnished incident to physicians' 
services.
    <bullet> Outpatient physical therapy services and outpatient 
occupational therapy services.
    <bullet> Antigens prepared by, or under the direct supervision of, 
a physician.
    <bullet> Services of physician assistants, certified registered 
nurse anesthetists, certified nurse midwives, clinical psychologists, 
clinical social workers, nurse practitioners, and certified nurse 
specialists.
    <bullet> Screening tests for prostate cancer, colorectal cancer, 
and glaucoma.

[[Page 70305]]

    <bullet> Screening mammography, screening pap smears, and screening 
pelvic exams.
    <bullet> Diabetes outpatient self-management training services.
    <bullet> Medical nutrition therapy services.
    <bullet> Diagnostic x-ray tests, diagnostic laboratory tests, and 
other diagnostic tests (including outpatient diagnostic laboratory 
tests paid through intermediaries).
    <bullet> X-ray, radium, and radioactive isotope therapy.
    <bullet> Surgical dressings, splints, casts, and other devices used 
for the reduction of fractures and dislocations.
    <bullet> Bone mass measurements.
    <bullet> An initial preventive exam.
    <bullet> Cardiovascular screening blood tests.
    <bullet> Diabetes screening tests.
    <bullet> Telehealth services.
    <bullet> Physician work and resources to establish and document the 
need for a power mobility device (see 70 FR 50940).
    Telehealth services and the power mobility device related services 
have been added because they meet the statutory criteria for services 
to be included in the SGR (that is, these services are commonly 
performed or furnished by a physician or in a physician's office).
    We appreciate the tremendous number of comments we received 
expressing concern about the negative update for 2006. Those comments 
are summarized below, along with our responses.
    Comment: Commenters noted that physicians' costs are rising, while 
fees are being cut. The cumulative impact of the projected reductions 
from 2006 to 2012 will be about -27 percent, while the MEI increase 
over this same period is projected to be 19 percent. Commenters predict 
that, based on the MEI alone, payments should increase by 3.5 percent 
in 2006. Instead, payments are being reduced. Because commercial 
insurance carriers base their payment updates upon Medicare's PFS, the 
overall negative impact is compounded.
    Many comments predict that costs to provide care will soon exceed 
reimbursement. The result will be that patient quality of care will be 
compromised, with doctors taking drastic measures to cut costs of 
health care delivery to remain solvent. Eventually, physicians will be 
unable to absorb the losses, and they will refuse or limit Medicare 
patients, resulting in reduced access to care. Costs will shift to 
inpatient settings, which will be more costly for Medicare, less 
efficient in delivering care, and yield worse health outcomes for 
beneficiaries.
    Commenters recommend that the SGR be replaced with an appropriate 
inflation rate (for example, the projected change in prices or the 
MEI). Updates should be linked to changes in the actual costs of 
medical practice.
    Response: We are fully cognizant of the potential implications of 
seven years of negative physician updates, remain concerned regarding 
those trends, and are closely monitoring physicians' participation in 
the Medicare program, as well as beneficiaries' access to care. At the 
same time, simply increasing spending by adding larger updates into the 
current volume-based payment system that is already experiencing 
increases of 12 to 13 percent or more per year would have an adverse 
effect from the standpoint both Medicare's finances and beneficiary 
premiums and cost-sharing, and therefore would not promote better 
quality care.
    However, it is clear, under our current system, that there is much 
potential for physicians to improve the value of our health care 
spending. Under the current system, there are substantial variations in 
resources and in spending growth for the same medical condition in 
different practices and in different parts of the country, without 
apparent differences in quality and outcomes, and without a clear basis 
in existing medical evidence. A study published in 2003 looked at 
regional variations in the number of services received by Medicare 
patients who were hospitalized for hip fractures, colorectal cancer, 
and acute myocardial infarction.\6\ The researchers found that patients 
in higher spending areas received approximately 60 percent more care, 
but that quality of care in those regions was no better on most 
measures and was even worse for several preventive care measures. 
Further, there are many examples of steps that physicians can take to 
improve quality while helping to keep overall costs down (for example, 
management of diabetic patients may result in reduced hospital 
admissions).
---------------------------------------------------------------------------

    \6\ Fisher, Elliott S., MD, MPH; David E. Wennberg, MD, MPH; 
Therese A. Stukel, Ph.D.; Daniel J. Gottlieb, MS; F.L. Lucas, Ph.D.; 
and Etoile L. Pinder, MS, ``The Implications of Regional Variations 
in Medicare Spending. Part 1: The Content, Quality, and 
Accessibility of Care,'' in The Annals of Internal Medicine, 
February 18, 2003, Vol 138, Issue 4.
---------------------------------------------------------------------------

    Because it is critical for CMS payment systems to support better 
outcomes for our beneficiaries while safeguarding Medicare's finances, 
we are working closely and collaboratively with medical professionals 
and the Congress to consider changes to increase the effectiveness of 
the payment methodology Medicare uses to compensate physicians for 
providing services to Medicare beneficiaries. We are engaging 
physicians on issues of quality and performance with the goal of 
supporting the most effective clinical and financial approaches to 
achieve better health outcomes for Medicare beneficiaries. We are 
committed to developing reporting and payment systems that enable us to 
support and reward quality, and to improve care without increasing 
overall Medicare costs. When clear, valid and widely accepted quality 
measures are in place, pay-for-performance is a tool that can enable 
our reimbursement methodology to better support efforts to improve 
quality and to avoid unnecessary costs.
    Currently, hospitals and physicians are paid under separate 
systems. Under these systems, physicians do not receive credit for 
avoiding unnecessary hospitalizations by providing better care to their 
patients. However, in our physician group practice demonstration 
project, physicians could receive performance-based payments derived 
from savings from preventing chronic disease complications, avoiding 
hospitalizations, and improving quality of care.
    The evidence is increasing that when healthcare providers are given 
incentives for achieving higher quality care, they respond by taking a 
range of steps from the simple to the high-tech to improve care and 
reduce costs (for example, by avoiding unnecessary hospital care). This 
is not surprising, as our health professionals are dedicated, and they 
want to do everything in their power to get the best care to their 
patients. So when we support high quality care, we enable professionals 
to do what they do best.
    We have seen this approach work first-hand with hospital payments 
where we have tied the annual hospital payment update to quality 
measure reporting. It has had a positive impact on the availability of 
quality information, with about 98 percent of the hospitals subject to 
this provision reporting quality data.
    Reporting clinically valid quality measures is an important step 
toward achieving major improvements in quality. If you cannot measure 
something, it is hard to take steps to improve it. We have been working 
hard in close collaboration with health professionals and other 
stakeholders to promote the development of better measures for 
reporting on the quality of care.
    Comment: Most commenters support the overall development of 
measures related to the quality and efficiency of care furnished by 
physicians, but many

[[Page 70306]]

are concerned that the promotion of high quality health care is 
incompatible with the current SGR system. Any performance measures may 
involve additional services or administrative actions, and will 
exacerbate the problems with the current volume-based update formula. 
Some commenters note that many electronic health record systems with 
decision support tools specifically prompt physicians to perform 
additional diagnostic tests and screenings, which, in turn, could 
offset any projected savings. Overall, pay-for-performance will drive 
spending over the target, negatively impacting future updates, and 
thereby penalizing physicians for participating in pay-for-performance.
    Commenters also expressed the concern that health information 
technology systems, a key component of many pay for performance 
programs, will be unaffordable to physicians facing payment cuts.
    Response: Medicare needs to encourage and reward efficiency and 
high quality care, and not simply pay for more services, regardless of 
the quality of those services or of the impact that those services have 
on patient health.
    Currently, the physician payment system does not always recognize 
clinically appropriate care. For example, Medicare will pay for a 
duplicate x-ray or blood test right before surgery if a hospital does 
not coordinate care adequately with the physician's office. The 
physician payment system should support, encourage, and provide an 
incentive for physicians to improve quality and reduce unnecessary 
Medicare costs by avoiding unnecessary services (like duplicate tests).
    Another way the current physician payment system fails to encourage 
clinically appropriate care is the way in which it tends to steer 
patient care decisions. Oncologists, for example, are paid less for 
transitioning a terminal patient to palliative care and focusing on 
quality of life issues, than for recommending and providing intensive 
procedures, even if the side effects of those procedures are 
significant and the benefits negligible. In addition, the current 
payment system does not reward physicians who actively prevent 
readmissions for patients with heart failure or diabetes.
    Linking a portion of Medicare payments to valid measures of quality 
and effective use of resources could give physicians more direct 
incentives to implement the innovative ideas and approaches that 
actually result in improvements in both the value and quality of care 
that people with Medicare receive.
    We have been working on the technical methods for supporting 
effective, simple, and least burdensome reporting and payment based on 
these measures. In the years ahead, it is expected that electronic 
record systems can be developed that would provide information that is 
needed to measure and report on quality while fully protecting patient 
confidentiality. However, while electronic health records would greatly 
facilitate the accurate and efficient use of information on quality 
measures and quality improvement, progress on supporting quality 
improvement should not be delayed until electronic health records are 
widely used. Indeed, taking steps now to promote quality reporting and 
improvement also could promote the adoption of and investment by 
physicians in electronic records, which would facilitate more efficient 
quality reporting and quality improvement activities. In the short 
term, there is considerable evidence that information on a broad range 
of quality measures can be obtained adequately via information 
transmitted on existing claims. Steps will be taken to ensure patient 
confidentiality when obtaining these quality measures.
    In addition, we believe that several Federal government actions are 
creating favorable market conditions for the adoption of health 
information technology. First, HHS, through the Office of the National 
Coordinator for Health Information Technology, is leading a public-
private partnership to reduce the risk of Health Information Technology 
investment by: harmonizing health information standards; certifying 
health IT products to ensure consistency with standards; addressing 
variations in privacy and security policies that can pose challenges to 
interoperability; and, developing an architecture for nationwide 
sharing of electronic health information. Second, two recently proposed 
rules discussed an exception to the Stark statute and a safe harbor to 
the anti-kickback statute for e-prescribing technology and electronic 
health records, which would create opportunities for physicians to 
acquire health information technology free or at a reduced cost.
    In January 2006, we will start the process of collecting quality 
information on services provided by physicians in certain specialties 
and subspecialties through the voluntary reporting of G-Codes for 
quality indicators. The G-codes were established by Medicare to 
supplement claims data with clinical data pertinent to a variety of 
quality measures, without the burdens of chart abstraction. Those 
quality measures have been achieved through a process of study and 
consensus with input from physicians and others.
    Comment: Commenters suggested that we should assume the leadership 
in pushing the Congress to enact legislation preventing a negative 
update for 2006, and to replace the SGR with a more sustainable system. 
They stated that it would be a show of good faith and leadership for 
CMS to take the administrative action to remove drugs from the SGR and 
levels of allowed expenditures retroactively to 1996, even prior to 
legislative action. The commenters opined that if CMS makes the 
administrative changes now, worth about $111 billion, then the 
legislative price tag will drop and will increase the likelihood of 
Congressional action to fix the SGR permanently.
    Response: We are concerned about the projections of seven years of 
negative updates to physician payments and are closely monitoring the 
current volume-based payment system for physicians' services. The CMS 
Office of the Actuary (OACT) estimated under its Mid-Session Baseline 
that removing drugs from the SGR and allowed expenditures retroactively 
to 1996 would cost $111 billion. We note that our current estimate is 
that removing drugs prospectively would not provide relief to the 
negative updates projected for 2006 and the succeeding several years. 
OACT estimates removing drugs prospectively would cost an additional 
$36 billion over 10 years. These changes would also have significant 
impacts on beneficiary premiums. Consequently, while we have carefully 
reviewed our authority to make this administrative change, we also have 
been working with the Congress and health professional organizations on 
payment reforms that would improve the effectiveness of the payment 
methodology for physicians without increasing overall Medicare costs.
    Comment: Many commenters indicated that they support removing the 
costs of Part B covered drugs from the calculation of the SGR, and 
provided or referenced legal opinions and Congressional support for 
this view. Some commented that they find no basis in the statute for 
ever including drugs in the definition of physicians' services, and CMS 
is therefore obligated to remove them retroactively from the SGR.
    Commenters contend that the rapid increase in the price of drugs is 
a major contributor to increased spending on physician-administered 
drugs. Therefore, it is not logical to include

[[Page 70307]]

drugs in calculating the target, because the growth in expenditures on 
these drugs is not controlled by physicians and reduced payments to 
physicians will not affect future spending on Part B drugs provided 
incident to physicians' services.
    Some commenters noted that including drugs in the SGR has not led 
to controls on drug spending and, as a result, removing them would not 
lead to increased spending on drugs. These commenters opined that 
spending on drugs is rising far more rapidly than spending on 
physicians' and other practitioners' services. According to these 
commenters, in 1996 drugs represented 3.7 percent of the physician 
spending portion of the SGR calculation, but in 2004, drugs represented 
9.8 percent.
    Commenters stated that growth in Medicare spending on drugs is 
driven primarily by the introduction of expensive new drugs to the 
Medicare population and extensive marketing (including direct-to-
consumer advertising), and that prices are set by drug companies that 
are not impacted by negative updates to the Medicare physician fee 
schedule.
    Some commenters indicated that the increase in drug spending is due 
to government policies that encourage the rapid development of drugs.
    Response: The statute provides the Secretary with clear authority 
to specify the services that are included in the SGR. Section 
1848(f)(4)(A) of the Act indicates that the term ``physicians 
services'' includes other items and services specified by the Secretary 
that are commonly performed or furnished by a physician or in a 
physician's office. We disagree with the comments suggesting that the 
Secretary does not have the authority to include drugs in the 
definition of physicians' services for purposes of determining allowed 
expenditures, actual expenditures, and the SGR. We define ``physicians' 
services'' to include many of the medical and other health services 
listed in section 1861(s) of the Act that meet the criterion of being 
commonly performed by a physician or furnished in a physicians' office. 
Because ``incident to'' drugs covered under 1861(s) of the Act are 
commonly furnished in physicians' offices, we include these items in 
the calculation of the SGR and allowed expenditures.
    We have indicated in the past that retrospective removal of drugs 
from the SGR is statutorily difficult. For example, the statute 
requires the estimated SGR be refined twice based on actual data. We do 
not see a legal basis to re-estimate the SGR and allowed expenditures 
for a year after it has been estimated and revised twice. Further, as 
noted previously, our current estimate is that removing drugs 
retroactively from the SGR would not result in a positive update for 
2006 or the succeeding few years.
    Comment: CMS has clearly excluded drugs from physicans' services 
for purposes of administering other Medicare payment provisions. For 
example, in the December 13, 2002 Inherent Reasonableness rule (67 FR 
76684), CMS applied inherent reasonableness to certain Part B items and 
services other than physicians' services as defined and paid for under 
section 1848 of the Act, stating that drugs are paid under section 
1842(o) of the Act and not section 1848 of the Act. In response to 
comments, CMS asserted that the inherent reasonableness provision 
should therefore be applied to drugs administered in physicians' 
offices.
    Response: As we pointed out in the December 13, 2002 Federal 
Register, the statute specifies that inherent reasonableness applies to 
certain Part B items and services other than physicians' services as 
defined and paid for under section 1848 of the Act. Drugs are paid 
under section 1842(o) of the Act and not section 1848 of the Act. The 
application of inherent reasonableness to payments for drugs relates to 
the payment methodology for drugs, not to whether they are physicians' 
services. Accordingly, our decision to permit the application of 
inherent reasonableness to compute the payment amounts for Part B drugs 
is not inconsistent with our determination that it is appropriate to 
include drugs furnished incident to a physician's services in the 
definition of physicians' services for purposes of computing the SGR 
and actual and allowed expenditures under the physician fee schedule.
    Comment: We received many comments criticizing the ability of the 
current SGR methodology to appropriately reflect many factors affecting 
physician spending. For example, malpractice insurance continues to 
escalate; there is a general increase in overhead and inflation; and 
there are additional expenses associated with regulatory compliance for 
which the SGR is not adjusted. The SGR does not account for trends in 
utilization attributable to important technological improvements, 
improved quality of care, and efficiency in the health care system 
overall.
    Also, commenters stated that payment updates under the SGR formula 
are tied to GDP, which bears little relationship to patients' health 
care needs or physicians' practice costs because medical needs of 
individual patients are not related to the overall economy. Patients' 
needs do not diminish in slower economies, and are therefore wholly 
unrelated to measures of GDP. In addition, Medicare patients have more 
chronic diseases and require more medications, tests, counseling, and 
education than the average health care consumer; therefore, the time 
required to see a Medicare patient is disproportionately high relative 
to the Medicare payment received. Commenters are concerned that 
services to Medicare beneficiaries are not adequately reflected in GDP 
because they are disproportionately more expensive than services 
provided to the rest of the population.
    Commenters believe that reliance on GDP makes the SGR an inherently 
unstable system, and unnecessarily detracts from an appropriate focus 
on an analysis of actual data regarding the increasing costs of 
providing physicians' services to Medicare beneficiaries. The formula 
fails to consider the growth in beneficiary population and utilization 
factors unrelated to economic trends. The GDP is a factor beyond 
physicians' control and it is inappropriate to use it as a means to 
control growth in Medicare spending.
    Response: Under section 1848(d)(4) of the Act, the PFS update is 
equal to the product of the percentage increase in the MEI and the UAF. 
The UAF is determined by comparing allowed and actual expenditures from 
prior years and the current year, and adjusting the update to account 
for the difference. The SGR is used to calculate allowed expenditures, 
and the GDP is one of the components used to calculate the SGR. Change 
in enrollment in fee-for-service Medicare is one of the factors used in 
computing the SGR. (See section 1848(f)(2)(B) of the Act.)
    The percentage change in the MEI is one of the key components used 
to update the PFS CF. In accounting for the weighted average price 
change for various inputs involved with producing physicians' services, 
the MEI measures inflation in physician practice costs and general wage 
levels. Elements of the MEI include measures of physicians' PEs, 
including nonphysician employee compensation, office expenses, medical 
material and supplies, professional liability insurance, and medical 
equipment. As noted above in this section, professional liability 
insurance experienced the largest percentage increase of any component 
of the MEI for 2006.

[[Page 70308]]

    The GDP is a general measure of economic growth. It is not intended 
to reflect factors specific to operating a medical practice because 
these are captured in the MEI. Currently, the statute requires that we 
use the GDP as a component of the SGD, which is then used to calculate 
the target level of expenditures.
    We disagree with the comment that use of GDP makes the SGR 
inherently unstable. The SGR is based on the 10 year average of GDP, so 
year-to-year changes are averaged over a significant period, modulating 
any fluctuations from one year to the next.
    Comment: Some commenters stated that physicians are penalized with 
pay cuts when Medicare spending on physicians' services exceeds the SGR 
spending target, yet the SGR is not adjusted to take into account many 
factors beyond physicians' control, including government policies that, 
although good for patients, promote Medicare spending on physicians' 
services. Specifically, government-induced increases in spending on 
physicians' services should be accurately reflected in the SGR target. 
The impact of these government policies on spending for physicians' 
services is ignored or underestimated in calculating the target. New 
government policies often result not only in direct expenditures, but 
can also lead to ancillary new expenditures that are not appropriately 
reflected in the target. For example, new preventive benefits can lead 
to additional physician services, such as office visits. CMS has not 
provided details as to how its estimates of costs for new benefits are 
calculated under section 1848(f)(2)(D) of the Act, making it impossible 
to judge the accuracy of its target adjustments.
    Commenters also contend there have been a number of regulatory 
changes that encouraged growth in spending on physicians' services by 
shifting services from facilities to physicians' offices. Services 
previously provided by facilities (and not included in the calculation 
of actual and allowed expenditures in the base year) are now provided 
in physicians' offices, and are not reflected in the current level of 
allowed expenditures. For example, the growth in therapy services was 
influenced by the elimination of cost-based reimbursement to many 
facilities. This led many rehabilitation agencies to terminate their 
provider numbers and enroll as physical therapists in private practice. 
It also provided incentives for hospitals to discharge patients sooner, 
leading to increased therapy services paid under the physician fee 
schedule.
    Commenters urge CMS to adjust for other spending increases 
attributable to quality improvement programs that trigger physicians' 
services. Commenters provided examples of increased administrative 
demands and costs being imposed upon physicians through Federal program 
requirements including: transition of new and dually eligible 
beneficiaries into Medicare Part D drug plans; electronic prescribing; 
national demonstration on pay for performance; and Medicare policies on 
competitive acquisition for outpatient drugs and biologicals under Part 
B.
    Response: As described previously, the calculation of the SGR is 
determined by statute. Policy changes due to statute or regulation are 
required to be accounted for in the SGR calculation. For example, past 
changes that were expected to result in increased spending for therapy 
were reflected in prior years' SGR calculations. (See the CY 2002 Final 
Rule (66 FR 55320).) Similarly, last year we made an adjustment to the 
SGR to account for increased Medicare spending for physicians' services 
as a result of the MMA provisions providing for Medicare coverage of an 
initial preventive physical examination, cardiovascular, and diabetes 
screening tests. (See the CY 2005 Final Rule (69 FR 66388).) Based on 
subsequent data, we will revise these estimates and adjust the SGR as 
discussed in section F. of this preamble.
    Comment: We received many public comments that argued for adjusting 
the SGR for changes in expenditures resulting from national coverage 
determinations (NCDs). According to these comments, any changes in 
national Medicare coverage policy, such as a Program Memorandum or an 
NCD, constitute regulatory changes for purposes of computing the SGR. 
The commenters indicate that, because the statute provides the 
authority to adjust the SGR for statutory or regulatory changes, any 
new coverage initiative should be taken into account in determining the 
SGR.
    Commenters noted that CMS has previously stated that it is very 
difficult to estimate any costs or savings associated with specific 
coverage decisions. Additionally, CMS has stated that adjustments to 
the target for NCDs would likely be of such a small magnitude that it 
would have little effect on future projected updates. Commenters noted 
that CMS adjusts Medicare Advantage payments to account for NCDs, so 
clearly CMS has some means to estimate the costs of NCDs. Some 
commenters contracted with a private research firm to estimate the 
costs of several NCDs, to illustrate that it is possible to make such 
estimates and to provide a sense of their magnitude. These studies 
indicated that although certain individual NCDs do not significantly 
increase Medicare spending, some NCDs do have a significant impact. 
Furthermore, even if individually, the impacts of new NCDs are 
relatively minor, taken in the aggregate, even those NCDs with marginal 
impact contribute to rising utilization.
    Response: The large majority of Medicare spending is for services 
that are covered at local carrier discretion. While we may establish 
national coverage (or noncoverage) for a new item or service with a 
defined statutory benefit category, the NCD does not necessarily 
increase Medicare spending to the extent that the service has or would 
have been covered at local carrier discretion in the absence of a NCD. 
Because Medicare would cover these services without an NCD, it is 
unclear whether there are any additional costs associated with the 
NCDs. We may also issue an NCD to clarify Medicare coverage for 
existing items or services. This decision may establish national policy 
that replaces differing local practices. In these cases, there may not 
have been consistency among Medicare carriers as to whether an item or 
service qualified for coverage based on existing statute or regulation. 
Thus, our NCD would replace differing local practices with a national 
determination which, based on existing law and regulations, clarifies 
Medicare coverage for an item or service. Spending may or may not 
increase or decrease depending upon the degree to which the particular 
item or service is currently being covered by Medicare carriers and 
whether the decision is to establish coverage or noncoverage of the 
item or service. As a result, at this time, we do not intend to make 
any adjustment to the SGR to account for new NCDs. We will examine this 
issue further, for example, to determine the impact of new NCDs on 
Medicare spending for physicians' services above and beyond what would 
happen with LCDs, though we expect that these NCDs would have, at most, 
a limited impact.
    Comment: In response to the discussion in the proposed rule about 
substantial growth in Medicare spending in certain areas, commenters 
suggested that growth may be due to previously unmet needs that are 
only now being met. The commenters pointed out that nothing in the data 
presented suggested that the increased levels of service were 
inappropriate. Some commenters noted that since the introduction of the 
SGR methodology

[[Page 70309]]

many procedures have begun to move from settings, such as outpatient 
facilities, to physicians' offices. As a result, the full cost of these 
procedures is not reflected in either the SGR or allowed expenditures. 
Commenters believe CMS must recognize this shift in site of service and 
make appropriate adjustments to the target.
    Response: We are taking collaborative steps to better understand 
these trends, including what changes in utilization are likely to be 
associated with important health improvements and which have limited or 
questionable health benefits. We have been reviewing the technical 
aspects of this situation in detail with health policy experts as well 
as the AMA and various specialty societies. Generally, our analysis 
indicates that while there are some identifiable factors that have 
contributed to higher spending, these factors do not account for a 
substantial part of the growth in spending on physicians' services. 
Major contributors to the rapid increase in spending are more frequent 
and more intensive following visits, more frequent and more complex 
imaging, more frequent and more intensive minor procedures such as 
physical therapy, more frequent and more complex laboratory tests, and 
increased use of drugs in physicians' offices. There is also a lot of 
evidence of much variation in the use of these services without much 
evidence of impact on health outcomes. This variation reinforces our 
commitment to continuing to develop better evidence on what additional 
spending is effective as well as to moving our payment system toward 
recognizing better quality care. Moreover, the statute does not provide 
a mechanism for us to recognize additional expenditures on physicians' 
services resulting from changes in medical practice that are not also 
changes in law and regulation. As a result, we do not see any legal 
basis to make adjustment to the SGR to reflect the additional 
expenditures associated with these factors.

C. Preliminary Estimate of the SGR for 2006

    Our preliminary estimate of the 2006 SGR is 1.7 percent. We first 
estimated the 2006 SGR in March and made the estimate available to the 
Medicare Payment Advisory Commission and on our web site. Table 36 
shows that March 2005 and our current estimates of the factors included 
in the 2006 SGR.

                                         Table 36.--2006 SGR Calculation
----------------------------------------------------------------------------------------------------------------
           Statutory factors                   March estimate                      Current estimate
----------------------------------------------------------------------------------------------------------------
Fees...................................  2.8 percent (1.028).......  2.7 percent (1.027).
Enrollment.............................  -2.5 percent (0.975)......  -3.1 percent (0.969).
Real Per Capita GDP....................  2.3 percent (1.023).......  2.2 percent (1.022).
Law and Regulation.....................  0.0 percent (1.000).......  0.0 percent (1.000).
                                        -----------------------------
    Total..............................  2.5 percent (1.025).......  1.7 percent (1.017)
----------------------------------------------------------------------------------------------------------------


    Note: Consistent with section 1848(f)(2) of the Act, the 
statutory factors are multiplied, not added, to produce the total 
(that is, 1.027 x 0.969 x 1.022 x 1.000 = 1.017). A more detailed 
explanation of each figure is provided in section VII.F.1 of this 
preamble.

D. Revised Sustainable Growth Rate for 2005

    Our current estimate of the 2005 SGR is 4.6 percent. Table 37 shows 
our preliminary estimate of the 2005 SGR that was published in the CY 
2005 Final Rule (69 FR 66386) and our current estimate.

                                         Table 37.--2005 SGR Calculation
----------------------------------------------------------------------------------------------------------------
                                            Estimate from CY 2005
           Statutory factors                     Final Rule                        Current estimate
----------------------------------------------------------------------------------------------------------------
Fees...................................  1.3 percent (1.013).......  0.8 percent (1.008).
Enrollment.............................  -0.3 percent (0.997)......  0.3 percent (1.003).
Real Per Capita GDP....................  2.2 percent (1.022).......  2.2 percent (1.022).
Law and Regulation.....................  1.0 percent (1.010).......  1.2 percent (1.010).
                                        -----------------------------
    Total..............................  4.3 percent (1.043).......  4.6 percent (1.046).
----------------------------------------------------------------------------------------------------------------

    A more detailed explanation of each figure is provided in section 
VII.F.2 of this preamble.

E. Final Sustainable Growth Rate for 2004

    The SGR for 2004 is 6.6 percent. Table 38 shows our preliminary 
estimate of the 2004 SGR from the CY 2004 Final Rule (68 FR 63249), our 
revised estimate from the CY 2005 Final Rule (69 FR 66387) and the 
final figures determined using the latest available data.

                                         Table 38.--2004 SGR Calculation
----------------------------------------------------------------------------------------------------------------
                                    Estimate from CY     Estimate from CY
        Statutory factors           2004 Final Rule      2005 Final Rule                    Final
----------------------------------------------------------------------------------------------------------------
Fees............................  2.7 percent (1.027)  1.4 percent (1.014)  1.3 percent (1.013).
Enrollment......................  1.7 percent (1.017)  1.7 percent (1.017)  1.3 percent (1.013).
Real Per Capita GDP.............  2.8 percent (1.028)  2.2 percent (1.022)  2.1 percent (1.021).
Law and Reg.....................  0.0 percent (1.000)  1.5 percent (1.015)  1.7 percent (1.017).
                                 ----------------------
    Total.......................  7.4 percent (1.074)  7.0 percent (1.070)  6.6 percent (1.066).
----------------------------------------------------------------------------------------------------------------


[[Page 70310]]

    A more detailed explanation of each figure is provided in section 
VII.F.3.

F. Calculation of 2006, 2005, and 2004 Sustainable Growth Rates

1. Detail on the 2006 SGR
    All of the figures used to determine the 2006 SGR are estimates 
that will be revised based on subsequent data. Any differences between 
these estimates and the actual measurement of these figures will be 
included in future revisions of the SGR and allowed expenditures and 
incorporated into subsequent PFS updates.

<bullet> Factor 1--Changes in Fees for Physicians' Services (Before 
Applying Legislative Adjustments) for 2006

    This factor is calculated as a weighted-average of the 2006 fee 
increases for the different types of services included in the 
definition of physicians' services for the SGR. Medical and other 
health services paid using the PFS are estimated to account for 
approximately 83.1 percent of total allowed charges included in the SGR 
in 2006 and are updated using the MEI. The MEI for 2006 is 2.8 percent. 
Diagnostic laboratory tests are estimated to represent approximately 
7.2 percent of Medicare allowed charges included in the SGR for 2006. 
Medicare payments for these tests are updated by the Consumer Price 
Index for Urban Areas (CPI-U). However, section 629 of the MMA 
specifies that diagnostic laboratory services will receive an update of 
0.0 percent from 2004 through 2008.
    Drugs are estimated to represent 9.7 percent of Medicare allowed 
charges included in the SGR in 2006. Sections 303 and 304 of the MMA 
require Medicare to pay for most drugs at 106 percent of ASP beginning 
January 1, 2005. We estimated a weighted-average change in fees for 
drugs included in the SGR (using the ASP plus 6 percent pricing 
methodology) of 4.1 percent for 2006. Table 39 shows the weighted-
average of the MEI, laboratory and drug price changes for 2006.

                                Table 39
------------------------------------------------------------------------
                                                       Weight    Update
------------------------------------------------------------------------
Physician...........................................     0.831       2.8
Laboratory..........................................     0.072       0.0
Drugs...............................................     0.097       4.1
Weighted-average....................................     1.000       2.7
------------------------------------------------------------------------

    We estimate that the weighted-average increase in fees for 
physicians' services in 2006 under the SGR (before applying any 
legislative adjustments) will be 2.7 percent.

<bullet> Factor 2--The Percentage Change in the Average Number of Part 
B Enrollees From 2005 to 2006

    This factor is our estimate of the percent change in the average 
number of fee-for-service enrollees from 2005 to 2006. Services 
provided to Medicare Advantage (MA) plan enrollees are outside the 
scope of the SGR and are excluded from this estimate. OACT estimates 
that the average number of Medicare Part B fee-for-service enrollees 
will decrease by -3.1 percent from 2005 to 2006. Table 40 illustrates 
how this figure was determined.

                                Table 40
------------------------------------------------------------------------
                                     2005                 2006
------------------------------------------------------------------------
Overall......................  39.536 million.  40.059 million.
Medicare Advantage (MA)......  5.070 million..  6.654 million.
Net..........................  34.466 million.  33.405 million.
Percent Increase.............  ...............   -3.1 percent.
------------------------------------------------------------------------

    An important factor affecting fee-for-service enrollment is 
beneficiary enrollment in MA plans. Because it is difficult to estimate 
the size of the MA enrollee population before the start of a calendar 
year, at this time we do not know how actual enrollment in MA plans 
will compare to current estimates. For this reason, the estimate may 
change substantially as actual Medicare fee-for-service enrollment for 
2006 becomes known.

<bullet> Factor 3--Estimated Real Gross Domestic Product Per Capita 
Growth in 2006

    We estimate that the growth in real GDP per capita from 2005 to 
2006 will be 2.2 percent (based on the 10-year average GDP over the ten 
years of 1997-2006). Our past experience indicates that there have also 
been changes in estimates of real per capita GDP growth made before the 
year begins and the actual change in GDP computed after the year is 
complete. Thus, it is possible that this figure will change as actual 
information on economic performance becomes available to us in 2006.

<bullet> Factor 4--Percentage Change in Expenditures for Physicians' 
Services Resulting From Changes in Statute or Regulations in 2006 
Compared With 2005

    The statutory and regulatory provisions that will affect 
expenditures in CY 2006 relative to CY 2005 are estimated to have an 
impact on expenditures of less than 0.05 percent. These provisions 
include the expiration of the temporary higher payments to physicians 
in Alaska, the new powered wheelchair code for physicians, and the 
impact of the new IVIG service discussed elsewhere in this final rule 
with comment.
2. Detail on the 2005 SGR
    A more detailed discussion of our revised estimates of the four 
elements of the 2005 SGR follows.

<bullet> Factor 1--Changes in Fees for Physicians' Services (Before 
Applying Legislative Adjustments) for 2005

    This factor was calculated as a weighted-average of the 2005 fee 
increases that apply for the different types of services included in 
the definition of physicians' services for the SGR.
    We estimate that services paid using the PFS account for 
approximately 84.3 percent of total allowed charges included in the SGR 
in 2005. These services were updated using the 2005 MEI of 3.1 percent. 
We estimate that diagnostic laboratory tests represent approximately 
7.0 percent of total allowed charges included in the SGR in 2005. 
Medicare payments for these tests are updated by the CPI-U. However, 
section 629 of the MMA specifies that diagnostic laboratory services 
will receive an update of 0.0 percent from 2004 through 2008.
    We estimate that drugs represent 8.7 percent of Medicare allowed 
charges included in the SGR in 2005. Sections 303 and 304 of the MMA 
require

[[Page 70311]]

Medicare to pay for most drugs at 106 percent of ASP beginning January 
1, 2005. We now estimate a weighted-average change in fees for drugs 
included in the SGR of -21.1 percent for 2005. The estimated weighted-
average change in the CY 2005 Final Rule was -14.7 percent. The decline 
in the estimate is due to updated ASP data. Table 41 shows the 
weighted-average of the MEI, laboratory and drug price changes for 
2005.

                                Table 41
------------------------------------------------------------------------
                                                   Weight       Update
------------------------------------------------------------------------
Physician.....................................        0.843          3.1
Laboratory....................................        0.070          0.0
Drugs.........................................        0.087        -21.1
Weighted-average..............................        1.000          0.8
------------------------------------------------------------------------

    After taking into account the elements described in Table 41, we 
estimate that the weighted-average increase in fees for physicians' 
services in 2005 under the SGR (before applying any legislative 
adjustments) will be 0.8 percent. Our estimate of this factor in the CY 
2005 Final Rule was 1.3 percent. The reduction from 1.3 percent to our 
current estimate of 0.8 percent is primarily due to application of the 
drug pricing changes required by sections 303 and 304 of the MMA.

<bullet> Factor 2--The Percentage Change in the Average Number of Part 
B Enrollees From 2004 to 2005

    OACT estimates that the average number of Medicare Part B fee-for-
service enrollees (excluding beneficiaries enrolled in M+C plans) 
increased by 0.3 percent in 2005. Table 42 illustrates how we 
determined this figure.

                                Table 42
------------------------------------------------------------------------
                                     2004                 2005
------------------------------------------------------------------------
Overall......................  39.048 million.  39.536 million.
Medicare+Choice..............  4.683 million..  5.070 million.
Net..........................  34.366 million.  34.466 million.
Percent Increase.............  ...............  0.3 percent.
------------------------------------------------------------------------

    OACT's estimate of the 0.3 percent change in the number of fee-for-
service enrollees, net of M+C enrollment for 2005 compared to 2004, is 
greater than our original estimate of -0.3 percent in the CY 2005 Final 
Rule (69 FR 66388). While our current projection based on data from 8 
months of 2005 is greater than our original estimate of -0.3 percent 
when we had no data, it is still possible that our final estimate of 
this figure will be different once we have complete information on 2005 
fee-for-service enrollment.

<bullet> Factor 3--Estimated Real Gross Domestic Product Per Capita 
Growth in 2005

    We estimate that the growth in real GDP per capita will be 2.2 
percent for 2005 (based on the 10-year average GDP over the ten years 
of 1996-2005). Our past experience indicates that there have also been 
differences between our estimates of real per capita GDP growth made 
prior to the year's end and the actual change in this factor. Thus, it 
is possible that this figure will change further as complete actual 
information on 2005 economic performance becomes available to us in 
2006.

<bullet> Factor 4--Percentage Change in Expenditures for Physicians' 
Services Resulting From Changes in Statute or Regulations in 2005 
Compared With 2004

    There are a number of statutory provisions that affect the 2005 
SGR. As mentioned previously in the preamble, sections 303 and 304 of 
the MMA changed Medicare payment for drugs. These provisions also 
changed Medicare payments for the administration of drugs. Section 
303(a)(1) of the MMA amended section 1848(c)(2) of the Act to require 
the Secretary to make a number of changes that increased Medicare 
payment for drug administration beginning January 1, 2004. These 
changes permanently increased Medicare payments for drug administration 
by a weighted-average of 110 percent. Section 303(a)(4) of the MMA 
required an additional transitional adjustment (temporary increase) to 
Medicare's payment for drug administration of 32 percent for 2004 and 3 
percent for 2005. The change in the transitional adjustment of 32 
percent for 2004 to 3 percent for 2005 would reduce Medicare payments 
for drug administration between 2004 and 2005. However, some of this 
reduction will be lessened because we also adopted changes to the codes 
and payment amounts for drug administration based on recommendations 
from the AMA's CPT Editorial Panel and Relative Value Update Committee 
(RUC), under the authority of section 1848(c)(2)(J) of the Act. We 
further increased PFS payments by paying separately for injections 
provided on the same day as another PFS service. We estimate that 
changes to our policy on injections and the changes to our drug 
administration payments taken together increased physician spending by 
0.8 percent.
    There are several other statutory provisions that are estimated to 
increase Medicare spending for physicians' services under the SGR. 
Section 413(a) of the MMA establishes a 5 percent increase in the PFS 
payment for services provided in physician scarcity areas. Section 
413(b) of the MMA improves the procedures for paying the 10 percent PFS 
bonus payment for services provided in health professional shortage 
areas. We estimate that the provisions of section 413 of the MMA will 
increase Medicare PFS payments by 0.1 percent.
    Sections 611 through 613 of the MMA provide Medicare coverage for 
an initial preventive physical examination, cardiovascular and diabetes 
screening tests. We estimate that new Medicare coverage for these 
preventive services will increase spending for physicians' services 
under the SGR by 0.3 percent. Taken together, we estimate that all of 
the statutory provisions for 2005 will increase Medicare spending for 
physicians' services by 1.2 percent.
3. Detail on the 2004 SGR
    A more detailed discussion of our final revised estimates of the 
four elements of the 2004 SGR follows.

<bullet> Factor 1--Changes in Fees for Physicians' Services (Before 
Applying Legislative Adjustments) for 2004

    This factor was calculated as a weighted-average of the 2004 fee 
increases that apply for the different types of services included in 
the definition of physicians' services for the SGR.
    Services paid using the PFS accounted for approximately 83.3

[[Page 70312]]

percent of total Medicare allowed charges included in the SGR for 2004 
and are updated using the MEI. The MEI for 2004 was 2.9 percent. 
Diagnostic laboratory tests represented approximately 6.8 percent of 
total 2004 Medicare allowed charges included in the SGR and are updated 
by the CPI-U. However, section 629 of the MMA specifies that diagnostic 
laboratory services will receive an update of 0.0 percent from 2004 
through 2008. Drugs represented approximately 9.9 percent of total 
Medicare allowed charges included in the SGR for 2004. Historically, 
Medicare paid for drugs under section 1842(o) of the Act at 95 percent 
of average wholesale price (AWP). However, with some exceptions, 
sections 303 and 304 of the MMA generally require Medicare to pay for 
drugs at 85 percent of the AWP determined as of April 1, 2003, or a 
specified percentage of AWP based on studies by the Government 
Accountability Office and the Office of the Inspector General in 2004. 
We implemented section 303 and 304 of the MMA in an interim final rule 
making changes to the PFS for 2004, which appeared in the Federal 
Register on January 7, 2004 (see 69 FR 1086). Taking sections 303 and 
304 of the MMA into account, we estimate a weighted-average change in 
fees for drugs included in the SGR of -11.5 percent for 2004. Table 43 
shows the weighted-average of the MEI, laboratory, and drug price 
increases for 2004.

                                Table 43
------------------------------------------------------------------------
                                                   Weight       Update
------------------------------------------------------------------------
Physician.....................................        0.833          2.9
Laboratory....................................        0.068          0.0
Drugs.........................................        0.099        -11.5
Weighted-average..............................        1.000          1.3
------------------------------------------------------------------------

    After taking into account the elements described in Table 43, we 
estimate that the weighted-average increase in fees for physicians' 
services in 2004 under the SGR (before applying any legislative 
adjustments) was 1.3 percent.

<bullet> Factor 2--The Percentage Change in the Average Number of Part 
B Enrollees From 2003 to 2004

    We estimate the increase in the number of fee-for-service enrollees 
(excluding beneficiaries enrolled in M+C plans) from 2003 to 2004 was 
1.3 percent. Our calculation of this factor is based on complete data 
from 2004. Table 44 illustrates the calculation of this factor.

                                Table 44
------------------------------------------------------------------------
                                     2003                 2004
------------------------------------------------------------------------
Overall......................  38.465 million.  39.048 million.
Medicare+Choice..............  4.655 million..  4.683 million.
Net..........................  33.810 million.  34.366 million.
Percent Increase.............  ...............  1.3 percent.
------------------------------------------------------------------------

<bullet> Factor 3--Estimated Real Gross Domestic Product Per Capita 
Growth in 2004

    We estimate that the growth in real per capita GDP was 2.1 percent 
in 2004 (based on the 10-year average GDP over the ten years of 1995-
2004). This figure is a final one based on complete data for 2004.

<bullet> Factor 4--Percentage Change in Expenditures for Physicians' 
Services Resulting From Changes in Statute or Regulations in 2004 
Compared With 2003

    There are four statutory provisions that increased 2004 Medicare 
spending relative to 2003. Section 412 of the MMA established a floor 
of 1.0 on adjustments to the physician work relative value unit for the 
GPCI for the years 2004 through 2006. Section 602 of the MMA increased 
the GPCIs for work, PE, and malpractice in Alaska to 1.67. We estimate 
that sections 412 and 602 of the MMA increased 2004 Medicare spending 
included in the SGR by 0.6 percent. Sections 303 and 304 of the MMA 
increased Medicare's payments for drug administration in 2004. It 
further exempted the increases in payment from the budget neutrality 
provisions of section 1848(c)(2) of the Act. We estimate the section 
303 and 304 provisions increased spending for physicians' services by 
1.0 percent in 2004. Taken together, we estimate that statutory 
provisions increased 2004 spending for physicians' services by 1.7 
percent (after accounting for rounding).

VIII. Anesthesia and Physician Fee Schedule Conversion Factors (CF) for 
CY 2006

    The 2006 PFS CF will be $36.1770. The 2006 national average 
anesthesia CF is $16.9591.

A. Physician Fee Schedule Conversion Factor

    Under section 1848(d)(1)(A) of the Act, the PFS CF is equal to the 
CF for the previous year multiplied by the update determined under 
section 1848(d)(4) of the Act.
    Under section 1848(c)(2) of the Act, adjustments to RVUs may not 
cause the amount of expenditures to differ by more than $20 million 
from the amount of expenditures that would have resulted without such 
adjustments. As described earlier, we are implementing several changes 
to the work RVUs that would result in a change in expenditures that 
would exceed $20 million if we made no offsetting adjustments to either 
the conversion factor or RVUs.
    With respect to the work RVUs, our policy has been to meet the 
budget-neutrality requirements in the statute by making an adjustment 
to the conversion factor. That is, we estimate the aggregate number of 
work RVUs that will be paid under current and revised policy in CY 
2006. We apply a uniform adjustment factor to the conversion factor to 
make the aggregate payments under the revised work RVUs equal the 
aggregate payments under the current work RVUs. As a result of the 2006 
work RVU changes described earlier, we will be making an adjustment of 
.9985 percent to the conversion factor to meet the budget neutrality 
requirements in the statute. Note that this adjustment is also being 
applied to the anesthesia fee schedule as shown in table 46.
    We illustrate the calculation for the 2006 PFS CF in Table 45.

                                Table 45
------------------------------------------------------------------------
 
------------------------------------------------------------------------
2005 Conversion Factor.................  $37.8975.
2006 Update............................  -4.4 percent.
2006 Adjustment for Work RVU Changes...  .9985.
2006 Conversion Factor.................  $36.1770.
------------------------------------------------------------------------


[[Page 70313]]

B. Anesthesia Fee Schedule Conversion Factor

    Anesthesia services do not have RVUs like other PFS services. 
Therefore, we account for any necessary RVU adjustments through an 
adjustment to the anesthesia fee schedule CF to simulate changes to 
RVUs. We modeled the resource-based practice expense methodology using 
imputed anesthesia RVUs that were made comparable to other physician 
fee schedule services. As a result of modeling practice expense 
changes, we are incorporating a 1.00039 adjustment to the anesthesia 
fee schedule conversion factor. We used the following figures to 
determine the anesthesia fee schedule CF (see Table 46).

                                Table 46
------------------------------------------------------------------------
 
------------------------------------------------------------------------
2005 Anesthesia Conversion Factor        $17.7594.
2006 Update                              -4.4 percent.
2006 Adjustment for Work RVU Changes     .9985.
2006 Adjustment for PE Changes           1.00039.
2006 Anesthesia Conversion Factor        $16.9591.
------------------------------------------------------------------------

IX. Telehealth Originating Site Facility Fee Payment Amount Update

    Section 1834(m) of the Act establishes the payment amount for the 
Medicare telehealth originating site facility fee for telehealth 
services provided from October 1, 2001 through December 31 2002, at 
$20. For telehealth services provided on or after January 1 of each 
subsequent calendar year, the telehealth originating site facility fee 
is increased by the percentage increase in the MEI as defined in 
section 1842(i)(3) of the Act. The MEI increase for 2006 is 2.8 
percent.
    Therefore, for CY 2006, the payment amount for HCPCS code ``Q3014, 
telehealth originating site facility fee'' is 80 percent of the lesser 
of the actual charge or $22.47. The Medicare telehealth originating 
site facility fee and MEI increase by the applicable time period is 
shown in Table 47.

                                Table 47
------------------------------------------------------------------------
                                MEI increase
        Facility fee             (percent)               Period
------------------------------------------------------------------------
$20.00......................              N/A      10/01/2001-12/31/2002
$20.60......................              3.0      01/01/2003-12/31/2003
$21.20......................              2.9      01/01/2004-12/31/2004
$21.86......................              3.1      01/01/2005-12/31/2005
$22.47......................              2.8      01/01/2006-12/31/2006
------------------------------------------------------------------------

X. Provisions of the Final Rule With Comment

    The provisions of this final rule with comment restate the 
provisions of the August 2005 proposed rule, except as noted elsewhere 
in the preamble.

XI. Waiver of Proposed Rulemaking

    We ordinarily publish a notice of proposed rulemaking in the 
Federal Register and invite public comment on the proposed rule. The 
notice of proposed rulemaking includes a reference to the legal 
authority under which the rule is proposed, and the terms and 
substances of the proposed rule or a description of the subjects and 
issues involved. This procedure can be waived, however, if an agency 
finds good cause that a notice-and-comment procedure is impracticable, 
unnecessary, or contrary to the public interest and incorporates a 
statement of the finding and its reasons in the rule issued.
    As discussed in sections III. and V. of this final rule with 
comment, we utilize HCPCS codes for Medicare payment purposes. The 
HCPCS is a national drug coding system comprised of Level I (CPT) codes 
and Level II (HCPCS National Codes) that are intended to provide 
uniformity to coding procedures, services, and supplies across all 
types of medical providers and suppliers. Level I (CPT) codes are 
copyrighted by the AMA and consist of several categories, including 
Category I codes which are 5-digit numeric codes, and Category III 
codes which are temporary codes to track emerging technology, services 
and procedures.
    The AMA issues an annual update of the CPT code set each Fall, with 
January 1 as the effective date for implementing the updated CPT codes. 
The HCPCS, including both Level I and Level II codes, is similarly 
updated annually on a CY basis. Annual coding changes are not available 
to the public until the Fall immediately preceding the annual January 
update of the PFS. Because of the timing of the release of these new 
codes, it is impracticable for CMS to provide prior notice and solicit 
comment on these codes and the RVUs assigned to them in advance of 
publication of the final rule that implements the PFS. Yet, it is 
imperative that these coding changes be accounted for and recognized 
timely under the PFS for payment because services represented by these 
codes will be provided to Medicare beneficiaries by physicians during 
the CY in which they become effective. Moreover, regulations 
implementing HIPAA (42 CFR parts 160 and 162) reguire that the HCPCS be 
used to report health care services, including services paid under the 
PFS. We also assign interim RVUs to any new codes based on a review of 
the RUC recommendations for valuing these services. By reviewing these 
RUC recommendations for the new codes, we are able to assign RVUs to 
services based on input from the medical community and to establish 
payment for them, on an interim basis, that corresponds to the relative 
resources associated with providing the services. If we did not assign 
RVUs to new codes on an interim basis, the alternative would be to 
either not pay for these services during the initial CY or have each 
carrier establish a payment rate for these new codes. We believe both 
of these alternatives are contrary to the public interest, particularly 
since the RUC process allows for an assessment of the valuation of 
these services by the medical community prior to our establishing 
payment for these codes on an interim basis. Therefore, we believe it 
would be contrary to the public interest to delay establishment of fee 
schedule payment amounts for these codes.
    For the reasons outlined above, we find good cause to waive the 
notice of proposed rulemaking for the interim RVUs for selected 
procedure codes identified in Addendum C and to establish RVUs for 
these codes on an interim final basis. We are providing a 60-day public 
comment period.

XII. Collection of Information Requirements

    Under the Paperwork Reduction Act of 1995, we are required to 
provide 60-

[[Page 70314]]

day notice in the Federal Register and solicit public comment before a 
collection of information requirement is submitted to the Office of 
Management and Budget (OMB) for review and approval. In order to fairly 
evaluate whether an information collection should be approved by OMB, 
section 3506(c)(2)(A) of the Paperwork Reduction Act of 1995 requires 
that we solicit comment on the following issues:
    <bullet> The need for the information collection and its usefulness 
in carrying out the proper functions of our agency.
    <bullet> The accuracy of our estimate of the information collection 
burden.
    <bullet> The quality, utility, and clarity of the information to be 
collected.
    <bullet> Recommendations to minimize the information collection 
burden on the affected public, including automated collection 
techniques.
    We are soliciting public comment on each of these issues for the 
following sections of this document that contain information collection 
requirements:

Section 413.180 Procedures for Requesting Exceptions to Payment Rates

    Paragraph (b) specifies the criteria for a pediatric ESRD facility 
requesting an exception to payment rates.
    Paragraph (e) outlines the documentation that a pediatric ESRD 
facility must submit to CMS when requesting an exception to its payment 
rates. Paragraph (i) discusses the period of approval for payment 
exception requests. A prospective exception payment rate approved by 
CMS applies for the period from the date the complete exception request 
was filed with its intermediary until thirty days after the 
intermediary's receipt of the facility's letter notifying the 
intermediary of the facility's request to give up its exception rate.
    The burden associated with the requirements in paragraph (e) is the 
time and effort required by the facility to prepare and submit the 
exception request to CMS. The burden associated with the requirement in 
paragraph (i) is the time and effort required by the facility to draft 
and mail the letter that notifies the intermediary of the facilities 
request to give up its exception rate.
    The collection requirement in this section has not changed. While 
this requirement is subject to the PRA, this requirement is currently 
approved in OMB No. 0938-0296.

Section 413.184 Payment Exception: Pediatric Patient Mix

    Paragraph (b) specifies the documentation requirements that a 
pediatric ESRD facility must meet in order to qualify for an exception 
to its prospective payment rate based on its pediatric patient mix. In 
addition to the other qualifications specified in this section, this 
section states that a facility must submit a listing of all outpatient 
dialysis patients (including all home patients) treated during the most 
recently completed and filed cost report.
    The burden associated with this requirement is the time and effort 
for the facility to submit a listing of all outpatient dialysis 
patients (including all home patients) treated during the most recently 
completed and filed cost report.
    The collection requirement in this section has not changed. While 
this requirement is subject to the PRA, this requirement is currently 
approved in OMB No. 0938-0296.

Section 413.186 Payment Exception: Self-Dialysis Training Costs in 
Pediatric Facilities

    In summary, this section outlines the requirements a pediatric ESRD 
facility must meet to qualify for an exception to the prospective 
payment rate based on self-dialysis training costs. Paragraph (e) 
states that a facility must provide specific information to support its 
exception request. Paragraph (f) states that in addition to the other 
qualifications outlined in this section, pediatric ESRD facility must 
submit with its exception request a list of patients, by modality, 
trained during the most recent cost report period, in order to justify 
its accelerated training exception request.
    The burden associated with these requirements is the time and 
effort for the facility to prepare and submit the required information 
to support its exception request, and the time and effort for the 
pediatric ESRD facility to prepare and submit with its exception 
request a list of patients, by modality, trained during the most recent 
cost report period.
    The collection requirements in this section have not changed. While 
these requirements are subject to the PRA, they are currently approved 
in OMB No.0938-0296.

Section 414.804 Basis of Payment

    In summary, this section requires manufacturers to report ASP data 
to CMS. This section details the process a manufacturer must follow to 
calculate the ASP. The ASP reporting requirements are discussed in 
further detail in the interim final rule with comment, Medicare 
Program; Manufacturer Submission of Manufacturer's Average Sales Price 
(ASP) Data for Medicare Part B Drugs and Biologicals, that published on 
April 2, 2004 in the Federal Register (69FR17935-17941).
    The burden associated with these requirements is the time and 
effort required by manufacturers of Medicare Part B Drugs and 
biologicals to prepare and submit to the required ASP data to CMS.
    While these requirements are subject to the PRA, the requirements 
are currently approved in OMB No. 0938-0921, with a current expiration 
date of September 30, 2007.
    We intend to revise this information collection to include adequate 
instructions for manufacturers to report the ASP, the WAC, and other 
data elements. These revisions will be addressed in detail in a revised 
information collection request in accordance with the Paperwork 
Reduction Act of 1995.
    We have submitted a copy of this proposed rule to OMB for its 
review of the information collection requirements described above. 
These requirements are not effective until they have been approved by 
OMB.
    If you comment on these information collection and recordkeeping 
requirements, please mail copies directly to the following:
    Centers for Medicare & Medicaid Services, Office of Strategic 
Operations and Regulatory Affairs, Regulations Development Group, Attn: 
Jim Wickliffe, [CMS-1502-P], Room C4-26-05, 7500 Security Boulevard, 
Baltimore, MD 21244-1850; and
    Office of Information and Regulatory Affairs, Office of Management 
and Budget, Room 10235, New Executive Office Building, Washington, DC 
20503, Attn: Brenda Aguilar, CMS Desk Officer, CMS-1502-P, 
<a href="/cdn-cgi/l/email-protection#bcfeced9d2d8dd92fddbc9d5d0ddcefcd3d1de92d9d3cc92dbd3ca"><span class="__cf_email__" data-cfemail="76340413181217583711031f1a170436191b145813190658111900">[email protected]</span></a>. Fax (202) 395-6974.

XIII. Response to Comments

    Because of the large number of public comments we normally receive 
on Federal Register documents, we are not able to acknowledge or 
respond to them individually. We will consider all comments we receive 
by the date and time specified in the DATES section of this preamble, 
and, when we proceed with a subsequent document, we will respond to the 
comments in the preamble to that document.

XIV. Regulatory Impact Analysis

    We have examined the impact of this rule as required by Executive 
Order 12866 (September 1993, Regulatory Planning and Review), the 
Regulatory Flexibility Act (RFA) (September 19, 1980 Pub. L. 96-354), 
section 1102(b) of the Social Security Act, the Unfunded

[[Page 70315]]

Mandates Reform Act of 1995 (Pub. L. 104-4), and Executive Order 13132.
    Executive Order 12866 (as amended by Executive Order 13258, which 
merely reassigns responsibilities of duties) directs agencies to assess 
all costs and benefits of available regulatory alternatives and, when 
regulation is necessary, to select regulatory approaches that maximize 
net benefits (including potential economic, environmental, public 
health and safety effects, distributive impacts, and equity). A 
regulatory impact analysis must be prepared for final rules with 
economically significant effects (that is, a final rule that would have 
an annual effect on the economy of $100 million or more in any one 
year, or would adversely affect in a material way the economy, a sector 
of the economy, productivity, competition, jobs, the environment, 
public health or safety, or State, local, or tribal governments or 
communities). As indicated in more detail below, we estimate that the 
PFS provisions included in this final rule with comment will 
redistribute more than $100 million in one year. We are considering 
this final rule with comment to be economically significant because its 
provisions are estimated to result in an increase, decrease or 
aggregate redistribution of Medicare spending that will exceed $100 
million. Therefore, this final rule with comment is a major rule and we 
have prepared a regulatory impact analysis.
    The RFA requires that we analyze regulatory options for small 
businesses and other entities. We prepare a regulatory flexibility 
analysis unless we certify that a rule would not have a significant 
economic impact on a substantial number of small entities. The analysis 
must include a justification concerning the reason action is being 
taken, the kinds and number of small entities the rule affects, and an 
explanation of any meaningful options that achieve the objectives with 
less significant adverse economic impact on the small entities.
    Section 1102(b) of the Act requires us to prepare a regulatory 
impact analysis for any rule that may have a significant impact on the 
operations of a substantial number of small rural hospitals. This 
analysis must conform to the provisions of section 604 of the RFA. For 
purposes of section 1102(b) of the Act, we define a small rural 
hospital as a hospital that is located outside a Metropolitan 
Statistical Area and has fewer than 100 beds. We have determined that 
this final rule with comment would have minimal impact on small 
hospitals located in rural areas. Of 227 hospital-based ESRD facilities 
located in rural areas, only 40 are affiliated with hospitals with 
fewer than 100 beds.
    For purposes of the RFA, physicians, nonphysician practitioners, 
and suppliers are considered small businesses if they generate revenues 
of $6 million or less. Approximately 95 percent of physicians are 
considered to be small entities. There are about 875,000 physicians, 
other practitioners and medical suppliers that receive Medicare payment 
under the PFS.
    For purposes of the RFA, approximately 90 percent of suppliers of 
durable medical equipment (DME) and prosthetic devices are considered 
small businesses according to the Small Business Administration's (SBA) 
size standards. We estimate that 106,000 entities bill Medicare for 
durable medical equipment, prosthetics, orthotics, and supplies 
(DMEPOS) each year. Total annual estimated Medicare revenues for DME 
suppliers exceed approximately $8.5 billion in 2004. Of this amount, 
approximately $1.4 billion were for nebulizer drugs in 2004. The vast 
majority, 95 percent, of retail pharmacy companies are small businesses 
as measured by the SBA size standard. Approximately, 16,000 pharmacies 
billed Medicare for immunosuppressive, oral anti-cancer, or oral anti-
emetic drugs in 2004. Pharmacies received Medicare revenues for those 
drugs of approximately $350 million in 2004.
    In addition, most ESRD facilities are considered small entities, 
either based on nonprofit status or by having revenues of $29 million 
or less in any year. We consider a substantial number of entities to be 
affected if the final rule is estimated to impact more than 5 percent 
of the total number of small entities. Based on our analysis of the 957 
nonprofit ESRD facilities considered small entities in accordance with 
the above definitions, we estimate that the combined impact of the 
changes to payment for renal dialysis services included in this final 
rule with comment would have a 1.5 percent decrease in payments 
relative to current payments.
    The impact of the CAP provisions included in this final rule with 
comment on an individual physician is dependent on whether the drugs 
they provide to Medicare beneficiaries are included in the list of CAP 
drugs and whether the physician chooses to obtain drugs administered to 
Medicare beneficiaries through the CAP.
    In addition, the CAP provisions in this rule will have a potential 
impact on entities, either existing or formed specifically for this 
purpose, that are involved in the dispensing or distribution of drugs. 
The impact is dependent on the ability of potential vendors to 
successfully compete on a national level and receive approval as a 
vendor under the CAP.
    The analysis and discussion provided in this section, as well as 
elsewhere in this final rule with comment, complies with the RFA 
requirements.
    Section 202 of the Unfunded Mandates Reform Act of 1995 also 
requires that agencies assess anticipated costs and benefits before 
issuing any rule that may result in expenditures in any year by State, 
local, or tribal governments, in the aggregate, or by the private 
sector, of $120 million. Medicare beneficiaries are considered to be 
part of the private sector for this purpose.
    We have examined this final rule with comment in accordance with 
Executive Order 13132 and have determined that this regulation would 
not have any significant impact on the rights, roles, or 
responsibilities of State, local, or tribal governments. A discussion 
concerning the impact of this rule on beneficiaries is found later in 
this section.
    We have prepared the following analysis, which, together with the 
information provided in the rest of this preamble, meets all assessment 
requirements. It explains the rationale for and purposes of the rule; 
details the costs and benefits of the rule; analyzes alternatives; and 
presents the measures we plan to use to minimize the burden on small 
entities. As indicated elsewhere in this final rule with comment, we 
are making a variety of changes to our regulations, payments, or 
payment policies to ensure that our payment systems reflect changes in 
medical practice and the relative value of services. We provide 
information for each of the policy changes in the relevant sections of 
this final rule with comment. We are unaware of any relevant Federal 
rules that duplicate, overlap or conflict with this rule. The relevant 
sections of this final rule with comment contain a description of 
significant alternatives if applicable.

A. Resource-Based Work and PE RVUs

    Under section 1848(c)(2) of the Act, adjustments to RVUs may not 
cause the amount of expenditures to differ by more than $20 million 
from the amount of expenditures that would have resulted without such 
adjustments. We are implementing several changes that would result in a 
change in expenditures that would exceed $20 million if we made no 
offsetting adjustments to either the CF or RVUs.
    With respect to the work RVUs, our policy has been to meet the 
budget-neutrality requirements in the statute by

[[Page 70316]]

making an adjustment to the CF. That is, we estimate the aggregate 
number of work RVUs that will be paid under current and revised policy 
in CY 2006. We apply a uniform adjustment factor to the CF to make the 
aggregate payments under the revised work RVUs equal the aggregate 
payments under the current work RVUs. As a result of the 2006 work RVU 
changes described earlier, we will be making an adjustment of -0.6 
percent to the CF to meet the budget neutrality requirements in the 
statute.
    For PE RVUs, our policy has been to meet the budget-neutrality 
requirements in the statute by incorporating a rescaling adjustment in 
the PE methodologies. That is, we estimate the aggregate number of PE 
RVUs that will be paid under current and revised policy in CY 2006. We 
apply a uniform adjustment factor to make the aggregate number of 
revised PE RVUs equal the number estimated that would be paid under 
current policy. While we are continuing to apply this policy for 
general changes in coding and RVUs, we are increasing aggregate PFS 
payments to account for the higher payments for drug administration 
services resulting from the incorporation of the survey data submitted 
by the AUA. These increases in payment are being made under the 
authority of section 1848(c)(2)(J) of the Act that exempts the changes 
in payments for drug administration from the budget neutrality 
requirements of section 1848(c)(2)(B)(iv) of the Act.
    As described earlier, we will base PE payments in 2006 on the 
current 2005 PE RVUs to the extent practicable after making changes 
required by law, such as the incorporation of the urology survey for 
the drug administration codes. In the situation where a code is new in 
2006 and we do not have 2005 PE RVUs, we created new PE RVUs to use as 
the basis for 2006 payments. Table 49, Impact of CY 2006 RVU Changes, 
Multiple Imaging Discount, and Conversion Factor Update on Total 
Medicare Allowed Charges by Specialty, shows the percentage impact by 
specialty of the PE changes in combination with other changes being 
implemented.
    The -4 percent decrease in payment for clinical psychology shown in 
the PE refinements column in Table 49 is attributable to the deletion 
of several codes and creation of new codes for certain psychological 
testing services. The deleted codes had reflected the practitioner's 
work in the PE RVUs. As indicated in Table 29 of section III.D., we 
accepted the recommendation of the RUC's HCPAC for work RVUs for the 
new codes. Thus, there is a shift in payment from the PE RVUs to the 
work RVUs for these psychological testing codes. We note that the 
increase in the payment in the work RVUs exceeds the decrease in 
payment in the PE RVUs, causing an overall net increase in payments to 
clinical psychologists of 2 percent as a result of the shift from the 
PE RVUs to the work RVUs for these new codes. While not included in 
table 49, we estimate that temporary payment associated with IVIG 
described previously will result in approximately $10 million in 
additional CY 2006 allowed charges under the PFS.

B. Malpractice RVUs

    As discussed in section II C. of this final rule with comment, we 
are making technical changes to the calculation of the malpractice 
RVUs. We are removing the malpractice data for specialties that occur 
less than 5 percent of the time in our data for a procedure code; 
adopting several changes to the crosswalks used to assign risk factors 
to specialties for which we did not otherwise have data; using the 
lowest risk factor of 1.00 for clinical psychology, licensed clinical 
social work, chiropractors, and physical therapists; and adding 
cardiology catheterization and angioplasty codes to the list of codes 
for which we apply surgical rather than nonsurgical risk adjustment 
factors. Table 49 shows the combined impact of these changes. The 
impact of these methodological changes in the calculation of resource-
based malpractice expense RVUs is negligible as malpractice RVUs 
account for less than 4 percent of total payments.

C. Multiple Imaging Procedures

    As discussed in section II.J of this final rule with comment, we 
are reducing payments for TCs of certain multiple imaging procedures 
performed in the same session within the same imaging families. In 
order to calculate the impact of this change, we examined 2004 PFS 
carrier claims processed through March 31, 2005. We extracted all 
claims that were billed on the same day, for the same beneficiary, at 
the same provider, for multiple diagnostic imaging procedures within 
the same family of codes. For each subset of claims, the procedures 
were arrayed based on the pricing of the TC of these services. In the 
proposed rule, we simulated the effect of the multiple procedure 
payment reduction by accounting for 100 percent of the highest priced 
TC, and 50 percent of all other TCs. In this final rule with comment, 
we simulated the effect of the multiple procedure payment reduction by 
accounting for 100 percent of the highest priced TC, and 25 percent of 
all other TCs. This change is the result of public comments described 
more fully in section II.J. of this rule. Note that if the procedure 
was billed globally, the professional component was always calculated 
at 100 percent of the professional component (modifier-26) value.
    The simulated total allowed charges for each family of codes 
includes all global, technical, and professional utilization for the 
family of codes (for example, the sum of claims where the multiple 
procedure payment reduction would have been in effect, in addition to 
claims that would not have been subject to the multiple procedure 
payment reduction). These simulated totals were then compared to the 
actual allowed charges for each family of codes within the same time 
period to calculate the impacts of the change.
    Table 48 shows the actual 2004 allowed charges by family of imaging 
procedures and lists the percentage impact by family if this policy had 
been in effect. Family 2 has the largest -9.5 percent impact, while 
Family 11 has the smallest -0.7 percent impact.

     Table 48.--Impact of Multiple Procedure Reduction for Diagnostic Imaging by Family of Imaging Services
----------------------------------------------------------------------------------------------------------------
                                                                                   2004 Medicare
                                             Description of family of imaging         allowed       Percentage
                 Family                                 procedures                charges  ($ in      impact
                                                                                     millions)
----------------------------------------------------------------------------------------------------------------
01.....................................  Ultrasound (Chest/Abdomen/Pelvis--Non-             $138            -3.4
                                          Obstetrical).
02.....................................  CT and CTA (Chest/Thorax/Abd/Pelvis)...             563            -9.5
03.....................................  CT and CTA (Head/Brain/Orbit/                        97            -1.3
                                          Maxillofacial/Neck).
04.....................................  MRI and MRA (Chest/Abd/Pelvis).........             105            -2.4
05.....................................  MRI and MRA (Head/Brain/Neck)..........             532            -3.1

[[Page 70317]]

 
06.....................................  MRI and MRA (spine)....................             540            -2.2
07.....................................  CT (spine).............................              24            -2.1
08.....................................  MRI and MRA (lower extremities)........             166            -1.6
09.....................................  CT and CTA (lower extremities).........               5            -1.0
10.....................................  MR and MRI (upper extremities and                   107            -1.4
                                          joints).
11.....................................  CT and CTA (upper extremities).........               2            -0.7
                                                                                 -----------------
                                         Total for all procedures subject to               2,276            -4.2
                                          multiple imaging reductions.
----------------------------------------------------------------------------------------------------------------

    Using the same data, we also summarized the dollar value of the 
reductions by specialty. Specialty-specific percentage impacts were 
calculated by comparing each specialty's 2004 allowed charges for all 
Medicare allowed services to the reduced allowed charges that would 
have occurred had this policy been in effect. As expected, the most 
significant impacts occur among radiologists, who would experience a -1 
percent impact. Diagnostic testing facilities also experience a -1 
percent impact. Most other specialties experience a very small (0.1 
percent) payment increase as a result of the budget neutrality 
adjustment. (Because this multiple procedure reduction adjustment would 
otherwise reduce overall payments by 0.1 percent, it is necessary to 
include a budget neutrality adjustment to the PE RVUs, resulting in 
positive impacts for most specialties.) Table 49 shows the percentage 
impact by specialty in combination with other changes being 
implemented.

D. Combined Impacts

    Our estimates of changes in Medicare revenues for PFS services 
compare payment rates for 2006 with payment rates for 2005 using 2004 
Medicare utilization for both years. We are using 2004 Medicare claims 
processed and paid through June 30, 2005, that we estimate are 98.5 
percent complete, and have adjusted the figures to reflect a full year 
of data. Thus, because we are using a single year of utilization, the 
estimated changes in revenues reflect payment changes only between 2005 
and 2006. To the extent that there are year-to-year changes in the 
volume and mix of services provided by physicians, the actual impact on 
total Medicare revenues will be different than those shown here. The 
payment impacts reflect averages for each specialty based on Medicare 
utilization. The payment impact for an individual physician would be 
different from the average, based on the mix of services the physician 
provides. The average change in total revenues would be less than the 
impact displayed here because physicians furnish services to both 
Medicare and non-Medicare patients and specialties may receive 
substantial Medicare revenues for services that are not paid under the 
PFS. For instance, independent laboratories receive approximately 80 
percent of their Medicare revenues from clinical laboratory services 
that are not paid under the PFS. Table 49 shows only the payment impact 
on PFS services.
    Table 49 shows the specialty level impact on payment of the work 
RVU changes, practice expense RVU changes, malpractice RVU changes, and 
multiple imaging payment changes being implemented for CY 2006. The 
column labeled ``Final Rule Impacts'' shows the combined effect of the 
changes in payment attributable to the work RVU changes, practice 
expense RVUs, malpractice RVUs, and the multiple imaging policy. The 
column labeled ``Impact of Update and Drug Admin. Transition shows the 
impact of these changes, and reflects the expiration of the 
transitional adjustment required by section 303 of the MMA for drug 
administration services. This adjustment was set at 32 percent for 2004 
and 3 percent for 2005. In addition, this column reflects a -4.4 
percent payment update to the CF described in section VI. of this final 
rule with comment and the budget neutrality scaler required by the 
changes in the work RVUs.

BILLING CODE 4120-01-U

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[[Page 70320]]


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BILLING CODE 4120-01-C
    Table 50 shows the impact on total payments for selected high-
volume procedures of all of the changes previously discussed. We 
selected these procedures because they are the most commonly provided 
by a broad spectrum of physician specialties. There are separate 
columns that show the change in the facility rates and the nonfacility 
rates. For an explanation of facility and nonfacility PE refer to 
section II.A. in the preamble of this final rule with comment.
BILLING CODE 4120-01-U

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[[Page 70322]]


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BILLING CODE 4120-01-C

    In the CY 2005 final rule, we showed the combined impact of PFS and 
drug payment changes on the total revenues for specialties that perform 
a significant volume of drug administration services. (69 FR 66406) 
Although we have not performed a similar combined impact analysis this 
year for all of the specialties considered last year, we have 
undertaken a similar analysis of hematology/oncology. In last year's 
final rule, we announced a 1 year demonstration to collect information 
about symptoms for cancer patients receiving chemotherapy (69 FR 
66308). In this final rule with comment, we are announcing a new 
demonstration project again focused on improving the quality of care 
provided to beneficiaries stricken with cancer. Although both of these 
demonstrations are implemented through the Secretary's authority under 
sections 402(a)(1)(B) and 402(b) of the Social Security Act Amendments 
of 1967 (Pub. L. 90-248), we discussed the impacts of the additional 
payments from the 2005 demonstration in last year's final rule impact 
analysis. Therefore, we are also including an analysis of the

[[Page 70323]]

impact on payments to oncologists as the 2005 demonstration project 
ends and the new demonstration project begins.
    We have updated the analysis from the proposed rule using more 
recent data. As indicated in Table 51, PFS services account for 
approximately 25 percent of Medicare revenues for oncologists. The 
current demonstration accounts for approximately 3 percent of Medicare 
revenues for oncologists. If we assume no growth in the volume of PFS 
services, the combined 2006 impact of changes in Medicare payments for 
all PFS and demonstration services provided by oncologists is -10 
percent.
    We estimate that approximately 70 percent of total Medicare 
revenues for oncologists are attributed to drugs. If we again assume no 
growth in the volume of PFS services and additionally assume no growth 
in Medicare Part B drug spending (price or volume), we project total 
Medicare revenues to oncologists would decline by -3 percent.
    If we assume historical growth for the volume of PFS services and 
continue to assume no growth in Medicare Part B drug spending, we 
estimate total Medicare revenues to oncologists would remain unchanged 
between 2005 and 2006.
    If we assure historical growth for the volume of PFS services and 
for the volume of Medicare Part B drugs, we estimate total Medicare 
revenues to oncologists would increase by 6 percent between 2005 and 
2006.
    We estimate that the revised chemotherapy demonstration project 
discussed earlier will result in additional allowed charges to 
oncologists of approximately $150 million in CY 2006.
[GRAPHIC] [TIFF OMITTED] TR21NO05.076

E. Medicare Telehealth Services

    In section II.D. of this final rule with comment, we are adding 
individual medical nutrition therapy, as represented by HCPCS codes 
G0270, 97802, and 97803, to the list of telehealth services. We believe 
that this change will have little effect on Medicare expenditures.

F. Contractor Pricing of CPT Codes 97039 and 97139

    As discussed earlier in the preamble of this final rule with 
comment (section II.E.), we will have the contractors value CPT codes 
97039 and 97139. This will make the pricing methodology for these 
services consistent with our policy for other unlisted services and 
should not have a significant impact on Medicare expenditures.

G. ESRD-MMA Related Provisions

    The ESRD related provisions in this final rule with comment are 
discussed in section II.G. To understand the impact of the changes 
affecting payments to different categories of ESRD facilities, it is 
necessary to compare estimated payments under the current payment 
system (current payments) to estimated payments under the revisions to 
the composite rate payment system as set forth in this final rule with 
comment (final payments). To estimate the impact among various classes 
of ESRD facilities, it is imperative that the estimates of current 
payments and final payments contain similar inputs. Therefore, we 
simulated payments only for those ESRD facilities for which we are able 
to calculate both current 2005 payments and final 2006 payments.
    Due to data limitations, we are unable to estimate current and 
final payments for 171 facilities that bill for ESRD dialysis 
treatments. ESRD providers were grouped into the categories based on 
characteristics provided in the Online Survey and Certification and 
Reporting (OSCAR) file and the most recent cost report data from the 
Healthcare Cost Report Information System (HCRIS). We also used the 
June 2005 update of CY 2004 Standard Analytical File (SAF) claims as a 
basis for Medicare dialysis treatments and separately billable drugs 
and biologicals. As we stated in the proposed rule, this is an updated 
version of the 2004 SAF file compared to the December 2004 version of 
the file we used in the proposed rule.

BILLING CODE 4120-01-P

[[Page 70324]]

[GRAPHIC] [TIFF OMITTED] TR21NO05.077

BILLING CODE 4120-01-C
    Table 52 shows the impact of CY 2006 changes to payments to 
hospital based and independent ESRD facilities. We have included both 
composite rate payments as well as payments for separately billable 
drugs and biologicals because both are affected by the CY 2006 changes. 
The first column of Table 52 identifies the type of ESRD provider, the 
second column indicates the number of ESRD facilities for each type, 
and the third column indicates the number of dialysis treatments.
    The fourth column shows the effect of changes to the ESRD wage 
index as it affects the composite rate payments to ESRD facilities. 
Composite rate

[[Page 70325]]

payments account for about 60 percent of revenues to ESRD facilities. 
The fourth column compares aggregate wage adjusted composite rate 
payments using the revised ESRD wage index compared to the current ESRD 
wage adjusted composite rate payments. Since CY 2006 is the first year 
of the 4-year transition to the revised ESRD wage index, ESRD 
facilities receive 25 percent of the revised CBSA-based wage adjusted 
composite rate and 75 percent of the current composite rate. The 
overall effect to all ESRD providers in aggregate is zero because the 
CY 2006 ESRD wage index has been multiplied by a BNF to comply with the 
statutory requirement that any wage index revisions be done in a manner 
that results in the same aggregate amount of expenditures as would have 
been made without any changes in the wage index. The percent changes 
shown in the fifth and sixth columns are the result of the increase to 
the drug add-on and the changes in drug prices which are explained in 
section XIV.G. of this final rule with comment.
    The fifth column shows the effect of the changes in drug payments 
to ESRD providers between CY 2006 and CY 2005. Drug payments account 
for about 40 percent of revenues to ESRD providers. Current payments 
for drugs represent 2005 Medicare reimbursement using AAP prices for 
the top ten drugs (as discussed earlier in this preamble). Current 
Medicare spending for the top ten drugs is estimated using 2005 AAP 
prices times actual drug utilization from 2004 claims. (EPO units are 
estimated using payments because the units field on bills represents 
the number of EPO administrations rather than the number of EPO units). 
Spending for CY 2006 is estimated by using the average of the four 
quarters of 2005 ASP +6 percent for the top ten drugs times actual drug 
utilization from 2004 claims. The prices for these top ten drugs are 
discussed earlier in this preamble and the average of the four quarters 
of 2005 are shown in Table 52. We did not have hospital-based 
facilities utilization data for top ten drugs other than EPO. 
Therefore, we needed a proxy to estimate CY 2006 payments to hospital-
based facilities under ASP +6 pricing. We estimated these drugs by 
using the weighted spread of the difference between ASP +6 and AWP 
prices from independent facilities and applying it to payments to 
hospital-based facilities for top ten drugs other than EPO.
    Payment for drugs in 2006 also includes the 14.7 percent drug add-
on to the composite rate. This amount is computed by multiplying the 
wage adjusted composite rate for each provider and the dialysis 
treatments from 2004 claims. Column 5 is computed by comparing spending 
under the CY 2006 payment for drugs (4 quarter average of 2005 ASP +6) 
including the 14.7 percent drug add-on amount to spending under current 
payments for drugs with the current drug add-on of 8.7 percent.
    We did not simulate any case mix in this impact table (Table 52) 
because 2004 claims data do not include the new data fields (height and 
weight) that are needed to calculate case mix. These data fields were 
not required to be reported by providers until January 1, 2005. 
However, we have not made any changes to case mix for CY 2006.
    Column 6 shows the overall effect of all changes in drug and 
composite rate payments to ESRD providers. The overall effect is 
measured as the difference between CY 2006 payment with all MMA changes 
in this final rule with comment and current payment. CY 2006 payment is 
computed by multiplying the composite rate for each provider (with both 
the CY 2006 ESRD wage index and the 14.7 percent drug add-on) times 
dialysis treatments from 2004. In addition, the CY 2006 payment 
includes payments for separately billable drugs under the ASP +6 drug 
pricing using a 4 quarter average of 2005 ASP +6. Current payment is 
the current wage adjusted composite rate for each provider times 
dialysis treatments from 2004 claims plus current AAP priced drug 
payments for separately billable drugs with the current 8.7 percent 
drug add-on.
    The overall impact on ESRD providers in the aggregate is 1.2 
percent increase. At first it may not seem obvious how the growth rates 
in columns 4 and 5 combine to result in the overall growth effect in 
column 6. While the wage index changes are budget neutral in aggregate, 
the drug payments to all ESRD providers have increased by 2.9 percent. 
Since drug payments to ESRD providers account for about 40 percent of 
revenues and the composite payment rate payment account for the other 
60 percent of revenues, the 2.9 percent growth in drugs combined with 
the budget neutral composite rate payments result in the overall 1.2 
percent growth in payment to all ESRD providers.
    Some commenters expressed concern regarding the reduction in 
payment rates for dialysis facilities in certain States and requested 
that we provide a State-specific impact analysis. Table 53 lists the 
impact for each State.

BILLING CODE 4120-01-U

[[Page 70326]]

[GRAPHIC] [TIFF OMITTED] TR21NO05.078

BILLING CODE 4120-01-C

[[Page 70327]]

H. Payment for Covered Outpatient Drugs and Biologicals, and CAP 
Provisions

    As discussed in section II.H of this final rule with comment, the 
changes to the supplying fee for immunosuppressive, oral anticancer, 
and oral anti-emetic drugs are estimated to reduce total Federal 
expenditures by $2 million in 2006, and $14 million over the 5-year 
period, CY 2006 to 2010. The changes to the inhalation drug dispensing 
fee are expected to reduce total Federal expenditures by $120 million 
in 2006, and $720 million over the 5-year period, CY 2006 to 2010.
    For the CAP provisions contained in this final rule with comment, 
the purpose of the CAP program is to provide choices to physicians and 
potentially achieve budgetary savings to Medicare and beneficiaries 
through a competitive bidding approach to determining Medicare payment 
rates for selected drugs. In addition the CAP will provide physicians 
with an alternative way to obtain these selected drugs that they use 
for treating their Medicare beneficiaries in their offices. As 
discussed in the July 6, 2005 interim final rule (70 FR 39091), we have 
estimated the impact of the costs of furnishing or administering drugs 
through the CAP on the Medicare program and expect it to be negligible, 
at the beginning until participating CAP physicians, approved CAP 
vendors and CMS gain more experience with the program. During the first 
year, we anticipate no significant additional cost savings or increases 
associated with the CAP, relative to the ASP payment system. The CAP 
program will provide alternatives to physicians who do not wish to 
purchase drugs directly or collect coinsurance.

I. Private Contracts and Opt-Out Provision

    The changes discussed in section II.I. of this final rule with 
comment, with respect to private contracts and the opt-out provision, 
are estimated to have no significant impact on Medicare expenditures. 
However, we believe the changes will clarify that the consequences for 
the failure to maintain opt-out will apply regardless of whether the 
physician or practitioner was notified by the carrier.

J. FQHC Supplemental Payment Provision

    Section 237 of the MMA amended section 1833(a)(3) of Act to provide 
supplemental payments to FQHCs that contract with Medicare Advantage 
(MA) organizations to cover the difference, if any, between the payment 
received by the health center for treating MA enrollees and the payment 
to which the FQHC would be entitled to receive under its cost-based 
all-inclusive payment rate. We estimate that this new MMA payment 
provision for FQHC services will not increase Medicare payments. In 
other words, this MMA provision will have no budgetary impact on the 
Medicare trust fund due to the fact that a supplemental payment will 
only be made when the MA payment to the health center is less than its 
original FQHC cost based rate. Consequently, no additional Medicare 
expenditures will be needed to pay the center up to what it would have 
received under original Medicare.

K. National Coverage Decisions Timeframes

    The changes to Sec.  426.340 discussed in section II.N. of this 
final rule with comment, are made in order to conform certain 
timeframes in the regulation to meet legislative changes made by the 
MMA of 2003. These changes to the regulation meet Congressional intent 
in the development of NCDs, and conform the regulation to the overall 
NCD process. There are no budget implications as a result of these 
changes.

L. Coverage of Screening for Glaucoma

    As discussed in section II.O. of the preamble to this final rule 
with comment, we are expanding the definition of an eligible 
beneficiary under the glaucoma screening benefit to include Hispanic 
Americans age 65 and over, effective January 1, 2006, subject to 
certain frequency and other limitations on coverage. At present, Sec.  
410.23(a)(2) (Conditions for and limitations on coverage of screening 
for glaucoma) defines the term ``eligible beneficiary'' to include 
individuals in the following high risk categories:
    <bullet> Individual with diabetes mellitus.
    <bullet> Individual with a family history of glaucoma.
    <bullet> African-Americans age 50 and over.
    Based on the projected utilization of these screening services and 
related medically necessary follow-up tests and treatment that may be 
required for the additional beneficiaries screened, we estimate that 
this expanded benefit will result in an increase in Medicare payments 
to ophthalmologists or optometrists who will provide these screening 
tests and related follow-up tests and treatment. However, as discussed 
in earlier in section II.O. this is not expected to have a significant 
cost impact on the Medicare program.

M. Physician Referral for Nuclear Medicine Services

    As discussed earlier in section V., we are revising the regulations 
at 411.351 to include all diagnostic and therapeutic nuclear medicine 
services and supplies furnished or referred on or after January 1, 
2007, in the definitions of ``radiology and certain other imaging 
services'' and ``radiation therapy services and supplies,'' 
respectively.
    As stated in the proposed rule, the inclusion of nuclear medicine 
as a designated health service (DHS) primarily would affect physicians 
and health care entities that furnish these types of items and services 
to Medicare beneficiaries. We are unable to quantify the number of 
physicians who have either an ownership or an investment interest in 
entities that furnish nuclear medicine services and/or supplies. Even 
if we assume that a substantial number of physicians have ownership or 
investment interests in these types of entities, we believe that, in 
general, the economic impact on these physicians would not necessarily 
be substantial, for the reasons stated below.
    Physician owners/investors of entities that furnish nuclear 
medicine services and supplies in a manner that satisfies the 
requirements of the in-office ancillary services exception would not be 
affected by this proposed rule. Similarly, a physician's ownership of, 
or investment in, a rural provider of nuclear medicine services and 
supplies would not be affected by this rule if the financial 
relationship complies with the rural provider exception at Sec.  
411.356(c)(1), which allows a physician to own and refer to an entity 
at least 75 percent of all DHS that it furnishes to residents of a 
rural area, as defined in the physician self-referral statute. We also 
do not know the extent to which equipment (such as a PET scanner) that 
was purchased by an entity in which a physician has an ownership or 
investment interest will be fully depreciated (or mostly so) or 
functionally obsolete by the time this rule is effective.
    Although the impact on an individual physician may be significant, 
we do not believe that physicians, in general, will be significantly 
affected if they are required to stop making referrals to an entity in 
which they have an ownership interest. We believe that the majority of 
physicians receive most of their income from the services they 
personally provide, and not from nuclear medicine services performed by 
entities that they own or invest in. In addition, we assume that, 
unless the physician established the entity to serve only his

[[Page 70328]]

or her patients, the entity receives referrals from other physicians. 
Thus, the physician may still receive a return on the ownership or 
investment. Likewise, we do not believe that a physician's divestiture 
of his or her ownership interest would necessarily have a significant 
economic effect. We assume, that, from an economic standpoint, most 
physicians invest in entities because they are income producing. If an 
investment is successful, a physician should have little difficulty 
finding new investors willing to acquire the physician's investment. We 
are unable to quantify the number of physicians who would wish to 
divest his or her ownership interest as a result of this rule, nor are 
we able to ascertain the degree to which these physicians would sell 
their ownership interests at a loss or profit. We believe the cost of 
divestiture will vary from situation to situation. Also, since the rule 
is not effective until January 1, 2007, this will give those physicians 
who wish to divest additional time to find a suitable buyer and will 
allow those physicians an additional year in which to depreciate their 
nuclear medicine equipment.
    We expect that this change may result in savings to both the 
Medicare and Medicaid programs by minimizing anti-competitive business 
arrangements as well as financial incentives that encourage over-
utilization of costly nuclear medicine services. We cannot gauge with 
any certainty the extent of these savings to either program at this 
time.

N. Alternatives Considered

    This final rule with comment contains a range of policies, 
including some which are related to specific MMA provisions. The 
preamble provides descriptions of the statutory provisions that are 
addressed, identifies those policies when discretion has been 
exercised, presents rationale for our decisions and, where relevant, 
alternatives that were considered.
    We considered making our proposal to include diagnostic and 
therapeutic nuclear medicine services and supplies as a DHS effective 
immediately; however, we are persuaded that delaying the effective date 
until January 1, 2007 would be less disruptive to physicians who may 
choose to divest their investment and to beneficiaries who may need to 
receive services and supplies at another location.

O. Impact on Beneficiaries

    There are a number of changes made in this final rule with comment 
that would have an effect on beneficiaries. In general, we believe 
these changes will improve beneficiary access to services that are 
currently covered or will expand the Medicare benefit package to 
include new services.
    As explained in more detail below, the regulatory provisions may 
affect beneficiary liability in some cases. Any changes in aggregate 
beneficiary liability from a particular provision will be a function of 
the coinsurance (20 percent if applicable for the particular provision 
after the beneficiary has met the deductible) and the effect of the 
aggregate cost (savings) of the provision on the calculation of the 
Medicare Part B premium rate (generally 25 percent of the provision's 
cost or savings).
    To illustrate this point, under this final rule with comment the 
2006 national payment amount in the nonfacility setting for CPT code 
99203, as shown in Table 50, is $92.61 which means that, in 2006, the 
beneficiary coinsurance for this service would be $18.52.
    In addition, as with the 2005 chemotherapy demonstration project, 
the Medicare beneficiaries, or their supplemental insurers, who receive 
office-based cancer treatment, will be liable for the 20 percent Part B 
coinsurance on the G codes billed under the 2006 oncology 
demonstration. The service linking the payment of the demonstration fee 
has changed from a chemotherapy infusion or push service in 2005 to an 
established office visit of level 2, 3, 4, or 5 in 2006. The 
demonstration fee payment will be lower per unit of service for the 
Medicare beneficiary in 2006 than 2005 thus, we expect that the 
coinsurance liability for a Medicare beneficiary will be reduced. 
However, the total impact on a beneficiary will depend upon the 
specific services received during 2006.
    Very few of the changes we are making impact overall payments and 
therefore will affect Medicare beneficiaries' coinsurance liability. 
Changes discussed above that do affect overall spending would similarly 
impact beneficiaries' coinsurance.
    For example, we have tried to ensure that the rule concerning 
physician self-referral for nuclear medicine services would not 
adversely impact the medical care of Medicare or Medicaid patients. We 
recognize that our proposal may have an impact on current arrangements 
under which patients are receiving medical care, and that some 
financial arrangements may have to be restructured for patients to 
continue receiving medically necessary nuclear medicine services and 
supplies at the same location or from the same entity. Therefore, we 
are delaying the effective date of this provision until January 1, 
2007. Implementation of this rule is consistent with the statutory 
intent of section 1877(h) of the Act. This final rule with comment may 
help minimize anti-competitive behavior that can affect where a 
beneficiary receives health care services. It may also reduce the 
potential for overutilization, and thus, decrease the number of 
unnecessary tests or procedures to which Medicare and Medicaid patients 
are subjected.
    With respect to the CAP provisions, we do not expect, during the 
first year of the program, that there will be an appreciable difference 
to the beneficiaries if their drugs were to be administered by a 
physician participating in the CAP or purchasing them and being 
reimbursed for them within the ASP payment system. At least initially, 
until approved CAP vendors, participating CAP physicians, and CMS gain 
more experience with this new program, we do not anticipate there would 
be any significant additional costs or savings to a beneficiary whose 
physician participates in the CAP. The CAP should be largely 
transparent to the beneficiary population. The only change should be 
the entity that bills the beneficiary for the coinsurance.
    We also do not believe that beneficiaries would experience drug 
access issues as a result of implementation of the CAP. However, we 
intend to monitor beneficiary access closely and may propose additional 
changes to our payment system in the future, if necessary.

P. Accounting Statement

    As required by OMB Circular A-4 (available at http://www.whitehouse.gov/omb/circulars/a004/a-4.pdf), in Table 54 we have 
prepared an accounting statement showing the classification of the 
expenditures associated with the provisions of this final rule with 
comment. Table 54 includes the impact of the changes in this rule on 
providers and suppliers and encompasses the -4.4 percent negative 
update to the PFS based on the statutory SGR formula.
    Expenditures are classified as transfers to Medicare providers or 
suppliers (that is, ESRD facilities and physicians, other practitioners 
and medical suppliers, including CAP vendors, that receive payment 
under the PFS or Medicare Part B).

[[Page 70329]]



      Table 54.--Accounting Statement: Classification of Estimated
                Expenditures, From CY 2005 to the CY 2006
                              [In millions]
------------------------------------------------------------------------
                Category                            Transfers
------------------------------------------------------------------------
Annualized Monetized Transfers.........  Negative transfer--Estimated
                                          decrease in expenditures
                                          $2668.
From Whom To Whom?.....................  Federal Government To ESRD
                                          Medicare Providers;
                                          physicians, other
                                          practitioners and suppliers,
                                          including CAP vendors that
                                          receive payment under the
                                          Medicare Physician Fee
                                          Schedule; and Medicare
                                          Suppliers billing for Part B
                                          drugs.
------------------------------------------------------------------------

    In accordance with the provisions of Executive Order 12866, this 
final rule with comment was reviewed by the Office of Management and 
Budget.

List of Subjects

42 CFR Part 405

    Administrative practice and procedure, Health facilities, Health 
professions, Kidney diseases, Medical devices, Medicare, Reporting and 
recordkeeping requirements, Rural areas, X-rays.

42 CFR Part 410

    Health facilities, Health professions, Kidney diseases, 
Laboratories, Medicare, Reporting and recordkeeping requirements, Rural 
areas, X-rays.

42 CFR Part 411

    Kidney diseases, Medicare, Physician Referral, Reporting and record 
keeping requirements.

42 CFR Part 413

    Health facilities, Kidney diseases, Medicare, Reporting and 
recordkeeping requirements.

42 CFR Part 414

    Administrative practice and procedure, Health facilities, Health 
professions, Kidney diseases, Medicare, Reporting and recordkeeping 
requirements.

42 CFR Part 424

    Emergency medical services, Health facilities, Health professions, 
Medicare, Reporting and recordkeeping requirements.

42 CFR Part 426

    Administrative practice and procedure, Medicare, Reporting and 
recordkeeping requirements.


0
For the reasons set forth in the preamble, the Centers for Medicare & 
Medicaid Services amends 42 CFR chapter IV as set forth below:

PART 405--FEDERAL HEALTH INSURANCE FOR THE AGED AND DISABLED

0
1. The authority citation for part 405 continues to read as follows:

    Authority: Secs. 1102, 1861, 1862(a), 1871, 1874, 1881, and 
1886(k) of the Social Security Act (42 U.S.C. 1302, 1395x, 1395y(a), 
1395hh, 1395kk, 1395rr, and 1395ww(k)), and sec. 353 of the Public 
Health Service Act (42 U.S.C. 263a).

Subpart D--Private Contracts

0
2. Section 405.435 is amended by--
0
A. Revising paragraph (b) introductory text.
0
B. Adding paragraph (d).
    The revision and addition read as follows:


Sec.  405.435  Failure to maintain opt-out.

* * * * *
    (b) If a physician or practitioner fails to maintain opt-out in 
accordance with paragraph (a) of this section, then, for the remainder 
of the opt-out period, except as provided by paragraph (d) of this 
section--
* * * * *
    (d) If a physician or practitioner demonstrates that he or she has 
taken good faith efforts to maintain opt-out (including by refunding 
amounts in excess of the charge limits to beneficiaries with whom he or 
she did not sign a private contract) within 45 days of a notice from 
the carrier of a violation of paragraph (a) of this section, then the 
requirements of paragraphs (b)(1) through (b)(8) of this section are 
not applicable. In situations where a violation of paragraph (a) of 
this section is not discovered by the carrier during the 2-year opt-out 
period when the violation actually occurred, then the requirements of 
paragraphs (b)(1) through (b)(8) of this section are applicable from 
the date that the first violation of paragraph (a) of this section 
occurred until the end of the opt-out period during which the violation 
occurred (unless the physician or practitioner takes good faith 
efforts, within 45 days of any notice from the carrier that the 
physician or practitioner failed to maintain opt-out, or within 45 days 
of the physician's or practitioner's discovery of the failure to 
maintain opt-out, whichever is earlier, to correct his or her 
violations of paragraph (a) of this section. Good faith efforts 
include, but are not limited to, refunding any amounts collected in 
excess of the charge limits to beneficiaries with whom he or she did 
not sign a private contract.

Subpart X--Rural Health Clinic and Federally Qualified Health 
Center Services

0
3. Add Sec.  405.2469 to read as follows:


Sec.  405.2469  Federally Qualified Health Centers supplemental 
payments.

    Federally Qualified Health Centers under contract (directly or 
indirectly) with Medicare Advantage organizations are eligible for 
supplemental payments for covered Federally Qualified Health Center 
services furnished to enrollees in Medicare Advantage plans offered by 
the Medicare Advantage organization to cover the difference, if any, 
between their payments from the Medicare Advantage plan and what they 
would receive under the cost-based Federally Qualified Health Center 
payment system.
    (a) Calculation of supplemental payment. (1) The supplemental 
payment for Federally Qualified Health Center covered services provided 
to Medicare patients enrolled in Medicare Advantage plans is based on--
    (i) The difference between payments received by the center from the 
Medicare Advantage plan as determined on a per visit basis;
    (ii) The Federally Qualified Health Center's all-inclusive cost-
based per visit rate as set forth in this subpart;
    (iii) Less any amount the FQHC may charge as described in section 
1857(e)(3)(B) of the Act.
    (2) Any financial incentives provided to Federally Qualified Health 
Centers under their Medicare Advantage contracts, such as risk pool 
payments, bonuses, or withholds, are prohibited from being included in 
the calculation of supplemental payments due to the Federally Qualified 
Health Center.

[[Page 70330]]

    (b) Per visit supplemental payment. A supplemental payment required 
under this section is made to the Federally Qualified Health Center 
when a covered face-to-face encounter occurs between a Medicare 
Advantage enrollee and a practitioner as set forth in Sec.  405.2463.

PART 410--SUPPLEMENTARY MEDICAL INSURANCE (SMI) BENEFITS

0
4. The authority citation for part 410 continues to read as follows:

    Authority: Secs. 1102 and 1871 of the Social Security Act (42 
U.S.C. 1302 and 1395hh).

Subpart B--Medical and Other Health Services

0
5. Section 410.23 is amended by--
0
A. Revising paragraphs (a)(2)(i) through (iii).
0
B. Adding a new paragraph (a)(2)(iv).
    The revision and addition read as follows:


Sec.  410.23  Screening for glaucoma: Conditions for and limitations on 
coverage.

    (a) * * *
    (2) * * *
    (i) Individual with diabetes mellitus.
    (ii) Individual with a family history of glaucoma.
    (iii) African-Americans age 50 and over.
    (iv) Hispanic-Americans age 65 and over.
* * * * *

0
6. Section 410.78 is amended by--
0
A. Revising paragraph (b) introductory text.
0
B. Adding paragraph (b)(2)(viii).
    The revision and addition read as follows:


Sec.  410.78  Telehealth services

* * * * *
    (b) General rule. Medicare Part B pays for office and other 
outpatient visits, professional consultation, psychiatric diagnostic 
interview examination, individual psychotherapy, pharmacologic 
management, end stage renal disease related services included in the 
monthly capitation payment (except for one visit per month to examine 
the access site), and individual medical nutrition therapy furnished by 
an interactive telecommunications system if the following conditions 
are met:
* * * * *
    (2) * * *
    (viii) A registered dietitian or nutrition professional as 
described in Sec.  410.134.
* * * * *

PART 411--EXCLUSIONS FROM MEDICARE AND LIMITATIONS ON MEDICARE 
PAYMENT

0
7. The authority citation for part 411 continues to read as follows:

    Authority: Secs. 1102 and 1871 of the Social Security Act (42 
U.S.C. 1302 and 1395hh).

Subpart J--Financial Relationships Between Physicians and Entities 
Furnishing Designated Health Services

0
8. Section 411.351 is amended by--
0
A. Revising the definition of ``Radiation therapy services and 
supplies''.
0
B. Revising the definition of ``Radiology and certain other imaging 
services''.
0
C. Revising the introductory text of paragraph (2) of the definition of 
``Referral''.
    The revisions read as follows:


Sec.  411.351  Definitions.

* * * * *
    Radiation therapy services and supplies means those particular 
services and supplies, including (effective January 1, 2007) 
therapeutic nuclear medicine services and supplies, so identified on 
the List of CPT/HCPCS Codes. All services and supplies so identified on 
the List of CPT/HCPCS Codes are radiation therapy services and supplies 
for purposes of this subpart. Any service or supply not specifically 
identified as radiation therapy services or supplies on the List of 
CPT/HCPCS Codes is not a radiation therapy service or supply for 
purposes of this subpart. The list of codes identifying radiation 
therapy services and supplies is based on section 1861(s)(4) of the Act 
and Sec.  410.35 of this chapter.
    Radiology and certain other imaging services means those particular 
services so identified on the List of CPT/HCPCS Codes. All services so 
identified on the List of CPT/HCPCS Codes are radiology and certain 
other imaging services for purposes of this subpart. Any service not 
specifically identified as radiology and certain other imaging services 
on the List of CPT/HCPCS Codes is not a radiology or certain other 
imaging service for purposes of this subpart. The list of codes 
identifying radiology and certain other imaging services includes the 
professional and technical components of any diagnostic test or 
procedure using x-rays, ultrasound, computerized axial tomography, 
magnetic resonance imaging, nuclear medicine (effective January 1, 
2007), or other imaging services. All codes identified as radiology and 
certain other imaging services are covered under section 1861(s)(3) of 
the Act and Sec.  410.32 and Sec.  410.34 of this chapter, but do not 
include--
    (1) X-ray, fluoroscopy, or ultrasound procedures that require the 
insertion of a needle, catheter, tube, or probe through the skin or 
into a body orifice; and
    (2) Radiology procedures that are integral to the performance of a 
nonradiological medical procedure and performed--
    (i) During the nonradiological medical procedure; or
    (ii) Immediately following the nonradiological medical procedure 
when necessary to confirm placement of an item placed during the 
nonradiological medical procedure.
    Referral--
* * * * *
    (2) Does not include a request by a pathologist for clinical 
diagnostic laboratory tests and pathological examination services, by a 
radiologist for diagnostic radiology services, and by a radiation 
oncologist for radiation therapy or ancillary services necessary for, 
and integral to, the provision of radiation therapy, if--
* * * * *

PART 413--PRINCIPLES OF REASONABLE COST REIMBURSEMENT; PAYMENT FOR 
END-STAGE RENAL DISEASE SERVICES; PROSPECTIVELY DETERMINED PAYMENT 
RATES FOR SKILLED NURSING FACILITIES

0
9. The authority citation for part 413 continues to read as follows:

    Authority: Secs. 1102, 1812(d), 1814(b), 1815, 1833(a), (i), and 
(n), 1871, 1881, 1883, and 1886 of the Social Security Act (42 
U.S.C. 1302, 1395D(D), 1395f(b), 1395g, 13951(a), (i), and (n), 
1395hh, 1395rr, 1395tt, and 1395ww).

Subpart H--Payment for End-Stage Renal Disease (ESRD) Services and 
Organ Procurement Costs

0
10. Section 413.170 is amended by revising paragraph (b) to read as 
follows:


Sec.  413.170  Scope.

* * * * *
    (b) Providing procedures and criteria under which a pediatric ESRD 
facility (an ESRD facility with at least a 50 percent pediatric patient 
mix as specified in Sec.  413.184 of this subpart) may receive an 
exception to the prospective payment rates; and
* * * * *

0
11. Section 413.174 is amended by--
0
A. Revising paragraph (f).

[[Page 70331]]

0
B. Removing paragraph (g).
    The revision reads as follows:


Sec.  413.174  Prospective rates for hospital-based and independent 
ESRD facilities.

* * * * *
    (f) Additional payment for separately billable drugs. CMS makes an 
additional payment for certain drugs furnished to ESRD patients by a 
Medicare-approved ESRD facility. CMS makes this payment directly to the 
ESRD facility. Payment for these drugs is made--
    (1) Only on an assignment basis, directly to the facility which 
must accept, as payment in full, the amount that CMS determines;
    (2) Subject to the Part B deductible and coinsurance;
    (3) Effective January 1, 2006, to hospital-based ESRD facilities in 
accordance with the methodology specified in Sec.  414.904 of this 
subchapter.
    (4) To independent ESRD facilities in accordance with the 
methodology specified in Sec.  405.517 of this subchapter.

0
12. Section 413.180 is amended by--
0
A. Revising paragraphs (b) and (d)
0
B. Removing paragraphs (e) and (k).
0
C. Redesignating paragraphs (f) through (j) as paragraphs (e) through 
(i).
0
D. Revising newly redesignated paragraph (i).
0
E. Redesignating paragraphs (l) and (m) as paragraphs (j) and (k).
0
F. Revising newly redesignated paragraph (k).
    The revisions read as follows:


Sec.  413.180  Procedures for requesting exceptions to payment rates.

* * * * *
    (b) Criteria for requesting an exception. If a pediatric ESRD 
facility projects on the basis of prior year costs and utilization 
trends that it has an allowable cost per treatment higher than its 
prospective rate set under Sec.  413.174, and if these excess costs are 
attributable to one or more of the factors in Sec.  413.182, the 
facility may request, in accordance with paragraph (e) of this section, 
that CMS approve an exception to that rate and set a higher prospective 
payment rate.
* * * * *
    (d) Payment rate exception request. Effective October 1, 2002, CMS 
may approve exceptions to a pediatric ESRD facility's updated 
prospective payment rate, if the pediatric ESRD facility did not have 
an approved exception rate as of October 1, 2002. A pediatric ESRD 
facility may request an exception to its payment rate at any time after 
it is in operation for at least 12 consecutive months.
* * * * *
    (i) Period of approval: Payment exception request. A prospective 
exception payment rate approved by CMS applies for the period from the 
date the complete exception request was filed with its intermediary 
until 30 days after the intermediary's receipt of the facility's letter 
notifying the intermediary of the facility's request to give up its 
exception rate and be subject to the basic case-mix adjusted composite 
payment rate methodology. ESRD facilities electing to retain their 
nonpediatric or pediatric exception rates (including self-dialysis 
training) do not need to notify their intermediaries. Once a facility 
notifies its fiscal intermediary in writing that it cannot retain its 
current exception rate, that decision cannot be subsequently reversed.
* * * * *
    (k) Criteria for refiling a denied exception request. A pediatric 
ESRD facility that was denied an exception request may immediately file 
another exception request. Any subsequent exception request must 
address and document the issues cited in CMS' denial letter.
0
13. Section 413.182 is revised to read as follows:


Sec.  413.182  Criteria for approval of exception requests.

    (a) CMS may approve exceptions to a pediatric ESRD facility's 
prospective payment rate if the pediatric ESRD facility did not have an 
approved exception rate as of October 1, 2002.
    (b) The pediatric ESRD facility must demonstrate, by convincing 
objective evidence, that its total per treatment costs are reasonable 
and allowable under the relevant cost reimbursement principles of part 
413 and that its per treatment costs in excess of its payment rate are 
directly attributable to any of the following criteria:
    (1) Pediatric patient mix, as specified in Sec.  413.184.
    (2) Self-dialysis training costs in pediatric facilities, as 
specified in Sec.  413.186.

0
14. Section 413.184 is amended by revising paragraphs (a) and (b)(1) to 
read as follows:


Sec.  413.184  Payment exception: Pediatric patient mix.

    (a) Qualifications. To qualify for an exception to its prospective 
payment rate based on its pediatric patient mix a facility must 
demonstrate that--
    (1) At least 50 percent of its patients are individuals under 18 
years of age;
    (2) Its nursing personnel costs are allocated properly between each 
mode of care;
    (3) The additional nursing hours per treatment are not the result 
of an excess number of employees;
    (4) Its pediatric patients require a significantly higher staff-to-
patient ratio than typical adult patients; and
    (5) These services, procedures, or supplies and their per treatment 
costs are clearly prudent and reasonable when compared to those of 
pediatric facilities with a similar patient mix.
    (b) Documentation. (1) A pediatric ESRD facility must submit a 
listing of all outpatient dialysis patients (including all home 
patients) treated during the most recently completed and filed cost 
report (in accordance with cost reporting requirements under Sec.  
413.198) showing--
    (i) Age of patients and percentage of patients under the age of 18;
    (ii) Individual patient diagnosis;
    (iii) Home patients and ages;
    (iv) In-facility patients, staff-assisted, or self-dialysis;
    (v) Diabetic patients; and
    (vi) Patients isolated because of contagious disease.
* * * * *


Sec.  413.186  [Removed]

0
15. Section 413.186 is removed.


Sec.  413.188  [Removed]

0
16. Section 413.188 is removed.


Sec.  414.190  [Redesignated as Sec.  413.186]

0
17. Redesignate Sec.  413.190 as Sec.  413.186 and revise the newly 
designated Sec.  413.186 to read as follows:


Sec.  413.186  Payment exception: Self-dialysis training costs in 
pediatric facilities.

    (a) Qualification. To qualify for an exception to the prospective 
payment rate based on self-dialysis training costs, the pediatric ESRD 
facility must establish that it incurs per treatment costs for 
furnishing self-dialysis and home dialysis training that exceed the 
facility's payment rate for the training sessions.
    (b) Justification. To justify its exception request, a facility 
must--
    (1) Separately identify those elements contributing to its costs in 
excess of the composite training rate; and
    (2) Demonstrate that its per treatment costs are reasonable and 
allowable.
    (c) Criteria for determining proper cost reporting. CMS considers 
the pediatric ESRD facility's total costs, cost finding and 
apportionment, including its allocation of costs, to determine if costs 
are properly reported by treatment modality.
    (d) Limitation of exception requests. Exception requests for a 
higher training rate are limited to those cost

[[Page 70332]]

components relating to training such as technical staff, medical 
supplies, and the special costs of education (manuals and education 
materials). These requests may include overhead and other indirect 
costs to the extent that these costs are directly attributable to the 
additional training costs.
    (e) Documentation. The pediatric ESRD facility must provide the 
following information to support its exception request:
    (1) A copy of the facility's training program.
    (2) Computation of the facility's cost per treatment for 
maintenance sessions and training sessions including an explanation of 
the cost difference between the two modalities.
    (3) Class size and patients' training schedules.
    (4) Number of training sessions required, by treatment modality, to 
train patients.
    (5) Number of patients trained for the current year and the prior 2 
years on a monthly basis.
    (6) Projection for the next 12 months of future training 
candidates.
    (7) The number and qualifications of staff at training sessions.
    (f) Accelerated training exception. (1) A pediatric ESRD facility 
may bill Medicare for a dialysis training session only when a patient 
receives a dialysis treatment (normally 3 times a week for 
hemodialysis). Continuous cycling peritoneal dialysis (CCPD) and 
continuous ambulatory peritoneal dialysis (CAPD) are daily treatment 
modalities; ESRD facilities are paid the equivalent of three 
hemodialysis treatments for each week that CCPD and CAPD treatments are 
provided.
    (2) If a pediatric ESRD facility elects to train all its patients 
using a particular treatment modality more often than during each 
dialysis treatment and, as a result, the number of billable training 
dialysis sessions is less than the number of actual training sessions, 
the facility may request a composite rate exception, limited to the 
lesser of the--
    (i) Facility's projected training cost per treatment; or
    (ii) Cost per treatment the facility receives in training a patient 
if it had trained patients only during a dialysis treatment, that is, 
three times per week.
    (3) An ESRD facility may bill a maximum of 25 training sessions per 
patient for hemodialysis training and 15 sessions for CCPD and CAPD 
training.
    (4) In computing the payment amount under an accelerated training 
exception, CMS uses a minimum number of training sessions per patient 
(15 for hemodialysis and 5 for CAPD and CCPD) when the facility 
actually provides fewer than the minimum number of training sessions.
    (5) To justify an accelerated training exception request, an ESRD 
facility must document that a significant number of training sessions 
for a particular modality are provided during a shorter but more 
condensed period.
    (6) The facility must submit with the exception request a list of 
patients, by modality, trained during the most recent cost report 
period. The list must include each beneficiary's--
    (i) Name;
    (ii) Age; and
    (iii) Training status (completed, not completed, being retrained, 
or in the process of being trained).
    (7) The total treatments from the patient list must be the same as 
the total treatments reported on the cost report filed with the 
request.


Sec.  413.192  [Removed]

0
18. Section 413.192 is removed.

PART 414--PAYMENT FOR PART B MEDICAL AND OTHER HEALTH SERVICES

0
19. The authority citation for part 414 continues to read as follows:

    Authority: Secs. 1102, 1871, and 1881(b)(1) of the Social 
Security Act (42 U.S.C. 1302, 1395hh, and 1395rr(b)(1)).

Subpart B--Physicians and Other Practitioners

0
20. Section 414.65 is amended by revising paragraph (a)(1) to read as 
follows:.


Sec.  414.65  Payment for telehealth services

    (a) * * *
    (1) The Medicare payment amount for office or other outpatient 
visits, consultation, individual psychotherapy, psychiatric diagnostic 
interview examination, pharmacologic management, end stage renal 
disease related services included in the monthly capitation payment 
(except for one visit per month to examine the access site), and 
individual medical nutrition therapy furnished via an interactive 
telecommunications system is equal to the current fee schedule amount 
applicable for the service of the physician or practitioner.
* * * * *

Subpart J--Submission of Manufacture's Average Sales Price Data

0
21. Section 414.804(a) is amended by revising paragraph (a)(3)(iv) to 
read as follows:


Sec.  414.804  Basis of payment.

    (a) * * *
    (3) * * *
    (iv) Example. The total lagged price concessions (discounts, 
rebates, etc.) over the most recent 12-month period available 
associated with direct sales for National Drug Code 12345-6789-01 
subject to the ASP reporting requirement equal $200,000. The total in 
dollars for the sales subject to the average sales price reporting 
requirement for the same period equals $600,000. The lagged price 
concessions percentage for this period equals 200,000/600,000 = .33333. 
The total in dollars for the direct sales subject to the average sales 
price reporting requirement for the quarter being reported equals 
$50,000 for 10,000 units sold. Assuming no non-lagged price concessions 
apply, the manufacturer's average sales price calculation for this 
National Drug Code for this quarter is: $50,000-(0.33333 x $50,000) = 
$33,334 (net total sales amount); $33,334/10,000 = $3.33 (average sales 
price).
* * * * *

0
22. Section 414.904 is amended by--
0
A. Revising paragraph (a) introductory text.
0
B. Adding a new paragraph (d)(2)(iii).
0
C. Revising paragraphs (d)(3) and (e)(2).
    The revisions and additions read as follows:


Sec.  414.904  Basis of payment

    (a) Method of payment. Payment for a drug furnished on or after 
January 1, 2005 is based on the lesser of--
* * * * *
    (d) * * *
    (2) * * *
    (iii) Effective for drugs and biologicals furnished in 2006, the 
payment for such drugs and biologicals furnished in connection with 
renal dialysis services and separately billed by freestanding and 
hospital-based renal dialysis facilities not paid on a cost basis is 
106 percent of the average sales price.
    (3) Widely available market price and average manufacturer price. 
If the Inspector General finds that the average sales price exceeds the 
widely available market price or the average manufacturer price by 5 
percent or more in calendar year 2006, the payment limit in the quarter 
following the transmittal of this information to the Secretary is the 
lesser of the widely available market price or 103 percent of the 
average manufacturer price.
    (e) * * *
    (2) Infusion drugs furnished through a covered item of durable 
medical equipment. The payment limit for an

[[Page 70333]]

infusion drug furnished through a covered item of durable medical 
equipment is calculated using 95 percent of the average wholesale price 
in effect on October 1, 2003 and is not updated in 2006.
* * * * *

0
23. Section 414.906 is amended by revising paragraph (f) to read as 
follows:


Sec.  414.906  Competitive acquisition program as the basis for 
payment.

* * * * *
    (f) Substitution or addition of drugs on an approved CAP vendor's 
CAP drug list. (1) Short-term substitution of a CAP drug. On an 
occasional basis (for a period of time less than 2 weeks), an approved 
CAP vendor may agree to furnish a substitute NDC within a HCPCS code on 
the approved CAP vendor's CAP drug list if the approved CAP vendor--
    (i) Is willing to accept the payment amount that was established 
for the HCPCS code under this section; and
    (ii) Obtains the participating CAP physician's prior approval.
    (2) Long-term substitution or addition of a CAP drug. An approved 
CAP vendor may submit a request, as specified in paragraph (f)(3) of 
this section, for approval to substitute an NDC supplied by the 
approved CAP vendor for another NDC within the same HCPCS code or to 
add an NDC to the approved CAP vendor's drug list, if at least one of 
the following criteria is met:
    (i) Proposed substitution of an NDC for a period of 2 weeks or 
longer.
    (ii) Proposed addition of one or more NDCs within a HCPCS code 
included in the CAP drug category specified by CMS or on the approved 
CAP vendor's approved CAP drug list.
    (iii) Proposed addition of--
    (A) One or more newly issued HCPCS codes; or
    (B) One of the following single indication orphan drug J codes or 
their updates: J0205, J0256, J9300, J1785, J2355, J3240, J7513, J9010, 
J9015, J9017, J9160, J9216.
    (iv) Beginning January 1, 2007, the proposed addition of a drug(s) 
that has not yet been assigned a HCPCS code, but for which a HCPCS code 
must be established.
    (3) Requesting the addition or substitution of CAP drug. An 
approved CAP vendor that meets the one of the criteria specified in 
paragraph (f)(2) must submit a written request to CMS or its designee. 
The request must--
    (i) Specify the NDC(s) and the respective HCPCS code that is to be 
added or substituted.
    (ii) Address the rationale for the substitution or addition of the 
NDC(s) or the addition of the HCPCS code(s) as applicable; and
    (iii) Address the impact of the substitution of the NDC(s) or the 
addition of the NDC(s) or HCPCS code(s), or both on--
    (A) Patient and drug safety;
    (B) Drug waste; and
    (C) The potential for cost savings.
    (4) Approval of a request(s). CMS or its designee notifies the 
approved CAP vendor of its decision.
    (i) Except as specified in paragraph (f)(4)(ii) of this section, an 
approved request is effective at the beginning of the next calendar 
quarter.
    (ii) Approved substitutions for request based on a drug shortage or 
other exigent circumstance may become effective immediately provided 
that--
    (A) CMS approves the immediate substitution; and
    (B) The approved CAP vendor's notifies its CAP participating 
physicians of the substitution immediately following CMS approval.
    (5) Payment for an approved drug change(s). The payment for-- (i) 
Substituted or added CAP drugs that are within a HCPCS code for which 
payment is computed under paragraph (c)(1) of this section is the 
single payment for that HCPCS code, as determined and updated in 
accordance with paragraph (c)(1) of this section; or
    (ii) Added CAP drugs that are not within a HCPCS code for which 
payment is computed under paragraph (c)(1) of this section is specified 
under paragraph (c)(2) of this section.

0
24. Section 414.908 is amended by--
0
A. Revising paragraphs (a)(3)(v)(M).
0
B. Redesignating paragraphs (a)(3)(vi) through (a)(3) (xii) as 
(a)(3)(viii) through (a)(3)(xiv).
0
C. Adding new paragraphs (a)(3)(vi) and (a)(3)(vii).
0
D. Revising paragraph (a)(5).
    The revisions and additions read as follows:


Sec.  414.908  Competitive acquisition program.

    (a) * * *
    (3) * * *
    (v) * * *
    (M) Additional patient information: date of birth, allergies, 
height/weight, ICD-9-CM (if necessary).
    (vi) Agrees to accept the particular National Drug Codes (NDCs) 
supplied by the approved CAP vendor for the duration of the 
participating CAP physician's enrollment with the approved CAP vendor, 
subject to paragraphs (a)(3)(vii) and (a)(3)(xiv) of this section. By 
electing to participate with an approved CAP vendor, the participating 
CAP physician also agrees to accept the changes to the approved CAP 
vendor's CAP drug list that have been approved in accordance with Sec.  
414.906(f).
    (vii) Agrees to place routine orders for CAP drugs at the HCPCs 
level, except when medical necessity requires a particular formulation 
on the approved CAP vendor's CAP drug list. Medical necessity must be 
documented. When the conditions of this paragraph are met, the 
participating CAP physician may submit a prescription order to the 
approved CAP vendor that specifies the NDC.
* * * * *
    (5) Additional opt out provision. In addition to the circumstances 
listed in paragraph (a)(2) of this section, if the approved CAP vendor 
refuses to ship to the participating CAP physician because the 
conditions of Sec.  414.914(h) were met, the physician can withdraw 
from the CAP category for the remainder of the year immediately upon 
notice to CMS and the approved CAP vendor.
* * * * *

0
25. Section 414.914 is amended by--
0
A. Redesignating paragraphs (f)(9) through (f)(11) as paragraphs 
(f)(14) through (f)(16).
0
B. Redesignating (f)(5) through (f)(8) as paragraphs (f)(9) through 
(f)(12) and paragraphs.
0
C. Adding new paragraphs (f)(5) through (f)(8) and (f)(13).
0
D. Revising paragraph (g)(3).
0
E. Revising paragraphs (h)(1) through (h)(3), (h)(5) and (h)(6), and 
(h)(8).
    The revisions and additions read as follows:


Sec.  414.914  Terms of contract.

* * * * *
    (f) * * *
    (5) Respond within 2 business days to any inquiry, or sooner if the 
inquiry is related to drug quality;
    (6) Staff a toll-free telephone line from 8:30 a.m. or earlier and 
until 5 p.m. or later for all time zones served in the continental 
United States by the CAP vendor on business days (Monday through Friday 
excluding Federal holidays) to provide customer assistance, and 
establish reasonable hours of operation for Hawaii, Alaska, Puerto 
Rico, and the other U.S. territories;
    (7) Staff an emergency toll-free telephone line for weekend and 
evening access when the call center is closed, and determine what hours 
on Saturday and Sunday the call center is staffed and which hours a 
toll-free emergency line is activated; and
    (8) Include assistance for the disabled, the hearing impaired, and 
Spanish-

[[Page 70334]]

speaking inquirers in all customer service operations.
* * * * *
    (13) Provide direct notification to participating CAP physicians 
enrolled with them of updates to the approved CAP vendor's CAP drug 
list on a quarterly basis. Changes must be disseminated at least 30 
days before the approved changes are due to take effect, unless 
immediate notification as described in Sec.  414.906(f)(4) is required. 
The approved CAP vendor's entire CAP drug list must be disseminated at 
least once yearly; and approved CAP vendors must make a complete list 
that incorporates the most recent updates available to physicians on an 
ongoing basis. CMS posts on its web site the updated CAP drug lists for 
each approved CAP vendor.
* * * * *
    (g) * * *
    (3) A full or partial waiver of the cost-sharing amount after 
determining in good faith that the individual is in financial need or 
the failure of reasonable collection efforts, provided that the waiver 
meets all of the requirements of section 1128A(i)(6)(A) of the Act and 
the corresponding regulations at paragraph (1) of the definition of 
``Remuneration'' in Sec.  1003.101 of this title. The availability of 
waivers may not be advertised or be made as part of a solicitation. 
Approved CAP vendors must inform beneficiaries that they generally make 
available the categories of assistance described in paragraphs (g)(1), 
(g)(2), and (g)(3) of this section. In no event may the approved CAP 
vendor include or make any statements or representations that promise 
or guarantee that beneficiaries receive cost-sharing waivers.
    (h) * * *
    (1) Subsequent to receipt of final payment by Medicare, or the 
verification of drug administration by the participating CAP physician, 
the approved CAP vendor must bill any applicable supplemental insurance 
policies.
    (2) If a balance remains, after the supplemental insurer pays their 
share of the bill, or if there is no supplemental insurance, the 
approved CAP vendor may bill the beneficiary.
    (3) At the time of billing the beneficiary, or the participating 
CAP physician's presentation of the bill on behalf of the approved CAP 
vendor, the approved CAP vendor must inform the beneficiary of any 
types of cost-sharing assistance that may be available consistent with 
the requirements of section 1128A(a)(5) of the Act and Sec.  
414.914(g).
    (4) * * *
    (5) For purposes of paragraph (h) delivery means postmark date, or 
the date the coinsurance bill or notice was presented to the 
beneficiary by the participating CAP physician on behalf of the 
approved CAP vendor.
    (i) Except as specified in paragraph (h)(5)(ii), if after 45 days 
from delivery of the approved CAP vendor's bill to the beneficiary, the 
beneficiary's cost-sharing obligation remains unpaid, the approved CAP 
vendor may refuse further shipments to the participating CAP physician 
for that beneficiary.
    (ii) If the beneficiary has requested cost-sharing assistance 
within 45 days of receiving delivery of the approved CAP vendor's bill, 
provisions of paragraphs (h)(6), (h)(7), or (h)(8) of this section, 
apply.
    (6) If the approved CAP vendor implements a reasonable payment 
plan, as specified in Sec.  414.914(g)(2), the approved CAP vendor must 
continue to ship CAP drugs for the beneficiary, as long as the 
beneficiary remains in compliance with the payment plan and makes an 
initial payment under the plan within 15 days after the delivery of the 
approved CAP vendor's written notice to the beneficiary offering the 
payment plan.
    (7) * * *
    (8) If the approved CAP vendor refers the beneficiary to a bona 
fide and independent charity in accordance with Sec.  414.914(g)(1), 
the approved CAP vendor may refuse to ship drugs if the past due 
balance is not paid 15 days after the date of delivery of the approved 
CAP vendor's written notice to the beneficiary containing the referral 
for cost-sharing assistance.
* * * * *

Subpart L--Supplying and Dispensing Fees

0
26. Section 414.1001 is revised to read as follows:


Sec.  414.1001  Basis of payment.

    (a) Supplying fees. Beginning in CY 2006--
    (1) A supplying fee of $24 is paid to a pharmacy for the first 
prescription of drugs and biologicals described in sections 
1861(s)(2)(J), 1861(s)(2)(Q), and 1861(s)(2)(T) of the Act, that the 
pharmacy provided to a beneficiary during a 30-day period.
    (2) A supplying fee of $16 is paid to a pharmacy for each 
prescription following the first prescription (as specified in 
paragraph (a)(1) of this section) of drugs and biologicals described in 
sections 1861(s)(2)(J), 1861(s)(2)(Q), and 1861(s)(2)(T) of the Act, 
that the pharmacy provided to a beneficiary during a 30-day period.
    (3) A separate supplying fee is paid to a pharmacy for each 
prescription of drugs and biologicals described in sections 
1861(s)(2)(J), 1861(s)(2)(Q), and 1861(s)(2)(T) of the Act.
    (b) Supplying fees following transplant. Beginning CY 2006--(1) A 
supplying fee of $50 is paid to pharmacy for the initial supplied 
prescription of drugs and biologicals described in section 
1861(s)(2)(J) of the Act, that the pharmacy provided to a patient 
during the first 30-day period following a transplant.
    (2) A supplying fee of $16 is paid to a pharmacy for each 
prescription following an initial prescription after a transplant (as 
specified in paragraph (b)(1) of this section) of drugs and biologicals 
describe in section 1861(s)(2)(J) of the Act, that the pharmacy 
provided to a beneficiary during a 30-day period.
    (c) 30-day dispensing fees. Beginning CY 2006--(1) A dispensing fee 
of $57 is paid to a supplier to the extent that the prescription is for 
the initial dispensed 30-day supply of inhalation drugs furnished 
through durable medical equipment covered under section 1861(n) of the 
Act, regardless of the number of partial shipments of that 30-day 
supply.
    (2) Except for supplied inhalation drugs that meet criteria 
described in paragraph (c)(1) of this section, a dispensing fee of $33 
is paid for each dispensed 30-day supply of inhalation drugs furnished 
through durable medical equipment covered under section 1861(n) of the 
Act, regardless of the number of partial shipments of that 30-day 
supply.
    (d) 90-day dispensing fee. Beginning CY 2006, a dispensing fee of 
$66 is paid to a supplier for each dispensed 90-day supply of 
inhalation drugs furnished through durable medical equipment covered 
under section 1861(n) of the Act, regardless of the number of partial 
shipments of that 90-day supply.

PART 424--CONDITIONS FOR MEDICARE PAYMENT

0
27. The authority citation for part 424 continues to read as follows:

    Authority: Secs. 1102 and 1871 of the Social Security Act (42 
U.S.C. 1302 and 1395hh).


Sec.  424.22  [Amended]

0
28. In Sec.  424.22--
0
A. The footnote for paragraph (a)(1)(iv), the term ``hosptial'' is 
removed and the term ``hospital'' is added in its place.

[[Page 70335]]

0
B. Paragraph (d), remove the reference to ``Sec.  411.351'' and add in 
its place the reference ``Sec.  411.354''.

PART 426--REVIEW OF NATIONAL COVERAGE DETERMINATIONS AND LOCAL 
COVERAGE DETERMINATIONS

0
29. The authority citation for part 426 continues to read as follows:

    Authority: Secs. 1102 and 1871 of the Social Security Act (42 
U.S.C. 1302 and 1395hh).


0
30. The heading for Part 426 is revised to read as set forth above.

Subpart C--General Provisions for the Review of LCDs and NCDs

0
31. Section 426.340 is amended by revising paragraphs (e)(2) and (f)(2) 
to read as follows:


Sec.  426.340  Procedures for review of new evidence.

* * * * *
    (e) * * *
    (2) Sets a reasonable timeframe--
    (i) For LCDs, of not more than 90 days, by which the contractor 
completes the reconsideration; or
    (ii) For NCDs, in compliance with the timeframes specified in 
section 1862(1) of the Act, by which CMS completes the reconsideration.
    (f) * * *
    (2) Does not meet--
    (i) For LCDs, the 90-day reconsideration timeframe; or
    (ii) For NCDs, the reconsideration timeframe specified by the 
Board, in compliance with section 1862(1) of the Act.
* * * * *

(Catalog of Federal Domestic Assistance Program No. 93.773, 
Medicare--Hospital Insurance; and Program No. 93.774, Medicare--
Supplementary Medical Insurance Program)

    Dated: October 26, 2005.
Mark B. McClellan,
Administrator, Centers for Medicare & Medicaid Services.
    Approved: November 1, 2005.
Michael O. Leavitt,
Secretary.

    Note: These addenda will not appear in the Code of Federal 
Regulations.

Addendum A: Explanation and Use of Addenda B

    The addenda on the following pages provides various data pertaining 
to the Medicare fee schedule for physicians' services furnished in 
2006. Addendum B contains the RVUs for work, non-facility PE, facility 
PE, and malpractice expense, and other information for all services 
included in the PFS.
    In previous years, we have listed many services in Addendum B that 
are not paid under the PFS. To avoid publishing as many pages of codes 
for these services, we are not including clinical laboratory codes and 
most alpha-numeric codes (Healthcare Common Procedure Coding System 
(HCPCS) codes not included in CPT) in Addendum B.

Addendum B--2006 Relative Value Units and Related Information Used in 
Determining Medicare Payments for 2006

    This addendum contains the following information for each CPT code 
and alphanumeric HCPCS code, except for: alphanumeric codes beginning 
with B (enteral and parenteral therapy), E (durable medical equipment), 
K (temporary codes for nonphysicians' services or items), or L 
(orthotics); and codes for anesthesiology.
    Please also note the following:
    <bullet> An ``NA'' in the ``Non-facility PE RVUs'' column of 
Addendum B means that CMS has not developed a PE RVU in the non-
facility setting for the service because it is typically performed in 
the hospital (for example, an open heart surgery is generally performed 
in the hospital setting and not a physician's office).
    <bullet> Services that have an ``NA'' in the ``Facility PE RVUs'' 
column of Addendum B are typically not paid using the PFS when provided 
in a facility setting. These services (which include ``incident to'' 
services and the technical portion of diagnostic tests) are generally 
paid under either the outpatient hospital prospective payment system or 
bundled into the hospital inpatient prospective payment system payment.
    1. CPT/HCPCS code. This is the CPT or alphanumeric HCPCS number for 
the service. Alphanumeric HCPCS codes are included at the end of this 
addendum.
    2. Modifier. A modifier is shown if there is a technical component 
(modifier TC) and a professional component (PC) (modifier -26) for the 
service. If there is a PC and a TC for the service, Addendum B contains 
three entries for the code. A code for: the global values (both 
professional and technical); modifier -26 (PC); and, modifier TC. The 
global service is not designated by a modifier, and physicians must 
bill using the code without a modifier if the physician furnishes both 
the PC and the TC of the service.
    Modifier -53 is shown for a discontinued procedure. There will be 
RVUs for the code (CPT code 45378) with this modifier.
    3. Status indicator. This indicator shows whether the CPT/HCPCS 
code is in the PFS and whether it is separately payable if the service 
is covered.
    A = Active code. These codes are separately payable under the PFS 
if covered. There will be RVUs for codes with this status. The presence 
of an ``A'' indicator does not mean that Medicare has made a national 
coverage determination regarding the service. Carriers remain 
responsible for coverage decisions in the absence of a national 
Medicare policy.
    B = Bundled code. Payments for covered services are always bundled 
into payment for other services not specified. If RVUs are shown, they 
are not used for Medicare payment. If these services are covered, 
payment for them is subsumed by the payment for the services to which 
they are incident (an example is a telephone call from a hospital nurse 
regarding care of a patient).
    C = Carrier-priced code. Carriers will establish RVUs and payment 
amounts for these services, generally on an individual case basis 
following review of documentation, such as an operative report.
    D = Deleted/discontinued code. These codes are deleted effective 
with the beginning of the CY and are always subject to a 90 day grace 
period.
    E = Excluded from the PFS by regulation. These codes are for items 
and services that CMS choses to exclude from the PFS payment by 
regulation. No RVUs are shown, and no payment may be made under the PFS 
for these codes. Payment for them, when covered, continues under 
reasonable charge procedures.
    F = Deleted/discontinued codes. (Code not subject to a 90-day grace 
period.) These codes are deleted effective with the beginning of the CY 
and are never subject to a grace period. This indicator is no longer 
effective with the 2006 PFS as of January 1, 2006.
    G = Code not valid for Medicare purposes. Medicare does not 
recognize codes assigned this status. Medicare uses another code for 
reporting of, and payment for, these services. (Code subject to a 90 
day grace period.) This indicator is no longer effective with the 2006 
PFS as of January 1, 2006.
    H = Deleted modifier. For 2000 and later years, either the TC or PC 
component shown for the code has been deleted and the deleted component 
is shown in the data base with the H status indicator.
    I = Not valid for Medicare purposes. Medicare uses another code for 
the

[[Page 70336]]

reporting of, and the payment for these services. (Code not subject to 
a 90-day grace period.)
    N = Noncovered service. These codes are noncovered services. 
Medicare payment may not be made for these codes. If RVUs are shown, 
they are not used for Medicare payment.
    P = Bundled or excluded code. There are no RVUs for these services. 
No separate payment is made for them under the PFS.

--If the item or service is covered as incident to a physician's 
service and is furnished on the same day as a physician's service, 
payment for it is bundled into the payment for the physician's service 
to which it is incident (an example is an elastic bandage furnished by 
a physician incident to a physician's service).
--If the item or service is covered as other than incident to a 
physician's service, it is excluded from the PFS (for example, 
colostomy supplies) and is paid under the other payment provisions of 
the Act.
    R = Restricted coverage. Special coverage instructions apply. If 
the service is covered and no RVUs are shown, it is carrier-priced.
    T = There are RVUs for these services, but they are only paid if 
there are no other services payable under the PFS billed on the same 
date by the same provider. If any other services payable under the PFS 
are billed on the same date by the same provider, these services are 
bundled into the service(s) for which payment is made.
    X = Exclusion by law. These codes represent an item or service that 
is not within the definition of ``physicians' services'' for PFS 
payment purposes. No RVUs are shown for these codes, and no payment may 
be made under the PFS. (Examples are ambulance services and clinical 
diagnostic laboratory services.)
    4. Description of code. This is an abbreviated version of the 
narrative description of the code.
    5. Physician work RVUs. These are the RVUs for the physician work 
for this service in 2006. Codes that are not used for Medicare payment 
are identified with a ``+.''
    6. Non-facility practice expense RVUs. These are the resource-based 
PE RVUs for non-facility settings.
    7. Facility practice expense RVUs. These are the resource-based PE 
RVUs for facility settings.
    8. Malpractice expense RVUs. These are the RVUs for the malpractice 
expense for the service for 2006.
    9. Non-facility total. This is the sum of the work, non-facility 
practice expense, and malpractice expense RVUs.
    10. Facility total. This is the sum of the work, facility PE, and 
malpractice expense RVUs.
    11. Global period. This indicator shows the number of days in the 
global period for the code (0, 10, or 90 days). An explanation of the 
alpha codes follows:
    MMM = The code describes a service furnished in uncomplicated 
maternity cases including antepartum care, delivery, and postpartum 
care. The usual global surgical concept does not apply. See the 1999 
Physicians' Current Procedural Terminology for specific definitions.
    XXX = The global concept does not apply.
    YYY = The global period is to be set by the carrier (for example, 
unlisted surgery codes).
    ZZZ = Code related to another service that is always included in 
the global period of the other service. (Note: Physician work and PE 
are associated with intra service time and in some instances the post 
service time.)



    --------------------
\1\ CPT codes and descriptions only are copyright 2005 American Medical 
Association. All Rights Reserved.

\2\ Copyright 2005 American Dental Association. All rights reserved.

\3\ +Indicates RVUs are not used for Medicare payment.

[[Page 70337]]



                                            Addendum B.--Relative Value Units (RVUs) and Related Information
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                             Physician     Non-                  Mal-       Non-
CPT \1\  HCPCS \2\        Mod            Status            Description          work     Facility   Facility   practice   Facility   Facility    Global
                                                                              RVUs \3\   PE RVUs    PE RVUs      RVUs      Total      Total
--------------------------------------------------------------------------------------------------------------------------------------------------------
0001F.............  ..............  I                Heart failure assessed       0.00       0.00       0.00       0.00       0.00       0.00        XXX
0003T.............  ..............  C                Cervicography.........       0.00       0.00       0.00       0.00       0.00       0.00        XXX
0005F.............  ..............  I                Osteoarthritis               0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      assessed.
0008T.............  ..............  C                Upper gi endoscopy w/        0.00       0.00       0.00       0.00       0.00        .00        XXX
                                                      suture.
0016T.............  ..............  C                Thermotx choroid vasc        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      lesion.
0017T.............  ..............  C                Photocoagulat macular        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      drusen.
0018T.............  ..............  C                Transcranial magnetic        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      stimul.
0019T.............  ..............  C                Extracorp shock wv           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      tx,ms nos.
0021T.............  ..............  C                Fetal oximetry,              0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      trnsvag/cerv.
0024T.............  ..............  C                Transcath cardiac            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      reduction.
0026T.............  ..............  C                Measure remnant              0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      lipoproteins.
0027T.............  ..............  C                Endoscopic epidural          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      lysis.
0028T.............  ..............  C                Dexa body composition        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      study.
0029T.............  ..............  C                Magnetic tx for              0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      incontinence.
0030T.............  ..............  C                Antiprothrombin              0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      antibody.
0031T.............  ..............  C                Speculoscopy..........       0.00       0.00       0.00       0.00       0.00       0.00        XXX
0032T.............  ..............  C                Speculoscopy w/direct        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      sample.
0041T.............  ..............  C                Detect ur infect agnt        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      w/cpas.
0042T.............  ..............  C                Ct perfusion w/              0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      contrast, cbf.
0043T.............  ..............  C                Co expired gas               0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      analysis.
0044T.............  ..............  C                Whole body photography       0.00       0.00       0.00       0.00       0.00       0.00        XXX
0045T.............  ..............  C                Whole body photography       0.00       0.00       0.00       0.00       0.00       0.00        XXX
0046T.............  ..............  C                Cath lavage, mammary         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      duct(s.
0047T.............  ..............  C                Cath lavage, mammary         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      duct(s).
0048T.............  ..............  C                Implant ventricular          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      device.
0049T.............  ..............  C                External circulation         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      assist.
0050T.............  ..............  C                Removal circulation          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      assist.
0051T.............  ..............  C                Implant total heart          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      system.
0052T.............  ..............  C                Replace component            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      heart syst.
0053T.............  ..............  C                Replace component            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      heart syst.
0054T.............  ..............  C                Bone surgery using           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      computer.
0055T.............  ..............  C                Bone surgery using           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      computer.
0056T.............  ..............  C                Bone surgery using           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      computer.
0058T.............  ..............  C                Cryopreservation,            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      ovary tiss.
0059T.............  ..............  C                Cryopreservation,            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      oocyte.
0060T.............  ..............  C                Electrical impedance         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      scan.
0061T.............  ..............  C                Destruction of tumor,        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      breast.
0062T.............  ..............  C                Rep intradisc                0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      annulus;1 lev.
0063T.............  ..............  C                Rep intradisc                0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      annulus;>1lev.
0064T.............  ..............  C                Spectroscop eval             0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      expired gas.
0065T.............  ..............  C                Ocular photoscreen           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      bilat.
0066T.............  26............  N                Ct colonography;screen       0.00       0.00       0.00       0.00       0.00       0.00        XXX
0066T.............  TC............  N                Ct colonography;screen       0.00       0.00       0.00       0.00       0.00       0.00        XXX
0066T.............  ..............  N                Ct colonography;screen       0.00       0.00       0.00       0.00       0.00       0.00        XXX
0067T.............  26............  C                Ct colonography;dx....       0.00       0.00       0.00       0.00       0.00       0.00        XXX
0067T.............  TC............  C                Ct colonography;dx....       0.00       0.00       0.00       0.00       0.00       0.00        XXX
0067T.............  ..............  C                Ct colonography;dx....       0.00       0.00       0.00       0.00       0.00       0.00        XXX
0068T.............  ..............  C                Interp/rept heart            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      sound.
0069T.............  ..............  C                Analysis only heart          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      sound.
0070T.............  ..............  C                Interp only heart            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      sound.
0071T.............  ..............  C                U/s leiomyomata ablate       0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      <200.
0072T.............  ..............  C                U/s leiomyomata ablate       0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      >200.
0073T.............  ..............  A                Delivery, comp imrt...       0.00      18.07         NA       0.13      18.20         NA        XXX
0074T.............  ..............  N                Online physician e/m..       0.00       0.00       0.00       0.00       0.00       0.00        XXX
0075T.............  26............  C                Perq stent/chest vert        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      art.
0075T.............  TC............  C                Perq stent/chest vert        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      art.
0075T.............  ..............  C                Perq stent/chest vert        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      art.
0076T.............  26............  C                S&i stent/chest vert         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      art.
0076T.............  TC............  C                S&i stent/chest vert         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      art.
0076T.............  ..............  C                S&i stent/chest vert         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      art.
0077T.............  ..............  C                Cereb therm perfusion        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      probe.
0078T.............  ..............  C                Endovasc aort repr w/        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      device.
0079T.............  ..............  C                Endovasc visc extnsn         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      repr.
0080T.............  ..............  C                Endovasc aort repr rad       0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      s&i.
0081T.............  ..............  C                Endovasc visc extnsn         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      s&i.
0082T.............  ..............  C                Stereotactic rad             0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      delivery.
0083T.............  ..............  C                Stereotactic rad tx          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      mngmt.
0084T.............  ..............  C                Temp prostate urethral       0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      stent.
0085T.............  ..............  C                Breath test heart            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      reject.
0086T.............  ..............  C                L ventricle fill             0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      pressure.
0087T.............  ..............  C                Sperm eval hyaluronan.       0.00       0.00       0.00       0.00       0.00       0.00        XXX
0088T.............  ..............  C                Rf tongue base vol           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      reduxn.
0089T.............  ..............  C                Actigraphy testing, 3-       0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      day.
0090T.............  ..............  C                Cervical artific disc.       0.00       0.00       0.00       0.00       0.00       0.00        XXX
0091T.............  ..............  C                Lumbar artific disc...       0.00       0.00       0.00       0.00       0.00       0.00        XXX

[[Page 70338]]

 
0092T.............  ..............  C                Artific disc addl.....       0.00       0.00       0.00       0.00       0.00       0.00        XXX
0093T.............  ..............  C                Cervical artific             0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      diskectomy.
0094T.............  ..............  C                Lumbar artific               0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      diskectomy.
0095T.............  ..............  C                Artific diskectomy           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      addl.
0096T.............  ..............  C                Rev cervical artific         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      disc.
0097T.............  ..............  C                Rev lumbar artific           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      disc.
0098T.............  ..............  C                Rev artific disc addl.       0.00       0.00       0.00       0.00       0.00       0.00        XXX
0099T.............  ..............  C                Implant corneal ring..       0.00       0.00       0.00       0.00       0.00       0.00        XXX
0100T.............  ..............  C                Prosth retina                0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      receive&gen.
0101T.............  ..............  C                Extracorp shockwv            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      tx,hi enrg.
0102T.............  ..............  C                Extracorp shockwv            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      tx,anesth.
0103T.............  ..............  C                Holotranscobalamin....       0.00       0.00       0.00       0.00       0.00       0.00        XXX
0104T.............  ..............  C                At rest cardio gas           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      rebreathe.
0105T.............  ..............  C                Exerc cardio gas             0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      rebreathe.
0106T.............  ..............  C                Touch quant sensory          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      test.
0107T.............  ..............  C                Vibrate quant sensory        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      test.
0108T.............  ..............  C                Cool quant sensory           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      test.
0109T.............  ..............  C                Heat quant sensory           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      test.
0110T.............  ..............  C                Nos quant sensory test       0.00       0.00       0.00       0.00       0.00       0.00        XXX
0111T.............  ..............  C                Rbc membranes fatty          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      acids.
0115T.............  ..............  C                Med tx mngmt 15 min...       0.00       0.00       0.00       0.00       0.00       0.00        XXX
0116T.............  ..............  C                Med tx mngmt subsqt...       0.00       0.00       0.00       0.00       0.00       0.00        XXX
0117T.............  ..............  C                Med tx mngmt addl 15         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      min.
0120T.............  ..............  C                Fibroadenoma                 0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      cryoablate, ea.
0123T.............  ..............  C                Scleral fistulization.       0.00       0.00       0.00       0.00       0.00       0.00        XXX
0124T.............  ..............  C                Conjunctival drug            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      placement.
0126T.............  ..............  C                Chd risk imt study....       0.00       0.00       0.00       0.00       0.00       0.00        XXX
0130T.............  ..............  C                Chron care drug              0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      investigatn.
0133T.............  ..............  C                Esophageal implant           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      injexn.
0135T.............  ..............  C                Perq cryoablate renal        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      tumor.
0137T.............  ..............  C                Prostate saturation          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      sampling.
0140T.............  ..............  C                Exhaled breath               0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      condensate ph.
0141T.............  ..............  C                Perq islet transplant.       0.00       0.00       0.00       0.00       0.00       0.00        XXX
0142T.............  ..............  C                Open islet transplant.       0.00       0.00       0.00       0.00       0.00       0.00        XXX
0143T.............  ..............  C                Laparoscopic islet           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      transplnt.
0144T.............  ..............  C                CT heart wo dye; qual        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      calc.
0145T.............  ..............  C                CT heart w/wo dye            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      funct.
0146T.............  ..............  C                CCTA w/wo dye.........       0.00       0.00       0.00       0.00       0.00       0.00        XXX
0147T.............  ..............  C                CCTA w/wo, quan              0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      calcium.
0148T.............  ..............  C                CCTA w/wo, strxr......       0.00       0.00       0.00       0.00       0.00       0.00        XXX
0149T.............  ..............  C                CCTA w/wo, strxr quan        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      calc.
0150T.............  ..............  C                CCTA w/wo, disease           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      strxr.
0151T.............  ..............  C                CT heart funct add-on.       0.00       0.00       0.00       0.00       0.00       0.00        XXX
0152T.............  ..............  C                Computer chest add-on.       0.00       0.00       0.00       0.00       0.00       0.00        XXX
0153T.............  ..............  C                Implant aneur sensor         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      add-on.
0154T.............  ..............  C                Implant aneur sensor         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      study.
0500F.............  ..............  I                Initial prenatal care        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      visit.
0501F.............  ..............  I                Prenatal flow sheet...       0.00       0.00       0.00       0.00       0.00       0.00        XXX
0502F.............  ..............  I                Subsequent prenatal          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      care.
0503F.............  ..............  I                Postpartum care visit.       0.00       0.00       0.00       0.00       0.00       0.00        XXX
1000F.............  ..............  I                Tobacco use, smoking,        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      assess.
1001F.............  ..............  I                Tobacco use, non-            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      smoking.
10021.............  ..............  A                Fna w/o image.........       1.27       2.16       0.54       0.10       3.53       1.91        XXX
10022.............  ..............  A                Fna w/image...........       1.27       2.55       0.42       0.08       3.90       1.77        XXX
1002F.............  ..............  I                Assess anginal symptom/      0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      level.
1003F.............  ..............  I                Level of activity            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      assess.
10040.............  ..............  A                Acne surgery..........       1.18       1.01       0.79       0.05       2.24       2.02        010
1004F.............  ..............  I                Clin symp vol ovrld          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      assess.
1005F.............  ..............  I                Asthma symptoms              0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      evaluate.
10060.............  ..............  A                Drainage of skin             1.17       1.21       0.93       0.12       2.50       2.22        010
                                                      abscess.
10061.............  ..............  A                Drainage of skin             2.40       1.83       1.50       0.26       4.49       4.16        010
                                                      abscess.
1006F.............  ..............  I                Osteoarthritis assess.       0.00       0.00       0.00       0.00       0.00       0.00        XXX
1007F.............  ..............  I                Anti-inflm/anlgsc otc        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      assess.
10080.............  ..............  A                Drainage of pilonidal        1.17       3.11       1.11       0.11       4.39       2.39        010
                                                      cyst.
10081.............  ..............  A                Drainage of pilonidal        2.45       4.08       1.50       0.24       6.77       4.19        010
                                                      cyst.
1008F.............  ..............  I                Gi/renal risk assess..       0.00       0.00       0.00       0.00       0.00       0.00        XXX
10120.............  ..............  A                Remove foreign body...       1.22       2.18       0.97       0.12       3.52       2.31        010
10121.............  ..............  A                Remove foreign body...       2.69       3.52       1.79       0.33       6.54       4.81        010
10140.............  ..............  A                Drainage of hematoma/        1.53       1.78       1.29       0.19       3.50       3.01        010
                                                      fluid.
10160.............  ..............  A                Puncture drainage of         1.20       1.60       1.08       0.14       2.94       2.42        010
                                                      lesion.
10180.............  ..............  A                Complex drainage,            2.25       2.99       1.99       0.35       5.59       4.59        010
                                                      wound.
11000.............  ..............  A                Debride infected skin.       0.60       0.58       0.22       0.07       1.25       0.89        000
11001.............  ..............  A                Debride infected skin        0.30       0.23       0.11       0.04       0.57       0.45        ZZZ
                                                      add-on.
11004.............  ..............  A                Debride genitalia &         10.31         NA       3.91       0.67         NA      14.89        000
                                                      perineum.
11005.............  ..............  A                Debride abdom wall....      13.75         NA       5.58       0.96         NA      20.29        000

[[Page 70339]]

 
11006.............  ..............  A                Debride genit/per/          12.61         NA       4.86       1.28         NA      18.75        000
                                                      abdom wall.
11008.............  ..............  A                Remove mesh from abd         5.00         NA       2.03       0.61         NA       7.64        ZZZ
                                                      wall.
11010.............  ..............  A                Debride skin, fx......       4.19       6.89       2.63       0.66      11.74       7.48        010
11011.............  ..............  A                Debride skin/muscle,         4.94       8.18       2.35       0.74      13.86       8.03        000
                                                      fx.
11012.............  ..............  A                Debride skin/muscle/         6.87      12.14       3.85       1.16      20.17      11.88        000
                                                      bone, fx.
11040.............  ..............  A                Debride skin, partial.       0.50       0.52       0.21       0.06       1.08       0.77        000
11041.............  ..............  A                Debride skin, full....       0.82       0.66       0.33       0.10       1.58       1.25        000
11042.............  ..............  A                Debride skin/tissue...       1.12       0.97       0.44       0.13       2.22       1.69        000
11043.............  ..............  A                Debride tissue/muscle.       2.38       3.39       2.60       0.32       6.09       5.30        010
11044.............  ..............  A                Debride tissue/muscle/       3.06       4.46       3.76       0.43       7.95       7.25        010
                                                      bone.
11055.............  ..............  R                Trim skin lesion......       0.43       0.56       0.17       0.05       1.04       0.65        000
11056.............  ..............  R                Trim skin lesions, 2         0.61       0.64       0.23       0.07       1.32       0.91        000
                                                      to 4.
11057.............  ..............  R                Trim skin lesions,           0.79       0.74       0.30       0.10       1.63       1.19        000
                                                      over 4.
11100.............  ..............  A                Biopsy, skin lesion...       0.81       1.25       0.37       0.03       2.09       1.21        000
11101.............  ..............  A                Biopsy, skin add-on...       0.41       0.33       0.19       0.02       0.76       0.62        ZZZ
11200.............  ..............  A                Removal of skin tags..       0.77       1.04       0.76       0.04       1.85       1.57        010
11201.............  ..............  A                Remove skin tags add-        0.29       0.16       0.12       0.02       0.47       0.43        ZZZ
                                                      on.
11300.............  ..............  A                Shave skin lesion.....       0.51       0.99       0.21       0.03       1.53       0.75        000
11301.............  ..............  A                Shave skin lesion.....       0.85       1.11       0.38       0.04       2.00       1.27        000
11302.............  ..............  A                Shave skin lesion.....       1.05       1.30       0.46       0.05       2.40       1.56        000
11303.............  ..............  A                Shave skin lesion.....       1.24       1.58       0.52       0.07       2.89       1.83        000
11305.............  ..............  A                Shave skin lesion.....       0.67       0.85       0.27       0.07       1.59       1.01        000
11306.............  ..............  A                Shave skin lesion.....       0.99       1.10       0.42       0.07       2.16       1.48        000
11307.............  ..............  A                Shave skin lesion.....       1.14       1.29       0.49       0.07       2.50       1.70        000
11308.............  ..............  A                Shave skin lesion.....       1.41       1.45       0.59       0.13       2.99       2.13        000
11310.............  ..............  A                Shave skin lesion.....       0.73       1.11       0.32       0.04       1.88       1.09        000
11311.............  ..............  A                Shave skin lesion.....       1.05       1.23       0.49       0.05       2.33       1.59        000
11312.............  ..............  A                Shave skin lesion.....       1.20       1.42       0.55       0.06       2.68       1.81        000
11313.............  ..............  A                Shave skin lesion.....       1.62       1.81       0.72       0.10       3.53       2.44        000
11400.............  ..............  A                Exc tr-ext b9+marg 0.5       0.85       2.00       0.88       0.06       2.91       1.79        010
                                                      < cm.
11401.............  ..............  A                Exc tr-ext b9+marg 0.6-      1.23       2.06       1.02       0.10       3.39       2.35        010
                                                      1 cm.
11402.............  ..............  A                Exc tr-ext b9+marg 1.1-      1.51       2.23       1.08       0.13       3.87       2.72        010
                                                      2 cm.
11403.............  ..............  A                Exc tr-ext b9+marg 2.1-      1.79       2.40       1.32       0.17       4.36       3.28        010
                                                      3 cm.
11404.............  ..............  A                Exc tr-ext b9+marg 3.1-      2.06       2.71       1.40       0.21       4.98       3.67        010
                                                      4 cm.
11406.............  ..............  A                Exc tr-ext b9+marg >         2.76       3.07       1.65       0.32       6.15       4.73        010
                                                      4.0 cm.
11420.............  ..............  A                Exc h-f-nk-sp b9+marg        0.98       1.77       0.93       0.09       2.84       2.00        010
                                                      0.5 <.
11421.............  ..............  A                Exc h-f-nk-sp b9+marg        1.42       2.07       1.11       0.13       3.62       2.66        010
                                                      0.6-1.
11422.............  ..............  A                Exc h-f-nk-sp b9+marg        1.63       2.26       1.33       0.16       4.05       3.12        010
                                                      1.1-2.
11423.............  ..............  A                Exc h-f-nk-sp b9+marg        2.01       2.59       1.45       0.20       4.80       3.66        010
                                                      2.1-3.
11424.............  ..............  A                Exc h-f-nk-sp b9+marg        2.43       2.81       1.60       0.25       5.49       4.28        010
                                                      3.1-4.
11426.............  ..............  A                Exc h-f-nk-sp b9+marg        3.77       3.49       2.11       0.44       7.70       6.32        010
                                                      > 4 cm.
11440.............  ..............  A                Exc face-mm b9+marg          1.06       2.21       1.31       0.08       3.35       2.45        010
                                                      0.5 < cm.
11441.............  ..............  A                Exc face-mm b9+marg          1.48       2.34       1.49       0.13       3.95       3.10        010
                                                      0.6-1 cm.
11442.............  ..............  A                Exc face-mm b9+marg          1.72       2.55       1.57       0.16       4.43       3.45        010
                                                      1.1-2 cm.
11443.............  ..............  A                Exc face-mm b9+marg          2.29       2.92       1.82       0.22       5.43       4.33        010
                                                      2.1-3 cm.
11444.............  ..............  A                Exc face-mm b9+marg          3.14       3.48       2.19       0.30       6.92       5.63        010
                                                      3.1-4 cm.
11446.............  ..............  A                Exc face-mm b9+marg >        4.48       4.05       2.78       0.43       8.96       7.69        010
                                                      4 cm.
11450.............  ..............  A                Removal, sweat gland         2.73       5.04       2.03       0.34       8.11       5.10        090
                                                      lesion.
11451.............  ..............  A                Removal, sweat gland         3.94       6.62       2.55       0.53      11.09       7.02        090
                                                      lesion.
11462.............  ..............  A                Removal, sweat gland         2.51       5.12       2.02       0.32       7.95       4.85        090
                                                      lesion.
11463.............  ..............  A                Removal, sweat gland         3.94       6.84       2.69       0.54      11.32       7.17        090
                                                      lesion.
11470.............  ..............  A                Removal, sweat gland         3.25       5.07       2.27       0.40       8.72       5.92        090
                                                      lesion.
11471.............  ..............  A                Removal, sweat gland         4.40       6.72       2.77       0.58      11.70       7.75        090
                                                      lesion.
11600.............  ..............  A                Exc tr-ext mlg+marg          1.31       2.64       0.97       0.10       4.05       2.38        010
                                                      0.5 < cm.
11601.............  ..............  A                Exc tr-ext mlg+marg          1.80       2.71       1.22       0.12       4.63       3.14        010
                                                      0.6-1 cm.
11602.............  ..............  A                Exc tr-ext mlg+marg          1.95       2.83       1.26       0.12       4.90       3.33        010
                                                      1.1-2 cm.
11603.............  ..............  A                Exc tr-ext mlg+marg          2.19       3.08       1.33       0.16       5.43       3.68        010
                                                      2.1-3 cm.
11604.............  ..............  A                Exc tr-ext mlg+marg          2.40       3.38       1.39       0.20       5.98       3.99        010
                                                      3.1-4 cm.
11606.............  ..............  A                Exc tr-ext mlg+marg >        3.42       4.07       1.74       0.36       7.85       5.52        010
                                                      4 cm.
11620.............  ..............  A                Exc h-f-nk-sp mlg+marg       1.19       2.60       0.95       0.09       3.88       2.23        010
                                                      0.5 <.
11621.............  ..............  A                Exc h-f-nk-sp mlg+marg       1.76       2.71       1.24       0.12       4.59       3.12        010
                                                      0.6-1.
11622.............  ..............  A                Exc h-f-nk-sp mlg+marg       2.09       2.97       1.39       0.14       5.20       3.62        010
                                                      1.1-2.
11623.............  ..............  A                Exc h-f-nk-sp mlg+marg       2.61       3.34       1.58       0.20       6.15       4.39        010
                                                      2.1-3.
11624.............  ..............  A                Exc h-f-nk-sp mlg+marg       3.06       3.75       1.78       0.27       7.08       5.11        010
                                                      3.1-4.
11626.............  ..............  A                Exc h-f-nk-sp mlg+mar        4.29       4.64       2.40       0.45       9.38       7.14        010
                                                      > 4 cm.
11640.............  ..............  A                Exc face-mm malig+marg       1.35       2.66       1.11       0.11       4.12       2.57        010
                                                      0.5 <.
11641.............  ..............  A                Exc face-mm malig+marg       2.16       3.03       1.53       0.16       5.35       3.85        010
                                                      0.6-1.
11642.............  ..............  A                Exc face-mm malig+marg       2.59       3.41       1.71       0.19       6.19       4.49        010
                                                      1.1-2.
11643.............  ..............  A                Exc face-mm malig+marg       3.10       3.81       1.97       0.26       7.17       5.33        010
                                                      2.1-3.
11644.............  ..............  A                Exc face-mm malig+marg       4.02       4.69       2.46       0.37       9.08       6.85        010
                                                      3.1-4.
11646.............  ..............  A                Exc face-mm mlg+marg >       5.94       5.77       3.48       0.61      12.32      10.03        010
                                                      4 cm.
11719.............  ..............  R                Trim nail(s)..........       0.17       0.25       0.07       0.02       0.44       0.26        000
11720.............  ..............  A                Debride nail, 1-5.....       0.32       0.34       0.12       0.04       0.70       0.48        000
11721.............  ..............  A                Debride nail, 6 or           0.54       0.44       0.21       0.07       1.05       0.82        000
                                                      more.
11730.............  ..............  A                Removal of nail plate.       1.13       1.03       0.43       0.14       2.30       1.70        000

[[Page 70340]]

 
11732.............  ..............  A                Remove nail plate, add-      0.57       0.44       0.22       0.07       1.08       0.86        ZZZ
                                                      on.
11740.............  ..............  A                Drain blood from under       0.37       0.55       0.35       0.04       0.96       0.76        000
                                                      nail.
11750.............  ..............  A                Removal of nail bed...       1.86       2.17       1.76       0.22       4.25       3.84        010
11752.............  ..............  A                Remove nail bed/finger       2.67       3.00       3.00       0.35       6.02       6.02        010
                                                      tip.
11755.............  ..............  A                Biopsy, nail unit.....       1.31       1.57       0.77       0.14       3.02       2.22        000
11760.............  ..............  A                Repair of nail bed....       1.58       2.63       1.79       0.21       4.42       3.58        010
11762.............  ..............  A                Reconstruction of nail       2.89       2.89       2.35       0.36       6.14       5.60        010
                                                      bed.
11765.............  ..............  A                Excision of nail fold,       0.69       1.79       0.76       0.08       2.56       1.53        010
                                                      toe.
11770.............  ..............  A                Removal of pilonidal         2.61       3.49       1.50       0.33       6.43       4.44        010
                                                      lesion.
11771.............  ..............  A                Removal of pilonidal         5.73       5.66       3.32       0.74      12.13       9.79        090
                                                      lesion.
11772.............  ..............  A                Removal of pilonidal         6.97       7.52       5.08       0.89      15.38      12.94        090
                                                      lesion.
11900.............  ..............  A                Injection into skin          0.52       0.65       0.21       0.02       1.19       0.75        000
                                                      lesions.
11901.............  ..............  A                Added skin lesions           0.80       0.66       0.35       0.03       1.49       1.18        000
                                                      injection.
11920.............  ..............  R                Correct skin color           1.61       3.71       1.09       0.24       5.56       2.94        000
                                                      defects.
11921.............  ..............  R                Correct skin color           1.93       3.97       1.27       0.29       6.19       3.49        000
                                                      defects.
11922.............  ..............  R                Correct skin color           0.49       1.14       0.25       0.07       1.70       0.81        ZZZ
                                                      defects.
11950.............  ..............  R                Therapy for contour          0.84       1.14       0.39       0.06       2.04       1.29        000
                                                      defects.
11951.............  ..............  R                Therapy for contour          1.19       1.49       0.51       0.11       2.79       1.81        000
                                                      defects.
11952.............  ..............  R                Therapy for contour          1.69       1.86       0.68       0.16       3.71       2.53        000
                                                      defects.
11954.............  ..............  R                Therapy for contour          1.85       2.45       0.90       0.25       4.55       3.00        000
                                                      defects.
11960.............  ..............  A                Insert tissue                9.07         NA      10.42       1.31         NA      20.80        090
                                                      expander(s).
11970.............  ..............  A                Replace tissue               7.05         NA       6.15       1.05         NA      14.25        090
                                                      expander.
11971.............  ..............  A                Remove tissue                2.13       9.14       3.80       0.32      11.59       6.25        090
                                                      expander(s).
11975.............  ..............  N                Insert contraceptive        +1.48       1.42       0.57       0.17       3.07       2.22        XXX
                                                      cap.
11976.............  ..............  R                Removal of                   1.78       1.72       0.68       0.21       3.71       2.67        000
                                                      contraceptive cap.
11977.............  ..............  N                Removal/reinsert            +3.30       2.28       1.26       0.37       5.95       4.93        XXX
                                                      contra cap.
11980.............  ..............  A                Implant hormone              1.48       1.08       0.54       0.13       2.69       2.15        000
                                                      pellet(s).
11981.............  ..............  A                Insert drug implant          1.48       1.70       0.68       0.12       3.30       2.28        XXX
                                                      device.
11982.............  ..............  A                Remove drug implant          1.78       1.95       0.83       0.17       3.90       2.78        XXX
                                                      device.
11983.............  ..............  A                Remove/insert drug           3.30       2.29       1.47       0.23       5.82       5.00        XXX
                                                      implant.
12001.............  ..............  A                Repair superficial           1.70       1.99       0.77       0.15       3.84       2.62        010
                                                      wound(s).
12002.............  ..............  A                Repair superficial           1.86       2.05       0.90       0.17       4.08       2.93        010
                                                      wound(s).
12004.............  ..............  A                Repair superficial           2.24       2.33       1.01       0.21       4.78       3.46        010
                                                      wound(s).
12005.............  ..............  A                Repair superficial           2.86       2.83       1.20       0.27       5.96       4.33        010
                                                      wound(s).
12006.............  ..............  A                Repair superficial           3.66       3.40       1.51       0.35       7.41       5.52        010
                                                      wound(s).
12007.............  ..............  A                Repair superficial           4.11       3.83       1.82       0.45       8.39       6.38        010
                                                      wound(s).
12011.............  ..............  A                Repair superficial           1.76       2.14       0.78       0.16       4.06       2.70        010
                                                      wound(s).
12013.............  ..............  A                Repair superficial           1.99       2.28       0.93       0.18       4.45       3.10        010
                                                      wound(s).
12014.............  ..............  A                Repair superficial           2.46       2.58       1.06       0.23       5.27       3.75        010
                                                      wound(s).
12015.............  ..............  A                Repair superficial           3.19       3.14       1.25       0.29       6.62       4.73        010
                                                      wound(s).
12016.............  ..............  A                Repair superficial           3.92       3.56       1.52       0.37       7.85       5.81        010
                                                      wound(s).
12017.............  ..............  A                Repair superficial           4.70         NA       1.90       0.47         NA       7.07        010
                                                      wound(s).
12018.............  ..............  A                Repair superficial           5.52         NA       2.26       0.64         NA       8.42        010
                                                      wound(s).
12020.............  ..............  A                Closure of split wound       2.62       3.83       1.93       0.30       6.75       4.85        010
12021.............  ..............  A                Closure of split wound       1.84       1.83       1.41       0.24       3.91       3.49        010
12031.............  ..............  A                Layer closure of             2.15       2.29       0.96       0.17       4.61       3.28        010
                                                      wound(s).
12032.............  ..............  A                Layer closure of             2.47       3.85       1.80       0.16       6.48       4.43        010
                                                      wound(s).
12034.............  ..............  A                Layer closure of             2.92       3.20       1.45       0.25       6.37       4.62        010
                                                      wound(s).
12035.............  ..............  A                Layer closure of             3.42       5.21       2.16       0.39       9.02       5.97        010
                                                      wound(s).
12036.............  ..............  A                Layer closure of             4.04       5.57       2.55       0.55      10.16       7.14        010
                                                      wound(s).
12037.............  ..............  A                Layer closure of             4.66       6.11       2.97       0.66      11.43       8.29        010
                                                      wound(s).
12041.............  ..............  A                Layer closure of             2.37       2.55       1.13       0.19       5.11       3.69        010
                                                      wound(s).
12042.............  ..............  A                Layer closure of             2.74       3.27       1.46       0.17       6.18       4.37        010
                                                      wound(s).
12044.............  ..............  A                Layer closure of             3.14       3.22       1.60       0.27       6.63       5.01        010
                                                      wound(s).
12045.............  ..............  A                Layer closure of             3.63       5.28       2.29       0.41       9.32       6.33        010
                                                      wound(s).
12046.............  ..............  A                Layer closure of             4.24       6.52       2.76       0.54      11.30       7.54        010
                                                      wound(s).
12047.............  ..............  A                Layer closure of             4.64       6.36       3.09       0.58      11.58       8.31        010
                                                      wound(s).
12051.............  ..............  A                Layer closure of             2.47       3.28       1.45       0.20       5.95       4.12        010
                                                      wound(s).
12052.............  ..............  A                Layer closure of             2.77       3.23       1.43       0.17       6.17       4.37        010
                                                      wound(s).
12053.............  ..............  A                Layer closure of             3.12       3.25       1.53       0.23       6.60       4.88        010
                                                      wound(s).
12054.............  ..............  A                Layer closure of             3.45       3.57       1.63       0.30       7.32       5.38        010
                                                      wound(s).
12055.............  ..............  A                Layer closure of             4.42       4.49       2.13       0.45       9.36       7.00        010
                                                      wound(s).
12056.............  ..............  A                Layer closure of             5.23       6.77       3.06       0.59      12.59       8.88        010
                                                      wound(s).
12057.............  ..............  A                Layer closure of             5.95       6.15       3.76       0.56      12.66      10.27        010
                                                      wound(s).
13100.............  ..............  A                Repair of wound or           3.12       4.06       2.31       0.26       7.44       5.69        010
                                                      lesion.
13101.............  ..............  A                Repair of wound or           3.91       4.67       2.69       0.26       8.84       6.86        010
                                                      lesion.
13102.............  ..............  A                Repair wound/lesion          1.24       1.17       0.57       0.13       2.54       1.94        ZZZ
                                                      add-on.
13120.............  ..............  A                Repair of wound or           3.30       4.15       2.35       0.26       7.71       5.91        010
                                                      lesion.
13121.............  ..............  A                Repair of wound or           4.32       4.86       2.80       0.25       9.43       7.37        010
                                                      lesion.
13122.............  ..............  A                Repair wound/lesion          1.44       1.51       0.63       0.15       3.10       2.22        ZZZ
                                                      add-on.
13131.............  ..............  A                Repair of wound or           3.78       4.37       2.69       0.26       8.41       6.73        010
                                                      lesion.
13132.............  ..............  A                Repair of wound or           5.94       5.92       4.17       0.32      12.18      10.43        010
                                                      lesion.
13133.............  ..............  A                Repair wound/lesion          2.19       1.66       1.03       0.18       4.03       3.40        ZZZ
                                                      add-on.
13150.............  ..............  A                Repair of wound or           3.80       4.88       2.77       0.34       9.02       6.91        010
                                                      lesion.
13151.............  ..............  A                Repair of wound or           4.44       4.81       3.15       0.31       9.56       7.90        010
                                                      lesion.

[[Page 70341]]

 
13152.............  ..............  A                Repair of wound or           6.32       6.05       4.05       0.40      12.77      10.77        010
                                                      lesion.
13153.............  ..............  A                Repair wound/lesion          2.38       1.94       1.14       0.24       4.56       3.76        ZZZ
                                                      add-on.
13160.............  ..............  A                Late closure of wound.      10.46         NA       7.18       1.54         NA      19.18        090
14000.............  ..............  A                Skin tissue                  5.88       7.87       5.48       0.59      14.34      11.95        090
                                                      rearrangement.
14001.............  ..............  A                Skin tissue                  8.46       9.44       7.09       0.82      18.72      16.37        090
                                                      rearrangement.
14020.............  ..............  A                Skin tissue                  6.58       8.63       6.55       0.64      15.85      13.77        090
                                                      rearrangement.
14021.............  ..............  A                Skin tissue                 10.04      10.01       8.30       0.81      20.86      19.15        090
                                                      rearrangement.
14040.............  ..............  A                Skin tissue                  7.86       8.83       7.22       0.62      17.31      15.70        090
                                                      rearrangement.
14041.............  ..............  A                Skin tissue                 11.47      10.62       8.70       0.73      22.82      20.90        090
                                                      rearrangement.
14060.............  ..............  A                Skin tissue                  8.49       8.81       7.45       0.68      17.98      16.62        090
                                                      rearrangement.
14061.............  ..............  A                Skin tissue                 12.27      11.63       9.53       0.76      24.66      22.56        090
                                                      rearrangement.
14300.............  ..............  A                Skin tissue                 11.74      11.16       9.20       1.16      24.06      22.10        090
                                                      rearrangement.
14350.............  ..............  A                Skin tissue                  9.60         NA       7.16       1.34         NA      18.10        090
                                                      rearrangement.
15000.............  ..............  A                Wound prep, 1st 100 sq       3.99       3.80       2.19       0.54       8.33       6.72        000
                                                      cm.
15001.............  ..............  A                Wound prep, addl 100         1.00       1.35       0.41       0.14       2.49       1.55        ZZZ
                                                      sq cm.
15040.............  ..............  A                Harvest cultured skin        2.00       4.57       1.13       0.24       6.81       3.37        000
                                                      graft.
15050.............  ..............  A                Skin pinch graft......       4.29       6.93       5.12       0.57      11.79       9.98        090
15100.............  ..............  A                Skin splt grft, trnk/        9.04      12.62       7.84       1.28      22.94      18.16        090
                                                      arm/leg.
15101.............  ..............  A                Skin splt grft t/a/l,        1.72       3.74       1.17       0.24       5.70       3.13        ZZZ
                                                      add-on.
15110.............  ..............  A                Epidrm autogrft trnk/        9.50      10.70       7.02       1.31      21.51      17.83        090
                                                      arm/leg.
15111.............  ..............  A                Epidrm autogrft t/a/l        1.85       1.29       0.79       0.26       3.40       2.90        ZZZ
                                                      add-on.
15115.............  ..............  A                Epidrm a-grft face/nck/      9.81       9.25       7.37       1.15      20.21      18.33        090
                                                      hf/g.
15116.............  ..............  A                Epidrm a-grft f/n/hf/g       2.50       1.58       1.12       0.33       4.41       3.95        ZZZ
                                                      addl.
15120.............  ..............  A                Skn splt a-grft fac/         9.82      10.75       7.80       1.16      21.73      18.78        090
                                                      nck/hf/g.
15121.............  ..............  A                Skn splt a-grft f/n/hf/      2.67       4.51       1.85       0.36       7.54       4.88        ZZZ
                                                      g add.
15130.............  ..............  A                Derm autograft, trnk/        7.00       9.89       6.36       0.97      17.86      14.33        090
                                                      arm/leg.
15131.............  ..............  A                Derm autograft t/a/l         1.50       1.07       0.64       0.21       2.78       2.35        ZZZ
                                                      add-on.
15135.............  ..............  A                Derm autograft face/        10.50       9.90       8.15       1.23      21.63      19.88        090
                                                      nck/hf/g.
15136.............  ..............  A                Derm autograft, f/n/hf/      1.50       0.89       0.67       0.20       2.59       2.37        ZZZ
                                                      g add.
15150.............  ..............  A                Cult epiderm grft t/         8.25       8.48       6.46       1.14      17.87      15.85        090
                                                      arm/leg.
15151.............  ..............  A                Cult epiderm grft t/a/       2.00       1.31       0.85       0.28       3.59       3.13        ZZZ
                                                      l addl.
15152.............  ..............  A                Cult epiderm graft t/a/      2.50       1.56       1.06       0.35       4.41       3.91        ZZZ
                                                      l +%.
15155.............  ..............  A                Cult epiderm graft, f/       9.00       7.84       6.98       1.05      17.89      17.03        090
                                                      n/hf/g.
15156.............  ..............  A                Cult epidrm grft f/n/        2.75       1.56       1.24       0.36       4.67       4.35        ZZZ
                                                      hfg add.
15157.............  ..............  A                Cult epiderm grft f/n/       3.00       1.78       1.35       0.39       5.17       4.74        ZZZ
                                                      hfg +%.
15170.............  ..............  A                Acell graft trunk/arms/      5.00       3.84       2.37       0.55       9.39       7.92        090
                                                      legs.
15171.............  ..............  A                Acell graft t/arm/leg        1.55       0.68       0.62       0.19       2.42       2.36        ZZZ
                                                      add-on.
15175.............  ..............  A                Acellular graft, f/n/        7.00       5.44       4.01       0.82      13.26      11.83        090
                                                      hf/g.
15176.............  ..............  A                Acell graft, f/n/hf/g        2.45       1.11       0.99       0.29       3.85       3.73        ZZZ
                                                      add-on.
15200.............  ..............  A                Skin full graft, trunk       8.02       9.43       6.22       0.98      18.43      15.22        090
15201.............  ..............  A                Skin full graft trunk        1.32       2.57       0.62       0.19       4.08       2.13        ZZZ
                                                      add-on.
15220.............  ..............  A                Skin full graft sclp/        7.86       9.21       6.70       0.84      17.91      15.40        090
                                                      arm/leg.
15221.............  ..............  A                Skin full graft add-on       1.19       2.33       0.56       0.16       3.68       1.91        ZZZ
15240.............  ..............  A                Skin full grft face/         9.03      10.23       7.97       0.92      20.18      17.92        090
                                                      genit/hf.
15241.............  ..............  A                Skin full graft add-on       1.86       2.45       0.91       0.23       4.54       3.00        ZZZ
15260.............  ..............  A                Skin full graft een &       10.04      10.24       8.60       0.69      20.97      19.33        090
                                                      lips.
15261.............  ..............  A                Skin full graft add-on       2.23       2.70       1.40       0.21       5.14       3.84        ZZZ
15300.............  ..............  A                Apply skinallogrft, t/       3.99       3.21       2.24       0.49       7.69       6.72        090
                                                      arm/lg.
15301.............  ..............  A                Apply sknallogrft t/a/       1.00       0.47       0.40       0.14       1.61       1.54        ZZZ
                                                      l addl.
15320.............  ..............  A                Apply skin allogrft f/       4.70       3.63       2.54       0.58       8.91       7.82        090
                                                      n/hf/g.
15321.............  ..............  A                Aply sknallogrft f/n/        1.50       0.69       0.59       0.21       2.40       2.30        ZZZ
                                                      hfg add.
15330.............  ..............  A                Aply acell alogrft t/        3.99       3.20       2.23       0.49       7.68       6.71        090
                                                      arm/leg.
15331.............  ..............  A                Aply acell grft t/a/l        1.00       0.46       0.40       0.14       1.60       1.54        ZZZ
                                                      add-on.
15335.............  ..............  A                Apply acell graft, f/n/      4.50       3.48       2.45       0.55       8.53       7.50        090
                                                      hf/g.
15336.............  ..............  A                Aply acell grft f/n/hf/      1.43       0.69       0.57       0.20       2.32       2.20        ZZZ
                                                      g add.
15340.............  ..............  A                Apply cult skin              3.72       4.01       2.76       0.41       8.14       6.89        010
                                                      substitute.
15341.............  ..............  A                Apply cult skin sub          0.50       0.61       0.20       0.06       1.17       0.76        ZZZ
                                                      add-on.
15360.............  ..............  A                Apply cult derm sub, t/      3.87       4.48       3.09       0.43       8.78       7.39        090
                                                      a/l.
15361.............  ..............  A                Aply cult derm sub t/a/      1.15       0.58       0.46       0.14       1.87       1.75        ZZZ
                                                      l add.
15365.............  ..............  A                Apply cult derm sub f/       4.15       4.56       3.20       0.46       9.17       7.81        090
                                                      n/hf/g.
15366.............  ..............  A                Apply cult derm f/hf/g       1.45       0.70       0.58       0.17       2.32       2.20        ZZZ
                                                      add.
15400.............  ..............  A                Apply skin xenograft,        3.99       4.02       4.02       0.47       8.48       8.48        090
                                                      t/a/l.
15401.............  ..............  A                Apply skn xenogrft t/a/      1.00       1.90       0.44       0.14       3.04       1.58        ZZZ
                                                      l add.
15420.............  ..............  A                Apply skin xgraft, f/n/      4.50       4.79       3.80       0.52       9.81       8.82        090
                                                      hf/g.
15421.............  ..............  A                Apply skn xgrft f/n/hf/      1.50       1.32       0.62       0.21       3.03       2.33        ZZZ
                                                      g add.
15430.............  ..............  A                Apply acellular              5.75       6.92       6.63       0.66      13.33      13.04        090
                                                      xenograft.
15431.............  ..............  C                Apply acellular xgraft       0.00       0.00       0.00       0.00       0.00       0.00        ZZZ
                                                      add.
15570.............  ..............  A                Form skin pedicle flap       9.20      11.33       6.78       1.34      21.87      17.32        090
15572.............  ..............  A                Form skin pedicle flap       9.26       9.52       6.47       1.20      19.98      16.93        090
15574.............  ..............  A                Form skin pedicle flap       9.87      10.71       7.81       1.20      21.78      18.88        090
15576.............  ..............  A                Form skin pedicle flap       8.68       9.78       6.90       0.87      19.33      16.45        090
15600.............  ..............  A                Skin graft............       1.91       7.62       3.07       0.27       9.80       5.25        090
15610.............  ..............  A                Skin graft............       2.42       4.70       3.43       0.35       7.47       6.20        090
15620.............  ..............  A                Skin graft............       2.94       7.80       3.89       0.35      11.09       7.18        090
15630.............  ..............  A                Skin graft............       3.27       7.06       4.16       0.34      10.67       7.77        090

[[Page 70342]]

 
15650.............  ..............  A                Transfer skin pedicle        3.96       7.16       4.22       0.42      11.54       8.60        090
                                                      flap.
15732.............  ..............  A                Muscle-skin graft,          17.81      18.09      12.25       1.99      37.89      32.05        090
                                                      head/neck.
15734.............  ..............  A                Muscle-skin graft,          17.76      18.16      12.41       2.61      38.53      32.78        090
                                                      trunk.
15736.............  ..............  A                Muscle-skin graft, arm      16.25      18.28      11.25       2.45      36.98      29.95        090
15738.............  ..............  A                Muscle-skin graft, leg      17.89      18.02      11.75       2.65      38.56      32.29        090
15740.............  ..............  A                Island pedicle flap         10.23      10.16       8.28       0.63      21.02      19.14        090
                                                      graft.
15750.............  ..............  A                Neurovascular pedicle       11.39         NA       9.07       1.42         NA      21.88        090
                                                      graft.
15756.............  ..............  A                Free myo/skin flap          35.18         NA      20.62       4.61         NA      60.41        090
                                                      microvasc.
15757.............  ..............  A                Free skin flap,             35.18         NA      21.65       3.89         NA      60.72        090
                                                      microvasc.
15758.............  ..............  A                Free fascial flap,          35.05         NA      21.63       4.23         NA      60.91        090
                                                      microvasc.
15760.............  ..............  A                Composite skin graft..       8.73      10.05       7.28       0.85      19.63      16.86        090
15770.............  ..............  A                Derma-fat-fascia graft       7.51         NA       6.70       1.05         NA      15.26        090
15775.............  ..............  R                Hair transplant punch        3.95       4.24       1.30       0.52       8.71       5.77        000
                                                      grafts.
15776.............  ..............  R                Hair transplant punch        5.53       5.37       2.81       0.72      11.62       9.06        000
                                                      grafts.
15780.............  ..............  A                Abrasion treatment of        7.28      11.55       8.27       0.67      19.50      16.22        090
                                                      skin.
15781.............  ..............  A                Abrasion treatment of        4.84       6.93       5.38       0.34      12.11      10.56        090
                                                      skin.
15782.............  ..............  A                Abrasion treatment of        4.31       9.88       6.57       0.34      14.53      11.22        090
                                                      skin.
15783.............  ..............  A                Abrasion treatment of        4.28       6.89       4.19       0.28      11.45       8.75        090
                                                      skin.
15786.............  ..............  A                Abrasion, lesion,            2.03       3.36       1.32       0.11       5.50       3.46        010
                                                      single.
15787.............  ..............  A                Abrasion, lesions, add-      0.33       1.09       0.16       0.04       1.46       0.53        ZZZ
                                                      on.
15788.............  ..............  R                Chemical peel, face,         2.09       6.73       3.09       0.11       8.93       5.29        090
                                                      epiderm.
15789.............  ..............  R                Chemical peel, face,         4.91       8.11       4.81       0.20      13.22       9.92        090
                                                      dermal.
15792.............  ..............  R                Chemical peel,               1.86       7.11       4.46       0.13       9.10       6.45        090
                                                      nonfacial.
15793.............  ..............  A                Chemical peel,               3.73       6.30       4.39       0.19      10.22       8.31        090
                                                      nonfacial.
15819.............  ..............  A                Plastic surgery, neck.       9.37         NA       7.20       0.97         NA      17.54        090
15820.............  ..............  A                Revision of lower            5.14       6.99       5.58       0.40      12.53      11.12        090
                                                      eyelid.
15821.............  ..............  A                Revision of lower            5.71       7.37       5.73       0.45      13.53      11.89        090
                                                      eyelid.
15822.............  ..............  A                Revision of upper            4.44       5.85       4.50       0.37      10.66       9.31        090
                                                      eyelid.
15823.............  ..............  A                Revision of upper            7.04       7.87       6.45       0.50      15.41      13.99        090
                                                      eyelid.
15824.............  ..............  R                Removal of forehead          0.00       0.00       0.00       0.00       0.00       0.00        000
                                                      wrinkles.
15825.............  ..............  R                Removal of neck              0.00       0.00       0.00       0.00       0.00       0.00        000
                                                      wrinkles.
15826.............  ..............  R                Removal of brow              0.00       0.00       0.00       0.00       0.00       0.00        000
                                                      wrinkles.
15828.............  ..............  R                Removal of face              0.00       0.00       0.00       0.00       0.00       0.00        000
                                                      wrinkles.
15829.............  ..............  R                Removal of skin              0.00       0.00       0.00       0.00       0.00       0.00        000
                                                      wrinkles.
15831.............  ..............  A                Excise excessive skin       12.38         NA       8.18       1.75         NA      22.31        090
                                                      tissue.
15832.............  ..............  A                Excise excessive skin       11.57         NA       8.36       1.66         NA      21.59        090
                                                      tissue.
15833.............  ..............  A                Excise excessive skin       10.62         NA       8.23       1.49         NA      20.34        090
                                                      tissue.
15834.............  ..............  A                Excise excessive skin       10.83         NA       7.71       1.61         NA      20.15        090
                                                      tissue.
15835.............  ..............  A                Excise excessive skin       11.65         NA       7.56       1.60         NA      20.81        090
                                                      tissue.
15836.............  ..............  A                Excise excessive skin        9.33         NA       6.80       1.34         NA      17.47        090
                                                      tissue.
15837.............  ..............  A                Excise excessive skin        8.42       8.57       7.39       1.18      18.17      16.99        090
                                                      tissue.
15838.............  ..............  A                Excise excessive skin        7.12         NA       6.08       0.58         NA      13.78        090
                                                      tissue.
15839.............  ..............  A                Excise excessive skin        9.37       8.85       6.41       1.22      19.44      17.00        090
                                                      tissue.
15840.............  ..............  A                Graft for face nerve        13.24         NA      10.00       1.32         NA      24.56        090
                                                      palsy.
15841.............  ..............  A                Graft for face nerve        23.23         NA      15.03       2.54         NA      40.80        090
                                                      palsy.
15842.............  ..............  A                Flap for face nerve         37.90         NA      22.98       4.93         NA      65.81        090
                                                      palsy.
15845.............  ..............  A                Skin and muscle             12.55         NA       9.33       0.81         NA      22.69        090
                                                      repair, face.
15850.............  ..............  B                Removal of sutures....      +0.78       1.56       0.30       0.05       2.39       1.13        XXX
15851.............  ..............  A                Removal of sutures....       0.86       1.68       0.31       0.06       2.60       1.23        000
15852.............  ..............  A                Dressing change not          0.86       1.85       0.33       0.09       2.80       1.28        000
                                                      for burn.
15860.............  ..............  A                Test for blood flow in       1.95       0.83       0.78       0.27       3.05       3.00        000
                                                      graft.
15876.............  ..............  R                Suction assisted             0.00       0.00       0.00       0.00       0.00       0.00        000
                                                      lipectomy.
15877.............  ..............  R                Suction assisted             0.00       0.00       0.00       0.00       0.00       0.00        000
                                                      lipectomy.
15878.............  ..............  R                Suction assisted             0.00       0.00       0.00       0.00       0.00       0.00        000
                                                      lipectomy.
15879.............  ..............  R                Suction assisted             0.00       0.00       0.00       0.00       0.00       0.00        000
                                                      lipectomy.
15920.............  ..............  A                Removal of tail bone         7.94         NA       5.57       1.04         NA      14.55        090
                                                      ulcer.
15922.............  ..............  A                Removal of tail bone         9.89         NA       7.23       1.42         NA      18.54        090
                                                      ulcer.
15931.............  ..............  A                Remove sacrum pressure       9.23         NA       5.70       1.25         NA      16.18        090
                                                      sore.
15933.............  ..............  A                Remove sacrum pressure      10.83         NA       7.87       1.52         NA      20.22        090
                                                      sore.
15934.............  ..............  A                Remove sacrum pressure      12.67         NA       8.06       1.78         NA      22.51        090
                                                      sore.
15935.............  ..............  A                Remove sacrum pressure      14.55         NA      10.35       2.09         NA      26.99        090
                                                      sore.
15936.............  ..............  A                Remove sacrum pressure      12.36         NA       8.24       1.76         NA      22.36        090
                                                      sore.
15937.............  ..............  A                Remove sacrum pressure      14.19         NA       9.85       2.06         NA      26.10        090
                                                      sore.
15940.............  ..............  A                Remove hip pressure          9.33         NA       6.19       1.31         NA      16.83        090
                                                      sore.
15941.............  ..............  A                Remove hip pressure         11.41         NA       9.48       1.66         NA      22.55        090
                                                      sore.
15944.............  ..............  A                Remove hip pressure         11.44         NA       8.62       1.65         NA      21.71        090
                                                      sore.
15945.............  ..............  A                Remove hip pressure         12.67         NA       9.67       1.84         NA      24.18        090
                                                      sore.
15946.............  ..............  A                Remove hip pressure         21.54         NA      14.41       3.16         NA      39.11        090
                                                      sore.
15950.............  ..............  A                Remove thigh pressure        7.53         NA       5.43       1.04         NA      14.00        090
                                                      sore.
15951.............  ..............  A                Remove thigh pressure       10.70         NA       7.88       1.49         NA      20.07        090
                                                      sore.
15952.............  ..............  A                Remove thigh pressure       11.37         NA       7.77       1.60         NA      20.74        090
                                                      sore.
15953.............  ..............  A                Remove thigh pressure       12.61         NA       9.02       1.79         NA      23.42        090
                                                      sore.
15956.............  ..............  A                Remove thigh pressure       15.50         NA      10.80       2.21         NA      28.51        090
                                                      sore.
15958.............  ..............  A                Remove thigh pressure       15.46         NA      11.07       2.25         NA      28.78        090
                                                      sore.
15999.............  ..............  C                Removal of pressure          0.00       0.00       0.00       0.00       0.00       0.00        YYY
                                                      sore.

[[Page 70343]]

 
16000.............  ..............  A                Initial treatment of         0.89       0.86       0.26       0.08       1.83       1.23        000
                                                      burn(s).
16020.............  ..............  A                Dress/debrid p-thick         0.80       1.29       0.58       0.08       2.17       1.46        000
                                                      burn, s.
16025.............  ..............  A                Dress/debrid p-thick         1.85       1.77       0.96       0.19       3.81       3.00        000
                                                      burn, m.
16030.............  ..............  A                Dress/debrid p-thick         2.08       2.18       1.12       0.24       4.50       3.44        000
                                                      burn, l.
16035.............  ..............  A                Incision of burn scab,       3.74         NA       1.58       0.46         NA       5.78        090
                                                      initi.
16036.............  ..............  A                Escharotomy; add'l           1.50         NA       0.60       0.20         NA       2.30        ZZZ
                                                      incision.
17000.............  ..............  A                Destroy benign/premlg        0.60       0.97       0.54       0.03       1.60       1.17        010
                                                      lesion.
17003.............  ..............  A                Destroy lesions, 2-14.       0.15       0.11       0.07       0.01       0.27       0.23        ZZZ
17004.............  ..............  A                Destroy lesions, 15 or       2.79       2.31       1.59       0.11       5.21       4.49        010
                                                      more.
17106.............  ..............  A                Destruction of skin          4.58       4.61       3.34       0.35       9.54       8.27        090
                                                      lesions.
17107.............  ..............  A                Destruction of skin          9.15       7.22       5.47       0.63      17.00      15.25        090
                                                      lesions.
17108.............  ..............  A                Destruction of skin         13.18       9.29       7.68       0.54      23.01      21.40        090
                                                      lesions.
17110.............  ..............  A                Destruct lesion, 1-14.       0.65       1.62       0.70       0.05       2.32       1.40        010
17111.............  ..............  A                Destruct lesion, 15 or       0.92       1.67       0.81       0.05       2.64       1.78        010
                                                      more.
17250.............  ..............  A                Chemical cautery,            0.50       1.22       0.34       0.06       1.78       0.90        000
                                                      tissue.
17260.............  ..............  A                Destruction of skin          0.91       1.28       0.67       0.04       2.23       1.62        010
                                                      lesions.
17261.............  ..............  A                Destruction of skin          1.17       1.61       0.83       0.05       2.83       2.05        010
                                                      lesions.
17262.............  ..............  A                Destruction of skin          1.58       1.89       1.02       0.06       3.53       2.66        010
                                                      lesions.
17263.............  ..............  A                Destruction of skin          1.79       2.06       1.09       0.07       3.92       2.95        010
                                                      lesions.
17264.............  ..............  A                Destruction of skin          1.94       2.23       1.12       0.08       4.25       3.14        010
                                                      lesions.
17266.............  ..............  A                Destruction of skin          2.34       2.51       1.22       0.09       4.94       3.65        010
                                                      lesions.
17270.............  ..............  A                Destruction of skin          1.32       1.70       0.87       0.05       3.07       2.24        010
                                                      lesions.
17271.............  ..............  A                Destruction of skin          1.49       1.78       0.98       0.06       3.33       2.53        010
                                                      lesions.
17272.............  ..............  A                Destruction of skin          1.77       2.00       1.11       0.07       3.84       2.95        010
                                                      lesions.
17273.............  ..............  A                Destruction of skin          2.05       2.21       1.21       0.08       4.34       3.34        010
                                                      lesions.
17274.............  ..............  A                Destruction of skin          2.59       2.57       1.44       0.10       5.26       4.13        010
                                                      lesions.
17276.............  ..............  A                Destruction of skin          3.20       2.95       1.68       0.16       6.31       5.04        010
                                                      lesions.
17280.............  ..............  A                Destruction of skin          1.17       1.61       0.81       0.05       2.83       2.03        010
                                                      lesions.
17281.............  ..............  A                Destruction of skin          1.72       1.91       1.09       0.07       3.70       2.88        010
                                                      lesions.
17282.............  ..............  A                Destruction of skin          2.04       2.16       1.24       0.08       4.28       3.36        010
                                                      lesions.
17283.............  ..............  A                Destruction of skin          2.64       2.55       1.49       0.11       5.30       4.24        010
                                                      lesions.
17284.............  ..............  A                Destruction of skin          3.21       2.93       1.76       0.13       6.27       5.10        010
                                                      lesions.
17286.............  ..............  A                Destruction of skin          4.43       3.68       2.45       0.23       8.34       7.11        010
                                                      lesions.
17304.............  ..............  A                1 stage mohs, up to 5        7.59       8.26       3.57       0.30      16.15      11.46        000
                                                      spec.
17305.............  ..............  A                2 stage mohs, up to 5        2.85       3.90       1.34       0.11       6.86       4.30        000
                                                      spec.
17306.............  ..............  A                3 stage mohs, up to 5        2.85       3.92       1.35       0.11       6.88       4.31        000
                                                      spec.
17307.............  ..............  A                Mohs addl stage up to        2.85       3.57       1.36       0.11       6.53       4.32        000
                                                      5 spec.
17310.............  ..............  A                Mohs any stage > 5           0.95       1.62       0.46       0.03       2.60       1.44        ZZZ
                                                      spec each.
17340.............  ..............  A                Cryotherapy of skin...       0.76       0.37       0.36       0.05       1.18       1.17        010
17360.............  ..............  A                Skin peel therapy.....       1.43       1.44       0.87       0.06       2.93       2.36        010
17380.............  ..............  R                Hair removal by              0.00       0.00       0.00       0.00       0.00       0.00        000
                                                      electrolysis.
17999.............  ..............  C                Skin tissue procedure.       0.00       0.00       0.00       0.00       0.00       0.00        YYY
19000.............  ..............  A                Drainage of breast           0.84       1.99       0.31       0.08       2.91       1.23        000
                                                      lesion.
19001.............  ..............  A                Drain breast lesion          0.42       0.25       0.14       0.04       0.71       0.60        ZZZ
                                                      add-on.
19020.............  ..............  A                Incision of breast           3.56       6.35       2.68       0.45      10.36       6.69        090
                                                      lesion.
19030.............  ..............  A                Injection for breast x-      1.53       2.87       0.50       0.09       4.49       2.12        000
                                                      ray.
19100.............  ..............  A                Bx breast percut w/o         1.27       2.09       0.42       0.16       3.52       1.85        000
                                                      image.
19101.............  ..............  A                Biopsy of breast, open       3.18       4.51       1.92       0.39       8.08       5.49        010
19102.............  ..............  A                Bx breast percut w/          2.00       3.84       0.66       0.14       5.98       2.80        000
                                                      image.
19103.............  ..............  A                Bx breast percut w/          3.69      11.52       1.23       0.30      15.51       5.22        000
                                                      device.
19110.............  ..............  A                Nipple exploration....       4.29       5.81       2.87       0.57      10.67       7.73        090
19112.............  ..............  A                Excise breast duct           3.66       6.08       2.69       0.48      10.22       6.83        090
                                                      fistula.
19120.............  ..............  A                Removal of breast            5.55       4.55       3.07       0.73      10.83       9.35        090
                                                      lesion.
19125.............  ..............  A                Excision, breast             6.05       4.79       3.29       0.80      11.64      10.14        090
                                                      lesion.
19126.............  ..............  A                Excision, addl breast        2.93         NA       1.00       0.38         NA       4.31        ZZZ
                                                      lesion.
19140.............  ..............  A                Removal of breast            5.13       7.16       3.40       0.69      12.98       9.22        090
                                                      tissue.
19160.............  ..............  A                Partial mastectomy....       5.98         NA       3.43       0.79         NA      10.20        090
19162.............  ..............  A                P-mastectomy w/ln           13.51         NA       6.35       1.79         NA      21.65        090
                                                      removal.
19180.............  ..............  A                Removal of breast.....       8.79         NA       5.03       1.18         NA      15.00        090
19182.............  ..............  A                Removal of breast.....       7.72         NA       4.76       1.04         NA      13.52        090
19200.............  ..............  A                Removal of breast.....      15.47         NA       7.98       1.92         NA      25.37        090
19220.............  ..............  A                Removal of breast.....      15.70         NA       8.25       2.07         NA      26.02        090
19240.............  ..............  A                Removal of breast.....      15.98         NA       8.22       2.12         NA      26.32        090
19260.............  ..............  A                Removal of chest wall       15.42         NA      11.18       2.13         NA      28.73        090
                                                      lesion.
19271.............  ..............  A                Revision of chest wall      18.87         NA      18.00       2.62         NA      39.49        090
19272.............  ..............  A                Extensive chest wall        21.52         NA      18.98       2.99         NA      43.49        090
                                                      surgery.
19290.............  ..............  A                Place needle wire,           1.27       2.86       0.42       0.07       4.20       1.76        000
                                                      breast.
19291.............  ..............  A                Place needle wire,           0.63       1.21       0.21       0.04       1.88       0.88        ZZZ
                                                      breast.
19295.............  ..............  A                Place breast clip,           0.00       2.70         NA       0.01       2.71         NA        ZZZ
                                                      percut.
19296.............  ..............  A                Place po breast cath         3.63     125.75       1.53       0.36     129.74       5.52        000
                                                      for rad.
19297.............  ..............  A                Place breast cath for        1.72         NA       0.64       0.17         NA       2.53        ZZZ
                                                      rad.
19298.............  ..............  A                Place breast rad tube/       6.00      42.28       2.42       0.43      48.71       8.85        000
                                                      caths.
19316.............  ..............  A                Suspension of breast..      10.67         NA       7.53       1.64         NA      19.84        090
19318.............  ..............  A                Reduction of large          15.60         NA      11.20       2.92         NA      29.72        090
                                                      breast.
19324.............  ..............  A                Enlarge breast........       5.84         NA       4.90       0.84         NA      11.58        090

[[Page 70344]]

 
19325.............  ..............  A                Enlarge breast with          8.44         NA       6.54       1.33         NA      16.31        090
                                                      implant.
19328.............  ..............  A                Removal of breast            5.67         NA       5.03       0.91         NA      11.61        090
                                                      implant.
19330.............  ..............  A                Removal of implant           7.58         NA       6.05       1.26         NA      14.89        090
                                                      material.
19340.............  ..............  A                Immediate breast             6.32         NA       3.12       1.06         NA      10.50        ZZZ
                                                      prosthesis.
19342.............  ..............  A                Delayed breast              11.18         NA       8.95       1.83         NA      21.96        090
                                                      prosthesis.
19350.............  ..............  A                Breast reconstruction.       8.91      13.88       7.19       1.41      24.20      17.51        090
19355.............  ..............  A                Correct inverted             7.56      10.28       4.71       0.92      18.76      13.19        090
                                                      nipple(s).
19357.............  ..............  A                Breast reconstruction.      18.13         NA      15.66       2.93         NA      36.72        090
19361.............  ..............  A                Breast reconstruction.      19.23         NA      12.47       2.92         NA      34.62        090
19364.............  ..............  A                Breast reconstruction.      40.94         NA      23.61       6.22         NA      70.77        090
19366.............  ..............  A                Breast reconstruction.      21.25         NA      11.61       3.24         NA      36.10        090
19367.............  ..............  A                Breast reconstruction.      25.69         NA      16.74       4.03         NA      46.46        090
19368.............  ..............  A                Breast reconstruction.      32.37         NA      18.97       5.52         NA      56.86        090
19369.............  ..............  A                Breast reconstruction.      29.78         NA      18.45       4.50         NA      52.73        090
19370.............  ..............  A                Surgery of breast            8.04         NA       6.92       1.29         NA      16.25        090
                                                      capsule.
19371.............  ..............  A                Removal of breast            9.34         NA       7.84       1.62         NA      18.80        090
                                                      capsule.
19380.............  ..............  A                Revise breast                9.13         NA       7.72       1.44         NA      18.29        090
                                                      reconstruction.
19396.............  ..............  A                Design custom breast         2.17       1.08       0.99       0.30       3.55       3.46        000
                                                      implant.
19499.............  ..............  C                Breast surgery               0.00       0.00       0.00       0.00       0.00       0.00        YYY
                                                      procedure.
20000.............  ..............  A                Incision of abscess...       2.12       2.70       1.74       0.25       5.07       4.11        010
20005.............  ..............  A                Incision of deep             3.41       3.50       2.26       0.46       7.37       6.13        010
                                                      abscess.
2000F.............  ..............  I                Blood pressure measure       0.00       0.00       0.00       0.00       0.00       0.00        XXX
2001F.............  ..............  I                Weight record.........       0.00       0.00       0.00       0.00       0.00       0.00        XXX
2002F.............  ..............  I                Clin sign vol ovrld          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      assess.
2003F.............  ..............  I                Auscultation heart           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      perform.
2004F.............  ..............  I                Initial exam involved        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      joints.
20100.............  ..............  A                Explore wound, neck...      10.06         NA       4.47       1.21         NA      15.74        010
20101.............  ..............  A                Explore wound, chest..       3.22       5.94       1.62       0.44       9.60       5.28        010
20102.............  ..............  A                Explore wound, abdomen       3.93       7.48       1.91       0.49      11.90       6.33        010
20103.............  ..............  A                Explore wound,               5.29       8.60       3.40       0.75      14.64       9.44        010
                                                      extremity.
20150.............  ..............  A                Excise epiphyseal bar.      13.67         NA       7.05       2.03         NA      22.75        090
20200.............  ..............  A                Muscle biopsy.........       1.46       3.04       0.75       0.23       4.73       2.44        000
20205.............  ..............  A                Deep muscle biopsy....       2.35       3.90       1.19       0.33       6.58       3.87        000
20206.............  ..............  A                Needle biopsy, muscle.       0.99       6.52       0.63       0.07       7.58       1.69        000
20220.............  ..............  A                Bone biopsy, trocar/         1.27       4.57       0.79       0.08       5.92       2.14        000
                                                      needle.
20225.............  ..............  A                Bone biopsy, trocar/         1.87      24.52       1.13       0.22      26.61       3.22        000
                                                      needle.
20240.............  ..............  A                Bone biopsy,                 3.23         NA       2.56       0.44         NA       6.23        010
                                                      excisional.
20245.............  ..............  A                Bone biopsy,                 7.77         NA       6.59       1.31         NA      15.67        010
                                                      excisional.
20250.............  ..............  A                Open bone biopsy......       5.02         NA       3.51       1.02         NA       9.55        010
20251.............  ..............  A                Open bone biopsy......       5.55         NA       4.17       1.15         NA      10.87        010
20500.............  ..............  A                Injection of sinus           1.23       2.27       1.53       0.12       3.62       2.88        010
                                                      tract.
20501.............  ..............  A                Inject sinus tract for       0.76       2.92       0.25       0.04       3.72       1.05        000
                                                      x-ray.
20520.............  ..............  A                Removal of foreign           1.85       2.92       1.77       0.21       4.98       3.83        010
                                                      body.
20525.............  ..............  A                Removal of foreign           3.49       9.17       2.63       0.51      13.17       6.63        010
                                                      body.
20526.............  ..............  A                Ther injection, carp         0.94       0.97       0.52       0.13       2.04       1.59        000
                                                      tunnel.
20550.............  ..............  A                Inj tendon sheath/           0.75       0.71       0.23       0.09       1.55       1.07        000
                                                      ligament.
20551.............  ..............  A                Inj tendon origin/           0.75       0.68       0.33       0.08       1.51       1.16        000
                                                      insertion.
20552.............  ..............  A                Inj trigger point, 1/2       0.66       0.72       0.20       0.05       1.43       0.91        000
                                                      muscl.
20553.............  ..............  A                Inject trigger points,       0.75       0.82       0.22       0.04       1.61       1.01        000
                                                      =/> 3.
20600.............  ..............  A                Drain/inject, joint/         0.66       0.65       0.35       0.08       1.39       1.09        000
                                                      bursa.
20605.............  ..............  A                Drain/inject, joint/         0.68       0.76       0.36       0.08       1.52       1.12        000
                                                      bursa.
20610.............  ..............  A                Drain/inject, joint/         0.79       0.95       0.42       0.11       1.85       1.32        000
                                                      bursa.
20612.............  ..............  A                Aspirate/inj ganglion        0.70       0.71       0.36       0.10       1.51       1.16        000
                                                      cyst.
20615.............  ..............  A                Treatment of bone cyst       2.28       3.52       1.85       0.20       6.00       4.33        010
20650.............  ..............  A                Insert and remove bone       2.23       2.37       1.55       0.31       4.91       4.09        010
                                                      pin.
20660.............  ..............  A                Apply, rem fixation          2.51       3.06       1.61       0.59       6.16       4.71        000
                                                      device.
20661.............  ..............  A                Application of head          4.88         NA       4.92       1.14         NA      10.94        090
                                                      brace.
20662.............  ..............  A                Application of pelvis        6.06         NA       5.54       0.56         NA      12.16        090
                                                      brace.
20663.............  ..............  A                Application of thigh         5.42         NA       4.84       0.94         NA      11.20        090
                                                      brace.
20664.............  ..............  A                Halo brace application       8.05         NA       7.06       1.74         NA      16.85        090
20665.............  ..............  A                Removal of fixation          1.31       2.16       1.35       0.19       3.66       2.85        010
                                                      device.
20670.............  ..............  A                Removal of support           1.74      11.57       2.11       0.28      13.59       4.13        010
                                                      implant.
20680.............  ..............  A                Removal of support           3.34       8.81       3.73       0.56      12.71       7.63        090
                                                      implant.
20690.............  ..............  A                Apply bone fixation          3.51         NA       2.52       0.59         NA       6.62        090
                                                      device.
20692.............  ..............  A                Apply bone fixation          6.40         NA       3.78       1.05         NA      11.23        090
                                                      device.
20693.............  ..............  A                Adjust bone fixation         5.85         NA       5.46       0.98         NA      12.29        090
                                                      device.
20694.............  ..............  A                Remove bone fixation         4.15       7.16       4.05       0.71      12.02       8.91        090
                                                      device.
20802.............  ..............  A                Replantation, arm,          41.09         NA      21.01       3.81         NA      65.91        090
                                                      complete.
20805.............  ..............  A                Replant forearm,            49.93         NA      34.41       4.84         NA      89.18        090
                                                      complete.
20808.............  ..............  A                Replantation hand,          61.56         NA      42.34       6.86         NA     110.76        090
                                                      complete.
20816.............  ..............  A                Replantation digit,         30.89         NA      37.90       4.52         NA      73.31        090
                                                      complete.
20822.............  ..............  A                Replantation digit,         25.55         NA      34.69       4.18         NA      64.42        090
                                                      complete.
20824.............  ..............  A                Replantation thumb,         30.89         NA      36.65       4.61         NA      72.15        090
                                                      complete.
20827.............  ..............  A                Replantation thumb,         26.37         NA      36.58       3.66         NA      66.61        090
                                                      complete.
20838.............  ..............  A                Replantation foot,          41.35         NA      22.34       1.12         NA      64.81        090
                                                      complete.

[[Page 70345]]

 
20900.............  ..............  A                Removal of bone for          5.57       8.45       5.69       0.94      14.96      12.20        090
                                                      graft.
20902.............  ..............  A                Removal of bone for          7.54         NA       6.90       1.30         NA      15.74        090
                                                      graft.
20910.............  ..............  A                Remove cartilage for         5.33         NA       5.20       0.71         NA      11.24        090
                                                      graft.
20912.............  ..............  A                Remove cartilage for         6.34         NA       5.81       0.69         NA      12.84        090
                                                      graft.
20920.............  ..............  A                Removal of fascia for        5.30         NA       4.23       0.66         NA      10.19        090
                                                      graft.
20922.............  ..............  A                Removal of fascia for        6.60       7.56       4.88       0.70      14.86      12.18        090
                                                      graft.
20924.............  ..............  A                Removal of tendon for        6.47         NA       5.90       1.04         NA      13.41        090
                                                      graft.
20926.............  ..............  A                Removal of tissue for        5.52         NA       4.76       0.87         NA      11.15        090
                                                      graft.
20930.............  ..............  B                Spinal bone allograft.       0.00       0.00       0.00       0.00       0.00       0.00        XXX
20931.............  ..............  A                Spinal bone allograft.       1.81         NA       0.93       0.43         NA       3.17        ZZZ
20936.............  ..............  B                Spinal bone autograft.       0.00       0.00       0.00       0.00       0.00       0.00        XXX
20937.............  ..............  A                Spinal bone autograft.       2.79         NA       1.45       0.54         NA       4.78        ZZZ
20938.............  ..............  A                Spinal bone autograft.       3.02         NA       1.56       0.64         NA       5.22        ZZZ
20950.............  ..............  A                Fluid pressure, muscle       1.26       6.86       0.99       0.20       8.32       2.45        000
20955.............  ..............  A                Fibula bone graft,          39.15         NA      24.34       4.89         NA      68.38        090
                                                      microvasc.
20956.............  ..............  A                Iliac bone graft,           39.21         NA      24.81       7.01         NA      71.03        090
                                                      microvasc.
20957.............  ..............  A                Mt bone graft,              40.59         NA      18.99       7.05         NA      66.63        090
                                                      microvasc.
20962.............  ..............  A                Other bone graft,           39.21         NA      26.60       6.55         NA      72.36        090
                                                      microvasc.
20969.............  ..............  A                Bone/skin graft,            43.85         NA      26.71       4.79         NA      75.35        090
                                                      microvasc.
20970.............  ..............  A                Bone/skin graft, iliac      43.00         NA      25.45       6.60         NA      75.05        090
                                                      crest.
20972.............  ..............  A                Bone/skin graft,            42.93         NA      20.64       5.30         NA      68.87        090
                                                      metatarsal.
20973.............  ..............  A                Bone/skin graft, great      45.69         NA      25.23       5.54         NA      76.46        090
                                                      toe.
20974.............  ..............  A                Electrical bone              0.62       0.69       0.54       0.11       1.42       1.27        000
                                                      stimulation.
20975.............  ..............  A                Electrical bone              2.60         NA       1.71       0.51         NA       4.82        000
                                                      stimulation.
20979.............  ..............  A                Us bone stimulation...       0.62       0.80       0.34       0.09       1.51       1.05        000
20982.............  ..............  A                Ablate, bone tumor(s)        7.27     109.86       2.98       0.69     117.82      10.94        000
                                                      perq.
20999.............  ..............  C                Musculoskeletal              0.00       0.00       0.00       0.00       0.00       0.00        YYY
                                                      surgery.
21010.............  ..............  A                Incision of jaw joint.      10.12         NA       7.11       1.11         NA      18.34        090
21015.............  ..............  A                Resection of facial          5.28         NA       5.02       0.70         NA      11.00        090
                                                      tumor.
21025.............  ..............  A                Excision of bone,           10.04      12.28       9.38       1.32      23.64      20.74        090
                                                      lower jaw.
21026.............  ..............  A                Excision of facial           4.84       7.88       6.34       0.60      13.32      11.78        090
                                                      bone(s).
21029.............  ..............  A                Contour of face bone         7.70       9.40       7.03       0.94      18.04      15.67        090
                                                      lesion.
21030.............  ..............  A                Excise max/zygoma b9         4.49       6.35       5.04       0.54      11.38      10.07        090
                                                      tumor.
21031.............  ..............  A                Remove exostosis,            3.24       5.18       3.63       0.48       8.90       7.35        090
                                                      mandible.
21032.............  ..............  A                Remove exostosis,            3.24       5.36       3.52       0.47       9.07       7.23        090
                                                      maxilla.
21034.............  ..............  A                Excise max/zygoma mlg       16.15      15.97      12.70       1.71      33.83      30.56        090
                                                      tumor.
21040.............  ..............  A                Excise mandible lesion       4.49       6.41       4.73       0.54      11.44       9.76        090
21044.............  ..............  A                Removal of jaw bone         11.84         NA       9.40       1.12         NA      22.36        090
                                                      lesion.
21045.............  ..............  A                Extensive jaw surgery.      16.15         NA      12.39       1.52         NA      30.06        090
21046.............  ..............  A                Remove mandible cyst        12.98         NA      11.93       1.85         NA      26.76        090
                                                      complex.
21047.............  ..............  A                Excise lwr jaw cyst w/      18.72         NA      13.48       2.12         NA      34.32        090
                                                      repair.
21048.............  ..............  A                Remove maxilla cyst         13.48         NA      12.17       1.76         NA      27.41        090
                                                      complex.
21049.............  ..............  A                Excis uppr jaw cyst w/      17.97         NA      13.06       1.59         NA      32.62        090
                                                      repair.
21050.............  ..............  A                Removal of jaw joint..      10.75         NA       9.47       1.47         NA      21.69        090
21060.............  ..............  A                Remove jaw joint            10.21         NA       8.63       1.38         NA      20.22        090
                                                      cartilage.
21070.............  ..............  A                Remove coronoid              8.19         NA       7.12       1.27         NA      16.58        090
                                                      process.
21076.............  ..............  A                Prepare face/oral           13.40      12.39      10.03       1.99      27.78      25.42        010
                                                      prosthesis.
21077.............  ..............  A                Prepare face/oral           33.70      31.42      26.08       4.55      69.67      64.33        090
                                                      prosthesis.
21079.............  ..............  A                Prepare face/oral           22.31      21.56      17.20       3.15      47.02      42.66        090
                                                      prosthesis.
21080.............  ..............  A                Prepare face/oral           25.06      24.56      19.42       3.74      53.36      48.22        090
                                                      prosthesis.
21081.............  ..............  A                Prepare face/oral           22.85      22.36      17.54       3.20      48.41      43.59        090
                                                      prosthesis.
21082.............  ..............  A                Prepare face/oral           20.84      19.40      15.78       3.11      43.35      39.73        090
                                                      prosthesis.
21083.............  ..............  A                Prepare face/oral           19.27      18.84      14.47       2.88      40.99      36.62        090
                                                      prosthesis.
21084.............  ..............  A                Prepare face/oral           22.48      22.50      17.75       2.18      47.16      42.41        090
                                                      prosthesis.
21085.............  ..............  A                Prepare face/oral            8.99       8.31       6.80       1.27      18.57      17.06        010
                                                      prosthesis.
21086.............  ..............  A                Prepare face/oral           24.88      23.81      19.49       3.71      52.40      48.08        090
                                                      prosthesis.
21087.............  ..............  A                Prepare face/oral           24.88      23.35      19.25       3.44      51.67      47.57        090
                                                      prosthesis.
21088.............  ..............  C                Prepare face/oral            0.00       0.00       0.00       0.00       0.00       0.00        090
                                                      prosthesis.
21089.............  ..............  C                Prepare face/oral            0.00       0.00       0.00       0.00       0.00       0.00        090
                                                      prosthesis.
21100.............  ..............  A                Maxillofacial fixation       4.21      11.56       4.75       0.34      16.11       9.30        090
21110.............  ..............  A                Interdental fixation..       5.20       9.59       8.38       0.72      15.51      14.30        090
21116.............  ..............  A                Injection, jaw joint x-      0.81       4.34       0.33       0.06       5.21       1.20        000
                                                      ray.
21120.............  ..............  A                Reconstruction of chin       4.92      10.61       7.51       0.60      16.13      13.03        090
21121.............  ..............  A                Reconstruction of chin       7.63       9.76       7.84       0.90      18.29      16.37        090
21122.............  ..............  A                Reconstruction of chin       8.51         NA       8.64       1.07         NA      18.22        090
21123.............  ..............  A                Reconstruction of chin      11.14         NA      10.83       1.40         NA      23.37        090
21125.............  ..............  A                Augmentation, lower         10.60      55.38       8.34       0.79      66.77      19.73        090
                                                      jaw bone.
21127.............  ..............  A                Augmentation, lower         11.10      42.92       9.48       1.52      55.54      22.10        090
                                                      jaw bone.
21137.............  ..............  A                Reduction of forehead.       9.81         NA       7.75       1.32         NA      18.88        090
21138.............  ..............  A                Reduction of forehead.      12.17         NA       9.56       1.74         NA      23.47        090
21139.............  ..............  A                Reduction of forehead.      14.59         NA      11.09       1.18         NA      26.86        090
21141.............  ..............  A                Reconstruct midface,        18.07         NA      13.69       2.35         NA      34.11        090
                                                      lefort.
21142.............  ..............  A                Reconstruct midface,        18.78         NA      12.86       2.38         NA      34.02        090
                                                      lefort.
21143.............  ..............  A                Reconstruct midface,        19.55         NA      14.35       1.66         NA      35.56        090
                                                      lefort.
21145.............  ..............  A                Reconstruct midface,        19.91         NA      13.94       2.84         NA      36.69        090
                                                      lefort.

[[Page 70346]]

 
21146.............  ..............  A                Reconstruct midface,        20.68         NA      15.37       3.09         NA      39.14        090
                                                      lefort.
21147.............  ..............  A                Reconstruct midface,        21.74         NA      15.09       1.84         NA      38.67        090
                                                      lefort.
21150.............  ..............  A                Reconstruct midface,        25.20         NA      16.81       2.55         NA      44.56        090
                                                      lefort.
21151.............  ..............  A                Reconstruct midface,        28.26         NA      23.02       2.30         NA      53.58        090
                                                      lefort.
21154.............  ..............  A                Reconstruct midface,        30.47         NA      23.19       2.48         NA      56.14        090
                                                      lefort.
21155.............  ..............  A                Reconstruct midface,        34.40         NA      23.96       6.64         NA      65.00        090
                                                      lefort.
21159.............  ..............  A                Reconstruct midface,        42.32         NA      29.16       8.18         NA      79.66        090
                                                      lefort.
21160.............  ..............  A                Reconstruct midface,        46.37         NA      27.55       4.13         NA      78.05        090
                                                      lefort.
21172.............  ..............  A                Reconstruct orbit/          27.76         NA      13.79       3.55         NA      45.10        090
                                                      forehead.
21175.............  ..............  A                Reconstruct orbit/          33.12         NA      17.84       4.83         NA      55.79        090
                                                      forehead.
21179.............  ..............  A                Reconstruct entire          22.22         NA      14.17       2.80         NA      39.19        090
                                                      forehead.
21180.............  ..............  A                Reconstruct entire          25.15         NA      15.42       3.48         NA      44.05        090
                                                      forehead.
21181.............  ..............  A                Contour cranial bone         9.89         NA       7.48       1.32         NA      18.69        090
                                                      lesion.
21182.............  ..............  A                Reconstruct cranial         32.14         NA      19.17       2.80         NA      54.11        090
                                                      bone.
21183.............  ..............  A                Reconstruct cranial         35.26         NA      20.89       4.47         NA      60.62        090
                                                      bone.
21184.............  ..............  A                Reconstruct cranial         38.18         NA      22.00       5.70         NA      65.88        090
                                                      bone.
21188.............  ..............  A                Reconstruction of           22.43         NA      18.92       1.69         NA      43.04        090
                                                      midface.
21193.............  ..............  A                Reconst lwr jaw w/o         17.12         NA      12.69       2.23         NA      32.04        090
                                                      graft.
21194.............  ..............  A                Reconst lwr jaw w/          19.81         NA      13.79       2.02         NA      35.62        090
                                                      graft.
21195.............  ..............  A                Reconst lwr jaw w/o         17.21         NA      14.86       1.64         NA      33.71        090
                                                      fixation.
21196.............  ..............  A                Reconst lwr jaw w/          18.88         NA      15.74       2.07         NA      36.69        090
                                                      fixation.
21198.............  ..............  A                Reconstr lwr jaw            14.14         NA      12.74       1.44         NA      28.32        090
                                                      segment.
21199.............  ..............  A                Reconstr lwr jaw w/         15.98         NA       9.14       1.39         NA      26.51        090
                                                      advance.
21206.............  ..............  A                Reconstruct upper jaw       14.08         NA      12.67       1.33         NA      28.08        090
                                                      bone.
21208.............  ..............  A                Augmentation of facial      10.21      22.39       9.61       1.09      33.69      20.91        090
                                                      bones.
21209.............  ..............  A                Reduction of facial          6.71      10.83       8.09       0.90      18.44      15.70        090
                                                      bones.
21210.............  ..............  A                Face bone graft.......      10.21      24.94       9.38       1.30      36.45      20.89        090
21215.............  ..............  A                Lower jaw bone graft..      10.75      42.00       9.39       1.53      54.28      21.67        090
21230.............  ..............  A                Rib cartilage graft...      10.75         NA       8.06       1.29         NA      20.10        090
21235.............  ..............  A                Ear cartilage graft...       6.71       9.87       6.43       0.61      17.19      13.75        090
21240.............  ..............  A                Reconstruction of jaw       14.03         NA      12.08       2.24         NA      28.35        090
                                                      joint.
21242.............  ..............  A                Reconstruction of jaw       12.93         NA      11.54       1.78         NA      26.25        090
                                                      joint.
21243.............  ..............  A                Reconstruction of jaw       20.76         NA      17.48       3.25         NA      41.49        090
                                                      joint.
21244.............  ..............  A                Reconstruction of           11.84         NA      12.13       1.25         NA      25.22        090
                                                      lower jaw.
21245.............  ..............  A                Reconstruction of jaw.      11.84      14.44       9.88       1.19      27.47      22.91        090
21246.............  ..............  A                Reconstruction of jaw.      12.45         NA       9.07       1.35         NA      22.87        090
21247.............  ..............  A                Reconstruct lower jaw       22.60         NA      17.40       2.83         NA      42.83        090
                                                      bone.
21248.............  ..............  A                Reconstruction of jaw.      11.46      12.17       9.43       1.55      25.18      22.44        090
21249.............  ..............  A                Reconstruction of jaw.      17.49      16.77      12.73       2.48      36.74      32.70        090
21255.............  ..............  A                Reconstruct lower jaw       16.69         NA      16.18       2.38         NA      35.25        090
                                                      bone.
21256.............  ..............  A                Reconstruction of           16.17         NA      11.85       1.50         NA      29.52        090
                                                      orbit.
21260.............  ..............  A                Revise eye sockets....      16.50         NA      12.80       0.97         NA      30.27        090
21261.............  ..............  A                Revise eye sockets....      31.44         NA      24.30       3.42         NA      59.16        090
21263.............  ..............  A                Revise eye sockets....      28.38         NA      19.13       2.62         NA      50.13        090
21267.............  ..............  A                Revise eye sockets....      18.87         NA      19.83       1.70         NA      40.40        090
21268.............  ..............  A                Revise eye sockets....      24.44         NA      20.27       3.65         NA      48.36        090
21270.............  ..............  A                Augmentation, cheek         10.21      11.68       7.27       0.72      22.61      18.20        090
                                                      bone.
21275.............  ..............  A                Revision, orbitofacial      11.22         NA       8.18       1.29         NA      20.69        090
                                                      bones.
21280.............  ..............  A                Revision of eyelid....       6.02         NA       5.94       0.42         NA      12.38        090
21282.............  ..............  A                Revision of eyelid....       3.48         NA       4.49       0.26         NA       8.23        090
21295.............  ..............  A                Revision of jaw muscle/      1.53         NA       2.54       0.16         NA       4.23        090
                                                      bone.
21296.............  ..............  A                Revision of jaw muscle/      4.24         NA       4.92       0.34         NA       9.50        090
                                                      bone.
21299.............  ..............  C                Cranio/maxillofacial         0.00       0.00       0.00       0.00       0.00       0.00        YYY
                                                      surgery.
21300.............  ..............  A                Treatment of skull           0.72       2.37       0.26       0.13       3.22       1.11        000
                                                      fracture.
21310.............  ..............  A                Treatment of nose            0.58       2.29       0.15       0.05       2.92       0.78        000
                                                      fracture.
21315.............  ..............  A                Treatment of nose            1.51       4.24       1.89       0.14       5.89       3.54        010
                                                      fracture.
21320.............  ..............  A                Treatment of nose            1.85       3.92       1.62       0.18       5.95       3.65        010
                                                      fracture.
21325.............  ..............  A                Treatment of nose            3.76         NA       8.64       0.31         NA      12.71        090
                                                      fracture.
21330.............  ..............  A                Treatment of nose            5.37         NA       9.73       0.56         NA      15.66        090
                                                      fracture.
21335.............  ..............  A                Treatment of nose            8.60         NA       9.65       0.74         NA      18.99        090
                                                      fracture.
21336.............  ..............  A                Treat nasal septal           5.71         NA       9.64       0.55         NA      15.90        090
                                                      fracture.
21337.............  ..............  A                Treat nasal septal           2.70       6.14       3.58       0.28       9.12       6.56        090
                                                      fracture.
21338.............  ..............  A                Treat nasoethmoid            6.45         NA      14.06       0.82         NA      21.33        090
                                                      fracture.
21339.............  ..............  A                Treat nasoethmoid            8.08         NA      13.94       0.96         NA      22.98        090
                                                      fracture.
21340.............  ..............  A                Treatment of nose           10.75         NA       8.42       1.15         NA      20.32        090
                                                      fracture.
21343.............  ..............  A                Treatment of sinus          12.93         NA      15.51       1.47         NA      29.91        090
                                                      fracture.
21344.............  ..............  A                Treatment of sinus          19.69         NA      16.55       2.43         NA      38.67        090
                                                      fracture.
21345.............  ..............  A                Treat nose/jaw               8.15       9.87       7.19       0.92      18.94      16.26        090
                                                      fracture.
21346.............  ..............  A                Treat nose/jaw              10.59         NA      12.24       1.21         NA      24.04        090
                                                      fracture.
21347.............  ..............  A                Treat nose/jaw              12.67         NA      16.24       1.47         NA      30.38        090
                                                      fracture.
21348.............  ..............  A                Treat nose/jaw              16.66         NA      11.14       2.48         NA      30.28        090
                                                      fracture.
21355.............  ..............  A                Treat cheek bone             3.76       6.25       3.49       0.34      10.35       7.59        010
                                                      fracture.
21356.............  ..............  A                Treat cheek bone             4.14       7.14       4.56       0.46      11.74       9.16        010
                                                      fracture.
21360.............  ..............  A                Treat cheek bone             6.45         NA       5.95       0.74         NA      13.14        090
                                                      fracture.
21365.............  ..............  A                Treat cheek bone            14.93         NA      10.86       1.69         NA      27.48        090
                                                      fracture.

[[Page 70347]]

 
21366.............  ..............  A                Treat cheek bone            17.74         NA      11.36       2.49         NA      31.59        090
                                                      fracture.
21385.............  ..............  A                Treat eye socket             9.15         NA       8.30       0.97         NA      18.42        090
                                                      fracture.
21386.............  ..............  A                Treat eye socket             9.15         NA       7.09       0.97         NA      17.21        090
                                                      fracture.
21387.............  ..............  A                Treat eye socket             9.69         NA       8.98       1.08         NA      19.75        090
                                                      fracture.
21390.............  ..............  A                Treat eye socket            10.11         NA       7.82       0.90         NA      18.83        090
                                                      fracture.
21395.............  ..............  A                Treat eye socket            12.66         NA       9.05       1.44         NA      23.15        090
                                                      fracture.
21400.............  ..............  A                Treat eye socket             1.40       2.62       1.88       0.15       4.17       3.43        090
                                                      fracture.
21401.............  ..............  A                Treat eye socket             3.26       8.01       3.50       0.38      11.65       7.14        090
                                                      fracture.
21406.............  ..............  A                Treat eye socket             7.00         NA       6.10       0.73         NA      13.83        090
                                                      fracture.
21407.............  ..............  A                Treat eye socket             8.60         NA       6.88       0.94         NA      16.42        090
                                                      fracture.
21408.............  ..............  A                Treat eye socket            12.36         NA       8.91       1.44         NA      22.71        090
                                                      fracture.
21421.............  ..............  A                Treat mouth roof             5.13       9.36       8.33       0.73      15.22      14.19        090
                                                      fracture.
21422.............  ..............  A                Treat mouth roof             8.31         NA       8.10       0.99         NA      17.40        090
                                                      fracture.
21423.............  ..............  A                Treat mouth roof            10.38         NA       9.35       1.27         NA      21.00        090
                                                      fracture.
21431.............  ..............  A                Treat craniofacial           7.04         NA       9.55       0.70         NA      17.29        090
                                                      fracture.
21432.............  ..............  A                Treat craniofacial           8.60         NA       8.08       0.81         NA      17.49        090
                                                      fracture.
21433.............  ..............  A                Treat craniofacial          25.31         NA      16.45       2.78         NA      44.54        090
                                                      fracture.
21435.............  ..............  A                Treat craniofacial          17.22         NA      12.74       1.98         NA      31.94        090
                                                      fracture.
21436.............  ..............  A                Treat craniofacial          28.00         NA      18.27       3.09         NA      49.36        090
                                                      fracture.
21440.............  ..............  A                Treat dental ridge           2.70       7.12       6.18       0.38      10.20       9.26        090
                                                      fracture.
21445.............  ..............  A                Treat dental ridge           5.37       9.78       8.39       0.78      15.93      14.54        090
                                                      fracture.
21450.............  ..............  A                Treat lower jaw              2.97       7.40       6.89       0.33      10.70      10.19        090
                                                      fracture.
21451.............  ..............  A                Treat lower jaw              4.86       9.38       8.42       0.63      14.87      13.91        090
                                                      fracture.
21452.............  ..............  A                Treat lower jaw              1.98      13.06       4.62       0.27      15.31       6.87        090
                                                      fracture.
21453.............  ..............  A                Treat lower jaw              5.53      10.77      10.76       0.74      17.04      17.03        090
                                                      fracture.
21454.............  ..............  A                Treat lower jaw              6.45         NA       6.28       0.82         NA      13.55        090
                                                      fracture.
21461.............  ..............  A                Treat lower jaw              8.08      24.53      12.70       0.98      33.59      21.76        090
                                                      fracture.
21462.............  ..............  A                Treat lower jaw              9.78      27.69      12.75       1.27      38.74      23.80        090
                                                      fracture.
21465.............  ..............  A                Treat lower jaw             11.89         NA       9.84       1.50         NA      23.23        090
                                                      fracture.
21470.............  ..............  A                Treat lower jaw             15.32         NA      12.05       1.96         NA      29.33        090
                                                      fracture.
21480.............  ..............  A                Reset dislocated jaw..       0.61       1.78       0.19       0.06       2.45       0.86        000
21485.............  ..............  A                Reset dislocated jaw..       3.98       8.24       7.68       0.51      12.73      12.17        090
21490.............  ..............  A                Repair dislocated jaw.      11.84         NA       9.72       1.96         NA      23.52        090
21495.............  ..............  A                Treat hyoid bone             5.68         NA       8.44       0.46         NA      14.58        090
                                                      fracture.
21497.............  ..............  A                Interdental wiring....       3.85       8.47       7.66       0.50      12.82      12.01        090
21499.............  ..............  C                Head surgery procedure       0.00       0.00       0.00       0.00       0.00       0.00        YYY
21501.............  ..............  A                Drain neck/chest             3.80       6.44       3.83       0.43      10.67       8.06        090
                                                      lesion.
21502.............  ..............  A                Drain chest lesion....       7.11         NA       5.65       0.97         NA      13.73        090
21510.............  ..............  A                Drainage of bone             5.73         NA       5.68       0.80         NA      12.21        090
                                                      lesion.
21550.............  ..............  A                Biopsy of neck/chest..       2.06       3.59       1.72       0.16       5.81       3.94        010
21555.............  ..............  A                Remove lesion, neck/         4.34       5.53       3.20       0.56      10.43       8.10        090
                                                      chest.
21556.............  ..............  A                Remove lesion, neck/         5.56         NA       4.11       0.65         NA      10.32        090
                                                      chest.
21557.............  ..............  A                Remove tumor, neck/          8.87         NA       5.37       1.08         NA      15.32        090
                                                      chest.
21600.............  ..............  A                Partial removal of rib       6.88         NA       5.75       0.99         NA      13.62        090
21610.............  ..............  A                Partial removal of rib      14.59         NA       8.89       3.07         NA      26.55        090
21615.............  ..............  A                Removal of rib........       9.86         NA       6.70       1.45         NA      18.01        090
21616.............  ..............  A                Removal of rib and          12.02         NA       8.04       1.86         NA      21.92        090
                                                      nerves.
21620.............  ..............  A                Partial removal of           6.78         NA       5.99       0.98         NA      13.75        090
                                                      sternum.
21627.............  ..............  A                Sternal debridement...       6.80         NA       6.32       1.02         NA      14.14        090
21630.............  ..............  A                Extensive sternum           17.35         NA      11.87       2.58         NA      31.80        090
                                                      surgery.
21632.............  ..............  A                Extensive sternum           18.11         NA      11.14       2.65         NA      31.90        090
                                                      surgery.
21685.............  ..............  A                Hyoid myotomy &             12.98         NA      10.00       1.06         NA      24.04        090
                                                      suspension.
21700.............  ..............  A                Revision of neck             6.18         NA       4.45       0.32         NA      10.95        090
                                                      muscle.
21705.............  ..............  A                Revision of neck             9.59         NA       5.60       1.43         NA      16.62        090
                                                      muscle/rib.
21720.............  ..............  A                Revision of neck             5.67       2.47       2.47       0.91       9.05       9.05        090
                                                      muscle.
21725.............  ..............  A                Revision of neck             6.98         NA       5.46       1.21         NA      13.65        090
                                                      muscle.
21740.............  ..............  A                Reconstruction of           16.48         NA       8.54       2.36         NA      27.38        090
                                                      sternum.
21742.............  ..............  C                Repair stern/nuss w/o        0.00       0.00       0.00       0.00       0.00       0.00        090
                                                      scope.
21743.............  ..............  C                Repair sternum/nuss w/       0.00       0.00       0.00       0.00       0.00       0.00        090
                                                      scope.
21750.............  ..............  A                Repair of sternum           10.75         NA       6.13       1.63         NA      18.51        090
                                                      separation.
21800.............  ..............  A                Treatment of rib             0.96         NA       1.34       0.09         NA       2.39        090
                                                      fracture.
21805.............  ..............  A                Treatment of rib             2.75         NA       3.21       0.38         NA       6.34        090
                                                      fracture.
21810.............  ..............  A                Treatment of rib             6.85         NA       4.98       0.94         NA      12.77        090
                                                      fracture(s).
21820.............  ..............  A                Treat sternum fracture       1.28       1.83       1.77       0.16       3.27       3.21        090
21825.............  ..............  A                Treat sternum fracture       7.40         NA       6.41       1.11         NA      14.92        090
21899.............  ..............  C                Neck/chest surgery           0.00       0.00       0.00       0.00       0.00       0.00        YYY
                                                      procedure.
21920.............  ..............  A                Biopsy soft tissue of        2.06       3.29       1.47       0.14       5.49       3.67        010
                                                      back.
21925.............  ..............  A                Biopsy soft tissue of        4.48       5.18       3.25       0.60      10.26       8.33        090
                                                      back.
21930.............  ..............  A                Remove lesion, back or       4.99       5.73       3.41       0.66      11.38       9.06        090
                                                      flank.
21935.............  ..............  A                Remove tumor, back....      17.93         NA       9.65       2.47         NA      30.05        090
22010.............  ..............  A                I&d, p-spine, c/t/cerv-     11.05         NA       8.91       1.73         NA      21.69        090
                                                      thor.
22015.............  ..............  A                I&d, p-spine, l/s/ls..      10.94         NA       8.85       1.71         NA      21.50        090
22100.............  ..............  A                Remove part of neck          9.72         NA       7.55       2.13         NA      19.40        090
                                                      vertebra.
22101.............  ..............  A                Remove part, thorax          9.80         NA       7.77       1.90         NA      19.47        090
                                                      vertebra.
22102.............  ..............  A                Remove part, lumbar          9.80         NA       8.13       1.87         NA      19.80        090
                                                      vertebra.

[[Page 70348]]

 
22103.............  ..............  A                Remove extra spine           2.34         NA       1.21       0.44         NA       3.99        ZZZ
                                                      segment.
22110.............  ..............  A                Remove part of neck         12.72         NA       9.19       2.76         NA      24.67        090
                                                      vertebra.
22112.............  ..............  A                Remove part, thorax         12.79         NA       9.30       2.52         NA      24.61        090
                                                      vertebra.
22114.............  ..............  A                Remove part, lumbar         12.79         NA       9.28       2.63         NA      24.70        090
                                                      vertebra.
22116.............  ..............  A                Remove extra spine           2.32         NA       1.17       0.50         NA       3.99        ZZZ
                                                      segment.
22210.............  ..............  A                Revision of neck spine      23.78         NA      15.45       5.44         NA      44.67        090
22212.............  ..............  A                Revision of thorax          19.39         NA      13.31       3.90         NA      36.60        090
                                                      spine.
22214.............  ..............  A                Revision of lumbar          19.42         NA      13.85       3.91         NA      37.18        090
                                                      spine.
22216.............  ..............  A                Revise, extra spine          6.03         NA       3.14       1.29         NA      10.46        ZZZ
                                                      segment.
22220.............  ..............  A                Revision of neck spine      21.34         NA      13.66       5.06         NA      40.06        090
22222.............  ..............  A                Revision of thorax          21.49         NA      11.16       4.12         NA      36.77        090
                                                      spine.
22224.............  ..............  A                Revision of lumbar          21.49         NA      14.26       4.18         NA      39.93        090
                                                      spine.
22226.............  ..............  A                Revise, extra spine          6.03         NA       3.10       1.29         NA      10.42        ZZZ
                                                      segment.
22305.............  ..............  A                Treat spine process          2.05       2.32       1.93       0.39       4.76       4.37        090
                                                      fracture.
22310.............  ..............  A                Treat spine fracture..       2.61       2.81       2.36       0.50       5.92       5.47        090
22315.............  ..............  A                Treat spine fracture..       8.83       9.71       7.35       1.85      20.39      18.03        090
22318.............  ..............  A                Treat odontoid fx w/o       21.47         NA      13.42       5.28         NA      40.17        090
                                                      graft.
22319.............  ..............  A                Treat odontoid fx w/        23.96         NA      14.75       6.03         NA      44.74        090
                                                      graft.
22325.............  ..............  A                Treat spine fracture..      18.27         NA      12.11       3.87         NA      34.25        090
22326.............  ..............  A                Treat neck spine            19.56         NA      12.74       4.42         NA      36.72        090
                                                      fracture.
22327.............  ..............  A                Treat thorax spine          19.17         NA      12.40       3.98         NA      35.55        090
                                                      fracture.
22328.............  ..............  A                Treat each add spine         4.60         NA       2.27       0.94         NA       7.81        ZZZ
                                                      fx.
22505.............  ..............  A                Manipulation of spine.       1.87         NA       0.94       0.36         NA       3.17        010
22520.............  ..............  A                Percut vertebroplasty        8.90      61.84       5.11       1.71      72.45      15.72        010
                                                      thor.
22521.............  ..............  A                Percut vertebroplasty        8.33      56.13       4.96       1.60      66.06      14.89        010
                                                      lumb.
22522.............  ..............  A                Percut vertebroplasty        4.30         NA       1.68       0.82         NA       6.80        ZZZ
                                                      add'l.
22523.............  ..............  A                Percut kyphoplasty,          8.94         NA       5.92       1.43         NA      16.29        010
                                                      thor.
22524.............  ..............  A                Percut kyphoplasty,          8.54         NA       5.71       1.36         NA      15.61        010
                                                      lumbar.
22525.............  ..............  A                Percut kyphoplasty,          4.47         NA       2.28       0.72         NA       7.47        ZZZ
                                                      add-on.
22532.............  ..............  A                Lat thorax spine            23.96         NA      14.86       4.34         NA      43.16        090
                                                      fusion.
22533.............  ..............  A                Lat lumbar spine            23.09         NA      13.63       3.15         NA      39.87        090
                                                      fusion.
22534.............  ..............  A                Lat thor/lumb, add'l         5.99         NA       3.04       1.25         NA      10.28        ZZZ
                                                      seg.
22548.............  ..............  A                Neck spine fusion.....      25.78         NA      15.85       5.59         NA      47.22        090
22554.............  ..............  A                Neck spine fusion.....      18.59         NA      12.38       4.45         NA      35.42        090
22556.............  ..............  A                Thorax spine fusion...      23.42         NA      14.77       4.34         NA      42.53        090
22558.............  ..............  A                Lumbar spine fusion...      22.25         NA      13.33       3.15         NA      38.73        090
22585.............  ..............  A                Additional spinal            5.52         NA       2.80       1.25         NA       9.57        ZZZ
                                                      fusion.
22590.............  ..............  A                Spine & skull spinal        20.48         NA      13.36       4.78         NA      38.62        090
                                                      fusion.
22595.............  ..............  A                Neck spinal fusion....      19.36         NA      12.87       4.40         NA      36.63        090
22600.............  ..............  A                Neck spine fusion.....      16.12         NA      11.22       3.72         NA      31.06        090
22610.............  ..............  A                Thorax spine fusion...      16.00         NA      11.44       3.52         NA      30.96        090
22612.............  ..............  A                Lumbar spine fusion...      20.97         NA      14.24       4.46         NA      39.67        090
22614.............  ..............  A                Spine fusion, extra          6.43         NA       3.36       1.38         NA      11.17        ZZZ
                                                      segment.
22630.............  ..............  A                Lumbar spine fusion...      20.81         NA      13.64       4.72         NA      39.17        090
22632.............  ..............  A                Spine fusion, extra          5.22         NA       2.67       1.16         NA       9.05        ZZZ
                                                      segment.
22800.............  ..............  A                Fusion of spine.......      18.22         NA      12.81       3.75         NA      34.78        090
22802.............  ..............  A                Fusion of spine.......      30.83         NA      19.65       6.15         NA      56.63        090
22804.............  ..............  A                Fusion of spine.......      36.22         NA      22.76       6.98         NA      65.96        090
22808.............  ..............  A                Fusion of spine.......      26.23         NA      16.35       4.92         NA      47.50        090
22810.............  ..............  A                Fusion of spine.......      30.22         NA      18.41       5.13         NA      53.76        090
22812.............  ..............  A                Fusion of spine.......      32.65         NA      20.12       5.28         NA      58.05        090
22818.............  ..............  A                Kyphectomy, 1-2             31.78         NA      18.92       6.45         NA      57.15        090
                                                      segments.
22819.............  ..............  A                Kyphectomy, 3 or more.      36.39         NA      20.11       7.65         NA      64.15        090
22830.............  ..............  A                Exploration of spinal       10.83         NA       7.98       2.29         NA      21.10        090
                                                      fusion.
22840.............  ..............  A                Insert spine fixation       12.52         NA       6.51       2.78         NA      21.81        ZZZ
                                                      device.
22841.............  ..............  B                Insert spine fixation        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      device.
22842.............  ..............  A                Insert spine fixation       12.56         NA       6.52       2.74         NA      21.82        ZZZ
                                                      device.
22843.............  ..............  A                Insert spine fixation       13.44         NA       6.62       2.85         NA      22.91        ZZZ
                                                      device.
22844.............  ..............  A                Insert spine fixation       16.42         NA       8.78       3.18         NA      28.38        ZZZ
                                                      device.
22845.............  ..............  A                Insert spine fixation       11.94         NA       6.09       2.85         NA      20.88        ZZZ
                                                      device.
22846.............  ..............  A                Insert spine fixation       12.40         NA       6.35       2.95         NA      21.70        ZZZ
                                                      device.
22847.............  ..............  A                Insert spine fixation       13.78         NA       7.04       2.99         NA      23.81        ZZZ
                                                      device.
22848.............  ..............  A                Insert pelv fixation         5.99         NA       3.19       1.15         NA      10.33        ZZZ
                                                      device.
22849.............  ..............  A                Reinsert spinal             18.48         NA      11.76       3.89         NA      34.13        090
                                                      fixation.
22850.............  ..............  A                Remove spine fixation        9.51         NA       7.01       2.04         NA      18.56        090
                                                      device.
22851.............  ..............  A                Apply spine prosth           6.70         NA       3.37       1.49         NA      11.56        ZZZ
                                                      device.
22852.............  ..............  A                Remove spine fixation        9.00         NA       6.81       1.89         NA      17.70        090
                                                      device.
22855.............  ..............  A                Remove spine fixation       15.11         NA       9.69       3.51         NA      28.31        090
                                                      device.
22899.............  ..............  C                Spine surgery                0.00       0.00       0.00       0.00       0.00       0.00        YYY
                                                      procedure.
22900.............  ..............  A                Remove abdominal wall        5.79         NA       3.23       0.76         NA       9.78        090
                                                      lesion.
22999.............  ..............  C                Abdomen surgery              0.00       0.00       0.00       0.00       0.00       0.00        YYY
                                                      procedure.
23000.............  ..............  A                Removal of calcium           4.35       8.55       4.43       0.68      13.58       9.46        090
                                                      deposits.
23020.............  ..............  A                Release shoulder joint       8.92         NA       7.58       1.54         NA      18.04        090
23030.............  ..............  A                Drain shoulder lesion.       3.42       7.41       2.91       0.57      11.40       6.90        010
23031.............  ..............  A                Drain shoulder bursa..       2.74       7.88       2.73       0.46      11.08       5.93        010

[[Page 70349]]

 
23035.............  ..............  A                Drain shoulder bone          8.60         NA       8.29       1.47         NA      18.36        090
                                                      lesion.
23040.............  ..............  A                Exploratory shoulder         9.19         NA       7.88       1.60         NA      18.67        090
                                                      surgery.
23044.............  ..............  A                Exploratory shoulder         7.11         NA       6.45       1.24         NA      14.80        090
                                                      surgery.
23065.............  ..............  A                Biopsy shoulder              2.27       2.49       1.62       0.20       4.96       4.09        010
                                                      tissues.
23066.............  ..............  A                Biopsy shoulder              4.15       7.69       3.99       0.63      12.47       8.77        090
                                                      tissues.
23075.............  ..............  A                Removal of shoulder          2.39       3.67       1.79       0.34       6.40       4.52        010
                                                      lesion.
23076.............  ..............  A                Removal of shoulder          7.62         NA       5.57       1.13         NA      14.32        090
                                                      lesion.
23077.............  ..............  A                Remove tumor of             16.07         NA      10.24       2.33         NA      28.64        090
                                                      shoulder.
23100.............  ..............  A                Biopsy of shoulder           6.02         NA       5.67       1.04         NA      12.73        090
                                                      joint.
23101.............  ..............  A                Shoulder joint surgery       5.57         NA       5.35       0.96         NA      11.88        090
23105.............  ..............  A                Remove shoulder joint        8.22         NA       7.14       1.42         NA      16.78        090
                                                      lining.
23106.............  ..............  A                Incision of collarbone       5.95         NA       5.72       0.99         NA      12.66        090
                                                      joint.
23107.............  ..............  A                Explore treat shoulder       8.61         NA       7.41       1.49         NA      17.51        090
                                                      joint.
23120.............  ..............  A                Partial removal,             7.10         NA       6.48       1.23         NA      14.81        090
                                                      collar bone.
23125.............  ..............  A                Removal of collar bone       9.38         NA       7.58       1.62         NA      18.58        090
23130.............  ..............  A                Remove shoulder bone,        7.54         NA       7.15       1.30         NA      15.99        090
                                                      part.
23140.............  ..............  A                Removal of bone lesion       6.88         NA       5.24       1.08         NA      13.20        090
23145.............  ..............  A                Removal of bone lesion       9.08         NA       7.46       1.49         NA      18.03        090
23146.............  ..............  A                Removal of bone lesion       7.82         NA       7.13       1.35         NA      16.30        090
23150.............  ..............  A                Removal of humerus           8.47         NA       6.94       1.32         NA      16.73        090
                                                      lesion.
23155.............  ..............  A                Removal of humerus          10.33         NA       8.35       1.80         NA      20.48        090
                                                      lesion.
23156.............  ..............  A                Removal of humerus           8.67         NA       7.40       1.50         NA      17.57        090
                                                      lesion.
23170.............  ..............  A                Remove collar bone           6.85         NA       6.04       1.12         NA      14.01        090
                                                      lesion.
23172.............  ..............  A                Remove shoulder blade        6.89         NA       6.30       1.01         NA      14.20        090
                                                      lesion.
23174.............  ..............  A                Remove humerus lesion.       9.50         NA       8.38       1.65         NA      19.53        090
23180.............  ..............  A                Remove collar bone           8.52         NA       9.02       1.47         NA      19.01        090
                                                      lesion.
23182.............  ..............  A                Remove shoulder blade        8.14         NA       8.57       1.37         NA      18.08        090
                                                      lesion.
23184.............  ..............  A                Remove humerus lesion.       9.37         NA       9.34       1.63         NA      20.34        090
23190.............  ..............  A                Partial removal of           7.23         NA       6.19       1.17         NA      14.59        090
                                                      scapula.
23195.............  ..............  A                Removal of head of           9.80         NA       7.75       1.70         NA      19.25        090
                                                      humerus.
23200.............  ..............  A                Removal of collar bone      12.06         NA       8.75       1.93         NA      22.74        090
23210.............  ..............  A                Removal of shoulder         12.47         NA       9.02       2.02         NA      23.51        090
                                                      blade.
23220.............  ..............  A                Partial removal of          14.54         NA      10.85       2.48         NA      27.87        090
                                                      humerus.
23221.............  ..............  A                Partial removal of          17.71         NA      11.75       3.05         NA      32.51        090
                                                      humerus.
23222.............  ..............  A                Partial removal of          23.88         NA      15.83       3.94         NA      43.65        090
                                                      humerus.
23330.............  ..............  A                Remove shoulder              1.85       3.69       1.89       0.24       5.78       3.98        010
                                                      foreign body.
23331.............  ..............  A                Remove shoulder              7.37         NA       6.81       1.27         NA      15.45        090
                                                      foreign body.
23332.............  ..............  A                Remove shoulder             11.60         NA       9.35       2.02         NA      22.97        090
                                                      foreign body.
23350.............  ..............  A                Injection for shoulder       1.00       3.47       0.33       0.06       4.53       1.39        000
                                                      x-ray.
23395.............  ..............  A                Muscle                      16.82         NA      12.90       2.93         NA      32.65        090
                                                      transfer,shoulder/arm.
23397.............  ..............  A                Muscle transfers......      16.11         NA      11.40       2.73         NA      30.24        090
23400.............  ..............  A                Fixation of shoulder        13.52         NA      10.10       2.29         NA      25.91        090
                                                      blade.
23405.............  ..............  A                Incision of tendon &         8.36         NA       6.94       1.45         NA      16.75        090
                                                      muscle.
23406.............  ..............  A                Incise tendon(s) &          10.77         NA       8.36       1.87         NA      21.00        090
                                                      muscle(s).
23410.............  ..............  A                Repair rotator cuff,        12.43         NA       9.43       2.16         NA      24.02        090
                                                      acute.
23412.............  ..............  A                Repair rotator cuff,        13.29         NA       9.92       2.31         NA      25.52        090
                                                      chronic.
23415.............  ..............  A                Release of shoulder          9.96         NA       8.01       1.73         NA      19.70        090
                                                      ligament.
23420.............  ..............  A                Repair of shoulder....      13.28         NA      10.87       2.31         NA      26.46        090
23430.............  ..............  A                Repair biceps tendon..       9.97         NA       8.12       1.73         NA      19.82        090
23440.............  ..............  A                Remove/transplant           10.46         NA       8.28       1.82         NA      20.56        090
                                                      tendon.
23450.............  ..............  A                Repair shoulder             13.38         NA       9.87       2.32         NA      25.57        090
                                                      capsule.
23455.............  ..............  A                Repair shoulder             14.35         NA      10.47       2.49         NA      27.31        090
                                                      capsule.
23460.............  ..............  A                Repair shoulder             15.35         NA      11.40       2.66         NA      29.41        090
                                                      capsule.
23462.............  ..............  A                Repair shoulder             15.28         NA      10.78       2.59         NA      28.65        090
                                                      capsule.
23465.............  ..............  A                Repair shoulder             15.83         NA      11.21       2.76         NA      29.80        090
                                                      capsule.
23466.............  ..............  A                Repair shoulder             14.20         NA      11.40       2.46         NA      28.06        090
                                                      capsule.
23470.............  ..............  A                Reconstruct shoulder        17.12         NA      12.29       2.98         NA      32.39        090
                                                      joint.
23472.............  ..............  A                Reconstruct shoulder        21.07         NA      14.45       3.66         NA      39.18        090
                                                      joint.
23480.............  ..............  A                Revision of collar          11.16         NA       8.80       1.94         NA      21.90        090
                                                      bone.
23485.............  ..............  A                Revision of collar          13.41         NA       9.92       2.33         NA      25.66        090
                                                      bone.
23490.............  ..............  A                Reinforce clavicle....      11.84         NA       8.72       1.47         NA      22.03        090
23491.............  ..............  A                Reinforce shoulder          14.19         NA      10.74       2.46         NA      27.39        090
                                                      bones.
23500.............  ..............  A                Treat clavicle               2.08       2.88       2.53       0.30       5.26       4.91        090
                                                      fracture.
23505.............  ..............  A                Treat clavicle               3.68       4.42       3.85       0.61       8.71       8.14        090
                                                      fracture.
23515.............  ..............  A                Treat clavicle               7.40         NA       6.57       1.28         NA      15.25        090
                                                      fracture.
23520.............  ..............  A                Treat clavicle               2.16       2.86       2.75       0.34       5.36       5.25        090
                                                      dislocation.
23525.............  ..............  A                Treat clavicle               3.59       4.55       3.95       0.46       8.60       8.00        090
                                                      dislocation.
23530.............  ..............  A                Treat clavicle               7.30         NA       5.95       1.20         NA      14.45        090
                                                      dislocation.
23532.............  ..............  A                Treat clavicle               8.00         NA       6.99       1.38         NA      16.37        090
                                                      dislocation.
23540.............  ..............  A                Treat clavicle               2.23       2.87       2.37       0.29       5.39       4.89        090
                                                      dislocation.
23545.............  ..............  A                Treat clavicle               3.25       4.20       3.37       0.35       7.80       6.97        090
                                                      dislocation.
23550.............  ..............  A                Treat clavicle               7.23         NA       6.39       1.25         NA      14.87        090
                                                      dislocation.
23552.............  ..............  A                Treat clavicle               8.44         NA       7.34       1.46         NA      17.24        090
                                                      dislocation.
23570.............  ..............  A                Treat shoulder blade         2.23       3.02       2.90       0.36       5.61       5.49        090
                                                      fx.
23575.............  ..............  A                Treat shoulder blade         4.05       4.89       4.32       0.59       9.53       8.96        090
                                                      fx.

[[Page 70350]]

 
23585.............  ..............  A                Treat scapula fracture       8.95         NA       7.66       1.54         NA      18.15        090
23600.............  ..............  A                Treat humerus fracture       2.93       4.56       3.56       0.48       7.97       6.97        090
23605.............  ..............  A                Treat humerus fracture       4.86       6.17       5.12       0.84      11.87      10.82        090
23615.............  ..............  A                Treat humerus fracture       9.34         NA       8.86       1.62         NA      19.82        090
23616.............  ..............  A                Treat humerus fracture      21.24         NA      14.18       3.69         NA      39.11        090
23620.............  ..............  A                Treat humerus fracture       2.40       3.62       2.99       0.40       6.42       5.79        090
23625.............  ..............  A                Treat humerus fracture       3.92       4.95       4.29       0.67       9.54       8.88        090
23630.............  ..............  A                Treat humerus fracture       7.34         NA       6.65       1.27         NA      15.26        090
23650.............  ..............  A                Treat shoulder               3.38       3.78       2.77       0.30       7.46       6.45        090
                                                      dislocation.
23655.............  ..............  A                Treat shoulder               4.56         NA       4.18       0.69         NA       9.43        090
                                                      dislocation.
23660.............  ..............  A                Treat shoulder               7.48         NA       6.40       1.29         NA      15.17        090
                                                      dislocation.
23665.............  ..............  A                Treat dislocation/           4.46       5.35       4.73       0.71      10.52       9.90        090
                                                      fracture.
23670.............  ..............  A                Treat dislocation/           7.89         NA       6.85       1.36         NA      16.10        090
                                                      fracture.
23675.............  ..............  A                Treat dislocation/           6.04       6.85       5.85       1.01      13.90      12.90        090
                                                      fracture.
23680.............  ..............  A                Treat dislocation/          10.04         NA       8.13       1.75         NA      19.92        090
                                                      fracture.
23700.............  ..............  A                Fixation of shoulder..       2.52         NA       2.18       0.44         NA       5.14        010
23800.............  ..............  A                Fusion of shoulder          14.14         NA      10.44       2.35         NA      26.93        090
                                                      joint.
23802.............  ..............  A                Fusion of shoulder          16.58         NA      10.20       2.70         NA      29.48        090
                                                      joint.
23900.............  ..............  A                Amputation of arm &         19.69         NA      11.74       3.18         NA      34.61        090
                                                      girdle.
23920.............  ..............  A                Amputation at shoulder      14.59         NA       9.95       2.46         NA      27.00        090
                                                      joint.
23921.............  ..............  A                Amputation follow-up         5.48         NA       5.09       0.78         NA      11.35        090
                                                      surgery.
23929.............  ..............  C                Shoulder surgery             0.00       0.00       0.00       0.00       0.00       0.00        YYY
                                                      procedure.
23930.............  ..............  A                Drainage of arm lesion       2.94       6.34       2.32       0.43       9.71       5.69        010
23931.............  ..............  A                Drainage of arm bursa.       1.79       5.93       2.18       0.28       8.00       4.25        010
23935.............  ..............  A                Drain arm/elbow bone         6.08         NA       5.93       1.05         NA      13.06        090
                                                      lesion.
24000.............  ..............  A                Exploratory elbow            5.81         NA       5.43       0.97         NA      12.21        090
                                                      surgery.
24006.............  ..............  A                Release elbow joint...       9.30         NA       7.77       1.50         NA      18.57        090
24065.............  ..............  A                Biopsy arm/elbow soft        2.08       3.22       1.75       0.17       5.47       4.00        010
                                                      tissue.
24066.............  ..............  A                Biopsy arm/elbow soft        5.20       8.96       4.14       0.80      14.96      10.14        090
                                                      tissue.
24075.............  ..............  A                Remove arm/elbow             3.91       7.37       3.41       0.56      11.84       7.88        090
                                                      lesion.
24076.............  ..............  A                Remove arm/elbow             6.29         NA       4.87       0.95         NA      12.11        090
                                                      lesion.
24077.............  ..............  A                Remove tumor of arm/        11.74         NA       7.76       1.72         NA      21.22        090
                                                      elbow.
24100.............  ..............  A                Biopsy elbow joint           4.92         NA       4.53       0.85         NA      10.30        090
                                                      lining.
24101.............  ..............  A                Explore/treat elbow          6.12         NA       5.95       1.03         NA      13.10        090
                                                      joint.
24102.............  ..............  A                Remove elbow joint           8.02         NA       6.88       1.33         NA      16.23        090
                                                      lining.
24105.............  ..............  A                Removal of elbow bursa       3.60         NA       4.40       0.61         NA       8.61        090
24110.............  ..............  A                Remove humerus lesion.       7.38         NA       6.68       1.28         NA      15.34        090
24115.............  ..............  A                Remove/graft bone            9.62         NA       7.23       1.67         NA      18.52        090
                                                      lesion.
24116.............  ..............  A                Remove/graft bone           11.79         NA       9.10       2.05         NA      22.94        090
                                                      lesion.
24120.............  ..............  A                Remove elbow lesion...       6.64         NA       5.94       1.10         NA      13.68        090
24125.............  ..............  A                Remove/graft bone            7.88         NA       6.18       1.06         NA      15.12        090
                                                      lesion.
24126.............  ..............  A                Remove/graft bone            8.30         NA       7.04       1.16         NA      16.50        090
                                                      lesion.
24130.............  ..............  A                Removal of head of           6.24         NA       6.04       1.04         NA      13.32        090
                                                      radius.
24134.............  ..............  A                Removal of arm bone          9.72         NA       8.88       1.64         NA      20.24        090
                                                      lesion.
24136.............  ..............  A                Remove radius bone           7.98         NA       7.24       1.38         NA      16.60        090
                                                      lesion.
24138.............  ..............  A                Remove elbow bone            8.04         NA       7.80       1.34         NA      17.18        090
                                                      lesion.
24140.............  ..............  A                Partial removal of arm       9.17         NA       9.13       1.51         NA      19.81        090
                                                      bone.
24145.............  ..............  A                Partial removal of           7.57         NA       8.08       1.25         NA      16.90        090
                                                      radius.
24147.............  ..............  A                Partial removal of           7.53         NA       8.62       1.30         NA      17.45        090
                                                      elbow.
24149.............  ..............  A                Radical resection of        14.18         NA      11.65       2.34         NA      28.17        090
                                                      elbow.
24150.............  ..............  A                Extensive humerus           13.25         NA      10.02       2.32         NA      25.59        090
                                                      surgery.
24151.............  ..............  A                Extensive humerus           15.56         NA      11.54       2.59         NA      29.69        090
                                                      surgery.
24152.............  ..............  A                Extensive radius            10.04         NA       7.75       1.48         NA      19.27        090
                                                      surgery.
24153.............  ..............  A                Extensive radius            11.52         NA       5.59       0.74         NA      17.85        090
                                                      surgery.
24155.............  ..............  A                Removal of elbow joint      11.71         NA       8.42       1.92         NA      22.05        090
24160.............  ..............  A                Remove elbow joint           7.82         NA       6.91       1.30         NA      16.03        090
                                                      implant.
24164.............  ..............  A                Remove radius head           6.22         NA       5.79       1.03         NA      13.04        090
                                                      implant.
24200.............  ..............  A                Removal of arm foreign       1.76       3.42       1.63       0.20       5.38       3.59        010
                                                      body.
24201.............  ..............  A                Removal of arm foreign       4.55       9.84       4.24       0.72      15.11       9.51        090
                                                      body.
24220.............  ..............  A                Injection for elbow x-       1.31       3.64       0.44       0.08       5.03       1.83        000
                                                      ray.
24300.............  ..............  A                Manipulate elbow w/          3.74         NA       5.73       0.65         NA      10.12        090
                                                      anesth.
24301.............  ..............  A                Muscle/tendon transfer      10.18         NA       8.20       1.66         NA      20.04        090
24305.............  ..............  A                Arm tendon lengthening       7.44         NA       6.73       1.15         NA      15.32        090
24310.............  ..............  A                Revision of arm tendon       5.97         NA       5.60       0.96         NA      12.53        090
24320.............  ..............  A                Repair of arm tendon..      10.54         NA       7.55       1.73         NA      19.82        090
24330.............  ..............  A                Revision of arm              9.59         NA       7.90       1.60         NA      19.09        090
                                                      muscles.
24331.............  ..............  A                Revision of arm             10.63         NA       8.70       1.77         NA      21.10        090
                                                      muscles.
24332.............  ..............  A                Tenolysis, triceps....       7.44         NA       6.79       1.23         NA      15.46        090
24340.............  ..............  A                Repair of biceps             7.88         NA       7.00       1.36         NA      16.24        090
                                                      tendon.
24341.............  ..............  A                Repair arm tendon/           7.89         NA       7.94       1.36         NA      17.19        090
                                                      muscle.
24342.............  ..............  A                Repair of ruptured          10.60         NA       8.54       1.85         NA      20.99        090
                                                      tendon.
24343.............  ..............  A                Repr elbow lat ligmnt        8.64         NA       8.17       1.43         NA      18.24        090
                                                      w/tiss.
24344.............  ..............  A                Reconstruct elbow lat       13.98         NA      11.55       2.36         NA      27.89        090
                                                      ligmnt.
24345.............  ..............  A                Repr elbw med ligmnt w/      8.64         NA       8.04       1.44         NA      18.12        090
                                                      tissu.
24346.............  ..............  A                Reconstruct elbow med       13.98         NA      11.37       2.33         NA      27.68        090
                                                      ligmnt.

[[Page 70351]]

 
24350.............  ..............  A                Repair of tennis elbow       5.24         NA       5.60       0.87         NA      11.71        090
24351.............  ..............  A                Repair of tennis elbow       5.90         NA       5.94       1.02         NA      12.86        090
24352.............  ..............  A                Repair of tennis elbow       6.42         NA       6.20       1.10         NA      13.72        090
24354.............  ..............  A                Repair of tennis elbow       6.47         NA       6.17       1.07         NA      13.71        090
24356.............  ..............  A                Revision of tennis           6.67         NA       6.33       1.11         NA      14.11        090
                                                      elbow.
24360.............  ..............  A                Reconstruct elbow           12.32         NA       9.50       2.05         NA      23.87        090
                                                      joint.
24361.............  ..............  A                Reconstruct elbow           14.06         NA      10.61       2.18         NA      26.85        090
                                                      joint.
24362.............  ..............  A                Reconstruct elbow           14.97         NA      10.07       2.60         NA      27.64        090
                                                      joint.
24363.............  ..............  A                Replace elbow joint...      18.46         NA      13.75       3.01         NA      35.22        090
24365.............  ..............  A                Reconstruct head of          8.38         NA       7.22       1.41         NA      17.01        090
                                                      radius.
24366.............  ..............  A                Reconstruct head of          9.12         NA       7.56       1.52         NA      18.20        090
                                                      radius.
24400.............  ..............  A                Revision of humerus...      11.04         NA       8.88       1.92         NA      21.84        090
24410.............  ..............  A                Revision of humerus...      14.80         NA      10.34       2.57         NA      27.71        090
24420.............  ..............  A                Revision of humerus...      13.42         NA      10.57       2.17         NA      26.16        090
24430.............  ..............  A                Repair of humerus.....      12.79         NA       9.77       2.21         NA      24.77        090
24435.............  ..............  A                Repair humerus with         13.15         NA      10.91       2.27         NA      26.33        090
                                                      graft.
24470.............  ..............  A                Revision of elbow            8.73         NA       7.74       1.48         NA      17.95        090
                                                      joint.
24495.............  ..............  A                Decompression of             8.11         NA       8.77       1.18         NA      18.06        090
                                                      forearm.
24498.............  ..............  A                Reinforce humerus.....      11.90         NA       9.29       2.06         NA      23.25        090
24500.............  ..............  A                Treat humerus fracture       3.21       4.86       3.69       0.50       8.57       7.40        090
24505.............  ..............  A                Treat humerus fracture       5.16       6.62       5.41       0.89      12.67      11.46        090
24515.............  ..............  A                Treat humerus fracture      11.63         NA       9.41       2.02         NA      23.06        090
24516.............  ..............  A                Treat humerus fracture      11.63         NA       9.14       2.02         NA      22.79        090
24530.............  ..............  A                Treat humerus fracture       3.49       5.22       4.05       0.57       9.28       8.11        090
24535.............  ..............  A                Treat humerus fracture       6.86       7.86       6.64       1.18      15.90      14.68        090
24538.............  ..............  A                Treat humerus fracture       9.42         NA       8.73       1.64         NA      19.79        090
24545.............  ..............  A                Treat humerus fracture      10.44         NA       8.47       1.82         NA      20.73        090
24546.............  ..............  A                Treat humerus fracture      15.67         NA      11.35       2.73         NA      29.75        090
24560.............  ..............  A                Treat humerus fracture       2.80       4.49       3.20       0.44       7.73       6.44        090
24565.............  ..............  A                Treat humerus fracture       5.55       6.63       5.54       0.93      13.11      12.02        090
24566.............  ..............  A                Treat humerus fracture       7.78         NA       8.18       1.30         NA      17.26        090
24575.............  ..............  A                Treat humerus fracture      10.64         NA       8.42       1.86         NA      20.92        090
24576.............  ..............  A                Treat humerus fracture       2.86       4.77       3.72       0.46       8.09       7.04        090
24577.............  ..............  A                Treat humerus fracture       5.78       6.95       5.86       0.95      13.68      12.59        090
24579.............  ..............  A                Treat humerus fracture      11.58         NA       8.86       2.02         NA      22.46        090
24582.............  ..............  A                Treat humerus fracture       8.54         NA       9.14       1.48         NA      19.16        090
24586.............  ..............  A                Treat elbow fracture..      15.19         NA      11.26       2.64         NA      29.09        090
24587.............  ..............  A                Treat elbow fracture..      15.14         NA      11.05       2.52         NA      28.71        090
24600.............  ..............  A                Treat elbow                  4.22       4.87       3.51       0.50       9.59       8.23        090
                                                      dislocation.
24605.............  ..............  A                Treat elbow                  5.41         NA       5.38       0.89         NA      11.68        090
                                                      dislocation.
24615.............  ..............  A                Treat elbow                  9.41         NA       7.84       1.60         NA      18.85        090
                                                      dislocation.
24620.............  ..............  A                Treat elbow fracture..       6.97         NA       6.27       1.07         NA      14.31        090
24635.............  ..............  A                Treat elbow fracture..      13.17         NA      14.09       2.28         NA      29.54        090
24640.............  ..............  A                Treat elbow                  1.20       1.85       0.80       0.12       3.17       2.12        010
                                                      dislocation.
24650.............  ..............  A                Treat radius fracture.       2.16       3.79       2.76       0.35       6.30       5.27        090
24655.............  ..............  A                Treat radius fracture.       4.39       5.97       4.80       0.70      11.06       9.89        090
24665.............  ..............  A                Treat radius fracture.       8.13         NA       7.53       1.41         NA      17.07        090
24666.............  ..............  A                Treat radius fracture.       9.48         NA       8.09       1.62         NA      19.19        090
24670.............  ..............  A                Treat ulnar fracture..       2.54       4.12       3.08       0.41       7.07       6.03        090
24675.............  ..............  A                Treat ulnar fracture..       4.71       6.02       4.98       0.81      11.54      10.50        090
24685.............  ..............  A                Treat ulnar fracture..       8.79         NA       7.54       1.52         NA      17.85        090
24800.............  ..............  A                Fusion of elbow joint.      11.18         NA       8.77       1.63         NA      21.58        090
24802.............  ..............  A                Fusion/graft of elbow       13.67         NA      10.41       2.37         NA      26.45        090
                                                      joint.
24900.............  ..............  A                Amputation of upper          9.59         NA       7.08       1.53         NA      18.20        090
                                                      arm.
24920.............  ..............  A                Amputation of upper          9.53         NA       6.96       1.61         NA      18.10        090
                                                      arm.
24925.............  ..............  A                Amputation follow-up         7.06         NA       6.10       1.14         NA      14.30        090
                                                      surgery.
24930.............  ..............  A                Amputation follow-up        10.23         NA       7.26       1.67         NA      19.16        090
                                                      surgery.
24931.............  ..............  A                Amputate upper arm &        12.70         NA       5.74       1.89         NA      20.33        090
                                                      implant.
24935.............  ..............  A                Revision of amputation      15.54         NA       8.04       2.13         NA      25.71        090
24940.............  ..............  C                Revision of upper arm.       0.00       0.00       0.00       0.00       0.00       0.00        090
24999.............  ..............  C                Upper arm/elbow              0.00       0.00       0.00       0.00       0.00       0.00        YYY
                                                      surgery.
25000.............  ..............  A                Incision of tendon           3.37         NA       6.89       0.55         NA      10.81        090
                                                      sheath.
25001.............  ..............  A                Incise flexor carpi          3.37         NA       4.24       0.55         NA       8.16        090
                                                      radialis.
25020.............  ..............  A                Decompress forearm 1         5.91         NA       9.59       0.93         NA      16.43        090
                                                      space.
25023.............  ..............  A                Decompress forearm 1        12.94         NA      14.98       2.03         NA      29.95        090
                                                      space.
25024.............  ..............  A                Decompress forearm 2         9.49         NA       7.49       1.36         NA      18.34        090
                                                      spaces.
25025.............  ..............  A                Decompress forearm 2        16.52         NA      10.00       1.82         NA      28.34        090
                                                      spaces.
25028.............  ..............  A                Drainage of forearm          5.24         NA       8.18       0.81         NA      14.23        090
                                                      lesion.
25031.............  ..............  A                Drainage of forearm          4.13         NA       7.94       0.63         NA      12.70        090
                                                      bursa.
25035.............  ..............  A                Treat forearm bone           7.35         NA      13.63       1.24         NA      22.22        090
                                                      lesion.
25040.............  ..............  A                Explore/treat wrist          7.17         NA       7.32       1.15         NA      15.64        090
                                                      joint.
25065.............  ..............  A                Biopsy forearm soft          1.99       3.23       1.91       0.15       5.37       4.05        010
                                                      tissues.
25066.............  ..............  A                Biopsy forearm soft          4.12         NA       7.08       0.64         NA      11.84        090
                                                      tissues.
25075.............  ..............  A                Removal forearm lesion       3.73         NA       5.91       0.55         NA      10.19        090
                                                      subcu.
25076.............  ..............  A                Removal forearm lesion       4.91         NA       9.57       0.74         NA      15.22        090
                                                      deep.

[[Page 70352]]

 
25077.............  ..............  A                Remove tumor, forearm/       9.75         NA      12.12       1.42         NA      23.29        090
                                                      wrist.
25085.............  ..............  A                Incision of wrist            5.49         NA       7.14       0.85         NA      13.48        090
                                                      capsule.
25100.............  ..............  A                Biopsy of wrist joint.       3.89         NA       5.29       0.59         NA       9.77        090
25101.............  ..............  A                Explore/treat wrist          4.68         NA       5.91       0.75         NA      11.34        090
                                                      joint.
25105.............  ..............  A                Remove wrist joint           5.84         NA       7.32       0.92         NA      14.08        090
                                                      lining.
25107.............  ..............  A                Remove wrist joint           6.42         NA       8.36       0.99         NA      15.77        090
                                                      cartilage.
25110.............  ..............  A                Remove wrist tendon          3.91         NA       7.07       0.62         NA      11.60        090
                                                      lesion.
25111.............  ..............  A                Remove wrist tendon          3.38         NA       4.71       0.53         NA       8.62        090
                                                      lesion.
25112.............  ..............  A                Reremove wrist tendon        4.52         NA       5.27       0.70         NA      10.49        090
                                                      lesion.
25115.............  ..............  A                Remove wrist/forearm         8.81         NA      14.07       1.31         NA      24.19        090
                                                      lesion.
25116.............  ..............  A                Remove wrist/forearm         7.10         NA      13.18       1.11         NA      21.39        090
                                                      lesion.
25118.............  ..............  A                Excise wrist tendon          4.36         NA       5.76       0.68         NA      10.80        090
                                                      sheath.
25119.............  ..............  A                Partial removal of           6.03         NA       7.62       0.96         NA      14.61        090
                                                      ulna.
25120.............  ..............  A                Removal of forearm           6.09         NA      12.12       1.00         NA      19.21        090
                                                      lesion.
25125.............  ..............  A                Remove/graft forearm         7.47         NA      12.88       1.06         NA      21.41        090
                                                      lesion.
25126.............  ..............  A                Remove/graft forearm         7.54         NA      13.05       1.27         NA      21.86        090
                                                      lesion.
25130.............  ..............  A                Removal of wrist             5.25         NA       6.44       0.80         NA      12.49        090
                                                      lesion.
25135.............  ..............  A                Remove & graft wrist         6.88         NA       7.53       1.02         NA      15.43        090
                                                      lesion.
25136.............  ..............  A                Remove & graft wrist         5.96         NA       6.61       1.03         NA      13.60        090
                                                      lesion.
25145.............  ..............  A                Remove forearm bone          6.36         NA      12.09       1.01         NA      19.46        090
                                                      lesion.
25150.............  ..............  A                Partial removal of           7.08         NA       8.23       1.14         NA      16.45        090
                                                      ulna.
25151.............  ..............  A                Partial removal of           7.38         NA      12.76       1.18         NA      21.32        090
                                                      radius.
25170.............  ..............  A                Extensive forearm           11.07         NA      15.19       1.77         NA      28.03        090
                                                      surgery.
25210.............  ..............  A                Removal of wrist bone.       5.94         NA       6.81       0.88         NA      13.63        090
25215.............  ..............  A                Removal of wrist bones       7.88         NA       8.78       1.19         NA      17.85        090
25230.............  ..............  A                Partial removal of           5.22         NA       6.16       0.79         NA      12.17        090
                                                      radius.
25240.............  ..............  A                Partial removal of           5.16         NA       6.97       0.81         NA      12.94        090
                                                      ulna.
25246.............  ..............  A                Injection for wrist x-       1.45       3.45       0.48       0.09       4.99       2.02        000
                                                      ray.
25248.............  ..............  A                Remove forearm foreign       5.13         NA       8.54       0.72         NA      14.39        090
                                                      body.
25250.............  ..............  A                Removal of wrist             6.59         NA       6.12       1.01         NA      13.72        090
                                                      prosthesis.
25251.............  ..............  A                Removal of wrist             9.56         NA       7.94       1.26         NA      18.76        090
                                                      prosthesis.
25259.............  ..............  A                Manipulate wrist w/          3.74         NA       5.74       0.62         NA      10.10        090
                                                      anesthes.
25260.............  ..............  A                Repair forearm tendon/       7.79         NA      13.35       1.19         NA      22.33        090
                                                      muscle.
25263.............  ..............  A                Repair forearm tendon/       7.81         NA      13.30       1.18         NA      22.29        090
                                                      muscle.
25265.............  ..............  A                Repair forearm tendon/       9.87         NA      14.35       1.47         NA      25.69        090
                                                      muscle.
25270.............  ..............  A                Repair forearm tendon/       5.99         NA      12.06       0.95         NA      19.00        090
                                                      muscle.
25272.............  ..............  A                Repair forearm tendon/       7.03         NA      12.83       1.11         NA      20.97        090
                                                      muscle.
25274.............  ..............  A                Repair forearm tendon/       8.74         NA      13.66       1.36         NA      23.76        090
                                                      muscle.
25275.............  ..............  A                Repair forearm tendon        8.49         NA       7.60       1.31         NA      17.40        090
                                                      sheath.
25280.............  ..............  A                Revise wrist/forearm         7.21         NA      12.67       1.08         NA      20.96        090
                                                      tendon.
25290.............  ..............  A                Incise wrist/forearm         5.28         NA      15.03       0.82         NA      21.13        090
                                                      tendon.
25295.............  ..............  A                Release wrist/forearm        6.54         NA      12.19       1.00         NA      19.73        090
                                                      tendon.
25300.............  ..............  A                Fusion of tendons at         8.79         NA       8.47       1.26         NA      18.52        090
                                                      wrist.
25301.............  ..............  A                Fusion of tendons at         8.39         NA       8.08       1.29         NA      17.76        090
                                                      wrist.
25310.............  ..............  A                Transplant forearm           8.13         NA      13.07       1.21         NA      22.41        090
                                                      tendon.
25312.............  ..............  A                Transplant forearm           9.56         NA      13.98       1.41         NA      24.95        090
                                                      tendon.
25315.............  ..............  A                Revise palsy hand           10.18         NA      14.44       1.58         NA      26.20        090
                                                      tendon(s).
25316.............  ..............  A                Revise palsy hand           12.31         NA      16.27       1.74         NA      30.32        090
                                                      tendon(s).
25320.............  ..............  A                Repair/revise wrist         10.75         NA      11.42       1.61         NA      23.78        090
                                                      joint.
25332.............  ..............  A                Revise wrist joint....      11.39         NA       9.20       1.83         NA      22.42        090
25335.............  ..............  A                Realignment of hand...      12.86         NA      11.62       1.92         NA      26.40        090
25337.............  ..............  A                Reconstruct ulna/           10.15         NA      11.11       1.61         NA      22.87        090
                                                      radioulnar.
25350.............  ..............  A                Revision of radius....       8.77         NA      14.01       1.46         NA      24.24        090
25355.............  ..............  A                Revision of radius....      10.15         NA      14.65       1.73         NA      26.53        090
25360.............  ..............  A                Revision of ulna......       8.42         NA      13.91       1.41         NA      23.74        090
25365.............  ..............  A                Revise radius & ulna..      12.38         NA      15.69       2.15         NA      30.22        090
25370.............  ..............  A                Revise radius or ulna.      13.34         NA      16.12       2.28         NA      31.74        090
25375.............  ..............  A                Revise radius & ulna..      13.02         NA      16.47       2.26         NA      31.75        090
25390.............  ..............  A                Shorten radius or ulna      10.38         NA      14.62       1.65         NA      26.65        090
25391.............  ..............  A                Lengthen radius or          13.63         NA      16.60       2.21         NA      32.44        090
                                                      ulna.
25392.............  ..............  A                Shorten radius & ulna.      13.93         NA      16.01       2.10         NA      32.04        090
25393.............  ..............  A                Lengthen radius & ulna      15.85         NA      17.63       2.76         NA      36.24        090
25394.............  ..............  A                Repair carpal bone,         10.38         NA       8.08       1.59         NA      20.05        090
                                                      shorten.
25400.............  ..............  A                Repair radius or ulna.      10.90         NA      15.23       1.82         NA      27.95        090
25405.............  ..............  A                Repair/graft radius or      14.36         NA      17.32       2.32         NA      34.00        090
                                                      ulna.
25415.............  ..............  A                Repair radius & ulna..      13.33         NA      16.56       2.17         NA      32.06        090
25420.............  ..............  A                Repair/graft radius &       16.31         NA      18.32       2.61         NA      37.24        090
                                                      ulna.
25425.............  ..............  A                Repair/graft radius or      13.19         NA      21.45       2.08         NA      36.72        090
                                                      ulna.
25426.............  ..............  A                Repair/graft radius &       15.80         NA      16.60       2.54         NA      34.94        090
                                                      ulna.
25430.............  ..............  A                Vasc graft into carpal       9.24         NA       7.36       1.27         NA      17.87        090
                                                      bone.
25431.............  ..............  A                Repair nonunion carpal      10.42         NA       8.42       1.90         NA      20.74        090
                                                      bone.
25440.............  ..............  A                Repair/graft wrist          10.42         NA       9.43       1.63         NA      21.48        090
                                                      bone.
25441.............  ..............  A                Reconstruct wrist           12.88         NA      10.03       2.07         NA      24.98        090
                                                      joint.
25442.............  ..............  A                Reconstruct wrist           10.83         NA       8.91       1.53         NA      21.27        090
                                                      joint.
25443.............  ..............  A                Reconstruct wrist           10.37         NA       8.80       1.37         NA      20.54        090
                                                      joint.

[[Page 70353]]

 
25444.............  ..............  A                Reconstruct wrist           11.13         NA       9.06       1.71         NA      21.90        090
                                                      joint.
25445.............  ..............  A                Reconstruct wrist            9.68         NA       8.01       1.55         NA      19.24        090
                                                      joint.
25446.............  ..............  A                Wrist replacement.....      16.53         NA      11.95       2.47         NA      30.95        090
25447.............  ..............  A                Repair wrist joint(s).      10.35         NA       8.68       1.61         NA      20.64        090
25449.............  ..............  A                Remove wrist joint          14.47         NA      10.70       2.21         NA      27.38        090
                                                      implant.
25450.............  ..............  A                Revision of wrist            7.86         NA      10.22       1.36         NA      19.44        090
                                                      joint.
25455.............  ..............  A                Revision of wrist            9.48         NA      10.89       0.96         NA      21.33        090
                                                      joint.
25490.............  ..............  A                Reinforce radius......       9.53         NA      13.77       1.43         NA      24.73        090
25491.............  ..............  A                Reinforce ulna........       9.95         NA      14.50       1.60         NA      26.05        090
25492.............  ..............  A                Reinforce radius and        12.31         NA      15.34       2.14         NA      29.79        090
                                                      ulna.
25500.............  ..............  A                Treat fracture of            2.45       3.58       2.72       0.35       6.38       5.52        090
                                                      radius.
25505.............  ..............  A                Treat fracture of            5.20       6.56       5.44       0.90      12.66      11.54        090
                                                      radius.
25515.............  ..............  A                Treat fracture of            9.17         NA       7.48       1.59         NA      18.24        090
                                                      radius.
25520.............  ..............  A                Treat fracture of            6.25       6.88       6.08       1.08      14.21      13.41        090
                                                      radius.
25525.............  ..............  A                Treat fracture of           12.22         NA      10.02       2.12         NA      24.36        090
                                                      radius.
25526.............  ..............  A                Treat fracture of           12.96         NA      13.54       2.19         NA      28.69        090
                                                      radius.
25530.............  ..............  A                Treat fracture of ulna       2.09       3.77       2.87       0.34       6.20       5.30        090
25535.............  ..............  A                Treat fracture of ulna       5.13       6.03       5.31       0.89      12.05      11.33        090
25545.............  ..............  A                Treat fracture of ulna       8.89         NA       7.68       1.53         NA      18.10        090
25560.............  ..............  A                Treat fracture radius        2.44       3.70       2.61       0.35       6.49       5.40        090
                                                      & ulna.
25565.............  ..............  A                Treat fracture radius        5.62       6.72       5.44       0.93      13.27      11.99        090
                                                      & ulna.
25574.............  ..............  A                Treat fracture radius        7.00         NA       7.22       1.21         NA      15.43        090
                                                      & ulna.
25575.............  ..............  A                Treat fracture radius/      10.43         NA       9.54       1.81         NA      21.78        090
                                                      ulna.
25600.............  ..............  A                Treat fracture radius/       2.63       4.10       2.98       0.42       7.15       6.03        090
                                                      ulna.
25605.............  ..............  A                Treat fracture radius/       5.80       7.25       6.24       1.00      14.05      13.04        090
                                                      ulna.
25611.............  ..............  A                Treat fracture radius/       7.76         NA       8.99       1.34         NA      18.09        090
                                                      ulna.
25620.............  ..............  A                Treat fracture radius/       8.54         NA       7.28       1.42         NA      17.24        090
                                                      ulna.
25622.............  ..............  A                Treat wrist bone             2.61       4.28       3.11       0.41       7.30       6.13        090
                                                      fracture.
25624.............  ..............  A                Treat wrist bone             4.52       6.32       5.08       0.76      11.60      10.36        090
                                                      fracture.
25628.............  ..............  A                Treat wrist bone             8.42         NA       7.84       1.37         NA      17.63        090
                                                      fracture.
25630.............  ..............  A                Treat wrist bone             2.88       4.19       2.95       0.45       7.52       6.28        090
                                                      fracture.
25635.............  ..............  A                Treat wrist bone             4.38       5.96       3.91       0.74      11.08       9.03        090
                                                      fracture.
25645.............  ..............  A                Treat wrist bone             7.24         NA       6.65       1.20         NA      15.09        090
                                                      fracture.
25650.............  ..............  A                Treat wrist bone             3.05       4.32       3.18       0.45       7.82       6.68        090
                                                      fracture.
25651.............  ..............  A                Pin ulnar styloid            5.35         NA       5.50       0.86         NA      11.71        090
                                                      fracture.
25652.............  ..............  A                Treat fracture ulnar         7.59         NA       7.02       1.21         NA      15.82        090
                                                      styloid.
25660.............  ..............  A                Treat wrist                  4.75         NA       4.72       0.58         NA      10.05        090
                                                      dislocation.
25670.............  ..............  A                Treat wrist                  7.91         NA       7.01       1.28         NA      16.20        090
                                                      dislocation.
25671.............  ..............  A                Pin radioulnar               5.99         NA       6.17       1.00         NA      13.16        090
                                                      dislocation.
25675.............  ..............  A                Treat wrist                  4.66       5.67       4.66       0.62      10.95       9.94        090
                                                      dislocation.
25676.............  ..............  A                Treat wrist                  8.03         NA       7.32       1.34         NA      16.69        090
                                                      dislocation.
25680.............  ..............  A                Treat wrist fracture..       5.98         NA       4.75       0.78         NA      11.51        090
25685.............  ..............  A                Treat wrist fracture..       9.77         NA       7.82       1.60         NA      19.19        090
25690.............  ..............  A                Treat wrist                  5.49         NA       5.52       0.88         NA      11.89        090
                                                      dislocation.
25695.............  ..............  A                Treat wrist                  8.33         NA       7.11       1.32         NA      16.76        090
                                                      dislocation.
25800.............  ..............  A                Fusion of wrist joint.       9.75         NA       9.12       1.57         NA      20.44        090
25805.............  ..............  A                Fusion/graft of wrist       11.26         NA      10.28       1.80         NA      23.34        090
                                                      joint.
25810.............  ..............  A                Fusion/graft of wrist       10.55         NA       9.93       1.67         NA      22.15        090
                                                      joint.
25820.............  ..............  A                Fusion of hand bones..       7.44         NA       7.87       1.22         NA      16.53        090
25825.............  ..............  A                Fuse hand bones with         9.26         NA       9.26       1.41         NA      19.93        090
                                                      graft.
25830.............  ..............  A                Fusion, radioulnar jnt/     10.04         NA      14.45       1.55         NA      26.04        090
                                                      ulna.
25900.............  ..............  A                Amputation of forearm.       9.00         NA      12.60       1.30         NA      22.90        090
25905.............  ..............  A                Amputation of forearm.       9.11         NA      12.33       1.40         NA      22.84        090
25907.............  ..............  A                Amputation follow-up         7.79         NA      11.79       1.10         NA      20.68        090
                                                      surgery.
25909.............  ..............  A                Amputation follow-up         8.95         NA      12.31       1.44         NA      22.70        090
                                                      surgery.
25915.............  ..............  A                Amputation of forearm.      17.05         NA      18.93       2.93         NA      38.91        090
25920.............  ..............  A                Amputate hand at wrist       8.67         NA       7.87       1.35         NA      17.89        090
25922.............  ..............  A                Amputate hand at wrist       7.41         NA       7.07       1.12         NA      15.60        090
25924.............  ..............  A                Amputation follow-up         8.45         NA       8.11       1.32         NA      17.88        090
                                                      surgery.
25927.............  ..............  A                Amputation of hand....       8.79         NA      11.71       1.27         NA      21.77        090
25929.............  ..............  A                Amputation follow-up         7.58         NA       5.89       1.14         NA      14.61        090
                                                      surgery.
25931.............  ..............  A                Amputation follow-up         7.80         NA      11.49       1.15         NA      20.44        090
                                                      surgery.
25999.............  ..............  C                Forearm or wrist             0.00       0.00       0.00       0.00       0.00       0.00        YYY
                                                      surgery.
26010.............  ..............  A                Drainage of finger           1.54       5.58       1.63       0.18       7.30       3.35        010
                                                      abscess.
26011.............  ..............  A                Drainage of finger           2.19       8.84       2.33       0.33      11.36       4.85        010
                                                      abscess.
26020.............  ..............  A                Drain hand tendon            4.66         NA       5.37       0.73         NA      10.76        090
                                                      sheath.
26025.............  ..............  A                Drainage of palm bursa       4.81         NA       5.13       0.76         NA      10.70        090
26030.............  ..............  A                Drainage of palm             5.92         NA       5.74       0.92         NA      12.58        090
                                                      bursa(s).
26034.............  ..............  A                Treat hand bone lesion       6.22         NA       6.37       1.01         NA      13.60        090
26035.............  ..............  A                Decompress fingers/          9.50         NA       7.89       1.47         NA      18.86        090
                                                      hand.
26037.............  ..............  A                Decompress fingers/          7.24         NA       6.34       1.13         NA      14.71        090
                                                      hand.
26040.............  ..............  A                Release palm                 3.33         NA       4.06       0.53         NA       7.92        090
                                                      contracture.
26045.............  ..............  A                Release palm                 5.55         NA       5.66       0.93         NA      12.14        090
                                                      contracture.
26055.............  ..............  A                Incise finger tendon         2.69      14.39       3.95       0.43      17.51       7.07        090
                                                      sheath.
26060.............  ..............  A                Incision of finger           2.81         NA       3.52       0.45         NA       6.78        090
                                                      tendon.

[[Page 70354]]

 
26070.............  ..............  A                Explore/treat hand           3.68         NA       3.37       0.48         NA       7.53        090
                                                      joint.
26075.............  ..............  A                Explore/treat finger         3.78         NA       3.79       0.53         NA       8.10        090
                                                      joint.
26080.............  ..............  A                Explore/treat finger         4.23         NA       4.86       0.66         NA       9.75        090
                                                      joint.
26100.............  ..............  A                Biopsy hand joint            3.66         NA       4.14       0.54         NA       8.34        090
                                                      lining.
26105.............  ..............  A                Biopsy finger joint          3.70         NA       4.24       0.59         NA       8.53        090
                                                      lining.
26110.............  ..............  A                Biopsy finger joint          3.52         NA       4.05       0.53         NA       8.10        090
                                                      lining.
26115.............  ..............  A                Removal hand lesion          3.85      13.13       4.78       0.59      17.57       9.22        090
                                                      subcut.
26116.............  ..............  A                Removal hand lesion,         5.52         NA       6.02       0.84         NA      12.38        090
                                                      deep.
26117.............  ..............  A                Remove tumor, hand/          8.54         NA       7.08       1.26         NA      16.88        090
                                                      finger.
26121.............  ..............  A                Release palm                 7.53         NA       6.98       1.17         NA      15.68        090
                                                      contracture.
26123.............  ..............  A                Release palm                 9.28         NA       8.88       1.43         NA      19.59        090
                                                      contracture.
26125.............  ..............  A                Release palm                 4.60         NA       2.45       0.70         NA       7.75        ZZZ
                                                      contracture.
26130.............  ..............  A                Remove wrist joint           5.41         NA       5.36       0.94         NA      11.71        090
                                                      lining.
26135.............  ..............  A                Revise finger joint,         6.95         NA       6.48       1.07         NA      14.50        090
                                                      each.
26140.............  ..............  A                Revise finger joint,         6.16         NA       6.06       0.92         NA      13.14        090
                                                      each.
26145.............  ..............  A                Tendon excision, palm/       6.31         NA       6.07       0.97         NA      13.35        090
                                                      finger.
26160.............  ..............  A                Remove tendon sheath         3.15      12.41       4.13       0.49      16.05       7.77        090
                                                      lesion.
26170.............  ..............  A                Removal of palm              4.76         NA       4.95       0.69         NA      10.40        090
                                                      tendon, each.
26180.............  ..............  A                Removal of finger            5.17         NA       5.43       0.78         NA      11.38        090
                                                      tendon.
26185.............  ..............  A                Remove finger bone....       5.24         NA       6.05       0.81         NA      12.10        090
26200.............  ..............  A                Remove hand bone             5.50         NA       5.37       0.88         NA      11.75        090
                                                      lesion.
26205.............  ..............  A                Remove/graft bone            7.69         NA       6.91       1.20         NA      15.80        090
                                                      lesion.
26210.............  ..............  A                Removal of finger            5.14         NA       5.44       0.79         NA      11.37        090
                                                      lesion.
26215.............  ..............  A                Remove/graft finger          7.09         NA       6.33       0.98         NA      14.40        090
                                                      lesion.
26230.............  ..............  A                Partial removal of           6.32         NA       5.93       1.01         NA      13.26        090
                                                      hand bone.
26235.............  ..............  A                Partial removal,             6.18         NA       5.83       0.95         NA      12.96        090
                                                      finger bone.
26236.............  ..............  A                Partial removal,             5.31         NA       5.34       0.81         NA      11.46        090
                                                      finger bone.
26250.............  ..............  A                Extensive hand surgery       7.54         NA       6.45       1.07         NA      15.06        090
26255.............  ..............  A                Extensive hand surgery      12.41         NA       9.40       1.68         NA      23.49        090
26260.............  ..............  A                Extensive finger             7.02         NA       6.20       1.01         NA      14.23        090
                                                      surgery.
26261.............  ..............  A                Extensive finger             9.08         NA       6.19       1.14         NA      16.41        090
                                                      surgery.
26262.............  ..............  A                Partial removal of           5.66         NA       5.35       0.88         NA      11.89        090
                                                      finger.
26320.............  ..............  A                Removal of implant           3.97         NA       4.32       0.59         NA       8.88        090
                                                      from hand.
26340.............  ..............  A                Manipulate finger w/         2.50         NA       4.89       0.39         NA       7.78        090
                                                      anesth.
26350.............  ..............  A                Repair finger/hand           5.98         NA      14.65       0.93         NA      21.56        090
                                                      tendon.
26352.............  ..............  A                Repair/graft hand            7.67         NA      15.40       1.13         NA      24.20        090
                                                      tendon.
26356.............  ..............  A                Repair finger/hand           8.06         NA      18.42       1.21         NA      27.69        090
                                                      tendon.
26357.............  ..............  A                Repair finger/hand           8.57         NA      15.68       1.33         NA      25.58        090
                                                      tendon.
26358.............  ..............  A                Repair/graft hand            9.13         NA      16.69       1.38         NA      27.20        090
                                                      tendon.
26370.............  ..............  A                Repair finger/hand           7.10         NA      15.15       1.12         NA      23.37        090
                                                      tendon.
26372.............  ..............  A                Repair/graft hand            8.75         NA      16.58       1.40         NA      26.73        090
                                                      tendon.
26373.............  ..............  A                Repair finger/hand           8.15         NA      16.09       1.23         NA      25.47        090
                                                      tendon.
26390.............  ..............  A                Revise hand/finger           9.18         NA      13.32       1.40         NA      23.90        090
                                                      tendon.
26392.............  ..............  A                Repair/graft hand           10.24         NA      16.77       1.57         NA      28.58        090
                                                      tendon.
26410.............  ..............  A                Repair hand tendon....       4.62         NA      11.97       0.73         NA      17.32        090
26412.............  ..............  A                Repair/graft hand            6.30         NA      13.31       0.97         NA      20.58        090
                                                      tendon.
26415.............  ..............  A                Excision, hand/finger        8.33         NA      11.81       0.98         NA      21.12        090
                                                      tendon.
26416.............  ..............  A                Graft hand or finger         9.36         NA      14.63       0.79         NA      24.78        090
                                                      tendon.
26418.............  ..............  A                Repair finger tendon..       4.24         NA      12.36       0.67         NA      17.27        090
26420.............  ..............  A                Repair/graft finger          6.76         NA      13.67       1.07         NA      21.50        090
                                                      tendon.
26426.............  ..............  A                Repair finger/hand           6.14         NA      13.20       0.95         NA      20.29        090
                                                      tendon.
26428.............  ..............  A                Repair/graft finger          7.20         NA      13.90       1.09         NA      22.19        090
                                                      tendon.
26432.............  ..............  A                Repair finger tendon..       4.01         NA      10.29       0.64         NA      14.94        090
26433.............  ..............  A                Repair finger tendon..       4.55         NA      10.82       0.72         NA      16.09        090
26434.............  ..............  A                Repair/graft finger          6.08         NA      11.57       0.93         NA      18.58        090
                                                      tendon.
26437.............  ..............  A                Realignment of tendons       5.81         NA      11.60       0.89         NA      18.30        090
26440.............  ..............  A                Release palm/finger          5.01         NA      13.47       0.75         NA      19.23        090
                                                      tendon.
26442.............  ..............  A                Release palm & finger        8.15         NA      15.99       1.20         NA      25.34        090
                                                      tendon.
26445.............  ..............  A                Release hand/finger          4.30         NA      13.18       0.65         NA      18.13        090
                                                      tendon.
26449.............  ..............  A                Release forearm/hand         6.99         NA      15.82       1.06         NA      23.87        090
                                                      tendon.
26450.............  ..............  A                Incision of palm             3.66         NA       7.35       0.59         NA      11.60        090
                                                      tendon.
26455.............  ..............  A                Incision of finger           3.63         NA       7.30       0.58         NA      11.51        090
                                                      tendon.
26460.............  ..............  A                Incise hand/finger           3.45         NA       7.16       0.55         NA      11.16        090
                                                      tendon.
26471.............  ..............  A                Fusion of finger             5.72         NA      11.27       0.88         NA      17.87        090
                                                      tendons.
26474.............  ..............  A                Fusion of finger             5.31         NA      11.42       0.76         NA      17.49        090
                                                      tendons.
26476.............  ..............  A                Tendon lengthening....       5.17         NA      10.96       0.79         NA      16.92        090
26477.............  ..............  A                Tendon shortening.....       5.14         NA      11.09       0.81         NA      17.04        090
26478.............  ..............  A                Lengthening of hand          5.79         NA      11.87       0.90         NA      18.56        090
                                                      tendon.
26479.............  ..............  A                Shortening of hand           5.73         NA      11.59       0.92         NA      18.24        090
                                                      tendon.
26480.............  ..............  A                Transplant hand tendon       6.68         NA      15.08       1.02         NA      22.78        090
26483.............  ..............  A                Transplant/graft hand        8.28         NA      15.54       1.26         NA      25.08        090
                                                      tendon.
26485.............  ..............  A                Transplant palm tendon       7.69         NA      15.40       1.15         NA      24.24        090
26489.............  ..............  A                Transplant/graft palm        9.54         NA      12.09       1.26         NA      22.89        090
                                                      tendon.
26490.............  ..............  A                Revise thumb tendon...       8.40         NA      12.86       1.21         NA      22.47        090
26492.............  ..............  A                Tendon transfer with         9.61         NA      13.64       1.40         NA      24.65        090
                                                      graft.

[[Page 70355]]

 
26494.............  ..............  A                Hand tendon/muscle           8.46         NA      13.01       1.28         NA      22.75        090
                                                      transfer.
26496.............  ..............  A                Revise thumb tendon...       9.58         NA      13.27       1.45         NA      24.30        090
26497.............  ..............  A                Finger tendon transfer       9.56         NA      13.61       1.41         NA      24.58        090
26498.............  ..............  A                Finger tendon transfer      13.98         NA      16.21       2.10         NA      32.29        090
26499.............  ..............  A                Revision of finger....       8.97         NA      13.08       1.35         NA      23.40        090
26500.............  ..............  A                Hand tendon                  5.95         NA      11.47       0.90         NA      18.32        090
                                                      reconstruction.
26502.............  ..............  A                Hand tendon                  7.13         NA      12.05       1.13         NA      20.31        090
                                                      reconstruction.
26504.............  ..............  A                Hand tendon                  7.46         NA      12.62       1.24         NA      21.32        090
                                                      reconstruction.
26508.............  ..............  A                Release thumb                6.00         NA      11.71       0.98         NA      18.69        090
                                                      contracture.
26510.............  ..............  A                Thumb tendon transfer.       5.42         NA      11.37       0.79         NA      17.58        090
26516.............  ..............  A                Fusion of knuckle            7.14         NA      12.27       1.10         NA      20.51        090
                                                      joint.
26517.............  ..............  A                Fusion of knuckle            8.82         NA      13.54       1.41         NA      23.77        090
                                                      joints.
26518.............  ..............  A                Fusion of knuckle            9.01         NA      13.43       1.35         NA      23.79        090
                                                      joints.
26520.............  ..............  A                Release knuckle              5.29         NA      13.93       0.80         NA      20.02        090
                                                      contracture.
26525.............  ..............  A                Release finger               5.32         NA      14.01       0.81         NA      20.14        090
                                                      contracture.
26530.............  ..............  A                Revise knuckle joint..       6.68         NA       6.16       1.04         NA      13.88        090
26531.............  ..............  A                Revise knuckle with          7.90         NA       7.14       1.17         NA      16.21        090
                                                      implant.
26535.............  ..............  A                Revise finger joint...       5.23         NA       3.75       0.71         NA       9.69        090
26536.............  ..............  A                Revise/implant finger        6.36         NA       9.68       0.96         NA      17.00        090
                                                      joint.
26540.............  ..............  A                Repair hand joint.....       6.42         NA      11.90       0.99         NA      19.31        090
26541.............  ..............  A                Repair hand joint with       8.61         NA      13.43       1.28         NA      23.32        090
                                                      graft.
26542.............  ..............  A                Repair hand joint with       6.77         NA      12.06       1.02         NA      19.85        090
                                                      graft.
26545.............  ..............  A                Reconstruct finger           6.91         NA      12.17       1.05         NA      20.13        090
                                                      joint.
26546.............  ..............  A                Repair nonunion hand..       8.91         NA      15.07       1.44         NA      25.42        090
26548.............  ..............  A                Reconstruct finger           8.02         NA      12.89       1.20         NA      22.11        090
                                                      joint.
26550.............  ..............  A                Construct thumb             21.21         NA      17.63       2.45         NA      41.29        090
                                                      replacement.
26551.............  ..............  A                Great toe-hand              46.51         NA      32.53       7.96         NA      87.00        090
                                                      transfer.
26553.............  ..............  A                Single transfer, toe-       46.20         NA      22.75       2.41         NA      71.36        090
                                                      hand.
26554.............  ..............  A                Double transfer, toe-       54.87         NA      37.64       9.41         NA     101.92        090
                                                      hand.
26555.............  ..............  A                Positional change of        16.61         NA      18.23       2.48         NA      37.32        090
                                                      finger.
26556.............  ..............  A                Toe joint transfer....      47.19         NA      33.42       2.57         NA      83.18        090
26560.............  ..............  A                Repair of web finger..       5.37         NA       9.83       0.85         NA      16.05        090
26561.............  ..............  A                Repair of web finger..      10.90         NA      12.38       1.45         NA      24.73        090
26562.............  ..............  A                Repair of web finger..      14.98         NA      17.19       2.23         NA      34.40        090
26565.............  ..............  A                Correct metacarpal           6.73         NA      12.04       1.00         NA      19.77        090
                                                      flaw.
26567.............  ..............  A                Correct finger               6.81         NA      11.98       1.04         NA      19.83        090
                                                      deformity.
26568.............  ..............  A                Lengthen metacarpal/         9.07         NA      15.47       1.49         NA      26.03        090
                                                      finger.
26580.............  ..............  A                Repair hand deformity.      18.15         NA      13.68       2.28         NA      34.11        090
26587.............  ..............  A                Reconstruct extra           14.03         NA       9.24       1.53         NA      24.80        090
                                                      finger.
26590.............  ..............  A                Repair finger               17.93         NA      13.98       2.77         NA      34.68        090
                                                      deformity.
26591.............  ..............  A                Repair muscles of hand       3.25         NA       9.65       0.48         NA      13.38        090
26593.............  ..............  A                Release muscles of           5.30         NA      11.16       0.78         NA      17.24        090
                                                      hand.
26596.............  ..............  A                Excision constricting        8.94         NA       8.85       1.43         NA      19.22        090
                                                      tissue.
26600.............  ..............  A                Treat metacarpal             1.96       3.62       2.66       0.30       5.88       4.92        090
                                                      fracture.
26605.............  ..............  A                Treat metacarpal             2.85       4.57       3.66       0.49       7.91       7.00        090
                                                      fracture.
26607.............  ..............  A                Treat metacarpal             5.35         NA       6.29       0.87         NA      12.51        090
                                                      fracture.
26608.............  ..............  A                Treat metacarpal             5.35         NA       6.27       0.88         NA      12.50        090
                                                      fracture.
26615.............  ..............  A                Treat metacarpal             5.32         NA       5.32       0.86         NA      11.50        090
                                                      fracture.
26641.............  ..............  A                Treat thumb                  3.93       4.58       3.54       0.39       8.90       7.86        090
                                                      dislocation.
26645.............  ..............  A                Treat thumb fracture..       4.40       5.18       4.20       0.67      10.25       9.27        090
26650.............  ..............  A                Treat thumb fracture..       5.71         NA       6.71       0.94         NA      13.36        090
26665.............  ..............  A                Treat thumb fracture..       7.59         NA       6.63       0.90         NA      15.12        090
26670.............  ..............  A                Treat hand dislocation       3.68       4.27       2.95       0.39       8.34       7.02        090
26675.............  ..............  A                Treat hand dislocation       4.63       5.49       4.48       0.77      10.89       9.88        090
26676.............  ..............  A                Pin hand dislocation..       5.51         NA       6.71       0.91         NA      13.13        090
26685.............  ..............  A                Treat hand dislocation       6.97         NA       6.16       1.09         NA      14.22        090
26686.............  ..............  A                Treat hand dislocation       7.93         NA       6.92       1.24         NA      16.09        090
26700.............  ..............  A                Treat knuckle                3.68       3.77       2.87       0.35       7.80       6.90        090
                                                      dislocation.
26705.............  ..............  A                Treat knuckle                4.18       5.35       4.31       0.66      10.19       9.15        090
                                                      dislocation.
26706.............  ..............  A                Pin knuckle                  5.11         NA       5.10       0.81         NA      11.02        090
                                                      dislocation.
26715.............  ..............  A                Treat knuckle                5.73         NA       5.53       0.91         NA      12.17        090
                                                      dislocation.
26720.............  ..............  A                Treat finger fracture,       1.66       2.79       2.06       0.24       4.69       3.96        090
                                                      each.
26725.............  ..............  A                Treat finger fracture,       3.33       4.78       3.51       0.53       8.64       7.37        090
                                                      each.
26727.............  ..............  A                Treat finger fracture,       5.22         NA       6.25       0.84         NA      12.31        090
                                                      each.
26735.............  ..............  A                Treat finger fracture,       5.97         NA       5.57       0.95         NA      12.49        090
                                                      each.
26740.............  ..............  A                Treat finger fracture,       1.94       3.14       2.71       0.31       5.39       4.96        090
                                                      each.
26742.............  ..............  A                Treat finger fracture,       3.84       5.00       3.89       0.58       9.42       8.31        090
                                                      each.
26746.............  ..............  A                Treat finger fracture,       5.80         NA       5.58       0.91         NA      12.29        090
                                                      each.
26750.............  ..............  A                Treat finger fracture,       1.70       2.49       2.02       0.22       4.41       3.94        090
                                                      each.
26755.............  ..............  A                Treat finger fracture,       3.10       4.43       3.01       0.42       7.95       6.53        090
                                                      each.
26756.............  ..............  A                Pin finger fracture,         4.38         NA       5.74       0.71         NA      10.83        090
                                                      each.
26765.............  ..............  A                Treat finger fracture,       4.16         NA       4.40       0.66         NA       9.22        090
                                                      each.
26770.............  ..............  A                Treat finger                 3.02       3.44       2.42       0.27       6.73       5.71        090
                                                      dislocation.
26775.............  ..............  A                Treat finger                 3.70       5.21       3.82       0.54       9.45       8.06        090
                                                      dislocation.
26776.............  ..............  A                Pin finger dislocation       4.79         NA       6.02       0.77         NA      11.58        090

[[Page 70356]]

 
26785.............  ..............  A                Treat finger                 4.20         NA       4.54       0.68         NA       9.42        090
                                                      dislocation.
26820.............  ..............  A                Thumb fusion with            8.25         NA      13.29       1.30         NA      22.84        090
                                                      graft.
26841.............  ..............  A                Fusion of thumb.......       7.12         NA      13.27       1.18         NA      21.57        090
26842.............  ..............  A                Thumb fusion with            8.23         NA      13.41       1.32         NA      22.96        090
                                                      graft.
26843.............  ..............  A                Fusion of hand joint..       7.60         NA      12.39       1.15         NA      21.14        090
26844.............  ..............  A                Fusion/graft of hand         8.72         NA      13.40       1.33         NA      23.45        090
                                                      joint.
26850.............  ..............  A                Fusion of knuckle.....       6.96         NA      12.24       1.06         NA      20.26        090
26852.............  ..............  A                Fusion of knuckle with       8.45         NA      12.93       1.22         NA      22.60        090
                                                      graft.
26860.............  ..............  A                Fusion of finger joint       4.68         NA      11.22       0.73         NA      16.63        090
26861.............  ..............  A                Fusion of finger jnt,        1.74         NA       0.93       0.27         NA       2.94        ZZZ
                                                      add-on.
26862.............  ..............  A                Fusion/graft of finger       7.36         NA      12.38       1.10         NA      20.84        090
                                                      joint.
26863.............  ..............  A                Fuse/graft added joint       3.89         NA       2.12       0.56         NA       6.57        ZZZ
26910.............  ..............  A                Amputate metacarpal          7.59         NA      11.25       1.16         NA      20.00        090
                                                      bone.
26951.............  ..............  A                Amputation of finger/        4.58         NA      10.18       0.71         NA      15.47        090
                                                      thumb.
26952.............  ..............  A                Amputation of finger/        6.30         NA      11.69       0.95         NA      18.94        090
                                                      thumb.
26989.............  ..............  C                Hand/finger surgery...       0.00       0.00       0.00       0.00       0.00       0.00        YYY
26990.............  ..............  A                Drainage of pelvis           7.47         NA       7.23       1.22         NA      15.92        090
                                                      lesion.
26991.............  ..............  A                Drainage of pelvis           6.67      11.19       5.45       1.11      18.97      13.23        090
                                                      bursa.
26992.............  ..............  A                Drainage of bone            13.00         NA      10.41       2.16         NA      25.57        090
                                                      lesion.
27000.............  ..............  A                Incision of hip tendon       5.61         NA       5.30       0.98         NA      11.89        090
27001.............  ..............  A                Incision of hip tendon       6.93         NA       6.11       1.24         NA      14.28        090
27003.............  ..............  A                Incision of hip tendon       7.33         NA       6.50       1.12         NA      14.95        090
27005.............  ..............  A                Incision of hip tendon       9.65         NA       7.84       1.72         NA      19.21        090
27006.............  ..............  A                Incision of hip              9.67         NA       8.00       1.69         NA      19.36        090
                                                      tendons.
27025.............  ..............  A                Incision of hip/thigh       11.14         NA       8.57       1.84         NA      21.55        090
                                                      fascia.
27030.............  ..............  A                Drainage of hip joint.      12.99         NA       9.67       2.26         NA      24.92        090
27033.............  ..............  A                Exploration of hip          13.37         NA       9.95       2.32         NA      25.64        090
                                                      joint.
27035.............  ..............  A                Denervation of hip          16.66         NA      11.26       2.15         NA      30.07        090
                                                      joint.
27036.............  ..............  A                Excision of hip joint/      12.86         NA      10.03       2.26         NA      25.15        090
                                                      muscle.
27040.............  ..............  A                Biopsy of soft tissues       2.87       5.25       2.02       0.27       8.39       5.16        010
27041.............  ..............  A                Biopsy of soft tissues       9.88         NA       6.66       1.35         NA      17.89        090
27047.............  ..............  A                Remove hip/pelvis            7.44       7.13       4.78       1.03      15.60      13.25        090
                                                      lesion.
27048.............  ..............  A                Remove hip/pelvis            6.24         NA       4.81       0.92         NA      11.97        090
                                                      lesion.
27049.............  ..............  A                Remove tumor, hip/          13.64         NA       8.42       2.06         NA      24.12        090
                                                      pelvis.
27050.............  ..............  A                Biopsy of sacroiliac         4.35         NA       4.43       0.60         NA       9.38        090
                                                      joint.
27052.............  ..............  A                Biopsy of hip joint...       6.22         NA       5.90       1.08         NA      13.20        090
27054.............  ..............  A                Removal of hip joint         8.53         NA       7.36       1.47         NA      17.36        090
                                                      lining.
27060.............  ..............  A                Removal of ischial           5.42         NA       4.38       0.80         NA      10.60        090
                                                      bursa.
27062.............  ..............  A                Remove femur lesion/         5.36         NA       5.21       0.93         NA      11.50        090
                                                      bursa.
27065.............  ..............  A                Removal of hip bone          5.89         NA       5.46       1.01         NA      12.36        090
                                                      lesion.
27066.............  ..............  A                Removal of hip bone         10.31         NA       8.46       1.79         NA      20.56        090
                                                      lesion.
27067.............  ..............  A                Remove/graft hip bone       13.81         NA      10.69       1.84         NA      26.34        090
                                                      lesion.
27070.............  ..............  A                Partial removal of hip      10.70         NA       9.16       1.74         NA      21.60        090
                                                      bone.
27071.............  ..............  A                Partial removal of hip      11.44         NA      10.15       1.92         NA      23.51        090
                                                      bone.
27075.............  ..............  A                Extensive hip surgery.      34.95         NA      19.26       5.64         NA      59.85        090
27076.............  ..............  A                Extensive hip surgery.      22.09         NA      14.55       3.70         NA      40.34        090
27077.............  ..............  A                Extensive hip surgery.      39.94         NA      22.73       6.12         NA      68.79        090
27078.............  ..............  A                Extensive hip surgery.      13.42         NA       9.97       2.22         NA      25.61        090
27079.............  ..............  A                Extensive hip surgery.      13.73         NA       9.57       1.94         NA      25.24        090
27080.............  ..............  A                Removal of tail bone..       6.38         NA       4.84       0.93         NA      12.15        090
27086.............  ..............  A                Remove hip foreign           1.87       4.56       1.83       0.25       6.68       3.95        010
                                                      body.
27087.............  ..............  A                Remove hip foreign           8.53         NA       6.68       1.35         NA      16.56        090
                                                      body.
27090.............  ..............  A                Removal of hip              11.13         NA       8.81       1.94         NA      21.88        090
                                                      prosthesis.
27091.............  ..............  A                Removal of hip              22.11         NA      14.03       3.84         NA      39.98        090
                                                      prosthesis.
27093.............  ..............  A                Injection for hip x-         1.30       4.47       0.48       0.13       5.90       1.91        000
                                                      ray.
27095.............  ..............  A                Injection for hip x-         1.50       5.74       0.52       0.14       7.38       2.16        000
                                                      ray.
27096.............  ..............  A                Inject sacroiliac            1.40       4.36       0.33       0.08       5.84       1.81        000
                                                      joint.
27097.............  ..............  A                Revision of hip tendon       8.79         NA       6.43       1.57         NA      16.79        090
27098.............  ..............  A                Transfer tendon to           8.82         NA       7.04       0.95         NA      16.81        090
                                                      pelvis.
27100.............  ..............  A                Transfer of abdominal       11.06         NA       8.69       1.85         NA      21.60        090
                                                      muscle.
27105.............  ..............  A                Transfer of spinal          11.75         NA       9.19       1.72         NA      22.66        090
                                                      muscle.
27110.............  ..............  A                Transfer of iliopsoas       13.24         NA       9.14       2.18         NA      24.56        090
                                                      muscle.
27111.............  ..............  A                Transfer of iliopsoas       12.13         NA       9.16       1.94         NA      23.23        090
                                                      muscle.
27120.............  ..............  A                Reconstruction of hip       17.98         NA      11.87       3.08         NA      32.93        090
                                                      socket.
27122.............  ..............  A                Reconstruction of hip       14.96         NA      11.07       2.61         NA      28.64        090
                                                      socket.
27125.............  ..............  A                Partial hip                 14.67         NA      10.65       2.54         NA      27.86        090
                                                      replacement.
27130.............  ..............  A                Total hip arthroplasty      20.09         NA      13.34       3.50         NA      36.93        090
27132.............  ..............  A                Total hip arthroplasty      23.27         NA      15.68       4.04         NA      42.99        090
27134.............  ..............  A                Revise hip joint            28.48         NA      17.84       4.94         NA      51.26        090
                                                      replacement.
27137.............  ..............  A                Revise hip joint            21.14         NA      13.97       3.67         NA      38.78        090
                                                      replacement.
27138.............  ..............  A                Revise hip joint            22.14         NA      14.43       3.84         NA      40.41        090
                                                      replacement.
27140.............  ..............  A                Transplant femur ridge      12.22         NA       9.44       2.11         NA      23.77        090
27146.............  ..............  A                Incision of hip bone..      17.40         NA      12.17       2.96         NA      32.53        090
27147.............  ..............  A                Revision of hip bone..      20.55         NA      13.29       3.57         NA      37.41        090
27151.............  ..............  A                Incision of hip bones.      22.48         NA       7.97       3.91         NA      34.36        090

[[Page 70357]]

 
27156.............  ..............  A                Revision of hip bones.      24.59         NA      16.11       4.21         NA      44.91        090
27158.............  ..............  A                Revision of pelvis....      19.71         NA      11.00       3.16         NA      33.87        090
27161.............  ..............  A                Incision of neck of         16.68         NA      12.14       2.94         NA      31.76        090
                                                      femur.
27165.............  ..............  A                Incision/fixation of        17.88         NA      12.95       3.10         NA      33.93        090
                                                      femur.
27170.............  ..............  A                Repair/graft femur          16.05         NA      11.33       2.81         NA      30.19        090
                                                      head/neck.
27175.............  ..............  A                Treat slipped                8.45         NA       6.69       1.46         NA      16.60        090
                                                      epiphysis.
27176.............  ..............  A                Treat slipped               12.03         NA       9.04       2.22         NA      23.29        090
                                                      epiphysis.
27177.............  ..............  A                Treat slipped               15.06         NA      10.92       2.61         NA      28.59        090
                                                      epiphysis.
27178.............  ..............  A                Treat slipped               11.97         NA       8.44       2.08         NA      22.49        090
                                                      epiphysis.
27179.............  ..............  A                Revise head/neck of         12.96         NA      10.02       2.25         NA      25.23        090
                                                      femur.
27181.............  ..............  A                Treat slipped               14.66         NA      10.23       1.57         NA      26.46        090
                                                      epiphysis.
27185.............  ..............  A                Revision of femur            9.17         NA       7.54       2.39         NA      19.10        090
                                                      epiphysis.
27187.............  ..............  A                Reinforce hip bones...      13.52         NA      10.35       2.37         NA      26.24        090
27193.............  ..............  A                Treat pelvic ring            5.55       5.10       5.10       0.96      11.61      11.61        090
                                                      fracture.
27194.............  ..............  A                Treat pelvic ring            9.64         NA       7.67       1.65         NA      18.96        090
                                                      fracture.
27200.............  ..............  A                Treat tail bone              1.84       2.23       2.16       0.28       4.35       4.28        090
                                                      fracture.
27202.............  ..............  A                Treat tail bone              7.03         NA      16.91       1.06         NA      25.00        090
                                                      fracture.
27215.............  ..............  A                Treat pelvic                10.03         NA       7.10       1.97         NA      19.10        090
                                                      fracture(s).
27216.............  ..............  A                Treat pelvic ring           15.17         NA       9.62       2.63         NA      27.42        090
                                                      fracture.
27217.............  ..............  A                Treat pelvic ring           14.09         NA      10.17       2.41         NA      26.67        090
                                                      fracture.
27218.............  ..............  A                Treat pelvic ring           20.12         NA      11.43       3.48         NA      35.03        090
                                                      fracture.
27220.............  ..............  A                Treat hip socket             6.17       5.74       5.65       1.07      12.98      12.89        090
                                                      fracture.
27222.............  ..............  A                Treat hip socket            12.68         NA      10.00       2.19         NA      24.87        090
                                                      fracture.
27226.............  ..............  A                Treat hip wall              14.89         NA       7.83       2.48         NA      25.20        090
                                                      fracture.
27227.............  ..............  A                Treat hip fracture(s).      23.41         NA      15.44       4.05         NA      42.90        090
27228.............  ..............  A                Treat hip fracture(s).      27.12         NA      17.67       4.66         NA      49.45        090
27230.............  ..............  A                Treat thigh fracture..       5.49       5.53       5.11       0.95      11.97      11.55        090
27232.............  ..............  A                Treat thigh fracture..      10.66         NA       7.19       1.85         NA      19.70        090
27235.............  ..............  A                Treat thigh fracture..      12.14         NA       9.48       2.11         NA      23.73        090
27236.............  ..............  A                Treat thigh fracture..      15.58         NA      11.08       2.71         NA      29.37        090
27238.............  ..............  A                Treat thigh fracture..       5.51         NA       5.15       0.89         NA      11.55        090
27240.............  ..............  A                Treat thigh fracture..      12.48         NA       9.50       2.16         NA      24.14        090
27244.............  ..............  A                Treat thigh fracture..      15.92         NA      11.33       2.77         NA      30.02        090
27245.............  ..............  A                Treat thigh fracture..      20.28         NA      13.78       3.52         NA      37.58        090
27246.............  ..............  A                Treat thigh fracture..       4.70       4.47       4.43       0.81       9.98       9.94        090
27248.............  ..............  A                Treat thigh fracture..      10.43         NA       8.23       1.81         NA      20.47        090
27250.............  ..............  A                Treat hip dislocation.       6.94         NA       4.63       0.62         NA      12.19        090
27252.............  ..............  A                Treat hip dislocation.      10.37         NA       7.45       1.66         NA      19.48        090
27253.............  ..............  A                Treat hip dislocation.      12.90         NA       9.81       2.24         NA      24.95        090
27254.............  ..............  A                Treat hip dislocation.      18.23         NA      12.05       3.17         NA      33.45        090
27256.............  ..............  A                Treat hip dislocation.       4.11       3.53       2.09       0.46       8.10       6.66        010
27257.............  ..............  A                Treat hip dislocation.       5.21         NA       2.82       0.69         NA       8.72        010
27258.............  ..............  A                Treat hip dislocation.      15.41         NA      10.90       2.64         NA      28.95        090
27259.............  ..............  A                Treat hip dislocation.      21.52         NA      14.16       3.74         NA      39.42        090
27265.............  ..............  A                Treat hip dislocation.       5.04         NA       4.80       0.63         NA      10.47        090
27266.............  ..............  A                Treat hip dislocation.       7.48         NA       6.36       1.29         NA      15.13        090
27275.............  ..............  A                Manipulation of hip          2.27         NA       2.11       0.39         NA       4.77        010
                                                      joint.
27280.............  ..............  A                Fusion of sacroiliac        13.37         NA      10.29       2.53         NA      26.19        090
                                                      joint.
27282.............  ..............  A                Fusion of pubic bones.      11.32         NA       8.02       1.86         NA      21.20        090
27284.............  ..............  A                Fusion of hip joint...      23.41         NA      14.80       3.92         NA      42.13        090
27286.............  ..............  A                Fusion of hip joint...      23.41         NA      15.84       3.12         NA      42.37        090
27290.............  ..............  A                Amputation of leg at        23.25         NA      14.10       3.43         NA      40.78        090
                                                      hip.
27295.............  ..............  A                Amputation of leg at        18.62         NA      11.34       2.95         NA      32.91        090
                                                      hip.
27299.............  ..............  C                Pelvis/hip joint             0.00       0.00       0.00       0.00       0.00       0.00        YYY
                                                      surgery.
27301.............  ..............  A                Drain thigh/knee             6.48      10.10       5.15       1.04      17.62      12.67        090
                                                      lesion.
27303.............  ..............  A                Drainage of bone             8.27         NA       7.00       1.43         NA      16.70        090
                                                      lesion.
27305.............  ..............  A                Incise thigh tendon &        5.91         NA       5.20       1.01         NA      12.12        090
                                                      fascia.
27306.............  ..............  A                Incision of thigh            4.61         NA       4.73       0.85         NA      10.19        090
                                                      tendon.
27307.............  ..............  A                Incision of thigh            5.79         NA       5.40       1.04         NA      12.23        090
                                                      tendons.
27310.............  ..............  A                Exploration of knee          9.26         NA       7.60       1.61         NA      18.47        090
                                                      joint.
27315.............  ..............  A                Partial removal, thigh       6.96         NA       4.96       1.09         NA      13.01        090
                                                      nerve.
27320.............  ..............  A                Partial removal, thigh       6.29         NA       5.25       1.06         NA      12.60        090
                                                      nerve.
27323.............  ..............  A                Biopsy, thigh soft           2.28       3.52       1.89       0.24       6.04       4.41        010
                                                      tissues.
27324.............  ..............  A                Biopsy, thigh soft           4.89         NA       4.19       0.75         NA       9.83        090
                                                      tissues.
27327.............  ..............  A                Removal of thigh             4.46       6.01       3.73       0.64      11.11       8.83        090
                                                      lesion.
27328.............  ..............  A                Removal of thigh             5.56         NA       4.38       0.84         NA      10.78        090
                                                      lesion.
27329.............  ..............  A                Remove tumor, thigh/        14.12         NA       9.05       2.14         NA      25.31        090
                                                      knee.
27330.............  ..............  A                Biopsy, knee joint           4.96         NA       4.58       0.86         NA      10.40        090
                                                      lining.
27331.............  ..............  A                Explore/treat knee           5.87         NA       5.54       1.02         NA      12.43        090
                                                      joint.
27332.............  ..............  A                Removal of knee              8.26         NA       7.14       1.43         NA      16.83        090
                                                      cartilage.
27333.............  ..............  A                Removal of knee              7.29         NA       6.69       1.26         NA      15.24        090
                                                      cartilage.
27334.............  ..............  A                Remove knee joint            8.69         NA       7.43       1.51         NA      17.63        090
                                                      lining.
27335.............  ..............  A                Remove knee joint            9.99         NA       8.24       1.74         NA      19.97        090
                                                      lining.
27340.............  ..............  A                Removal of kneecap           4.17         NA       4.57       0.72         NA       9.46        090
                                                      bursa.
27345.............  ..............  A                Removal of knee cyst..       5.91         NA       5.64       1.00         NA      12.55        090

[[Page 70358]]

 
27347.............  ..............  A                Remove knee cyst......       5.77         NA       5.44       0.98         NA      12.19        090
27350.............  ..............  A                Removal of kneecap....       8.16         NA       7.26       1.41         NA      16.83        090
27355.............  ..............  A                Remove femur lesion...       7.64         NA       6.79       1.32         NA      15.75        090
27356.............  ..............  A                Remove femur lesion/         9.47         NA       7.87       1.65         NA      18.99        090
                                                      graft.
27357.............  ..............  A                Remove femur lesion/        10.51         NA       8.73       1.95         NA      21.19        090
                                                      graft.
27358.............  ..............  A                Remove femur lesion/         4.73         NA       2.53       0.82         NA       8.08        ZZZ
                                                      fixation.
27360.............  ..............  A                Partial removal, leg        10.48         NA       9.58       1.83         NA      21.89        090
                                                      bone(s).
27365.............  ..............  A                Extensive leg surgery.      16.25         NA      11.71       2.79         NA      30.75        090
27370.............  ..............  A                Injection for knee x-        0.96       3.73       0.32       0.08       4.77       1.36        000
                                                      ray.
27372.............  ..............  A                Removal of foreign           5.06      10.08       4.70       0.84      15.98      10.60        090
                                                      body.
27380.............  ..............  A                Repair of kneecap            7.15         NA       7.30       1.24         NA      15.69        090
                                                      tendon.
27381.............  ..............  A                Repair/graft kneecap        10.32         NA       9.12       1.79         NA      21.23        090
                                                      tendon.
27385.............  ..............  A                Repair of thigh muscle       7.75         NA       7.65       1.36         NA      16.76        090
27386.............  ..............  A                Repair/graft of thigh       10.54         NA       9.54       1.85         NA      21.93        090
                                                      muscle.
27390.............  ..............  A                Incision of thigh            5.32         NA       5.12       0.92         NA      11.36        090
                                                      tendon.
27391.............  ..............  A                Incision of thigh            7.19         NA       6.58       1.23         NA      15.00        090
                                                      tendons.
27392.............  ..............  A                Incision of thigh            9.19         NA       7.61       1.57         NA      18.37        090
                                                      tendons.
27393.............  ..............  A                Lengthening of thigh         6.38         NA       5.85       1.10         NA      13.33        090
                                                      tendon.
27394.............  ..............  A                Lengthening of thigh         8.49         NA       7.24       1.47         NA      17.20        090
                                                      tendons.
27395.............  ..............  A                Lengthening of thigh        11.71         NA       9.35       2.04         NA      23.10        090
                                                      tendons.
27396.............  ..............  A                Transplant of thigh          7.85         NA       7.02       1.34         NA      16.21        090
                                                      tendon.
27397.............  ..............  A                Transplants of thigh        11.26         NA       9.07       1.82         NA      22.15        090
                                                      tendons.
27400.............  ..............  A                Revise thigh muscles/        9.01         NA       7.27       1.31         NA      17.59        090
                                                      tendons.
27403.............  ..............  A                Repair of knee               8.32         NA       7.20       1.44         NA      16.96        090
                                                      cartilage.
27405.............  ..............  A                Repair of knee               8.64         NA       7.51       1.51         NA      17.66        090
                                                      ligament.
27407.............  ..............  A                Repair of knee              10.26         NA       8.34       1.78         NA      20.38        090
                                                      ligament.
27409.............  ..............  A                Repair of knee              12.88         NA       9.98       2.24         NA      25.10        090
                                                      ligaments.
27412.............  ..............  A                Autochondrocyte             23.23         NA      14.84       4.35         NA      42.42        090
                                                      implant knee.
27415.............  ..............  A                Osteochondral knee          18.49         NA      12.59       4.35         NA      35.43        090
                                                      allograft.
27418.............  ..............  A                Repair degenerated          10.83         NA       8.93       1.88         NA      21.64        090
                                                      kneecap.
27420.............  ..............  A                Revision of unstable         9.82         NA       8.13       1.71         NA      19.66        090
                                                      kneecap.
27422.............  ..............  A                Revision of unstable         9.77         NA       8.14       1.70         NA      19.61        090
                                                      kneecap.
27424.............  ..............  A                Revision/removal of          9.80         NA       8.11       1.70         NA      19.61        090
                                                      kneecap.
27425.............  ..............  A                Lat retinacular              5.21         NA       5.54       0.90         NA      11.65        090
                                                      release open.
27427.............  ..............  A                Reconstruction, knee..       9.35         NA       7.82       1.63         NA      18.80        090
27428.............  ..............  A                Reconstruction, knee..      13.98         NA      11.27       2.42         NA      27.67        090
27429.............  ..............  A                Reconstruction, knee..      15.50         NA      12.45       2.70         NA      30.65        090
27430.............  ..............  A                Revision of thigh            9.66         NA       8.02       1.69         NA      19.37        090
                                                      muscles.
27435.............  ..............  A                Incision of knee joint       9.48         NA       8.50       1.69         NA      19.67        090
27437.............  ..............  A                Revise kneecap........       8.45         NA       7.26       1.49         NA      17.20        090
27438.............  ..............  A                Revise kneecap with         11.21         NA       8.56       1.95         NA      21.72        090
                                                      implant.
27440.............  ..............  A                Revision of knee joint      10.41         NA       6.01       1.81         NA      18.23        090
27441.............  ..............  A                Revision of knee joint      10.80         NA       6.73       1.88         NA      19.41        090
27442.............  ..............  A                Revision of knee joint      11.87         NA       8.94       2.09         NA      22.90        090
27443.............  ..............  A                Revision of knee joint      10.91         NA       8.75       1.90         NA      21.56        090
27445.............  ..............  A                Revision of knee joint      17.65         NA      12.39       3.08         NA      33.12        090
27446.............  ..............  A                Revision of knee joint      15.82         NA      11.30       2.80         NA      29.92        090
27447.............  ..............  A                Total knee                  21.45         NA      14.64       3.79         NA      39.88        090
                                                      arthroplasty.
27448.............  ..............  A                Incision of thigh.....      11.04         NA       8.62       1.94         NA      21.60        090
27450.............  ..............  A                Incision of thigh.....      13.96         NA      10.61       2.42         NA      26.99        090
27454.............  ..............  A                Realignment of thigh        17.53         NA      12.54       3.12         NA      33.19        090
                                                      bone.
27455.............  ..............  A                Realignment of knee...      12.80         NA       9.91       2.24         NA      24.95        090
27457.............  ..............  A                Realignment of knee...      13.43         NA       9.95       2.34         NA      25.72        090
27465.............  ..............  A                Shortening of thigh         13.85         NA      10.25       2.47         NA      26.57        090
                                                      bone.
27466.............  ..............  A                Lengthening of thigh        16.31         NA      11.86       2.77         NA      30.94        090
                                                      bone.
27468.............  ..............  A                Shorten/lengthen            18.94         NA      12.39       3.30         NA      34.63        090
                                                      thighs.
27470.............  ..............  A                Repair of thigh.......      16.05         NA      11.82       2.79         NA      30.66        090
27472.............  ..............  A                Repair/graft of thigh.      17.69         NA      12.72       3.07         NA      33.48        090
27475.............  ..............  A                Surgery to stop leg          8.63         NA       7.23       1.36         NA      17.22        090
                                                      growth.
27477.............  ..............  A                Surgery to stop leg          9.84         NA       7.75       1.73         NA      19.32        090
                                                      growth.
27479.............  ..............  A                Surgery to stop leg         12.78         NA       9.67       2.78         NA      25.23        090
                                                      growth.
27485.............  ..............  A                Surgery to stop leg          8.83         NA       7.42       1.53         NA      17.78        090
                                                      growth.
27486.............  ..............  A                Revise/replace knee         19.24         NA      13.53       3.36         NA      36.13        090
                                                      joint.
27487.............  ..............  A                Revise/replace knee         25.23         NA      16.60       4.39         NA      46.22        090
                                                      joint.
27488.............  ..............  A                Removal of knee             15.72         NA      11.73       2.74         NA      30.19        090
                                                      prosthesis.
27495.............  ..............  A                Reinforce thigh.......      15.53         NA      11.44       2.71         NA      29.68        090
27496.............  ..............  A                Decompression of thigh/      6.10         NA       5.62       0.99         NA      12.71        090
                                                      knee.
27497.............  ..............  A                Decompression of thigh/      7.16         NA       5.45       1.15         NA      13.76        090
                                                      knee.
27498.............  ..............  A                Decompression of thigh/      7.98         NA       5.97       1.24         NA      15.19        090
                                                      knee.
27499.............  ..............  A                Decompression of thigh/      8.99         NA       6.84       1.47         NA      17.30        090
                                                      knee.
27500.............  ..............  A                Treatment of thigh           5.91       6.14       5.00       1.02      13.07      11.93        090
                                                      fracture.
27501.............  ..............  A                Treatment of thigh           5.91       5.81       5.40       1.03      12.75      12.34        090
                                                      fracture.
27502.............  ..............  A                Treatment of thigh          10.56         NA       8.13       1.78         NA      20.47        090
                                                      fracture.
27503.............  ..............  A                Treatment of thigh          10.56         NA       8.31       1.84         NA      20.71        090
                                                      fracture.
27506.............  ..............  A                Treatment of thigh          17.42         NA      12.82       3.03         NA      33.27        090
                                                      fracture.

[[Page 70359]]

 
27507.............  ..............  A                Treatment of thigh          13.97         NA       9.87       2.42         NA      26.26        090
                                                      fracture.
27508.............  ..............  A                Treatment of thigh           5.82       6.48       5.50       0.97      13.27      12.29        090
                                                      fracture.
27509.............  ..............  A                Treatment of thigh           7.70         NA       7.98       1.34         NA      17.02        090
                                                      fracture.
27510.............  ..............  A                Treatment of thigh           9.12         NA       7.35       1.53         NA      18.00        090
                                                      fracture.
27511.............  ..............  A                Treatment of thigh          13.62         NA      11.23       2.37         NA      27.22        090
                                                      fracture.
27513.............  ..............  A                Treatment of thigh          17.89         NA      13.92       3.12         NA      34.93        090
                                                      fracture.
27514.............  ..............  A                Treatment of thigh          17.27         NA      13.39       3.00         NA      33.66        090
                                                      fracture.
27516.............  ..............  A                Treat thigh fx growth        5.36       6.37       5.53       0.81      12.54      11.70        090
                                                      plate.
27517.............  ..............  A                Treat thigh fx growth        8.77         NA       7.47       1.22         NA      17.46        090
                                                      plate.
27519.............  ..............  A                Treat thigh fx growth       15.00         NA      11.62       2.55         NA      29.17        090
                                                      plate.
27520.............  ..............  A                Treat kneecap fracture       2.86       4.55       3.45       0.47       7.88       6.78        090
27524.............  ..............  A                Treat kneecap fracture       9.99         NA       8.25       1.74         NA      19.98        090
27530.............  ..............  A                Treat knee fracture...       3.77       5.33       4.43       0.65       9.75       8.85        090
27532.............  ..............  A                Treat knee fracture...       7.29       7.38       6.47       1.26      15.93      15.02        090
27535.............  ..............  A                Treat knee fracture...      11.48         NA      10.14       2.00         NA      23.62        090
27536.............  ..............  A                Treat knee fracture...      15.63         NA      11.64       2.73         NA      30.00        090
27538.............  ..............  A                Treat knee fracture(s)       4.86       6.15       5.21       0.84      11.85      10.91        090
27540.............  ..............  A                Treat knee fracture...      13.08         NA       9.54       2.27         NA      24.89        090
27550.............  ..............  A                Treat knee dislocation       5.75       6.03       4.94       0.76      12.54      11.45        090
27552.............  ..............  A                Treat knee dislocation       7.89         NA       6.97       1.36         NA      16.22        090
27556.............  ..............  A                Treat knee dislocation      14.39         NA      11.68       2.50         NA      28.57        090
27557.............  ..............  A                Treat knee dislocation      16.74         NA      13.16       2.97         NA      32.87        090
27558.............  ..............  A                Treat knee dislocation      17.69         NA      13.08       3.08         NA      33.85        090
27560.............  ..............  A                Treat kneecap                3.81       4.85       3.19       0.40       9.06       7.40        090
                                                      dislocation.
27562.............  ..............  A                Treat kneecap                5.78         NA       4.78       0.94         NA      11.50        090
                                                      dislocation.
27566.............  ..............  A                Treat kneecap               12.21         NA       9.35       2.12         NA      23.68        090
                                                      dislocation.
27570.............  ..............  A                Fixation of knee joint       1.74         NA       1.78       0.30         NA       3.82        010
27580.............  ..............  A                Fusion of knee........      19.34         NA      14.84       3.37         NA      37.55        090
27590.............  ..............  A                Amputate leg at thigh.      12.01         NA       6.69       1.74         NA      20.44        090
27591.............  ..............  A                Amputate leg at thigh.      12.66         NA       8.67       2.02         NA      23.35        090
27592.............  ..............  A                Amputate leg at thigh.      10.00         NA       6.19       1.45         NA      17.64        090
27594.............  ..............  A                Amputation follow-up         6.91         NA       5.18       1.02         NA      13.11        090
                                                      surgery.
27596.............  ..............  A                Amputation follow-up        10.58         NA       6.83       1.57         NA      18.98        090
                                                      surgery.
27598.............  ..............  A                Amputate lower leg at       10.51         NA       7.04       1.65         NA      19.20        090
                                                      knee.
27599.............  ..............  C                Leg surgery procedure.       0.00       0.00       0.00       0.00       0.00       0.00        YYY
27600.............  ..............  A                Decompression of lower       5.64         NA       4.54       0.86         NA      11.04        090
                                                      leg.
27601.............  ..............  A                Decompression of lower       5.63         NA       4.86       0.80         NA      11.29        090
                                                      leg.
27602.............  ..............  A                Decompression of lower       7.34         NA       5.14       1.10         NA      13.58        090
                                                      leg.
27603.............  ..............  A                Drain lower leg lesion       4.93       7.51       4.17       0.74      13.18       9.84        090
27604.............  ..............  A                Drain lower leg bursa.       4.46       6.10       3.97       0.69      11.25       9.12        090
27605.............  ..............  A                Incision of achilles         2.87       7.70       2.33       0.41      10.98       5.61        010
                                                      tendon.
27606.............  ..............  A                Incision of achilles         4.13         NA       3.37       0.69         NA       8.19        010
                                                      tendon.
27607.............  ..............  A                Treat lower leg bone         7.96         NA       6.19       1.31         NA      15.46        090
                                                      lesion.
27610.............  ..............  A                Explore/treat ankle          8.33         NA       7.02       1.40         NA      16.75        090
                                                      joint.
27612.............  ..............  A                Exploration of ankle         7.32         NA       6.11       1.13         NA      14.56        090
                                                      joint.
27613.............  ..............  A                Biopsy lower leg soft        2.17       3.24       1.81       0.20       5.61       4.18        010
                                                      tissue.
27614.............  ..............  A                Biopsy lower leg soft        5.65       7.15       4.45       0.78      13.58      10.88        090
                                                      tissue.
27615.............  ..............  A                Remove tumor, lower         12.54         NA       9.42       1.83         NA      23.79        090
                                                      leg.
27618.............  ..............  A                Remove lower leg             5.08       6.03       4.00       0.72      11.83       9.80        090
                                                      lesion.
27619.............  ..............  A                Remove lower leg             8.39       9.54       5.97       1.25      19.18      15.61        090
                                                      lesion.
27620.............  ..............  A                Explore/treat ankle          5.97         NA       5.48       0.97         NA      12.42        090
                                                      joint.
27625.............  ..............  A                Remove ankle joint           8.29         NA       6.48       1.28         NA      16.05        090
                                                      lining.
27626.............  ..............  A                Remove ankle joint           8.90         NA       6.94       1.48         NA      17.32        090
                                                      lining.
27630.............  ..............  A                Removal of tendon            4.79       7.58       4.39       0.74      13.11       9.92        090
                                                      lesion.
27635.............  ..............  A                Remove lower leg bone        7.77         NA       6.76       1.31         NA      15.84        090
                                                      lesion.
27637.............  ..............  A                Remove/graft leg bone        9.84         NA       8.31       1.66         NA      19.81        090
                                                      lesion.
27638.............  ..............  A                Remove/graft leg bone       10.55         NA       8.31       1.84         NA      20.70        090
                                                      lesion.
27640.............  ..............  A                Partial removal of          11.35         NA      10.34       1.88         NA      23.57        090
                                                      tibia.
27641.............  ..............  A                Partial removal of           9.23         NA       8.36       1.46         NA      19.05        090
                                                      fibula.
27645.............  ..............  A                Extensive lower leg         14.15         NA      12.08       2.41         NA      28.64        090
                                                      surgery.
27646.............  ..............  A                Extensive lower leg         12.64         NA      11.06       2.05         NA      25.75        090
                                                      surgery.
27647.............  ..............  A                Extensive ankle/heel        12.22         NA       7.63       1.75         NA      21.60        090
                                                      surgery.
27648.............  ..............  A                Injection for ankle x-       0.96       3.53       0.33       0.08       4.57       1.37        000
                                                      ray.
27650.............  ..............  A                Repair achilles tendon       9.68         NA       7.53       1.59         NA      18.80        090
27652.............  ..............  A                Repair/graft achilles       10.31         NA       8.05       1.71         NA      20.07        090
                                                      tendon.
27654.............  ..............  A                Repair of achilles          10.00         NA       7.16       1.58         NA      18.74        090
                                                      tendon.
27656.............  ..............  A                Repair leg fascia            4.56       8.55       3.78       0.69      13.80       9.03        090
                                                      defect.
27658.............  ..............  A                Repair of leg tendon,        4.97         NA       4.57       0.79         NA      10.33        090
                                                      each.
27659.............  ..............  A                Repair of leg tendon,        6.80         NA       5.66       1.09         NA      13.55        090
                                                      each.
27664.............  ..............  A                Repair of leg tendon,        4.58         NA       4.56       0.76         NA       9.90        090
                                                      each.
27665.............  ..............  A                Repair of leg tendon,        5.39         NA       4.98       0.89         NA      11.26        090
                                                      each.
27675.............  ..............  A                Repair lower leg             7.17         NA       5.75       1.11         NA      14.03        090
                                                      tendons.
27676.............  ..............  A                Repair lower leg             8.41         NA       6.77       1.37         NA      16.55        090
                                                      tendons.
27680.............  ..............  A                Release of lower leg         5.73         NA       5.12       0.93         NA      11.78        090
                                                      tendon.
27681.............  ..............  A                Release of lower leg         6.81         NA       5.93       1.15         NA      13.89        090
                                                      tendons.

[[Page 70360]]

 
27685.............  ..............  A                Revision of lower leg        6.49       7.31       5.48       0.97      14.77      12.94        090
                                                      tendon.
27686.............  ..............  A                Revise lower leg             7.45         NA       6.51       1.24         NA      15.20        090
                                                      tendons.
27687.............  ..............  A                Revision of calf             6.23         NA       5.33       1.00         NA      12.56        090
                                                      tendon.
27690.............  ..............  A                Revise lower leg             8.70         NA       6.37       1.33         NA      16.40        090
                                                      tendon.
27691.............  ..............  A                Revise lower leg             9.95         NA       7.78       1.64         NA      19.37        090
                                                      tendon.
27692.............  ..............  A                Revise additional leg        1.87         NA       0.93       0.32         NA       3.12        ZZZ
                                                      tendon.
27695.............  ..............  A                Repair of ankle              6.50         NA       5.89       1.05         NA      13.44        090
                                                      ligament.
27696.............  ..............  A                Repair of ankle              8.26         NA       6.45       1.28         NA      15.99        090
                                                      ligaments.
27698.............  ..............  A                Repair of ankle              9.35         NA       6.96       1.47         NA      17.78        090
                                                      ligament.
27700.............  ..............  A                Revision of ankle            9.28         NA       5.70       1.30         NA      16.28        090
                                                      joint.
27702.............  ..............  A                Reconstruct ankle           13.65         NA      10.49       2.37         NA      26.51        090
                                                      joint.
27703.............  ..............  A                Reconstruction, ankle       15.85         NA      11.26       2.76         NA      29.87        090
                                                      joint.
27704.............  ..............  A                Removal of ankle             7.61         NA       5.61       1.27         NA      14.49        090
                                                      implant.
27705.............  ..............  A                Incision of tibia.....      10.36         NA       8.19       1.80         NA      20.35        090
27707.............  ..............  A                Incision of fibula....       4.36         NA       4.95       0.76         NA      10.07        090
27709.............  ..............  A                Incision of tibia &          9.94         NA       8.15       1.73         NA      19.82        090
                                                      fibula.
27712.............  ..............  A                Realignment of lower        14.23         NA      10.77       2.47         NA      27.47        090
                                                      leg.
27715.............  ..............  A                Revision of lower leg.      14.37         NA      10.80       2.49         NA      27.66        090
27720.............  ..............  A                Repair of tibia.......      11.77         NA       9.43       2.04         NA      23.24        090
27722.............  ..............  A                Repair/graft of tibia.      11.80         NA       9.16       2.05         NA      23.01        090
27724.............  ..............  A                Repair/graft of tibia.      18.17         NA      12.40       3.16         NA      33.73        090
27725.............  ..............  A                Repair of lower leg...      15.57         NA      11.94       2.71         NA      30.22        090
27727.............  ..............  A                Repair of lower leg...      13.99         NA      10.37       2.43         NA      26.79        090
27730.............  ..............  A                Repair of tibia              7.40         NA       6.44       1.72         NA      15.56        090
                                                      epiphysis.
27732.............  ..............  A                Repair of fibula             5.31         NA       4.94       0.77         NA      11.02        090
                                                      epiphysis.
27734.............  ..............  A                Repair lower leg             8.47         NA       6.30       1.35         NA      16.12        090
                                                      epiphyses.
27740.............  ..............  A                Repair of leg                9.29         NA       8.01       1.62         NA      18.92        090
                                                      epiphyses.
27742.............  ..............  A                Repair of leg               10.28       5.58       5.58       1.79      17.65      17.65        090
                                                      epiphyses.
27745.............  ..............  A                Reinforce tibia.......      10.05         NA       8.19       1.75         NA      19.99        090
27750.............  ..............  A                Treatment of tibia           3.19       4.77       3.86       0.55       8.51       7.60        090
                                                      fracture.
27752.............  ..............  A                Treatment of tibia           5.83       6.67       5.69       1.01      13.51      12.53        090
                                                      fracture.
27756.............  ..............  A                Treatment of tibia           6.77         NA       6.48       1.17         NA      14.42        090
                                                      fracture.
27758.............  ..............  A                Treatment of tibia          11.65         NA       9.21       2.03         NA      22.89        090
                                                      fracture.
27759.............  ..............  A                Treatment of tibia          13.74         NA      10.34       2.38         NA      26.46        090
                                                      fracture.
27760.............  ..............  A                Treatment of ankle           3.01       4.69       3.60       0.48       8.18       7.09        090
                                                      fracture.
27762.............  ..............  A                Treatment of ankle           5.24       6.35       5.29       0.85      12.44      11.38        090
                                                      fracture.
27766.............  ..............  A                Treatment of ankle           8.35         NA       7.24       1.44         NA      17.03        090
                                                      fracture.
27780.............  ..............  A                Treatment of fibula          2.65       4.19       3.22       0.41       7.25       6.28        090
                                                      fracture.
27781.............  ..............  A                Treatment of fibula          4.39       5.51       4.65       0.73      10.63       9.77        090
                                                      fracture.
27784.............  ..............  A                Treatment of fibula          7.10         NA       6.49       1.23         NA      14.82        090
                                                      fracture.
27786.............  ..............  A                Treatment of ankle           2.84       4.47       3.34       0.46       7.77       6.64        090
                                                      fracture.
27788.............  ..............  A                Treatment of ankle           4.44       5.66       4.66       0.74      10.84       9.84        090
                                                      fracture.
27792.............  ..............  A                Treatment of ankle           7.65         NA       6.98       1.32         NA      15.95        090
                                                      fracture.
27808.............  ..............  A                Treatment of ankle           2.83       4.81       3.71       0.46       8.10       7.00        090
                                                      fracture.
27810.............  ..............  A                Treatment of ankle           5.12       6.26       5.16       0.82      12.20      11.10        090
                                                      fracture.
27814.............  ..............  A                Treatment of ankle          10.66         NA       8.58       1.85         NA      21.09        090
                                                      fracture.
27816.............  ..............  A                Treatment of ankle           2.89       4.39       3.42       0.43       7.71       6.74        090
                                                      fracture.
27818.............  ..............  A                Treatment of ankle           5.49       6.39       5.18       0.82      12.70      11.49        090
                                                      fracture.
27822.............  ..............  A                Treatment of ankle          10.98         NA      10.68       1.91         NA      23.57        090
                                                      fracture.
27823.............  ..............  A                Treatment of ankle          12.98         NA      11.50       2.25         NA      26.73        090
                                                      fracture.
27824.............  ..............  A                Treat lower leg              2.89       4.07       3.57       0.45       7.41       6.91        090
                                                      fracture.
27825.............  ..............  A                Treat lower leg              6.18       6.62       5.40       1.02      13.82      12.60        090
                                                      fracture.
27826.............  ..............  A                Treat lower leg              8.53         NA       8.85       1.47         NA      18.85        090
                                                      fracture.
27827.............  ..............  A                Treat lower leg             14.04         NA      12.80       2.43         NA      29.27        090
                                                      fracture.
27828.............  ..............  A                Treat lower leg             16.21         NA      13.97       2.81         NA      32.99        090
                                                      fracture.
27829.............  ..............  A                Treat lower leg joint.       5.48         NA       6.80       0.95         NA      13.23        090
27830.............  ..............  A                Treat lower leg              3.78       4.40       3.86       0.54       8.72       8.18        090
                                                      dislocation.
27831.............  ..............  A                Treat lower leg              4.55         NA       4.47       0.73         NA       9.75        090
                                                      dislocation.
27832.............  ..............  A                Treat lower leg              6.48         NA       6.19       1.03         NA      13.70        090
                                                      dislocation.
27840.............  ..............  A                Treat ankle                  4.57         NA       3.77       0.46         NA       8.80        090
                                                      dislocation.
27842.............  ..............  A                Treat ankle                  6.20         NA       5.13       1.00         NA      12.33        090
                                                      dislocation.
27846.............  ..............  A                Treat ankle                  9.78         NA       7.95       1.70         NA      19.43        090
                                                      dislocation.
27848.............  ..............  A                Treat ankle                 11.18         NA       9.74       1.94         NA      22.86        090
                                                      dislocation.
27860.............  ..............  A                Fixation of ankle            2.34         NA       1.99       0.39         NA       4.72        010
                                                      joint.
27870.............  ..............  A                Fusion of ankle joint,      13.89         NA      10.55       2.36         NA      26.80        090
                                                      open.
27871.............  ..............  A                Fusion of tibiofibular       9.16         NA       7.60       1.59         NA      18.35        090
                                                      joint.
27880.............  ..............  A                Amputation of lower         11.83         NA       7.15       1.75         NA      20.73        090
                                                      leg.
27881.............  ..............  A                Amputation of lower         12.32         NA       8.87       1.98         NA      23.17        090
                                                      leg.
27882.............  ..............  A                Amputation of lower          8.93         NA       6.50       1.29         NA      16.72        090
                                                      leg.
27884.............  ..............  A                Amputation follow-up         8.20         NA       5.77       1.22         NA      15.19        090
                                                      surgery.
27886.............  ..............  A                Amputation follow-up         9.31         NA       6.53       1.40         NA      17.24        090
                                                      surgery.
27888.............  ..............  A                Amputation of foot at        9.66         NA       7.52       1.51         NA      18.69        090
                                                      ankle.
27889.............  ..............  A                Amputation of foot at        9.97         NA       6.49       1.46         NA      17.92        090
                                                      ankle.
27892.............  ..............  A                Decompression of leg..       7.38         NA       5.61       1.10         NA      14.09        090
27893.............  ..............  A                Decompression of leg..       7.34         NA       5.48       1.10         NA      13.92        090

[[Page 70361]]

 
27894.............  ..............  A                Decompression of leg..      10.47         NA       7.79       1.65         NA      19.91        090
27899.............  ..............  C                Leg/ankle surgery            0.00       0.00       0.00       0.00       0.00       0.00        YYY
                                                      procedure.
28001.............  ..............  A                Drainage of bursa of         2.73       2.99       1.96       0.33       6.05       5.02        010
                                                      foot.
28002.............  ..............  A                Treatment of foot            4.61       5.00       3.78       0.61      10.22       9.00        010
                                                      infection.
28003.............  ..............  A                Treatment of foot            8.40       6.25       5.24       1.12      15.77      14.76        090
                                                      infection.
28005.............  ..............  A                Treat foot bone lesion       8.67         NA       6.06       1.16         NA      15.89        090
28008.............  ..............  A                Incision of foot             4.44       4.56       3.21       0.57       9.57       8.22        090
                                                      fascia.
28010.............  ..............  A                Incision of toe tendon       2.84       2.38       2.38       0.36       5.58       5.58        090
28011.............  ..............  A                Incision of toe              4.13         NA       3.31       0.59         NA       8.03        090
                                                      tendons.
28020.............  ..............  A                Exploration of foot          5.00       6.03       4.14       0.72      11.75       9.86        090
                                                      joint.
28022.............  ..............  A                Exploration of foot          4.66       5.21       3.86       0.62      10.49       9.14        090
                                                      joint.
28024.............  ..............  A                Exploration of toe           4.37       5.23       3.93       0.58      10.18       8.88        090
                                                      joint.
28030.............  ..............  A                Removal of foot nerve.       6.14         NA       3.66       0.74         NA      10.54        090
28035.............  ..............  A                Decompression of tibia       5.08       5.87       4.10       0.70      11.65       9.88        090
                                                      nerve.
28043.............  ..............  A                Excision of foot             3.53       3.82       3.18       0.46       7.81       7.17        090
                                                      lesion.
28045.............  ..............  A                Excision of foot             4.71       5.39       3.61       0.63      10.73       8.95        090
                                                      lesion.
28046.............  ..............  A                Resection of tumor,         10.16       8.79       6.49       1.36      20.31      18.01        090
                                                      foot.
28050.............  ..............  A                Biopsy of foot joint         4.24       4.90       3.60       0.60       9.74       8.44        090
                                                      lining.
28052.............  ..............  A                Biopsy of foot joint         3.93       4.92       3.44       0.53       9.38       7.90        090
                                                      lining.
28054.............  ..............  A                Biopsy of toe joint          3.44       4.73       3.24       0.46       8.63       7.14        090
                                                      lining.
28060.............  ..............  A                Partial removal, foot        5.22       5.49       3.88       0.70      11.41       9.80        090
                                                      fascia.
28062.............  ..............  A                Removal of foot fascia       6.51       6.53       4.02       0.83      13.87      11.36        090
28070.............  ..............  A                Removal of foot joint        5.09       5.23       3.82       0.73      11.05       9.64        090
                                                      lining.
28072.............  ..............  A                Removal of foot joint        4.57       5.54       4.31       0.68      10.79       9.56        090
                                                      lining.
28080.............  ..............  A                Removal of foot lesion       3.57       5.12       3.69       0.47       9.16       7.73        090
28086.............  ..............  A                Excise foot tendon           4.77       8.00       4.69       0.76      13.53      10.22        090
                                                      sheath.
28088.............  ..............  A                Excise foot tendon           3.85       5.77       3.90       0.61      10.23       8.36        090
                                                      sheath.
28090.............  ..............  A                Removal of foot lesion       4.40       5.15       3.46       0.59      10.14       8.45        090
28092.............  ..............  A                Removal of toe lesions       3.63       5.23       3.53       0.49       9.35       7.65        090
28100.............  ..............  A                Removal of ankle/heel        5.65       7.98       4.70       0.82      14.45      11.17        090
                                                      lesion.
28102.............  ..............  A                Remove/graft foot            7.72         NA       5.96       1.14         NA      14.82        090
                                                      lesion.
28103.............  ..............  A                Remove/graft foot            6.49         NA       4.62       0.91         NA      12.02        090
                                                      lesion.
28104.............  ..............  A                Removal of foot lesion       5.11       5.50       3.93       0.70      11.31       9.74        090
28106.............  ..............  A                Remove/graft foot            7.15         NA       4.44       0.97         NA      12.56        090
                                                      lesion.
28107.............  ..............  A                Remove/graft foot            5.55       6.54       4.21       0.74      12.83      10.50        090
                                                      lesion.
28108.............  ..............  A                Removal of toe lesions       4.15       4.60       3.26       0.53       9.28       7.94        090
28110.............  ..............  A                Part removal of              4.07       5.23       3.23       0.54       9.84       7.84        090
                                                      metatarsal.
28111.............  ..............  A                Part removal of              5.00       6.29       3.66       0.67      11.96       9.33        090
                                                      metatarsal.
28112.............  ..............  A                Part removal of              4.48       5.82       3.58       0.61      10.91       8.67        090
                                                      metatarsal.
28113.............  ..............  A                Part removal of              4.78       6.07       4.32       0.63      11.48       9.73        090
                                                      metatarsal.
28114.............  ..............  A                Removal of metatarsal        9.78      11.65       8.39       1.42      22.85      19.59        090
                                                      heads.
28116.............  ..............  A                Revision of foot......       7.74       6.81       5.18       1.03      15.58      13.95        090
28118.............  ..............  A                Removal of heel bone..       5.95       6.26       4.35       0.84      13.05      11.14        090
28119.............  ..............  A                Removal of heel spur..       5.38       5.44       3.73       0.70      11.52       9.81        090
28120.............  ..............  A                Part removal of ankle/       5.39       7.30       4.42       0.77      13.46      10.58        090
                                                      heel.
28122.............  ..............  A                Partial removal of           7.28       6.85       5.28       0.98      15.11      13.54        090
                                                      foot bone.
28124.............  ..............  A                Partial removal of toe       4.80       5.00       3.66       0.60      10.40       9.06        090
28126.............  ..............  A                Partial removal of toe       3.51       4.22       3.00       0.45       8.18       6.96        090
28130.............  ..............  A                Removal of ankle bone.       8.10         NA       6.73       1.26         NA      16.09        090
28140.............  ..............  A                Removal of metatarsal.       6.90       7.24       4.77       0.92      15.06      12.59        090
28150.............  ..............  A                Removal of toe........       4.08       4.84       3.29       0.53       9.45       7.90        090
28153.............  ..............  A                Partial removal of toe       3.65       4.32       2.69       0.47       8.44       6.81        090
28160.............  ..............  A                Partial removal of toe       3.73       4.57       3.34       0.49       8.79       7.56        090
28171.............  ..............  A                Extensive foot surgery       9.59         NA       5.44       1.33         NA      16.36        090
28173.............  ..............  A                Extensive foot surgery       8.79       7.61       5.21       1.12      17.52      15.12        090
28175.............  ..............  A                Extensive foot surgery       6.04       5.72       3.71       0.73      12.49      10.48        090
28190.............  ..............  A                Removal of foot              1.96       3.40       1.48       0.22       5.58       3.66        010
                                                      foreign body.
28192.............  ..............  A                Removal of foot              4.63       5.49       3.65       0.61      10.73       8.89        090
                                                      foreign body.
28193.............  ..............  A                Removal of foot              5.72       5.62       3.93       0.73      12.07      10.38        090
                                                      foreign body.
28200.............  ..............  A                Repair of foot tendon.       4.59       5.10       3.56       0.61      10.30       8.76        090
28202.............  ..............  A                Repair/graft of foot         6.83       7.23       4.50       0.91      14.97      12.24        090
                                                      tendon.
28208.............  ..............  A                Repair of foot tendon.       4.36       4.82       3.31       0.58       9.76       8.25        090
28210.............  ..............  A                Repair/graft of foot         6.34       6.23       4.03       0.81      13.38      11.18        090
                                                      tendon.
28220.............  ..............  A                Release of foot tendon       4.52       4.68       3.43       0.57       9.77       8.52        090
28222.............  ..............  A                Release of foot              5.61       5.25       4.13       0.69      11.55      10.43        090
                                                      tendons.
28225.............  ..............  A                Release of foot tendon       3.65       4.29       2.91       0.46       8.40       7.02        090
28226.............  ..............  A                Release of foot              4.52       4.80       3.75       0.58       9.90       8.85        090
                                                      tendons.
28230.............  ..............  A                Incision of foot             4.23       4.68       3.68       0.55       9.46       8.46        090
                                                      tendon(s).
28232.............  ..............  A                Incision of toe tendon       3.38       4.53       3.32       0.44       8.35       7.14        090
28234.............  ..............  A                Incision of foot             3.36       4.68       3.36       0.44       8.48       7.16        090
                                                      tendon.
28238.............  ..............  A                Revision of foot             7.72       7.26       4.94       1.06      16.04      13.72        090
                                                      tendon.
28240.............  ..............  A                Release of big toe....       4.35       4.64       3.49       0.58       9.57       8.42        090
28250.............  ..............  A                Revision of foot             5.91       5.64       4.14       0.82      12.37      10.87        090
                                                      fascia.
28260.............  ..............  A                Release of midfoot           7.95       6.34       5.00       1.14      15.43      14.09        090
                                                      joint.
28261.............  ..............  A                Revision of foot            11.71       8.63       7.32       1.57      21.91      20.60        090
                                                      tendon.

[[Page 70362]]

 
28262.............  ..............  A                Revision of foot and        15.81      13.59      10.94       2.59      31.99      29.34        090
                                                      ankle.
28264.............  ..............  A                Release of midfoot          10.33       7.75       7.30       1.54      19.62      19.17        090
                                                      joint.
28270.............  ..............  A                Release of foot              4.75       4.90       3.74       0.62      10.27       9.11        090
                                                      contracture.
28272.............  ..............  A                Release of toe joint,        3.79       4.19       2.86       0.46       8.44       7.11        090
                                                      each.
28280.............  ..............  A                Fusion of toes........       5.18       6.26       4.49       0.73      12.17      10.40        090
28285.............  ..............  A                Repair of hammertoe...       4.58       4.87       3.43       0.59      10.04       8.60        090
28286.............  ..............  A                Repair of hammertoe...       4.55       4.80       3.26       0.57       9.92       8.38        090
28288.............  ..............  A                Partial removal of           4.73       5.95       4.89       0.65      11.33      10.27        090
                                                      foot bone.
28289.............  ..............  A                Repair hallux rigidus.       7.03       8.00       5.78       1.02      16.05      13.83        090
28290.............  ..............  A                Correction of bunion..       5.65       6.27       4.73       0.82      12.74      11.20        090
28292.............  ..............  A                Correction of bunion..       7.03       7.48       5.55       0.91      15.42      13.49        090
28293.............  ..............  A                Correction of bunion..       9.14      10.77       6.12       1.13      21.04      16.39        090
28294.............  ..............  A                Correction of bunion..       8.55       7.45       4.72       1.09      17.09      14.36        090
28296.............  ..............  A                Correction of bunion..       9.17       8.17       5.43       1.19      18.53      15.79        090
28297.............  ..............  A                Correction of bunion..       9.17       8.97       6.27       1.32      19.46      16.76        090
28298.............  ..............  A                Correction of bunion..       7.93       7.23       5.01       1.05      16.21      13.99        090
28299.............  ..............  A                Correction of bunion..      10.56       8.79       6.08       1.37      20.72      18.01        090
28300.............  ..............  A                Incision of heel bone.       9.53         NA       7.05       1.54         NA      18.12        090
28302.............  ..............  A                Incision of ankle bone       9.54         NA       6.90       1.42         NA      17.86        090
28304.............  ..............  A                Incision of midfoot          9.15       7.96       5.75       1.27      18.38      16.17        090
                                                      bones.
28305.............  ..............  A                Incise/graft midfoot        10.48         NA       6.74       1.27         NA      18.49        090
                                                      bones.
28306.............  ..............  A                Incision of metatarsal       5.85       6.85       4.18       0.84      13.54      10.87        090
28307.............  ..............  A                Incision of metatarsal       6.32      11.05       5.30       0.90      18.27      12.52        090
28308.............  ..............  A                Incision of metatarsal       5.28       5.76       3.69       0.70      11.74       9.67        090
28309.............  ..............  A                Incision of                 12.76         NA       7.97       2.04         NA      22.77        090
                                                      metatarsals.
28310.............  ..............  A                Revision of big toe...       5.42       5.76       3.56       0.70      11.88       9.68        090
28312.............  ..............  A                Revision of toe.......       4.54       5.45       3.64       0.63      10.62       8.81        090
28313.............  ..............  A                Repair deformity of          5.00       5.29       4.84       0.73      11.02      10.57        090
                                                      toe.
28315.............  ..............  A                Removal of sesamoid          4.85       4.90       3.34       0.63      10.38       8.82        090
                                                      bone.
28320.............  ..............  A                Repair of foot bones..       9.17         NA       6.73       1.43         NA      17.33        090
28322.............  ..............  A                Repair of metatarsals.       8.33       9.20       6.35       1.27      18.80      15.95        090
28340.............  ..............  A                Resect enlarged toe          6.97       6.46       4.25       0.84      14.27      12.06        090
                                                      tissue.
28341.............  ..............  A                Resect enlarged toe...       8.40       6.95       4.82       1.01      16.36      14.23        090
28344.............  ..............  A                Repair extra toe(s)...       4.25       5.76       3.64       0.51      10.52       8.40        090
28345.............  ..............  A                Repair webbed toe(s)..       5.91       6.21       4.69       0.80      12.92      11.40        090
28360.............  ..............  A                Reconstruct cleft foot      13.32         NA      10.52       2.28         NA      26.12        090
28400.............  ..............  A                Treatment of heel            2.16       3.64       3.06       0.35       6.15       5.57        090
                                                      fracture.
28405.............  ..............  A                Treatment of heel            4.56       4.84       4.63       0.73      10.13       9.92        090
                                                      fracture.
28406.............  ..............  A                Treatment of heel            6.30         NA       6.81       1.11         NA      14.22        090
                                                      fracture.
28415.............  ..............  A                Treat heel fracture...      15.95         NA      13.32       2.66         NA      31.93        090
28420.............  ..............  A                Treat/graft heel            16.62         NA      12.95       2.80         NA      32.37        090
                                                      fracture.
28430.............  ..............  A                Treatment of ankle           2.09       3.40       2.57       0.31       5.80       4.97        090
                                                      fracture.
28435.............  ..............  A                Treatment of ankle           3.39       3.89       3.75       0.55       7.83       7.69        090
                                                      fracture.
28436.............  ..............  A                Treatment of ankle           4.70         NA       5.93       0.81         NA      11.44        090
                                                      fracture.
28445.............  ..............  A                Treat ankle fracture..      15.60         NA      11.06       2.58         NA      29.24        090
28450.............  ..............  A                Treat midfoot                1.90       3.12       2.48       0.28       5.30       4.66        090
                                                      fracture, each.
28455.............  ..............  A                Treat midfoot                3.09       3.43       3.43       0.44       6.96       6.96        090
                                                      fracture, each.
28456.............  ..............  A                Treat midfoot fracture       2.68         NA       4.16       0.44         NA       7.28        090
28465.............  ..............  A                Treat midfoot                7.00         NA       6.33       1.10         NA      14.43        090
                                                      fracture, each.
28470.............  ..............  A                Treat metatarsal             1.99       3.13       2.45       0.30       5.42       4.74        090
                                                      fracture.
28475.............  ..............  A                Treat metatarsal             2.97       3.34       3.22       0.44       6.75       6.63        090
                                                      fracture.
28476.............  ..............  A                Treat metatarsal             3.37         NA       4.99       0.54         NA       8.90        090
                                                      fracture.
28485.............  ..............  A                Treat metatarsal             5.70         NA       5.46       0.83         NA      11.99        090
                                                      fracture.
28490.............  ..............  A                Treat big toe fracture       1.09       2.02       1.64       0.14       3.25       2.87        090
28495.............  ..............  A                Treat big toe fracture       1.58       2.18       2.07       0.20       3.96       3.85        090
28496.............  ..............  A                Treat big toe fracture       2.33       8.27       3.20       0.36      10.96       5.89        090
28505.............  ..............  A                Treat big toe fracture       3.80       8.12       3.91       0.56      12.48       8.27        090
28510.............  ..............  A                Treatment of toe             1.09       1.53       1.53       0.14       2.76       2.76        090
                                                      fracture.
28515.............  ..............  A                Treatment of toe             1.46       1.90       1.90       0.18       3.54       3.54        090
                                                      fracture.
28525.............  ..............  A                Treat toe fracture....       3.32       7.53       3.44       0.49      11.34       7.25        090
28530.............  ..............  A                Treat sesamoid bone          1.06       1.44       1.44       0.14       2.64       2.64        090
                                                      fracture.
28531.............  ..............  A                Treat sesamoid bone          2.35       7.28       2.07       0.34       9.97       4.76        090
                                                      fracture.
28540.............  ..............  A                Treat foot dislocation       2.04       2.41       2.41       0.26       4.71       4.71        090
28545.............  ..............  A                Treat foot dislocation       2.45       2.35       2.35       0.37       5.17       5.17        090
28546.............  ..............  A                Treat foot dislocation       3.20       6.93       4.39       0.52      10.65       8.11        090
28555.............  ..............  A                Repair foot                  6.29       9.93       5.69       1.04      17.26      13.02        090
                                                      dislocation.
28570.............  ..............  A                Treat foot dislocation       1.66       2.43       2.34       0.23       4.32       4.23        090
28575.............  ..............  A                Treat foot dislocation       3.31       3.73       3.73       0.56       7.60       7.60        090
28576.............  ..............  A                Treat foot dislocation       4.16         NA       4.18       0.69         NA       9.03        090
28585.............  ..............  A                Repair foot                  7.98       7.34       5.85       1.25      16.57      15.08        090
                                                      dislocation.
28600.............  ..............  A                Treat foot dislocation       1.89       2.82       2.69       0.27       4.98       4.85        090
28605.............  ..............  A                Treat foot dislocation       2.71       3.13       3.13       0.40       6.24       6.24        090
28606.............  ..............  A                Treat foot dislocation       4.89         NA       4.70       0.82         NA      10.41        090
28615.............  ..............  A                Repair foot                  7.76         NA       8.06       1.30         NA      17.12        090
                                                      dislocation.
28630.............  ..............  A                Treat toe dislocation.       1.70       1.57       1.00       0.20       3.47       2.90        010

[[Page 70363]]

 
28635.............  ..............  A                Treat toe dislocation.       1.91       2.03       1.53       0.26       4.20       3.70        010
28636.............  ..............  A                Treat toe dislocation.       2.77       3.88       2.63       0.43       7.08       5.83        010
28645.............  ..............  A                Repair toe dislocation       4.21       4.96       3.28       0.57       9.74       8.06        090
28660.............  ..............  A                Treat toe dislocation.       1.23       1.26       0.79       0.13       2.62       2.15        010
28665.............  ..............  A                Treat toe dislocation.       1.92         NA       1.43       0.26         NA       3.61        010
28666.............  ..............  A                Treat toe dislocation.       2.66       5.90       2.59       0.43       8.99       5.68        010
28675.............  ..............  A                Repair of toe                2.92       7.16       3.36       0.45      10.53       6.73        090
                                                      dislocation.
28705.............  ..............  A                Fusion of foot bones..      18.77         NA      12.47       3.08         NA      34.32        090
28715.............  ..............  A                Fusion of foot bones..      13.08         NA       9.78       2.16         NA      25.02        090
28725.............  ..............  A                Fusion of foot bones..      11.59         NA       8.26       1.86         NA      21.71        090
28730.............  ..............  A                Fusion of foot bones..      10.74         NA       8.50       1.70         NA      20.94        090
28735.............  ..............  A                Fusion of foot bones..      10.83         NA       7.84       1.68         NA      20.35        090
28737.............  ..............  A                Revision of foot bones       9.63         NA       6.82       1.47         NA      17.92        090
28740.............  ..............  A                Fusion of foot bones..       8.01      10.89       6.48       1.22      20.12      15.71        090
28750.............  ..............  A                Fusion of big toe            7.29      11.94       6.68       1.13      20.36      15.10        090
                                                      joint.
28755.............  ..............  A                Fusion of big toe            4.73       6.12       3.76       0.65      11.50       9.14        090
                                                      joint.
28760.............  ..............  A                Fusion of big toe            7.74       7.99       5.53       1.05      16.78      14.32        090
                                                      joint.
28800.............  ..............  A                Amputation of midfoot.       8.20         NA       5.81       1.15         NA      15.16        090
28805.............  ..............  A                Amputation thru              8.38         NA       5.66       1.18         NA      15.22        090
                                                      metatarsal.
28810.............  ..............  A                Amputation toe &             6.20         NA       4.48       0.86         NA      11.54        090
                                                      metatarsal.
28820.............  ..............  A                Amputation of toe.....       4.40       7.57       3.79       0.61      12.58       8.80        090
28825.............  ..............  A                Partial amputation of        3.58       7.01       3.49       0.50      11.09       7.57        090
                                                      toe.
28890.............  ..............  A                High energy eswt,            3.30       5.73       2.09       0.41       9.44       5.80        090
                                                      plantar f.
28899.............  ..............  C                Foot/toes surgery            0.00       0.00       0.00       0.00       0.00       0.00        YYY
                                                      procedure.
29000.............  ..............  A                Application of body          2.25       2.97       1.74       0.41       5.63       4.40        000
                                                      cast.
29010.............  ..............  A                Application of body          2.06       3.29       1.78       0.45       5.80       4.29        000
                                                      cast.
29015.............  ..............  A                Application of body          2.41       2.98       1.60       0.28       5.67       4.29        000
                                                      cast.
29020.............  ..............  A                Application of body          2.11       3.19       1.41       0.28       5.58       3.80        000
                                                      cast.
29025.............  ..............  A                Application of body          2.40       3.15       1.86       0.44       5.99       4.70        000
                                                      cast.
29035.............  ..............  A                Application of body          1.77       3.62       1.58       0.28       5.67       3.63        000
                                                      cast.
29040.............  ..............  A                Application of body          2.22       2.47       1.51       0.36       5.05       4.09        000
                                                      cast.
29044.............  ..............  A                Application of body          2.12       3.98       1.91       0.35       6.45       4.38        000
                                                      cast.
29046.............  ..............  A                Application of body          2.41       3.24       2.10       0.42       6.07       4.93        000
                                                      cast.
29049.............  ..............  A                Application of figure        0.89       1.30       0.53       0.13       2.32       1.55        000
                                                      eight.
29055.............  ..............  A                Application of               1.78       2.99       1.47       0.30       5.07       3.55        000
                                                      shoulder cast.
29058.............  ..............  A                Application of               1.31       1.56       0.72       0.17       3.04       2.20        000
                                                      shoulder cast.
29065.............  ..............  A                Application of long          0.87       1.33       0.75       0.15       2.35       1.77        000
                                                      arm cast.
29075.............  ..............  A                Application of forearm       0.77       1.26       0.68       0.13       2.16       1.58        000
                                                      cast.
29085.............  ..............  A                Apply hand/wrist cast.       0.87       1.28       0.63       0.14       2.29       1.64        000
29086.............  ..............  A                Apply finger cast.....       0.62       0.96       0.49       0.07       1.65       1.18        000
29105.............  ..............  A                Apply long arm splint.       0.87       1.23       0.51       0.12       2.22       1.50        000
29125.............  ..............  A                Apply forearm splint..       0.59       1.02       0.39       0.07       1.68       1.05        000
29126.............  ..............  A                Apply forearm splint..       0.77       1.21       0.46       0.07       2.05       1.30        000
29130.............  ..............  A                Application of finger        0.50       0.47       0.17       0.06       1.03       0.73        000
                                                      splint.
29131.............  ..............  A                Application of finger        0.55       0.74       0.24       0.03       1.32       0.82        000
                                                      splint.
29200.............  ..............  A                Strapping of chest....       0.65       0.72       0.34       0.04       1.41       1.03        000
29220.............  ..............  A                Strapping of low back.       0.64       0.72       0.39       0.04       1.40       1.07        000
29240.............  ..............  A                Strapping of shoulder.       0.71       0.85       0.36       0.06       1.62       1.13        000
29260.............  ..............  A                Strapping of elbow or        0.55       0.74       0.32       0.05       1.34       0.92        000
                                                      wrist.
29280.............  ..............  A                Strapping of hand or         0.51       0.80       0.32       0.03       1.34       0.86        000
                                                      finger.
29305.............  ..............  A                Application of hip           2.03       3.35       1.77       0.35       5.73       4.15        000
                                                      cast.
29325.............  ..............  A                Application of hip           2.32       3.54       1.96       0.40       6.26       4.68        000
                                                      casts.
29345.............  ..............  A                Application of long          1.40       1.77       1.06       0.24       3.41       2.70        000
                                                      leg cast.
29355.............  ..............  A                Application of long          1.53       1.71       1.12       0.26       3.50       2.91        000
                                                      leg cast.
29358.............  ..............  A                Apply long leg cast          1.43       2.07       1.09       0.25       3.75       2.77        000
                                                      brace.
29365.............  ..............  A                Application of long          1.18       1.66       0.95       0.20       3.04       2.33        000
                                                      leg cast.
29405.............  ..............  A                Apply short leg cast..       0.86       1.22       0.71       0.14       2.22       1.71        000
29425.............  ..............  A                Apply short leg cast..       1.01       1.23       0.74       0.15       2.39       1.90        000
29435.............  ..............  A                Apply short leg cast..       1.18       1.56       0.93       0.20       2.94       2.31        000
29440.............  ..............  A                Addition of walker to        0.57       0.69       0.27       0.08       1.34       0.92        000
                                                      cast.
29445.............  ..............  A                Apply rigid leg cast..       1.78       1.81       0.96       0.27       3.86       3.01        000
29450.............  ..............  A                Application of leg           2.08       1.47       1.09       0.27       3.82       3.44        000
                                                      cast.
29505.............  ..............  A                Application, long leg        0.69       1.18       0.45       0.08       1.95       1.22        000
                                                      splint.
29515.............  ..............  A                Application lower leg        0.73       0.87       0.46       0.09       1.69       1.28        000
                                                      splint.
29520.............  ..............  A                Strapping of hip......       0.54       0.85       0.47       0.03       1.42       1.04        000
29530.............  ..............  A                Strapping of knee.....       0.57       0.79       0.33       0.05       1.41       0.95        000
29540.............  ..............  A                Strapping of ankle and/      0.51       0.42       0.31       0.06       0.99       0.88        000
                                                      or ft.
29550.............  ..............  A                Strapping of toes.....       0.47       0.42       0.28       0.06       0.95       0.81        000
29580.............  ..............  A                Application of paste         0.57       0.65       0.35       0.07       1.29       0.99        000
                                                      boot.
29590.............  ..............  A                Application of foot          0.76       0.51       0.29       0.09       1.36       1.14        000
                                                      splint.
29700.............  ..............  A                Removal/revision of          0.57       0.89       0.28       0.08       1.54       0.93        000
                                                      cast.
29705.............  ..............  A                Removal/revision of          0.76       0.82       0.38       0.13       1.71       1.27        000
                                                      cast.
29710.............  ..............  A                Removal/revision of          1.34       1.53       0.70       0.20       3.07       2.24        000
                                                      cast.
29715.............  ..............  A                Removal/revision of          0.94       1.17       0.40       0.09       2.20       1.43        000
                                                      cast.
29720.............  ..............  A                Repair of body cast...       0.68       1.16       0.39       0.12       1.96       1.19        000

[[Page 70364]]

 
29730.............  ..............  A                Windowing of cast.....       0.75       0.81       0.35       0.12       1.68       1.22        000
29740.............  ..............  A                Wedging of cast.......       1.12       1.15       0.49       0.18       2.45       1.79        000
29750.............  ..............  A                Wedging of clubfoot          1.26       1.06       0.58       0.21       2.53       2.05        000
                                                      cast.
29799.............  ..............  C                Casting/strapping            0.00       0.00       0.00       0.00       0.00       0.00        YYY
                                                      procedure.
29800.............  ..............  A                Jaw arthroscopy/             6.42         NA       6.99       0.99         NA      14.40        090
                                                      surgery.
29804.............  ..............  A                Jaw arthroscopy/             8.13         NA       7.64       1.38         NA      17.15        090
                                                      surgery.
29805.............  ..............  A                Shoulder arthroscopy,        5.88         NA       5.69       1.02         NA      12.59        090
                                                      dx.
29806.............  ..............  A                Shoulder arthroscopy/       14.35         NA      11.19       2.49         NA      28.03        090
                                                      surgery.
29807.............  ..............  A                Shoulder arthroscopy/       13.88         NA      11.02       2.41         NA      27.31        090
                                                      surgery.
29819.............  ..............  A                Shoulder arthroscopy/        7.61         NA       6.81       1.32         NA      15.74        090
                                                      surgery.
29820.............  ..............  A                Shoulder arthroscopy/        7.06         NA       6.24       1.22         NA      14.52        090
                                                      surgery.
29821.............  ..............  A                Shoulder arthroscopy/        7.71         NA       6.82       1.33         NA      15.86        090
                                                      surgery.
29822.............  ..............  A                Shoulder arthroscopy/        7.42         NA       6.71       1.28         NA      15.41        090
                                                      surgery.
29823.............  ..............  A                Shoulder arthroscopy/        8.16         NA       7.24       1.41         NA      16.81        090
                                                      surgery.
29824.............  ..............  A                Shoulder arthroscopy/        8.24         NA       7.55       1.42         NA      17.21        090
                                                      surgery.
29825.............  ..............  A                Shoulder arthroscopy/        7.61         NA       6.78       1.32         NA      15.71        090
                                                      surgery.
29826.............  ..............  A                Shoulder arthroscopy/        8.98         NA       7.55       1.55         NA      18.08        090
                                                      surgery.
29827.............  ..............  A                Arthroscop rotator          15.34         NA      11.56       2.66         NA      29.56        090
                                                      cuff repr.
29830.............  ..............  A                Elbow arthroscopy.....       5.75         NA       5.36       0.99         NA      12.10        090
29834.............  ..............  A                Elbow arthroscopy/           6.27         NA       5.85       1.08         NA      13.20        090
                                                      surgery.
29835.............  ..............  A                Elbow arthroscopy/           6.47         NA       5.90       1.13         NA      13.50        090
                                                      surgery.
29836.............  ..............  A                Elbow arthroscopy/           7.54         NA       6.81       1.22         NA      15.57        090
                                                      surgery.
29837.............  ..............  A                Elbow arthroscopy/           6.86         NA       6.15       1.19         NA      14.20        090
                                                      surgery.
29838.............  ..............  A                Elbow arthroscopy/           7.70         NA       6.91       1.30         NA      15.91        090
                                                      surgery.
29840.............  ..............  A                Wrist arthroscopy.....       5.53         NA       5.34       0.84         NA      11.71        090
29843.............  ..............  A                Wrist arthroscopy/           6.00         NA       5.64       0.92         NA      12.56        090
                                                      surgery.
29844.............  ..............  A                Wrist arthroscopy/           6.36         NA       5.84       1.04         NA      13.24        090
                                                      surgery.
29845.............  ..............  A                Wrist arthroscopy/           7.51         NA       6.49       0.99         NA      14.99        090
                                                      surgery.
29846.............  ..............  A                Wrist arthroscopy/           6.74         NA       6.07       1.07         NA      13.88        090
                                                      surgery.
29847.............  ..............  A                Wrist arthroscopy/           7.07         NA       6.21       1.08         NA      14.36        090
                                                      surgery.
29848.............  ..............  A                Wrist endoscopy/             5.43         NA       5.62       0.86         NA      11.91        090
                                                      surgery.
29850.............  ..............  A                Knee arthroscopy/            8.18         NA       5.05       1.25         NA      14.48        090
                                                      surgery.
29851.............  ..............  A                Knee arthroscopy/           13.08         NA       9.82       2.34         NA      25.24        090
                                                      surgery.
29855.............  ..............  A                Tibial arthroscopy/         10.60         NA       8.79       1.84         NA      21.23        090
                                                      surgery.
29856.............  ..............  A                Tibial arthroscopy/         14.12         NA      10.70       2.39         NA      27.21        090
                                                      surgery.
29860.............  ..............  A                Hip arthroscopy, dx...       8.04         NA       6.97       1.36         NA      16.37        090
29861.............  ..............  A                Hip arthroscopy/             9.14         NA       7.36       1.59         NA      18.09        090
                                                      surgery.
29862.............  ..............  A                Hip arthroscopy/             9.89         NA       8.58       1.62         NA      20.09        090
                                                      surgery.
29863.............  ..............  A                Hip arthroscopy/             9.89         NA       8.53       1.42         NA      19.84        090
                                                      surgery.
29866.............  ..............  A                Autgrft implnt, knee w/     13.88         NA      11.38       2.39         NA      27.65        090
                                                      scope.
29867.............  ..............  A                Allgrft implnt, knee w/     17.00         NA      13.26       2.78         NA      33.04        090
                                                      scope.
29868.............  ..............  A                Meniscal trnspl, knee       23.59         NA      16.84       4.35         NA      44.78        090
                                                      w/scpe.
29870.............  ..............  A                Knee arthroscopy, dx..       5.06         NA       4.90       0.85         NA      10.81        090
29871.............  ..............  A                Knee arthroscopy/            6.54         NA       5.89       1.14         NA      13.57        090
                                                      drainage.
29873.............  ..............  A                Knee arthroscopy/            5.99         NA       6.59       1.04         NA      13.62        090
                                                      surgery.
29874.............  ..............  A                Knee arthroscopy/            7.04         NA       6.09       1.11         NA      14.24        090
                                                      surgery.
29875.............  ..............  A                Knee arthroscopy/            6.30         NA       5.87       1.09         NA      13.26        090
                                                      surgery.
29876.............  ..............  A                Knee arthroscopy/            7.91         NA       7.04       1.37         NA      16.32        090
                                                      surgery.
29877.............  ..............  A                Knee arthroscopy/            7.34         NA       6.76       1.28         NA      15.38        090
                                                      surgery.
29879.............  ..............  A                Knee arthroscopy/            8.03         NA       7.14       1.39         NA      16.56        090
                                                      surgery.
29880.............  ..............  A                Knee arthroscopy/            8.49         NA       7.38       1.47         NA      17.34        090
                                                      surgery.
29881.............  ..............  A                Knee arthroscopy/            7.75         NA       6.98       1.34         NA      16.07        090
                                                      surgery.
29882.............  ..............  A                Knee arthroscopy/            8.64         NA       7.26       1.50         NA      17.40        090
                                                      surgery.
29883.............  ..............  A                Knee arthroscopy/           11.03         NA       9.09       1.92         NA      22.04        090
                                                      surgery.
29884.............  ..............  A                Knee arthroscopy/            7.32         NA       6.72       1.27         NA      15.31        090
                                                      surgery.
29885.............  ..............  A                Knee arthroscopy/            9.08         NA       7.99       1.58         NA      18.65        090
                                                      surgery.
29886.............  ..............  A                Knee arthroscopy/            7.53         NA       6.87       1.30         NA      15.70        090
                                                      surgery.
29887.............  ..............  A                Knee arthroscopy/            9.03         NA       7.95       1.57         NA      18.55        090
                                                      surgery.
29888.............  ..............  A                Knee arthroscopy/           13.88         NA      10.23       2.41         NA      26.52        090
                                                      surgery.
29889.............  ..............  A                Knee arthroscopy/           15.98         NA      12.47       2.78         NA      31.23        090
                                                      surgery.
29891.............  ..............  A                Ankle arthroscopy/           8.39         NA       7.53       1.39         NA      17.31        090
                                                      surgery.
29892.............  ..............  A                Ankle arthroscopy/           8.99         NA       7.76       1.41         NA      18.16        090
                                                      surgery.
29893.............  ..............  A                Scope, plantar               5.21       6.30       4.00       0.63      12.14       9.84        090
                                                      fasciotomy.
29894.............  ..............  A                Ankle arthroscopy/           7.20         NA       5.49       1.15         NA      13.84        090
                                                      surgery.
29895.............  ..............  A                Ankle arthroscopy/           6.98         NA       5.49       1.11         NA      13.58        090
                                                      surgery.
29897.............  ..............  A                Ankle arthroscopy/           7.17         NA       5.90       1.17         NA      14.24        090
                                                      surgery.
29898.............  ..............  A                Ankle arthroscopy/           8.31         NA       6.21       1.28         NA      15.80        090
                                                      surgery.
29899.............  ..............  A                Ankle arthroscopy/          13.89         NA      10.57       2.40         NA      26.86        090
                                                      surgery.
29900.............  ..............  A                Mcp joint arthroscopy,       5.41         NA       5.88       0.94         NA      12.23        090
                                                      dx.
29901.............  ..............  A                Mcp joint arthroscopy,       6.12         NA       6.28       1.06         NA      13.46        090
                                                      surg.
29902.............  ..............  A                Mcp joint arthroscopy,       6.69         NA       6.56       1.12         NA      14.37        090
                                                      surg.
29999.............  ..............  C                Arthroscopy of joint..       0.00       0.00       0.00       0.00       0.00       0.00        YYY
30000.............  ..............  A                Drainage of nose             1.43       4.08       1.39       0.12       5.63       2.94        010
                                                      lesion.
3000F.............  ..............  I                Blood press </= 140/90       0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      mmhg.
30020.............  ..............  A                Drainage of nose             1.43       3.28       1.47       0.12       4.83       3.02        010
                                                      lesion.

[[Page 70365]]

 
3002F.............  ..............  I                Blood pressure > 140/        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      90 mmhg.
30100.............  ..............  A                Intranasal biopsy.....       0.94       1.98       0.82       0.07       2.99       1.83        000
30110.............  ..............  A                Removal of nose              1.63       3.25       1.57       0.14       5.02       3.34        010
                                                      polyp(s).
30115.............  ..............  A                Removal of nose              4.34         NA       5.78       0.41         NA      10.53        090
                                                      polyp(s).
30117.............  ..............  A                Removal of intranasal        3.16      13.18       4.64       0.26      16.60       8.06        090
                                                      lesion.
30118.............  ..............  A                Removal of intranasal        9.68         NA       9.22       0.78         NA      19.68        090
                                                      lesion.
30120.............  ..............  A                Revision of nose......       5.26       6.51       6.02       0.52      12.29      11.80        090
30124.............  ..............  A                Removal of nose lesion       3.10         NA       3.62       0.25         NA       6.97        090
30125.............  ..............  A                Removal of nose lesion       7.15         NA       8.34       0.63         NA      16.12        090
30130.............  ..............  A                Excise inferior              3.37         NA       5.61       0.31         NA       9.29        090
                                                      turbinate.
30140.............  ..............  A                Resect inferior              3.42         NA       6.21       0.35         NA       9.98        090
                                                      turbinate.
30150.............  ..............  A                Partial removal of           9.13         NA      11.04       0.93         NA      21.10        090
                                                      nose.
30160.............  ..............  A                Removal of nose.......       9.57         NA      10.24       0.88         NA      20.69        090
30200.............  ..............  A                Injection treatment of       0.78       1.62       0.74       0.06       2.46       1.58        000
                                                      nose.
30210.............  ..............  A                Nasal sinus therapy...       1.08       2.11       1.31       0.09       3.28       2.48        010
30220.............  ..............  A                Insert nasal septal          1.54       4.24       1.53       0.12       5.90       3.19        010
                                                      button.
30300.............  ..............  A                Remove nasal foreign         1.04       4.64       1.92       0.08       5.76       3.04        010
                                                      body.
30310.............  ..............  A                Remove nasal foreign         1.96         NA       3.11       0.16         NA       5.23        010
                                                      body.
30320.............  ..............  A                Remove nasal foreign         4.51         NA       7.06       0.39         NA      11.96        090
                                                      body.
30400.............  ..............  R                Reconstruction of nose       9.82         NA      15.53       1.04         NA      26.39        090
30410.............  ..............  R                Reconstruction of nose      12.96         NA      18.42       1.42         NA      32.80        090
30420.............  ..............  R                Reconstruction of nose      15.86         NA      17.96       1.46         NA      35.28        090
30430.............  ..............  R                Revision of nose......       7.20         NA      16.06       0.77         NA      24.03        090
30435.............  ..............  R                Revision of nose......      11.69         NA      19.41       1.22         NA      32.32        090
30450.............  ..............  R                Revision of nose......      18.62         NA      21.95       1.96         NA      42.53        090
30460.............  ..............  A                Revision of nose......       9.95         NA       9.97       1.03         NA      20.95        090
30462.............  ..............  A                Revision of nose......      19.54         NA      20.30       2.53         NA      42.37        090
30465.............  ..............  A                Repair nasal stenosis.      11.62         NA      12.00       1.06         NA      24.68        090
30520.............  ..............  A                Repair of nasal septum       5.69         NA       6.68       0.46         NA      12.83        090
30540.............  ..............  A                Repair nasal defect...       7.74         NA       9.30       0.67         NA      17.71        090
30545.............  ..............  A                Repair nasal defect...      11.36         NA      11.93       1.70         NA      24.99        090
30560.............  ..............  A                Release of nasal             1.26       4.78       2.14       0.10       6.14       3.50        010
                                                      adhesions.
30580.............  ..............  A                Repair upper jaw             6.68       7.79       5.81       0.89      15.36      13.38        090
                                                      fistula.
30600.............  ..............  A                Repair mouth/nose            6.01       7.54       5.03       0.70      14.25      11.74        090
                                                      fistula.
30620.............  ..............  A                Intranasal                   5.96         NA       8.86       0.57         NA      15.39        090
                                                      reconstruction.
30630.............  ..............  A                Repair nasal septum          7.11         NA       7.97       0.61         NA      15.69        090
                                                      defect.
30801.............  ..............  A                Ablate inf turbinate,        1.09       4.14       1.93       0.09       5.32       3.11        010
                                                      superf.
30802.............  ..............  A                Cauterization, inner         2.03       4.62       2.37       0.16       6.81       4.56        010
                                                      nose.
30901.............  ..............  A                Control of nosebleed..       1.21       1.36       0.32       0.11       2.68       1.64        000
30903.............  ..............  A                Control of nosebleed..       1.54       2.72       0.50       0.13       4.39       2.17        000
30905.............  ..............  A                Control of nosebleed..       1.97       3.52       0.76       0.17       5.66       2.90        000
30906.............  ..............  A                Repeat control of            2.45       3.90       1.20       0.20       6.55       3.85        000
                                                      nosebleed.
30915.............  ..............  A                Ligation, nasal sinus        7.19         NA       6.71       0.58         NA      14.48        090
                                                      artery.
30920.............  ..............  A                Ligation, upper jaw          9.82         NA       9.00       0.80         NA      19.62        090
                                                      artery.
30930.............  ..............  A                Ther fx, nasal inf           1.26         NA       1.62       0.12         NA       3.00        010
                                                      turbinate.
30999.............  ..............  C                Nasal surgery                0.00       0.00       0.00       0.00       0.00       0.00        YYY
                                                      procedure.
31000.............  ..............  A                Irrigation, maxillary        1.15       2.85       1.40       0.09       4.09       2.64        010
                                                      sinus.
31002.............  ..............  A                Irrigation, sphenoid         1.91         NA       3.25       0.15         NA       5.31        010
                                                      sinus.
31020.............  ..............  A                Exploration, maxillary       2.94       8.55       5.20       0.29      11.78       8.43        090
                                                      sinus.
31030.............  ..............  A                Exploration, maxillary       5.91      11.53       6.68       0.60      18.04      13.19        090
                                                      sinus.
31032.............  ..............  A                Explore sinus, remove        6.56         NA       7.25       0.59         NA      14.40        090
                                                      polyps.
31040.............  ..............  A                Exploration behind           9.41         NA       9.85       0.87         NA      20.13        090
                                                      upper jaw.
31050.............  ..............  A                Exploration, sphenoid        5.27         NA       6.37       0.49         NA      12.13        090
                                                      sinus.
31051.............  ..............  A                Sphenoid sinus surgery       7.10         NA       8.26       0.62         NA      15.98        090
31070.............  ..............  A                Exploration of frontal       4.27         NA       5.95       0.38         NA      10.60        090
                                                      sinus.
31075.............  ..............  A                Exploration of frontal       9.15         NA       9.76       0.75         NA      19.66        090
                                                      sinus.
31080.............  ..............  A                Removal of frontal          11.40         NA      13.57       1.23         NA      26.20        090
                                                      sinus.
31081.............  ..............  A                Removal of frontal          12.73         NA      14.04       2.46         NA      29.23        090
                                                      sinus.
31084.............  ..............  A                Removal of frontal          13.49         NA      13.54       1.19         NA      28.22        090
                                                      sinus.
31085.............  ..............  A                Removal of frontal          14.18         NA      14.00       1.72         NA      29.90        090
                                                      sinus.
31086.............  ..............  A                Removal of frontal          12.84         NA      13.32       1.07         NA      27.23        090
                                                      sinus.
31087.............  ..............  A                Removal of frontal          13.08         NA      12.57       1.44         NA      27.09        090
                                                      sinus.
31090.............  ..............  A                Exploration of sinuses       9.52         NA      12.59       0.94         NA      23.05        090
31200.............  ..............  A                Removal of ethmoid           4.96         NA       9.24       0.29         NA      14.49        090
                                                      sinus.
31201.............  ..............  A                Removal of ethmoid           8.36         NA       9.20       0.82         NA      18.38        090
                                                      sinus.
31205.............  ..............  A                Removal of ethmoid          10.22         NA      11.91       0.67         NA      22.80        090
                                                      sinus.
31225.............  ..............  A                Removal of upper jaw..      19.20         NA      17.87       1.59         NA      38.66        090
31230.............  ..............  A                Removal of upper jaw..      21.91         NA      19.42       1.77         NA      43.10        090
31231.............  ..............  A                Nasal endoscopy, dx...       1.10       3.39       0.88       0.09       4.58       2.07        000
31233.............  ..............  A                Nasal/sinus endoscopy,       2.18       4.31       1.48       0.20       6.69       3.86        000
                                                      dx.
31235.............  ..............  A                Nasal/sinus endoscopy,       2.64       4.92       1.72       0.26       7.82       4.62        000
                                                      dx.
31237.............  ..............  A                Nasal/sinus endoscopy,       2.98       5.21       1.89       0.28       8.47       5.15        000
                                                      surg.
31238.............  ..............  A                Nasal/sinus endoscopy,       3.26       5.25       2.10       0.27       8.78       5.63        000
                                                      surg.
31239.............  ..............  A                Nasal/sinus endoscopy,       8.69         NA       8.02       0.62         NA      17.33        010
                                                      surg.
31240.............  ..............  A                Nasal/sinus endoscopy,       2.61         NA       1.74       0.24         NA       4.59        000
                                                      surg.

[[Page 70366]]

 
31254.............  ..............  A                Revision of ethmoid          4.64         NA       2.86       0.45         NA       7.95        000
                                                      sinus.
31255.............  ..............  A                Removal of ethmoid           6.95         NA       4.12       0.73         NA      11.80        000
                                                      sinus.
31256.............  ..............  A                Exploration maxillary        3.29         NA       2.12       0.33         NA       5.74        000
                                                      sinus.
31267.............  ..............  A                Endoscopy, maxillary         5.45         NA       3.30       0.55         NA       9.30        000
                                                      sinus.
31276.............  ..............  A                Sinus endoscopy,             8.84         NA       5.13       0.92         NA      14.89        000
                                                      surgical.
31287.............  ..............  A                Nasal/sinus endoscopy,       3.91         NA       2.46       0.39         NA       6.76        000
                                                      surg.
31288.............  ..............  A                Nasal/sinus endoscopy,       4.57         NA       2.82       0.46         NA       7.85        000
                                                      surg.
31290.............  ..............  A                Nasal/sinus endoscopy,      17.21         NA      12.08       1.40         NA      30.69        010
                                                      surg.
31291.............  ..............  A                Nasal/sinus endoscopy,      18.16         NA      12.51       1.68         NA      32.35        010
                                                      surg.
31292.............  ..............  A                Nasal/sinus endoscopy,      14.74         NA      10.64       1.21         NA      26.59        010
                                                      surg.
31293.............  ..............  A                Nasal/sinus endoscopy,      16.19         NA      11.41       1.28         NA      28.88        010
                                                      surg.
31294.............  ..............  A                Nasal/sinus endoscopy,      19.03         NA      12.91       1.53         NA      33.47        010
                                                      surg.
31299.............  ..............  C                Sinus surgery                0.00       0.00       0.00       0.00       0.00       0.00        YYY
                                                      procedure.
31300.............  ..............  A                Removal of larynx           14.27         NA      15.02       1.17         NA      30.46        090
                                                      lesion.
31320.............  ..............  A                Diagnostic incision,         5.25         NA      10.33       0.46         NA      16.04        090
                                                      larynx.
31360.............  ..............  A                Removal of larynx.....      17.05         NA      16.77       1.38         NA      35.20        090
31365.............  ..............  A                Removal of larynx.....      24.12         NA      20.42       1.97         NA      46.51        090
31367.............  ..............  A                Partial removal of          21.83         NA      21.95       1.78         NA      45.56        090
                                                      larynx.
31368.............  ..............  A                Partial removal of          27.05         NA      25.56       2.20         NA      54.81        090
                                                      larynx.
31370.............  ..............  A                Partial removal of          21.35         NA      22.32       1.74         NA      45.41        090
                                                      larynx.
31375.............  ..............  A                Partial removal of          20.18         NA      20.44       1.63         NA      42.25        090
                                                      larynx.
31380.............  ..............  A                Partial removal of          20.18         NA      20.66       1.70         NA      42.54        090
                                                      larynx.
31382.............  ..............  A                Partial removal of          20.49         NA      21.67       1.67         NA      43.83        090
                                                      larynx.
31390.............  ..............  A                Removal of larynx &         27.49         NA      24.45       2.23         NA      54.17        090
                                                      pharynx.
31395.............  ..............  A                Reconstruct larynx &        31.04         NA      28.38       2.48         NA      61.90        090
                                                      pharynx.
31400.............  ..............  A                Revision of larynx....      10.29         NA      13.81       0.83         NA      24.93        090
31420.............  ..............  A                Removal of epiglottis.      10.20         NA       9.57       0.83         NA      20.60        090
31500.............  ..............  A                Insert emergency             2.33         NA       0.55       0.17         NA       3.05        000
                                                      airway.
31502.............  ..............  A                Change of windpipe           0.65       0.31       0.28       0.05       1.01       0.98        000
                                                      airway.
31505.............  ..............  A                Diagnostic                   0.61       1.45       0.61       0.05       2.11       1.27        000
                                                      laryngoscopy.
31510.............  ..............  A                Laryngoscopy with            1.92       3.31       1.25       0.16       5.39       3.33        000
                                                      biopsy.
31511.............  ..............  A                Remove foreign body,         2.16       3.13       1.06       0.19       5.48       3.41        000
                                                      larynx.
31512.............  ..............  A                Removal of larynx            2.07       3.21       1.36       0.18       5.46       3.61        000
                                                      lesion.
31513.............  ..............  A                Injection into vocal         2.10         NA       1.46       0.17         NA       3.73        000
                                                      cord.
31515.............  ..............  A                Laryngoscopy for             1.80       3.55       1.06       0.14       5.49       3.00        000
                                                      aspiration.
31520.............  ..............  A                Dx laryngoscopy,             2.56         NA       1.56       0.20         NA       4.32        000
                                                      newborn.
31525.............  ..............  A                Dx laryngoscopy excl         2.63       3.65       1.66       0.21       6.49       4.50        000
                                                      nb.
31526.............  ..............  A                Dx laryngoscopy w/oper       2.57         NA       1.72       0.21         NA       4.50        000
                                                      scope.
31527.............  ..............  A                Laryngoscopy for             3.27         NA       1.88       0.26         NA       5.41        000
                                                      treatment.
31528.............  ..............  A                Laryngoscopy and             2.37         NA       1.46       0.19         NA       4.02        000
                                                      dilation.
31529.............  ..............  A                Laryngoscopy and             2.68         NA       1.71       0.22         NA       4.61        000
                                                      dilation.
31530.............  ..............  A                Laryngoscopy w/fb            3.38         NA       1.96       0.29         NA       5.63        000
                                                      removal.
31531.............  ..............  A                Laryngoscopy w/fb & op       3.58         NA       2.28       0.29         NA       6.15        000
                                                      scope.
31535.............  ..............  A                Laryngoscopy w/biopsy.       3.16         NA       2.00       0.26         NA       5.42        000
31536.............  ..............  A                Laryngoscopy w/bx & op       3.55         NA       2.26       0.29         NA       6.10        000
                                                      scope.
31540.............  ..............  A                Laryngoscopy w/exc of        4.12         NA       2.55       0.33         NA       7.00        000
                                                      tumor.
31541.............  ..............  A                Larynscop w/tumr exc +       4.52         NA       2.79       0.37         NA       7.68        000
                                                      scope.
31545.............  ..............  A                Remove vc lesion w/          6.30         NA       3.48       0.37         NA      10.15        000
                                                      scope.
31546.............  ..............  A                Remove vc lesion scope/      9.73         NA       4.98       0.78         NA      15.49        000
                                                      graft.
31560.............  ..............  A                Laryngoscop w/               5.45         NA       3.16       0.43         NA       9.04        000
                                                      arytenoidectom.
31561.............  ..............  A                Larynscop, remve cart        5.99         NA       3.38       0.49         NA       9.86        000
                                                      + scop.
31570.............  ..............  A                Laryngoscope w/vc inj.       3.86       5.69       2.39       0.31       9.86       6.56        000
31571.............  ..............  A                Laryngoscop w/vc inj +       4.26         NA       2.61       0.35         NA       7.22        000
                                                      scope.
31575.............  ..............  A                Diagnostic                   1.10       1.91       0.89       0.09       3.10       2.08        000
                                                      laryngoscopy.
31576.............  ..............  A                Laryngoscopy with            1.97       3.67       1.29       0.14       5.78       3.40        000
                                                      biopsy.
31577.............  ..............  A                Remove foreign body,         2.47       3.77       1.53       0.21       6.45       4.21        000
                                                      larynx.
31578.............  ..............  A                Removal of larynx            2.84       4.29       1.52       0.23       7.36       4.59        000
                                                      lesion.
31579.............  ..............  A                Diagnostic                   2.26       3.79       1.48       0.18       6.23       3.92        000
                                                      laryngoscopy.
31580.............  ..............  A                Revision of larynx....      12.36         NA      15.96       1.00         NA      29.32        090
31582.............  ..............  A                Revision of larynx....      21.59         NA      25.87       1.75         NA      49.21        090
31584.............  ..............  A                Treat larynx fracture.      19.61         NA      18.20       1.71         NA      39.52        090
31587.............  ..............  A                Revision of larynx....      11.97         NA       9.29       0.97         NA      22.23        090
31588.............  ..............  A                Revision of larynx....      13.09         NA      13.65       1.06         NA      27.80        090
31590.............  ..............  A                Reinnervate larynx....       6.96         NA      15.58       0.84         NA      23.38        090
31595.............  ..............  A                Larynx nerve surgery..       8.33         NA      10.58       0.68         NA      19.59        090
31599.............  ..............  C                Larynx surgery               0.00       0.00       0.00       0.00       0.00       0.00        YYY
                                                      procedure.
31600.............  ..............  A                Incision of windpipe..       7.17         NA       3.20       0.80         NA      11.17        000
31601.............  ..............  A                Incision of windpipe..       4.44         NA       2.41       0.40         NA       7.25        000
31603.............  ..............  A                Incision of windpipe..       4.14         NA       1.71       0.44         NA       6.29        000
31605.............  ..............  A                Incision of windpipe..       3.57         NA       1.19       0.40         NA       5.16        000
31610.............  ..............  A                Incision of windpipe..       8.75         NA       8.28       0.79         NA      17.82        090
31611.............  ..............  A                Surgery/speech               5.63         NA       7.08       0.46         NA      13.17        090
                                                      prosthesis.
31612.............  ..............  A                Puncture/clear               0.91       1.10       0.35       0.08       2.09       1.34        000
                                                      windpipe.
31613.............  ..............  A                Repair windpipe              4.58         NA       6.01       0.42         NA      11.01        090
                                                      opening.
31614.............  ..............  A                Repair windpipe              7.11         NA       8.74       0.58         NA      16.43        090
                                                      opening.

[[Page 70367]]

 
31615.............  ..............  A                Visualization of             2.09       2.60       1.20       0.16       4.85       3.45        000
                                                      windpipe.
31620.............  ..............  A                Endobronchial us add-        1.40       5.66       0.55       0.11       7.17       2.06        ZZZ
                                                      on.
31622.............  ..............  A                Dx bronchoscope/wash..       2.78       5.67       1.06       0.18       8.63       4.02        000
31623.............  ..............  A                Dx bronchoscope/brush.       2.88       6.44       1.05       0.13       9.45       4.06        000
31624.............  ..............  A                Dx bronchoscope/lavage       2.88       5.79       1.05       0.13       8.80       4.06        000
31625.............  ..............  A                Bronchoscopy w/              3.36       5.83       1.21       0.18       9.37       4.75        000
                                                      biopsy(s).
31628.............  ..............  A                Bronchoscopy/lung bx,        3.80       7.04       1.30       0.18      11.02       5.28        000
                                                      each.
31629.............  ..............  A                Bronchoscopy/needle          4.09      14.29       1.40       0.16      18.54       5.65        000
                                                      bx, each.
31630.............  ..............  A                Bronchoscopy dilate/fx       3.81         NA       1.72       0.32         NA       5.85        000
                                                      repr.
31631.............  ..............  A                Bronchoscopy, dilate w/      4.36         NA       1.77       0.34         NA       6.47        000
                                                      stent.
31632.............  ..............  A                Bronchoscopy/lung bx,        1.03       0.81       0.31       0.18       2.02       1.52        ZZZ
                                                      add'l.
31633.............  ..............  A                Bronchoscopy/needle bx       1.32       0.92       0.40       0.16       2.40       1.88        ZZZ
                                                      add'l.
31635.............  ..............  A                Bronchoscopy w/fb            3.67       6.13       1.43       0.24      10.04       5.34        000
                                                      removal.
31636.............  ..............  A                Bronchoscopy, bronch         4.30         NA       1.77       0.31         NA       6.38        000
                                                      stents.
31637.............  ..............  A                Bronchoscopy, stent          1.58         NA       0.56       0.13         NA       2.27        ZZZ
                                                      add-on.
31638.............  ..............  A                Bronchoscopy, revise         4.88         NA       1.98       0.22         NA       7.08        000
                                                      stent.
31640.............  ..............  A                Bronchoscopy w/tumor         4.93         NA       2.08       0.46         NA       7.47        000
                                                      excise.
31641.............  ..............  A                Bronchoscopy, treat          5.02         NA       1.89       0.35         NA       7.26        000
                                                      blockage.
31643.............  ..............  A                Diag bronchoscope/           3.49         NA       1.23       0.20         NA       4.92        000
                                                      catheter.
31645.............  ..............  A                Bronchoscopy, clear          3.16       5.15       1.12       0.16       8.47       4.44        000
                                                      airways.
31646.............  ..............  A                Bronchoscopy, reclear        2.72       4.87       1.00       0.14       7.73       3.86        000
                                                      airway.
31656.............  ..............  A                Bronchoscopy, inj for        2.17       7.31       0.83       0.15       9.63       3.15        000
                                                      x-ray.
31700.............  ..............  A                Insertion of airway          1.34       2.16       0.68       0.08       3.58       2.10        000
                                                      catheter.
31708.............  ..............  A                Instill airway               1.41       2.04       0.46       0.07       3.52       1.94        000
                                                      contrast dye.
31710.............  ..............  A                Insertion of airway          1.30         NA       0.41       0.12         NA       1.83        000
                                                      catheter.
31715.............  ..............  A                Injection for bronchus       1.11         NA       0.34       0.07         NA       1.52        000
                                                      x-ray.
31717.............  ..............  A                Bronchial brush biopsy       2.12       8.27       0.79       0.14      10.53       3.05        000
31720.............  ..............  A                Clearance of airways..       1.06       0.33       0.33       0.07       1.46       1.46        000
31725.............  ..............  A                Clearance of airways..       1.96       0.65       0.58       0.14       2.75       2.68        000
31730.............  ..............  A                Intro, windpipe wire/        2.85       2.20       1.00       0.21       5.26       4.06        000
                                                      tube.
31750.............  ..............  A                Repair of windpipe....      13.00         NA      17.60       1.05         NA      31.65        090
31755.............  ..............  A                Repair of windpipe....      15.91         NA      24.59       1.29         NA      41.79        090
31760.............  ..............  A                Repair of windpipe....      22.32         NA      10.74       2.94         NA      36.00        090
31766.............  ..............  A                Reconstruction of           30.38         NA      13.69       4.52         NA      48.59        090
                                                      windpipe.
31770.............  ..............  A                Repair/graft of             22.48         NA      10.27       2.83         NA      35.58        090
                                                      bronchus.
31775.............  ..............  A                Reconstruct bronchus..      23.50         NA      11.82       3.01         NA      38.33        090
31780.............  ..............  A                Reconstruct windpipe..      17.69         NA      11.08       1.65         NA      30.42        090
31781.............  ..............  A                Reconstruct windpipe..      23.49         NA      12.16       2.24         NA      37.89        090
31785.............  ..............  A                Remove windpipe lesion      17.20         NA      10.21       1.59         NA      29.00        090
31786.............  ..............  A                Remove windpipe lesion      23.94         NA      13.13       3.29         NA      40.36        090
31800.............  ..............  A                Repair of windpipe           7.42         NA       9.27       0.79         NA      17.48        090
                                                      injury.
31805.............  ..............  A                Repair of windpipe          13.11         NA       7.23       1.82         NA      22.16        090
                                                      injury.
31820.............  ..............  A                Closure of windpipe          4.48       5.68       3.66       0.38      10.54       8.52        090
                                                      lesion.
31825.............  ..............  A                Repair of windpipe           6.80       7.68       5.39       0.53      15.01      12.72        090
                                                      defect.
31830.............  ..............  A                Revise windpipe scar..       4.49       5.78       3.99       0.44      10.71       8.92        090
31899.............  ..............  C                Airways surgical             0.00       0.00       0.00       0.00       0.00       0.00        YYY
                                                      procedure.
32000.............  ..............  A                Drainage of chest.....       1.54       3.06       0.48       0.08       4.68       2.10        000
32002.............  ..............  A                Treatment of collapsed       2.19       3.22       1.06       0.12       5.53       3.37        000
                                                      lung.
32005.............  ..............  A                Treat lung lining            2.19       6.47       0.70       0.23       8.89       3.12        000
                                                      chemically.
32019.............  ..............  A                Insert pleural               4.17      20.02       1.65       0.42      24.61       6.24        000
                                                      catheter.
32020.............  ..............  A                Insertion of chest           3.97         NA       1.35       0.43         NA       5.75        000
                                                      tube.
32035.............  ..............  A                Exploration of chest..       8.66         NA       5.87       1.26         NA      15.79        090
32036.............  ..............  A                Exploration of chest..       9.67         NA       6.45       1.43         NA      17.55        090
32095.............  ..............  A                Biopsy through chest         8.35         NA       5.38       1.22         NA      14.95        090
                                                      wall.
32100.............  ..............  A                Exploration/biopsy of       15.22         NA       7.84       2.23         NA      25.29        090
                                                      chest.
32110.............  ..............  A                Explore/repair chest..      22.97         NA      10.76       3.21         NA      36.94        090
32120.............  ..............  A                Re-exploration of           11.52         NA       7.09       1.63         NA      20.24        090
                                                      chest.
32124.............  ..............  A                Explore chest free          12.70         NA       7.23       1.89         NA      21.82        090
                                                      adhesions.
32140.............  ..............  A                Removal of lung             13.91         NA       7.70       1.96         NA      23.57        090
                                                      lesion(s).
32141.............  ..............  A                Remove/treat lung           13.98         NA       7.57       2.00         NA      23.55        090
                                                      lesions.
32150.............  ..............  A                Removal of lung             14.13         NA       7.62       2.00         NA      23.75        090
                                                      lesion(s).
32151.............  ..............  A                Remove lung foreign         14.19         NA       8.02       2.03         NA      24.24        090
                                                      body.
32160.............  ..............  A                Open chest heart             9.29         NA       5.28       1.31         NA      15.88        090
                                                      massage.
32200.............  ..............  A                Drain, open, lung           15.27         NA       8.63       2.13         NA      26.03        090
                                                      lesion.
32201.............  ..............  A                Drain, percut, lung          3.99      20.76       1.30       0.24      24.99       5.53        000
                                                      lesion.
32215.............  ..............  A                Treat chest lining....      11.31         NA       6.92       1.68         NA      19.91        090
32220.............  ..............  A                Release of lung.......      23.96         NA      12.99       3.56         NA      40.51        090
32225.............  ..............  A                Partial release of          13.94         NA       7.67       2.06         NA      23.67        090
                                                      lung.
32310.............  ..............  A                Removal of chest            13.42         NA       7.41       1.99         NA      22.82        090
                                                      lining.
32320.............  ..............  A                Free/remove chest           23.96         NA      12.19       3.51         NA      39.66        090
                                                      lining.
32400.............  ..............  A                Needle biopsy chest          1.76       2.13       0.55       0.10       3.99       2.41        000
                                                      lining.
32402.............  ..............  A                Open biopsy chest            7.55         NA       5.12       1.07         NA      13.74        090
                                                      lining.
32405.............  ..............  A                Biopsy, lung or              1.93       0.67       0.63       0.11       2.71       2.67        000
                                                      mediastinum.
32420.............  ..............  A                Puncture/clear lung...       2.18         NA       0.68       0.12         NA       2.98        000
32440.............  ..............  A                Removal of lung.......      24.96         NA      12.93       3.68         NA      41.57        090

[[Page 70368]]

 
32442.............  ..............  A                Sleeve pneumonectomy..      26.20         NA      14.80       3.84         NA      44.84        090
32445.............  ..............  A                Removal of lung.......      25.05         NA      14.10       3.71         NA      42.86        090
32480.............  ..............  A                Partial removal of          23.71         NA      12.09       3.49         NA      39.29        090
                                                      lung.
32482.............  ..............  A                Bilobectomy...........      24.96         NA      12.95       3.66         NA      41.57        090
32484.............  ..............  A                Segmentectomy.........      20.66         NA      11.41       3.03         NA      35.10        090
32486.............  ..............  A                Sleeve lobectomy......      23.88         NA      13.28       3.51         NA      40.67        090
32488.............  ..............  A                Completion                  25.67         NA      13.82       3.80         NA      43.29        090
                                                      pneumonectomy.
32491.............  ..............  R                Lung volume reduction.      21.22         NA      12.66       2.98         NA      36.86        090
32500.............  ..............  A                Partial removal of          21.97         NA      12.39       3.25         NA      37.61        090
                                                      lung.
32501.............  ..............  A                Repair bronchus add-on       4.68         NA       1.54       0.65         NA       6.87        ZZZ
32503.............  ..............  A                Resect apical lung          30.00         NA      15.11       4.37         NA      49.48        090
                                                      tumor.
32504.............  ..............  A                Resect apical lung tum/     34.80         NA      16.72       5.07         NA      56.59        090
                                                      chest.
32540.............  ..............  A                Removal of lung lesion      14.62         NA       9.66       2.07         NA      26.35        090
32601.............  ..............  A                Thoracoscopy,                5.45         NA       2.36       0.80         NA       8.61        000
                                                      diagnostic.
32602.............  ..............  A                Thoracoscopy,                5.95         NA       2.53       0.87         NA       9.35        000
                                                      diagnostic.
32603.............  ..............  A                Thoracoscopy,                7.80         NA       3.04       1.14         NA      11.98        000
                                                      diagnostic.
32604.............  ..............  A                Thoracoscopy,                8.77         NA       3.46       1.25         NA      13.48        000
                                                      diagnostic.
32605.............  ..............  A                Thoracoscopy,                6.92         NA       2.91       1.00         NA      10.83        000
                                                      diagnostic.
32606.............  ..............  A                Thoracoscopy,                8.39         NA       3.34       1.22         NA      12.95        000
                                                      diagnostic.
32650.............  ..............  A                Thoracoscopy, surgical      10.73         NA       6.78       1.58         NA      19.09        090
32651.............  ..............  A                Thoracoscopy, surgical      12.89         NA       7.25       1.86         NA      22.00        090
32652.............  ..............  A                Thoracoscopy, surgical      18.63         NA      10.17       2.72         NA      31.52        090
32653.............  ..............  A                Thoracoscopy, surgical      12.85         NA       6.99       1.88         NA      21.72        090
32654.............  ..............  A                Thoracoscopy, surgical      12.42         NA       7.55       1.63         NA      21.60        090
32655.............  ..............  A                Thoracoscopy, surgical      13.08         NA       7.26       1.89         NA      22.23        090
32656.............  ..............  A                Thoracoscopy, surgical      12.89         NA       7.96       1.89         NA      22.74        090
32657.............  ..............  A                Thoracoscopy, surgical      13.63         NA       7.70       1.99         NA      23.32        090
32658.............  ..............  A                Thoracoscopy, surgical      11.61         NA       7.37       1.69         NA      20.67        090
32659.............  ..............  A                Thoracoscopy, surgical      11.57         NA       7.47       1.62         NA      20.66        090
32660.............  ..............  A                Thoracoscopy, surgical      17.40         NA       9.51       2.08         NA      28.99        090
32661.............  ..............  A                Thoracoscopy, surgical      13.23         NA       7.81       1.92         NA      22.96        090
32662.............  ..............  A                Thoracoscopy, surgical      16.42         NA       8.85       2.17         NA      27.44        090
32663.............  ..............  A                Thoracoscopy, surgical      18.44         NA      10.79       2.72         NA      31.95        090
32664.............  ..............  A                Thoracoscopy, surgical      14.18         NA       7.65       2.32         NA      24.15        090
32665.............  ..............  A                Thoracoscopy, surgical      15.52         NA       8.15       2.15         NA      25.82        090
32800.............  ..............  A                Repair lung hernia....      13.67         NA       7.43       1.98         NA      23.08        090
32810.............  ..............  A                Close chest after           13.03         NA       7.54       1.93         NA      22.50        090
                                                      drainage.
32815.............  ..............  A                Close bronchial             23.12         NA      11.00       3.27         NA      37.39        090
                                                      fistula.
32820.............  ..............  A                Reconstruct injured         21.45         NA      12.20       2.52         NA      36.17        090
                                                      chest.
32850.............  ..............  X                Donor pneumonectomy...       0.00       0.00       0.00       0.00       0.00       0.00        XXX
32851.............  ..............  A                Lung transplant,            38.57         NA      27.74       5.56         NA      71.87        090
                                                      single.
32852.............  ..............  A                Lung transplant with        41.74         NA      33.26       6.00         NA      81.00        090
                                                      bypass.
32853.............  ..............  A                Lung transplant,            47.74         NA      31.84       7.05         NA      86.63        090
                                                      double.
32854.............  ..............  A                Lung transplant with        50.90         NA      34.83       7.20         NA      92.93        090
                                                      bypass.
32855.............  ..............  C                Prepare donor lung,          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      single.
32856.............  ..............  C                Prepare donor lung,          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      double.
32900.............  ..............  A                Removal of rib(s).....      20.24         NA       9.91       2.93         NA      33.08        090
32905.............  ..............  A                Revise & repair chest       20.72         NA      10.16       3.15         NA      34.03        090
                                                      wall.
32906.............  ..............  A                Revise & repair chest       26.73         NA      12.09       3.97         NA      42.79        090
                                                      wall.
32940.............  ..............  A                Revision of lung......      19.40         NA       9.50       2.88         NA      31.78        090
32960.............  ..............  A                Therapeutic                  1.84       1.74       0.56       0.16       3.74       2.56        000
                                                      pneumothorax.
32997.............  ..............  A                Total lung lavage.....       5.99         NA       1.92       0.55         NA       8.46        000
32999.............  ..............  C                Chest surgery                0.00       0.00       0.00       0.00       0.00       0.00        YYY
                                                      procedure.
33010.............  ..............  A                Drainage of heart sac.       2.24         NA       0.78       0.14         NA       3.16        000
33011.............  ..............  A                Repeat drainage of           2.24         NA       0.81       0.15         NA       3.20        000
                                                      heart sac.
33015.............  ..............  A                Incision of heart sac.       6.79         NA       4.96       0.65         NA      12.40        090
33020.............  ..............  A                Incision of heart sac.      12.59         NA       6.80       1.79         NA      21.18        090
33025.............  ..............  A                Incision of heart sac.      12.07         NA       6.37       1.80         NA      20.24        090
33030.............  ..............  A                Partial removal of          18.68         NA       9.55       2.83         NA      31.06        090
                                                      heart sac.
33031.............  ..............  A                Partial removal of          21.76         NA      10.06       3.13         NA      34.95        090
                                                      heart sac.
33050.............  ..............  A                Removal of heart sac        14.34         NA       7.86       2.14         NA      24.34        090
                                                      lesion.
33120.............  ..............  A                Removal of heart            24.52         NA      11.61       3.69         NA      39.82        090
                                                      lesion.
33130.............  ..............  A                Removal of heart            21.36         NA      10.14       3.00         NA      34.50        090
                                                      lesion.
33140.............  ..............  A                Heart revascularize         19.97         NA      10.91       2.85         NA      33.73        090
                                                      (tmr).
33141.............  ..............  A                Heart tmr w/other            4.83         NA       1.58       0.69         NA       7.10        ZZZ
                                                      procedure.
33200.............  ..............  A                Insertion of heart          12.46         NA       6.86       1.70         NA      21.02        090
                                                      pacemaker.
33201.............  ..............  A                Insertion of heart          10.16         NA       6.60       1.36         NA      18.12        090
                                                      pacemaker.
33206.............  ..............  A                Insertion of heart           6.66         NA       4.47       0.52         NA      11.65        090
                                                      pacemaker.
33207.............  ..............  A                Insertion of heart           8.03         NA       4.67       0.59         NA      13.29        090
                                                      pacemaker.
33208.............  ..............  A                Insertion of heart           8.12         NA       4.78       0.56         NA      13.46        090
                                                      pacemaker.
33210.............  ..............  A                Insertion of heart           3.30         NA       1.25       0.18         NA       4.73        000
                                                      electrode.
33211.............  ..............  A                Insertion of heart           3.39         NA       1.31       0.21         NA       4.91        000
                                                      electrode.
33212.............  ..............  A                Insertion of pulse           5.51         NA       3.37       0.43         NA       9.31        090
                                                      generator.
33213.............  ..............  A                Insertion of pulse           6.36         NA       3.73       0.45         NA      10.54        090
                                                      generator.
33214.............  ..............  A                Upgrade of pacemaker         7.74         NA       4.90       0.58         NA      13.22        090
                                                      system.

[[Page 70369]]

 
33215.............  ..............  A                Reposition pacing-           4.75         NA       3.19       0.37         NA       8.31        090
                                                      defib lead.
33216.............  ..............  A                Insert lead pace-            5.77         NA       4.21       0.36         NA      10.34        090
                                                      defib, one.
33217.............  ..............  A                Insert lead pace-            5.74         NA       4.24       0.39         NA      10.37        090
                                                      defib, dual.
33218.............  ..............  A                Repair lead pace-            5.43         NA       4.31       0.37         NA      10.11        090
                                                      defib, one.
33220.............  ..............  A                Repair lead pace-            5.51         NA       4.28       0.37         NA      10.16        090
                                                      defib, dual.
33222.............  ..............  A                Revise pocket,               4.95         NA       4.30       0.42         NA       9.67        090
                                                      pacemaker.
33223.............  ..............  A                Revise pocket, pacing-       6.45         NA       4.60       0.45         NA      11.50        090
                                                      defib.
33224.............  ..............  A                Insert pacing lead &         9.04         NA       4.01       0.54         NA      13.59        000
                                                      connect.
33225.............  ..............  A                L ventric pacing lead        8.33         NA       3.26       0.45         NA      12.04        ZZZ
                                                      add-on.
33226.............  ..............  A                Reposition l ventric         8.68         NA       3.83       0.59         NA      13.10        000
                                                      lead.
33233.............  ..............  A                Removal of pacemaker         3.29         NA       3.28       0.22         NA       6.79        090
                                                      system.
33234.............  ..............  A                Removal of pacemaker         7.81         NA       4.92       0.56         NA      13.29        090
                                                      system.
33235.............  ..............  A                Removal pacemaker            9.39         NA       6.83       0.73         NA      16.95        090
                                                      electrode.
33236.............  ..............  A                Remove electrode/           12.58         NA       7.45       1.68         NA      21.71        090
                                                      thoracotomy.
33237.............  ..............  A                Remove electrode/           13.69         NA       7.80       1.59         NA      23.08        090
                                                      thoracotomy.
33238.............  ..............  A                Remove electrode/           15.20         NA       8.22       2.02         NA      25.44        090
                                                      thoracotomy.
33240.............  ..............  A                Insert pulse generator       7.59         NA       4.59       0.41         NA      12.59        090
33241.............  ..............  A                Remove pulse generator       3.24         NA       2.97       0.18         NA       6.39        090
33243.............  ..............  A                Remove eltrd/               22.61         NA      11.49       2.09         NA      36.19        090
                                                      thoracotomy.
33244.............  ..............  A                Remove eltrd, transven      13.74         NA       8.92       0.99         NA      23.65        090
33245.............  ..............  A                Insert epic eltrd pace-     14.28         NA       7.92       2.01         NA      24.21        090
                                                      defib.
33246.............  ..............  A                Insert epic eltrd/          20.68         NA      10.31       2.63         NA      33.62        090
                                                      generator.
33249.............  ..............  A                Eltrd/insert pace-          14.21         NA       8.38       0.77         NA      23.36        090
                                                      defib.
33250.............  ..............  A                Ablate heart dysrhythm      21.82         NA      11.05       3.18         NA      36.05        090
                                                      focus.
33251.............  ..............  A                Ablate heart dysrhythm      24.84         NA      11.69       3.59         NA      40.12        090
                                                      focus.
33253.............  ..............  A                Reconstruct atria.....      31.01         NA      13.86       4.52         NA      49.39        090
33261.............  ..............  A                Ablate heart dysrhythm      24.84         NA      11.80       3.45         NA      40.09        090
                                                      focus.
33282.............  ..............  A                Implant pat-active ht        4.16         NA       4.03       0.23         NA       8.42        090
                                                      record.
33284.............  ..............  A                Remove pat-active ht         2.50         NA       3.54       0.14         NA       6.18        090
                                                      record.
33300.............  ..............  A                Repair of heart wound.      17.89         NA       9.26       2.65         NA      29.80        090
33305.............  ..............  A                Repair of heart wound.      21.41         NA      10.64       3.12         NA      35.17        090
33310.............  ..............  A                Exploratory heart           18.48         NA       9.61       2.58         NA      30.67        090
                                                      surgery.
33315.............  ..............  A                Exploratory heart           22.34         NA      10.91       3.27         NA      36.52        090
                                                      surgery.
33320.............  ..............  A                Repair major blood          16.76         NA       8.24       2.07         NA      27.07        090
                                                      vessel(s).
33321.............  ..............  A                Repair major vessel...      20.17         NA       9.81       2.90         NA      32.88        090
33322.............  ..............  A                Repair major blood          20.59         NA      10.39       2.85         NA      33.83        090
                                                      vessel(s).
33330.............  ..............  A                Insert major vessel         21.40         NA      10.29       2.81         NA      34.50        090
                                                      graft.
33332.............  ..............  A                Insert major vessel         23.92         NA      10.54       3.02         NA      37.48        090
                                                      graft.
33335.............  ..............  A                Insert major vessel         29.96         NA      13.37       4.27         NA      47.60        090
                                                      graft.
33400.............  ..............  A                Repair of aortic valve      28.46         NA      15.71       4.10         NA      48.27        090
33401.............  ..............  A                Valvuloplasty, open...      23.87         NA      13.54       3.56         NA      40.97        090
33403.............  ..............  A                Valvuloplasty, w/cp         24.85         NA      14.34       3.54         NA      42.73        090
                                                      bypass.
33404.............  ..............  A                Prepare heart-aorta         28.50         NA      14.58       4.32         NA      47.40        090
                                                      conduit.
33405.............  ..............  A                Replacement of aortic       34.95         NA      18.34       5.31         NA      58.60        090
                                                      valve.
33406.............  ..............  A                Replacement of aortic       37.44         NA      19.18       5.43         NA      62.05        090
                                                      valve.
33410.............  ..............  A                Replacement of aortic       32.41         NA      16.63       4.68         NA      53.72        090
                                                      valve.
33411.............  ..............  A                Replacement of aortic       36.20         NA      18.79       5.46         NA      60.45        090
                                                      valve.
33412.............  ..............  A                Replacement of aortic       41.94         NA      20.46       6.37         NA      68.77        090
                                                      valve.
33413.............  ..............  A                Replacement of aortic       43.43         NA      20.87       6.51         NA      70.81        090
                                                      valve.
33414.............  ..............  A                Repair of aortic valve      30.30         NA      14.17       4.56         NA      49.03        090
33415.............  ..............  A                Revision, subvalvular       27.11         NA      12.05       4.13         NA      43.29        090
                                                      tissue.
33416.............  ..............  A                Revise ventricle            30.30         NA      13.54       4.56         NA      48.40        090
                                                      muscle.
33417.............  ..............  A                Repair of aortic valve      28.49         NA      13.65       4.09         NA      46.23        090
33420.............  ..............  A                Revision of mitral          22.67         NA       9.59       1.81         NA      34.07        090
                                                      valve.
33422.............  ..............  A                Revision of mitral          25.90         NA      13.69       3.93         NA      43.52        090
                                                      valve.
33425.............  ..............  A                Repair of mitral valve      26.96         NA      13.09       4.06         NA      44.11        090
33426.............  ..............  A                Repair of mitral valve      32.95         NA      17.18       5.01         NA      55.14        090
33427.............  ..............  A                Repair of mitral valve      39.94         NA      19.42       6.07         NA      65.43        090
33430.............  ..............  A                Replacement of mitral       33.45         NA      17.34       5.08         NA      55.87        090
                                                      valve.
33460.............  ..............  A                Revision of tricuspid       23.56         NA      11.33       3.44         NA      38.33        090
                                                      valve.
33463.............  ..............  A                Valvuloplasty,              25.58         NA      12.95       3.86         NA      42.39        090
                                                      tricuspid.
33464.............  ..............  A                Valvuloplasty,              27.29         NA      13.56       4.14         NA      44.99        090
                                                      tricuspid.
33465.............  ..............  A                Replace tricuspid           28.75         NA      13.00       4.38         NA      46.13        090
                                                      valve.
33468.............  ..............  A                Revision of tricuspid       30.07         NA      13.69       4.06         NA      47.82        090
                                                      valve.
33470.............  ..............  A                Revision of pulmonary       20.78         NA      10.72       1.03         NA      32.53        090
                                                      valve.
33471.............  ..............  A                Valvotomy, pulmonary        22.22         NA       9.78       3.38         NA      35.38        090
                                                      valve.
33472.............  ..............  A                Revision of pulmonary       22.22         NA      11.89       3.54         NA      37.65        090
                                                      valve.
33474.............  ..............  A                Revision of pulmonary       23.01         NA      10.91       3.21         NA      37.13        090
                                                      valve.
33475.............  ..............  A                Replacement, pulmonary      32.95         NA      15.41       4.92         NA      53.28        090
                                                      valve.
33476.............  ..............  A                Revision of heart           25.73         NA      11.99       2.41         NA      40.13        090
                                                      chamber.
33478.............  ..............  A                Revision of heart           26.70         NA      13.09       3.88         NA      43.67        090
                                                      chamber.
33496.............  ..............  A                Repair, prosth valve        27.21         NA      12.78       4.12         NA      44.11        090
                                                      clot.
33500.............  ..............  A                Repair heart vessel         25.51         NA      11.49       3.86         NA      40.86        090
                                                      fistula.
33501.............  ..............  A                Repair heart vessel         17.75         NA       8.30       1.90         NA      27.95        090
                                                      fistula.
33502.............  ..............  A                Coronary artery             21.01         NA      11.10       2.99         NA      35.10        090
                                                      correction.

[[Page 70370]]

 
33503.............  ..............  A                Coronary artery graft.      21.75         NA       9.76       1.77         NA      33.28        090
33504.............  ..............  A                Coronary artery graft.      24.62         NA      11.84       3.35         NA      39.81        090
33505.............  ..............  A                Repair artery w/tunnel      26.80         NA      12.94       2.18         NA      41.92        090
33506.............  ..............  A                Repair artery,              35.45         NA      14.60       4.65         NA      54.70        090
                                                      translocation.
33507.............  ..............  A                Repair art, intramural      30.00         NA      13.68       4.05         NA      47.73        090
33508.............  ..............  A                Endoscopic vein              0.31         NA       0.10       0.04         NA       0.45        ZZZ
                                                      harvest.
33510.............  ..............  A                CABG, vein, single....      28.96         NA      16.38       4.40         NA      49.74        090
33511.............  ..............  A                CABG, vein, two.......      29.96         NA      17.12       4.55         NA      51.63        090
33512.............  ..............  A                CABG, vein, three.....      31.75         NA      17.65       4.66         NA      54.06        090
33513.............  ..............  A                CABG, vein, four......      31.95         NA      17.83       4.87         NA      54.65        090
33514.............  ..............  A                CABG, vein, five......      32.70         NA      18.10       4.76         NA      55.56        090
33516.............  ..............  A                Cabg, vein, six or          34.95         NA      18.85       5.11         NA      58.91        090
                                                      more.
33517.............  ..............  A                CABG, artery-vein,           2.57         NA       0.84       0.39         NA       3.80        ZZZ
                                                      single.
33518.............  ..............  A                CABG, artery-vein, two       4.84         NA       1.58       0.73         NA       7.15        ZZZ
33519.............  ..............  A                CABG, artery-vein,           7.11         NA       2.33       1.04         NA      10.48        ZZZ
                                                      three.
33521.............  ..............  A                CABG, artery-vein,           9.39         NA       3.08       1.37         NA      13.84        ZZZ
                                                      four.
33522.............  ..............  A                CABG, artery-vein,          11.65         NA       3.82       1.77         NA      17.24        ZZZ
                                                      five.
33523.............  ..............  A                Cabg, art-vein, six or      13.93         NA       4.54       2.12         NA      20.59        ZZZ
                                                      more.
33530.............  ..............  A                Coronary artery,             5.85         NA       1.92       0.88         NA       8.65        ZZZ
                                                      bypass/reop.
33533.............  ..............  A                CABG, arterial, single      29.96         NA      16.51       4.55         NA      51.02        090
33534.............  ..............  A                CABG, arterial, two...      32.15         NA      17.76       4.69         NA      54.60        090
33535.............  ..............  A                CABG, arterial, three.      34.45         NA      18.18       5.01         NA      57.64        090
33536.............  ..............  A                Cabg, arterial, four        37.44         NA      18.34       5.42         NA      61.20        090
                                                      or more.
33542.............  ..............  A                Removal of heart            28.81         NA      13.03       4.37         NA      46.21        090
                                                      lesion.
33545.............  ..............  A                Repair of heart damage      36.72         NA      15.67       5.19         NA      57.58        090
33548.............  ..............  A                Restore/remodel,            37.97         NA      19.35       5.51         NA      62.83        090
                                                      ventricle.
33572.............  ..............  A                Open coronary                4.44         NA       1.45       0.65         NA       6.54        ZZZ
                                                      endarterectomy.
33600.............  ..............  A                Closure of valve......      29.47         NA      12.55       4.41         NA      46.43        090
33602.............  ..............  A                Closure of valve......      28.50         NA      12.48       3.81         NA      44.79        090
33606.............  ..............  A                Anastomosis/artery-         30.69         NA      13.71       4.40         NA      48.80        090
                                                      aorta.
33608.............  ..............  A                Repair anomaly w/           31.04         NA      14.14       4.73         NA      49.91        090
                                                      conduit.
33610.............  ..............  A                Repair by enlargement.      30.56         NA      13.64       4.55         NA      48.75        090
33611.............  ..............  A                Repair double               33.95         NA      14.17       4.36         NA      52.48        090
                                                      ventricle.
33612.............  ..............  A                Repair double               34.95         NA      15.19       5.28         NA      55.42        090
                                                      ventricle.
33615.............  ..............  A                Repair, modified            33.95         NA      13.18       4.31         NA      51.44        090
                                                      fontan.
33617.............  ..............  A                Repair single               36.94         NA      16.04       5.64         NA      58.62        090
                                                      ventricle.
33619.............  ..............  A                Repair single               44.93         NA      20.86       6.44         NA      72.23        090
                                                      ventricle.
33641.............  ..............  A                Repair heart septum         21.36         NA       9.60       3.22         NA      34.18        090
                                                      defect.
33645.............  ..............  A                Revision of heart           24.78         NA      11.80       3.78         NA      40.36        090
                                                      veins.
33647.............  ..............  A                Repair heart septum         28.69         NA      13.81       3.31         NA      45.81        090
                                                      defects.
33660.............  ..............  A                Repair of heart             29.96         NA      13.52       4.48         NA      47.96        090
                                                      defects.
33665.............  ..............  A                Repair of heart             28.56         NA      13.87       3.99         NA      46.42        090
                                                      defects.
33670.............  ..............  A                Repair of heart             34.95         NA      13.21       4.64         NA      52.80        090
                                                      chambers.
33681.............  ..............  A                Repair heart septum         30.56         NA      14.72       4.44         NA      49.72        090
                                                      defect.
33684.............  ..............  A                Repair heart septum         29.61         NA      13.66       3.38         NA      46.65        090
                                                      defect.
33688.............  ..............  A                Repair heart septum         30.57         NA      10.50       4.72         NA      45.79        090
                                                      defect.
33690.............  ..............  A                Reinforce pulmonary         19.52         NA      10.19       1.96         NA      31.67        090
                                                      artery.
33692.............  ..............  A                Repair of heart             30.70         NA      13.96       4.57         NA      49.23        090
                                                      defects.
33694.............  ..............  A                Repair of heart             33.95         NA      14.26       5.26         NA      53.47        090
                                                      defects.
33697.............  ..............  A                Repair of heart             35.95         NA      14.91       4.08         NA      54.94        090
                                                      defects.
33702.............  ..............  A                Repair of heart             26.50         NA      12.60       3.67         NA      42.77        090
                                                      defects.
33710.............  ..............  A                Repair of heart             29.67         NA      14.00       4.42         NA      48.09        090
                                                      defects.
33720.............  ..............  A                Repair of heart defect      26.52         NA      12.32       3.83         NA      42.67        090
33722.............  ..............  A                Repair of heart defect      28.37         NA      13.89       1.30         NA      43.56        090
33730.............  ..............  A                Repair heart-vein           34.20         NA      14.16       5.01         NA      53.37        090
                                                      defect(s).
33732.............  ..............  A                Repair heart-vein           28.12         NA      13.42       3.67         NA      45.21        090
                                                      defect.
33735.............  ..............  A                Revision of heart           21.36         NA       8.98       1.91         NA      32.25        090
                                                      chamber.
33736.............  ..............  A                Revision of heart           23.48         NA      11.88       3.08         NA      38.44        090
                                                      chamber.
33737.............  ..............  A                Revision of heart           21.73         NA      10.96       3.24         NA      35.93        090
                                                      chamber.
33750.............  ..............  A                Major vessel shunt....      21.38         NA      10.24       1.16         NA      32.78        090
33755.............  ..............  A                Major vessel shunt....      21.76         NA       8.83       3.25         NA      33.84        090
33762.............  ..............  A                Major vessel shunt....      21.76         NA      10.18       3.13         NA      35.07        090
33764.............  ..............  A                Major vessel shunt &        21.76         NA      10.25       3.00         NA      35.01        090
                                                      graft.
33766.............  ..............  A                Major vessel shunt....      22.73         NA      11.70       3.69         NA      38.12        090
33767.............  ..............  A                Major vessel shunt....      24.46         NA      11.75       3.81         NA      40.02        090
33768.............  ..............  A                Cavopulmonary shunting       8.00         NA       2.67       1.19         NA      11.86        ZZZ
33770.............  ..............  A                Repair great vessels        36.94         NA      14.72       5.72         NA      57.38        090
                                                      defect.
33771.............  ..............  A                Repair great vessels        34.60         NA      12.42       5.66         NA      52.68        090
                                                      defect.
33774.............  ..............  A                Repair great vessels        30.93         NA      14.70       4.80         NA      50.43        090
                                                      defect.
33775.............  ..............  A                Repair great vessels        32.15         NA      15.03       4.98         NA      52.16        090
                                                      defect.
33776.............  ..............  A                Repair great vessels        33.99         NA      15.85       5.07         NA      54.91        090
                                                      defect.
33777.............  ..............  A                Repair great vessels        33.41         NA      15.66       5.47         NA      54.54        090
                                                      defect.
33778.............  ..............  A                Repair great vessels        39.94         NA      16.94       6.18         NA      63.06        090
                                                      defect.
33779.............  ..............  A                Repair great vessels        36.16         NA      15.41       2.91         NA      54.48        090
                                                      defect.
33780.............  ..............  A                Repair great vessels        41.69         NA      19.14       3.67         NA      64.50        090
                                                      defect.

[[Page 70371]]

 
33781.............  ..............  A                Repair great vessels        36.40         NA      13.37       5.95         NA      55.72        090
                                                      defect.
33786.............  ..............  A                Repair arterial trunk.      38.94         NA      16.76       5.69         NA      61.39        090
33788.............  ..............  A                Revision of pulmonary       26.58         NA      11.98       4.02         NA      42.58        090
                                                      artery.
33800.............  ..............  A                Aortic suspension.....      16.22         NA       8.13       2.45         NA      26.80        090
33802.............  ..............  A                Repair vessel defect..      17.63         NA       9.25       2.26         NA      29.14        090
33803.............  ..............  A                Repair vessel defect..      19.57         NA       9.79       3.19         NA      32.55        090
33813.............  ..............  A                Repair septal defect..      20.62         NA      10.94       3.12         NA      34.68        090
33814.............  ..............  A                Repair septal defect..      25.73         NA      12.68       3.84         NA      42.25        090
33820.............  ..............  A                Revise major vessel...      16.27         NA       8.38       2.34         NA      26.99        090
33822.............  ..............  A                Revise major vessel...      17.29         NA       8.98       2.67         NA      28.94        090
33824.............  ..............  A                Revise major vessel...      19.49         NA      10.01       2.88         NA      32.38        090
33840.............  ..............  A                Remove aorta                20.60         NA      10.32       2.15         NA      33.07        090
                                                      constriction.
33845.............  ..............  A                Remove aorta                22.09         NA      11.38       3.21         NA      36.68        090
                                                      constriction.
33851.............  ..............  A                Remove aorta                21.24         NA      10.71       3.17         NA      35.12        090
                                                      constriction.
33852.............  ..............  A                Repair septal defect..      23.67         NA      11.39       2.15         NA      37.21        090
33853.............  ..............  A                Repair septal defect..      31.67         NA      14.86       4.47         NA      51.00        090
33860.............  ..............  A                Ascending aortic graft      37.94         NA      16.50       5.74         NA      60.18        090
33861.............  ..............  A                Ascending aortic graft      41.94         NA      17.76       6.35         NA      66.05        090
33863.............  ..............  A                Ascending aortic graft      44.93         NA      18.74       6.57         NA      70.24        090
33870.............  ..............  A                Transverse aortic arch      43.93         NA      18.43       6.60         NA      68.96        090
                                                      graft.
33875.............  ..............  A                Thoracic aortic graft.      33.01         NA      14.13       4.88         NA      52.02        090
33877.............  ..............  A                Thoracoabdominal graft      42.54         NA      16.36       5.92         NA      64.82        090
33880.............  ..............  A                Endovasc taa repr incl      33.00         NA      13.51       2.74         NA      49.25        090
                                                      subcl.
33881.............  ..............  A                Endovasc taa repr w/o       28.00         NA      11.99       2.32         NA      42.31        090
                                                      subcl.
33883.............  ..............  A                Insert endovasc             20.00         NA       9.21       2.10         NA      31.31        090
                                                      prosth, taa.
33884.............  ..............  A                Endovasc prosth, taa,        8.20         NA       2.58       0.86         NA      11.64        ZZZ
                                                      add-on.
33886.............  ..............  A                Endovasc prosth,            17.00         NA       8.25       1.79         NA      27.04        090
                                                      delayed.
33889.............  ..............  A                Artery transpose/           15.92         NA       5.19       2.17         NA      23.28        000
                                                      endovas taa.
33891.............  ..............  A                Car-car bp grft/            20.00         NA       6.98       2.72         NA      29.70        000
                                                      endovas taa.
33910.............  ..............  A                Remove lung artery          24.55         NA      11.46       3.69         NA      39.70        090
                                                      emboli.
33915.............  ..............  A                Remove lung artery          20.99         NA       9.66       1.44         NA      32.09        090
                                                      emboli.
33916.............  ..............  A                Surgery of great            25.79         NA      11.37       3.66         NA      40.82        090
                                                      vessel.
33917.............  ..............  A                Repair pulmonary            24.46         NA      12.22       3.69         NA      40.37        090
                                                      artery.
33920.............  ..............  A                Repair pulmonary            31.90         NA      13.86       4.37         NA      50.13        090
                                                      atresia.
33922.............  ..............  A                Transect pulmonary          23.48         NA      10.93       3.09         NA      37.50        090
                                                      artery.
33924.............  ..............  A                Remove pulmonary shunt       5.49         NA       1.85       0.82         NA       8.16        ZZZ
33925.............  ..............  A                Rpr pul art unifocal w/     29.50         NA      14.70       4.60         NA      48.80        090
                                                      o cpb.
33926.............  ..............  A                Repr pul art, unifocal      42.00         NA      17.73       6.20         NA      65.93        090
                                                      w/cpb.
33930.............  ..............  X                Removal of donor heart/      0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      lung.
33933.............  ..............  C                Prepare donor heart/         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      lung.
33935.............  ..............  R                Transplantation, heart/     60.87         NA      28.85       9.03         NA      98.75        090
                                                      lung.
33940.............  ..............  X                Removal of donor heart       0.00       0.00       0.00       0.00       0.00       0.00        XXX
33944.............  ..............  C                Prepare donor heart...       0.00       0.00       0.00       0.00       0.00       0.00        XXX
33945.............  ..............  R                Transplantation of          42.04         NA      21.45       6.24         NA      69.73        090
                                                      heart.
33960.............  ..............  A                External circulation        19.33         NA       4.92       2.66         NA      26.91        000
                                                      assist.
33961.............  ..............  A                External circulation        10.91         NA       3.62       0.88         NA      15.41        ZZZ
                                                      assist.
33967.............  ..............  A                Insert ia percut             4.84         NA       1.85       0.35         NA       7.04        000
                                                      device.
33968.............  ..............  A                Remove aortic assist         0.64         NA       0.23       0.07         NA       0.94        000
                                                      device.
33970.............  ..............  A                Aortic circulation           6.74         NA       2.29       0.82         NA       9.85        000
                                                      assist.
33971.............  ..............  A                Aortic circulation           9.68         NA       6.02       1.25         NA      16.95        090
                                                      assist.
33973.............  ..............  A                Insert balloon device.       9.75         NA       3.32       1.26         NA      14.33        000
33974.............  ..............  A                Remove intra-aortic         14.39         NA       7.90       1.73         NA      24.02        090
                                                      balloon.
33975.............  ..............  A                Implant ventricular         20.97         NA       6.30       3.06         NA      30.33        XXX
                                                      device.
33976.............  ..............  A                Implant ventricular         22.97         NA       7.57       3.25         NA      33.79        XXX
                                                      device.
33977.............  ..............  A                Remove ventricular          19.26         NA      11.10       2.80         NA      33.16        090
                                                      device.
33978.............  ..............  A                Remove ventricular          21.70         NA      11.78       3.30         NA      36.78        090
                                                      device.
33979.............  ..............  A                Insert intracorporeal       45.93         NA      14.96       6.95         NA      67.84        XXX
                                                      device.
33980.............  ..............  A                Remove intracorporeal       56.17         NA      25.31       8.56         NA      90.04        090
                                                      device.
33999.............  ..............  C                Cardiac surgery              0.00       0.00       0.00       0.00       0.00       0.00        YYY
                                                      procedure.
34001.............  ..............  A                Removal of artery clot      12.89         NA       6.73       1.84         NA      21.46        090
34051.............  ..............  A                Removal of artery clot      15.19         NA       7.80       2.20         NA      25.19        090
34101.............  ..............  A                Removal of artery clot       9.99         NA       5.37       1.41         NA      16.77        090
34111.............  ..............  A                Removal of arm artery        9.99         NA       5.37       1.40         NA      16.76        090
                                                      clot.
34151.............  ..............  A                Removal of artery clot      24.96         NA      10.43       3.55         NA      38.94        090
34201.............  ..............  A                Removal of artery clot      10.01         NA       5.43       1.45         NA      16.89        090
34203.............  ..............  A                Removal of leg artery       16.48         NA       8.08       2.35         NA      26.91        090
                                                      clot.
34401.............  ..............  A                Removal of vein clot..      24.96         NA      10.69       3.09         NA      38.74        090
34421.............  ..............  A                Removal of vein clot..      11.98         NA       6.31       1.55         NA      19.84        090
34451.............  ..............  A                Removal of vein clot..      26.96         NA      11.47       3.83         NA      42.26        090
34471.............  ..............  A                Removal of vein clot..      10.16         NA       5.32       1.18         NA      16.66        090
34490.............  ..............  A                Removal of vein clot..       9.85         NA       5.44       1.41         NA      16.70        090
34501.............  ..............  A                Repair valve, femoral       15.98         NA       8.51       2.34         NA      26.83        090
                                                      vein.
34502.............  ..............  A                Reconstruct vena cava.      26.91         NA      12.33       3.62         NA      42.86        090
34510.............  ..............  A                Transposition of vein       18.92         NA       9.44       2.32         NA      30.68        090
                                                      valve.
34520.............  ..............  A                Cross-over vein graft.      17.92         NA       8.47       2.28         NA      28.67        090

[[Page 70372]]

 
34530.............  ..............  A                Leg vein fusion.......      16.62         NA       8.63       1.73         NA      26.98        090
34800.............  ..............  A                Endovas aaa repr w/sm       20.72         NA       9.19       2.45         NA      32.36        090
                                                      tube.
34802.............  ..............  A                Endovas aaa repr w/2-p      22.97         NA       9.81       2.32         NA      35.10        090
                                                      part.
34803.............  ..............  A                Endovas aaa repr w/3-p      24.00         NA      10.24       2.00         NA      36.24        090
                                                      part.
34804.............  ..............  A                Endovas aaa repr w/1-p      22.97         NA       9.83       2.29         NA      35.09        090
                                                      part.
34805.............  ..............  A                Endovas aaa repr w/         21.85         NA       9.67       2.00         NA      33.52        090
                                                      long tube.
34808.............  ..............  A                Endovas iliac a device       4.12         NA       1.37       0.59         NA       6.08        ZZZ
                                                      addon.
34812.............  ..............  A                Xpose for endoprosth,        6.74         NA       2.24       1.18         NA      10.16        000
                                                      femorl.
34813.............  ..............  A                Femoral endovas graft        4.79         NA       1.57       0.67         NA       7.03        ZZZ
                                                      add-on.
34820.............  ..............  A                Xpose for endoprosth,        9.74         NA       3.24       1.50         NA      14.48        000
                                                      iliac.
34825.............  ..............  A                Endovasc extend             11.98         NA       6.16       1.28         NA      19.42        090
                                                      prosth, init.
34826.............  ..............  A                Endovasc exten prosth,       4.12         NA       1.37       0.44         NA       5.93        ZZZ
                                                      add'l.
34830.............  ..............  A                Open aortic tube            32.54         NA      13.73       4.54         NA      50.81        090
                                                      prosth repr.
34831.............  ..............  A                Open aortoiliac prosth      35.29         NA      11.76       4.88         NA      51.93        090
                                                      repr.
34832.............  ..............  A                Open aortofemor prosth      35.29         NA      14.66       4.84         NA      54.79        090
                                                      repr.
34833.............  ..............  A                Xpose for endoprosth,       11.98         NA       4.44       1.69         NA      18.11        000
                                                      iliac.
34834.............  ..............  A                Xpose, endoprosth,           5.34         NA       2.20       0.76         NA       8.30        000
                                                      brachial.
34900.............  ..............  A                Endovasc iliac repr w/      16.36         NA       7.60       1.99         NA      25.95        090
                                                      graft.
35001.............  ..............  A                Repair defect of            19.61         NA       9.58       2.80         NA      31.99        090
                                                      artery.
35002.............  ..............  A                Repair artery rupture,      20.97         NA       9.72       2.99         NA      33.68        090
                                                      neck.
35005.............  ..............  A                Repair defect of            18.09         NA       8.87       1.76         NA      28.72        090
                                                      artery.
35011.............  ..............  A                Repair defect of            17.97         NA       8.00       2.54         NA      28.51        090
                                                      artery.
35013.............  ..............  A                Repair artery rupture,      21.97         NA       9.70       3.09         NA      34.76        090
                                                      arm.
35021.............  ..............  A                Repair defect of            19.62         NA       9.44       2.86         NA      31.92        090
                                                      artery.
35022.............  ..............  A                Repair artery rupture,      23.15         NA       9.88       3.16         NA      36.19        090
                                                      chest.
35045.............  ..............  A                Repair defect of arm        17.54         NA       7.52       2.44         NA      27.50        090
                                                      artery.
35081.............  ..............  A                Repair defect of            27.97         NA      11.49       4.00         NA      43.46        090
                                                      artery.
35082.............  ..............  A                Repair artery rupture,      38.44         NA      15.33       5.42         NA      59.19        090
                                                      aorta.
35091.............  ..............  A                Repair defect of            35.35         NA      13.60       5.12         NA      54.07        090
                                                      artery.
35092.............  ..............  A                Repair artery rupture,      44.93         NA      17.68       6.38         NA      68.99        090
                                                      aorta.
35102.............  ..............  A                Repair defect of            30.71         NA      12.39       4.47         NA      47.57        090
                                                      artery.
35103.............  ..............  A                Repair artery rupture,      40.44         NA      15.89       5.74         NA      62.07        090
                                                      groin.
35111.............  ..............  A                Repair defect of            24.96         NA      10.49       3.46         NA      38.91        090
                                                      artery.
35112.............  ..............  A                Repair artery               29.96         NA      11.99       4.07         NA      46.02        090
                                                      rupture,spleen.
35121.............  ..............  A                Repair defect of            29.96         NA      12.40       4.29         NA      46.65        090
                                                      artery.
35122.............  ..............  A                Repair artery rupture,      34.95         NA      13.84       4.74         NA      53.53        090
                                                      belly.
35131.............  ..............  A                Repair defect of            24.96         NA      10.77       3.79         NA      39.52        090
                                                      artery.
35132.............  ..............  A                Repair artery rupture,      29.96         NA      12.41       4.29         NA      46.66        090
                                                      groin.
35141.............  ..............  A                Repair defect of            19.97         NA       8.94       2.89         NA      31.80        090
                                                      artery.
35142.............  ..............  A                Repair artery rupture,      23.27         NA      10.39       3.35         NA      37.01        090
                                                      thigh.
35151.............  ..............  A                Repair defect of            22.61         NA      10.01       3.23         NA      35.85        090
                                                      artery.
35152.............  ..............  A                Repair artery rupture,      25.58         NA      11.40       3.60         NA      40.58        090
                                                      knee.
35180.............  ..............  A                Repair blood vessel         13.60         NA       6.96       1.00         NA      21.56        090
                                                      lesion.
35182.............  ..............  A                Repair blood vessel         29.96         NA      12.83       4.35         NA      47.14        090
                                                      lesion.
35184.............  ..............  A                Repair blood vessel         17.97         NA       8.31       2.52         NA      28.80        090
                                                      lesion.
35188.............  ..............  A                Repair blood vessel         14.26         NA       7.65       2.15         NA      24.06        090
                                                      lesion.
35189.............  ..............  A                Repair blood vessel         27.96         NA      11.98       4.00         NA      43.94        090
                                                      lesion.
35190.............  ..............  A                Repair blood vessel         12.73         NA       6.49       1.79         NA      21.01        090
                                                      lesion.
35201.............  ..............  A                Repair blood vessel         16.12         NA       8.01       2.33         NA      26.46        090
                                                      lesion.
35206.............  ..............  A                Repair blood vessel         13.23         NA       6.57       1.86         NA      21.66        090
                                                      lesion.
35207.............  ..............  A                Repair blood vessel         10.13         NA       7.37       1.48         NA      18.98        090
                                                      lesion.
35211.............  ..............  A                Repair blood vessel         22.09         NA      10.64       3.19         NA      35.92        090
                                                      lesion.
35216.............  ..............  A                Repair blood vessel         18.72         NA       9.00       2.64         NA      30.36        090
                                                      lesion.
35221.............  ..............  A                Repair blood vessel         24.35         NA       9.96       3.36         NA      37.67        090
                                                      lesion.
35226.............  ..............  A                Repair blood vessel         14.48         NA       7.45       2.01         NA      23.94        090
                                                      lesion.
35231.............  ..............  A                Repair blood vessel         19.97         NA       9.79       2.88         NA      32.64        090
                                                      lesion.
35236.............  ..............  A                Repair blood vessel         17.08         NA       7.90       2.42         NA      27.40        090
                                                      lesion.
35241.............  ..............  A                Repair blood vessel         23.09         NA      11.15       3.52         NA      37.76        090
                                                      lesion.
35246.............  ..............  A                Repair blood vessel         26.41         NA      11.45       3.85         NA      41.71        090
                                                      lesion.
35251.............  ..............  A                Repair blood vessel         30.15         NA      11.82       4.12         NA      46.09        090
                                                      lesion.
35256.............  ..............  A                Repair blood vessel         18.33         NA       8.37       2.62         NA      29.32        090
                                                      lesion.
35261.............  ..............  A                Repair blood vessel         17.77         NA       8.03       2.60         NA      28.40        090
                                                      lesion.
35266.............  ..............  A                Repair blood vessel         14.89         NA       7.02       2.09         NA      24.00        090
                                                      lesion.
35271.............  ..............  A                Repair blood vessel         22.09         NA      10.54       3.15         NA      35.78        090
                                                      lesion.
35276.............  ..............  A                Repair blood vessel         24.21         NA      11.23       3.48         NA      38.92        090
                                                      lesion.
35281.............  ..............  A                Repair blood vessel         27.96         NA      11.73       3.96         NA      43.65        090
                                                      lesion.
35286.............  ..............  A                Repair blood vessel         16.14         NA       8.07       2.34         NA      26.55        090
                                                      lesion.
35301.............  ..............  A                Rechanneling of artery      18.67         NA       8.45       2.67         NA      29.79        090
35311.............  ..............  A                Rechanneling of artery      26.96         NA      11.77       3.41         NA      42.14        090
35321.............  ..............  A                Rechanneling of artery      15.98         NA       7.40       2.24         NA      25.62        090
35331.............  ..............  A                Rechanneling of artery      26.16         NA      11.26       3.82         NA      41.24        090
35341.............  ..............  A                Rechanneling of artery      25.07         NA      10.89       3.77         NA      39.73        090
35351.............  ..............  A                Rechanneling of artery      22.97         NA       9.62       3.34         NA      35.93        090
35355.............  ..............  A                Rechanneling of artery      18.47         NA       8.10       2.66         NA      29.23        090
35361.............  ..............  A                Rechanneling of artery      28.16         NA      11.73       4.14         NA      44.03        090

[[Page 70373]]

 
35363.............  ..............  A                Rechanneling of artery      30.15         NA      12.62       4.32         NA      47.09        090
35371.............  ..............  A                Rechanneling of artery      14.70         NA       6.97       2.13         NA      23.80        090
35372.............  ..............  A                Rechanneling of artery      17.97         NA       8.06       2.62         NA      28.65        090
35381.............  ..............  A                Rechanneling of artery      15.79         NA       7.83       2.25         NA      25.87        090
35390.............  ..............  A                Reoperation, carotid         3.19         NA       1.06       0.46         NA       4.71        ZZZ
                                                      add-on.
35400.............  ..............  A                Angioscopy............       3.00         NA       1.11       0.43         NA       4.54        ZZZ
35450.............  ..............  A                Repair arterial             10.05         NA       3.57       1.25         NA      14.87        000
                                                      blockage.
35452.............  ..............  A                Repair arterial              6.90         NA       2.61       0.94         NA      10.45        000
                                                      blockage.
35454.............  ..............  A                Repair arterial              6.03         NA       2.32       0.87         NA       9.22        000
                                                      blockage.
35456.............  ..............  A                Repair arterial              7.34         NA       2.77       1.04         NA      11.15        000
                                                      blockage.
35458.............  ..............  A                Repair arterial              9.48         NA       3.48       1.26         NA      14.22        000
                                                      blockage.
35459.............  ..............  A                Repair arterial              8.62         NA       3.18       1.21         NA      13.01        000
                                                      blockage.
35460.............  ..............  A                Repair venous blockage       6.03         NA       2.28       0.83         NA       9.14        000
35470.............  ..............  A                Repair arterial              8.62      89.12       3.36       0.69      98.43      12.67        000
                                                      blockage.
35471.............  ..............  A                Repair arterial             10.05     100.55       3.96       0.67     111.27      14.68        000
                                                      blockage.
35472.............  ..............  A                Repair arterial              6.90      64.54       2.75       0.58      72.02      10.23        000
                                                      blockage.
35473.............  ..............  A                Repair arterial              6.03      60.01       2.43       0.51      66.55       8.97        000
                                                      blockage.
35474.............  ..............  A                Repair arterial              7.35      87.98       2.90       0.57      95.90      10.82        000
                                                      blockage.
35475.............  ..............  R                Repair arterial              9.48      56.26       3.57       0.62      66.36      13.67        000
                                                      blockage.
35476.............  ..............  A                Repair venous blockage       6.03      44.86       2.36       0.34      51.23       8.73        000
35480.............  ..............  A                Atherectomy, open.....      11.06         NA       4.05       1.28         NA      16.39        000
35481.............  ..............  A                Atherectomy, open.....       7.60         NA       2.88       1.13         NA      11.61        000
35482.............  ..............  A                Atherectomy, open.....       6.64         NA       2.57       0.89         NA      10.10        000
35483.............  ..............  A                Atherectomy, open.....       8.09         NA       3.03       1.15         NA      12.27        000
35484.............  ..............  A                Atherectomy, open.....      10.42         NA       3.78       1.27         NA      15.47        000
35485.............  ..............  A                Atherectomy, open.....       9.48         NA       3.54       1.35         NA      14.37        000
35490.............  ..............  A                Atherectomy,                11.06         NA       4.71       0.71         NA      16.48        000
                                                      percutaneous.
35491.............  ..............  A                Atherectomy,                 7.60         NA       3.30       0.74         NA      11.64        000
                                                      percutaneous.
35492.............  ..............  A                Atherectomy,                 6.64         NA       3.20       0.43         NA      10.27        000
                                                      percutaneous.
35493.............  ..............  A                Atherectomy,                 8.09         NA       3.81       0.56         NA      12.46        000
                                                      percutaneous.
35494.............  ..............  A                Atherectomy,                10.42         NA       4.47       0.59         NA      15.48        000
                                                      percutaneous.
35495.............  ..............  A                Atherectomy,                 9.48         NA       4.40       0.69         NA      14.57        000
                                                      percutaneous.
35500.............  ..............  A                Harvest vein for             6.44         NA       2.03       0.93         NA       9.40        ZZZ
                                                      bypass.
35501.............  ..............  A                Artery bypass graft...      19.16         NA       8.48       2.80         NA      30.44        090
35506.............  ..............  A                Artery bypass graft...      19.64         NA       9.49       2.86         NA      31.99        090
35507.............  ..............  A                Artery bypass graft...      19.64         NA       9.45       2.84         NA      31.93        090
35508.............  ..............  A                Artery bypass graft...      18.62         NA       9.47       2.77         NA      30.86        090
35509.............  ..............  A                Artery bypass graft...      18.04         NA       8.79       2.61         NA      29.44        090
35510.............  ..............  A                Artery bypass graft...      22.97         NA      10.20       2.11         NA      35.28        090
35511.............  ..............  A                Artery bypass graft...      21.17         NA       9.38       2.90         NA      33.45        090
35512.............  ..............  A                Artery bypass graft...      22.47         NA      10.03       2.11         NA      34.61        090
35515.............  ..............  A                Artery bypass graft...      18.62         NA       9.31       2.77         NA      30.70        090
35516.............  ..............  A                Artery bypass graft...      16.30         NA       6.82       2.33         NA      25.45        090
35518.............  ..............  A                Artery bypass graft...      21.17         NA       9.00       3.02         NA      33.19        090
35521.............  ..............  A                Artery bypass graft...      22.17         NA       9.86       3.12         NA      35.15        090
35522.............  ..............  A                Artery bypass graft...      21.73         NA       9.78       2.11         NA      33.62        090
35525.............  ..............  A                Artery bypass graft...      20.60         NA       9.40       2.11         NA      32.11        090
35526.............  ..............  A                Artery bypass graft...      29.91         NA      12.54       3.62         NA      46.07        090
35531.............  ..............  A                Artery bypass graft...      36.15         NA      14.51       5.16         NA      55.82        090
35533.............  ..............  A                Artery bypass graft...      27.96         NA      11.75       3.84         NA      43.55        090
35536.............  ..............  A                Artery bypass graft...      31.65         NA      12.98       4.61         NA      49.24        090
35541.............  ..............  A                Artery bypass graft...      25.76         NA      11.23       3.70         NA      40.69        090
35546.............  ..............  A                Artery bypass graft...      25.50         NA      10.89       3.69         NA      40.08        090
35548.............  ..............  A                Artery bypass graft...      21.54         NA       9.45       2.97         NA      33.96        090
35549.............  ..............  A                Artery bypass graft...      23.31         NA      10.40       3.29         NA      37.00        090
35551.............  ..............  A                Artery bypass graft...      26.63         NA      11.52       3.74         NA      41.89        090
35556.............  ..............  A                Artery bypass graft...      21.73         NA       9.75       3.09         NA      34.57        090
35558.............  ..............  A                Artery bypass graft...      21.17         NA       9.57       2.99         NA      33.73        090
35560.............  ..............  A                Artery bypass graft...      31.95         NA      13.35       4.74         NA      50.04        090
35563.............  ..............  A                Artery bypass graft...      24.16         NA      10.55       3.51         NA      38.22        090
35565.............  ..............  A                Artery bypass graft...      23.17         NA      10.16       3.29         NA      36.62        090
35566.............  ..............  A                Artery bypass graft...      26.88         NA      11.41       3.82         NA      42.11        090
35571.............  ..............  A                Artery bypass graft...      24.02         NA      10.87       3.42         NA      38.31        090
35572.............  ..............  A                Harvest                      6.81         NA       2.25       0.99         NA      10.05        ZZZ
                                                      femoropopliteal vein.
35583.............  ..............  A                Vein bypass graft.....      22.34         NA      10.18       3.16         NA      35.68        090
35585.............  ..............  A                Vein bypass graft.....      28.35         NA      12.25       4.01         NA      44.61        090
35587.............  ..............  A                Vein bypass graft.....      24.71         NA      11.48       3.51         NA      39.70        090
35600.............  ..............  A                Harvest artery for           4.94         NA       1.62       0.73         NA       7.29        ZZZ
                                                      cabg.
35601.............  ..............  A                Artery bypass graft...      17.47         NA       8.64       2.49         NA      28.60        090
35606.............  ..............  A                Artery bypass graft...      18.68         NA       9.04       2.69         NA      30.41        090
35612.............  ..............  A                Artery bypass graft...      15.74         NA       7.90       2.08         NA      25.72        090
35616.............  ..............  A                Artery bypass graft...      15.68         NA       8.12       2.19         NA      25.99        090
35621.............  ..............  A                Artery bypass graft...      19.97         NA       8.70       2.91         NA      31.58        090
35623.............  ..............  A                Bypass graft, not vein      23.96         NA      10.52       3.45         NA      37.93        090
35626.............  ..............  A                Artery bypass graft...      27.71         NA      12.00       4.07         NA      43.78        090

[[Page 70374]]

 
35631.............  ..............  A                Artery bypass graft...      33.95         NA      13.87       4.95         NA      52.77        090
35636.............  ..............  A                Artery bypass graft...      29.46         NA      12.33       4.09         NA      45.88        090
35641.............  ..............  A                Artery bypass graft...      24.53         NA      11.09       3.53         NA      39.15        090
35642.............  ..............  A                Artery bypass graft...      17.95         NA       8.71       2.27         NA      28.93        090
35645.............  ..............  A                Artery bypass graft...      17.44         NA       8.29       2.49         NA      28.22        090
35646.............  ..............  A                Artery bypass graft...      30.95         NA      13.14       4.43         NA      48.52        090
35647.............  ..............  A                Artery bypass graft...      27.96         NA      11.80       3.98         NA      43.74        090
35650.............  ..............  A                Artery bypass graft...      18.97         NA       8.38       2.71         NA      30.06        090
35651.............  ..............  A                Artery bypass graft...      25.00         NA      10.75       3.35         NA      39.10        090
35654.............  ..............  A                Artery bypass graft...      24.96         NA      10.68       3.52         NA      39.16        090
35656.............  ..............  A                Artery bypass graft...      19.50         NA       8.62       2.79         NA      30.91        090
35661.............  ..............  A                Artery bypass graft...      18.97         NA       8.95       2.71         NA      30.63        090
35663.............  ..............  A                Artery bypass graft...      21.97         NA      10.00       3.10         NA      35.07        090
35665.............  ..............  A                Artery bypass graft...      20.97         NA       9.47       3.00         NA      33.44        090
35666.............  ..............  A                Artery bypass graft...      22.16         NA      10.67       3.15         NA      35.98        090
35671.............  ..............  A                Artery bypass graft...      19.30         NA       9.39       2.77         NA      31.46        090
35681.............  ..............  A                Composite bypass graft       1.60         NA       0.53       0.23         NA       2.36        ZZZ
35682.............  ..............  A                Composite bypass graft       7.19         NA       2.39       1.03         NA      10.61        ZZZ
35683.............  ..............  A                Composite bypass graft       8.49         NA       2.83       1.20         NA      12.52        ZZZ
35685.............  ..............  A                Bypass graft patency/        4.04         NA       1.35       0.58         NA       5.97        ZZZ
                                                      patch.
35686.............  ..............  A                Bypass graft/av fist         3.34         NA       1.13       0.47         NA       4.94        ZZZ
                                                      patency.
35691.............  ..............  A                Arterial transposition      18.02         NA       8.42       2.58         NA      29.02        090
35693.............  ..............  A                Arterial transposition      15.34         NA       7.74       2.21         NA      25.29        090
35694.............  ..............  A                Arterial transposition      19.13         NA       8.62       2.69         NA      30.44        090
35695.............  ..............  A                Arterial transposition      19.13         NA       8.57       2.73         NA      30.43        090
35697.............  ..............  A                Reimplant artery each.       3.00         NA       1.02       0.41         NA       4.43        ZZZ
35700.............  ..............  A                Reoperation, bypass          3.08         NA       1.02       0.44         NA       4.54        ZZZ
                                                      graft.
35701.............  ..............  A                Exploration, carotid         8.49         NA       5.16       1.12         NA      14.77        090
                                                      artery.
35721.............  ..............  A                Exploration, femoral         7.17         NA       4.44       1.03         NA      12.64        090
                                                      artery.
35741.............  ..............  A                Exploration popliteal        7.99         NA       4.67       1.12         NA      13.78        090
                                                      artery.
35761.............  ..............  A                Exploration of artery/       5.36         NA       4.02       0.75         NA      10.13        090
                                                      vein.
35800.............  ..............  A                Explore neck vessels..       7.01         NA       4.66       0.95         NA      12.62        090
35820.............  ..............  A                Explore chest vessels.      12.86         NA       7.22       1.94         NA      22.02        090
35840.............  ..............  A                Explore abdominal            9.76         NA       5.30       1.34         NA      16.40        090
                                                      vessels.
35860.............  ..............  A                Explore limb vessels..       5.54         NA       4.04       0.78         NA      10.36        090
35870.............  ..............  A                Repair vessel graft         22.14         NA       9.79       3.00         NA      34.93        090
                                                      defect.
35875.............  ..............  A                Removal of clot in          10.11         NA       5.20       1.41         NA      16.72        090
                                                      graft.
35876.............  ..............  A                Removal of clot in          16.97         NA       7.53       2.39         NA      26.89        090
                                                      graft.
35879.............  ..............  A                Revise graft w/vein...      15.98         NA       7.71       2.27         NA      25.96        090
35881.............  ..............  A                Revise graft w/vein...      17.97         NA       8.69       2.55         NA      29.21        090
35901.............  ..............  A                Excision, graft, neck.       8.18         NA       5.32       1.15         NA      14.65        090
35903.............  ..............  A                Excision, graft,             9.38         NA       6.17       1.30         NA      16.85        090
                                                      extremity.
35905.............  ..............  A                Excision, graft,            31.20         NA      13.22       4.43         NA      48.85        090
                                                      thorax.
35907.............  ..............  A                Excision, graft,            34.95         NA      14.20       4.91         NA      54.06        090
                                                      abdomen.
36000.............  ..............  A                Place needle in vein..       0.18       0.57       0.05       0.01       0.76       0.24        XXX
36002.............  ..............  A                Pseudoaneurysm               1.96       2.87       0.97       0.17       5.00       3.10        000
                                                      injection trt.
36005.............  ..............  A                Injection ext                0.95       7.67       0.31       0.05       8.67       1.31        000
                                                      venography.
36010.............  ..............  A                Place catheter in vein       2.43      19.36       0.79       0.20      21.99       3.42        XXX
36011.............  ..............  A                Place catheter in vein       3.14      27.90       1.06       0.27      31.31       4.47        XXX
36012.............  ..............  A                Place catheter in vein       3.51      19.00       1.19       0.23      22.74       4.93        XXX
36013.............  ..............  A                Place catheter in            2.52      21.42       0.69       0.25      24.19       3.46        XXX
                                                      artery.
36014.............  ..............  A                Place catheter in            3.02      20.18       1.03       0.19      23.39       4.24        XXX
                                                      artery.
36015.............  ..............  A                Place catheter in            3.51      23.73       1.19       0.21      27.45       4.91        XXX
                                                      artery.
36100.............  ..............  A                Establish access to          3.02      12.11       1.11       0.26      15.39       4.39        XXX
                                                      artery.
36120.............  ..............  A                Establish access to          2.01      10.73       0.65       0.14      12.88       2.80        XXX
                                                      artery.
36140.............  ..............  A                Establish access to          2.01      12.81       0.64       0.16      14.98       2.81        XXX
                                                      artery.
36145.............  ..............  A                Artery to vein shunt..       2.01      12.59       0.66       0.11      14.71       2.78        XXX
36160.............  ..............  A                Establish access to          2.52      13.52       0.84       0.26      16.30       3.62        XXX
                                                      aorta.
36200.............  ..............  A                Place catheter in            3.02      16.56       1.01       0.24      19.82       4.27        XXX
                                                      aorta.
36215.............  ..............  A                Place catheter in            4.67      27.11       1.61       0.27      32.05       6.55        XXX
                                                      artery.
36216.............  ..............  A                Place catheter in            5.27      29.16       1.80       0.31      34.74       7.38        XXX
                                                      artery.
36217.............  ..............  A                Place catheter in            6.29      55.60       2.18       0.44      62.33       8.91        XXX
                                                      artery.
36218.............  ..............  A                Place catheter in            1.01       5.10       0.34       0.07       6.18       1.42        ZZZ
                                                      artery.
36245.............  ..............  A                Place catheter in            4.67      32.18       1.68       0.31      37.16       6.66        XXX
                                                      artery.
36246.............  ..............  A                Place catheter in            5.27      30.05       1.83       0.38      35.70       7.48        XXX
                                                      artery.
36247.............  ..............  A                Place catheter in            6.29      49.65       2.15       0.47      56.41       8.91        XXX
                                                      artery.
36248.............  ..............  A                Place catheter in            1.01       4.05       0.34       0.07       5.13       1.42        ZZZ
                                                      artery.
36260.............  ..............  A                Insertion of infusion        9.70         NA       4.89       1.29         NA      15.88        090
                                                      pump.
36261.............  ..............  A                Revision of infusion         5.44         NA       3.67       0.70         NA       9.81        090
                                                      pump.
36262.............  ..............  A                Removal of infusion          4.01         NA       2.76       0.54         NA       7.31        090
                                                      pump.
36299.............  ..............  C                Vessel injection             0.00       0.00       0.00       0.00       0.00       0.00        YYY
                                                      procedure.
36400.............  ..............  A                Bl draw < 3 yrs fem/         0.38       0.28       0.09       0.03       0.69       0.50        XXX
                                                      jugular.
36405.............  ..............  A                Bl draw < 3 yrs scalp        0.31       0.26       0.08       0.03       0.60       0.42        XXX
                                                      vein.
36406.............  ..............  A                Bl draw < 3 yrs other        0.18       0.28       0.05       0.01       0.47       0.24        XXX
                                                      vein.
36410.............  ..............  A                Non-routine bl draw >        0.18       0.29       0.05       0.01       0.48       0.24        XXX
                                                      3 yrs.

[[Page 70375]]

 
36415.............  ..............  X                Routine venipuncture..       0.00       0.00       0.00       0.00       0.00       0.00        XXX
36416.............  ..............  B                Capillary blood draw..       0.00       0.00       0.00       0.00       0.00       0.00        XXX
36420.............  ..............  A                Vein access cutdown <        1.01       0.34       0.27       0.07       1.42       1.35        XXX
                                                      1 yr.
36425.............  ..............  A                Vein access cutdown >        0.76         NA       0.22       0.06         NA       1.04        XXX
                                                      1 yr.
36430.............  ..............  A                Blood transfusion            0.00       1.01         NA       0.06       1.07         NA        XXX
                                                      service.
36440.............  ..............  A                Bl push transfuse, 2         1.03         NA       0.29       0.10         NA       1.42        XXX
                                                      yr or <.
36450.............  ..............  A                Bl exchange/transfuse,       2.23         NA       0.71       0.21         NA       3.15        XXX
                                                      nb.
36455.............  ..............  A                Bl exchange/transfuse        2.43         NA       1.01       0.15         NA       3.59        XXX
                                                      non-nb.
36460.............  ..............  A                Transfusion service,         6.58         NA       2.25       0.79         NA       9.62        XXX
                                                      fetal.
36468.............  ..............  R                Injection(s), spider         0.00       0.00       0.00       0.00       0.00       0.00        000
                                                      veins.
36469.............  ..............  R                Injection(s), spider         0.00       0.00       0.00       0.00       0.00       0.00        000
                                                      veins.
36470.............  ..............  A                Injection therapy of         1.09       2.69       0.73       0.12       3.90       1.94        010
                                                      vein.
36471.............  ..............  A                Injection therapy of         1.57       3.08       0.96       0.19       4.84       2.72        010
                                                      veins.
36475.............  ..............  A                Endovenous rf, 1st           6.72      51.54       2.54       0.37      58.63       9.63        000
                                                      vein.
36476.............  ..............  A                Endovenous rf, vein          3.38       7.90       1.14       0.18      11.46       4.70        ZZZ
                                                      add-on.
36478.............  ..............  A                Endovenous laser, 1st        6.72      46.91       2.54       0.37      54.00       9.63        000
                                                      vein.
36479.............  ..............  A                Endovenous laser vein        3.38       8.01       1.14       0.18      11.57       4.70        ZZZ
                                                      addon.
36481.............  ..............  A                Insertion of catheter,       6.98       5.75       2.60       0.55      13.28      10.13        000
                                                      vein.
36500.............  ..............  A                Insertion of catheter,       3.51         NA       1.37       0.20         NA       5.08        000
                                                      vein.
36510.............  ..............  A                Insertion of catheter,       1.09       3.90       0.61       0.10       5.09       1.80        000
                                                      vein.
36511.............  ..............  A                Apheresis wbc.........       1.74         NA       0.73       0.08         NA       2.55        000
36512.............  ..............  A                Apheresis rbc.........       1.74         NA       0.74       0.08         NA       2.56        000
36513.............  ..............  A                Apheresis platelets...       1.74         NA       0.73       0.17         NA       2.64        000
36514.............  ..............  A                Apheresis plasma......       1.74      17.02       0.71       0.08      18.84       2.53        000
36515.............  ..............  A                Apheresis, adsorp/           1.74      66.49       0.66       0.08      68.31       2.48        000
                                                      reinfuse.
36516.............  ..............  A                Apheresis, selective..       1.22      84.29       0.48       0.08      85.59       1.78        000
36522.............  ..............  A                Photopheresis.........       1.67      32.46       0.96       0.13      34.26       2.76        000
36540.............  ..............  B                Collect blood venous         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      device.
36550.............  ..............  A                Declot vascular device       0.00       0.39         NA       0.37       0.76         NA        XXX
36555.............  ..............  A                Insert non-tunnel cv         2.68       5.77       0.80       0.11       8.56       3.59        000
                                                      cath.
36556.............  ..............  A                Insert non-tunnel cv         2.50       5.64       0.74       0.19       8.33       3.43        000
                                                      cath.
36557.............  ..............  A                Insert tunneled cv           5.09      21.20       2.66       0.57      26.86       8.32        010
                                                      cath.
36558.............  ..............  A                Insert tunneled cv           4.79      21.10       2.56       0.57      26.46       7.92        010
                                                      cath.
36560.............  ..............  A                Insert tunneled cv           6.24      29.76       3.04       0.57      36.57       9.85        010
                                                      cath.
36561.............  ..............  A                Insert tunneled cv           5.99      29.67       2.96       0.57      36.23       9.52        010
                                                      cath.
36563.............  ..............  A                Insert tunneled cv           6.19      26.82       2.99       0.84      33.85      10.02        010
                                                      cath.
36565.............  ..............  A                Insert tunneled cv           5.99      24.77       2.96       0.57      31.33       9.52        010
                                                      cath.
36566.............  ..............  A                Insert tunneled cv           6.49      25.57       3.12       0.57      32.63      10.18        010
                                                      cath.
36568.............  ..............  A                Insert picc cath......       1.92       7.55       0.58       0.11       9.58       2.61        000
36569.............  ..............  A                Insert picc cath......       1.82       7.36       0.57       0.19       9.37       2.58        000
36570.............  ..............  A                Insert picvad cath....       5.31      33.27       2.73       0.57      39.15       8.61        010
36571.............  ..............  A                Insert picvad cath....       5.29      33.34       2.72       0.57      39.20       8.58        010
36575.............  ..............  A                Repair tunneled cv           0.67       4.06       0.26       0.20       4.93       1.13        000
                                                      cath.
36576.............  ..............  A                Repair tunneled cv           3.19       6.96       1.85       0.19      10.34       5.23        010
                                                      cath.
36578.............  ..............  A                Replace tunneled cv          3.49      11.16       2.31       0.19      14.84       5.99        010
                                                      cath.
36580.............  ..............  A                Replace cvad cath.....       1.31       6.96       0.41       0.19       8.46       1.91        000
36581.............  ..............  A                Replace tunneled cv          3.43      19.55       1.93       0.19      23.17       5.55        010
                                                      cath.
36582.............  ..............  A                Replace tunneled cv          5.19      26.09       2.87       0.19      31.47       8.25        010
                                                      cath.
36583.............  ..............  A                Replace tunneled cv          5.24      26.11       2.89       0.19      31.54       8.32        010
                                                      cath.
36584.............  ..............  A                Replace picc cath.....       1.20       6.99       0.55       0.19       8.38       1.94        000
36585.............  ..............  A                Replace picvad cath...       4.79      27.90       2.74       0.19      32.88       7.72        010
36589.............  ..............  A                Removal tunneled cv          2.27       2.25       1.39       0.24       4.76       3.90        010
                                                      cath.
36590.............  ..............  A                Removal tunneled cv          3.30       3.38       1.72       0.44       7.12       5.46        010
                                                      cath.
36595.............  ..............  A                Mech remov tunneled cv       3.59      17.30       1.45       0.21      21.10       5.25        000
                                                      cath.
36596.............  ..............  A                Mech remov tunneled cv       0.75       3.70       0.50       0.05       4.50       1.30        000
                                                      cath.
36597.............  ..............  A                Reposition venous            1.21       2.41       0.44       0.07       3.69       1.72        000
                                                      catheter.
36598.............  ..............  T                Inj w/fluor, eval cv         0.74       2.65       2.65       0.05       3.44       3.44        000
                                                      device.
36600.............  ..............  A                Withdrawal of arterial       0.32       0.49       0.09       0.02       0.83       0.43        XXX
                                                      blood.
36620.............  ..............  A                Insertion catheter,          1.15         NA       0.23       0.07         NA       1.45        000
                                                      artery.
36625.............  ..............  A                Insertion catheter,          2.11         NA       0.53       0.26         NA       2.90        000
                                                      artery.
36640.............  ..............  A                Insertion catheter,          2.10         NA       1.04       0.21         NA       3.35        000
                                                      artery.
36660.............  ..............  A                Insertion catheter,          1.40         NA       0.44       0.14         NA       1.98        000
                                                      artery.
36680.............  ..............  A                Insert needle, bone          1.20         NA       0.49       0.11         NA       1.80        000
                                                      cavity.
36800.............  ..............  A                Insertion of cannula..       2.43         NA       1.81       0.25         NA       4.49        000
36810.............  ..............  A                Insertion of cannula..       3.96         NA       1.68       0.45         NA       6.09        000
36815.............  ..............  A                Insertion of cannula..       2.62         NA       1.17       0.35         NA       4.14        000
36818.............  ..............  A                Av fuse, uppr arm,          11.52         NA       6.05       1.89         NA      19.46        090
                                                      cephalic.
36819.............  ..............  A                Av fuse, uppr arm,          13.98         NA       6.39       1.95         NA      22.32        090
                                                      basilic.
36820.............  ..............  A                Av fusion/forearm vein      13.98         NA       6.40       1.94         NA      22.32        090
36821.............  ..............  A                Av fusion direct any         8.92         NA       4.66       1.23         NA      14.81        090
                                                      site.
36822.............  ..............  A                Insertion of                 5.41         NA       4.39       0.79         NA      10.59        090
                                                      cannula(s).
36823.............  ..............  A                Insertion of                20.97         NA       9.40       2.88         NA      33.25        090
                                                      cannula(s).
36825.............  ..............  A                Artery-vein autograft.       9.83         NA       5.06       1.35         NA      16.24        090
36830.............  ..............  A                Artery-vein                 11.98         NA       5.25       1.66         NA      18.89        090
                                                      nonautograft.
36831.............  ..............  A                Open thrombect av            7.99         NA       3.95       1.09         NA      13.03        090
                                                      fistula.

[[Page 70376]]

 
36832.............  ..............  A                Av fistula revision,        10.48         NA       4.73       1.44         NA      16.65        090
                                                      open.
36833.............  ..............  A                Av fistula revision...      11.93         NA       5.22       1.65         NA      18.80        090
36834.............  ..............  A                Repair A-V aneurysm...       9.92         NA       4.80       1.37         NA      16.09        090
36835.............  ..............  A                Artery to vein shunt..       7.14         NA       4.33       0.98         NA      12.45        090
36838.............  ..............  A                Dist revas ligation,        20.60         NA       9.41       3.01         NA      33.02        090
                                                      hemo.
36860.............  ..............  A                External cannula             2.01       1.78       0.68       0.11       3.90       2.80        000
                                                      declotting.
36861.............  ..............  A                Cannula declotting....       2.52         NA       1.49       0.27         NA       4.28        000
36870.............  ..............  A                Percut thrombect av          5.15      53.18       3.16       0.29      58.62       8.60        090
                                                      fistula.
37140.............  ..............  A                Revision of                 23.56         NA      10.51       2.01         NA      36.08        090
                                                      circulation.
37145.............  ..............  A                Revision of                 24.57         NA      10.89       3.25         NA      38.71        090
                                                      circulation.
37160.............  ..............  A                Revision of                 21.57         NA       9.28       2.81         NA      33.66        090
                                                      circulation.
37180.............  ..............  A                Revision of                 24.57         NA      10.32       3.34         NA      38.23        090
                                                      circulation.
37181.............  ..............  A                Splice spleen/kidney        26.64         NA      11.03       3.40         NA      41.07        090
                                                      veins.
37182.............  ..............  A                Insert hepatic shunt        16.97         NA       6.08       1.00         NA      24.05        000
                                                      (tips).
37183.............  ..............  A                Remove hepatic shunt         7.99         NA       3.02       0.47         NA      11.48        000
                                                      (tips).
37184.............  ..............  A                Prim art mech                8.66      71.90       3.36       0.55      81.11      12.57        000
                                                      thrombectomy.
37185.............  ..............  A                Prim art m-thrombect         3.28      22.95       1.11       0.21      26.44       4.60        ZZZ
                                                      add-on.
37186.............  ..............  A                Sec art m-thrombect          4.92      49.53       1.66       0.32      54.77       6.90        ZZZ
                                                      add-on.
37187.............  ..............  A                Venous mech                  8.03      70.38       3.15       0.51      78.92      11.69        000
                                                      thrombectomy.
37188.............  ..............  A                Venous m-thrombectomy        5.71      62.15       2.37       0.37      68.23       8.45        000
                                                      add-on.
37195.............  ..............  C                Thrombolytic therapy,        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      stroke.
37200.............  ..............  A                Transcatheter biopsy..       4.55         NA       1.50       0.27         NA       6.32        000
37201.............  ..............  A                Transcatheter therapy        4.99         NA       2.55       0.33         NA       7.87        000
                                                      infuse.
37202.............  ..............  A                Transcatheter therapy        5.67         NA       3.04       0.43         NA       9.14        000
                                                      infuse.
37203.............  ..............  A                Transcatheter                5.02      32.97       2.04       0.29      38.28       7.35        000
                                                      retrieval.
37204.............  ..............  A                Transcatheter               18.11         NA       5.92       1.48         NA      25.51        000
                                                      occlusion.
37205.............  ..............  A                Transcath iv stent,          8.27         NA       3.76       0.60         NA      12.63        000
                                                      percut.
37206.............  ..............  A                Transcath iv stent/          4.12         NA       1.43       0.31         NA       5.86        ZZZ
                                                      perc addl.
37207.............  ..............  A                Transcath iv stent,          8.27         NA       3.17       1.17         NA      12.61        000
                                                      open.
37208.............  ..............  A                Transcath iv stent/          4.12         NA       1.38       0.59         NA       6.09        ZZZ
                                                      open addl.
37209.............  ..............  A                Change iv cath at            2.27         NA       0.74       0.15         NA       3.16        000
                                                      thromb tx.
37215.............  ..............  R                Transcath stent, cca w/     18.71         NA       9.12       1.09         NA      28.92        090
                                                      eps.
37216.............  ..............  R                Transcath stent, cca w/     17.98         NA       8.84       1.04         NA      27.86        090
                                                      o eps.
37250.............  ..............  A                Iv us first vessel add-      2.10         NA       0.75       0.21         NA       3.06        ZZZ
                                                      on.
37251.............  ..............  A                Iv us each add vessel        1.60         NA       0.55       0.19         NA       2.34        ZZZ
                                                      add-on.
37500.............  ..............  A                Endoscopy ligate perf       10.98         NA       6.87       1.54         NA      19.39        090
                                                      veins.
37501.............  ..............  C                Vascular endoscopy           0.00       0.00       0.00       0.00       0.00       0.00        YYY
                                                      procedure.
37565.............  ..............  A                Ligation of neck vein.      10.86         NA       5.64       1.33         NA      17.83        090
37600.............  ..............  A                Ligation of neck            11.23         NA       6.65       1.41         NA      19.29        090
                                                      artery.
37605.............  ..............  A                Ligation of neck            13.09         NA       6.92       1.98         NA      21.99        090
                                                      artery.
37606.............  ..............  A                Ligation of neck             6.27         NA       4.57       1.23         NA      12.07        090
                                                      artery.
37607.............  ..............  A                Ligation of a-v              6.15         NA       3.57       0.85         NA      10.57        090
                                                      fistula.
37609.............  ..............  A                Temporal artery              3.00       4.51       1.97       0.36       7.87       5.33        010
                                                      procedure.
37615.............  ..............  A                Ligation of neck             5.72         NA       4.12       0.68         NA      10.52        090
                                                      artery.
37616.............  ..............  A                Ligation of chest           16.47         NA       8.10       2.32         NA      26.89        090
                                                      artery.
37617.............  ..............  A                Ligation of abdomen         22.03         NA       9.20       2.97         NA      34.20        090
                                                      artery.
37618.............  ..............  A                Ligation of extremity        4.83         NA       3.62       0.67         NA       9.12        090
                                                      artery.
37620.............  ..............  A                Revision of major vein      10.54         NA       5.73       0.91         NA      17.18        090
37650.............  ..............  A                Revision of major vein       7.79         NA       4.69       1.01         NA      13.49        090
37660.............  ..............  A                Revision of major vein      20.97         NA       9.08       2.48         NA      32.53        090
37700.............  ..............  A                Revise leg vein.......       3.72         NA       2.80       0.53         NA       7.05        090
37718.............  ..............  A                Ligate/strip short leg       6.76         NA       4.07       0.14         NA      10.97        090
                                                      vein.
37722.............  ..............  A                Ligate/strip long leg        7.79         NA       4.42       0.86         NA      13.07        090
                                                      vein.
37735.............  ..............  A                Removal of leg veins/       10.51         NA       5.52       1.48         NA      17.51        090
                                                      lesion.
37760.............  ..............  A                Ligation, leg veins,        10.45         NA       5.36       1.44         NA      17.25        090
                                                      open.
37765.............  ..............  A                Phleb veins - extrem -       7.34         NA       4.63       0.48         NA      12.45        090
                                                      to 20.
37766.............  ..............  A                Phleb veins - extrem         9.29         NA       5.34       0.48         NA      15.11        090
                                                      20+.
37780.............  ..............  A                Revision of leg vein..       3.83         NA       2.86       0.53         NA       7.22        090
37785.............  ..............  A                Ligate/divide/excise         3.83       5.21       2.73       0.54       9.58       7.10        090
                                                      vein.
37788.............  ..............  A                Revascularization,          21.98         NA       9.11       2.25         NA      33.34        090
                                                      penis.
37790.............  ..............  A                Penile venous                8.33         NA       4.38       0.59         NA      13.30        090
                                                      occlusion.
37799.............  ..............  C                Vascular surgery             0.00       0.00       0.00       0.00       0.00       0.00        YYY
                                                      procedure.
38100.............  ..............  A                Removal of spleen,          14.48         NA       6.19       1.91         NA      22.58        090
                                                      total.
38101.............  ..............  A                Removal of spleen,          15.29         NA       6.54       2.04         NA      23.87        090
                                                      partial.
38102.............  ..............  A                Removal of spleen,           4.79         NA       1.64       0.63         NA       7.06        ZZZ
                                                      total.
38115.............  ..............  A                Repair of ruptured          15.80         NA       6.66       2.08         NA      24.54        090
                                                      spleen.
38120.............  ..............  A                Laparoscopy,                16.97         NA       7.40       2.24         NA      26.61        090
                                                      splenectomy.
38129.............  ..............  C                Laparoscope proc,            0.00       0.00       0.00       0.00       0.00       0.00        YYY
                                                      spleen.
38200.............  ..............  A                Injection for spleen x-      2.64         NA       0.89       0.14         NA       3.67        000
                                                      ray.
38204.............  ..............  B                Bl donor search              0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      management.
38205.............  ..............  R                Harvest allogenic stem       1.50         NA       0.67       0.07         NA       2.24        000
                                                      cells.
38206.............  ..............  R                Harvest auto stem            1.50         NA       0.67       0.07         NA       2.24        000
                                                      cells.
38207.............  ..............  I                Cryopreserve stem            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      cells.
38208.............  ..............  I                Thaw preserved stem          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      cells.
38209.............  ..............  I                Wash harvest stem            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      cells.

[[Page 70377]]

 
38210.............  ..............  I                T-cell depletion of          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      harvest.
38211.............  ..............  I                Tumor cell deplete of        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      harvst.
38212.............  ..............  I                Rbc depletion of             0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      harvest.
38213.............  ..............  I                Platelet deplete of          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      harvest.
38214.............  ..............  I                Volume deplete of            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      harvest.
38215.............  ..............  I                Harvest stem cell            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      concentrte.
38220.............  ..............  A                Bone marrow aspiration       1.08       3.73       0.52       0.05       4.86       1.65        XXX
38221.............  ..............  A                Bone marrow biopsy....       1.37       3.94       0.65       0.07       5.38       2.09        XXX
38230.............  ..............  R                Bone marrow collection       4.53         NA       3.23       0.48         NA       8.24        010
38240.............  ..............  R                Bone marrow/stem             2.24         NA       1.03       0.11         NA       3.38        XXX
                                                      transplant.
38241.............  ..............  R                Bone marrow/stem             2.24         NA       1.04       0.11         NA       3.39        XXX
                                                      transplant.
38242.............  ..............  A                Lymphocyte infuse            1.71         NA       0.78       0.08         NA       2.57        000
                                                      transplant.
38300.............  ..............  A                Drainage, lymph node         1.99       4.31       2.06       0.25       6.55       4.30        010
                                                      lesion.
38305.............  ..............  A                Drainage, lymph node         5.99         NA       4.45       0.88         NA      11.32        090
                                                      lesion.
38308.............  ..............  A                Incision of lymph            6.44         NA       3.75       0.85         NA      11.04        090
                                                      channels.
38380.............  ..............  A                Thoracic duct                7.45         NA       5.70       0.74         NA      13.89        090
                                                      procedure.
38381.............  ..............  A                Thoracic duct               12.86         NA       6.90       1.84         NA      21.60        090
                                                      procedure.
38382.............  ..............  A                Thoracic duct               10.06         NA       5.77       1.37         NA      17.20        090
                                                      procedure.
38500.............  ..............  A                Biopsy/removal, lymph        3.74       3.70       2.09       0.49       7.93       6.32        010
                                                      nodes.
38505.............  ..............  A                Needle biopsy, lymph         1.14       2.06       0.78       0.09       3.29       2.01        000
                                                      nodes.
38510.............  ..............  A                Biopsy/removal, lymph        6.42       5.56       3.49       0.72      12.70      10.63        010
                                                      nodes.
38520.............  ..............  A                Biopsy/removal, lymph        6.66         NA       4.06       0.84         NA      11.56        090
                                                      nodes.
38525.............  ..............  A                Biopsy/removal, lymph        6.06         NA       3.30       0.80         NA      10.16        090
                                                      nodes.
38530.............  ..............  A                Biopsy/removal, lymph        7.97         NA       4.40       1.12         NA      13.49        090
                                                      nodes.
38542.............  ..............  A                Explore deep node(s),        5.90         NA       4.49       0.60         NA      10.99        090
                                                      neck.
38550.............  ..............  A                Removal, neck/armpit         6.91         NA       3.92       0.88         NA      11.71        090
                                                      lesion.
38555.............  ..............  A                Removal, neck/armpit        14.12         NA       8.55       1.75         NA      24.42        090
                                                      lesion.
38562.............  ..............  A                Removal, pelvic lymph       10.47         NA       5.79       1.20         NA      17.46        090
                                                      nodes.
38564.............  ..............  A                Removal, abdomen lymph      10.81         NA       5.26       1.32         NA      17.39        090
                                                      nodes.
38570.............  ..............  A                Laparoscopy, lymph           9.24         NA       3.98       1.13         NA      14.35        010
                                                      node biop.
38571.............  ..............  A                Laparoscopy,                14.66         NA       5.66       1.15         NA      21.47        010
                                                      lymphadenectomy.
38572.............  ..............  A                Laparoscopy,                16.57         NA       7.09       1.90         NA      25.56        010
                                                      lymphadenectomy.
38589.............  ..............  C                Laparoscope proc,            0.00       0.00       0.00       0.00       0.00       0.00        YYY
                                                      lymphatic.
38700.............  ..............  A                Removal of lymph             8.23         NA       6.25       0.72         NA      15.20        090
                                                      nodes, neck.
38720.............  ..............  A                Removal of lymph            13.59         NA       9.38       1.20         NA      24.17        090
                                                      nodes, neck.
38724.............  ..............  A                Removal of lymph            14.52         NA       9.86       1.28         NA      25.66        090
                                                      nodes, neck.
38740.............  ..............  A                Remove armpit lymph         10.01         NA       4.95       1.32         NA      16.28        090
                                                      nodes.
38745.............  ..............  A                Remove armpit lymph         13.08         NA       6.09       1.73         NA      20.90        090
                                                      nodes.
38746.............  ..............  A                Remove thoracic lymph        4.88         NA       1.61       0.72         NA       7.21        ZZZ
                                                      nodes.
38747.............  ..............  A                Remove abdominal lymph       4.88         NA       1.67       0.64         NA       7.19        ZZZ
                                                      nodes.
38760.............  ..............  A                Remove groin lymph          12.93         NA       6.14       1.71         NA      20.78        090
                                                      nodes.
38765.............  ..............  A                Remove groin lymph          19.95         NA       8.83       2.47         NA      31.25        090
                                                      nodes.
38770.............  ..............  A                Remove pelvis lymph         13.21         NA       5.76       1.40         NA      20.37        090
                                                      nodes.
38780.............  ..............  A                Remove abdomen lymph        16.57         NA       8.22       1.88         NA      26.67        090
                                                      nodes.
38790.............  ..............  A                Inject for lymphatic x-      1.29       7.37       0.76       0.13       8.79       2.18        000
                                                      ray.
38792.............  ..............  A                Identify sentinel node       0.52         NA       0.44       0.06         NA       1.02        000
38794.............  ..............  A                Access thoracic lymph        4.44         NA       3.46       0.32         NA       8.22        090
                                                      duct.
38999.............  ..............  C                Blood/lymph system           0.00       0.00       0.00       0.00       0.00       0.00        YYY
                                                      procedure.
39000.............  ..............  A                Exploration of chest..       6.09         NA       4.66       0.89         NA      11.64        090
39010.............  ..............  A                Exploration of chest..      11.77         NA       7.56       1.75         NA      21.08        090
39200.............  ..............  A                Removal chest lesion..      13.60         NA       7.55       2.02         NA      23.17        090
39220.............  ..............  A                Removal chest lesion..      17.39         NA       9.39       2.45         NA      29.23        090
39400.............  ..............  A                Visualization of chest       5.60         NA       4.86       0.82         NA      11.28        010
39499.............  ..............  C                Chest procedure.......       0.00       0.00       0.00       0.00       0.00       0.00        YYY
39501.............  ..............  A                Repair diaphragm            13.17         NA       6.47       1.77         NA      21.41        090
                                                      laceration.
39502.............  ..............  A                Repair paraesophageal       16.31         NA       7.16       2.16         NA      25.63        090
                                                      hernia.
39503.............  ..............  A                Repair of diaphragm         94.86         NA      33.47      10.95         NA     139.28        090
                                                      hernia.
39520.............  ..............  A                Repair of diaphragm         16.08         NA       8.06       2.23         NA      26.37        090
                                                      hernia.
39530.............  ..............  A                Repair of diaphragm         15.39         NA       7.15       2.10         NA      24.64        090
                                                      hernia.
39531.............  ..............  A                Repair of diaphragm         16.40         NA       7.40       2.21         NA      26.01        090
                                                      hernia.
39540.............  ..............  A                Repair of diaphragm         13.30         NA       6.24       1.79         NA      21.33        090
                                                      hernia.
39541.............  ..............  A                Repair of diaphragm         14.39         NA       6.60       1.92         NA      22.91        090
                                                      hernia.
39545.............  ..............  A                Revision of diaphragm.      13.35         NA       7.56       1.83         NA      22.74        090
39560.............  ..............  A                Resect diaphragm,           11.98         NA       6.30       1.59         NA      19.87        090
                                                      simple.
39561.............  ..............  A                Resect diaphragm,           17.47         NA       9.36       2.44         NA      29.27        090
                                                      complex.
39599.............  ..............  C                Diaphragm surgery            0.00       0.00       0.00       0.00       0.00       0.00        YYY
                                                      procedure.
4000F.............  ..............  I                Tobacco use txmnt            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      counseling.
4001F.............  ..............  I                Tobacco use txmnt,           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      pharmacol.
4002F.............  ..............  I                Statin therapy, rx....       0.00       0.00       0.00       0.00       0.00       0.00        XXX
4003F.............  ..............  I                Pt ed write/oral, pts        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      w/ hf.
4006F.............  ..............  I                Beta-blocker therapy         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      rx.
4009F.............  ..............  I                Ace inhibitor therapy        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      rx.
4011F.............  ..............  I                Oral antiplatelet            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      therapy rx.
4012F.............  ..............  I                Warfarin therapy rx...       0.00       0.00       0.00       0.00       0.00       0.00        XXX
4014F.............  ..............  I                Written discharge            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      instr prvd.

[[Page 70378]]

 
4015F.............  ..............  I                Persist asthma               0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      medicine ctrl.
4016F.............  ..............  I                Anti-inflm/anlgsc            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      agent rx.
4017F.............  ..............  I                Gi prophylaxis for           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      nsaid rx.
4018F.............  ..............  I                Therapy exercise joint       0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      rx.
40490.............  ..............  A                Biopsy of lip.........       1.22       1.63       0.61       0.05       2.90       1.88        000
40500.............  ..............  A                Partial excision of          4.27       6.91       4.34       0.38      11.56       8.99        090
                                                      lip.
40510.............  ..............  A                Partial excision of          4.69       6.63       4.02       0.49      11.81       9.20        090
                                                      lip.
40520.............  ..............  A                Partial excision of          4.66       7.56       4.12       0.52      12.74       9.30        090
                                                      lip.
40525.............  ..............  A                Reconstruct lip with         7.54         NA       6.32       0.85         NA      14.71        090
                                                      flap.
40527.............  ..............  A                Reconstruct lip with         9.12         NA       7.37       0.97         NA      17.46        090
                                                      flap.
40530.............  ..............  A                Partial removal of lip       5.39       7.83       4.59       0.55      13.77      10.53        090
40650.............  ..............  A                Repair lip............       3.63       6.81       3.30       0.38      10.82       7.31        090
40652.............  ..............  A                Repair lip............       4.25       7.76       4.27       0.52      12.53       9.04        090
40654.............  ..............  A                Repair lip............       5.30       8.62       4.94       0.60      14.52      10.84        090
40700.............  ..............  A                Repair cleft lip/nasal      12.77         NA       9.10       0.95         NA      22.82        090
40701.............  ..............  A                Repair cleft lip/nasal      15.83         NA      11.36       1.65         NA      28.84        090
40702.............  ..............  A                Repair cleft lip/nasal      13.02         NA       8.27       1.23         NA      22.52        090
40720.............  ..............  A                Repair cleft lip/nasal      13.53         NA       9.92       1.79         NA      25.24        090
40761.............  ..............  A                Repair cleft lip/nasal      14.70         NA      10.30       1.93         NA      26.93        090
40799.............  ..............  C                Lip surgery procedure.       0.00       0.00       0.00       0.00       0.00       0.00        YYY
40800.............  ..............  A                Drainage of mouth            1.17       2.97       1.78       0.13       4.27       3.08        010
                                                      lesion.
40801.............  ..............  A                Drainage of mouth            2.53       4.03       2.75       0.31       6.87       5.59        010
                                                      lesion.
40804.............  ..............  A                Removal, foreign body,       1.24       3.40       1.86       0.11       4.75       3.21        010
                                                      mouth.
40805.............  ..............  A                Removal, foreign body,       2.69       4.49       2.82       0.32       7.50       5.83        010
                                                      mouth.
40806.............  ..............  A                Incision of lip fold..       0.31       1.84       0.50       0.04       2.19       0.85        000
40808.............  ..............  A                Biopsy of mouth lesion       0.96       2.66       1.48       0.10       3.72       2.54        010
40810.............  ..............  A                Excision of mouth            1.31       2.89       1.66       0.13       4.33       3.10        010
                                                      lesion.
40812.............  ..............  A                Excise/repair mouth          2.31       3.73       2.41       0.28       6.32       5.00        010
                                                      lesion.
40814.............  ..............  A                Excise/repair mouth          3.41       4.95       3.90       0.41       8.77       7.72        090
                                                      lesion.
40816.............  ..............  A                Excision of mouth            3.66       5.18       4.01       0.40       9.24       8.07        090
                                                      lesion.
40818.............  ..............  A                Excise oral mucosa for       2.41       5.18       3.98       0.21       7.80       6.60        090
                                                      graft.
40819.............  ..............  A                Excise lip or cheek          2.41       4.09       3.10       0.29       6.79       5.80        090
                                                      fold.
40820.............  ..............  A                Treatment of mouth           1.28       3.94       2.45       0.11       5.33       3.84        010
                                                      lesion.
40830.............  ..............  A                Repair mouth                 1.76       3.73       2.10       0.19       5.68       4.05        010
                                                      laceration.
40831.............  ..............  A                Repair mouth                 2.46       4.67       3.06       0.30       7.43       5.82        010
                                                      laceration.
40840.............  ..............  R                Reconstruction of            8.72       9.81       6.99       1.08      19.61      16.79        090
                                                      mouth.
40842.............  ..............  R                Reconstruction of            8.72      10.09       6.80       1.08      19.89      16.60        090
                                                      mouth.
40843.............  ..............  R                Reconstruction of           12.08      11.98       7.83       1.39      25.45      21.30        090
                                                      mouth.
40844.............  ..............  R                Reconstruction of           15.99      15.81      11.59       1.99      33.79      29.57        090
                                                      mouth.
40845.............  ..............  R                Reconstruction of           18.55      17.11      13.25       2.00      37.66      33.80        090
                                                      mouth.
40899.............  ..............  C                Mouth surgery                0.00       0.00       0.00       0.00       0.00       0.00        YYY
                                                      procedure.
41000.............  ..............  A                Drainage of mouth            1.30       2.32       1.41       0.12       3.74       2.83        010
                                                      lesion.
41005.............  ..............  A                Drainage of mouth            1.26       3.34       1.72       0.12       4.72       3.10        010
                                                      lesion.
41006.............  ..............  A                Drainage of mouth            3.24       4.80       3.18       0.35       8.39       6.77        090
                                                      lesion.
41007.............  ..............  A                Drainage of mouth            3.10       5.15       3.03       0.31       8.56       6.44        090
                                                      lesion.
41008.............  ..............  A                Drainage of mouth            3.36       4.69       3.21       0.42       8.47       6.99        090
                                                      lesion.
41009.............  ..............  A                Drainage of mouth            3.58       4.98       3.58       0.47       9.03       7.63        090
                                                      lesion.
41010.............  ..............  A                Incision of tongue           1.06       3.43       1.60       0.07       4.56       2.73        010
                                                      fold.
41015.............  ..............  A                Drainage of mouth            3.95       5.42       4.15       0.46       9.83       8.56        090
                                                      lesion.
41016.............  ..............  A                Drainage of mouth            4.06       5.63       4.23       0.53      10.22       8.82        090
                                                      lesion.
41017.............  ..............  A                Drainage of mouth            4.06       5.65       4.31       0.53      10.24       8.90        090
                                                      lesion.
41018.............  ..............  A                Drainage of mouth            5.09       6.15       4.58       0.68      11.92      10.35        090
                                                      lesion.
41100.............  ..............  A                Biopsy of tongue......       1.63       2.43       1.42       0.15       4.21       3.20        010
41105.............  ..............  A                Biopsy of tongue......       1.42       2.31       1.32       0.13       3.86       2.87        010
41108.............  ..............  A                Biopsy of floor of           1.05       2.08       1.13       0.10       3.23       2.28        010
                                                      mouth.
41110.............  ..............  A                Excision of tongue           1.51       2.99       1.64       0.13       4.63       3.28        010
                                                      lesion.
41112.............  ..............  A                Excision of tongue           2.73       4.48       3.23       0.28       7.49       6.24        090
                                                      lesion.
41113.............  ..............  A                Excision of tongue           3.19       4.75       3.48       0.34       8.28       7.01        090
                                                      lesion.
41114.............  ..............  A                Excision of tongue           8.46         NA       7.21       0.83         NA      16.50        090
                                                      lesion.
41115.............  ..............  A                Excision of tongue           1.74       3.30       1.86       0.18       5.22       3.78        010
                                                      fold.
41116.............  ..............  A                Excision of mouth            2.44       4.36       2.81       0.23       7.03       5.48        090
                                                      lesion.
41120.............  ..............  A                Partial removal of           9.76         NA      15.35       0.79         NA      25.90        090
                                                      tongue.
41130.............  ..............  A                Partial removal of          11.13         NA      16.24       0.93         NA      28.30        090
                                                      tongue.
41135.............  ..............  A                Tongue and neck             23.06         NA      23.29       1.88         NA      48.23        090
                                                      surgery.
41140.............  ..............  A                Removal of tongue.....      25.46         NA      26.75       2.26         NA      54.47        090
41145.............  ..............  A                Tongue removal, neck        30.01         NA      30.63       2.54         NA      63.18        090
                                                      surgery.
41150.............  ..............  A                Tongue, mouth, jaw          23.01         NA      24.78       1.94         NA      49.73        090
                                                      surgery.
41153.............  ..............  A                Tongue, mouth, neck         23.73         NA      25.09       2.00         NA      50.82        090
                                                      surgery.
41155.............  ..............  A                Tongue, jaw, & neck         27.68         NA      26.88       2.33         NA      56.89        090
                                                      surgery.
41250.............  ..............  A                Repair tongue                1.91       2.75       1.18       0.18       4.84       3.27        010
                                                      laceration.
41251.............  ..............  A                Repair tongue                2.27       3.28       1.55       0.22       5.77       4.04        010
                                                      laceration.
41252.............  ..............  A                Repair tongue                2.97       3.90       2.26       0.29       7.16       5.52        010
                                                      laceration.
41500.............  ..............  A                Fixation of tongue....       3.70         NA       7.47       0.30         NA      11.47        090
41510.............  ..............  A                Tongue to lip surgery.       3.41         NA       7.95       0.20         NA      11.56        090
41520.............  ..............  A                Reconstruction, tongue       2.73       4.63       3.63       0.27       7.63       6.63        090
                                                      fold.

[[Page 70379]]

 
41599.............  ..............  C                Tongue and mouth             0.00       0.00       0.00       0.00       0.00       0.00        YYY
                                                      surgery.
41800.............  ..............  A                Drainage of gum lesion       1.17       2.60       1.28       0.12       3.89       2.57        010
41805.............  ..............  A                Removal foreign body,        1.24       2.68       2.22       0.13       4.05       3.59        010
                                                      gum.
41806.............  ..............  A                Removal foreign              2.69       3.59       3.04       0.37       6.65       6.10        010
                                                      body,jawbone.
41820.............  ..............  R                Excision, gum, each          0.00       0.00       0.00       0.00       0.00       0.00        000
                                                      quadrant.
41821.............  ..............  R                Excision of gum flap..       0.00       0.00       0.00       0.00       0.00       0.00        000
41822.............  ..............  R                Excision of gum lesion       2.31       3.90       1.88       0.31       6.52       4.50        010
41823.............  ..............  R                Excision of gum lesion       3.30       5.58       4.02       0.47       9.35       7.79        090
41825.............  ..............  A                Excision of gum lesion       1.31       3.07       2.25       0.15       4.53       3.71        010
41826.............  ..............  A                Excision of gum lesion       2.31       2.44       2.11       0.30       5.05       4.72        010
41827.............  ..............  A                Excision of gum lesion       3.41       5.53       3.67       0.35       9.29       7.43        090
41828.............  ..............  R                Excision of gum lesion       3.09       3.81       2.97       0.44       7.34       6.50        010
41830.............  ..............  R                Removal of gum tissue.       3.34       4.97       3.63       0.44       8.75       7.41        010
41850.............  ..............  R                Treatment of gum             0.00       0.00       0.00       0.00       0.00       0.00        000
                                                      lesion.
41870.............  ..............  R                Gum graft.............       0.00       0.00       0.00       0.00       0.00       0.00        000
41872.............  ..............  R                Repair gum............       2.59       5.03       3.47       0.30       7.92       6.36        090
41874.............  ..............  R                Repair tooth socket...       3.09       4.85       3.18       0.45       8.39       6.72        090
41899.............  ..............  C                Dental surgery               0.00       0.00       0.00       0.00       0.00       0.00        YYY
                                                      procedure.
42000.............  ..............  A                Drainage mouth roof          1.23       2.57       1.25       0.12       3.92       2.60        010
                                                      lesion.
42100.............  ..............  A                Biopsy roof of mouth..       1.31       2.09       1.36       0.13       3.53       2.80        010
42104.............  ..............  A                Excision lesion, mouth       1.64       2.55       1.55       0.16       4.35       3.35        010
                                                      roof.
42106.............  ..............  A                Excision lesion, mouth       2.10       3.23       2.45       0.25       5.58       4.80        010
                                                      roof.
42107.............  ..............  A                Excision lesion, mouth       4.43       5.73       3.96       0.44      10.60       8.83        090
                                                      roof.
42120.............  ..............  A                Remove palate/lesion..       6.16         NA      11.80       0.52         NA      18.48        090
42140.............  ..............  A                Excision of uvula.....       1.62       3.73       2.10       0.13       5.48       3.85        090
42145.............  ..............  A                Repair palate, pharynx/      8.04         NA       7.51       0.65         NA      16.20        090
                                                      uvula.
42160.............  ..............  A                Treatment mouth roof         1.80       4.26       2.30       0.17       6.23       4.27        010
                                                      lesion.
42180.............  ..............  A                Repair palate.........       2.50       3.08       2.11       0.21       5.79       4.82        010
42182.............  ..............  A                Repair palate.........       3.82       3.88       3.04       0.40       8.10       7.26        010
42200.............  ..............  A                Reconstruct cleft           11.98         NA      10.24       1.27         NA      23.49        090
                                                      palate.
42205.............  ..............  A                Reconstruct cleft           13.27         NA      10.10       1.58         NA      24.95        090
                                                      palate.
42210.............  ..............  A                Reconstruct cleft           14.48         NA      11.49       2.16         NA      28.13        090
                                                      palate.
42215.............  ..............  A                Reconstruct cleft            8.81         NA       9.10       1.31         NA      19.22        090
                                                      palate.
42220.............  ..............  A                Reconstruct cleft            7.01         NA       6.80       0.73         NA      14.54        090
                                                      palate.
42225.............  ..............  A                Reconstruct cleft            9.53         NA      17.11       0.86         NA      27.50        090
                                                      palate.
42226.............  ..............  A                Lengthening of palate.       9.99         NA      14.74       1.01         NA      25.74        090
42227.............  ..............  A                Lengthening of palate.       9.51         NA      15.59       0.98         NA      26.08        090
42235.............  ..............  A                Repair palate.........       7.86         NA      11.89       0.72         NA      20.47        090
42260.............  ..............  A                Repair nose to lip           9.79      10.22       7.08       1.26      21.27      18.13        090
                                                      fistula.
42280.............  ..............  A                Preparation, palate          1.54       1.97       1.14       0.19       3.70       2.87        010
                                                      mold.
42281.............  ..............  A                Insertion, palate            1.93       2.64       1.88       0.17       4.74       3.98        010
                                                      prosthesis.
42299.............  ..............  C                Palate/uvula surgery..       0.00       0.00       0.00       0.00       0.00       0.00        YYY
42300.............  ..............  A                Drainage of salivary         1.93       2.83       1.82       0.16       4.92       3.91        010
                                                      gland.
42305.............  ..............  A                Drainage of salivary         6.06         NA       4.73       0.51         NA      11.30        090
                                                      gland.
42310.............  ..............  A                Drainage of salivary         1.56       2.27       1.54       0.13       3.96       3.23        010
                                                      gland.
42320.............  ..............  A                Drainage of salivary         2.35       3.28       2.10       0.21       5.84       4.66        010
                                                      gland.
42330.............  ..............  A                Removal of salivary          2.21       3.15       1.85       0.19       5.55       4.25        010
                                                      stone.
42335.............  ..............  A                Removal of salivary          3.31       4.91       3.15       0.29       8.51       6.75        090
                                                      stone.
42340.............  ..............  A                Removal of salivary          4.59       6.06       3.94       0.42      11.07       8.95        090
                                                      stone.
42400.............  ..............  A                Biopsy of salivary           0.78       1.65       0.72       0.06       2.49       1.56        000
                                                      gland.
42405.............  ..............  A                Biopsy of salivary           3.29       4.01       2.46       0.28       7.58       6.03        010
                                                      gland.
42408.............  ..............  A                Excision of salivary         4.53       5.93       3.62       0.45      10.91       8.60        090
                                                      cyst.
42409.............  ..............  A                Drainage of salivary         2.81       4.53       2.77       0.27       7.61       5.85        090
                                                      cyst.
42410.............  ..............  A                Excise parotid gland/        9.33         NA       6.24       0.91         NA      16.48        090
                                                      lesion.
42415.............  ..............  A                Excise parotid gland/       16.86         NA      10.89       1.43         NA      29.18        090
                                                      lesion.
42420.............  ..............  A                Excise parotid gland/       19.56         NA      12.41       1.65         NA      33.62        090
                                                      lesion.
42425.............  ..............  A                Excise parotid gland/       13.00         NA       8.63       1.05         NA      22.68        090
                                                      lesion.
42426.............  ..............  A                Excise parotid gland/       21.23         NA      13.05       1.80         NA      36.08        090
                                                      lesion.
42440.............  ..............  A                Excise submaxillary          6.96         NA       4.80       0.59         NA      12.35        090
                                                      gland.
42450.............  ..............  A                Excise sublingual            4.61       5.92       4.26       0.42      10.95       9.29        090
                                                      gland.
42500.............  ..............  A                Repair salivary duct..       4.29       5.70       4.19       0.41      10.40       8.89        090
42505.............  ..............  A                Repair salivary duct..       6.17       7.14       5.38       0.55      13.86      12.10        090
42507.............  ..............  A                Parotid duct diversion       6.10         NA       6.55       0.49         NA      13.14        090
42508.............  ..............  A                Parotid duct diversion       9.09         NA       8.36       1.04         NA      18.49        090
42509.............  ..............  A                Parotid duct diversion      11.52         NA      10.22       0.93         NA      22.67        090
42510.............  ..............  A                Parotid duct diversion       8.14         NA       7.81       0.66         NA      16.61        090
42550.............  ..............  A                Injection for salivary       1.25       3.22       0.41       0.07       4.54       1.73        000
                                                      x-ray.
42600.............  ..............  A                Closure of salivary          4.81       6.60       4.13       0.43      11.84       9.37        090
                                                      fistula.
42650.............  ..............  A                Dilation of salivary         0.77       1.10       0.71       0.07       1.94       1.55        000
                                                      duct.
42660.............  ..............  A                Dilation of salivary         1.13       1.35       0.85       0.09       2.57       2.07        000
                                                      duct.
42665.............  ..............  A                Ligation of salivary         2.53       4.18       2.60       0.23       6.94       5.36        090
                                                      duct.
42699.............  ..............  C                Salivary surgery             0.00       0.00       0.00       0.00       0.00       0.00        YYY
                                                      procedure.
42700.............  ..............  A                Drainage of tonsil           1.62       2.66       1.70       0.13       4.41       3.45        010
                                                      abscess.
42720.............  ..............  A                Drainage of throat           5.41       4.84       3.80       0.44      10.69       9.65        010
                                                      abscess.
42725.............  ..............  A                Drainage of throat          10.70         NA       8.24       0.91         NA      19.85        090
                                                      abscess.

[[Page 70380]]

 
42800.............  ..............  A                Biopsy of throat......       1.39       2.19       1.40       0.11       3.69       2.90        010
42802.............  ..............  A                Biopsy of throat......       1.54       4.77       2.07       0.12       6.43       3.73        010
42804.............  ..............  A                Biopsy of upper nose/        1.24       3.75       1.74       0.10       5.09       3.08        010
                                                      throat.
42806.............  ..............  A                Biopsy of upper nose/        1.58       4.08       1.94       0.13       5.79       3.65        010
                                                      throat.
42808.............  ..............  A                Excise pharynx lesion.       2.30       3.10       1.94       0.19       5.59       4.43        010
42809.............  ..............  A                Remove pharynx foreign       1.81       2.34       1.33       0.16       4.31       3.30        010
                                                      body.
42810.............  ..............  A                Excision of neck cyst.       3.25       5.73       3.55       0.29       9.27       7.09        090
42815.............  ..............  A                Excision of neck cyst.       7.06         NA       6.43       0.61         NA      14.10        090
42820.............  ..............  A                Remove tonsils and           3.90         NA       3.30       0.31         NA       7.51        090
                                                      adenoids.
42821.............  ..............  A                Remove tonsils and           4.28         NA       3.51       0.35         NA       8.14        090
                                                      adenoids.
42825.............  ..............  A                Removal of tonsils....       3.41         NA       3.18       0.25         NA       6.84        090
42826.............  ..............  A                Removal of tonsils....       3.37         NA       3.04       0.27         NA       6.68        090
42830.............  ..............  A                Removal of adenoids...       2.57         NA       2.57       0.20         NA       5.34        090
42831.............  ..............  A                Removal of adenoids...       2.71         NA       2.85       0.22         NA       5.78        090
42835.............  ..............  A                Removal of adenoids...       2.30         NA       2.47       0.21         NA       4.98        090
42836.............  ..............  A                Removal of adenoids...       3.18         NA       2.97       0.26         NA       6.41        090
42842.............  ..............  A                Extensive surgery of         8.75         NA      11.02       0.71         NA      20.48        090
                                                      throat.
42844.............  ..............  A                Extensive surgery of        14.29         NA      16.28       1.16         NA      31.73        090
                                                      throat.
42845.............  ..............  A                Extensive surgery of        24.25         NA      23.25       1.98         NA      49.48        090
                                                      throat.
42860.............  ..............  A                Excision of tonsil           2.22         NA       2.41       0.18         NA       4.81        090
                                                      tags.
42870.............  ..............  A                Excision of lingual          5.39         NA       8.59       0.44         NA      14.42        090
                                                      tonsil.
42890.............  ..............  A                Partial removal of          12.92         NA      14.19       1.05         NA      28.16        090
                                                      pharynx.
42892.............  ..............  A                Revision of pharyngeal      15.81         NA      17.22       1.28         NA      34.31        090
                                                      walls.
42894.............  ..............  A                Revision of pharyngeal      22.85         NA      22.08       1.86         NA      46.79        090
                                                      walls.
42900.............  ..............  A                Repair throat wound...       5.24         NA       3.67       0.50         NA       9.41        010
42950.............  ..............  A                Reconstruction of            8.09         NA      11.90       0.72         NA      20.71        090
                                                      throat.
42953.............  ..............  A                Repair throat,               8.95         NA      17.38       0.88         NA      27.21        090
                                                      esophagus.
42955.............  ..............  A                Surgical opening of          7.38         NA      10.70       0.80         NA      18.88        090
                                                      throat.
42960.............  ..............  A                Control throat               2.33         NA       1.97       0.19         NA       4.49        010
                                                      bleeding.
42961.............  ..............  A                Control throat               5.58         NA       4.97       0.45         NA      11.00        090
                                                      bleeding.
42962.............  ..............  A                Control throat               7.13         NA       5.93       0.58         NA      13.64        090
                                                      bleeding.
42970.............  ..............  A                Control nose/throat          5.42         NA       4.19       0.39         NA      10.00        090
                                                      bleeding.
42971.............  ..............  A                Control nose/throat          6.20         NA       5.13       0.51         NA      11.84        090
                                                      bleeding.
42972.............  ..............  A                Control nose/throat          7.19         NA       5.72       0.62         NA      13.53        090
                                                      bleeding.
42999.............  ..............  C                Throat surgery               0.00       0.00       0.00       0.00       0.00       0.00        YYY
                                                      procedure.
43020.............  ..............  A                Incision of esophagus.       8.08         NA       5.43       0.87         NA      14.38        090
43030.............  ..............  A                Throat muscle surgery.       7.68         NA       5.51       0.70         NA      13.89        090
43045.............  ..............  A                Incision of esophagus.      20.09         NA      10.73       2.58         NA      33.40        090
43100.............  ..............  A                Excision of esophagus        9.18         NA       6.24       0.93         NA      16.35        090
                                                      lesion.
43101.............  ..............  A                Excision of esophagus       16.22         NA       7.90       2.31         NA      26.43        090
                                                      lesion.
43107.............  ..............  A                Removal of esophagus..      39.94         NA      18.31       5.22         NA      63.47        090
43108.............  ..............  A                Removal of esophagus..      34.14         NA      14.25       4.07         NA      52.46        090
43112.............  ..............  A                Removal of esophagus..      43.43         NA      19.42       5.79         NA      68.64        090
43113.............  ..............  A                Removal of esophagus..      35.22         NA      15.15       4.42         NA      54.79        090
43116.............  ..............  A                Partial removal of          31.17         NA      16.74       3.05         NA      50.96        090
                                                      esophagus.
43117.............  ..............  A                Partial removal of          39.94         NA      17.32       5.17         NA      62.43        090
                                                      esophagus.
43118.............  ..............  A                Partial removal of          33.15         NA      13.82       4.10         NA      51.07        090
                                                      esophagus.
43121.............  ..............  A                Partial removal of          29.15         NA      13.71       3.90         NA      46.76        090
                                                      esophagus.
43122.............  ..............  A                Partial removal of          39.94         NA      17.44       5.40         NA      62.78        090
                                                      esophagus.
43123.............  ..............  A                Partial removal of          33.15         NA      14.14       4.15         NA      51.44        090
                                                      esophagus.
43124.............  ..............  A                Removal of esophagus..      27.28         NA      13.12       3.73         NA      44.13        090
43130.............  ..............  A                Removal of esophagus        11.73         NA       7.58       1.16         NA      20.47        090
                                                      pouch.
43135.............  ..............  A                Removal of esophagus        16.08         NA       8.11       2.33         NA      26.52        090
                                                      pouch.
43200.............  ..............  A                Esophagus endoscopy...       1.59       4.14       1.07       0.13       5.86       2.79        000
43201.............  ..............  A                Esoph scope w/               2.09       4.64       1.10       0.15       6.88       3.34        000
                                                      submucous inj.
43202.............  ..............  A                Esophagus endoscopy,         1.89       5.56       0.94       0.15       7.60       2.98        000
                                                      biopsy.
43204.............  ..............  A                Esoph scope w/               3.76         NA       1.52       0.30         NA       5.58        000
                                                      sclerosis inj.
43205.............  ..............  A                Esophagus endoscopy/         3.78         NA       1.52       0.28         NA       5.58        000
                                                      ligation.
43215.............  ..............  A                Esophagus endoscopy...       2.60         NA       1.20       0.22         NA       4.02        000
43216.............  ..............  A                Esophagus endoscopy/         2.40         NA       1.06       0.20         NA       3.66        000
                                                      lesion.
43217.............  ..............  A                Esophagus endoscopy...       2.90       6.97       1.19       0.26      10.13       4.35        000
43219.............  ..............  A                Esophagus endoscopy...       2.80         NA       1.35       0.24         NA       4.39        000
43220.............  ..............  A                Esoph endoscopy,             2.10         NA       0.97       0.17         NA       3.24        000
                                                      dilation.
43226.............  ..............  A                Esoph endoscopy,             2.34         NA       1.03       0.19         NA       3.56        000
                                                      dilation.
43227.............  ..............  A                Esoph endoscopy,             3.59         NA       1.45       0.28         NA       5.32        000
                                                      repair.
43228.............  ..............  A                Esoph endoscopy,             3.76         NA       1.55       0.34         NA       5.65        000
                                                      ablation.
43231.............  ..............  A                Esoph endoscopy w/us         3.19         NA       1.31       0.23         NA       4.73        000
                                                      exam.
43232.............  ..............  A                Esoph endoscopy w/us         4.47         NA       1.82       0.34         NA       6.63        000
                                                      fn bx.
43234.............  ..............  A                Upper GI endoscopy,          2.01       5.34       0.87       0.17       7.52       3.05        000
                                                      exam.
43235.............  ..............  A                Uppr gi endoscopy,           2.39       5.18       1.02       0.19       7.76       3.60        000
                                                      diagnosis.
43236.............  ..............  A                Uppr gi scope w/submuc       2.92       6.42       1.22       0.21       9.55       4.35        000
                                                      inj.
43237.............  ..............  A                Endoscopic us exam,          3.98         NA       1.59       0.43         NA       6.00        000
                                                      esoph.
43238.............  ..............  A                Uppr gi endoscopy w/us       5.02         NA       1.97       0.43         NA       7.42        000
                                                      fn bx.
43239.............  ..............  A                Upper GI endoscopy,          2.87       5.73       1.19       0.22       8.82       4.28        000
                                                      biopsy.
43240.............  ..............  A                Esoph endoscope w/           6.85         NA       2.61       0.56         NA      10.02        000
                                                      drain cyst.

[[Page 70381]]

 
43241.............  ..............  A                Upper GI endoscopy           2.59         NA       1.10       0.21         NA       3.90        000
                                                      with tube.
43242.............  ..............  A                Uppr gi endoscopy w/us       7.30         NA       2.74       0.53         NA      10.57        000
                                                      fn bx.
43243.............  ..............  A                Upper gi endoscopy &         4.56         NA       1.80       0.33         NA       6.69        000
                                                      inject.
43244.............  ..............  A                Upper GI endoscopy/          5.04         NA       1.97       0.37         NA       7.38        000
                                                      ligation.
43245.............  ..............  A                Uppr gi scope dilate         3.18         NA       1.30       0.26         NA       4.74        000
                                                      strictr.
43246.............  ..............  A                Place gastrostomy tube       4.32         NA       1.69       0.34         NA       6.35        000
43247.............  ..............  A                Operative upper GI           3.38         NA       1.37       0.27         NA       5.02        000
                                                      endoscopy.
43248.............  ..............  A                Uppr gi endoscopy/           3.15         NA       1.31       0.23         NA       4.69        000
                                                      guide wire.
43249.............  ..............  A                Esoph endoscopy,             2.90         NA       1.21       0.22         NA       4.33        000
                                                      dilation.
43250.............  ..............  A                Upper GI endoscopy/          3.20         NA       1.31       0.26         NA       4.77        000
                                                      tumor.
43251.............  ..............  A                Operative upper GI           3.69         NA       1.48       0.29         NA       5.46        000
                                                      endoscopy.
43255.............  ..............  A                Operative upper GI           4.81         NA       1.89       0.35         NA       7.05        000
                                                      endoscopy.
43256.............  ..............  A                Uppr gi endoscopy w/         4.34         NA       1.71       0.32         NA       6.37        000
                                                      stent.
43257.............  ..............  A                Uppr gi scope w/thrml        5.50         NA       2.21       0.36         NA       8.07        000
                                                      txmnt.
43258.............  ..............  A                Operative upper GI           4.54         NA       1.79       0.33         NA       6.66        000
                                                      endoscopy.
43259.............  ..............  A                Endoscopic ultrasound        5.19         NA       2.00       0.35         NA       7.54        000
                                                      exam.
43260.............  ..............  A                Endo                         5.95         NA       2.29       0.43         NA       8.67        000
                                                      cholangiopancreatogra
                                                      ph.
43261.............  ..............  A                Endo                         6.26         NA       2.40       0.46         NA       9.12        000
                                                      cholangiopancreatogra
                                                      ph.
43262.............  ..............  A                Endo                         7.38         NA       2.79       0.54         NA      10.71        000
                                                      cholangiopancreatogra
                                                      ph.
43263.............  ..............  A                Endo                         7.28         NA       2.77       0.54         NA      10.59        000
                                                      cholangiopancreatogra
                                                      ph.
43264.............  ..............  A                Endo                         8.89         NA       3.32       0.65         NA      12.86        000
                                                      cholangiopancreatogra
                                                      ph.
43265.............  ..............  A                Endo                        10.00         NA       3.70       0.73         NA      14.43        000
                                                      cholangiopancreatogra
                                                      ph.
43267.............  ..............  A                Endo                         7.38         NA       2.79       0.54         NA      10.71        000
                                                      cholangiopancreatogra
                                                      ph.
43268.............  ..............  A                Endo                         7.38         NA       2.89       0.54         NA      10.81        000
                                                      cholangiopancreatogra
                                                      ph.
43269.............  ..............  A                Endo                         8.20         NA       3.08       0.60         NA      11.88        000
                                                      cholangiopancreatogra
                                                      ph.
43271.............  ..............  A                Endo                         7.38         NA       2.79       0.54         NA      10.71        000
                                                      cholangiopancreatogra
                                                      ph.
43272.............  ..............  A                Endo                         7.38         NA       2.79       0.54         NA      10.71        000
                                                      cholangiopancreatogra
                                                      ph.
43280.............  ..............  A                Laparoscopy,                17.22         NA       7.29       2.27         NA      26.78        090
                                                      fundoplasty.
43289.............  ..............  C                Laparoscope proc,            0.00       0.00       0.00       0.00       0.00       0.00        YYY
                                                      esoph.
43300.............  ..............  A                Repair of esophagus...       9.13         NA       6.39       1.12         NA      16.64        090
43305.............  ..............  A                Repair esophagus and        17.36         NA      10.72       1.54         NA      29.62        090
                                                      fistula.
43310.............  ..............  A                Repair of esophagus...      25.35         NA      11.09       3.60         NA      40.04        090
43312.............  ..............  A                Repair esophagus and        28.38         NA      11.92       4.00         NA      44.30        090
                                                      fistula.
43313.............  ..............  A                Esophagoplasty              45.21         NA      18.86       5.45         NA      69.52        090
                                                      congenital.
43314.............  ..............  A                Tracheo-esophagoplasty      50.19         NA      19.24       6.63         NA      76.06        090
                                                      cong.
43320.............  ..............  A                Fuse esophagus &            19.90         NA       9.23       2.73         NA      31.86        090
                                                      stomach.
43324.............  ..............  A                Revise esophagus &          20.54         NA       8.79       2.75         NA      32.08        090
                                                      stomach.
43325.............  ..............  A                Revise esophagus &          20.03         NA       8.81       2.59         NA      31.43        090
                                                      stomach.
43326.............  ..............  A                Revise esophagus &          19.71         NA       9.32       2.84         NA      31.87        090
                                                      stomach.
43330.............  ..............  A                Repair of esophagus...      19.74         NA       8.55       2.62         NA      30.91        090
43331.............  ..............  A                Repair of esophagus...      20.10         NA       9.81       2.93         NA      32.84        090
43340.............  ..............  A                Fuse esophagus &            19.58         NA       8.99       2.45         NA      31.02        090
                                                      intestine.
43341.............  ..............  A                Fuse esophagus &            20.82         NA      10.04       2.91         NA      33.77        090
                                                      intestine.
43350.............  ..............  A                Surgical opening,           15.76         NA       8.46       1.42         NA      25.64        090
                                                      esophagus.
43351.............  ..............  A                Surgical opening,           18.32         NA       9.82       2.46         NA      30.60        090
                                                      esophagus.
43352.............  ..............  A                Surgical opening,           15.24         NA       8.40       2.05         NA      25.69        090
                                                      esophagus.
43360.............  ..............  A                Gastrointestinal            35.65         NA      15.11       4.96         NA      55.72        090
                                                      repair.
43361.............  ..............  A                Gastrointestinal            40.44         NA      16.93       4.49         NA      61.86        090
                                                      repair.
43400.............  ..............  A                Ligate esophagus veins      21.17         NA       9.46       1.95         NA      32.58        090
43401.............  ..............  A                Esophagus surgery for       22.06         NA       9.51       3.04         NA      34.61        090
                                                      veins.
43405.............  ..............  A                Ligate/staple               19.98         NA       9.61       2.83         NA      32.42        090
                                                      esophagus.
43410.............  ..............  A                Repair esophagus wound      13.45         NA       7.65       1.71         NA      22.81        090
43415.............  ..............  A                Repair esophagus wound      24.96         NA      11.77       3.52         NA      40.25        090
43420.............  ..............  A                Repair esophagus            14.33         NA       7.42       1.43         NA      23.18        090
                                                      opening.
43425.............  ..............  A                Repair esophagus            21.00         NA      10.00       3.02         NA      34.02        090
                                                      opening.
43450.............  ..............  A                Dilate esophagus......       1.38       2.64       0.69       0.11       4.13       2.18        000
43453.............  ..............  A                Dilate esophagus......       1.51       6.08       0.73       0.11       7.70       2.35        000
43456.............  ..............  A                Dilate esophagus......       2.57      13.78       1.10       0.20      16.55       3.87        000
43458.............  ..............  A                Dilate esophagus......       3.06       6.67       1.28       0.24       9.97       4.58        000
43460.............  ..............  A                Pressure treatment           3.79         NA       1.49       0.31         NA       5.59        000
                                                      esophagus.
43496.............  ..............  C                Free jejunum flap,           0.00       0.00       0.00       0.00       0.00       0.00        090
                                                      microvasc.
43499.............  ..............  C                Esophagus surgery            0.00       0.00       0.00       0.00       0.00       0.00        YYY
                                                      procedure.
43500.............  ..............  A                Surgical opening of         11.03         NA       4.98       1.45         NA      17.46        090
                                                      stomach.
43501.............  ..............  A                Surgical repair of          20.01         NA       8.32       2.64         NA      30.97        090
                                                      stomach.
43502.............  ..............  A                Surgical repair of          23.10         NA       9.48       3.09         NA      35.67        090
                                                      stomach.
43510.............  ..............  A                Surgical opening of         13.06         NA       6.60       1.48         NA      21.14        090
                                                      stomach.
43520.............  ..............  A                Incision of pyloric          9.98         NA       5.27       1.36         NA      16.61        090
                                                      muscle.
43600.............  ..............  A                Biopsy of stomach.....       1.91         NA       0.66       0.14         NA       2.71        000
43605.............  ..............  A                Biopsy of stomach.....      11.96         NA       5.30       1.58         NA      18.84        090
43610.............  ..............  A                Excision of stomach         14.58         NA       6.16       1.93         NA      22.67        090
                                                      lesion.
43611.............  ..............  A                Excision of stomach         17.81         NA       7.58       2.35         NA      27.74        090
                                                      lesion.
43620.............  ..............  A                Removal of stomach....      29.99         NA      11.82       3.95         NA      45.76        090
43621.............  ..............  A                Removal of stomach....      30.68         NA      12.00       4.03         NA      46.71        090
43622.............  ..............  A                Removal of stomach....      32.48         NA      12.62       4.29         NA      49.39        090
43631.............  ..............  A                Removal of stomach,         22.56         NA       9.18       2.98         NA      34.72        090
                                                      partial.

[[Page 70382]]

 
43632.............  ..............  A                Removal of stomach,         22.56         NA       9.18       2.98         NA      34.72        090
                                                      partial.
43633.............  ..............  A                Removal of stomach,         23.07         NA       9.35       3.05         NA      35.47        090
                                                      partial.
43634.............  ..............  A                Removal of stomach,         25.08         NA      10.11       3.32         NA      38.51        090
                                                      partial.
43635.............  ..............  A                Removal of stomach,          2.06         NA       0.70       0.27         NA       3.03        ZZZ
                                                      partial.
43640.............  ..............  A                Vagotomy & pylorus          16.99         NA       7.27       2.25         NA      26.51        090
                                                      repair.
43641.............  ..............  A                Vagotomy & pylorus          17.24         NA       7.38       2.24         NA      26.86        090
                                                      repair.
43644.............  ..............  A                Lap gastric bypass/         27.83         NA      11.24       3.15         NA      42.22        090
                                                      roux-en-y.
43645.............  ..............  A                Lap gastr bypass incl       29.96         NA      12.04       3.53         NA      45.53        090
                                                      smll i.
43651.............  ..............  A                Laparoscopy, vagus          10.13         NA       4.77       1.33         NA      16.23        090
                                                      nerve.
43652.............  ..............  A                Laparoscopy, vagus          12.13         NA       5.77       1.55         NA      19.45        090
                                                      nerve.
43653.............  ..............  A                Laparoscopy,                 7.72         NA       4.19       1.01         NA      12.92        090
                                                      gastrostomy.
43659.............  ..............  C                Laparoscope proc, stom       0.00       0.00       0.00       0.00       0.00       0.00        YYY
43750.............  ..............  A                Place gastrostomy tube       4.48         NA       2.20       0.43         NA       7.11        010
43752.............  ..............  A                Nasal/orogastric w/          0.81       0.28       0.26       0.02       1.11       1.09        000
                                                      stent.
43760.............  ..............  A                Change gastrostomy           1.10       2.09       0.45       0.09       3.28       1.64        000
                                                      tube.
43761.............  ..............  A                Reposition gastrostomy       2.01       1.17       0.66       0.13       3.31       2.80        000
                                                      tube.
43770.............  ..............  A                Lap, place gastr            16.71         NA       7.73       2.18         NA      26.62        090
                                                      adjust band.
43771.............  ..............  A                Lap, revise adjust          19.50         NA       8.61       2.54         NA      30.65        090
                                                      gast band.
43772.............  ..............  A                Lap, remove adjust          15.00         NA       6.44       1.92         NA      23.36        090
                                                      gast band.
43773.............  ..............  A                Lap, change adjust          19.50         NA       8.61       2.55         NA      30.66        090
                                                      gast band.
43774.............  ..............  A                Lap remov adj gast          15.00         NA       6.58       1.84         NA      23.42        090
                                                      band/port.
43800.............  ..............  A                Reconstruction of           13.67         NA       5.91       1.81         NA      21.39        090
                                                      pylorus.
43810.............  ..............  A                Fusion of stomach and       14.63         NA       6.19       1.93         NA      22.75        090
                                                      bowel.
43820.............  ..............  A                Fusion of stomach and       15.35         NA       6.42       2.03         NA      23.80        090
                                                      bowel.
43825.............  ..............  A                Fusion of stomach and       19.19         NA       8.03       2.53         NA      29.75        090
                                                      bowel.
43830.............  ..............  A                Place gastrostomy tube       9.52         NA       4.85       1.25         NA      15.62        090
43831.............  ..............  A                Place gastrostomy tube       7.83         NA       4.52       1.03         NA      13.38        090
43832.............  ..............  A                Place gastrostomy tube      15.58         NA       6.86       1.97         NA      24.41        090
43840.............  ..............  A                Repair of stomach           15.54         NA       6.78       2.05         NA      24.37        090
                                                      lesion.
43842.............  ..............  A                V-band gastroplasty...      18.44         NA       7.81       2.44         NA      28.69        090
43843.............  ..............  A                Gastroplasty w/o v-         18.62         NA       7.78       2.45         NA      28.85        090
                                                      band.
43845.............  ..............  A                Gastroplasty duodenal       31.00      10.80      10.80       4.05      45.85      45.85        090
                                                      switch.
43846.............  ..............  A                Gastric bypass for          24.01         NA      10.05       3.18         NA      37.24        090
                                                      obesity.
43847.............  ..............  A                Gastric bypass incl         26.88         NA      10.92       3.55         NA      41.35        090
                                                      small i.
43848.............  ..............  A                Revision gastroplasty.      29.35         NA      11.84       3.87         NA      45.06        090
43850.............  ..............  A                Revise stomach-bowel        24.68         NA       9.84       3.27         NA      37.79        090
                                                      fusion.
43855.............  ..............  A                Revise stomach-bowel        26.12         NA      10.35       3.46         NA      39.93        090
                                                      fusion.
43860.............  ..............  A                Revise stomach-bowel        24.96         NA       9.99       3.30         NA      38.25        090
                                                      fusion.
43865.............  ..............  A                Revise stomach-bowel        26.48         NA      10.53       3.50         NA      40.51        090
                                                      fusion.
43870.............  ..............  A                Repair stomach opening       9.68         NA       4.52       1.27         NA      15.47        090
43880.............  ..............  A                Repair stomach-bowel        24.61         NA       9.92       3.26         NA      37.79        090
                                                      fistula.
43886.............  ..............  A                Revise gastric port,         4.00         NA       3.14       0.25         NA       7.39        090
                                                      open.
43887.............  ..............  A                Remove gastric port,         3.95         NA       2.78       0.51         NA       7.24        090
                                                      open.
43888.............  ..............  A                Change gastric port,         5.80         NA       3.77       0.70         NA      10.27        090
                                                      open.
43999.............  ..............  C                Stomach surgery              0.00       0.00       0.00       0.00       0.00       0.00        YYY
                                                      procedure.
44005.............  ..............  A                Freeing of bowel            16.21         NA       6.73       2.14         NA      25.08        090
                                                      adhesion.
44010.............  ..............  A                Incision of small           12.50         NA       5.46       1.64         NA      19.60        090
                                                      bowel.
44015.............  ..............  A                Insert needle cath           2.62         NA       0.88       0.35         NA       3.85        ZZZ
                                                      bowel.
44020.............  ..............  A                Explore small               13.97         NA       5.95       1.85         NA      21.77        090
                                                      intestine.
44021.............  ..............  A                Decompress small bowel      14.06         NA       5.98       1.86         NA      21.90        090
44025.............  ..............  A                Incision of large           14.26         NA       6.04       1.89         NA      22.19        090
                                                      bowel.
44050.............  ..............  A                Reduce bowel                14.01         NA       5.97       1.85         NA      21.83        090
                                                      obstruction.
44055.............  ..............  A                Correct malrotation of      21.97         NA       8.75       2.90         NA      33.62        090
                                                      bowel.
44100.............  ..............  A                Biopsy of bowel.......       2.01         NA       0.71       0.17         NA       2.89        000
44110.............  ..............  A                Excise intestine            11.79         NA       5.24       1.55         NA      18.58        090
                                                      lesion(s).
44111.............  ..............  A                Excision of bowel           14.27         NA       6.12       1.86         NA      22.25        090
                                                      lesion(s).
44120.............  ..............  A                Removal of small            16.97         NA       7.09       2.24         NA      26.30        090
                                                      intestine.
44121.............  ..............  A                Removal of small             4.44         NA       1.52       0.58         NA       6.54        ZZZ
                                                      intestine.
44125.............  ..............  A                Removal of small            17.51         NA       7.27       2.26         NA      27.04        090
                                                      intestine.
44126.............  ..............  A                Enterectomy w/o taper,      35.45         NA      14.15       4.68         NA      54.28        090
                                                      cong.
44127.............  ..............  A                Enterectomy w/taper,        40.94         NA      15.76       5.75         NA      62.45        090
                                                      cong.
44128.............  ..............  A                Enterectomy cong, add-       4.44         NA       1.53       0.61         NA       6.58        ZZZ
                                                      on.
44130.............  ..............  A                Bowel to bowel fusion.      14.47         NA       6.23       1.87         NA      22.57        090
44132.............  ..............  R                Enterectomy, cadaver         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      donor.
44133.............  ..............  R                Enterectomy, live            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      donor.
44135.............  ..............  R                Intestine transplnt,         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      cadaver.
44136.............  ..............  R                Intestine transplant,        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      live.
44137.............  ..............  C                Remove intestinal            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      allograft.
44139.............  ..............  A                Mobilization of colon.       2.23         NA       0.76       0.28         NA       3.27        ZZZ
44140.............  ..............  A                Partial removal of          20.97         NA       8.67       2.70         NA      32.34        090
                                                      colon.
44141.............  ..............  A                Partial removal of          19.48         NA      10.07       2.52         NA      32.07        090
                                                      colon.
44143.............  ..............  A                Partial removal of          22.96         NA      10.71       3.04         NA      36.71        090
                                                      colon.
44144.............  ..............  A                Partial removal of          21.50         NA       9.64       2.85         NA      33.99        090
                                                      colon.
44145.............  ..............  A                Partial removal of          26.38         NA      10.83       3.28         NA      40.49        090
                                                      colon.
44146.............  ..............  A                Partial removal of          27.50         NA      12.89       3.40         NA      43.79        090
                                                      colon.

[[Page 70383]]

 
44147.............  ..............  A                Partial removal of          20.68         NA       8.71       2.55         NA      31.94        090
                                                      colon.
44150.............  ..............  A                Removal of colon......      23.91         NA      12.05       3.03         NA      38.99        090
44151.............  ..............  A                Removal of colon/           26.84         NA      13.43       3.48         NA      43.75        090
                                                      ileostomy.
44152.............  ..............  A                Removal of colon/           27.79         NA      11.62       3.51         NA      42.92        090
                                                      ileostomy.
44153.............  ..............  A                Removal of colon/           30.54         NA      14.41       3.54         NA      48.49        090
                                                      ileostomy.
44155.............  ..............  A                Removal of colon/           27.82         NA      13.34       3.27         NA      44.43        090
                                                      ileostomy.
44156.............  ..............  A                Removal of colon/           30.74         NA      15.07       3.94         NA      49.75        090
                                                      ileostomy.
44160.............  ..............  A                Removal of colon......      18.59         NA       7.76       2.36         NA      28.71        090
44180.............  ..............  A                Lap, enterolysis......      14.42         NA       6.25       1.85         NA      22.52        090
44186.............  ..............  A                Lap, jejunostomy......       9.77         NA       4.80       1.27         NA      15.84        090
44187.............  ..............  A                Lap, ileo/jejuno-stomy      15.93         NA       8.29       1.95         NA      26.17        090
44188.............  ..............  A                Lap, colostomy........      17.61         NA       8.87       2.23         NA      28.71        090
44202.............  ..............  A                Lap, enterectomy......      22.01         NA       8.95       2.84         NA      33.80        090
44203.............  ..............  A                Lap resect s/                4.44         NA       1.50       0.57         NA       6.51        ZZZ
                                                      intestine, addl.
44204.............  ..............  A                Laparo partial              25.04         NA       9.98       3.10         NA      38.12        090
                                                      colectomy.
44205.............  ..............  A                Lap colectomy part w/       22.20         NA       8.87       2.74         NA      33.81        090
                                                      ileum.
44206.............  ..............  A                Lap part colectomy w/       26.96         NA      11.28       3.45         NA      41.69        090
                                                      stoma.
44207.............  ..............  A                L colectomy/                29.96         NA      11.51       3.66         NA      45.13        090
                                                      coloproctostomy.
44208.............  ..............  A                L colectomy/                31.95         NA      13.17       3.87         NA      48.99        090
                                                      coloproctostomy.
44210.............  ..............  A                Laparo total                27.96         NA      11.90       3.41         NA      43.27        090
                                                      proctocolectomy.
44211.............  ..............  A                Laparo total                34.95         NA      14.71       4.16         NA      53.82        090
                                                      proctocolectomy.
44212.............  ..............  A                Laparo total                32.45         NA      13.72       3.77         NA      49.94        090
                                                      proctocolectomy.
44213.............  ..............  A                Lap, mobil splenic fl        3.50         NA       1.22       0.44         NA       5.16        ZZZ
                                                      add-on.
44227.............  ..............  A                Lap, close enterostomy      26.50         NA      10.65       3.37         NA      40.52        090
44238.............  ..............  C                Laparoscope proc,            0.00       0.00       0.00       0.00       0.00       0.00        YYY
                                                      intestine.
44300.............  ..............  A                Open bowel to skin....      12.09         NA       5.50       1.60         NA      19.19        090
44310.............  ..............  A                Ileostomy/jejunostomy.      15.93         NA       6.71       1.98         NA      24.62        090
44312.............  ..............  A                Revision of ileostomy.       8.01         NA       4.00       0.92         NA      12.93        090
44314.............  ..............  A                Revision of ileostomy.      15.03         NA       6.57       1.74         NA      23.34        090
44316.............  ..............  A                Devise bowel pouch....      21.06         NA       8.56       2.37         NA      31.99        090
44320.............  ..............  A                Colostomy.............      17.61         NA       7.67       2.25         NA      27.53        090
44322.............  ..............  A                Colostomy with              11.96         NA       8.59       1.54         NA      22.09        090
                                                      biopsies.
44340.............  ..............  A                Revision of colostomy.       7.71         NA       4.27       0.99         NA      12.97        090
44345.............  ..............  A                Revision of colostomy.      15.41         NA       6.90       1.96         NA      24.27        090
44346.............  ..............  A                Revision of colostomy.      16.96         NA       7.40       2.12         NA      26.48        090
44360.............  ..............  A                Small bowel endoscopy.       2.59         NA       1.10       0.19         NA       3.88        000
44361.............  ..............  A                Small bowel endoscopy/       2.87         NA       1.20       0.21         NA       4.28        000
                                                      biopsy.
44363.............  ..............  A                Small bowel endoscopy.       3.49         NA       1.38       0.27         NA       5.14        000
44364.............  ..............  A                Small bowel endoscopy.       3.73         NA       1.49       0.27         NA       5.49        000
44365.............  ..............  A                Small bowel endoscopy.       3.31         NA       1.36       0.24         NA       4.91        000
44366.............  ..............  A                Small bowel endoscopy.       4.40         NA       1.74       0.32         NA       6.46        000
44369.............  ..............  A                Small bowel endoscopy.       4.51         NA       1.74       0.33         NA       6.58        000
44370.............  ..............  A                Small bowel endoscopy/       4.79         NA       1.98       0.37         NA       7.14        000
                                                      stent.
44372.............  ..............  A                Small bowel endoscopy.       4.40         NA       1.74       0.35         NA       6.49        000
44373.............  ..............  A                Small bowel endoscopy.       3.49         NA       1.42       0.27         NA       5.18        000
44376.............  ..............  A                Small bowel endoscopy.       5.25         NA       2.03       0.42         NA       7.70        000
44377.............  ..............  A                Small bowel endoscopy/       5.52         NA       2.14       0.40         NA       8.06        000
                                                      biopsy.
44378.............  ..............  A                Small bowel endoscopy.       7.12         NA       2.70       0.52         NA      10.34        000
44379.............  ..............  A                S bowel endoscope w/         7.46         NA       2.92       0.62         NA      11.00        000
                                                      stent.
44380.............  ..............  A                Small bowel endoscopy.       1.05         NA       0.55       0.08         NA       1.68        000
44382.............  ..............  A                Small bowel endoscopy.       1.27         NA       0.63       0.12         NA       2.02        000
44383.............  ..............  A                Ileoscopy w/stent.....       2.94         NA       1.27       0.21         NA       4.42        000
44385.............  ..............  A                Endoscopy of bowel           1.82       3.36       0.75       0.15       5.33       2.72        000
                                                      pouch.
44386.............  ..............  A                Endoscopy, bowel pouch/      2.12       6.66       0.88       0.20       8.98       3.20        000
                                                      biop.
44388.............  ..............  A                Colonoscopy...........       2.82       5.09       1.15       0.26       8.17       4.23        000
44389.............  ..............  A                Colonoscopy with             3.13       6.64       1.27       0.27      10.04       4.67        000
                                                      biopsy.
44390.............  ..............  A                Colonoscopy for              3.82       7.13       1.49       0.32      11.27       5.63        000
                                                      foreign body.
44391.............  ..............  A                Colonoscopy for              4.31       8.75       1.69       0.34      13.40       6.34        000
                                                      bleeding.
44392.............  ..............  A                Colonoscopy &                3.81       6.60       1.49       0.34      10.75       5.64        000
                                                      polypectomy.
44393.............  ..............  A                Colonoscopy, lesion          4.83       6.92       1.87       0.42      12.17       7.12        000
                                                      removal.
44394.............  ..............  A                Colonoscopy w/snare...       4.42       7.83       1.72       0.38      12.63       6.52        000
44397.............  ..............  A                Colonoscopy w/stent...       4.70         NA       1.80       0.39         NA       6.89        000
44500.............  ..............  A                Intro,                       0.49         NA       0.16       0.03         NA       0.68        000
                                                      gastrointestinal tube.
44602.............  ..............  A                Suture, small               16.01         NA       6.41       2.11         NA      24.53        090
                                                      intestine.
44603.............  ..............  A                Suture, small               18.63         NA       7.29       2.41         NA      28.33        090
                                                      intestine.
44604.............  ..............  A                Suture, large               16.01         NA       6.47       2.11         NA      24.59        090
                                                      intestine.
44605.............  ..............  A                Repair of bowel lesion      19.50         NA       8.41       2.51         NA      30.42        090
44615.............  ..............  A                Intestinal                  15.91         NA       6.69       2.06         NA      24.66        090
                                                      stricturoplasty.
44620.............  ..............  A                Repair bowel opening..      12.18         NA       5.34       1.51         NA      19.03        090
44625.............  ..............  A                Repair bowel opening..      15.03         NA       6.32       1.85         NA      23.20        090
44626.............  ..............  A                Repair bowel opening..      25.32         NA       9.84       3.26         NA      38.42        090
44640.............  ..............  A                Repair bowel-skin           21.62         NA       8.59       2.77         NA      32.98        090
                                                      fistula.
44650.............  ..............  A                Repair bowel fistula..      22.54         NA       8.91       2.92         NA      34.37        090
44660.............  ..............  A                Repair bowel-bladder        21.33         NA       8.36       2.13         NA      31.82        090
                                                      fistula.
44661.............  ..............  A                Repair bowel-bladder        24.77         NA       9.58       2.80         NA      37.15        090
                                                      fistula.

[[Page 70384]]

 
44680.............  ..............  A                Surgical revision,          15.38         NA       6.46       1.99         NA      23.83        090
                                                      intestine.
44700.............  ..............  A                Suspend bowel w/            16.09         NA       6.68       1.83         NA      24.60        090
                                                      prosthesis.
44701.............  ..............  A                Intraop colon lavage         3.10         NA       1.06       0.37         NA       4.53        ZZZ
                                                      add-on.
44715.............  ..............  C                Prepare donor                0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      intestine.
44720.............  ..............  A                Prep donor intestine/        5.00         NA       1.71       0.37         NA       7.08        XXX
                                                      venous.
44721.............  ..............  A                Prep donor intestine/        7.00         NA       2.40       0.97         NA      10.37        XXX
                                                      artery.
44799.............  ..............  C                Unlisted procedure           0.00       0.00       0.00       0.00       0.00       0.00        YYY
                                                      intestine.
44800.............  ..............  A                Excision of bowel           11.21         NA       5.40       1.47         NA      18.08        090
                                                      pouch.
44820.............  ..............  A                Excision of mesentery       12.07         NA       5.50       1.59         NA      19.16        090
                                                      lesion.
44850.............  ..............  A                Repair of mesentery...      10.72         NA       5.01       1.39         NA      17.12        090
44899.............  ..............  C                Bowel surgery                0.00       0.00       0.00       0.00       0.00       0.00        YYY
                                                      procedure.
44900.............  ..............  A                Drain app abscess,          10.12         NA       4.70       1.33         NA      16.15        090
                                                      open.
44901.............  ..............  A                Drain app abscess,           3.37      27.97       1.11       0.22      31.56       4.70        000
                                                      percut.
44950.............  ..............  A                Appendectomy..........       9.99         NA       4.32       1.31         NA      15.62        090
44955.............  ..............  A                Appendectomy add-on...       1.53         NA       0.54       0.20         NA       2.27        ZZZ
44960.............  ..............  A                Appendectomy..........      12.32         NA       5.35       1.63         NA      19.30        090
44970.............  ..............  A                Laparoscopy,                 8.69         NA       4.09       1.14         NA      13.92        090
                                                      appendectomy.
44979.............  ..............  C                Laparoscope proc, app.       0.00       0.00       0.00       0.00       0.00       0.00        YYY
45000.............  ..............  A                Drainage of pelvic           4.51         NA       2.97       0.52         NA       8.00        090
                                                      abscess.
45005.............  ..............  A                Drainage of rectal           1.99       4.06       1.58       0.25       6.30       3.82        010
                                                      abscess.
45020.............  ..............  A                Drainage of rectal           4.71         NA       3.28       0.55         NA       8.54        090
                                                      abscess.
45100.............  ..............  A                Biopsy of rectum......       3.67         NA       2.37       0.44         NA       6.48        090
45108.............  ..............  A                Removal of anorectal         4.75         NA       2.78       0.59         NA       8.12        090
                                                      lesion.
45110.............  ..............  A                Removal of rectum.....      27.96         NA      12.43       3.35         NA      43.74        090
45111.............  ..............  A                Partial removal of          16.46         NA       7.18       2.06         NA      25.70        090
                                                      rectum.
45112.............  ..............  A                Removal of rectum.....      30.49         NA      11.79       3.42         NA      45.70        090
45113.............  ..............  A                Partial proctectomy...      30.53         NA      12.63       3.48         NA      46.64        090
45114.............  ..............  A                Partial removal of          27.28         NA      10.90       3.35         NA      41.53        090
                                                      rectum.
45116.............  ..............  A                Partial removal of          24.54         NA      10.05       2.87         NA      37.46        090
                                                      rectum.
45119.............  ..............  A                Remove rectum w/            30.79         NA      12.49       3.35         NA      46.63        090
                                                      reservoir.
45120.............  ..............  A                Removal of rectum.....      24.56         NA      10.15       2.89         NA      37.60        090
45121.............  ..............  A                Removal of rectum and       27.00         NA      11.13       3.24         NA      41.37        090
                                                      colon.
45123.............  ..............  A                Partial proctectomy...      16.68         NA       6.87       1.85         NA      25.40        090
45126.............  ..............  A                Pelvic exenteration...      45.09         NA      19.26       4.32         NA      68.67        090
45130.............  ..............  A                Excision of rectal          16.42         NA       6.78       1.79         NA      24.99        090
                                                      prolapse.
45135.............  ..............  A                Excision of rectal          19.25         NA       8.43       2.35         NA      30.03        090
                                                      prolapse.
45136.............  ..............  A                Excise ileoanal             27.26         NA      12.55       2.81         NA      42.62        090
                                                      reservior.
45150.............  ..............  A                Excision of rectal           5.66         NA       2.97       0.61         NA       9.24        090
                                                      stricture.
45160.............  ..............  A                Excision of rectal          15.30         NA       6.66       1.67         NA      23.63        090
                                                      lesion.
45170.............  ..............  A                Excision of rectal          11.47         NA       5.25       1.35         NA      18.07        090
                                                      lesion.
45190.............  ..............  A                Destruction, rectal          9.73         NA       4.63       1.13         NA      15.49        090
                                                      tumor.
45300.............  ..............  A                Proctosigmoidoscopy dx       0.38       1.53       0.28       0.04       1.95       0.70        000
45303.............  ..............  A                Proctosigmoidoscopy          0.44      18.73       0.33       0.05      19.22       0.82        000
                                                      dilate.
45305.............  ..............  A                Proctosigmoidoscopy w/       1.01       2.64       0.50       0.11       3.76       1.62        000
                                                      bx.
45307.............  ..............  A                Proctosigmoidoscopy fb       0.94       3.04       0.48       0.11       4.09       1.53        000
45308.............  ..............  A                Proctosigmoidoscopy          0.83       2.00       0.44       0.09       2.92       1.36        000
                                                      removal.
45309.............  ..............  A                Proctosigmoidoscopy          2.01       2.82       0.84       0.22       5.05       3.07        000
                                                      removal.
45315.............  ..............  A                Proctosigmoidoscopy          1.40       2.87       0.63       0.15       4.42       2.18        000
                                                      removal.
45317.............  ..............  A                Proctosigmoidoscopy          1.50       2.44       0.66       0.15       4.09       2.31        000
                                                      bleed.
45320.............  ..............  A                Proctosigmoidoscopy          1.58       2.92       0.71       0.16       4.66       2.45        000
                                                      ablate.
45321.............  ..............  A                Proctosigmoidoscopy          1.17         NA       0.56       0.13         NA       1.86        000
                                                      volvul.
45327.............  ..............  A                Proctosigmoidoscopy w/       1.65         NA       0.69       0.16         NA       2.50        000
                                                      stent.
45330.............  ..............  A                Diagnostic                   0.96       2.28       0.50       0.08       3.32       1.54        000
                                                      sigmoidoscopy.
45331.............  ..............  A                Sigmoidoscopy and            1.15       3.08       0.59       0.09       4.32       1.83        000
                                                      biopsy.
45332.............  ..............  A                Sigmoidoscopy w/fb           1.79       5.01       0.80       0.16       6.96       2.75        000
                                                      removal.
45333.............  ..............  A                Sigmoidoscopy &              1.79       4.88       0.80       0.15       6.82       2.74        000
                                                      polypectomy.
45334.............  ..............  A                Sigmoidoscopy for            2.73         NA       1.14       0.20         NA       4.07        000
                                                      bleeding.
45335.............  ..............  A                Sigmoidoscopy w/submuc       1.46       3.22       0.69       0.11       4.79       2.26        000
                                                      inj.
45337.............  ..............  A                Sigmoidoscopy &              2.36         NA       1.00       0.21         NA       3.57        000
                                                      decompress.
45338.............  ..............  A                Sigmoidoscopy w/tumr         2.34       5.23       1.00       0.19       7.76       3.53        000
                                                      remove.
45339.............  ..............  A                Sigmoidoscopy w/ablate       3.14       3.47       1.28       0.26       6.87       4.68        000
                                                      tumr.
45340.............  ..............  A                Sig w/balloon dilation       1.89       6.19       0.83       0.15       8.23       2.87        000
45341.............  ..............  A                Sigmoidoscopy w/             2.60         NA       1.07       0.19         NA       3.86        000
                                                      ultrasound.
45342.............  ..............  A                Sigmoidoscopy w/us           4.05         NA       1.54       0.30         NA       5.89        000
                                                      guide bx.
45345.............  ..............  A                Sigmoidoscopy w/stent.       2.92         NA       1.16       0.23         NA       4.31        000
45355.............  ..............  A                Surgical colonoscopy..       3.51         NA       1.38       0.36         NA       5.25        000
45378.............  53............  A                Diagnostic colonoscopy       0.96       2.28       0.50       0.08       3.32       1.54        000
45378.............  ..............  A                Diagnostic colonoscopy       3.69       6.16       1.47       0.30      10.15       5.46        000
45379.............  ..............  A                Colonoscopy w/fb             4.68       7.68       1.82       0.39      12.75       6.89        000
                                                      removal.
45380.............  ..............  A                Colonoscopy and biopsy       4.43       7.21       1.74       0.35      11.99       6.52        000
45381.............  ..............  A                Colonoscopy, submucous       4.19       7.13       1.65       0.30      11.62       6.14        000
                                                      inj.
45382.............  ..............  A                Colonoscopy/control          5.68       9.97       2.19       0.41      16.06       8.28        000
                                                      bleeding.
45383.............  ..............  A                Lesion removal               5.86       7.94       2.23       0.48      14.28       8.57        000
                                                      colonoscopy.
45384.............  ..............  A                Lesion remove                4.69       6.82       1.83       0.38      11.89       6.90        000
                                                      colonoscopy.
45385.............  ..............  A                Lesion removal               5.30       7.82       2.04       0.42      13.54       7.76        000
                                                      colonoscopy.

[[Page 70385]]

 
45386.............  ..............  A                Colonoscopy dilate           4.57      12.44       1.79       0.39      17.40       6.75        000
                                                      stricture.
45387.............  ..............  A                Colonoscopy w/stent...       5.90         NA       2.34       0.48         NA       8.72        000
45391.............  ..............  A                Colonoscopy w/               5.09         NA       1.98       0.42         NA       7.49        000
                                                      endoscope us.
45392.............  ..............  A                Colonoscopy w/               6.54         NA       2.49       0.42         NA       9.45        000
                                                      endoscopic fnb.
45395.............  ..............  A                Lap, removal of rectum      30.50         NA      13.71       3.62         NA      47.83        090
45397.............  ..............  A                Lap, remove rectum w/       34.00         NA      14.30       3.66         NA      51.96        090
                                                      pouch.
45400.............  ..............  A                Laparoscopic                18.06         NA       7.85       2.02         NA      27.93        090
                                                      proctopexy.
45402.............  ..............  A                Lap proctopexy w/sig        25.04         NA      10.01       2.81         NA      37.86        090
                                                      resect.
45499.............  ..............  C                Laparoscope proc,            0.00       0.00       0.00       0.00       0.00       0.00        YYY
                                                      rectum.
45500.............  ..............  A                Repair of rectum......       7.28         NA       3.54       0.75         NA      11.57        090
45505.............  ..............  A                Repair of rectum......       7.57         NA       3.86       0.86         NA      12.29        090
45520.............  ..............  A                Treatment of rectal          0.55       1.64       0.37       0.05       2.24       0.97        000
                                                      prolapse.
45540.............  ..............  A                Correct rectal              16.25         NA       6.81       1.84         NA      24.90        090
                                                      prolapse.
45541.............  ..............  A                Correct rectal              13.38         NA       5.96       1.55         NA      20.89        090
                                                      prolapse.
45550.............  ..............  A                Repair rectum/remove        22.97         NA       9.24       2.61         NA      34.82        090
                                                      sigmoid.
45560.............  ..............  A                Repair of rectocele...      10.56         NA       5.06       1.13         NA      16.75        090
45562.............  ..............  A                Exploration/repair of       15.36         NA       7.00       1.83         NA      24.19        090
                                                      rectum.
45563.............  ..............  A                Exploration/repair of       23.43         NA      10.54       3.10         NA      37.07        090
                                                      rectum.
45800.............  ..............  A                Repair rect/bladder         17.74         NA       7.44       1.85         NA      27.03        090
                                                      fistula.
45805.............  ..............  A                Repair fistula w/           20.75         NA       9.53       2.02         NA      32.30        090
                                                      colostomy.
45820.............  ..............  A                Repair rectourethral        18.45         NA       7.64       1.58         NA      27.67        090
                                                      fistula.
45825.............  ..............  A                Repair fistula w/           21.22         NA       9.84       2.31         NA      33.37        090
                                                      colostomy.
45900.............  ..............  A                Reduction of rectal          2.61         NA       1.50       0.30         NA       4.41        010
                                                      prolapse.
45905.............  ..............  A                Dilation of anal             2.30         NA       1.43       0.27         NA       4.00        010
                                                      sphincter.
45910.............  ..............  A                Dilation of rectal           2.80         NA       1.66       0.30         NA       4.76        010
                                                      narrowing.
45915.............  ..............  A                Remove rectal                3.14       4.33       2.10       0.30       7.77       5.54        010
                                                      obstruction.
45990.............  ..............  A                Surg dx exam,                1.80         NA       0.79       0.17         NA       2.76        000
                                                      anorectal.
45999.............  ..............  C                Rectum surgery               0.00       0.00       0.00       0.00       0.00       0.00        YYY
                                                      procedure.
46020.............  ..............  A                Placement of seton....       2.90       2.34       1.86       0.31       5.55       5.07        010
46030.............  ..............  A                Removal of rectal            1.23       1.35       0.71       0.14       2.72       2.08        010
                                                      marker.
46040.............  ..............  A                Incision of rectal           4.95       5.51       3.59       0.62      11.08       9.16        090
                                                      abscess.
46045.............  ..............  A                Incision of rectal           4.31         NA       2.90       0.54         NA       7.75        090
                                                      abscess.
46050.............  ..............  A                Incision of anal             1.19       2.55       0.84       0.14       3.88       2.17        010
                                                      abscess.
46060.............  ..............  A                Incision of rectal           5.68         NA       3.25       0.67         NA       9.60        090
                                                      abscess.
46070.............  ..............  A                Incision of anal             2.71         NA       1.84       0.36         NA       4.91        090
                                                      septum.
46080.............  ..............  A                Incision of anal             2.49       2.37       1.13       0.30       5.16       3.92        010
                                                      sphincter.
46083.............  ..............  A                Incise external              1.40       2.53       0.92       0.15       4.08       2.47        010
                                                      hemorrhoid.
46200.............  ..............  A                Removal of anal              3.41       3.86       2.87       0.39       7.66       6.67        090
                                                      fissure.
46210.............  ..............  A                Removal of anal crypt.       2.67       5.12       2.63       0.31       8.10       5.61        090
46211.............  ..............  A                Removal of anal crypts       4.24       5.42       3.51       0.48      10.14       8.23        090
46220.............  ..............  A                Removal of anal tag...       1.56       2.30       0.95       0.17       4.03       2.68        010
46221.............  ..............  A                Ligation of                  2.04       2.65       1.75       0.23       4.92       4.02        010
                                                      hemorrhoid(s).
46230.............  ..............  A                Removal of anal tags..       2.57       3.08       1.29       0.30       5.95       4.16        010
46250.............  ..............  A                Hemorrhoidectomy......       3.88       5.32       2.62       0.48       9.68       6.98        090
46255.............  ..............  A                Hemorrhoidectomy......       4.59       5.85       2.84       0.58      11.02       8.01        090
46257.............  ..............  A                Remove hemorrhoids &         5.39         NA       2.88       0.64         NA       8.91        090
                                                      fissure.
46258.............  ..............  A                Remove hemorrhoids &         5.72         NA       3.28       0.68         NA       9.68        090
                                                      fistula.
46260.............  ..............  A                Hemorrhoidectomy......       6.36         NA       3.19       0.76         NA      10.31        090
46261.............  ..............  A                Remove hemorrhoids &         7.07         NA       3.61       0.79         NA      11.47        090
                                                      fissure.
46262.............  ..............  A                Remove hemorrhoids &         7.49         NA       3.74       0.83         NA      12.06        090
                                                      fistula.
46270.............  ..............  A                Removal of anal              3.71       5.00       2.84       0.46       9.17       7.01        090
                                                      fistula.
46275.............  ..............  A                Removal of anal              4.55       4.64       2.98       0.52       9.71       8.05        090
                                                      fistula.
46280.............  ..............  A                Removal of anal              5.97         NA       3.26       0.66         NA       9.89        090
                                                      fistula.
46285.............  ..............  A                Removal of anal              4.08       3.77       2.75       0.44       8.29       7.27        090
                                                      fistula.
46288.............  ..............  A                Repair anal fistula...       7.12         NA       3.68       0.79         NA      11.59        090
46320.............  ..............  A                Removal of hemorrhoid        1.61       2.13       0.85       0.18       3.92       2.64        010
                                                      clot.
46500.............  ..............  A                Injection into               1.61       2.12       1.15       0.16       3.89       2.92        010
                                                      hemorrhoid(s).
46505.............  ..............  A                Chemodenervation anal        2.86       3.05       1.97       0.14       6.05       4.97        010
                                                      musc.
46600.............  ..............  A                Diagnostic anoscopy...       0.50       1.56       0.34       0.05       2.11       0.89        000
46604.............  ..............  A                Anoscopy and dilation.       1.31       9.15       0.62       0.12      10.58       2.05        000
46606.............  ..............  A                Anoscopy and biopsy...       0.81       3.79       0.43       0.09       4.69       1.33        000
46608.............  ..............  A                Anoscopy, remove for         1.51       4.41       0.65       0.16       6.08       2.32        000
                                                      body.
46610.............  ..............  A                Anoscopy, remove             1.32       4.04       0.61       0.15       5.51       2.08        000
                                                      lesion.
46611.............  ..............  A                Anoscopy..............       1.81       3.34       0.78       0.19       5.34       2.78        000
46612.............  ..............  A                Anoscopy, remove             2.34       5.20       0.98       0.28       7.82       3.60        000
                                                      lesions.
46614.............  ..............  A                Anoscopy, control            2.01       2.33       0.84       0.20       4.54       3.05        000
                                                      bleeding.
46615.............  ..............  A                Anoscopy..............       2.68       2.49       1.07       0.33       5.50       4.08        000
46700.............  ..............  A                Repair of anal               9.12         NA       4.21       0.94         NA      14.27        090
                                                      stricture.
46705.............  ..............  A                Repair of anal               6.89         NA       3.69       0.91         NA      11.49        090
                                                      stricture.
46706.............  ..............  A                Repr of anal fistula w/      2.39         NA       1.25       0.28         NA       3.92        010
                                                      glue.
46710.............  ..............  A                Repr per/vag pouch          16.00         NA       7.77       1.38         NA      25.15        090
                                                      sngl proc.
46712.............  ..............  A                Repr per/vag pouch dbl      34.00         NA      15.08       3.66         NA      52.74        090
                                                      proc.
46715.............  ..............  A                Rep perf anoper fistu.       7.19         NA       3.58       0.92         NA      11.69        090
46716.............  ..............  A                Rep perf anoper/vestib      15.05         NA       7.99       1.58         NA      24.62        090
                                                      fistu.
46730.............  ..............  A                Construction of absent      26.71         NA      12.05       2.46         NA      41.22        090
                                                      anus.

[[Page 70386]]

 
46735.............  ..............  A                Construction of absent      32.12         NA      13.58       3.20         NA      48.90        090
                                                      anus.
46740.............  ..............  A                Construction of absent      29.96         NA      13.26       2.41         NA      45.63        090
                                                      anus.
46742.............  ..............  A                Repair of imperforated      35.75         NA      17.43       3.19         NA      56.37        090
                                                      anus.
46744.............  ..............  A                Repair of cloacal           52.55         NA      21.17       6.38         NA      80.10        090
                                                      anomaly.
46746.............  ..............  A                Repair of cloacal           58.13         NA      25.21       7.68         NA      91.02        090
                                                      anomaly.
46748.............  ..............  A                Repair of cloacal           64.11         NA      23.70       3.36         NA      91.17        090
                                                      anomaly.
46750.............  ..............  A                Repair of anal              10.23         NA       5.06       1.10         NA      16.39        090
                                                      sphincter.
46751.............  ..............  A                Repair of anal               8.76         NA       5.43       0.94         NA      15.13        090
                                                      sphincter.
46753.............  ..............  A                Reconstruction of anus       8.28         NA       3.85       0.94         NA      13.07        090
46754.............  ..............  A                Removal of suture from       2.20       3.60       1.67       0.19       5.99       4.06        010
                                                      anus.
46760.............  ..............  A                Repair of anal              14.41         NA       7.10       1.59         NA      23.10        090
                                                      sphincter.
46761.............  ..............  A                Repair of anal              13.82         NA       6.02       1.43         NA      21.27        090
                                                      sphincter.
46762.............  ..............  A                Implant artificial          12.69         NA       5.53       1.24         NA      19.46        090
                                                      sphincter.
46900.............  ..............  A                Destruction, anal            1.91       2.59       1.27       0.17       4.67       3.35        010
                                                      lesion(s).
46910.............  ..............  A                Destruction, anal            1.86       2.91       1.06       0.19       4.96       3.11        010
                                                      lesion(s).
46916.............  ..............  A                Cryosurgery, anal            1.86       3.16       1.39       0.11       5.13       3.36        010
                                                      lesion(s).
46917.............  ..............  A                Laser surgery, anal          1.86       9.15       1.12       0.21      11.22       3.19        010
                                                      lesions.
46922.............  ..............  A                Excision of anal             1.86       3.28       1.07       0.22       5.36       3.15        010
                                                      lesion(s).
46924.............  ..............  A                Destruction, anal            2.76       8.71       1.35       0.26      11.73       4.37        010
                                                      lesion(s).
46934.............  ..............  A                Destruction of               3.50       5.08       2.96       0.32       8.90       6.78        090
                                                      hemorrhoids.
46935.............  ..............  A                Destruction of               2.43       3.47       1.21       0.23       6.13       3.87        010
                                                      hemorrhoids.
46936.............  ..............  A                Destruction of               3.68       4.88       2.50       0.34       8.90       6.52        090
                                                      hemorrhoids.
46937.............  ..............  A                Cryotherapy of rectal        2.69       2.78       1.22       0.14       5.61       4.05        010
                                                      lesion.
46938.............  ..............  A                Cryotherapy of rectal        4.65       4.00       3.06       0.58       9.23       8.29        090
                                                      lesion.
46940.............  ..............  A                Treatment of anal            2.32       2.00       1.09       0.23       4.55       3.64        010
                                                      fissure.
46942.............  ..............  A                Treatment of anal            2.04       1.84       1.02       0.19       4.07       3.25        010
                                                      fissure.
46945.............  ..............  A                Ligation of                  1.84       3.27       2.48       0.19       5.30       4.51        090
                                                      hemorrhoids.
46946.............  ..............  A                Ligation of                  2.58       3.73       2.40       0.27       6.58       5.25        090
                                                      hemorrhoids.
46947.............  ..............  A                Hemorrhoidopexy by           5.20         NA       2.72       0.75         NA       8.67        090
                                                      stapling.
46999.............  ..............  C                Anus surgery procedure       0.00       0.00       0.00       0.00       0.00       0.00        YYY
47000.............  ..............  A                Needle biopsy of liver       1.90       3.08       0.63       0.12       5.10       2.65        000
47001.............  ..............  A                Needle biopsy, liver         1.90         NA       0.65       0.25         NA       2.80        ZZZ
                                                      add-on.
47010.............  ..............  A                Open drainage, liver        15.99         NA       8.41       1.80         NA      26.20        090
                                                      lesion.
47011.............  ..............  A                Percut drain, liver          3.69         NA       1.21       0.22         NA       5.12        000
                                                      lesion.
47015.............  ..............  A                Inject/aspirate liver       15.09         NA       7.50       1.83         NA      24.42        090
                                                      cyst.
47100.............  ..............  A                Wedge biopsy of liver.      11.65         NA       6.05       1.53         NA      19.23        090
47120.............  ..............  A                Partial removal of          35.45         NA      15.18       4.65         NA      55.28        090
                                                      liver.
47122.............  ..............  A                Extensive removal of        55.05         NA      21.50       7.19         NA      83.74        090
                                                      liver.
47125.............  ..............  A                Partial removal of          49.12         NA      19.56       6.45         NA      75.13        090
                                                      liver.
47130.............  ..............  A                Partial removal of          53.27         NA      21.02       6.94         NA      81.23        090
                                                      liver.
47133.............  ..............  X                Removal of donor liver       0.00       0.00       0.00       0.00       0.00       0.00        XXX
47135.............  ..............  R                Transplantation of          81.40         NA      31.59       9.93         NA     122.92        090
                                                      liver.
47136.............  ..............  R                Transplantation of          68.50         NA      27.09       8.41         NA     104.00        090
                                                      liver.
47140.............  ..............  A                Partial removal, donor      54.92         NA      22.33       5.17         NA      82.42        090
                                                      liver.
47141.............  ..............  A                Partial removal, donor      67.40         NA      26.98       5.17         NA      99.55        090
                                                      liver.
47142.............  ..............  A                Partial removal, donor      74.89         NA      29.55       5.17         NA     109.61        090
                                                      liver.
47143.............  ..............  C                Prep donor liver,            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      whole.
47144.............  ..............  C                Prep donor liver, 3-         0.00       0.00       0.00       0.00       0.00       0.00        090
                                                      segment.
47145.............  ..............  C                Prep donor liver, lobe       0.00       0.00       0.00       0.00       0.00       0.00        090
                                                      split.
47146.............  ..............  A                Prep donor liver/            6.00         NA       2.06       0.83         NA       8.89        XXX
                                                      venous.
47147.............  ..............  A                Prep donor liver/            7.00         NA       2.40       0.97         NA      10.37        XXX
                                                      arterial.
47300.............  ..............  A                Surgery for liver           15.06         NA       7.24       1.98         NA      24.28        090
                                                      lesion.
47350.............  ..............  A                Repair liver wound....      19.53         NA       8.89       2.58         NA      31.00        090
47360.............  ..............  A                Repair liver wound....      26.88         NA      11.60       3.37         NA      41.85        090
47361.............  ..............  A                Repair liver wound....      47.05         NA      18.56       5.85         NA      71.46        090
47362.............  ..............  A                Repair liver wound....      18.48         NA       8.74       2.50         NA      29.72        090
47370.............  ..............  A                Laparo ablate liver         19.66         NA       8.15       2.55         NA      30.36        090
                                                      tumor rf.
47371.............  ..............  A                Laparo ablate liver         19.66         NA       8.16       2.60         NA      30.42        090
                                                      cryosurg.
47379.............  ..............  C                Laparoscope procedure,       0.00       0.00       0.00       0.00       0.00       0.00        YYY
                                                      liver.
47380.............  ..............  A                Open ablate liver           22.97         NA       9.38       2.86         NA      35.21        090
                                                      tumor rf.
47381.............  ..............  A                Open ablate liver           23.24         NA       9.61       2.84         NA      35.69        090
                                                      tumor cryo.
47382.............  ..............  A                Percut ablate liver rf      15.17         NA       6.09       0.96         NA      22.22        010
47399.............  ..............  C                Liver surgery                0.00       0.00       0.00       0.00       0.00       0.00        YYY
                                                      procedure.
47400.............  ..............  A                Incision of liver duct      32.44         NA      13.47       3.07         NA      48.98        090
47420.............  ..............  A                Incision of bile duct.      19.85         NA       8.78       2.62         NA      31.25        090
47425.............  ..............  A                Incision of bile duct.      19.80         NA       8.83       2.61         NA      31.24        090
47460.............  ..............  A                Incise bile duct            18.01         NA       8.38       2.20         NA      28.59        090
                                                      sphincter.
47480.............  ..............  A                Incision of                 10.80         NA       5.92       1.42         NA      18.14        090
                                                      gallbladder.
47490.............  ..............  A                Incision of                  7.22         NA       5.58       0.43         NA      13.23        090
                                                      gallbladder.
47500.............  ..............  A                Injection for liver x-       1.96         NA       0.64       0.12         NA       2.72        000
                                                      rays.
47505.............  ..............  A                Injection for liver x-       0.76         NA       0.25       0.04         NA       1.05        000
                                                      rays.
47510.............  ..............  A                Insert catheter, bile        7.82         NA       5.02       0.46         NA      13.30        090
                                                      duct.
47511.............  ..............  A                Insert bile duct drain      10.48         NA       5.09       0.62         NA      16.19        090
47525.............  ..............  A                Change bile duct             5.54      15.13       2.81       0.33      21.00       8.68        010
                                                      catheter.
47530.............  ..............  A                Revise/reinsert bile         5.84      33.88       3.72       0.37      40.09       9.93        090
                                                      tube.

[[Page 70387]]

 
47550.............  ..............  A                Bile duct endoscopy          3.02         NA       1.02       0.40         NA       4.44        ZZZ
                                                      add-on.
47552.............  ..............  A                Biliary endoscopy thru       6.03         NA       2.38       0.42         NA       8.83        000
                                                      skin.
47553.............  ..............  A                Biliary endoscopy thru       6.34         NA       2.07       0.37         NA       8.78        000
                                                      skin.
47554.............  ..............  A                Biliary endoscopy thru       9.05         NA       3.36       0.96         NA      13.37        000
                                                      skin.
47555.............  ..............  A                Biliary endoscopy thru       7.55         NA       2.47       0.45         NA      10.47        000
                                                      skin.
47556.............  ..............  A                Biliary endoscopy thru       8.55         NA       2.79       0.50         NA      11.84        000
                                                      skin.
47560.............  ..............  A                Laparoscopy w/               4.88         NA       1.67       0.65         NA       7.20        000
                                                      cholangio.
47561.............  ..............  A                Laparo w/cholangio/          5.17         NA       1.92       0.66         NA       7.75        000
                                                      biopsy.
47562.............  ..............  A                Laparoscopic                11.07         NA       4.99       1.46         NA      17.52        090
                                                      cholecystectomy.
47563.............  ..............  A                Laparo cholecystectomy/     11.92         NA       5.31       1.58         NA      18.81        090
                                                      graph.
47564.............  ..............  A                Laparo cholecystectomy/     14.21         NA       5.96       1.88         NA      22.05        090
                                                      explr.
47570.............  ..............  A                Laparo                      12.56         NA       5.38       1.65         NA      19.59        090
                                                      cholecystoenterostomy.
47579.............  ..............  C                Laparoscope proc,            0.00       0.00       0.00       0.00       0.00       0.00        YYY
                                                      biliary.
47600.............  ..............  A                Removal of gallbladder      13.56         NA       6.14       1.79         NA      21.49        090
47605.............  ..............  A                Removal of gallbladder      14.67         NA       6.51       1.94         NA      23.12        090
47610.............  ..............  A                Removal of gallbladder      18.79         NA       7.94       2.48         NA      29.21        090
47612.............  ..............  A                Removal of gallbladder      18.75         NA       7.89       2.47         NA      29.11        090
47620.............  ..............  A                Removal of gallbladder      20.61         NA       8.53       2.73         NA      31.87        090
47630.............  ..............  A                Remove bile duct stone       9.10         NA       4.89       0.65         NA      14.64        090
47700.............  ..............  A                Exploration of bile         15.60         NA       7.42       2.06         NA      25.08        090
                                                      ducts.
47701.............  ..............  A                Bile duct revision....      27.77         NA      11.50       3.67         NA      42.94        090
47711.............  ..............  A                Excision of bile duct       23.00         NA       9.94       3.04         NA      35.98        090
                                                      tumor.
47712.............  ..............  A                Excision of bile duct       30.19         NA      12.44       3.92         NA      46.55        090
                                                      tumor.
47715.............  ..............  A                Excision of bile duct       18.77         NA       8.44       2.48         NA      29.69        090
                                                      cyst.
47716.............  ..............  A                Fusion of bile duct         16.42         NA       7.83       2.14         NA      26.39        090
                                                      cyst.
47720.............  ..............  A                Fuse gallbladder &          15.89         NA       7.48       2.10         NA      25.47        090
                                                      bowel.
47721.............  ..............  A                Fuse upper gi               19.09         NA       8.57       2.52         NA      30.18        090
                                                      structures.
47740.............  ..............  A                Fuse gallbladder &          18.45         NA       8.38       2.41         NA      29.24        090
                                                      bowel.
47741.............  ..............  A                Fuse gallbladder &          21.31         NA       9.30       2.82         NA      33.43        090
                                                      bowel.
47760.............  ..............  A                Fuse bile ducts and         25.81         NA      10.86       3.41         NA      40.08        090
                                                      bowel.
47765.............  ..............  A                Fuse liver ducts &          24.84         NA      10.81       3.29         NA      38.94        090
                                                      bowel.
47780.............  ..............  A                Fuse bile ducts and         26.46         NA      11.22       3.49         NA      41.17        090
                                                      bowel.
47785.............  ..............  A                Fuse bile ducts and         31.13         NA      12.93       4.09         NA      48.15        090
                                                      bowel.
47800.............  ..............  A                Reconstruction of bile      23.27         NA      10.07       3.07         NA      36.41        090
                                                      ducts.
47801.............  ..............  A                Placement, bile duct        15.15         NA       8.16       1.16         NA      24.47        090
                                                      support.
47802.............  ..............  A                Fuse liver duct &           21.52         NA       9.68       2.85         NA      34.05        090
                                                      intestine.
47900.............  ..............  A                Suture bile duct            19.87         NA       8.88       2.64         NA      31.39        090
                                                      injury.
47999.............  ..............  C                Bile tract surgery           0.00       0.00       0.00       0.00       0.00       0.00        YYY
                                                      procedure.
48000.............  ..............  A                Drainage of abdomen...      28.03         NA      11.52       3.47         NA      43.02        090
48001.............  ..............  A                Placement of drain,         35.40         NA      13.90       4.68         NA      53.98        090
                                                      pancreas.
48005.............  ..............  A                Resect/debride              42.11         NA      16.59       5.54         NA      64.24        090
                                                      pancreas.
48020.............  ..............  A                Removal of pancreatic       15.68         NA       7.31       2.12         NA      25.11        090
                                                      stone.
48100.............  ..............  A                Biopsy of pancreas,         12.21         NA       5.60       1.62         NA      19.43        090
                                                      open.
48102.............  ..............  A                Needle biopsy,               4.67       7.97       1.95       0.28      12.92       6.90        010
                                                      pancreas.
48120.............  ..............  A                Removal of pancreas         15.83         NA       6.86       2.09         NA      24.78        090
                                                      lesion.
48140.............  ..............  A                Partial removal of          22.91         NA       9.55       3.02         NA      35.48        090
                                                      pancreas.
48145.............  ..............  A                Partial removal of          23.98         NA       9.84       3.17         NA      36.99        090
                                                      pancreas.
48146.............  ..............  A                Pancreatectomy........      26.36         NA      12.00       3.49         NA      41.85        090
48148.............  ..............  A                Removal of pancreatic       17.31         NA       7.61       2.29         NA      27.21        090
                                                      duct.
48150.............  ..............  A                Partial removal of          47.93         NA      19.54       6.30         NA      73.77        090
                                                      pancreas.
48152.............  ..............  A                Pancreatectomy........      43.68         NA      18.23       5.78         NA      67.69        090
48153.............  ..............  A                Pancreatectomy........      47.82         NA      19.58       6.29         NA      73.69        090
48154.............  ..............  A                Pancreatectomy........      44.03         NA      18.26       5.82         NA      68.11        090
48155.............  ..............  A                Removal of pancreas...      24.60         NA      11.68       3.26         NA      39.54        090
48160.............  ..............  N                Pancreas removal/            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      transplant.
48180.............  ..............  A                Fuse pancreas and           24.68         NA      10.17       3.27         NA      38.12        090
                                                      bowel.
48400.............  ..............  A                Injection, intraop add-      1.95         NA       0.64       0.15         NA       2.74        ZZZ
                                                      on.
48500.............  ..............  A                Surgery of pancreatic       15.26         NA       7.34       2.02         NA      24.62        090
                                                      cyst.
48510.............  ..............  A                Drain pancreatic            14.29         NA       7.45       1.82         NA      23.56        090
                                                      pseudocyst.
48511.............  ..............  A                Drain pancreatic             3.99      20.95       1.31       0.24      25.18       5.54        000
                                                      pseudocyst.
48520.............  ..............  A                Fuse pancreas cyst and      15.57         NA       6.71       2.05         NA      24.33        090
                                                      bowel.
48540.............  ..............  A                Fuse pancreas cyst and      19.69         NA       8.12       2.60         NA      30.41        090
                                                      bowel.
48545.............  ..............  A                Pancreatorrhaphy......      18.15         NA       7.99       2.37         NA      28.51        090
48547.............  ..............  A                Duodenal exclusion....      25.79         NA      10.50       3.41         NA      39.70        090
48550.............  ..............  X                Donor pancreatectomy..       0.00       0.00       0.00       0.00       0.00       0.00        XXX
48551.............  ..............  C                Prep donor pancreas...       0.00       0.00       0.00       0.00       0.00       0.00        XXX
48552.............  ..............  A                Prep donor pancreas/         4.30         NA       1.46       0.31         NA       6.07        XXX
                                                      venous.
48554.............  ..............  R                Transpl allograft           34.12         NA      18.30       4.18         NA      56.60        090
                                                      pancreas.
48556.............  ..............  A                Removal, allograft          15.69         NA       8.08       2.07         NA      25.84        090
                                                      pancreas.
48999.............  ..............  C                Pancreas surgery             0.00       0.00       0.00       0.00       0.00       0.00        YYY
                                                      procedure.
49000.............  ..............  A                Exploration of abdomen      11.66         NA       5.39       1.52         NA      18.57        090
49002.............  ..............  A                Reopening of abdomen..      10.47         NA       5.02       1.37         NA      16.86        090
49010.............  ..............  A                Exploration behind          12.26         NA       5.91       1.51         NA      19.68        090
                                                      abdomen.
49020.............  ..............  A                Drain abdominal             22.81         NA      10.21       2.84         NA      35.86        090
                                                      abscess.
49021.............  ..............  A                Drain abdominal              3.37      21.11       1.11       0.20      24.68       4.68        000
                                                      abscess.

[[Page 70388]]

 
49040.............  ..............  A                Drain, open, abdom          13.50         NA       6.43       1.69         NA      21.62        090
                                                      abscess.
49041.............  ..............  A                Drain, percut, abdom         3.99      19.57       1.31       0.24      23.80       5.54        000
                                                      abscess.
49060.............  ..............  A                Drain, open, retrop         15.84         NA       7.44       1.74         NA      25.02        090
                                                      abscess.
49061.............  ..............  A                Drain, percut,               3.69      19.68       1.21       0.22      23.59       5.12        000
                                                      retroper absc.
49062.............  ..............  A                Drain to peritoneal         11.34         NA       5.44       1.39         NA      18.17        090
                                                      cavity.
49080.............  ..............  A                Puncture, peritoneal         1.35       3.99       0.46       0.08       5.42       1.89        000
                                                      cavity.
49081.............  ..............  A                Removal of abdominal         1.26       2.59       0.43       0.09       3.94       1.78        000
                                                      fluid.
49085.............  ..............  A                Remove abdomen foreign      12.12         NA       5.51       1.62         NA      19.25        090
                                                      body.
49180.............  ..............  A                Biopsy, abdominal mass       1.73       3.11       0.57       0.10       4.94       2.40        000
49200.............  ..............  A                Removal of abdominal        10.23         NA       5.03       1.24         NA      16.50        090
                                                      lesion.
49201.............  ..............  A                Remove abdom lesion,        14.82         NA       7.04       1.87         NA      23.73        090
                                                      complex.
49215.............  ..............  A                Excise sacral spine         33.45         NA      14.08       4.37         NA      51.90        090
                                                      tumor.
49220.............  ..............  A                Multiple surgery,           14.86         NA       6.64       1.88         NA      23.38        090
                                                      abdomen.
49250.............  ..............  A                Excision of umbilicus.       8.34         NA       4.27       1.08         NA      13.69        090
49255.............  ..............  A                Removal of omentum....      11.12         NA       5.62       1.43         NA      18.17        090
49320.............  ..............  A                Diag laparo separate         5.09         NA       2.64       0.65         NA       8.38        010
                                                      proc.
49321.............  ..............  A                Laparoscopy, biopsy...       5.39         NA       2.65       0.70         NA       8.74        010
49322.............  ..............  A                Laparoscopy,                 5.69         NA       3.00       0.71         NA       9.40        010
                                                      aspiration.
49323.............  ..............  A                Laparo drain                 9.47         NA       4.50       1.20         NA      15.17        090
                                                      lymphocele.
49329.............  ..............  C                Laparo proc, abdm/per/       0.00       0.00       0.00       0.00       0.00       0.00        YYY
                                                      oment.
49400.............  ..............  A                Air injection into           1.88       3.08       0.62       0.15       5.11       2.65        000
                                                      abdomen.
49419.............  ..............  A                Insrt abdom cath for         6.64         NA       3.57       0.81         NA      11.02        090
                                                      chemotx.
49420.............  ..............  A                Insert abdom drain,          2.22         NA       1.09       0.21         NA       3.52        000
                                                      temp.
49421.............  ..............  A                Insert abdom drain,          5.53         NA       3.16       0.74         NA       9.43        090
                                                      perm.
49422.............  ..............  A                Remove perm cannula/         6.24         NA       2.90       0.83         NA       9.97        010
                                                      catheter.
49423.............  ..............  A                Exchange drainage            1.46      14.11       0.52       0.09      15.66       2.07        000
                                                      catheter.
49424.............  ..............  A                Assess cyst, contrast        0.76       3.72       0.29       0.04       4.52       1.09        000
                                                      inject.
49425.............  ..............  A                Insert abdomen-venous       11.35         NA       5.61       1.54         NA      18.50        090
                                                      drain.
49426.............  ..............  A                Revise abdomen-venous        9.62         NA       4.77       1.28         NA      15.67        090
                                                      shunt.
49427.............  ..............  A                Injection, abdominal         0.89         NA       0.30       0.07         NA       1.26        000
                                                      shunt.
49428.............  ..............  A                Ligation of shunt.....       6.05         NA       3.93       0.80         NA      10.78        010
49429.............  ..............  A                Removal of shunt......       7.39         NA       3.43       1.02         NA      11.84        010
49491.............  ..............  A                Rpr hern preemie reduc      11.11         NA       5.06       1.40         NA      17.57        090
49492.............  ..............  A                Rpr ing hern premie,        14.01         NA       6.12       1.80         NA      21.93        090
                                                      blocked.
49495.............  ..............  A                Rpr ing hernia baby,         5.88         NA       2.96       0.74         NA       9.58        090
                                                      reduc.
49496.............  ..............  A                Rpr ing hernia baby,         8.78         NA       4.28       1.07         NA      14.13        090
                                                      blocked.
49500.............  ..............  A                Rpr ing hernia, init,        5.47         NA       3.12       0.71         NA       9.30        090
                                                      reduce.
49501.............  ..............  A                Rpr ing hernia, init         8.87         NA       4.21       1.12         NA      14.20        090
                                                      blocked.
49505.............  ..............  A                Prp i/hern init reduc        7.59         NA       3.75       1.03         NA      12.37        090
                                                      >5 yr.
49507.............  ..............  A                Prp i/hern init block        9.56         NA       4.46       1.27         NA      15.29        090
                                                      >5 yr.
49520.............  ..............  A                Rerepair ing hernia,         9.62         NA       4.44       1.28         NA      15.34        090
                                                      reduce.
49521.............  ..............  A                Rerepair ing hernia,        11.95         NA       5.25       1.59         NA      18.79        090
                                                      blocked.
49525.............  ..............  A                Repair ing hernia,           8.56         NA       4.08       1.13         NA      13.77        090
                                                      sliding.
49540.............  ..............  A                Repair lumbar hernia..      10.37         NA       4.75       1.37         NA      16.49        090
49550.............  ..............  A                Rpr rem hernia, init,        8.62         NA       4.13       1.14         NA      13.89        090
                                                      reduce.
49553.............  ..............  A                Rpr fem hernia, init         9.43         NA       4.42       1.24         NA      15.09        090
                                                      blocked.
49555.............  ..............  A                Rerepair fem hernia,         9.02         NA       4.27       1.20         NA      14.49        090
                                                      reduce.
49557.............  ..............  A                Rerepair fem hernia,        11.13         NA       4.99       1.47         NA      17.59        090
                                                      blocked.
49560.............  ..............  A                Rpr ventral hern init,      11.55         NA       5.15       1.52         NA      18.22        090
                                                      reduc.
49561.............  ..............  A                Rpr ventral hern init,      14.23         NA       6.07       1.88         NA      22.18        090
                                                      block.
49565.............  ..............  A                Rerepair ventrl hern,       11.55         NA       5.23       1.52         NA      18.30        090
                                                      reduce.
49566.............  ..............  A                Rerepair ventrl hern,       14.38         NA       6.14       1.90         NA      22.42        090
                                                      block.
49568.............  ..............  A                Hernia repair w/mesh..       4.88         NA       1.67       0.64         NA       7.19        ZZZ
49570.............  ..............  A                Rpr epigastric hern,         5.68         NA       3.17       0.75         NA       9.60        090
                                                      reduce.
49572.............  ..............  A                Rpr epigastric hern,         6.72         NA       3.47       0.88         NA      11.07        090
                                                      blocked.
49580.............  ..............  A                Rpr umbil hern, reduc        4.10         NA       2.60       0.54         NA       7.24        090
                                                      < 5 yr.
49582.............  ..............  A                Rpr umbil hern, block        6.64         NA       3.47       0.88         NA      10.99        090
                                                      < 5 yr.
49585.............  ..............  A                Rpr umbil hern, reduc        6.22         NA       3.30       0.82         NA      10.34        090
                                                      > 5 yr.
49587.............  ..............  A                Rpr umbil hern, block        7.55         NA       3.74       0.99         NA      12.28        090
                                                      > 5 yr.
49590.............  ..............  A                Repair spigelian             8.53         NA       4.09       1.13         NA      13.75        090
                                                      hernia.
49600.............  ..............  A                Repair umbilical            10.94         NA       5.34       1.32         NA      17.60        090
                                                      lesion.
49605.............  ..............  A                Repair umbilical            75.89         NA      28.58       9.36         NA     113.83        090
                                                      lesion.
49606.............  ..............  A                Repair umbilical            18.57         NA       7.70       2.45         NA      28.72        090
                                                      lesion.
49610.............  ..............  A                Repair umbilical            10.48         NA       5.21       1.07         NA      16.76        090
                                                      lesion.
49611.............  ..............  A                Repair umbilical             8.91         NA       6.99       0.78         NA      16.68        090
                                                      lesion.
49650.............  ..............  A                Laparo hernia repair         6.26         NA       3.20       0.93         NA      10.39        090
                                                      initial.
49651.............  ..............  A                Laparo hernia repair         8.23         NA       4.05       1.14         NA      13.42        090
                                                      recur.
49659.............  ..............  C                Laparo proc, hernia          0.00       0.00       0.00       0.00       0.00       0.00        YYY
                                                      repair.
49900.............  ..............  A                Repair of abdominal         12.26         NA       6.24       1.62         NA      20.12        090
                                                      wall.
49904.............  ..............  A                Omental flap, extra-        19.97         NA      15.25       2.69         NA      37.91        090
                                                      abdom.
49905.............  ..............  A                Omental flap, intra-         6.54         NA       2.30       0.75         NA       9.59        ZZZ
                                                      abdom.
49906.............  ..............  C                Free omental flap,           0.00       0.00       0.00       0.00       0.00       0.00        090
                                                      microvasc.
49999.............  ..............  C                Abdomen surgery              0.00       0.00       0.00       0.00       0.00       0.00        YYY
                                                      procedure.
50010.............  ..............  A                Exploration of kidney.      10.96         NA       5.23       0.93         NA      17.12        090
50020.............  ..............  A                Renal abscess, open         14.64         NA       7.76       1.34         NA      23.74        090
                                                      drain.

[[Page 70389]]

 
50021.............  ..............  A                Renal abscess, percut        3.37      21.71       1.10       0.20      25.28       4.67        000
                                                      drain.
50040.............  ..............  A                Drainage of kidney....      14.92         NA       6.82       1.03         NA      22.77        090
50045.............  ..............  A                Exploration of kidney.      15.44         NA       6.61       1.24         NA      23.29        090
50060.............  ..............  A                Removal of kidney           19.27         NA       7.84       1.36         NA      28.47        090
                                                      stone.
50065.............  ..............  A                Incision of kidney....      20.76         NA       6.09       1.59         NA      28.44        090
50070.............  ..............  A                Incision of kidney....      20.29         NA       8.23       1.44         NA      29.96        090
50075.............  ..............  A                Removal of kidney           25.30         NA       9.92       1.80         NA      37.02        090
                                                      stone.
50080.............  ..............  A                Removal of kidney           14.69         NA       6.29       1.04         NA      22.02        090
                                                      stone.
50081.............  ..............  A                Removal of kidney           21.77         NA       8.78       1.54         NA      32.09        090
                                                      stone.
50100.............  ..............  A                Revise kidney blood         16.07         NA       7.80       2.06         NA      25.93        090
                                                      vessels.
50120.............  ..............  A                Exploration of kidney.      15.89         NA       6.78       1.21         NA      23.88        090
50125.............  ..............  A                Explore and drain           16.50         NA       6.98       1.43         NA      24.91        090
                                                      kidney.
50130.............  ..............  A                Removal of kidney           17.26         NA       7.18       1.22         NA      25.66        090
                                                      stone.
50135.............  ..............  A                Exploration of kidney.      19.15         NA       7.79       1.33         NA      28.27        090
50200.............  ..............  A                Biopsy of kidney......       2.63         NA       1.29       0.16         NA       4.08        000
50205.............  ..............  A                Biopsy of kidney......      11.29         NA       5.02       1.30         NA      17.61        090
50220.............  ..............  A                Remove kidney, open...      17.12         NA       7.25       1.35         NA      25.72        090
50225.............  ..............  A                Removal kidney open,        20.20         NA       8.16       1.50         NA      29.86        090
                                                      complex.
50230.............  ..............  A                Removal kidney open,        22.04         NA       8.59       1.55         NA      32.18        090
                                                      radical.
50234.............  ..............  A                Removal of kidney &         22.37         NA       8.85       1.59         NA      32.81        090
                                                      ureter.
50236.............  ..............  A                Removal of kidney &         24.82         NA      10.27       1.76         NA      36.85        090
                                                      ureter.
50240.............  ..............  A                Partial removal of          21.97         NA       9.03       1.55         NA      32.55        090
                                                      kidney.
50250.............  ..............  A                Cryoablate renal mass       19.97         NA       9.18       1.39         NA      30.54        090
                                                      open.
50280.............  ..............  A                Removal of kidney           15.65         NA       6.70       1.19         NA      23.54        090
                                                      lesion.
50290.............  ..............  A                Removal of kidney           14.71         NA       6.47       1.41         NA      22.59        090
                                                      lesion.
50300.............  ..............  X                Remove cadaver donor         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      kidney.
50320.............  ..............  A                Remove kidney, living       22.18         NA      10.68       2.35         NA      35.21        090
                                                      donor.
50323.............  ..............  C                Prep cadaver renal           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      allograft.
50325.............  ..............  C                Prep donor renal graft       0.00       0.00       0.00       0.00       0.00       0.00        XXX
50327.............  ..............  A                Prep renal graft/            4.00         NA       1.35       0.29         NA       5.64        XXX
                                                      venous.
50328.............  ..............  A                Prep renal graft/            3.50         NA       1.18       0.26         NA       4.94        XXX
                                                      arterial.
50329.............  ..............  A                Prep renal graft/            3.34         NA       1.13       0.25         NA       4.72        XXX
                                                      ureteral.
50340.............  ..............  A                Removal of kidney.....      12.13         NA       6.51       1.65         NA      20.29        090
50360.............  ..............  A                Transplantation of          31.48         NA      15.51       3.81         NA      50.80        090
                                                      kidney.
50365.............  ..............  A                Transplantation of          36.75         NA      18.24       4.42         NA      59.41        090
                                                      kidney.
50370.............  ..............  A                Remove transplanted         13.70         NA       7.16       1.67         NA      22.53        090
                                                      kidney.
50380.............  ..............  A                Reimplantation of           20.73         NA      12.05       2.50         NA      35.28        090
                                                      kidney.
50382.............  ..............  A                Change ureter stent,         5.50      36.22       1.87       0.34      42.06       7.71        000
                                                      percut.
50384.............  ..............  A                Remove ureter stent,         5.00      35.32       1.71       0.31      40.63       7.02        000
                                                      percut.
50387.............  ..............  A                Change ext/int ureter        2.00      18.26       0.67       0.12      20.38       2.79        000
                                                      stent.
50389.............  ..............  A                Remove renal tube w/         1.10      12.78       0.37       0.07      13.95       1.54        000
                                                      fluoro.
50390.............  ..............  A                Drainage of kidney           1.96         NA       0.64       0.12         NA       2.72        000
                                                      lesion.
50391.............  ..............  A                Instll rx agnt into          1.96       1.58       0.63       0.14       3.68       2.73        000
                                                      rnal tub.
50392.............  ..............  A                Insert kidney drain...       3.37         NA       1.52       0.20         NA       5.09        000
50393.............  ..............  A                Insert ureteral tube..       4.15         NA       1.79       0.25         NA       6.19        000
50394.............  ..............  A                Injection for kidney x-      0.76       2.69       0.66       0.05       3.50       1.47        000
                                                      ray.
50395.............  ..............  A                Create passage to            3.37         NA       1.50       0.21         NA       5.08        000
                                                      kidney.
50396.............  ..............  A                Measure kidney               2.09         NA       1.08       0.13         NA       3.30        000
                                                      pressure.
50398.............  ..............  A                Change kidney tube....       1.46      16.36       0.52       0.09      17.91       2.07        000
50400.............  ..............  A                Revision of kidney/         19.47         NA       7.89       1.38         NA      28.74        090
                                                      ureter.
50405.............  ..............  A                Revision of kidney/         23.89         NA       9.05       1.78         NA      34.72        090
                                                      ureter.
50500.............  ..............  A                Repair of kidney wound      19.54         NA       8.40       2.01         NA      29.95        090
50520.............  ..............  A                Close kidney-skin           17.20         NA       7.44       1.49         NA      26.13        090
                                                      fistula.
50525.............  ..............  A                Repair renal-abdomen        22.24         NA       9.02       1.83         NA      33.09        090
                                                      fistula.
50526.............  ..............  A                Repair renal-abdomen        23.98         NA       9.88       1.96         NA      35.82        090
                                                      fistula.
50540.............  ..............  A                Revision of horseshoe       19.90         NA       8.34       1.36         NA      29.60        090
                                                      kidney.
50541.............  ..............  A                Laparo ablate renal         15.98         NA       6.50       1.13         NA      23.61        090
                                                      cyst.
50542.............  ..............  A                Laparo ablate renal         19.97         NA       8.15       1.39         NA      29.51        090
                                                      mass.
50543.............  ..............  A                Laparo partial              25.46         NA      10.22       1.80         NA      37.48        090
                                                      nephrectomy.
50544.............  ..............  A                Laparoscopy,                22.37         NA       8.54       1.58         NA      32.49        090
                                                      pyeloplasty.
50545.............  ..............  A                Laparo radical              23.96         NA       9.21       1.70         NA      34.87        090
                                                      nephrectomy.
50546.............  ..............  A                Laparoscopic                20.45         NA       8.38       1.57         NA      30.40        090
                                                      nephrectomy.
50547.............  ..............  A                Laparo removal donor        25.46         NA      11.13       2.76         NA      39.35        090
                                                      kidney.
50548.............  ..............  A                Laparo remove w/ureter      24.36         NA       9.20       1.72         NA      35.28        090
50549.............  ..............  C                Laparoscope proc,            0.00       0.00       0.00       0.00       0.00       0.00        YYY
                                                      renal.
50551.............  ..............  A                Kidney endoscopy......       5.59       4.15       1.98       0.40      10.14       7.97        000
50553.............  ..............  A                Kidney endoscopy......       5.98       4.37       2.18       0.39      10.74       8.55        000
50555.............  ..............  A                Kidney endoscopy &           6.52       4.82       2.34       0.45      11.79       9.31        000
                                                      biopsy.
50557.............  ..............  A                Kidney endoscopy &           6.61       4.59       2.30       0.47      11.67       9.38        000
                                                      treatment.
50561.............  ..............  A                Kidney endoscopy &           7.58       5.09       2.65       0.54      13.21      10.77        000
                                                      treatment.
50562.............  ..............  A                Renal scope w/tumor         10.90         NA       4.32       0.73         NA      15.95        090
                                                      resect.
50570.............  ..............  A                Kidney endoscopy......       9.53         NA       3.22       0.68         NA      13.43        000
50572.............  ..............  A                Kidney endoscopy......      10.33         NA       3.51       0.85         NA      14.69        000
50574.............  ..............  A                Kidney endoscopy &          11.00         NA       3.75       0.77         NA      15.52        000
                                                      biopsy.
50575.............  ..............  A                Kidney endoscopy......      13.96         NA       4.64       0.99         NA      19.59        000

[[Page 70390]]

 
50576.............  ..............  A                Kidney endoscopy &          10.97         NA       3.67       0.78         NA      15.42        000
                                                      treatment.
50580.............  ..............  A                Kidney endoscopy &          11.84         NA       3.97       0.83         NA      16.64        000
                                                      treatment.
50590.............  ..............  A                Fragmenting of kidney        9.08      12.43       4.12       0.65      22.16      13.85        090
                                                      stone.
50592.............  ..............  A                Perc rf ablate renal         6.75     149.45       2.99       0.43     156.63      10.17        010
                                                      tumor.
50600.............  ..............  A                Exploration of ureter.      15.82         NA       6.68       1.13         NA      23.63        090
50605.............  ..............  A                Insert ureteral             15.44         NA       6.75       1.45         NA      23.64        090
                                                      support.
50610.............  ..............  A                Removal of ureter           15.90         NA       6.98       1.43         NA      24.31        090
                                                      stone.
50620.............  ..............  A                Removal of ureter           15.14         NA       6.35       1.07         NA      22.56        090
                                                      stone.
50630.............  ..............  A                Removal of ureter           14.92         NA       6.29       1.09         NA      22.30        090
                                                      stone.
50650.............  ..............  A                Removal of ureter.....      17.38         NA       7.24       1.23         NA      25.85        090
50660.............  ..............  A                Removal of ureter.....      19.52         NA       7.97       1.38         NA      28.87        090
50684.............  ..............  A                Injection for ureter x-      0.76       4.98       0.47       0.05       5.79       1.28        000
                                                      ray.
50686.............  ..............  A                Measure ureter               1.51       3.45       0.82       0.11       5.07       2.44        000
                                                      pressure.
50688.............  ..............  A                Change of ureter tube/       1.17         NA       1.06       0.07         NA       2.30        010
                                                      stent.
50690.............  ..............  A                Injection for ureter x-      1.16       1.83       0.72       0.07       3.06       1.95        000
                                                      ray.
50700.............  ..............  A                Revision of ureter....      15.19         NA       7.13       1.27         NA      23.59        090
50715.............  ..............  A                Release of ureter.....      18.87         NA       8.76       2.13         NA      29.76        090
50722.............  ..............  A                Release of ureter.....      16.33         NA       7.82       1.90         NA      26.05        090
50725.............  ..............  A                Release/revise ureter.      18.46         NA       8.06       1.52         NA      28.04        090
50727.............  ..............  A                Revise ureter.........       8.17         NA       4.28       0.61         NA      13.06        090
50728.............  ..............  A                Revise ureter.........      12.00         NA       5.57       1.00         NA      18.57        090
50740.............  ..............  A                Fusion of ureter &          18.39         NA       7.75       1.96         NA      28.10        090
                                                      kidney.
50750.............  ..............  A                Fusion of ureter &          19.48         NA       8.00       1.38         NA      28.86        090
                                                      kidney.
50760.............  ..............  A                Fusion of ureters.....      18.39         NA       7.69       1.55         NA      27.63        090
50770.............  ..............  A                Splicing of ureters...      19.48         NA       7.99       1.45         NA      28.92        090
50780.............  ..............  A                Reimplant ureter in         18.33         NA       7.60       1.51         NA      27.44        090
                                                      bladder.
50782.............  ..............  A                Reimplant ureter in         19.51         NA       8.79       1.61         NA      29.91        090
                                                      bladder.
50783.............  ..............  A                Reimplant ureter in         20.52         NA       8.23       1.98         NA      30.73        090
                                                      bladder.
50785.............  ..............  A                Reimplant ureter in         20.49         NA       8.31       1.45         NA      30.25        090
                                                      bladder.
50800.............  ..............  A                Implant ureter in           14.50         NA       6.48       1.19         NA      22.17        090
                                                      bowel.
50810.............  ..............  A                Fusion of ureter &          20.02         NA       9.11       2.31         NA      31.44        090
                                                      bowel.
50815.............  ..............  A                Urine shunt to              19.90         NA       8.46       1.54         NA      29.90        090
                                                      intestine.
50820.............  ..............  A                Construct bowel             21.86         NA       8.66       1.89         NA      32.41        090
                                                      bladder.
50825.............  ..............  A                Construct bowel             28.14         NA      11.15       2.07         NA      41.36        090
                                                      bladder.
50830.............  ..............  A                Revise urine flow.....      31.23         NA      12.20       2.37         NA      45.80        090
50840.............  ..............  A                Replace ureter by           19.97         NA       8.44       1.47         NA      29.88        090
                                                      bowel.
50845.............  ..............  A                Appendico-vesicostomy.      20.86         NA       8.92       1.57         NA      31.35        090
50860.............  ..............  A                Transplant ureter to        15.34         NA       6.63       1.29         NA      23.26        090
                                                      skin.
50900.............  ..............  A                Repair of ureter......      13.60         NA       6.15       1.14         NA      20.89        090
50920.............  ..............  A                Closure ureter/skin         14.31         NA       6.58       1.01         NA      21.90        090
                                                      fistula.
50930.............  ..............  A                Closure ureter/bowel        18.69         NA       7.98       1.28         NA      27.95        090
                                                      fistula.
50940.............  ..............  A                Release of ureter.....      14.49         NA       6.41       1.26         NA      22.16        090
50945.............  ..............  A                Laparoscopy                 16.97         NA       7.05       1.36         NA      25.38        090
                                                      ureterolithotomy.
50947.............  ..............  A                Laparo new ureter/          24.46         NA       9.71       2.16         NA      36.33        090
                                                      bladder.
50948.............  ..............  A                Laparo new ureter/          22.47         NA       8.71       1.70         NA      32.88        090
                                                      bladder.
50949.............  ..............  C                Laparoscope proc,            0.00       0.00       0.00       0.00       0.00       0.00        YYY
                                                      ureter.
50951.............  ..............  A                Endoscopy of ureter...       5.83       4.30       2.06       0.41      10.54       8.30        000
50953.............  ..............  A                Endoscopy of ureter...       6.23       4.41       2.37       0.43      11.07       9.03        000
50955.............  ..............  A                Ureter endoscopy &           6.74       6.43       2.69       0.48      13.65       9.91        000
                                                      biopsy.
50957.............  ..............  A                Ureter endoscopy &           6.78       4.57       2.38       0.48      11.83       9.64        000
                                                      treatment.
50961.............  ..............  A                Ureter endoscopy &           6.04       4.37       2.19       0.41      10.82       8.64        000
                                                      treatment.
50970.............  ..............  A                Ureter endoscopy......       7.13         NA       2.47       0.52         NA      10.12        000
50972.............  ..............  A                Ureter endoscopy &           6.88         NA       2.47       0.49         NA       9.84        000
                                                      catheter.
50974.............  ..............  A                Ureter endoscopy &           9.16         NA       3.11       0.64         NA      12.91        000
                                                      biopsy.
50976.............  ..............  A                Ureter endoscopy &           9.03         NA       3.07       0.66         NA      12.76        000
                                                      treatment.
50980.............  ..............  A                Ureter endoscopy &           6.84         NA       2.38       0.48         NA       9.70        000
                                                      treatment.
51000.............  ..............  A                Drainage of bladder...       0.78       1.95       0.24       0.05       2.78       1.07        000
51005.............  ..............  A                Drainage of bladder...       1.02       4.71       0.34       0.10       5.83       1.46        000
51010.............  ..............  A                Drainage of bladder...       3.52       5.62       1.88       0.28       9.42       5.68        010
51020.............  ..............  A                Incise & treat bladder       6.70         NA       3.86       0.47         NA      11.03        090
51030.............  ..............  A                Incise & treat bladder       6.76         NA       3.98       0.58         NA      11.32        090
51040.............  ..............  A                Incise & drain bladder       4.39         NA       2.77       0.31         NA       7.47        090
51045.............  ..............  A                Incise bladder/drain         6.76         NA       3.93       0.52         NA      11.21        090
                                                      ureter.
51050.............  ..............  A                Removal of bladder           6.91         NA       3.65       0.49         NA      11.05        090
                                                      stone.
51060.............  ..............  A                Removal of ureter            8.84         NA       4.51       0.62         NA      13.97        090
                                                      stone.
51065.............  ..............  A                Remove ureter calculus       8.84         NA       4.36       0.63         NA      13.83        090
51080.............  ..............  A                Drainage of bladder          5.95         NA       3.55       0.43         NA       9.93        090
                                                      abscess.
51500.............  ..............  A                Removal of bladder          10.12         NA       5.01       1.03         NA      16.16        090
                                                      cyst.
51520.............  ..............  A                Removal of bladder           9.28         NA       4.68       0.69         NA      14.65        090
                                                      lesion.
51525.............  ..............  A                Removal of bladder          13.95         NA       6.14       0.99         NA      21.08        090
                                                      lesion.
51530.............  ..............  A                Removal of bladder          12.36         NA       5.76       1.05         NA      19.17        090
                                                      lesion.
51535.............  ..............  A                Repair of ureter            12.55         NA       6.12       1.23         NA      19.90        090
                                                      lesion.
51550.............  ..............  A                Partial removal of          15.64         NA       6.74       1.31         NA      23.69        090
                                                      bladder.
51555.............  ..............  A                Partial removal of          21.20         NA       8.68       1.69         NA      31.57        090
                                                      bladder.
51565.............  ..............  A                Revise bladder &            21.59         NA       8.98       1.63         NA      32.20        090
                                                      ureter(s).

[[Page 70391]]

 
51570.............  ..............  A                Removal of bladder....      24.20         NA       9.76       1.71         NA      35.67        090
51575.............  ..............  A                Removal of bladder &        30.40         NA      12.05       2.16         NA      44.61        090
                                                      nodes.
51580.............  ..............  A                Remove bladder/revise       31.03         NA      12.52       2.24         NA      45.79        090
                                                      tract.
51585.............  ..............  A                Removal of bladder &        35.18         NA      13.73       2.48         NA      51.39        090
                                                      nodes.
51590.............  ..............  A                Remove bladder/revise       32.61         NA      12.64       2.27         NA      47.52        090
                                                      tract.
51595.............  ..............  A                Remove bladder/revise       37.08         NA      14.16       2.59         NA      53.83        090
                                                      tract.
51596.............  ..............  A                Remove bladder/create       39.46         NA      15.26       2.77         NA      57.49        090
                                                      pouch.
51597.............  ..............  A                Removal of pelvic           38.29         NA      14.86       2.81         NA      55.96        090
                                                      structures.
51600.............  ..............  A                Injection for bladder        0.88       5.06       0.29       0.06       6.00       1.23        000
                                                      x-ray.
51605.............  ..............  A                Preparation for              0.64       6.07       0.35       0.04       6.75       1.03        000
                                                      bladder xray.
51610.............  ..............  A                Injection for bladder        1.05       2.29       0.60       0.07       3.41       1.72        000
                                                      x-ray.
51700.............  ..............  A                Irrigation of bladder.       0.88       1.60       0.28       0.06       2.54       1.22        000
51701.............  ..............  A                Insert bladder               0.50       1.58       0.19       0.04       2.12       0.73        000
                                                      catheter.
51702.............  ..............  A                Insert temp bladder          0.50       2.09       0.24       0.04       2.63       0.78        000
                                                      cath.
51703.............  ..............  A                Insert bladder cath,         1.47       2.74       0.56       0.10       4.31       2.13        000
                                                      complex.
51705.............  ..............  A                Change of bladder tube       1.02       2.28       0.61       0.07       3.37       1.70        010
51710.............  ..............  A                Change of bladder tube       1.49       3.34       0.77       0.11       4.94       2.37        010
51715.............  ..............  A                Endoscopic injection/        3.73       3.91       1.35       0.29       7.93       5.37        000
                                                      implant.
51720.............  ..............  A                Treatment of bladder         1.96       1.75       0.69       0.14       3.85       2.79        000
                                                      lesion.
51725.............  26............  A                Simple cystometrogram.       1.51       0.49       0.49       0.12       2.12       2.12        000
51725.............  TC............  A                Simple cystometrogram.       0.00       5.11         NA       0.04       5.15         NA        000
51725.............  ..............  A                Simple cystometrogram.       1.51       5.60         NA       0.16       7.27         NA        000
51726.............  26............  A                Complex cystometrogram       1.71       0.56       0.56       0.13       2.40       2.40        000
51726.............  TC............  A                Complex cystometrogram       0.00       6.96         NA       0.05       7.01         NA        000
51726.............  ..............  A                Complex cystometrogram       1.71       7.52         NA       0.18       9.41         NA        000
51736.............  26............  A                Urine flow measurement       0.61       0.20       0.20       0.05       0.86       0.86        000
51736.............  TC............  A                Urine flow measurement       0.00       0.38         NA       0.01       0.39         NA        000
51736.............  ..............  A                Urine flow measurement       0.61       0.58         NA       0.06       1.25         NA        000
51741.............  26............  A                Electro-uroflowmetry,        1.14       0.37       0.37       0.09       1.60       1.60        000
                                                      first.
51741.............  TC............  A                Electro-uroflowmetry,        0.00       0.42         NA       0.02       0.44         NA        000
                                                      first.
51741.............  ..............  A                Electro-uroflowmetry,        1.14       0.79         NA       0.11       2.04         NA        000
                                                      first.
51772.............  26............  A                Urethra pressure             1.61       0.55       0.55       0.15       2.31       2.31        000
                                                      profile.
51772.............  TC............  A                Urethra pressure             0.00       5.04         NA       0.05       5.09         NA        000
                                                      profile.
51772.............  ..............  A                Urethra pressure             1.61       5.59         NA       0.20       7.40         NA        000
                                                      profile.
51784.............  26............  A                Anal/urinary muscle          1.53       0.50       0.50       0.12       2.15       2.15        000
                                                      study.
51784.............  TC............  A                Anal/urinary muscle          0.00       3.49         NA       0.04       3.53         NA        000
                                                      study.
51784.............  ..............  A                Anal/urinary muscle          1.53       3.99         NA       0.16       5.68         NA        000
                                                      study.
51785.............  26............  A                Anal/urinary muscle          1.53       0.50       0.50       0.11       2.14       2.14        000
                                                      study.
51785.............  TC............  A                Anal/urinary muscle          0.00       3.95         NA       0.04       3.99         NA        000
                                                      study.
51785.............  ..............  A                Anal/urinary muscle          1.53       4.45         NA       0.15       6.13         NA        000
                                                      study.
51792.............  26............  A                Urinary reflex study..       1.10       0.41       0.41       0.07       1.58       1.58        000
51792.............  TC............  A                Urinary reflex study..       0.00       5.60         NA       0.13       5.73         NA        000
51792.............  ..............  A                Urinary reflex study..       1.10       6.01         NA       0.20       7.31         NA        000
51795.............  26............  A                Urine voiding pressure       1.53       0.50       0.50       0.12       2.15       2.15        000
                                                      study.
51795.............  TC............  A                Urine voiding pressure       0.00       6.81         NA       0.10       6.91         NA        000
                                                      study.
51795.............  ..............  A                Urine voiding pressure       1.53       7.31         NA       0.22       9.06         NA        000
                                                      study.
51797.............  26............  A                Intraabdominal               1.60       0.53       0.53       0.12       2.25       2.25        000
                                                      pressure test.
51797.............  TC............  A                Intraabdominal               0.00       5.27         NA       0.05       5.32         NA        000
                                                      pressure test.
51797.............  ..............  A                Intraabdominal               1.60       5.80         NA       0.17       7.57         NA        000
                                                      pressure test.
51798.............  ..............  A                Us urine capacity            0.00       0.34         NA       0.08       0.42         NA        XXX
                                                      measure.
51800.............  ..............  A                Revision of bladder/        17.39         NA       7.58       1.32         NA      26.29        090
                                                      urethra.
51820.............  ..............  A                Revision of urinary         17.86         NA       8.30       1.74         NA      27.90        090
                                                      tract.
51840.............  ..............  A                Attach bladder/urethra      10.69         NA       5.58       1.06         NA      17.33        090
51841.............  ..............  A                Attach bladder/urethra      13.01         NA       6.39       1.24         NA      20.64        090
51845.............  ..............  A                Repair bladder neck...       9.72         NA       4.75       0.79         NA      15.26        090
51860.............  ..............  A                Repair of bladder           12.00         NA       5.77       1.16         NA      18.93        090
                                                      wound.
51865.............  ..............  A                Repair of bladder           15.02         NA       6.69       1.23         NA      22.94        090
                                                      wound.
51880.............  ..............  A                Repair of bladder            7.65         NA       3.96       0.72         NA      12.33        090
                                                      opening.
51900.............  ..............  A                Repair bladder/vagina       12.95         NA       6.08       1.21         NA      20.24        090
                                                      lesion.
51920.............  ..............  A                Close bladder-uterus        11.79         NA       5.65       1.18         NA      18.62        090
                                                      fistula.
51925.............  ..............  A                Hysterectomy/bladder        15.56         NA       8.63       2.03         NA      26.22        090
                                                      repair.
51940.............  ..............  A                Correction of bladder       28.39         NA      12.11       2.14         NA      42.64        090
                                                      defect.
51960.............  ..............  A                Revision of bladder &       22.98         NA       9.66       1.63         NA      34.27        090
                                                      bowel.
51980.............  ..............  A                Construct bladder           11.34         NA       5.39       0.86         NA      17.59        090
                                                      opening.
51990.............  ..............  A                Laparo urethral             12.48         NA       6.16       1.39         NA      20.03        090
                                                      suspension.
51992.............  ..............  A                Laparo sling operation      13.99         NA       6.22       1.41         NA      21.62        090
51999.............  ..............  C                Laparoscope proc,            0.00       0.00       0.00       0.00       0.00       0.00        YYY
                                                      bladder.
52000.............  ..............  A                Cystoscopy............       2.01       3.31       0.76       0.14       5.46       2.91        000
52001.............  ..............  A                Cystoscopy, removal of       5.44       5.08       1.87       0.39      10.91       7.70        000
                                                      clots.
52005.............  ..............  A                Cystoscopy & ureter          2.37       5.58       0.89       0.17       8.12       3.43        000
                                                      catheter.
52007.............  ..............  A                Cystoscopy and biopsy.       3.02      16.49       1.15       0.22      19.73       4.39        000
52010.............  ..............  A                Cystoscopy & duct            3.02      10.78       1.15       0.21      14.01       4.38        000
                                                      catheter.
52204.............  ..............  A                Cystoscopy............       2.37      14.55       0.90       0.17      17.09       3.44        000
52214.............  ..............  A                Cystoscopy and               3.70      38.21       1.33       0.26      42.17       5.29        000
                                                      treatment.
52224.............  ..............  A                Cystoscopy and               3.14      36.56       1.15       0.22      39.92       4.51        000
                                                      treatment.

[[Page 70392]]

 
52234.............  ..............  A                Cystoscopy and               4.62         NA       1.66       0.33         NA       6.61        000
                                                      treatment.
52235.............  ..............  A                Cystoscopy and               5.44         NA       1.94       0.39         NA       7.77        000
                                                      treatment.
52240.............  ..............  A                Cystoscopy and               9.71         NA       3.31       0.69         NA      13.71        000
                                                      treatment.
52250.............  ..............  A                Cystoscopy and               4.49         NA       1.65       0.32         NA       6.46        000
                                                      radiotracer.
52260.............  ..............  A                Cystoscopy and               3.91         NA       1.42       0.28         NA       5.61        000
                                                      treatment.
52265.............  ..............  A                Cystoscopy and               2.94      13.38       1.11       0.22      16.54       4.27        000
                                                      treatment.
52270.............  ..............  A                Cystoscopy & revise          3.36      11.06       1.24       0.24      14.66       4.84        000
                                                      urethra.
52275.............  ..............  A                Cystoscopy & revise          4.69      15.60       1.66       0.33      20.62       6.68        000
                                                      urethra.
52276.............  ..............  A                Cystoscopy and               4.99         NA       1.79       0.35         NA       7.13        000
                                                      treatment.
52277.............  ..............  A                Cystoscopy and               6.16         NA       2.23       0.44         NA       8.83        000
                                                      treatment.
52281.............  ..............  A                Cystoscopy and               2.80       7.11       1.08       0.20      10.11       4.08        000
                                                      treatment.
52282.............  ..............  A                Cystoscopy, implant          6.39         NA       2.24       0.45         NA       9.08        000
                                                      stent.
52283.............  ..............  A                Cystoscopy and               3.73       3.95       1.38       0.26       7.94       5.37        000
                                                      treatment.
52285.............  ..............  A                Cystoscopy and               3.60       4.02       1.33       0.26       7.88       5.19        000
                                                      treatment.
52290.............  ..............  A                Cystoscopy and               4.58         NA       1.65       0.32         NA       6.55        000
                                                      treatment.
52300.............  ..............  A                Cystoscopy and               5.30         NA       1.91       0.38         NA       7.59        000
                                                      treatment.
52301.............  ..............  A                Cystoscopy and               5.50         NA       1.99       0.46         NA       7.95        000
                                                      treatment.
52305.............  ..............  A                Cystoscopy and               5.30         NA       1.86       0.38         NA       7.54        000
                                                      treatment.
52310.............  ..............  A                Cystoscopy and               2.81       4.70       1.03       0.20       7.71       4.04        000
                                                      treatment.
52315.............  ..............  A                Cystoscopy and               5.20       8.69       1.84       0.37      14.26       7.41        000
                                                      treatment.
52317.............  ..............  A                Remove bladder stone..       6.71      29.02       2.29       0.48      36.21       9.48        000
52318.............  ..............  A                Remove bladder stone..       9.18         NA       3.10       0.65         NA      12.93        000
52320.............  ..............  A                Cystoscopy and               4.69         NA       1.63       0.33         NA       6.65        000
                                                      treatment.
52325.............  ..............  A                Cystoscopy, stone            6.15         NA       2.12       0.44         NA       8.71        000
                                                      removal.
52327.............  ..............  A                Cystoscopy, inject           5.18      31.90       1.82       0.37      37.45       7.37        000
                                                      material.
52330.............  ..............  A                Cystoscopy and               5.03      38.93       1.76       0.36      44.32       7.15        000
                                                      treatment.
52332.............  ..............  A                Cystoscopy and               2.83       5.76       1.05       0.21       8.80       4.09        000
                                                      treatment.
52334.............  ..............  A                Create passage to            4.82         NA       1.74       0.35         NA       6.91        000
                                                      kidney.
52341.............  ..............  A                Cysto w/ureter               5.99         NA       2.22       0.43         NA       8.64        000
                                                      stricture tx.
52342.............  ..............  A                Cysto w/up stricture         6.49         NA       2.35       0.46         NA       9.30        000
                                                      tx.
52343.............  ..............  A                Cysto w/renal                7.19         NA       2.59       0.51         NA      10.29        000
                                                      stricture tx.
52344.............  ..............  A                Cysto/uretero,               7.69         NA       2.80       0.55         NA      11.04        000
                                                      stricture tx.
52345.............  ..............  A                Cysto/uretero w/up           8.19         NA       2.96       0.58         NA      11.73        000
                                                      stricture.
52346.............  ..............  A                Cystouretero w/renal         9.22         NA       3.29       0.65         NA      13.16        000
                                                      strict.
52351.............  ..............  A                Cystouretero & or            5.85         NA       2.15       0.41         NA       8.41        000
                                                      pyeloscope.
52352.............  ..............  A                Cystouretero w/stone         6.87         NA       2.51       0.49         NA       9.87        000
                                                      remove.
52353.............  ..............  A                Cystouretero w/              7.96         NA       2.86       0.57         NA      11.39        000
                                                      lithotripsy.
52354.............  ..............  A                Cystouretero w/biopsy.       7.33         NA       2.68       0.52         NA      10.53        000
52355.............  ..............  A                Cystouretero w/excise        8.81         NA       3.15       0.63         NA      12.59        000
                                                      tumor.
52400.............  ..............  A                Cystouretero w/congen        9.67         NA       3.74       0.68         NA      14.09        090
                                                      repr.
52402.............  ..............  A                Cystourethro cut             5.27         NA       1.70       0.40         NA       7.37        000
                                                      ejacul duct.
52450.............  ..............  A                Incision of prostate..       7.63         NA       3.68       0.54         NA      11.85        090
52500.............  ..............  A                Revision of bladder          8.46         NA       3.93       0.60         NA      12.99        090
                                                      neck.
52510.............  ..............  A                Dilation prostatic           6.71         NA       3.12       0.48         NA      10.31        090
                                                      urethra.
52601.............  ..............  A                Prostatectomy (TURP)..      12.35         NA       5.11       0.87         NA      18.33        090
52606.............  ..............  A                Control postop               8.12         NA       3.56       0.57         NA      12.25        090
                                                      bleeding.
52612.............  ..............  A                Prostatectomy, first         7.97         NA       3.74       0.56         NA      12.27        090
                                                      stage.
52614.............  ..............  A                Prostatectomy, second        6.83         NA       3.35       0.48         NA      10.66        090
                                                      stage.
52620.............  ..............  A                Remove residual              6.60         NA       2.99       0.47         NA      10.06        090
                                                      prostate.
52630.............  ..............  A                Remove prostate              7.25         NA       3.20       0.51         NA      10.96        090
                                                      regrowth.
52640.............  ..............  A                Relieve bladder              6.61         NA       2.97       0.47         NA      10.05        090
                                                      contracture.
52647.............  ..............  A                Laser surgery of            10.34      74.15       4.54       0.73      85.22      15.61        090
                                                      prostate.
52648.............  ..............  A                Laser surgery of            11.19         NA       4.80       0.79         NA      16.78        090
                                                      prostate.
52700.............  ..............  A                Drainage of prostate         6.79         NA       3.19       0.48         NA      10.46        090
                                                      abscess.
53000.............  ..............  A                Incision of urethra...       2.28         NA       1.54       0.16         NA       3.98        010
53010.............  ..............  A                Incision of urethra...       3.63         NA       2.92       0.24         NA       6.79        090
53020.............  ..............  A                Incision of urethra...       1.77       3.01       0.67       0.13       4.91       2.57        000
53025.............  ..............  A                Incision of urethra...       1.13       3.74       0.51       0.08       4.95       1.72        000
53040.............  ..............  A                Drainage of urethra          6.39         NA       3.44       0.45         NA      10.28        090
                                                      abscess.
53060.............  ..............  A                Drainage of urethra          2.63       2.09       1.37       0.28       5.00       4.28        010
                                                      abscess.
53080.............  ..............  A                Drainage of urinary          6.28         NA       5.97       0.52         NA      12.77        090
                                                      leakage.
53085.............  ..............  A                Drainage of urinary         10.25         NA       7.42       0.92         NA      18.59        090
                                                      leakage.
53200.............  ..............  A                Biopsy of urethra.....       2.59       1.32       0.98       0.20       4.11       3.77        000
53210.............  ..............  A                Removal of urethra....      12.55         NA       5.85       0.89         NA      19.29        090
53215.............  ..............  A                Removal of urethra....      15.56         NA       6.64       1.10         NA      23.30        090
53220.............  ..............  A                Treatment of urethra         6.99         NA       3.72       0.49         NA      11.20        090
                                                      lesion.
53230.............  ..............  A                Removal of urethra           9.57         NA       4.72       0.73         NA      15.02        090
                                                      lesion.
53235.............  ..............  A                Removal of urethra          10.12         NA       4.91       0.72         NA      15.75        090
                                                      lesion.
53240.............  ..............  A                Surgery for urethra          6.44         NA       3.53       0.52         NA      10.49        090
                                                      pouch.
53250.............  ..............  A                Removal of urethra           5.88         NA       3.30       0.49         NA       9.67        090
                                                      gland.
53260.............  ..............  A                Treatment of urethra         2.98       2.25       1.42       0.25       5.48       4.65        010
                                                      lesion.
53265.............  ..............  A                Treatment of urethra         3.12       2.72       1.42       0.24       6.08       4.78        010
                                                      lesion.
53270.............  ..............  A                Removal of urethra           3.09       2.21       1.54       0.30       5.60       4.93        010
                                                      gland.
53275.............  ..............  A                Repair of urethra            4.52         NA       2.26       0.32         NA       7.10        010
                                                      defect.
53400.............  ..............  A                Revise urethra, stage       12.75         NA       6.04       0.98         NA      19.77        090
                                                      1.

[[Page 70393]]

 
53405.............  ..............  A                Revise urethra, stage       14.46         NA       6.33       1.10         NA      21.89        090
                                                      2.
53410.............  ..............  A                Reconstruction of           16.42         NA       7.07       1.16         NA      24.65        090
                                                      urethra.
53415.............  ..............  A                Reconstruction of           19.38         NA       7.35       1.37         NA      28.10        090
                                                      urethra.
53420.............  ..............  A                Reconstruct urethra,        14.06         NA       6.30       0.96         NA      21.32        090
                                                      stage 1.
53425.............  ..............  A                Reconstruct urethra,        15.96         NA       6.90       1.13         NA      23.99        090
                                                      stage 2.
53430.............  ..............  A                Reconstruction of           16.32         NA       7.01       1.15         NA      24.48        090
                                                      urethra.
53431.............  ..............  A                Reconstruct urethra/        19.86         NA       8.07       1.41         NA      29.34        090
                                                      bladder.
53440.............  ..............  A                Male sling procedure..      13.60         NA       5.99       0.96         NA      20.55        090
53442.............  ..............  A                Remove/revise male          11.55         NA       5.45       0.82         NA      17.82        090
                                                      sling.
53444.............  ..............  A                Insert tandem cuff....      13.38         NA       5.89       0.94         NA      20.21        090
53445.............  ..............  A                Insert uro/ves nck          14.04         NA       7.10       0.99         NA      22.13        090
                                                      sphincter.
53446.............  ..............  A                Remove uro sphincter..      10.21         NA       5.23       0.72         NA      16.16        090
53447.............  ..............  A                Remove/replace ur           13.47         NA       6.44       0.95         NA      20.86        090
                                                      sphincter.
53448.............  ..............  A                Remov/replc ur              21.12         NA       9.07       1.50         NA      31.69        090
                                                      sphinctr comp.
53449.............  ..............  A                Repair uro sphincter..       9.69         NA       4.73       0.68         NA      15.10        090
53450.............  ..............  A                Revision of urethra...       6.13         NA       3.30       0.43         NA       9.86        090
53460.............  ..............  A                Revision of urethra...       7.11         NA       3.70       0.50         NA      11.31        090
53500.............  ..............  A                Urethrlys, transvag w/      12.19         NA       6.22       0.90         NA      19.31        090
                                                      scope.
53502.............  ..............  A                Repair of urethra            7.62         NA       3.99       0.62         NA      12.23        090
                                                      injury.
53505.............  ..............  A                Repair of urethra            7.62         NA       3.87       0.54         NA      12.03        090
                                                      injury.
53510.............  ..............  A                Repair of urethra           10.09         NA       5.17       0.74         NA      16.00        090
                                                      injury.
53515.............  ..............  A                Repair of urethra           13.29         NA       5.94       1.05         NA      20.28        090
                                                      injury.
53520.............  ..............  A                Repair of urethra            8.67         NA       4.48       0.61         NA      13.76        090
                                                      defect.
53600.............  ..............  A                Dilate urethra               1.21       1.14       0.43       0.09       2.44       1.73        000
                                                      stricture.
53601.............  ..............  A                Dilate urethra               0.98       1.27       0.37       0.07       2.32       1.42        000
                                                      stricture.
53605.............  ..............  A                Dilate urethra               1.28         NA       0.41       0.09         NA       1.78        000
                                                      stricture.
53620.............  ..............  A                Dilate urethra               1.62       2.00       0.59       0.11       3.73       2.32        000
                                                      stricture.
53621.............  ..............  A                Dilate urethra               1.35       2.08       0.49       0.10       3.53       1.94        000
                                                      stricture.
53660.............  ..............  A                Dilation of urethra...       0.71       1.31       0.31       0.05       2.07       1.07        000
53661.............  ..............  A                Dilation of urethra...       0.72       1.30       0.29       0.05       2.07       1.06        000
53665.............  ..............  A                Dilation of urethra...       0.76         NA       0.25       0.06         NA       1.07        000
53850.............  ..............  A                Prostatic microwave          9.44      94.33       3.95       0.67     104.44      14.06        090
                                                      thermotx.
53852.............  ..............  A                Prostatic rf thermotx.       9.87      89.03       4.38       0.70      99.60      14.95        090
53853.............  ..............  A                Prostatic water              5.23      55.50       2.86       0.37      61.10       8.46        090
                                                      thermother.
53899.............  ..............  C                Urology surgery              0.00       0.00       0.00       0.00       0.00       0.00        YYY
                                                      procedure.
54000.............  ..............  A                Slitting of prepuce...       1.54       2.92       0.93       0.11       4.57       2.58        010
54001.............  ..............  A                Slitting of prepuce...       2.19       3.19       1.11       0.15       5.53       3.45        010
54015.............  ..............  A                Drain penis lesion....       5.31         NA       2.56       0.38         NA       8.25        010
54050.............  ..............  A                Destruction, penis           1.24       1.66       1.03       0.08       2.98       2.35        010
                                                      lesion(s).
54055.............  ..............  A                Destruction, penis           1.22       1.57       0.80       0.08       2.87       2.10        010
                                                      lesion(s).
54056.............  ..............  A                Cryosurgery, penis           1.24       1.69       1.13       0.06       2.99       2.43        010
                                                      lesion(s).
54057.............  ..............  A                Laser surg, penis            1.24       2.22       0.83       0.09       3.55       2.16        010
                                                      lesion(s).
54060.............  ..............  A                Excision of penis            1.93       3.11       1.06       0.13       5.17       3.12        010
                                                      lesion(s).
54065.............  ..............  A                Destruction, penis           2.42       2.64       1.23       0.13       5.19       3.78        010
                                                      lesion(s).
54100.............  ..............  A                Biopsy of penis.......       1.90       2.81       0.82       0.10       4.81       2.82        000
54105.............  ..............  A                Biopsy of penis.......       3.49       4.29       1.94       0.25       8.03       5.68        010
54110.............  ..............  A                Treatment of penis          10.11         NA       4.76       0.72         NA      15.59        090
                                                      lesion.
54111.............  ..............  A                Treat penis lesion,         13.55         NA       5.78       0.96         NA      20.29        090
                                                      graft.
54112.............  ..............  A                Treat penis lesion,         15.84         NA       6.81       1.11         NA      23.76        090
                                                      graft.
54115.............  ..............  A                Treatment of penis           6.14       4.38       3.46       0.43      10.95      10.03        090
                                                      lesion.
54120.............  ..............  A                Partial removal of           9.96         NA       4.68       0.68         NA      15.32        090
                                                      penis.
54125.............  ..............  A                Removal of penis......      13.51         NA       5.84       0.95         NA      20.30        090
54130.............  ..............  A                Remove penis & nodes..      20.11         NA       8.19       1.52         NA      29.82        090
54135.............  ..............  A                Remove penis & nodes..      26.32         NA      10.19       1.87         NA      38.38        090
54150.............  ..............  A                Circumcision..........       1.81       4.36       0.70       0.16       6.33       2.67        000
54152.............  ..............  A                Circumcision..........       2.31         NA       1.20       0.19         NA       3.70        010
54160.............  ..............  A                Circumcision..........       2.48       4.15       1.09       0.19       6.82       3.76        010
54161.............  ..............  A                Circumcision..........       3.27         NA       1.56       0.23         NA       5.06        010
54162.............  ..............  A                Lysis penil circumic         3.00       4.66       1.44       0.21       7.87       4.65        010
                                                      lesion.
54163.............  ..............  A                Repair of circumcision       3.00         NA       2.01       0.21         NA       5.22        010
54164.............  ..............  A                Frenulotomy of penis..       2.50         NA       1.84       0.18         NA       4.52        010
54200.............  ..............  A                Treatment of penis           1.06       1.80       0.97       0.08       2.94       2.11        010
                                                      lesion.
54205.............  ..............  A                Treatment of penis           7.92         NA       4.69       0.56         NA      13.17        090
                                                      lesion.
54220.............  ..............  A                Treatment of penis           2.42       3.85       0.95       0.17       6.44       3.54        000
                                                      lesion.
54230.............  ..............  A                Prepare penis study...       1.34       1.08       0.63       0.09       2.51       2.06        000
54231.............  ..............  A                Dynamic cavernosometry       2.04       1.37       0.87       0.16       3.57       3.07        000
54235.............  ..............  A                Penile injection......       1.19       0.96       0.58       0.08       2.23       1.85        000
54240.............  26............  A                Penis study...........       1.31       0.43       0.43       0.11       1.85       1.85        000
54240.............  TC............  A                Penis study...........       0.00       0.60         NA       0.06       0.66         NA        000
54240.............  ..............  A                Penis study...........       1.31       1.03         NA       0.17       2.51         NA        000
54250.............  26............  A                Penis study...........       2.22       0.71       0.71       0.16       3.09       3.09        000
54250.............  TC............  A                Penis study...........       0.00       0.20         NA       0.02       0.22         NA        000
54250.............  ..............  A                Penis study...........       2.22       0.91         NA       0.18       3.31         NA        000
54300.............  ..............  A                Revision of penis.....      10.39         NA       5.58       0.76         NA      16.73        090
54304.............  ..............  A                Revision of penis.....      12.47         NA       6.34       0.88         NA      19.69        090

[[Page 70394]]

 
54308.............  ..............  A                Reconstruction of           11.81         NA       5.97       0.84         NA      18.62        090
                                                      urethra.
54312.............  ..............  A                Reconstruction of           13.55         NA       7.00       1.24         NA       1.79        090
                                                      urethra.
54316.............  ..............  A                Reconstruction of           16.79         NA       7.96       1.21         NA      25.96        090
                                                      urethra.
54318.............  ..............  A                Reconstruction of           11.23         NA       5.80       1.39         NA      18.42        090
                                                      urethra.
54322.............  ..............  A                Reconstruction of           12.99         NA       6.47       0.92         NA      20.38        090
                                                      urethra.
54324.............  ..............  A                Reconstruction of           16.29         NA       7.97       1.14         NA      25.40        090
                                                      urethra.
54326.............  ..............  A                Reconstruction of           15.70         NA       7.79       1.11         NA      24.60        090
                                                      urethra.
54328.............  ..............  A                Revise penis/urethra..      15.63         NA       7.26       0.98         NA      23.87        090
54332.............  ..............  A                Revise penis/urethra..      17.05         NA       7.74       1.21         NA      26.00        090
54336.............  ..............  A                Revise penis/urethra..      20.01         NA      10.31       2.20         NA      32.52        090
54340.............  ..............  A                Secondary urethral           8.90         NA       5.04       0.63         NA      14.57        090
                                                      surgery.
54344.............  ..............  A                Secondary urethral          15.92         NA       7.76       1.54         NA      25.22        090
                                                      surgery.
54348.............  ..............  A                Secondary urethral          17.12         NA       8.36       1.23         NA      26.71        090
                                                      surgery.
54352.............  ..............  A                Reconstruct urethra/        24.70         NA      11.20       2.24         NA      38.14        090
                                                      penis.
54360.............  ..............  A                Penis plastic surgery.      11.91         NA       6.04       0.84         NA      18.79        090
54380.............  ..............  A                Repair penis..........      13.16         NA       6.62       0.93         NA      20.71        090
54385.............  ..............  A                Repair penis..........      15.37         NA       8.27       0.86         NA      24.50        090
54390.............  ..............  A                Repair penis and            21.58         NA       9.43       1.54         NA      32.55        090
                                                      bladder.
54400.............  ..............  A                Insert semi-rigid            8.98         NA       4.35       0.64         NA      13.97        090
                                                      prosthesis.
54401.............  ..............  A                Insert self-contd           10.26         NA       5.74       0.73         NA      16.73        090
                                                      prosthesis.
54405.............  ..............  A                Insert multi-comp           13.41         NA       5.93       0.95         NA      20.29        090
                                                      penis pros.
54406.............  ..............  A                Remove muti-comp penis      12.08         NA       5.43       0.86         NA      18.37        090
                                                      pros.
54408.............  ..............  A                Repair multi-comp           12.73         NA       5.74       0.90         NA      19.37        090
                                                      penis pros.
54410.............  ..............  A                Remove/replace penis        15.48         NA       6.63       1.10         NA      23.21        090
                                                      prosth.
54411.............  ..............  A                Remov/replc penis           15.98         NA       7.05       1.13         NA      24.16        090
                                                      pros, comp.
54415.............  ..............  A                Remove self-contd            8.19         NA       4.20       0.58         NA      12.97        090
                                                      penis pros.
54416.............  ..............  A                Remv/repl penis             10.85         NA       5.38       0.77         NA      17.00        090
                                                      contain pros.
54417.............  ..............  A                Remv/replc penis pros,      14.17         NA       6.18       1.00         NA      21.35        090
                                                      compl.
54420.............  ..............  A                Revision of penis.....      11.40         NA       5.58       0.81         NA      17.79        090
54430.............  ..............  A                Revision of penis.....      10.13         NA       5.11       0.72         NA      15.96        090
54435.............  ..............  A                Revision of penis.....       6.11         NA       3.62       0.43         NA      10.16        090
54440.............  ..............  C                Repair of penis.......       0.00       0.00       0.00       0.00       0.00       0.00        090
54450.............  ..............  A                Preputial stretching..       1.12       0.95       0.44       0.08       2.15       1.64        000
54500.............  ..............  A                Biopsy of testis......       1.31       0.61       0.56       0.10       2.02       1.97        000
54505.............  ..............  A                Biopsy of testis......       3.45         NA       1.92       0.27         NA       5.64        010
54512.............  ..............  A                Excise lesion testis..       8.57         NA       4.13       0.67         NA      13.37        090
54520.............  ..............  A                Removal of testis.....       5.22         NA       2.79       0.50         NA       8.51        090
54522.............  ..............  A                Orchiectomy, partial..       9.49         NA       4.87       0.89         NA      15.25        090
54530.............  ..............  A                Removal of testis.....       8.57         NA       4.24       0.66         NA      13.47        090
54535.............  ..............  A                Extensive testis            12.14         NA       5.55       0.95         NA      18.64        090
                                                      surgery.
54550.............  ..............  A                Exploration for testis       7.77         NA       3.81       0.59         NA      12.17        090
54560.............  ..............  A                Exploration for testis      11.11         NA       5.16       0.90         NA      17.17        090
54600.............  ..............  A                Reduce testis torsion.       7.00         NA       3.55       0.51         NA      11.06        090
54620.............  ..............  A                Suspension of testis..       4.89         NA       2.44       0.37         NA       7.70        010
54640.............  ..............  A                Suspension of testis..       6.89         NA       3.74       0.62         NA      11.25        090
54650.............  ..............  A                Orchiopexy (Fowler-         11.43         NA       5.41       1.16         NA      18.00        090
                                                      Stephens).
54660.............  ..............  A                Revision of testis....       5.10         NA       3.00       0.44         NA       8.54        090
54670.............  ..............  A                Repair testis injury..       6.40         NA       3.54       0.47         NA      10.41        090
54680.............  ..............  A                Relocation of               12.63         NA       6.16       1.16         NA      19.95        090
                                                      testis(es).
54690.............  ..............  A                Laparoscopy,                10.94         NA       4.94       1.02         NA      16.90        090
                                                      orchiectomy.
54692.............  ..............  A                Laparoscopy,                12.86         NA       5.44       1.30         NA      19.60        090
                                                      orchiopexy.
54699.............  ..............  C                Laparoscope proc,            0.00       0.00       0.00       0.00       0.00       0.00        YYY
                                                      testis.
54700.............  ..............  A                Drainage of scrotum...       3.42         NA       1.94       0.28         NA       5.64        010
54800.............  ..............  A                Biopsy of epididymis..       2.33       0.94       0.90       0.23       3.50       3.46        000
54820.............  ..............  A                Exploration of               5.13         NA       2.94       0.40         NA       8.47        090
                                                      epididymis.
54830.............  ..............  A                Remove epididymis            5.37         NA       3.02       0.41         NA       8.80        090
                                                      lesion.
54840.............  ..............  A                Remove epididymis            5.19         NA       2.78       0.37         NA       8.34        090
                                                      lesion.
54860.............  ..............  A                Removal of epididymis.       6.31         NA       3.31       0.45         NA      10.07        090
54861.............  ..............  A                Removal of epididymis.       8.89         NA       4.31       0.63         NA      13.83        090
54900.............  ..............  A                Fusion of spermatic         13.18         NA       5.80       0.93         NA      19.91        090
                                                      ducts.
54901.............  ..............  A                Fusion of spermatic         17.91         NA       7.53       1.82         NA      27.26        090
                                                      ducts.
55000.............  ..............  A                Drainage of hydrocele.       1.43       2.07       0.65       0.11       3.61       2.19        000
55040.............  ..............  A                Removal of hydrocele..       5.35         NA       2.90       0.43         NA       8.68        090
55041.............  ..............  A                Removal of hydroceles.       7.73         NA       3.97       0.60         NA      12.30        090
55060.............  ..............  A                Repair of hydrocele...       5.51         NA       3.08       0.46         NA       9.05        090
55100.............  ..............  A                Drainage of scrotum          2.13       3.68       1.56       0.17       5.98       3.86        010
                                                      abscess.
55110.............  ..............  A                Explore scrotum.......       5.69         NA       3.13       0.43         NA       9.25        090
55120.............  ..............  A                Removal of scrotum           5.08         NA       2.95       0.39         NA       8.42        090
                                                      lesion.
55150.............  ..............  A                Removal of scrotum....       7.21         NA       3.84       0.56         NA      11.61        090
55175.............  ..............  A                Revision of scrotum...       5.23         NA       3.01       0.37         NA       8.61        090
55180.............  ..............  A                Revision of scrotum...      10.70         NA       5.37       0.90         NA      16.97        090
55200.............  ..............  A                Incision of sperm duct       4.23      12.35       2.38       0.33      16.91       6.94        090
55250.............  ..............  A                Removal of sperm             3.29      11.50       2.22       0.25      15.04       5.76        090
                                                      duct(s).
55300.............  ..............  A                Prepare, sperm duct x-       3.50         NA       1.31       0.25         NA       5.06        000
                                                      ray.
55400.............  ..............  A                Repair of sperm duct..       8.48         NA       4.06       0.64         NA      13.18        090

[[Page 70395]]

 
55450.............  ..............  A                Ligation of sperm duct       4.11       7.01       1.87       0.29      11.41       6.27        010
55500.............  ..............  A                Removal of hydrocele..       5.58         NA       3.09       0.55         NA       9.22        090
55520.............  ..............  A                Removal of sperm cord        6.02         NA       3.25       0.75         NA      10.02        090
                                                      lesion.
55530.............  ..............  A                Revise spermatic cord        5.65         NA       3.01       0.45         NA       9.11        090
                                                      veins.
55535.............  ..............  A                Revise spermatic cord        6.55         NA       3.40       0.47         NA      10.42        090
                                                      veins.
55540.............  ..............  A                Revise hernia & sperm        7.66         NA       3.80       0.94         NA      12.40        090
                                                      veins.
55550.............  ..............  A                Laparo ligate                6.56         NA       3.30       0.57         NA      10.43        090
                                                      spermatic vein.
55559.............  ..............  C                Laparo proc, spermatic       0.00       0.00       0.00       0.00       0.00       0.00        YYY
                                                      cord.
55600.............  ..............  A                Incise sperm duct            6.37         NA       3.33       0.62         NA      10.32        090
                                                      pouch.
55605.............  ..............  A                Incise sperm duct            7.95         NA       4.29       0.64         NA      12.88        090
                                                      pouch.
55650.............  ..............  A                Remove sperm duct           11.78         NA       5.28       0.92         NA      17.98        090
                                                      pouch.
55680.............  ..............  A                Remove sperm pouch           5.18         NA       2.97       0.47         NA       8.62        090
                                                      lesion.
55700.............  ..............  A                Biopsy of prostate....       1.57       4.20       0.64       0.11       5.88       2.32        000
55705.............  ..............  A                Biopsy of prostate....       4.56         NA       2.30       0.32         NA       7.18        010
55720.............  ..............  A                Drainage of prostate         7.63         NA       3.82       0.95         NA      12.40        090
                                                      abscess.
55725.............  ..............  A                Drainage of prostate         8.67         NA       4.49       0.70         NA      13.86        090
                                                      abscess.
55801.............  ..............  A                Removal of prostate...      17.77         NA       7.62       1.34         NA      26.73        090
55810.............  ..............  A                Extensive prostate          22.55         NA       8.95       1.60         NA      33.10        090
                                                      surgery.
55812.............  ..............  A                Extensive prostate          27.47         NA      10.99       2.04         NA      40.50        090
                                                      surgery.
55815.............  ..............  A                Extensive prostate          30.41         NA      11.90       2.16         NA      44.47        090
                                                      surgery.
55821.............  ..............  A                Removal of prostate...      14.23         NA       6.21       1.01         NA      21.45        090
55831.............  ..............  A                Removal of prostate...      15.60         NA       6.66       1.10         NA      23.36        090
55840.............  ..............  A                Extensive prostate          22.66         NA       9.29       1.61         NA      33.56        090
                                                      surgery.
55842.............  ..............  A                Extensive prostate          24.34         NA       9.85       1.72         NA      35.91        090
                                                      surgery.
55845.............  ..............  A                Extensive prostate          28.51         NA      10.94       2.02         NA      41.47        090
                                                      surgery.
55859.............  ..............  A                Percut/needle insert,       12.50         NA       5.85       0.89         NA      19.24        090
                                                      pros.
55860.............  ..............  A                Surgical exposure,          14.43         NA       6.41       1.02         NA      21.86        090
                                                      prostate.
55862.............  ..............  A                Extensive prostate          18.36         NA       7.85       1.49         NA      27.70        090
                                                      surgery.
55865.............  ..............  A                Extensive prostate          22.84         NA       9.27       1.63         NA      33.74        090
                                                      surgery.
55866.............  ..............  A                Laparo radical              30.69         NA      11.73       2.16         NA      44.58        090
                                                      prostatectomy.
55870.............  ..............  A                Electroejaculation....       2.58       1.53       1.08       0.16       4.27       3.82        000
55873.............  ..............  A                Cryoablate prostate...      19.44         NA       8.96       1.38         NA      29.78        090
55899.............  ..............  C                Genital surgery              0.00       0.00       0.00       0.00       0.00       0.00        YYY
                                                      procedure.
55970.............  ..............  N                Sex transformation, M        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      to F.
55980.............  ..............  N                Sex transformation, F        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      to M.
56405.............  ..............  A                I & D of vulva/              1.44       1.33       1.14       0.17       2.94       2.75        010
                                                      perineum.
56420.............  ..............  A                Drainage of gland            1.39       2.28       1.04       0.16       3.83       2.59        010
                                                      abscess.
56440.............  ..............  A                Surgery for vulva            2.84         NA       1.71       0.34         NA       4.89        010
                                                      lesion.
56441.............  ..............  A                Lysis of labial              1.97       1.82       1.41       0.20       3.99       3.58        010
                                                      lesion(s).
56501.............  ..............  A                Destroy, vulva               1.53       1.79       1.24       0.18       3.50       2.95        010
                                                      lesions, sim.
56515.............  ..............  A                Destroy vulva lesion/s       2.76       2.55       1.82       0.33       5.64       4.91        010
                                                      compl.
56605.............  ..............  A                Biopsy of vulva/             1.10       1.07       0.46       0.13       2.30       1.69        000
                                                      perineum.
56606.............  ..............  A                Biopsy of vulva/             0.55       0.49       0.22       0.07       1.11       0.84        ZZZ
                                                      perineum.
56620.............  ..............  A                Partial removal of           7.46         NA       4.80       0.90         NA      13.16        090
                                                      vulva.
56625.............  ..............  A                Complete removal of          8.39         NA       5.33       1.02         NA      14.74        090
                                                      vulva.
56630.............  ..............  A                Extensive vulva             12.34         NA       6.85       1.49         NA      20.68        090
                                                      surgery.
56631.............  ..............  A                Extensive vulva             16.18         NA       8.83       1.95         NA      26.96        090
                                                      surgery.
56632.............  ..............  A                Extensive vulva             20.26         NA       9.54       2.38         NA      32.18        090
                                                      surgery.
56633.............  ..............  A                Extensive vulva             16.45         NA       8.61       1.97         NA      27.03        090
                                                      surgery.
56634.............  ..............  A                Extensive vulva             17.85         NA       9.45       2.16         NA      29.46        090
                                                      surgery.
56637.............  ..............  A                Extensive vulva             21.94         NA      11.09       2.60         NA      35.63        090
                                                      surgery.
56640.............  ..............  A                Extensive vulva             22.14         NA      10.64       2.88         NA      35.66        090
                                                      surgery.
56700.............  ..............  A                Partial removal of           2.52         NA       1.84       0.30         NA       4.66        010
                                                      hymen.
56720.............  ..............  A                Incision of hymen.....       0.68         NA       0.51       0.08         NA       1.27        000
56740.............  ..............  A                Remove vagina gland          4.56         NA       2.57       0.56         NA       7.69        010
                                                      lesion.
56800.............  ..............  A                Repair of vagina......       3.88         NA       2.20       0.44         NA       6.52        010
56805.............  ..............  A                Repair clitoris.......      18.83         NA       9.44       2.14         NA      30.41        090
56810.............  ..............  A                Repair of perineum....       4.12         NA       2.30       0.49         NA       6.91        010
56820.............  ..............  A                Exam of vulva w/scope.       1.50       1.31       0.65       0.18       2.99       2.33        000
56821.............  ..............  A                Exam/biopsy of vulva w/      2.05       1.76       0.91       0.25       4.06       3.21        000
                                                      scope.
57000.............  ..............  A                Exploration of vagina.       2.97         NA       1.72       0.31         NA       5.00        010
57010.............  ..............  A                Drainage of pelvic           6.02         NA       3.81       0.71         NA      10.54        090
                                                      abscess.
57020.............  ..............  A                Drainage of pelvic           1.50       0.94       0.59       0.18       2.62       2.27        000
                                                      fluid.
57022.............  ..............  A                I & d vaginal                2.56         NA       1.49       0.26         NA       4.31        010
                                                      hematoma, pp.
57023.............  ..............  A                I & d vag hematoma,          4.74         NA       2.58       0.58         NA       7.90        010
                                                      non-ob.
57061.............  ..............  A                Destroy vag lesions,         1.25       1.65       1.12       0.15       3.05       2.52        010
                                                      simple.
57065.............  ..............  A                Destroy vag lesions,         2.61       2.30       1.67       0.31       5.22       4.59        010
                                                      complex.
57100.............  ..............  A                Biopsy of vagina......       1.20       1.08       0.48       0.14       2.42       1.82        000
57105.............  ..............  A                Biopsy of vagina......       1.69       1.80       1.42       0.20       3.69       3.31        010
57106.............  ..............  A                Remove vagina wall,          6.35         NA       4.19       0.73         NA      11.27        090
                                                      partial.
57107.............  ..............  A                Remove vagina tissue,       22.97         NA      10.49       2.71         NA      36.17        090
                                                      part.
57109.............  ..............  A                Vaginectomy partial w/      26.96         NA      11.27       3.21         NA      41.44        090
                                                      nodes.
57110.............  ..............  A                Remove vagina wall,         14.27         NA       7.29       1.73         NA      23.29        090
                                                      complete.
57111.............  ..............  A                Remove vagina tissue,       26.96         NA      12.65       3.17         NA      42.78        090
                                                      compl.
57112.............  ..............  A                Vaginectomy w/nodes,        28.96         NA      12.13       3.07         NA      44.16        090
                                                      compl.

[[Page 70396]]

 
57120.............  ..............  A                Closure of vagina.....       7.40         NA       4.61       0.89         NA      12.90        090
57130.............  ..............  A                Remove vagina lesion..       2.43       2.16       1.54       0.29       4.88       4.26        010
57135.............  ..............  A                Remove vagina lesion..       2.67       2.27       1.65       0.31       5.25       4.63        010
57150.............  ..............  A                Treat vagina infection       0.55       1.10       0.21       0.07       1.72       0.83        000
57155.............  ..............  A                Insert uteri tandems/        6.26         NA       4.57       0.43         NA      11.26        090
                                                      ovoids.
57160.............  ..............  A                Insert pessary/other         0.89       1.01       0.34       0.10       2.00       1.33        000
                                                      device.
57170.............  ..............  A                Fitting of diaphragm/        0.91       1.48       0.33       0.11       2.50       1.35        000
                                                      cap.
57180.............  ..............  A                Treat vaginal bleeding       1.58       2.17       1.26       0.19       3.94       3.03        010
57200.............  ..............  A                Repair of vagina......       3.93         NA       2.90       0.46         NA       7.29        090
57210.............  ..............  A                Repair vagina/perineum       5.16         NA       3.44       0.62         NA       9.22        090
57220.............  ..............  A                Revision of urethra...       4.30         NA       3.11       0.51         NA       7.92        090
57230.............  ..............  A                Repair of urethral           5.63         NA       3.41       0.54         NA       9.58        090
                                                      lesion.
57240.............  ..............  A                Repair bladder &             6.06         NA       3.82       0.62         NA      10.50        090
                                                      vagina.
57250.............  ..............  A                Repair rectum & vagina       5.52         NA       3.58       0.65         NA       9.75        090
57260.............  ..............  A                Repair of vagina......       8.26         NA       4.84       0.97         NA      14.07        090
57265.............  ..............  A                Extensive repair of         11.32         NA       6.05       1.32         NA      18.69        090
                                                      vagina.
57267.............  ..............  A                Insert mesh/pelvic flr       4.88         NA       1.98       0.64         NA       7.50        ZZZ
                                                      addon.
57268.............  ..............  A                Repair of bowel bulge.       6.75         NA       4.20       0.79         NA      11.74        090
57270.............  ..............  A                Repair of bowel pouch.      12.09         NA       6.26       1.42         NA      19.77        090
57280.............  ..............  A                Suspension of vagina..      15.02         NA       7.38       1.67         NA      24.07        090
57282.............  ..............  A                Colpopexy,                   6.86         NA       4.51       1.02         NA      12.39        090
                                                      extraperitoneal.
57283.............  ..............  A                Colpopexy,                  10.84         NA       5.93       1.02         NA      17.79        090
                                                      intraperitoneal.
57284.............  ..............  A                Repair paravaginal          12.68         NA       7.16       1.41         NA      21.25        090
                                                      defect.
57287.............  ..............  A                Revise/remove sling         10.69         NA       5.49       0.90         NA      17.08        090
                                                      repair.
57288.............  ..............  A                Repair bladder defect.      13.00         NA       5.92       1.12         NA      20.04        090
57289.............  ..............  A                Repair bladder &            11.56         NA       6.05       1.21         NA      18.82        090
                                                      vagina.
57291.............  ..............  A                Construction of vagina       7.94         NA       4.93       0.93         NA      13.80        090
57292.............  ..............  A                Construct vagina with       13.07         NA       6.95       1.58         NA      21.60        090
                                                      graft.
57295.............  ..............  A                Change vaginal graft..       7.45         NA       4.44       0.91         NA      12.80        090
57300.............  ..............  A                Repair rectum-vagina         7.60         NA       4.29       0.87         NA      12.76        090
                                                      fistula.
57305.............  ..............  A                Repair rectum-vagina        13.75         NA       6.28       1.72         NA      21.75        090
                                                      fistula.
57307.............  ..............  A                Fistula repair &            15.91         NA       7.01       2.01         NA      24.93        090
                                                      colostomy.
57308.............  ..............  A                Fistula repair,              9.93         NA       5.10       1.14         NA      16.17        090
                                                      transperine.
57310.............  ..............  A                Repair urethrovaginal        6.77         NA       3.84       0.54         NA      11.15        090
                                                      lesion.
57311.............  ..............  A                Repair urethrovaginal        7.97         NA       4.12       0.65         NA      12.74        090
                                                      lesion.
57320.............  ..............  A                Repair bladder-vagina        8.00         NA       4.37       0.69         NA      13.06        090
                                                      lesion.
57330.............  ..............  A                Repair bladder-vagina       12.33         NA       5.72       1.06         NA      19.11        090
                                                      lesion.
57335.............  ..............  A                Repair vagina.........      18.70         NA       9.05       1.91         NA      29.66        090
57400.............  ..............  A                Dilation of vagina....       2.27         NA       1.11       0.26         NA       3.64        000
57410.............  ..............  A                Pelvic examination....       1.75       2.02       0.89       0.18       3.95       2.82        000
57415.............  ..............  A                Remove vaginal foreign       2.17         NA       1.42       0.24         NA       3.83        010
                                                      body.
57420.............  ..............  A                Exam of vagina w/scope       1.60       1.35       0.67       0.19       3.14       2.46        000
57421.............  ..............  A                Exam/biopsy of vag w/        2.20       1.85       0.96       0.27       4.32       3.43        000
                                                      scope.
57425.............  ..............  A                Laparoscopy, surg,          15.73         NA       6.65       1.75         NA      24.13        090
                                                      colpopexy.
57452.............  ..............  A                Exam of cervix w/scope       1.50       1.28       0.76       0.18       2.96       2.44        000
57454.............  ..............  A                Bx/curett of cervix w/       2.33       1.64       1.15       0.28       4.25       3.76        000
                                                      scope.
57455.............  ..............  A                Biopsy of cervix w/          1.99       1.72       0.87       0.24       3.95       3.10        000
                                                      scope.
57456.............  ..............  A                Endocerv curettage w/        1.85       1.65       0.82       0.22       3.72       2.89        000
                                                      scope.
57460.............  ..............  A                Bx of cervix w/scope,        2.83       5.86       1.38       0.34       9.03       4.55        000
                                                      leep.
57461.............  ..............  A                Conz of cervix w/            3.43       6.12       1.47       0.41       9.96       5.31        000
                                                      scope, leep.
57500.............  ..............  A                Biopsy of cervix......       0.97       2.55       0.63       0.12       3.64       1.72        000
57505.............  ..............  A                Endocervical curettage       1.14       1.46       1.10       0.14       2.74       2.38        010
57510.............  ..............  A                Cauterization of             1.90       1.56       1.04       0.23       3.69       3.17        010
                                                      cervix.
57511.............  ..............  A                Cryocautery of cervix.       1.90       1.83       1.37       0.23       3.96       3.50        010
57513.............  ..............  A                Laser surgery of             1.90       1.72       1.40       0.23       3.85       3.53        010
                                                      cervix.
57520.............  ..............  A                Conization of cervix..       4.03       3.94       2.88       0.49       8.46       7.40        090
57522.............  ..............  A                Conization of cervix..       3.35       3.16       2.46       0.41       6.92       6.22        090
57530.............  ..............  A                Removal of cervix.....       4.78         NA       3.39       0.58         NA       8.75        090
57531.............  ..............  A                Removal of cervix,          27.96         NA      13.20       3.34         NA      44.50        090
                                                      radical.
57540.............  ..............  A                Removal of residual         12.20         NA       6.25       1.49         NA      19.94        090
                                                      cervix.
57545.............  ..............  A                Remove cervix/repair        13.01         NA       6.69       1.52         NA      21.22        090
                                                      pelvis.
57550.............  ..............  A                Removal of residual          5.52         NA       3.83       0.67         NA      10.02        090
                                                      cervix.
57555.............  ..............  A                Remove cervix/repair         8.94         NA       5.09       1.09         NA      15.12        090
                                                      vagina.
57556.............  ..............  A                Remove cervix, repair        8.36         NA       4.86       0.92         NA      14.14        090
                                                      bowel.
57700.............  ..............  A                Revision of cervix....       3.54         NA       3.11       0.41         NA       7.06        090
57720.............  ..............  A                Revision of cervix....       4.12         NA       3.11       0.49         NA       7.72        090
57800.............  ..............  A                Dilation of cervical         0.77       0.76       0.47       0.09       1.62       1.33        000
                                                      canal.
57820.............  ..............  A                D & c of residual            1.67       1.47       1.14       0.20       3.34       3.01        010
                                                      cervix.
58100.............  ..............  A                Biopsy of uterus             1.53       1.32       0.72       0.18       3.03       2.43        000
                                                      lining.
58110.............  ..............  A                Bx done w/colposcopy         0.77       0.55       0.31       0.09       1.41       1.17        ZZZ
                                                      add-on.
58120.............  ..............  A                Dilation and curettage       3.27       2.31       1.88       0.39       5.97       5.54        010
58140.............  ..............  A                Myomectomy abdom            14.58         NA       7.12       1.81         NA      23.51        090
                                                      method.
58145.............  ..............  A                Myomectomy vag method.       8.03         NA       4.80       0.97         NA      13.80        090
58146.............  ..............  A                Myomectomy abdom            18.97         NA       9.03       2.32         NA      30.32        090
                                                      complex.
58150.............  ..............  A                Total hysterectomy....      15.22         NA       7.50       1.84         NA      24.56        090

[[Page 70397]]

 
58152.............  ..............  A                Total hysterectomy....      20.57         NA       9.88       2.47         NA      32.92        090
58180.............  ..............  A                Partial hysterectomy..      15.27         NA       7.47       1.64         NA      24.38        090
58200.............  ..............  A                Extensive hysterectomy      21.56         NA      10.02       2.54         NA      34.12        090
58210.............  ..............  A                Extensive hysterectomy      28.81         NA      13.23       3.37         NA      45.41        090
58240.............  ..............  A                Removal of pelvis           38.33         NA      17.66       4.22         NA      60.21        090
                                                      contents.
58260.............  ..............  A                Vaginal hysterectomy..      12.96         NA       6.71       1.57         NA      21.24        090
58262.............  ..............  A                Vag hyst including t/o      14.75         NA       7.40       1.79         NA      23.94        090
58263.............  ..............  A                Vag hyst w/t/o & vag        16.04         NA       7.90       1.94         NA      25.88        090
                                                      repair.
58267.............  ..............  A                Vag hyst w/urinary          17.01         NA       8.39       2.06         NA      27.46        090
                                                      repair.
58270.............  ..............  A                Vag hyst w/enterocele       14.24         NA       7.08       1.73         NA      23.05        090
                                                      repair.
58275.............  ..............  A                Hysterectomy/revise         15.74         NA       7.79       1.91         NA      25.44        090
                                                      vagina.
58280.............  ..............  A                Hysterectomy/revise         16.98         NA       8.27       2.06         NA      27.31        090
                                                      vagina.
58285.............  ..............  A                Extensive hysterectomy      22.23         NA       9.97       2.70         NA      34.90        090
58290.............  ..............  A                Vag hyst complex......      18.97         NA       9.15       2.29         NA      30.41        090
58291.............  ..............  A                Vag hyst incl t/o,          20.76         NA       9.90       2.52         NA      33.18        090
                                                      complex.
58292.............  ..............  A                Vag hyst t/o & repair,      22.05         NA      10.39       2.67         NA      35.11        090
                                                      compl.
58293.............  ..............  A                Vag hyst w/uro repair,      23.03         NA      10.68       2.78         NA      36.49        090
                                                      compl.
58294.............  ..............  A                Vag hyst w/enterocele,      20.25         NA       9.58       2.39         NA      32.22        090
                                                      compl.
58300.............  ..............  N                Insert intrauterine         +1.01       1.42       0.38       0.12       2.55       1.51        XXX
                                                      device.
58301.............  ..............  A                Remove intrauterine          1.27       1.32       0.48       0.15       2.74       1.90        000
                                                      device.
58321.............  ..............  A                Artificial                   0.92       1.15       0.37       0.10       2.17       1.39        000
                                                      insemination.
58322.............  ..............  A                Artificial                   1.10       1.20       0.42       0.13       2.43       1.65        000
                                                      insemination.
58323.............  ..............  A                Sperm washing.........       0.23       0.53       0.09       0.03       0.79       0.35        000
58340.............  ..............  A                Catheter for                 0.88       3.17       0.65       0.09       4.14       1.62        000
                                                      hysterography.
58345.............  ..............  A                Reopen fallopian tube.       4.65         NA       2.44       0.41         NA       7.50        010
58346.............  ..............  A                Insert heyman uteri          6.74         NA       3.93       0.56         NA      11.23        090
                                                      capsule.
58350.............  ..............  A                Reopen fallopian tube.       1.01       1.49       0.92       0.12       2.62       2.05        010
58353.............  ..............  A                Endometr ablate,             3.55      35.76       2.06       0.43      39.74       6.04        010
                                                      thermal.
58356.............  ..............  A                Endometrial                  6.36      61.61       2.70       0.82      68.79       9.88        010
                                                      cryoablation.
58400.............  ..............  A                Suspension of uterus..       6.35         NA       3.94       0.75         NA      11.04        090
58410.............  ..............  A                Suspension of uterus..      12.71         NA       6.45       1.45         NA      20.61        090
58520.............  ..............  A                Repair of ruptured          11.90         NA       6.05       1.47         NA      19.42        090
                                                      uterus.
58540.............  ..............  A                Revision of uterus....      14.62         NA       6.97       1.78         NA      23.37        090
58545.............  ..............  A                Laparoscopic                14.58         NA       7.20       1.77         NA      23.55        090
                                                      myomectomy.
58546.............  ..............  A                Laparo-myomectomy,          18.97         NA       8.94       2.30         NA      30.21        090
                                                      complex.
58550.............  ..............  A                Laparo-asst vag             14.17         NA       7.31       1.72         NA      23.20        090
                                                      hysterectomy.
58552.............  ..............  A                Laparo-vag hyst incl t/     15.98         NA       8.03       1.72         NA      25.73        090
                                                      o.
58553.............  ..............  A                Laparo-vag hyst,            18.97         NA       8.94       2.30         NA      30.21        090
                                                      complex.
58554.............  ..............  A                Laparo-vag hyst w/t/o,      21.97         NA      10.42       2.27         NA      34.66        090
                                                      compl.
58555.............  ..............  A                Hysteroscopy, dx, sep        3.33       2.20       1.55       0.40       5.93       5.28        000
                                                      proc.
58558.............  ..............  A                Hysteroscopy, biopsy..       4.74         NA       2.18       0.57         NA       7.49        000
58559.............  ..............  A                Hysteroscopy, lysis...       6.16         NA       2.74       0.74         NA       9.64        000
58560.............  ..............  A                Hysteroscopy, resect         6.99         NA       3.09       0.84         NA      10.92        000
                                                      septum.
58561.............  ..............  A                Hysteroscopy, remove         9.99         NA       4.29       1.21         NA      15.49        000
                                                      myoma.
58562.............  ..............  A                Hysteroscopy, remove         5.20         NA       2.36       0.63         NA       8.19        000
                                                      fb.
58563.............  ..............  A                Hysteroscopy, ablation       6.16      56.35       2.76       0.74      63.25       9.66        000
58565.............  ..............  A                Hysteroscopy,                7.02      49.70       3.91       1.19      57.91      12.12        090
                                                      sterilization.
58578.............  ..............  C                Laparo proc, uterus...       0.00       0.00       0.00       0.00       0.00       0.00        YYY
58579.............  ..............  C                Hysteroscope procedure       0.00       0.00       0.00       0.00       0.00       0.00        YYY
58600.............  ..............  A                Division of fallopian        5.59         NA       3.34       0.66         NA       9.59        090
                                                      tube.
58605.............  ..............  A                Division of fallopian        4.99         NA       3.12       0.59         NA       8.70        090
                                                      tube.
58611.............  ..............  A                Ligate oviduct(s) add-       1.45         NA       0.57       0.18         NA       2.20        ZZZ
                                                      on.
58615.............  ..............  A                Occlude fallopian            3.89         NA       2.71       0.47         NA       7.07        010
                                                      tube(s).
58660.............  ..............  A                Laparoscopy, lysis....      11.27         NA       5.27       1.40         NA      17.94        090
58661.............  ..............  A                Laparoscopy, remove         11.03         NA       5.13       1.34         NA      17.50        010
                                                      adnexa.
58662.............  ..............  A                Laparoscopy, excise         11.77         NA       5.80       1.43         NA      19.00        090
                                                      lesions.
58670.............  ..............  A                Laparoscopy, tubal           5.59         NA       3.28       0.67         NA       9.54        090
                                                      cautery.
58671.............  ..............  A                Laparoscopy, tubal           5.59         NA       3.28       0.68         NA       9.55        090
                                                      block.
58672.............  ..............  A                Laparoscopy,                12.86         NA       6.20       1.60         NA      20.66        090
                                                      fimbrioplasty.
58673.............  ..............  A                Laparoscopy,                13.72         NA       6.59       1.69         NA      22.00        090
                                                      salpingostomy.
58679.............  ..............  C                Laparo proc, oviduct-        0.00       0.00       0.00       0.00       0.00       0.00        YYY
                                                      ovary.
58700.............  ..............  A                Removal of fallopian        12.03         NA       6.00       1.51         NA      19.54        090
                                                      tube.
58720.............  ..............  A                Removal of ovary/           11.34         NA       5.79       1.39         NA      18.52        090
                                                      tube(s).
58740.............  ..............  A                Revise fallopian            13.98         NA       7.15       1.71         NA      22.84        090
                                                      tube(s).
58750.............  ..............  A                Repair oviduct........      14.82         NA       7.38       1.84         NA      24.04        090
58752.............  ..............  A                Revise ovarian tube(s)      14.82         NA       6.96       1.80         NA      23.58        090
58760.............  ..............  A                Remove tubal                13.11         NA       6.73       1.79         NA      21.63        090
                                                      obstruction.
58770.............  ..............  A                Create new tubal            13.95         NA       6.92       1.73         NA      22.60        090
                                                      opening.
58800.............  ..............  A                Drainage of ovarian          4.13       3.65       2.91       0.43       8.21       7.47        090
                                                      cyst(s).
58805.............  ..............  A                Drainage of ovarian          5.87         NA       3.51       0.69         NA      10.07        090
                                                      cyst(s).
58820.............  ..............  A                Drain ovary abscess,         4.21         NA       3.30       0.52         NA       8.03        090
                                                      open.
58822.............  ..............  A                Drain ovary abscess,        10.11         NA       5.23       1.16         NA      16.50        090
                                                      percut.
58823.............  ..............  A                Drain pelvic abscess,        3.37      21.38       1.12       0.24      24.99       4.73        000
                                                      percut.
58825.............  ..............  A                Transposition,              10.96         NA       5.81       1.32         NA      18.09        090
                                                      ovary(s).
58900.............  ..............  A                Biopsy of ovary(s)....       5.98         NA       3.58       0.69         NA      10.25        090

[[Page 70398]]

 
58920.............  ..............  A                Partial removal of          11.34         NA       5.59       1.43         NA      18.36        090
                                                      ovary(s).
58925.............  ..............  A                Removal of ovarian          11.34         NA       5.70       1.41         NA      18.45        090
                                                      cyst(s).
58940.............  ..............  A                Removal of ovary(s)...       7.28         NA       4.11       0.91         NA      12.30        090
58943.............  ..............  A                Removal of ovary(s)...      18.40         NA       8.67       2.22         NA      29.29        090
58950.............  ..............  A                Resect ovarian              16.90         NA       8.42       2.04         NA      27.36        090
                                                      malignancy.
58951.............  ..............  A                Resect ovarian              22.35         NA      10.47       2.63         NA      35.45        090
                                                      malignancy.
58952.............  ..............  A                Resect ovarian              24.97         NA      11.78       3.02         NA      39.77        090
                                                      malignancy.
58953.............  ..............  A                Tah, rad dissect for        31.95         NA      14.58       3.83         NA      50.36        090
                                                      debulk.
58954.............  ..............  A                Tah rad debulk/lymph        34.95         NA      15.75       4.17         NA      54.87        090
                                                      remove.
58956.............  ..............  A                Bso, omentectomy w/tah      20.78         NA      10.34       4.00         NA      35.12        090
58960.............  ..............  A                Exploration of abdomen      14.63         NA       7.37       1.79         NA      23.79        090
58970.............  ..............  A                Retrieval of oocyte...       3.52       2.32       1.49       0.43       6.27       5.44        000
58974.............  ..............  C                Transfer of embryo....       0.00       0.00       0.00       0.00       0.00       0.00        000
58976.............  ..............  A                Transfer of embryo....       3.82       2.69       1.83       0.47       6.98       6.12        000
58999.............  ..............  C                Genital surgery              0.00       0.00       0.00       0.00       0.00       0.00        YYY
                                                      procedure.
59000.............  ..............  A                Amniocentesis,               1.30       2.08       0.67       0.31       3.69       2.28        000
                                                      diagnostic.
59001.............  ..............  A                Amniocentesis,               3.00         NA       1.41       0.71         NA       5.12        000
                                                      therapeutic.
59012.............  ..............  A                Fetal cord puncture,         3.44         NA       1.54       0.82         NA       5.80        000
                                                      prenatal.
59015.............  ..............  A                Chorion biopsy........       2.20       1.55       1.04       0.52       4.27       3.76        000
59020.............  26............  A                Fetal contract stress        0.66       0.26       0.26       0.16       1.08       1.08        000
                                                      test.
59020.............  TC............  A                Fetal contract stress        0.00       0.52         NA       0.10       0.62         NA        000
                                                      test.
59020.............  ..............  A                Fetal contract stress        0.66       0.78         NA       0.26       1.70         NA        000
                                                      test.
59025.............  26............  A                Fetal non-stress test.       0.53       0.21       0.21       0.13       0.87       0.87        000
59025.............  TC............  A                Fetal non-stress test.       0.00       0.23         NA       0.02       0.25         NA        000
59025.............  ..............  A                Fetal non-stress test.       0.53       0.44         NA       0.15       1.12         NA        000
59030.............  ..............  A                Fetal scalp blood            1.99         NA       0.77       0.47         NA       3.23        000
                                                      sample.
59050.............  ..............  A                Fetal monitor w/report       0.89         NA       0.35       0.21         NA       1.45        XXX
59051.............  ..............  A                Fetal monitor/               0.74         NA       0.29       0.17         NA       1.20        XXX
                                                      interpret only.
59070.............  ..............  A                Transabdom amnioinfus        5.24       5.16       2.32       0.28      10.68       7.84        000
                                                      w/us.
59072.............  ..............  A                Umbilical cord occlud        8.99         NA       3.13       0.16         NA      12.28        000
                                                      w/us.
59074.............  ..............  A                Fetal fluid drainage w/      5.24       4.58       2.32       0.28      10.10       7.84        000
                                                      us.
59076.............  ..............  A                Fetal shunt placement,       8.99         NA       3.13       0.16         NA      12.28        000
                                                      w/us.
59100.............  ..............  A                Remove uterus lesion..      12.33         NA       6.47       2.94         NA      21.74        090
59120.............  ..............  A                Treat ectopic               11.47         NA       6.26       2.72         NA      20.45        090
                                                      pregnancy.
59121.............  ..............  A                Treat ectopic               11.65         NA       6.34       2.78         NA      20.77        090
                                                      pregnancy.
59130.............  ..............  A                Treat ectopic               14.20         NA       4.80       3.38         NA      22.38        090
                                                      pregnancy.
59135.............  ..............  A                Treat ectopic               13.86         NA       7.24       3.30         NA      24.40        090
                                                      pregnancy.
59136.............  ..............  A                Treat ectopic               13.16         NA       6.62       3.13         NA      22.91        090
                                                      pregnancy.
59140.............  ..............  A                Treat ectopic                5.45       2.22       2.22       1.29       8.96       8.96        090
                                                      pregnancy.
59150.............  ..............  A                Treat ectopic               11.65         NA       6.01       2.78         NA      20.44        090
                                                      pregnancy.
59151.............  ..............  A                Treat ectopic               11.47         NA       6.07       2.73         NA      20.27        090
                                                      pregnancy.
59160.............  ..............  A                D & c after delivery..       2.71       3.30       2.14       0.64       6.65       5.49        010
59200.............  ..............  A                Insert cervical              0.79       1.19       0.30       0.19       2.17       1.28        000
                                                      dilator.
59300.............  ..............  A                Episiotomy or vaginal        2.41       2.18       0.96       0.57       5.16       3.94        000
                                                      repair.
59320.............  ..............  A                Revision of cervix....       2.48         NA       1.24       0.59         NA       4.31        000
59325.............  ..............  A                Revision of cervix....       4.06         NA       1.90       0.88         NA       6.84        000
59350.............  ..............  A                Repair of uterus......       4.94         NA       1.88       1.17         NA       7.99        000
59400.............  ..............  A                Obstetrical care......      23.03         NA      15.36       5.48         NA      43.87        MMM
59409.............  ..............  A                Obstetrical care......      13.48         NA       5.32       3.21         NA      22.01        MMM
59410.............  ..............  A                Obstetrical care......      14.76         NA       6.32       3.51         NA      24.59        MMM
59412.............  ..............  A                Antepartum                   1.71         NA       0.81       0.40         NA       2.92        MMM
                                                      manipulation.
59414.............  ..............  A                Deliver placenta......       1.61         NA       0.64       0.38         NA       2.63        MMM
59425.............  ..............  A                Antepartum care only..       4.80       4.21       1.86       1.14      10.15       7.80        MMM
59426.............  ..............  A                Antepartum care only..       8.27       7.56       3.23       1.97      17.80      13.47        MMM
59430.............  ..............  A                Care after delivery...       2.13       1.23       0.94       0.50       3.86       3.57        MMM
59510.............  ..............  A                Cesarean delivery.....      26.18         NA      17.31       6.23         NA      49.72        MMM
59514.............  ..............  A                Cesarean delivery only      15.95         NA       6.23       3.79         NA      25.97        MMM
59515.............  ..............  A                Cesarean delivery.....      17.34         NA       7.85       4.12         NA      29.31        MMM
59525.............  ..............  A                Remove uterus after          8.53         NA       3.31       1.94         NA      13.78        ZZZ
                                                      cesarean.
59610.............  ..............  A                Vbac delivery.........      24.58         NA      15.91       5.85         NA      46.34        MMM
59612.............  ..............  A                Vbac delivery only....      15.04         NA       6.07       3.58         NA      24.69        MMM
59614.............  ..............  A                Vbac care after             16.32         NA       6.95       3.88         NA      27.15        MMM
                                                      delivery.
59618.............  ..............  A                Attempted vbac              27.74         NA      18.28       6.59         NA      52.61        MMM
                                                      delivery.
59620.............  ..............  A                Attempted vbac              17.50         NA       6.78       4.16         NA      28.44        MMM
                                                      delivery only.
59622.............  ..............  A                Attempted vbac after        18.90         NA       8.66       4.49         NA      32.05        MMM
                                                      care.
59812.............  ..............  A                Treatment of                 4.00         NA       2.55       0.95         NA       7.50        090
                                                      miscarriage.
59820.............  ..............  A                Care of miscarriage...       4.00       4.43       3.57       0.95       9.38       8.52        090
59821.............  ..............  A                Treatment of                 4.46       4.28       3.41       1.06       9.80       8.93        090
                                                      miscarriage.
59830.............  ..............  A                Treat uterus infection       6.10         NA       3.99       1.44         NA      11.53        090
59840.............  ..............  R                Abortion..............       3.01         NA       2.13       0.71         NA       5.85        010
59841.............  ..............  R                Abortion..............       5.23       3.50       2.98       1.24       9.97       9.45        010
59850.............  ..............  R                Abortion..............       5.90         NA       3.26       1.28         NA      10.44        090
59851.............  ..............  R                Abortion..............       5.92         NA       3.75       1.28         NA      10.95        090
59852.............  ..............  R                Abortion..............       8.23         NA       5.05       1.80         NA      15.08        090
59855.............  ..............  R                Abortion..............       6.11         NA       3.55       1.45         NA      11.11        090

[[Page 70399]]

 
59856.............  ..............  R                Abortion..............       7.47         NA       4.07       1.78         NA      13.32        090
59857.............  ..............  R                Abortion..............       9.28         NA       4.72       2.01         NA      16.01        090
59866.............  ..............  R                Abortion (mpr)........       3.99         NA       1.90       0.87         NA       6.76        000
59870.............  ..............  A                Evacuate mole of             6.00         NA       4.49       1.42         NA      11.91        090
                                                      uterus.
59871.............  ..............  A                Remove cerclage suture       2.13       1.75       1.13       0.50       4.38       3.76        000
59897.............  ..............  C                Fetal invas px w/us...       0.00       0.00       0.00       0.00       0.00       0.00        YYY
59898.............  ..............  C                Laparo proc, ob care/        0.00       0.00       0.00       0.00       0.00       0.00        YYY
                                                      deliver.
59899.............  ..............  C                Maternity care               0.00       0.00       0.00       0.00       0.00       0.00        YYY
                                                      procedure.
60000.............  ..............  A                Drain thyroid/tongue         1.76       1.93       1.71       0.15       3.84       3.62        010
                                                      cyst.
60001.............  ..............  A                Aspirate/inject              0.97       1.41       0.33       0.07       2.45       1.37        000
                                                      thyriod cyst.
60100.............  ..............  A                Biopsy of thyroid.....       1.56       1.40       0.53       0.10       3.06       2.19        000
60200.............  ..............  A                Remove thyroid lesion.       9.54         NA       6.00       1.01         NA      16.55        090
60210.............  ..............  A                Partial thyroid             10.86         NA       5.65       1.23         NA      17.74        090
                                                      excision.
60212.............  ..............  A                Partial thyroid             16.01         NA       7.69       1.94         NA      25.64        090
                                                      excision.
60220.............  ..............  A                Partial removal of          11.88         NA       6.16       1.32         NA      19.36        090
                                                      thyroid.
60225.............  ..............  A                Partial removal of          14.17         NA       7.42       1.64         NA      23.23        090
                                                      thyroid.
60240.............  ..............  A                Removal of thyroid....      16.04         NA       7.60       1.85         NA      25.49        090
60252.............  ..............  A                Removal of thyroid....      20.54         NA      10.12       2.29         NA      32.95        090
60254.............  ..............  A                Extensive thyroid           26.95         NA      14.18       2.60         NA      43.73        090
                                                      surgery.
60260.............  ..............  A                Repeat thyroid surgery      17.44         NA       8.67       1.93         NA      28.04        090
60270.............  ..............  A                Removal of thyroid....      20.24         NA      10.48       2.32         NA      33.04        090
60271.............  ..............  A                Removal of thyroid....      16.80         NA       8.60       1.74         NA      27.14        090
60280.............  ..............  A                Remove thyroid duct          5.86         NA       4.67       0.54         NA      11.07        090
                                                      lesion.
60281.............  ..............  A                Remove thyroid duct          8.52         NA       5.85       0.73         NA      15.10        090
                                                      lesion.
60500.............  ..............  A                Explore parathyroid         16.21         NA       7.42       2.00         NA      25.63        090
                                                      glands.
60502.............  ..............  A                Re-explore                  20.32         NA       9.38       2.53         NA      32.23        090
                                                      parathyroids.
60505.............  ..............  A                Explore parathyroid         21.46         NA      10.95       2.64         NA      35.05        090
                                                      glands.
60512.............  ..............  A                Autotransplant               4.44         NA       1.62       0.53         NA       6.59        ZZZ
                                                      parathyroid.
60520.............  ..............  A                Removal of thymus           16.78         NA       8.31       2.19         NA      27.28        090
                                                      gland.
60521.............  ..............  A                Removal of thymus           18.84         NA       9.57       2.81         NA      31.22        090
                                                      gland.
60522.............  ..............  A                Removal of thymus           23.06         NA      11.29       3.26         NA      37.61        090
                                                      gland.
60540.............  ..............  A                Explore adrenal gland.      17.00         NA       7.60       1.74         NA      26.34        090
60545.............  ..............  A                Explore adrenal gland.      19.85         NA       8.55       2.07         NA      30.47        090
60600.............  ..............  A                Remove carotid body         17.90         NA      10.99       2.19         NA      31.08        090
                                                      lesion.
60605.............  ..............  A                Remove carotid body         20.21         NA      12.29       2.49         NA      34.99        090
                                                      lesion.
60650.............  ..............  A                Laparoscopy                 19.97         NA       8.00       2.28         NA      30.25        090
                                                      adrenalectomy.
60659.............  ..............  C                Laparo proc, endocrine       0.00       0.00       0.00       0.00       0.00       0.00        YYY
60699.............  ..............  C                Endocrine surgery            0.00       0.00       0.00       0.00       0.00       0.00        YYY
                                                      procedure.
61000.............  ..............  A                Remove cranial cavity        1.58         NA       0.95       0.13         NA       2.66        000
                                                      fluid.
61001.............  ..............  A                Remove cranial cavity        1.49         NA       1.06       0.16         NA       2.71        000
                                                      fluid.
61020.............  ..............  A                Remove brain cavity          1.51         NA       1.34       0.34         NA       3.19        000
                                                      fluid.
61026.............  ..............  A                Injection into brain         1.69         NA       1.39       0.33         NA       3.41        000
                                                      canal.
61050.............  ..............  A                Remove brain canal           1.51         NA       1.27       0.11         NA       2.89        000
                                                      fluid.
61055.............  ..............  A                Injection into brain         2.10         NA       1.42       0.17         NA       3.69        000
                                                      canal.
61070.............  ..............  A                Brain canal shunt            0.89         NA       1.01       0.17         NA       2.07        000
                                                      procedure.
61105.............  ..............  A                Twist drill hole......       5.13         NA       3.94       1.32         NA      10.39        090
61107.............  ..............  A                Drill skull for              4.99         NA       2.54       1.29         NA       8.82        000
                                                      implantation.
61108.............  ..............  A                Drill skull for             10.17         NA       7.16       2.63         NA      19.96        090
                                                      drainage.
61120.............  ..............  A                Burr hole for puncture       8.75         NA       6.01       2.09         NA      16.85        090
61140.............  ..............  A                Pierce skull for            15.88         NA       9.91       4.11         NA      29.90        090
                                                      biopsy.
61150.............  ..............  A                Pierce skull for            17.54         NA      10.40       4.31         NA      32.25        090
                                                      drainage.
61151.............  ..............  A                Pierce skull for            12.40         NA       7.83       3.00         NA      23.23        090
                                                      drainage.
61154.............  ..............  A                Pierce skull & remove       14.97         NA       9.51       4.20         NA      28.68        090
                                                      clot.
61156.............  ..............  A                Pierce skull for            16.30         NA       9.86       4.22         NA      30.38        090
                                                      drainage.
61210.............  ..............  A                Pierce skull, implant        5.83         NA       2.92       1.50         NA      10.25        000
                                                      device.
61215.............  ..............  A                Insert brain-fluid           4.88         NA       4.01       1.26         NA      10.15        090
                                                      device.
61250.............  ..............  A                Pierce skull & explore      10.40         NA       6.87       2.76         NA      20.03        090
61253.............  ..............  A                Pierce skull & explore      12.34         NA       7.74       2.61         NA      22.69        090
61304.............  ..............  A                Open skull for              21.93         NA      12.87       5.61         NA      40.41        090
                                                      exploration.
61305.............  ..............  A                Open skull for              26.57         NA      15.35       6.07         NA      47.99        090
                                                      exploration.
61312.............  ..............  A                Open skull for              24.53         NA      15.08       6.34         NA      45.95        090
                                                      drainage.
61313.............  ..............  A                Open skull for              24.89         NA      14.84       6.43         NA      46.16        090
                                                      drainage.
61314.............  ..............  A                Open skull for              24.19         NA      13.07       6.26         NA      43.52        090
                                                      drainage.
61315.............  ..............  A                Open skull for              27.64         NA      16.06       7.14         NA      50.84        090
                                                      drainage.
61316.............  ..............  A                Implt cran bone flap         1.39         NA       0.60       0.35         NA       2.34        ZZZ
                                                      to abdo.
61320.............  ..............  A                Open skull for              25.58         NA      14.79       6.60         NA      46.97        090
                                                      drainage.
61321.............  ..............  A                Open skull for              28.46         NA      16.17       7.12         NA      51.75        090
                                                      drainage.
61322.............  ..............  A                Decompressive               29.46         NA      15.71       7.61         NA      52.78        090
                                                      craniotomy.
61323.............  ..............  A                Decompressive               30.95         NA      16.13       8.01         NA      55.09        090
                                                      lobectomy.
61330.............  ..............  A                Decompress eye socket.      23.29         NA      13.76       2.31         NA      39.36        090
61332.............  ..............  A                Explore/biopsy eye          27.24         NA      15.64       4.82         NA      47.70        090
                                                      socket.
61333.............  ..............  A                Explore orbit/remove        27.91         NA      15.62       3.91         NA      47.44        090
                                                      lesion.
61334.............  ..............  A                Explore orbit/remove        18.24         NA      10.66       1.74         NA      30.64        090
                                                      object.
61340.............  ..............  A                Subtemporal                 18.63         NA      11.15       4.83         NA      34.61        090
                                                      decompression.
61343.............  ..............  A                Incise skull (press         29.73         NA      16.85       7.62         NA      54.20        090
                                                      relief).

[[Page 70400]]

 
61345.............  ..............  A                Relieve cranial             27.16         NA      15.43       7.02         NA      49.61        090
                                                      pressure.
61440.............  ..............  A                Incise skull for            26.59         NA      14.24       6.88         NA      47.71        090
                                                      surgery.
61450.............  ..............  A                Incise skull for            25.91         NA      14.32       5.77         NA      46.00        090
                                                      surgery.
61458.............  ..............  A                Incise skull for brain      27.25         NA      15.55       7.01         NA      49.81        090
                                                      wound.
61460.............  ..............  A                Incise skull for            28.35         NA      16.46       6.02         NA      50.83        090
                                                      surgery.
61470.............  ..............  A                Incise skull for            26.02         NA      13.89       5.88         NA      45.79        090
                                                      surgery.
61480.............  ..............  A                Incise skull for            26.45         NA      15.31       6.71         NA      48.47        090
                                                      surgery.
61490.............  ..............  A                Incise skull for            25.62         NA      14.36       6.90         NA      46.88        090
                                                      surgery.
61500.............  ..............  A                Removal of skull            17.89         NA      10.83       4.10         NA      32.82        090
                                                      lesion.
61501.............  ..............  A                Remove infected skull       14.82         NA       9.23       3.21         NA      27.26        090
                                                      bone.
61510.............  ..............  A                Removal of brain            28.41         NA      16.74       7.33         NA      52.48        090
                                                      lesion.
61512.............  ..............  A                Remove brain lining         35.04         NA      19.73       9.05         NA      63.82        090
                                                      lesion.
61514.............  ..............  A                Removal of brain            25.22         NA      14.47       6.52         NA      46.21        090
                                                      abscess.
61516.............  ..............  A                Removal of brain            24.57         NA      14.30       6.33         NA      45.20        090
                                                      lesion.
61517.............  ..............  A                Implt brain chemotx          1.38         NA       0.64       0.35         NA       2.37        ZZZ
                                                      add-on.
61518.............  ..............  A                Removal of brain            37.26         NA      21.15       9.62         NA      68.03        090
                                                      lesion.
61519.............  ..............  A                Remove brain lining         41.33         NA      22.71      10.60         NA      74.64        090
                                                      lesion.
61520.............  ..............  A                Removal of brain            54.76         NA      30.41      11.18         NA      96.35        090
                                                      lesion.
61521.............  ..............  A                Removal of brain            44.41         NA      24.28      11.36         NA      80.05        090
                                                      lesion.
61522.............  ..............  A                Removal of brain            29.41         NA      16.46       7.60         NA      53.47        090
                                                      abscess.
61524.............  ..............  A                Removal of brain            27.82         NA      15.71       7.14         NA      50.67        090
                                                      lesion.
61526.............  ..............  A                Removal of brain            52.09         NA      29.57       7.05         NA      88.71        090
                                                      lesion.
61530.............  ..............  A                Removal of brain            43.79         NA      25.12       6.13         NA      75.04        090
                                                      lesion.
61531.............  ..............  A                Implant brain               14.61         NA       9.15       3.78         NA      27.54        090
                                                      electrodes.
61533.............  ..............  A                Implant brain               19.68         NA      11.56       5.10         NA      36.34        090
                                                      electrodes.
61534.............  ..............  A                Removal of brain            20.94         NA      12.12       5.42         NA      38.48        090
                                                      lesion.
61535.............  ..............  A                Remove brain                11.61         NA       7.44       3.01         NA      22.06        090
                                                      electrodes.
61536.............  ..............  A                Removal of brain            35.47         NA      19.84       9.18         NA      64.49        090
                                                      lesion.
61537.............  ..............  A                Removal of brain            24.96         NA      14.78       6.92         NA      46.66        090
                                                      tissue.
61538.............  ..............  A                Removal of brain            26.77         NA      15.35       6.92         NA      49.04        090
                                                      tissue.
61539.............  ..............  A                Removal of brain            32.03         NA      17.81       8.30         NA      58.14        090
                                                      tissue.
61540.............  ..............  A                Removal of brain            29.96         NA      17.29       8.30         NA      55.55        090
                                                      tissue.
61541.............  ..............  A                Incision of brain           28.81         NA      16.25       6.58         NA      51.64        090
                                                      tissue.
61542.............  ..............  A                Removal of brain            30.97         NA      17.87       8.01         NA      56.85        090
                                                      tissue.
61543.............  ..............  A                Removal of brain            29.18         NA      16.43       7.54         NA      53.15        090
                                                      tissue.
61544.............  ..............  A                Remove & treat brain        25.46         NA      13.86       5.95         NA      45.27        090
                                                      lesion.
61545.............  ..............  A                Excision of brain           43.73         NA      24.28      10.60         NA      78.61        090
                                                      tumor.
61546.............  ..............  A                Removal of pituitary        31.25         NA      17.54       7.65         NA      56.44        090
                                                      gland.
61548.............  ..............  A                Removal of pituitary        21.50         NA      12.82       3.42         NA      37.74        090
                                                      gland.
61550.............  ..............  A                Release of skull seams      14.63         NA       6.95       0.98         NA      22.56        090
61552.............  ..............  A                Release of skull seams      19.53         NA       9.14       1.06         NA      29.73        090
61556.............  ..............  A                Incise skull/sutures..      22.23         NA      11.39       4.64         NA      38.26        090
61557.............  ..............  A                Incise skull/sutures..      22.35         NA      13.66       5.78         NA      41.79        090
61558.............  ..............  A                Excision of skull/          25.54         NA      14.23       1.36         NA      41.13        090
                                                      sutures.
61559.............  ..............  A                Excision of skull/          32.74         NA      19.37       8.48         NA      60.59        090
                                                      sutures.
61563.............  ..............  A                Excision of skull           26.79         NA      15.28       5.15         NA      47.22        090
                                                      tumor.
61564.............  ..............  A                Excision of skull           33.78         NA      18.33       8.75         NA      60.86        090
                                                      tumor.
61566.............  ..............  A                Removal of brain            30.95         NA      17.82       6.92         NA      55.69        090
                                                      tissue.
61567.............  ..............  A                Incision of brain           35.45         NA      20.73       6.52         NA      62.70        090
                                                      tissue.
61570.............  ..............  A                Remove foreign body,        24.56         NA      13.95       5.86         NA      44.37        090
                                                      brain.
61571.............  ..............  A                Incise skull for brain      26.35         NA      15.18       6.77         NA      48.30        090
                                                      wound.
61575.............  ..............  A                Skull base/brainstem        34.31         NA      19.69       5.32         NA      59.32        090
                                                      surgery.
61576.............  ..............  A                Skull base/brainstem        52.35         NA      34.83       5.56         NA      92.74        090
                                                      surgery.
61580.............  ..............  A                Craniofacial approach,      30.30         NA      25.65       3.36         NA      59.31        090
                                                      skull.
61581.............  ..............  A                Craniofacial approach,      34.55         NA      23.51       3.91         NA      61.97        090
                                                      skull.
61582.............  ..............  A                Craniofacial approach,      31.61         NA      27.38       7.19         NA      66.18        090
                                                      skull.
61583.............  ..............  A                Craniofacial approach,      36.16         NA      25.18       9.18         NA      70.52        090
                                                      skull.
61584.............  ..............  A                Orbitocranial approach/     34.60         NA      24.59       8.16         NA      67.35        090
                                                      skull.
61585.............  ..............  A                Orbitocranial approach/     38.55         NA      26.57       7.01         NA      72.13        090
                                                      skull.
61586.............  ..............  A                Resect nasopharynx,         25.06         NA      22.65       4.36         NA      52.07        090
                                                      skull.
61590.............  ..............  A                Infratemporal approach/     41.72         NA      28.70       5.29         NA      75.71        090
                                                      skull.
61591.............  ..............  A                Infratemporal approach/     43.61         NA      29.61       5.64         NA      78.86        090
                                                      skull.
61592.............  ..............  A                Orbitocranial approach/     39.58         NA      26.58      10.04         NA      76.20        090
                                                      skull.
61595.............  ..............  A                Transtemporal approach/     29.53         NA      22.41       3.97         NA      55.91        090
                                                      skull.
61596.............  ..............  A                Transcochlear approach/     35.58         NA      24.51       3.39         NA      63.48        090
                                                      skull.
61597.............  ..............  A                Transcondylar approach/     37.90         NA      23.06       8.81         NA      69.77        090
                                                      skull.
61598.............  ..............  A                Transpetrosal approach/     33.36         NA      23.30       5.68         NA      62.34        090
                                                      skull.
61600.............  ..............  A                Resect/excise cranial       25.81         NA      19.83       3.78         NA      49.42        090
                                                      lesion.
61601.............  ..............  A                Resect/excise cranial       27.85         NA      20.55       6.61         NA      55.01        090
                                                      lesion.
61605.............  ..............  A                Resect/excise cranial       29.29         NA      22.02       2.85         NA      54.16        090
                                                      lesion.
61606.............  ..............  A                Resect/excise cranial       38.77         NA      25.22       8.94         NA      72.93        090
                                                      lesion.
61607.............  ..............  A                Resect/excise cranial       36.22         NA      23.85       6.88         NA      66.95        090
                                                      lesion.
61608.............  ..............  A                Resect/excise cranial       42.04         NA      26.66      10.72         NA      79.42        090
                                                      lesion.
61609.............  ..............  A                Transect artery, sinus       9.88         NA       4.86       2.55         NA      17.29        ZZZ
61610.............  ..............  A                Transect artery, sinus      29.63         NA      13.18       7.66         NA      50.47        ZZZ

[[Page 70401]]

 
61611.............  ..............  A                Transect artery, sinus       7.41         NA       3.83       1.88         NA      13.12        ZZZ
61612.............  ..............  A                Transect artery, sinus      27.84         NA      13.35       4.30         NA      45.49        ZZZ
61613.............  ..............  A                Remove aneurysm, sinus      40.80         NA      26.34       8.42         NA      75.56        090
61615.............  ..............  A                Resect/excise lesion,       32.02         NA      22.79       4.72         NA      59.53        090
                                                      skull.
61616.............  ..............  A                Resect/excise lesion,       43.27         NA      28.73       8.24         NA      80.24        090
                                                      skull.
61618.............  ..............  A                Repair dura...........      16.96         NA      10.47       3.71         NA      31.14        090
61619.............  ..............  A                Repair dura...........      20.68         NA      12.28       3.94         NA      36.90        090
61623.............  ..............  A                Endovasc tempory             9.95         NA       4.09       1.05         NA      15.09        000
                                                      vessel occl.
61624.............  ..............  A                Transcath occlusion,        20.12         NA       6.91       1.95         NA      28.98        000
                                                      cns.
61626.............  ..............  A                Transcath occlusion,        16.60         NA       5.53       1.24         NA      23.37        000
                                                      non-cns.
61630.............  ..............  N                Intracranial                 0.00       0.00       0.00       0.00       0.00       0.00        090
                                                      angioplasty.
61635.............  ..............  N                Intracran angioplsty w/      0.00       0.00       0.00       0.00       0.00       0.00        090
                                                      stent.
61640.............  ..............  N                Dilate ic vasospasm,         0.00       0.00       0.00       0.00       0.00       0.00        000
                                                      init.
61641.............  ..............  N                Dilate ic vasospasm          0.00       0.00       0.00       0.00       0.00       0.00        ZZZ
                                                      add-on.
61642.............  ..............  N                Dilate ic vasospasm          0.00       0.00       0.00       0.00       0.00       0.00        ZZZ
                                                      add-on.
61680.............  ..............  A                Intracranial vessel         30.66         NA      17.48       7.93         NA      56.07        090
                                                      surgery.
61682.............  ..............  A                Intracranial vessel         61.48         NA      32.30      15.85         NA     109.63        090
                                                      surgery.
61684.............  ..............  A                Intracranial vessel         39.75         NA      22.06      10.28         NA      72.09        090
                                                      surgery.
61686.............  ..............  A                Intracranial vessel         64.39         NA      34.82      16.66         NA     115.87        090
                                                      surgery.
61690.............  ..............  A                Intracranial vessel         29.27         NA      16.77       6.92         NA      52.96        090
                                                      surgery.
61692.............  ..............  A                Intracranial vessel         51.79         NA      27.55      13.39         NA      92.73        090
                                                      surgery.
61697.............  ..............  A                Brain aneurysm repr,        50.44         NA      28.09      12.81         NA      91.34        090
                                                      complx.
61698.............  ..............  A                Brain aneurysm repr,        48.34         NA      26.77      12.50         NA      87.61        090
                                                      complx.
61700.............  ..............  A                Brain aneurysm repr,        50.44         NA      27.88      12.98         NA      91.30        090
                                                      simple.
61702.............  ..............  A                Inner skull vessel          48.34         NA      26.11      10.76         NA      85.21        090
                                                      surgery.
61703.............  ..............  A                Clamp neck artery.....      17.44         NA      10.49       4.05         NA      31.98        090
61705.............  ..............  A                Revise circulation to       36.15         NA      19.31       8.84         NA      64.30        090
                                                      head.
61708.............  ..............  A                Revise circulation to       35.25         NA      15.19       2.50         NA      52.94        090
                                                      head.
61710.............  ..............  A                Revise circulation to       29.63         NA      13.68       4.51         NA      47.82        090
                                                      head.
61711.............  ..............  A                Fusion of skull             36.28         NA      19.86       9.39         NA      65.53        090
                                                      arteries.
61720.............  ..............  A                Incise skull/brain          16.74         NA      10.00       2.78         NA      29.52        090
                                                      surgery.
61735.............  ..............  A                Incise skull/brain          20.40         NA      12.20       2.72         NA      35.32        090
                                                      surgery.
61750.............  ..............  A                Incise skull/brain          18.17         NA      10.64       4.71         NA      33.52        090
                                                      biopsy.
61751.............  ..............  A                Brain biopsy w/ct/mr        17.59         NA      10.85       4.55         NA      32.99        090
                                                      guide.
61760.............  ..............  A                Implant brain               22.24         NA       8.74       5.40         NA      36.38        090
                                                      electrodes.
61770.............  ..............  A                Incise skull for            21.41         NA      12.29       3.54         NA      37.24        090
                                                      treatment.
61790.............  ..............  A                Treat trigeminal nerve      10.84         NA       5.93       2.81         NA      19.58        090
61791.............  ..............  A                Treat trigeminal tract      14.59         NA       8.94       3.39         NA      26.92        090
61793.............  ..............  A                Focus radiation beam..      17.21         NA      10.15       4.45         NA      31.81        090
61795.............  ..............  A                Brain surgery using          4.03         NA       2.04       0.79         NA       6.86        ZZZ
                                                      computer.
61850.............  ..............  A                Implant                     12.37         NA       7.69       3.21         NA      23.27        090
                                                      neuroelectrodes.
61860.............  ..............  A                Implant                     20.84         NA      12.09       4.94         NA      37.87        090
                                                      neuroelectrodes.
61863.............  ..............  A                Implant neuroelectrode      18.97         NA      11.80       5.41         NA      36.18        090
61864.............  ..............  A                Implant neuroelectrde,       4.49         NA       2.29       5.41         NA      12.19        ZZZ
                                                      addl.
61867.............  ..............  A                Implant neuroelectrode      31.29         NA      18.07       5.41         NA      54.77        090
61868.............  ..............  A                Implant neuroelectrde,       7.91         NA       4.02       5.41         NA      17.34        ZZZ
                                                      add'l.
61870.............  ..............  A                Implant                     14.92         NA       9.73       3.86         NA      28.51        090
                                                      neuroelectrodes.
61875.............  ..............  A                Implant                     15.04         NA       8.59       2.94         NA      26.57        090
                                                      neuroelectrodes.
61880.............  ..............  A                Revise/remove                6.28         NA       4.58       1.66         NA      12.52        090
                                                      neuroelectrode.
61885.............  ..............  A                Insrt/redo neurostim 1       5.84         NA       5.32       1.59         NA      12.75        090
                                                      array.
61886.............  ..............  A                Implant neurostim            7.99         NA       6.37       1.96         NA      16.32        090
                                                      arrays.
61888.............  ..............  A                Revise/remove                5.06         NA       3.68       1.33         NA      10.07        010
                                                      neuroreceiver.
62000.............  ..............  A                Treat skull fracture..      12.51         NA       5.53       1.06         NA      19.10        090
62005.............  ..............  A                Treat skull fracture..      16.15         NA       8.82       3.86         NA      28.83        090
62010.............  ..............  A                Treatment of head           19.78         NA      11.74       5.12         NA      36.64        090
                                                      injury.
62100.............  ..............  A                Repair brain fluid          22.00         NA      12.82       4.83         NA      39.65        090
                                                      leakage.
62115.............  ..............  A                Reduction of skull          21.63         NA      11.67       5.49         NA      38.79        090
                                                      defect.
62116.............  ..............  A                Reduction of skull          23.55         NA      13.40       6.09         NA      43.04        090
                                                      defect.
62117.............  ..............  A                Reduction of skull          26.56         NA      15.41       4.52         NA      46.49        090
                                                      defect.
62120.............  ..............  A                Repair skull cavity         23.31         NA      18.53       2.99         NA      44.83        090
                                                      lesion.
62121.............  ..............  A                Incise skull repair...      21.55         NA      15.49       4.16         NA      41.20        090
62140.............  ..............  A                Repair of skull defect      13.49         NA       8.34       3.46         NA      25.29        090
62141.............  ..............  A                Repair of skull defect      14.89         NA       9.07       3.75         NA      27.71        090
62142.............  ..............  A                Remove skull plate/         10.77         NA       7.01       2.72         NA      20.50        090
                                                      flap.
62143.............  ..............  A                Replace skull plate/        13.03         NA       8.06       3.36         NA      24.45        090
                                                      flap.
62145.............  ..............  A                Repair of skull &           18.79         NA      10.92       4.49         NA      34.20        090
                                                      brain.
62146.............  ..............  A                Repair of skull with        16.10         NA       9.66       3.61         NA      29.37        090
                                                      graft.
62147.............  ..............  A                Repair of skull with        19.31         NA      11.33       4.31         NA      34.95        090
                                                      graft.
62148.............  ..............  A                Retr bone flap to fix        2.00         NA       0.86       0.48         NA       3.34        ZZZ
                                                      skull.
62160.............  ..............  A                Neuroendoscopy add-on.       3.00         NA       1.53       0.77         NA       5.30        ZZZ
62161.............  ..............  A                Dissect brain w/scope.      19.97         NA      12.13       5.17         NA      37.27        090
62162.............  ..............  A                Remove colloid cyst w/      25.21         NA      14.89       5.89         NA      45.99        090
                                                      scope.
62163.............  ..............  A                Neuroendoscopy w/fb         15.48         NA       9.95       4.00         NA      29.43        090
                                                      removal.
62164.............  ..............  A                Remove brain tumor w/       27.46         NA      14.99       5.36         NA      47.81        090
                                                      scope.
62165.............  ..............  A                Remove pituit tumor w/      21.97         NA      13.42       3.00         NA      38.39        090
                                                      scope.

[[Page 70402]]

 
62180.............  ..............  A                Establish brain cavity      21.03         NA      12.32       4.97         NA      38.32        090
                                                      shunt.
62190.............  ..............  A                Establish brain cavity      11.05         NA       7.10       2.79         NA      20.94        090
                                                      shunt.
62192.............  ..............  A                Establish brain cavity      12.23         NA       7.64       3.01         NA      22.88        090
                                                      shunt.
62194.............  ..............  A                Replace/irrigate             5.02         NA       2.44       0.92         NA       8.38        010
                                                      catheter.
62200.............  ..............  A                Establish brain cavity      18.29         NA      10.87       4.64         NA      33.80        090
                                                      shunt.
62201.............  ..............  A                Brain cavity shunt w/       14.84         NA       9.47       3.67         NA      27.98        090
                                                      scope.
62220.............  ..............  A                Establish brain cavity      12.98         NA       8.00       3.34         NA      24.32        090
                                                      shunt.
62223.............  ..............  A                Establish brain cavity      12.85         NA       8.26       3.13         NA      24.24        090
                                                      shunt.
62225.............  ..............  A                Replace/irrigate             5.40         NA       4.10       1.39         NA      10.89        090
                                                      catheter.
62230.............  ..............  A                Replace/revise brain        10.52         NA       6.50       2.70         NA      19.72        090
                                                      shunt.
62252.............  26............  A                Csf shunt reprogram...       0.74       0.37       0.37       0.19       1.30       1.30        XXX
62252.............  TC............  A                Csf shunt reprogram...       0.00       1.10         NA       0.02       1.12         NA        XXX
62252.............  ..............  A                Csf shunt reprogram...       0.74       1.47         NA       0.21       2.42         NA        XXX
62256.............  ..............  A                Remove brain cavity          6.59         NA       4.70       1.71         NA      13.00        090
                                                      shunt.
62258.............  ..............  A                Replace brain cavity        14.52         NA       8.74       3.73         NA      26.99        090
                                                      shunt.
62263.............  ..............  A                Epidural lysis mult          6.13      12.73       3.20       0.41      19.27       9.74        010
                                                      sessions.
62264.............  ..............  A                Epidural lysis on            4.42       7.75       1.42       0.27      12.44       6.11        010
                                                      single day.
62268.............  ..............  A                Drain spinal cord cyst       4.73      11.56       2.15       0.43      16.72       7.31        000
62269.............  ..............  A                Needle biopsy, spinal        5.01      14.72       1.98       0.37      20.10       7.36        000
                                                      cord.
62270.............  ..............  A                Spinal fluid tap,            1.13       3.00       0.56       0.08       4.21       1.77        000
                                                      diagnostic.
62272.............  ..............  A                Drain cerebro spinal         1.35       3.62       0.71       0.18       5.15       2.24        000
                                                      fluid.
62273.............  ..............  A                Inject epidural patch.       2.15       2.72       0.71       0.13       5.00       2.99        000
62280.............  ..............  A                Treat spinal cord            2.63       6.95       1.01       0.30       9.88       3.94        010
                                                      lesion.
62281.............  ..............  A                Treat spinal cord            2.66       5.67       0.89       0.19       8.52       3.74        010
                                                      lesion.
62282.............  ..............  A                Treat spinal canal           2.33       8.38       0.92       0.17      10.88       3.42        010
                                                      lesion.
62284.............  ..............  A                Injection for                1.54       4.97       0.68       0.13       6.64       2.35        000
                                                      myelogram.
62287.............  ..............  A                Percutaneous                 8.07         NA       5.57       0.58         NA      14.22        090
                                                      diskectomy.
62290.............  ..............  A                Inject for spine disk        3.00       7.15       1.38       0.23      10.38       4.61        000
                                                      x-ray.
62291.............  ..............  A                Inject for spine disk        2.91       5.95       1.23       0.26       9.12       4.40        000
                                                      x-ray.
62292.............  ..............  A                Injection into disk          7.85         NA       4.48       0.82         NA      13.15        090
                                                      lesion.
62294.............  ..............  A                Injection into spinal       11.81         NA       5.60       1.24         NA      18.65        090
                                                      artery.
62310.............  ..............  A                Inject spine c/t......       1.91       4.82       0.65       0.12       6.85       2.68        000
62311.............  ..............  A                Inject spine l/s (cd).       1.54       4.93       0.59       0.09       6.56       2.22        000
62318.............  ..............  A                Inject spine w/cath, c/      2.04       5.74       0.65       0.12       7.90       2.81        000
                                                      t.
62319.............  ..............  A                Inject spine w/cath l/       1.87       4.99       0.61       0.11       6.97       2.59        000
                                                      s (cd).
62350.............  ..............  A                Implant spinal canal         6.86         NA       3.95       1.02         NA      11.83        090
                                                      cath.
62351.............  ..............  A                Implant spinal canal         9.99         NA       7.14       2.24         NA      19.37        090
                                                      cath.
62355.............  ..............  A                Remove spinal canal          5.44         NA       3.17       0.71         NA       9.32        090
                                                      catheter.
62360.............  ..............  A                Insert spine infusion        2.62         NA       2.69       0.34         NA       5.65        090
                                                      device.
62361.............  ..............  A                Implant spine infusion       5.41         NA       3.93       0.80         NA      10.14        090
                                                      pump.
62362.............  ..............  A                Implant spine infusion       7.03         NA       4.37       1.18         NA      12.58        090
                                                      pump.
62365.............  ..............  A                Remove spine infusion        5.41         NA       3.59       0.86         NA       9.86        090
                                                      device.
62367.............  ..............  A                Analyze spine infusion       0.48       0.61       0.10       0.03       1.12       0.61        XXX
                                                      pump.
62368.............  ..............  A                Analyze spine infusion       0.75       0.69       0.17       0.06       1.50       0.98        XXX
                                                      pump.
63001.............  ..............  A                Removal of spinal           15.80         NA       9.54       3.76         NA      29.10        090
                                                      lamina.
63003.............  ..............  A                Removal of spinal           15.93         NA       9.89       3.72         NA      29.54        090
                                                      lamina.
63005.............  ..............  A                Removal of spinal           14.90         NA      10.00       3.34         NA      28.24        090
                                                      lamina.
63011.............  ..............  A                Removal of spinal           14.50         NA       8.29       3.37         NA      26.16        090
                                                      lamina.
63012.............  ..............  A                Removal of spinal           15.38         NA      10.15       3.48         NA      29.01        090
                                                      lamina.
63015.............  ..............  A                Removal of spinal           19.32         NA      11.90       4.75         NA      35.97        090
                                                      lamina.
63016.............  ..............  A                Removal of spinal           19.17         NA      11.81       4.58         NA      35.56        090
                                                      lamina.
63017.............  ..............  A                Removal of spinal           15.92         NA      10.42       3.63         NA      29.97        090
                                                      lamina.
63020.............  ..............  A                Neck spine disk             14.79         NA       9.70       3.71         NA      28.20        090
                                                      surgery.
63030.............  ..............  A                Low back disk surgery.      11.98         NA       8.44       3.00         NA      23.42        090
63035.............  ..............  A                Spinal disk surgery          3.15         NA       1.59       0.79         NA       5.53        ZZZ
                                                      add-on.
63040.............  ..............  A                Laminotomy, single          18.78         NA      11.53       4.67         NA      34.98        090
                                                      cervical.
63042.............  ..............  A                Laminotomy, single          17.44         NA      11.37       4.25         NA      33.06        090
                                                      lumbar.
63043.............  ..............  C                Laminotomy, add'l            0.00       0.00       0.00       0.00       0.00       0.00        ZZZ
                                                      cervical.
63044.............  ..............  C                Laminotomy, add'l            0.00       0.00       0.00       0.00       0.00       0.00        ZZZ
                                                      lumbar.
63045.............  ..............  A                Removal of spinal           16.48         NA      10.38       3.98         NA      30.84        090
                                                      lamina.
63046.............  ..............  A                Removal of spinal           15.78         NA      10.21       3.55         NA      29.54        090
                                                      lamina.
63047.............  ..............  A                Removal of spinal           14.59         NA       9.92       3.23         NA      27.74        090
                                                      lamina.
63048.............  ..............  A                Remove spinal lamina         3.26         NA       1.66       0.72         NA       5.64        ZZZ
                                                      add-on.
63050.............  ..............  A                Cervical laminoplasty.      20.75         NA      11.87       4.66         NA      37.28        090
63051.............  ..............  A                C-laminoplasty w/graft/     24.25         NA      13.51       4.66         NA      42.42        090
                                                      plate.
63055.............  ..............  A                Decompress spinal cord      21.96         NA      13.17       5.27         NA      40.40        090
63056.............  ..............  A                Decompress spinal cord      20.33         NA      12.60       4.75         NA      37.68        090
63057.............  ..............  A                Decompress spine cord        5.25         NA       2.64       1.22         NA       9.11        ZZZ
                                                      add-on.
63064.............  ..............  A                Decompress spinal cord      24.57         NA      14.46       5.69         NA      44.72        090
63066.............  ..............  A                Decompress spine cord        3.26         NA       1.66       0.69         NA       5.61        ZZZ
                                                      add-on.
63075.............  ..............  A                Neck spine disk             19.38         NA      12.12       4.62         NA      36.12        090
                                                      surgery.
63076.............  ..............  A                Neck spine disk              4.04         NA       2.06       0.96         NA       7.06        ZZZ
                                                      surgery.
63077.............  ..............  A                Spine disk surgery,         21.41         NA      12.83       3.98         NA      38.22        090
                                                      thorax.
63078.............  ..............  A                Spine disk surgery,          3.28         NA       1.64       0.66         NA       5.58        ZZZ
                                                      thorax.
63081.............  ..............  A                Removal of vertebral        23.69         NA      14.36       5.54         NA      43.59        090
                                                      body.

[[Page 70403]]

 
63082.............  ..............  A                Remove vertebral body        4.36         NA       2.23       1.02         NA       7.61        ZZZ
                                                      add-on.
63085.............  ..............  A                Removal of vertebral        26.88         NA      15.51       4.48         NA      46.87        090
                                                      body.
63086.............  ..............  A                Remove vertebral body        3.19         NA       1.59       0.59         NA       5.37        ZZZ
                                                      add-on.
63087.............  ..............  A                Removal of vertebral        35.52         NA      19.51       6.20         NA      61.23        090
                                                      body.
63088.............  ..............  A                Remove vertebral body        4.32         NA       2.18       0.82         NA       7.32        ZZZ
                                                      add-on.
63090.............  ..............  A                Removal of vertebral        28.12         NA      16.08       4.21         NA      48.41        090
                                                      body.
63091.............  ..............  A                Remove vertebral body        3.03         NA       1.46       0.48         NA       4.97        ZZZ
                                                      add-on.
63101.............  ..............  A                Removal of vertebral        31.95         NA      19.33       5.69         NA      56.97        090
                                                      body.
63102.............  ..............  A                Removal of vertebral        31.95         NA      19.33       5.69         NA      56.97        090
                                                      body.
63103.............  ..............  A                Remove vertebral body        4.82         NA       2.51       0.69         NA       8.02        ZZZ
                                                      add-on.
63170.............  ..............  A                Incise spinal cord          19.80         NA      11.89       4.86         NA      36.55        090
                                                      tract(s).
63172.............  ..............  A                Drainage of spinal          17.63         NA      10.67       4.48         NA      32.78        090
                                                      cyst.
63173.............  ..............  A                Drainage of spinal          21.96         NA      12.84       5.68         NA      40.48        090
                                                      cyst.
63180.............  ..............  A                Revise spinal cord          18.24         NA      11.01       3.95         NA      33.20        090
                                                      ligaments.
63182.............  ..............  A                Revise spinal cord          20.47         NA      10.98       5.30         NA      36.75        090
                                                      ligaments.
63185.............  ..............  A                Incise spinal column/       15.02         NA       8.11       2.79         NA      25.92        090
                                                      nerves.
63190.............  ..............  A                Incise spinal column/       17.42         NA      10.16       3.24         NA      30.82        090
                                                      nerves.
63191.............  ..............  A                Incise spinal column/       17.51         NA      10.50       6.34         NA      34.35        090
                                                      nerves.
63194.............  ..............  A                Incise spinal column &      19.16         NA      11.74       3.26         NA      34.16        090
                                                      cord.
63195.............  ..............  A                Incise spinal column &      18.81         NA      11.07       4.87         NA      34.75        090
                                                      cord.
63196.............  ..............  A                Incise spinal column &      22.27         NA      13.42       5.76         NA      41.45        090
                                                      cord.
63197.............  ..............  A                Incise spinal column &      21.08         NA      12.24       5.36         NA      38.68        090
                                                      cord.
63198.............  ..............  A                Incise spinal column &      25.34         NA       8.45       6.43         NA      40.22        090
                                                      cord.
63199.............  ..............  A                Incise spinal column &      26.85         NA      15.07       1.40         NA      43.32        090
                                                      cord.
63200.............  ..............  A                Release of spinal cord      19.15         NA      11.32       4.96         NA      35.43        090
63250.............  ..............  A                Revise spinal cord          40.70         NA      19.98       9.01         NA      69.69        090
                                                      vessels.
63251.............  ..............  A                Revise spinal cord          41.14         NA      22.65      10.41         NA      74.20        090
                                                      vessels.
63252.............  ..............  A                Revise spinal cord          41.13         NA      22.29      10.64         NA      74.06        090
                                                      vessels.
63265.............  ..............  A                Excise intraspinal          21.53         NA      12.80       5.43         NA      39.76        090
                                                      lesion.
63266.............  ..............  A                Excise intraspinal          22.27         NA      13.21       5.54         NA      41.02        090
                                                      lesion.
63267.............  ..............  A                Excise intraspinal          17.92         NA      11.10       4.37         NA      33.39        090
                                                      lesion.
63268.............  ..............  A                Excise intraspinal          18.49         NA      10.39       3.69         NA      32.57        090
                                                      lesion.
63270.............  ..............  A                Excise intraspinal          26.76         NA      15.50       6.82         NA      49.08        090
                                                      lesion.
63271.............  ..............  A                Excise intraspinal          26.88         NA      15.61       6.90         NA      49.39        090
                                                      lesion.
63272.............  ..............  A                Excise intraspinal          25.28         NA      14.72       6.18         NA      46.18        090
                                                      lesion.
63273.............  ..............  A                Excise intraspinal          24.25         NA      14.37       5.74         NA      44.36        090
                                                      lesion.
63275.............  ..............  A                Biopsy/excise spinal        23.64         NA      13.80       5.80         NA      43.24        090
                                                      tumor.
63276.............  ..............  A                Biopsy/excise spinal        23.41         NA      13.71       5.83         NA      42.95        090
                                                      tumor.
63277.............  ..............  A                Biopsy/excise spinal        20.80         NA      12.55       5.01         NA      38.36        090
                                                      tumor.
63278.............  ..............  A                Biopsy/excise spinal        20.53         NA      12.42       4.55         NA      37.50        090
                                                      tumor.
63280.............  ..............  A                Biopsy/excise spinal        28.31         NA      16.35       7.27         NA      51.93        090
                                                      tumor.
63281.............  ..............  A                Biopsy/excise spinal        28.01         NA      16.21       7.17         NA      51.39        090
                                                      tumor.
63282.............  ..............  A                Biopsy/excise spinal        26.35         NA      15.36       6.76         NA      48.47        090
                                                      tumor.
63283.............  ..............  A                Biopsy/excise spinal        24.96         NA      14.69       6.26         NA      45.91        090
                                                      tumor.
63285.............  ..............  A                Biopsy/excise spinal        35.95         NA      19.99       9.18         NA      65.12        090
                                                      tumor.
63286.............  ..............  A                Biopsy/excise spinal        35.58         NA      19.95       9.21         NA      64.74        090
                                                      tumor.
63287.............  ..............  A                Biopsy/excise spinal        36.64         NA      20.47       9.39         NA      66.50        090
                                                      tumor.
63290.............  ..............  A                Biopsy/excise spinal        37.32         NA      20.64       9.02         NA      66.98        090
                                                      tumor.
63295.............  ..............  A                Repair of laminectomy        5.25         NA       2.15       1.03         NA       8.43        ZZZ
                                                      defect.
63300.............  ..............  A                Removal of vertebral        24.39         NA      14.33       5.97         NA      44.69        090
                                                      body.
63301.............  ..............  A                Removal of vertebral        27.56         NA      15.59       5.39         NA      48.54        090
                                                      body.
63302.............  ..............  A                Removal of vertebral        27.77         NA      15.89       5.53         NA      49.19        090
                                                      body.
63303.............  ..............  A                Removal of vertebral        30.45         NA      16.95       4.68         NA      52.08        090
                                                      body.
63304.............  ..............  A                Removal of vertebral        30.28         NA      17.31       6.41         NA      54.00        090
                                                      body.
63305.............  ..............  A                Removal of vertebral        31.98         NA      18.09       5.71         NA      55.78        090
                                                      body.
63306.............  ..............  A                Removal of vertebral        32.17         NA      17.84       8.33         NA      58.34        090
                                                      body.
63307.............  ..............  A                Removal of vertebral        31.58         NA      16.85       4.46         NA      52.89        090
                                                      body.
63308.............  ..............  A                Remove vertebral body        5.24         NA       2.61       1.29         NA       9.14        ZZZ
                                                      add-on.
63600.............  ..............  A                Remove spinal cord          14.00         NA       5.41       1.52         NA      20.93        090
                                                      lesion.
63610.............  ..............  A                Stimulation of spinal        8.72      59.85       2.26       0.86      69.43      11.84        000
                                                      cord.
63615.............  ..............  A                Remove lesion of            16.26         NA       9.29       2.84         NA      28.39        090
                                                      spinal cord.
63650.............  ..............  A                Implant                      6.73         NA       3.18       0.53         NA      10.44        090
                                                      neuroelectrodes.
63655.............  ..............  A                Implant                     10.27         NA       6.91       2.43         NA      19.61        090
                                                      neuroelectrodes.
63660.............  ..............  A                Revise/remove                6.15         NA       3.62       0.78         NA      10.55        090
                                                      neuroelectrode.
63685.............  ..............  A                Insrt/redo spine n           7.03         NA       4.15       1.05         NA      12.23        090
                                                      generator.
63688.............  ..............  A                Revise/remove                5.38         NA       3.56       0.89         NA       9.83        090
                                                      neuroreceiver.
63700.............  ..............  A                Repair of spinal            16.51         NA      10.33       3.52         NA      30.36        090
                                                      herniation.
63702.............  ..............  A                Repair of spinal            18.45         NA      11.06       4.12         NA      33.63        090
                                                      herniation.
63704.............  ..............  A                Repair of spinal            21.15         NA      12.95       4.57         NA      38.67        090
                                                      herniation.
63706.............  ..............  A                Repair of spinal            24.07         NA      13.61       6.23         NA      43.91        090
                                                      herniation.
63707.............  ..............  A                Repair spinal fluid         11.24         NA       7.72       2.51         NA      21.47        090
                                                      leakage.
63709.............  ..............  A                Repair spinal fluid         14.30         NA       9.42       3.09         NA      26.81        090
                                                      leakage.
63710.............  ..............  A                Graft repair of spine       14.05         NA       9.06       3.40         NA      26.51        090
                                                      defect.
63740.............  ..............  A                Install spinal shunt..      11.34         NA       7.36       2.93         NA      21.63        090
63741.............  ..............  A                Install spinal shunt..       8.24         NA       4.76       1.66         NA      14.66        090

[[Page 70404]]

 
63744.............  ..............  A                Revision of spinal           8.09         NA       5.27       1.89         NA      15.25        090
                                                      shunt.
63746.............  ..............  A                Removal of spinal            6.42         NA       3.78       1.53         NA      11.73        090
                                                      shunt.
64400.............  ..............  A                N block inj,                 1.11       1.90       0.43       0.07       3.08       1.61        000
                                                      trigeminal.
64402.............  ..............  A                N block inj, facial...       1.25       1.61       0.60       0.09       2.95       1.94        000
64405.............  ..............  A                N block inj, occipital       1.32       1.46       0.46       0.08       2.86       1.86        000
64408.............  ..............  A                N block inj, vagus....       1.41       1.58       0.85       0.10       3.09       2.36        000
64410.............  ..............  A                N block inj, phrenic..       1.43       2.51       0.46       0.09       4.03       1.98        000
64412.............  ..............  A                N block inj, spinal          1.18       2.66       0.43       0.08       3.92       1.69        000
                                                      accessor.
64413.............  ..............  A                N block inj, cervical        1.40       1.85       0.50       0.08       3.33       1.98        000
                                                      plexus.
64415.............  ..............  A                N block inj, brachial        1.48       2.81       0.46       0.09       4.38       2.03        000
                                                      plexus.
64416.............  ..............  A                N block cont infuse, b       3.49         NA       0.79       0.31         NA       4.59        010
                                                      plex.
64417.............  ..............  A                N block inj, axillary.       1.44       3.04       0.49       0.11       4.59       2.04        000
64418.............  ..............  A                N block inj,                 1.32       2.63       0.44       0.07       4.02       1.83        000
                                                      suprascapular.
64420.............  ..............  A                N block inj,                 1.18       3.89       0.42       0.08       5.15       1.68        000
                                                      intercost, sng.
64421.............  ..............  A                N block inj,                 1.68       6.10       0.52       0.11       7.89       2.31        000
                                                      intercost, mlt.
64425.............  ..............  A                N block inj, ilio-ing/       1.75       1.65       0.54       0.13       3.53       2.42        000
                                                      hypogi.
64430.............  ..............  A                N block inj, pudendal.       1.46       2.52       0.55       0.10       4.08       2.11        000
64435.............  ..............  A                N block inj,                 1.45       2.53       0.69       0.16       4.14       2.30        000
                                                      paracervical.
64445.............  ..............  A                N block inj, sciatic,        1.48       2.68       0.50       0.10       4.26       2.08        000
                                                      sng.
64446.............  ..............  A                N blk inj, sciatic,          3.25         NA       1.00       0.20         NA       4.45        010
                                                      cont inf.
64447.............  ..............  A                N block inj fem,             1.50         NA       0.43       0.09         NA       2.02        000
                                                      single.
64448.............  ..............  A                N block inj fem, cont        3.00         NA       0.81       0.18         NA       3.99        010
                                                      inf.
64449.............  ..............  A                N block inj, lumbar          3.00         NA       0.96       0.15         NA       4.11        010
                                                      plexus.
64450.............  ..............  A                N block, other               1.27       1.24       0.48       0.13       2.64       1.88        000
                                                      peripheral.
64470.............  ..............  A                Inj paravertebral c/t.       1.85       7.25       0.71       0.11       9.21       2.67        000
64472.............  ..............  A                Inj paravertebral c/t        1.29       2.34       0.34       0.08       3.71       1.71        ZZZ
                                                      add-on.
64475.............  ..............  A                Inj paravertebral l/s.       1.41       6.90       0.63       0.10       8.41       2.14        000
64476.............  ..............  A                Inj paravertebral l/s        0.98       2.13       0.24       0.07       3.18       1.29        ZZZ
                                                      add-on.
64479.............  ..............  A                Inj foramen epidural c/      2.20       7.51       0.89       0.12       9.83       3.21        000
                                                      t.
64480.............  ..............  A                Inj foramen epidural         1.54       2.85       0.47       0.10       4.49       2.11        ZZZ
                                                      add-on.
64483.............  ..............  A                Inj foramen epidural l/      1.90       7.91       0.83       0.11       9.92       2.84        000
                                                      s.
64484.............  ..............  A                Inj foramen epidural         1.33       3.29       0.37       0.08       4.70       1.78        ZZZ
                                                      add-on.
64505.............  ..............  A                N block, spenopalatine       1.36       1.24       0.66       0.10       2.70       2.12        000
                                                      gangl.
64508.............  ..............  A                N block, carotid sinus       1.12       3.33       0.74       0.07       4.52       1.93        000
                                                      s/p.
64510.............  ..............  A                N block, stellate            1.22       3.46       0.51       0.07       4.75       1.80        000
                                                      ganglion.
64517.............  ..............  A                N block inj, hypogas         2.20       2.73       0.87       0.11       5.04       3.18        000
                                                      plxs.
64520.............  ..............  A                N block, lumbar/             1.35       5.15       0.55       0.08       6.58       1.98        000
                                                      thoracic.
64530.............  ..............  A                N block inj, celiac          1.58       4.46       0.65       0.10       6.14       2.33        000
                                                      pelus.
64550.............  ..............  A                Apply neurostimulator.       0.18       0.28       0.05       0.01       0.47       0.24        000
64553.............  ..............  A                Implant                      2.31       2.84       1.86       0.18       5.33       4.35        010
                                                      neuroelectrodes.
64555.............  ..............  A                Implant                      2.27       3.11       1.19       0.19       5.57       3.65        010
                                                      neuroelectrodes.
64560.............  ..............  A                Implant                      2.36       2.64       1.28       0.22       5.22       3.86        010
                                                      neuroelectrodes.
64561.............  ..............  A                Implant                      6.73      30.14       2.78       0.51      37.38      10.02        010
                                                      neuroelectrodes.
64565.............  ..............  A                Implant                      1.76       3.29       1.26       0.13       5.18       3.15        010
                                                      neuroelectrodes.
64573.............  ..............  A                Implant                      7.49         NA       5.26       1.60         NA      14.35        090
                                                      neuroelectrodes.
64575.............  ..............  A                Implant                      4.34         NA       2.68       0.61         NA       7.63        090
                                                      neuroelectrodes.
64577.............  ..............  A                Implant                      4.61         NA       3.29       1.04         NA       8.94        090
                                                      neuroelectrodes.
64580.............  ..............  A                Implant                      4.11         NA       3.56       0.36         NA       8.03        090
                                                      neuroelectrodes.
64581.............  ..............  A                Implant                     13.48         NA       5.39       1.05         NA      19.92        090
                                                      neuroelectrodes.
64585.............  ..............  A                Revise/remove                2.06      11.31       2.14       0.20      13.57       4.40        010
                                                      neuroelectrode.
64590.............  ..............  A                Insrt/redo perph n           2.40       7.16       2.29       0.19       9.75       4.88        010
                                                      generator.
64595.............  ..............  A                Revise/remove                1.73      10.42       1.93       0.19      12.34       3.85        010
                                                      neuroreceiver.
64600.............  ..............  A                Injection treatment of       3.44       9.38       1.65       0.34      13.16       5.43        010
                                                      nerve.
64605.............  ..............  A                Injection treatment of       5.60       9.58       2.19       0.79      15.97       8.58        010
                                                      nerve.
64610.............  ..............  A                Injection treatment of       7.15       8.89       3.72       1.58      17.62      12.45        010
                                                      nerve.
64612.............  ..............  A                Destroy nerve, face          1.96       2.49       1.32       0.11       4.56       3.39        010
                                                      muscle.
64613.............  ..............  A                Destroy nerve, neck          1.96       2.94       1.22       0.11       5.01       3.29        010
                                                      muscle.
64614.............  ..............  A                Destroy nerve, extrem        2.20       3.23       1.31       0.10       5.53       3.61        010
                                                      musc.
64620.............  ..............  A                Injection treatment of       2.84       5.07       1.33       0.20       8.11       4.37        010
                                                      nerve.
64622.............  ..............  A                Destr paravertebrl           3.00       7.78       1.37       0.18      10.96       4.55        010
                                                      nerve l/s.
64623.............  ..............  A                Destr paravertebral n        0.99       2.97       0.22       0.06       4.02       1.27        ZZZ
                                                      add-on.
64626.............  ..............  A                Destr paravertebrl           3.28       7.80       1.97       0.20      11.28       5.45        010
                                                      nerve c/t.
64627.............  ..............  A                Destr paravertebral n        1.16       4.54       0.27       0.07       5.77       1.50        ZZZ
                                                      add-on.
64630.............  ..............  A                Injection treatment of       3.00       2.74       1.41       0.22       5.96       4.63        010
                                                      nerve.
64640.............  ..............  A                Injection treatment of       2.76       4.19       1.85       0.29       7.24       4.90        010
                                                      nerve.
64650.............  ..............  A                Chemodenerv eccrine          0.70       0.87       0.30       0.06       1.63       1.06        000
                                                      glands.
64653.............  ..............  A                Chemodenerv eccrine          0.88       0.92       0.38       0.08       1.88       1.34        000
                                                      glands.
64680.............  ..............  A                Injection treatment of       2.62       6.73       1.43       0.18       9.53       4.23        010
                                                      nerve.
64681.............  ..............  A                Injection treatment of       3.54       9.32       2.07       0.28      13.14       5.89        010
                                                      nerve.
64702.............  ..............  A                Revise finger/toe            4.22         NA       3.87       0.61         NA       8.70        090
                                                      nerve.
64704.............  ..............  A                Revise hand/foot nerve       4.56         NA       3.32       0.61         NA       8.49        090
64708.............  ..............  A                Revise arm/leg nerve..       6.11         NA       4.87       0.96         NA      11.94        090
64712.............  ..............  A                Revision of sciatic          7.74         NA       4.97       0.95         NA      13.66        090
                                                      nerve.
64713.............  ..............  A                Revision of arm             10.98         NA       5.89       1.82         NA      18.69        090
                                                      nerve(s).
64714.............  ..............  A                Revise low back             10.31         NA       4.21       1.19         NA      15.71        090
                                                      nerve(s).

[[Page 70405]]

 
64716.............  ..............  A                Revision of cranial          6.30         NA       5.99       0.63         NA      12.92        090
                                                      nerve.
64718.............  ..............  A                Revise ulnar nerve at        5.98         NA       6.01       1.05         NA      13.04        090
                                                      elbow.
64719.............  ..............  A                Revise ulnar nerve at        4.84         NA       4.53       0.77         NA      10.14        090
                                                      wrist.
64721.............  ..............  A                Carpal tunnel surgery.       4.28         NA       5.38       0.73         NA      10.39        090
64722.............  ..............  A                Relieve pressure on          4.69         NA       3.05       0.48         NA       8.22        090
                                                      nerve(s).
64726.............  ..............  A                Release foot/toe nerve       4.17         NA       2.80       0.54         NA       7.51        090
64727.............  ..............  A                Internal nerve               3.10         NA       1.50       0.48         NA       5.08        ZZZ
                                                      revision.
64732.............  ..............  A                Incision of brow nerve       4.40         NA       3.51       0.98         NA       8.89        090
64734.............  ..............  A                Incision of cheek            4.91         NA       4.06       0.89         NA       9.86        090
                                                      nerve.
64736.............  ..............  A                Incision of chin nerve       4.59         NA       4.03       0.52         NA       9.14        090
64738.............  ..............  A                Incision of jaw nerve.       5.72         NA       4.62       1.08         NA      11.42        090
64740.............  ..............  A                Incision of tongue           5.58         NA       5.13       0.69         NA      11.40        090
                                                      nerve.
64742.............  ..............  A                Incision of facial           6.21         NA       4.71       0.73         NA      11.65        090
                                                      nerve.
64744.............  ..............  A                Incise nerve, back of        5.23         NA       3.78       1.16         NA      10.17        090
                                                      head.
64746.............  ..............  A                Incise diaphragm nerve       5.92         NA       4.51       0.82         NA      11.25        090
64752.............  ..............  A                Incision of vagus            7.05         NA       4.29       0.93         NA      12.27        090
                                                      nerve.
64755.............  ..............  A                Incision of stomach         13.50         NA       5.65       1.83         NA      20.98        090
                                                      nerves.
64760.............  ..............  A                Incision of vagus            6.95         NA       3.46       0.81         NA      11.22        090
                                                      nerve.
64761.............  ..............  A                Incision of pelvis           6.40         NA       3.53       0.53         NA      10.46        090
                                                      nerve.
64763.............  ..............  A                Incise hip/thigh nerve       6.92         NA       5.21       0.94         NA      13.07        090
64766.............  ..............  A                Incise hip/thigh nerve       8.66         NA       5.26       1.06         NA      14.98        090
64771.............  ..............  A                Sever cranial nerve...       7.34         NA       5.57       1.23         NA      14.14        090
64772.............  ..............  A                Incision of spinal           7.20         NA       4.93       1.40         NA      13.53        090
                                                      nerve.
64774.............  ..............  A                Remove skin nerve            5.16         NA       3.84       0.74         NA       9.74        090
                                                      lesion.
64776.............  ..............  A                Remove digit nerve           5.11         NA       3.69       0.76         NA       9.56        090
                                                      lesion.
64778.............  ..............  A                Digit nerve surgery          3.11         NA       1.50       0.46         NA       5.07        ZZZ
                                                      add-on.
64782.............  ..............  A                Remove limb nerve            6.22         NA       3.78       0.86         NA      10.86        090
                                                      lesion.
64783.............  ..............  A                Limb nerve surgery add-      3.71         NA       1.84       0.51         NA       6.06        ZZZ
                                                      on.
64784.............  ..............  A                Remove nerve lesion...       9.81         NA       6.61       1.38         NA      17.80        090
64786.............  ..............  A                Remove sciatic nerve        15.44         NA       9.86       2.60         NA      27.90        090
                                                      lesion.
64787.............  ..............  A                Implant nerve end.....       4.29         NA       2.13       0.58         NA       7.00        ZZZ
64788.............  ..............  A                Remove skin nerve            4.60         NA       3.47       0.73         NA       8.80        090
                                                      lesion.
64790.............  ..............  A                Removal of nerve            11.29         NA       7.22       2.10         NA      20.61        090
                                                      lesion.
64792.............  ..............  A                Removal of nerve            14.90         NA       8.85       2.48         NA      26.23        090
                                                      lesion.
64795.............  ..............  A                Biopsy of nerve.......       3.01         NA       1.56       0.52         NA       5.09        000
64802.............  ..............  A                Remove sympathetic           9.14         NA       5.14       1.29         NA      15.57        090
                                                      nerves.
64804.............  ..............  A                Remove sympathetic          14.62         NA       7.18       2.14         NA      23.94        090
                                                      nerves.
64809.............  ..............  A                Remove sympathetic          13.65         NA       5.78       1.50         NA      20.93        090
                                                      nerves.
64818.............  ..............  A                Remove sympathetic          10.28         NA       5.30       1.33         NA      16.91        090
                                                      nerves.
64820.............  ..............  A                Remove sympathetic          10.35         NA       7.14       1.49         NA      18.98        090
                                                      nerves.
64821.............  ..............  A                Remove sympathetic           8.74         NA       7.36       1.24         NA      17.34        090
                                                      nerves.
64822.............  ..............  A                Remove sympathetic           8.74         NA       7.25       1.30         NA      17.29        090
                                                      nerves.
64823.............  ..............  A                Remove sympathetic          10.35         NA       8.15       1.57         NA      20.07        090
                                                      nerves.
64831.............  ..............  A                Repair of digit nerve.       9.43         NA       7.09       1.41         NA      17.93        090
64832.............  ..............  A                Repair nerve add-on...       5.65         NA       2.94       0.85         NA       9.44        ZZZ
64834.............  ..............  A                Repair of hand or foot      10.17         NA       7.11       1.54         NA      18.82        090
                                                      nerve.
64835.............  ..............  A                Repair of hand or foot      10.92         NA       7.71       1.73         NA      20.36        090
                                                      nerve.
64836.............  ..............  A                Repair of hand or foot      10.92         NA       7.68       1.67         NA      20.27        090
                                                      nerve.
64837.............  ..............  A                Repair nerve add-on...       6.25         NA       3.24       0.97         NA      10.46        ZZZ
64840.............  ..............  A                Repair of leg nerve...      13.00         NA       8.27       1.37         NA      22.64        090
64856.............  ..............  A                Repair/transpose nerve      13.78         NA       9.21       2.12         NA      25.11        090
64857.............  ..............  A                Repair arm/leg nerve..      14.47         NA       9.66       2.21         NA      26.34        090
64858.............  ..............  A                Repair sciatic nerve..      16.47         NA      10.80       3.33         NA      30.60        090
64859.............  ..............  A                Nerve surgery.........       4.25         NA       2.20       0.67         NA       7.12        ZZZ
64861.............  ..............  A                Repair of arm nerves..      19.21         NA      11.80       4.08         NA      35.09        090
64862.............  ..............  A                Repair of low back          19.41         NA      11.96       4.31         NA      35.68        090
                                                      nerves.
64864.............  ..............  A                Repair of facial nerve      12.53         NA       8.79       1.26         NA      22.58        090
64865.............  ..............  A                Repair of facial nerve      15.22         NA      13.56       1.50         NA      30.28        090
64866.............  ..............  A                Fusion of facial/other      15.72         NA      13.20       2.04         NA      30.96        090
                                                      nerve.
64868.............  ..............  A                Fusion of facial/other      14.02         NA      11.46       1.43         NA      26.91        090
                                                      nerve.
64870.............  ..............  A                Fusion of facial/other      15.97         NA       8.75       1.30         NA      26.02        090
                                                      nerve.
64872.............  ..............  A                Subsequent repair of         1.99         NA       1.08       0.29         NA       3.36        ZZZ
                                                      nerve.
64874.............  ..............  A                Repair & revise nerve        2.98         NA       1.53       0.42         NA       4.93        ZZZ
                                                      add-on.
64876.............  ..............  A                Repair nerve/shorten         3.37         NA       1.75       0.47         NA       5.59        ZZZ
                                                      bone.
64885.............  ..............  A                Nerve graft, head or        17.50         NA      11.63       1.63         NA      30.76        090
                                                      neck.
64886.............  ..............  A                Nerve graft, head or        20.72         NA      13.58       2.08         NA      36.38        090
                                                      neck.
64890.............  ..............  A                Nerve graft, hand or        15.13         NA      10.02       2.29         NA      27.44        090
                                                      foot.
64891.............  ..............  A                Nerve graft, hand or        16.12         NA       7.60       1.63         NA      25.35        090
                                                      foot.
64892.............  ..............  A                Nerve graft, arm or         14.63         NA       8.89       2.47         NA      25.99        090
                                                      leg.
64893.............  ..............  A                Nerve graft, arm or         15.58         NA       9.89       2.61         NA      28.08        090
                                                      leg.
64895.............  ..............  A                Nerve graft, hand or        19.22         NA       9.68       2.57         NA      31.47        090
                                                      foot.
64896.............  ..............  A                Nerve graft, hand or        20.46         NA      11.01       3.16         NA      34.63        090
                                                      foot.
64897.............  ..............  A                Nerve graft, arm or         18.21         NA      10.72       2.54         NA      31.47        090
                                                      leg.
64898.............  ..............  A                Nerve graft, arm or         19.47         NA      11.82       2.77         NA      34.06        090
                                                      leg.
64901.............  ..............  A                Nerve graft add-on....      10.20         NA       5.28       1.37         NA      16.85        ZZZ

[[Page 70406]]

 
64902.............  ..............  A                Nerve graft add-on....      11.81         NA       5.98       1.55         NA      19.34        ZZZ
64905.............  ..............  A                Nerve pedicle transfer      14.00         NA       8.51       2.00         NA      24.51        090
64907.............  ..............  A                Nerve pedicle transfer      18.80         NA      12.56       3.16         NA      34.52        090
64999.............  ..............  C                Nervous system surgery       0.00       0.00       0.00       0.00       0.00       0.00        YYY
65091.............  ..............  A                Revise eye............       6.45         NA       8.37       0.32         NA      15.14        090
65093.............  ..............  A                Revise eye with              6.86         NA       8.74       0.34         NA      15.94        090
                                                      implant.
65101.............  ..............  A                Removal of eye........       7.02         NA       9.55       0.35         NA      16.92        090
65103.............  ..............  A                Remove eye/insert            7.56         NA       9.76       0.37         NA      17.69        090
                                                      implant.
65105.............  ..............  A                Remove eye/attach            8.48         NA      10.49       0.42         NA      19.39        090
                                                      implant.
65110.............  ..............  A                Removal of eye........      13.93         NA      13.71       0.81         NA      28.45        090
65112.............  ..............  A                Remove eye/revise           16.36         NA      16.18       1.30         NA      33.84        090
                                                      socket.
65114.............  ..............  A                Remove eye/revise           17.50         NA      16.39       1.02         NA      34.91        090
                                                      socket.
65125.............  ..............  A                Revise ocular implant.       3.12       8.83       3.61       0.19      12.14       6.92        090
65130.............  ..............  A                Insert ocular implant.       7.14         NA       9.19       0.35         NA      16.68        090
65135.............  ..............  A                Insert ocular implant.       7.32         NA       9.34       0.36         NA      17.02        090
65140.............  ..............  A                Attach ocular implant.       8.01         NA       9.90       0.40         NA      18.31        090
65150.............  ..............  A                Revise ocular implant.       6.25         NA       7.99       0.31         NA      14.55        090
65155.............  ..............  A                Reinsert ocular              8.65         NA      10.51       0.50         NA      19.66        090
                                                      implant.
65175.............  ..............  A                Removal of ocular            6.27         NA       8.50       0.31         NA      15.08        090
                                                      implant.
65205.............  ..............  A                Remove foreign body          0.71       0.64       0.29       0.03       1.38       1.03        000
                                                      from eye.
65210.............  ..............  A                Remove foreign body          0.84       0.81       0.38       0.04       1.69       1.26        000
                                                      from eye.
65220.............  ..............  A                Remove foreign body          0.71       0.64       0.28       0.05       1.40       1.04        000
                                                      from eye.
65222.............  ..............  A                Remove foreign body          0.93       0.89       0.38       0.04       1.86       1.35        000
                                                      from eye.
65235.............  ..............  A                Remove foreign body          7.56         NA       6.76       0.37         NA      14.69        090
                                                      from eye.
65260.............  ..............  A                Remove foreign body         10.94         NA       9.68       0.57         NA      21.19        090
                                                      from eye.
65265.............  ..............  A                Remove foreign body         12.57         NA      10.65       0.62         NA      23.84        090
                                                      from eye.
65270.............  ..............  A                Repair of eye wound...       1.90       5.24       1.39       0.09       7.23       3.38        010
65272.............  ..............  A                Repair of eye wound...       3.81       7.73       3.30       0.19      11.73       7.30        090
65273.............  ..............  A                Repair of eye wound...       4.35         NA       3.59       0.22         NA       8.16        090
65275.............  ..............  A                Repair of eye wound...       5.33       6.33       3.95       0.26      11.92       9.54        090
65280.............  ..............  A                Repair of eye wound...       7.65         NA       6.25       0.38         NA      14.28        090
65285.............  ..............  A                Repair of eye wound...      12.88         NA       9.24       0.64         NA      22.76        090
65286.............  ..............  A                Repair of eye wound...       5.50      11.17       4.63       0.27      16.94      10.40        090
65290.............  ..............  A                Repair of eye socket         5.40         NA       4.75       0.31         NA      10.46        090
                                                      wound.
65400.............  ..............  A                Removal of eye lesion.       6.05       8.35       6.14       0.30      14.70      12.49        090
65410.............  ..............  A                Biopsy of cornea......       1.47       2.12       0.97       0.07       3.66       2.51        000
65420.............  ..............  A                Removal of eye lesion.       4.16       8.88       4.45       0.21      13.25       8.82        090
65426.............  ..............  A                Removal of eye lesion.       5.24      10.20       4.93       0.25      15.69      10.42        090
65430.............  ..............  A                Corneal smear.........       1.47       1.29       0.98       0.07       2.83       2.52        000
65435.............  ..............  A                Curette/treat cornea..       0.92       1.00       0.71       0.04       1.96       1.67        000
65436.............  ..............  A                Curette/treat cornea..       4.18       4.10       3.68       0.21       8.49       8.07        090
65450.............  ..............  A                Treatment of corneal         3.27       4.08       3.95       0.16       7.51       7.38        090
                                                      lesion.
65600.............  ..............  A                Revision of cornea....       3.39       5.02       3.36       0.17       8.58       6.92        090
65710.............  ..............  A                Corneal transplant....      12.33         NA      11.23       0.61         NA      24.17        090
65730.............  ..............  A                Corneal transplant....      14.23         NA      12.05       0.70         NA      26.98        090
65750.............  ..............  A                Corneal transplant....      14.98         NA      12.00       0.74         NA      27.72        090
65755.............  ..............  A                Corneal transplant....      14.87         NA      11.92       0.73         NA      27.52        090
65760.............  ..............  N                Revision of cornea....       0.00       0.00       0.00       0.00       0.00       0.00        XXX
65765.............  ..............  N                Revision of cornea....       0.00       0.00       0.00       0.00       0.00       0.00        XXX
65767.............  ..............  N                Corneal tissue               0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      transplant.
65770.............  ..............  A                Revise cornea with          17.53         NA      13.24       0.87         NA      31.64        090
                                                      implant.
65771.............  ..............  N                Radial keratotomy.....       0.00       0.00       0.00       0.00       0.00       0.00        XXX
65772.............  ..............  A                Correction of                4.28       5.55       4.14       0.21      10.04       8.63        090
                                                      astigmatism.
65775.............  ..............  A                Correction of                5.78         NA       5.97       0.28         NA      12.03        090
                                                      astigmatism.
65780.............  ..............  A                Ocular reconst,             10.23         NA      10.32       0.44         NA      20.99        090
                                                      transplant.
65781.............  ..............  A                Ocular reconst,             17.64         NA      13.71       0.44         NA      31.79        090
                                                      transplant.
65782.............  ..............  A                Ocular reconst,             14.98         NA      12.02       0.44         NA      27.44        090
                                                      transplant.
65800.............  ..............  A                Drainage of eye.......       1.91       1.80       1.18       0.09       3.80       3.18        000
65805.............  ..............  A                Drainage of eye.......       1.91       2.18       1.19       0.09       4.18       3.19        000
65810.............  ..............  A                Drainage of eye.......       4.86         NA       4.71       0.24         NA       9.81        090
65815.............  ..............  A                Drainage of eye.......       5.04      10.03       4.82       0.25      15.32      10.11        090
65820.............  ..............  A                Relieve inner eye            8.12         NA       9.08       0.40         NA      17.60        090
                                                      pressure.
65850.............  ..............  A                Incision of eye.......      10.50         NA       8.46       0.52         NA      19.48        090
65855.............  ..............  A                Laser surgery of eye..       3.84       4.32       3.11       0.19       8.35       7.14        010
65860.............  ..............  A                Incise inner eye             3.54       4.05       2.51       0.18       7.77       6.23        090
                                                      adhesions.
65865.............  ..............  A                Incise inner eye             5.59         NA       5.64       0.28         NA      11.51        090
                                                      adhesions.
65870.............  ..............  A                Incise inner eye             6.26         NA       6.43       0.31         NA      13.00        090
                                                      adhesions.
65875.............  ..............  A                Incise inner eye             6.53         NA       6.81       0.32         NA      13.66        090
                                                      adhesions.
65880.............  ..............  A                Incise inner eye             7.08         NA       7.05       0.35         NA      14.48        090
                                                      adhesions.
65900.............  ..............  A                Remove eye lesion.....      10.91         NA      10.28       0.54         NA      21.73        090
65920.............  ..............  A                Remove implant of eye.       8.39         NA       8.19       0.41         NA      16.99        090
65930.............  ..............  A                Remove blood clot from       7.43         NA       6.85       0.37         NA      14.65        090
                                                      eye.
66020.............  ..............  A                Injection treatment of       1.59       3.13       1.44       0.08       4.80       3.11        010
                                                      eye.
66030.............  ..............  A                Injection treatment of       1.25       2.97       1.28       0.06       4.28       2.59        010
                                                      eye.
66130.............  ..............  A                Remove eye lesion.....       7.68       9.65       5.63       0.38      17.71      13.69        090

[[Page 70407]]

 
66150.............  ..............  A                Glaucoma surgery......       8.29         NA       9.43       0.46         NA      18.18        090
66155.............  ..............  A                Glaucoma surgery......       8.28         NA       9.38       0.41         NA      18.07        090
66160.............  ..............  A                Glaucoma surgery......      10.15         NA      10.22       0.50         NA      20.87        090
66165.............  ..............  A                Glaucoma surgery......       8.00         NA       9.27       0.40         NA      17.67        090
66170.............  ..............  A                Glaucoma surgery......      12.14         NA      12.26       0.60         NA      25.00        090
66172.............  ..............  A                Incision of eye.......      15.02         NA      15.24       0.74         NA      31.00        090
66180.............  ..............  A                Implant eye shunt.....      14.53         NA      10.79       0.71         NA      26.03        090
66185.............  ..............  A                Revise eye shunt......       8.13         NA       7.40       0.40         NA      15.93        090
66220.............  ..............  A                Repair eye lesion.....       7.76         NA       7.12       0.40         NA      15.28        090
66225.............  ..............  A                Repair/graft eye            11.03         NA       8.76       0.55         NA      20.34        090
                                                      lesion.
66250.............  ..............  A                Follow-up surgery of         5.97      11.72       5.50       0.30      17.99      11.77        090
                                                      eye.
66500.............  ..............  A                Incision of iris......       3.70         NA       4.65       0.18         NA       8.53        090
66505.............  ..............  A                Incision of iris......       4.07         NA       5.00       0.20         NA       9.27        090
66600.............  ..............  A                Remove iris and lesion       8.67         NA       8.24       0.43         NA      17.34        090
66605.............  ..............  A                Removal of iris.......      12.77         NA      10.05       0.77         NA      23.59        090
66625.............  ..............  A                Removal of iris.......       5.12         NA       4.74       0.26         NA      10.12        090
66630.............  ..............  A                Removal of iris.......       6.15         NA       5.73       0.31         NA      12.19        090
66635.............  ..............  A                Removal of iris.......       6.24         NA       5.76       0.31         NA      12.31        090
66680.............  ..............  A                Repair iris & ciliary        5.43         NA       5.29       0.27         NA      10.99        090
                                                      body.
66682.............  ..............  A                Repair iris & ciliary        6.20         NA       6.63       0.31         NA      13.14        090
                                                      body.
66700.............  ..............  A                Destruction, ciliary         4.77       5.26       3.94       0.24      10.27       8.95        090
                                                      body.
66710.............  ..............  A                Ciliary transsleral          4.77       5.18       3.85       0.23      10.18       8.85        090
                                                      therapy.
66711.............  ..............  A                Ciliary endoscopic           6.60         NA       6.49       0.30         NA      13.39        090
                                                      ablation.
66720.............  ..............  A                Destruction, ciliary         4.77       5.81       4.73       0.26      10.84       9.76        090
                                                      body.
66740.............  ..............  A                Destruction, ciliary         4.77       5.10       3.98       0.23      10.10       8.98        090
                                                      body.
66761.............  ..............  A                Revision of iris......       4.06       5.61       4.32       0.20       9.87       8.58        090
66762.............  ..............  A                Revision of iris......       4.57       5.67       4.30       0.23      10.47       9.10        090
66770.............  ..............  A                Removal of inner eye         5.17       6.10       4.81       0.26      11.53      10.24        090
                                                      lesion.
66820.............  ..............  A                Incision, secondary          3.88         NA       5.83       0.19         NA       9.90        090
                                                      cataract.
66821.............  ..............  A                After cataract laser         2.35       4.10       3.63       0.11       6.56       6.09        090
                                                      surgery.
66825.............  ..............  A                Reposition intraocular       8.22         NA       9.09       0.40         NA      17.71        090
                                                      lens.
66830.............  ..............  A                Removal of lens lesion       8.19         NA       6.97       0.36         NA      15.52        090
66840.............  ..............  A                Removal of lens              7.90         NA       6.88       0.39         NA      15.17        090
                                                      material.
66850.............  ..............  A                Removal of lens              9.10         NA       7.66       0.45         NA      17.21        090
                                                      material.
66852.............  ..............  A                Removal of lens              9.96         NA       8.12       0.49         NA      18.57        090
                                                      material.
66920.............  ..............  A                Extraction of lens....       8.85         NA       7.32       0.44         NA      16.61        090
66930.............  ..............  A                Extraction of lens....      10.16         NA       8.16       0.49         NA      18.81        090
66940.............  ..............  A                Extraction of lens....       8.92         NA       7.62       0.43         NA      16.97        090
66982.............  ..............  A                Cataract surgery,           13.48         NA       9.89       0.63         NA      24.00        090
                                                      complex.
66983.............  ..............  A                Cataract surg w/iol, 1       8.98         NA       6.13       0.14         NA      15.25        090
                                                      stage.
66984.............  ..............  A                Cataract surg w/iol, 1      10.21         NA       7.44       0.39         NA      18.04        090
                                                      stage.
66985.............  ..............  A                Insert lens prosthesis       8.38         NA       7.47       0.36         NA      16.21        090
66986.............  ..............  A                Exchange lens               12.26         NA       9.20       0.60         NA      22.06        090
                                                      prosthesis.
66990.............  ..............  A                Ophthalmic endoscope         1.51         NA       0.69       0.07         NA       2.27        ZZZ
                                                      add-on.
66999.............  ..............  C                Eye surgery procedure.       0.00       0.00       0.00       0.00       0.00       0.00        YYY
67005.............  ..............  A                Partial removal of eye       5.69         NA       4.87       0.28         NA      10.84        090
                                                      fluid.
67010.............  ..............  A                Partial removal of eye       6.86         NA       5.43       0.34         NA      12.63        090
                                                      fluid.
67015.............  ..............  A                Release of eye fluid..       6.91         NA       6.47       0.34         NA      13.72        090
67025.............  ..............  A                Replace eye fluid.....       6.83       9.25       6.24       0.34      16.42      13.41        090
67027.............  ..............  A                Implant eye drug            10.83         NA       8.02       0.54         NA      19.39        090
                                                      system.
67028.............  ..............  A                Injection eye drug....       2.52       2.71       1.46       0.12       5.35       4.10        000
67030.............  ..............  A                Incise inner eye             4.83         NA       5.87       0.24         NA      10.94        090
                                                      strands.
67031.............  ..............  A                Laser surgery, eye           3.66       4.61       3.65       0.18       8.45       7.49        090
                                                      strands.
67036.............  ..............  A                Removal of inner eye        11.87         NA       9.15       0.58         NA      21.60        090
                                                      fluid.
67038.............  ..............  A                Strip retinal membrane      21.21         NA      15.53       1.04         NA      37.78        090
67039.............  ..............  A                Laser treatment of          14.50         NA      12.22       0.71         NA      27.43        090
                                                      retina.
67040.............  ..............  A                Laser treatment of          17.20         NA      13.72       0.85         NA      31.77        090
                                                      retina.
67101.............  ..............  A                Repair detached retina       7.52       9.15       6.55       0.37      17.04      14.44        090
67105.............  ..............  A                Repair detached retina       7.40       8.10       6.17       0.37      15.87      13.94        090
67107.............  ..............  A                Repair detached retina      14.82         NA      11.33       0.73         NA      26.88        090
67108.............  ..............  A                Repair detached retina      20.79         NA      14.46       1.02         NA      36.27        090
67110.............  ..............  A                Repair detached retina       8.80      10.26       7.41       0.44      19.50      16.65        090
67112.............  ..............  A                Rerepair detached           16.83         NA      11.84       0.83         NA      29.50        090
                                                      retina.
67115.............  ..............  A                Release encircling           4.98         NA       5.09       0.25         NA      10.32        090
                                                      material.
67120.............  ..............  A                Remove eye implant           5.97       8.60       5.55       0.29      14.86      11.81        090
                                                      material.
67121.............  ..............  A                Remove eye implant          10.65         NA       8.55       0.53         NA      19.73        090
                                                      material.
67141.............  ..............  A                Treatment of retina...       5.19       5.87       4.87       0.26      11.32      10.32        090
67145.............  ..............  A                Treatment of retina...       5.36       5.74       4.94       0.27      11.37      10.57        090
67208.............  ..............  A                Treatment of retinal         6.69       6.14       5.53       0.33      13.16      12.55        090
                                                      lesion.
67210.............  ..............  A                Treatment of retinal         8.81       6.59       5.90       0.44      15.84      15.15        090
                                                      lesion.
67218.............  ..............  A                Treatment of retinal        18.50         NA      12.19       0.92         NA      31.61        090
                                                      lesion.
67220.............  ..............  A                Treatment of choroid        13.11      10.45       9.04       0.65      24.21      22.80        090
                                                      lesion.
67221.............  ..............  R                Ocular photodynamic          4.00       4.34       1.81       0.20       8.54       6.01        000
                                                      ther.
67225.............  ..............  A                Eye photodynamic ther        0.47       0.25       0.21       0.02       0.74       0.70        ZZZ
                                                      add-on.
67227.............  ..............  A                Treatment of retinal         6.57       6.60       5.54       0.33      13.50      12.44        090
                                                      lesion.

[[Page 70408]]

 
67228.............  ..............  A                Treatment of retinal        12.72      11.51       8.56       0.63      24.86      21.91        090
                                                      lesion.
67250.............  ..............  A                Reinforce eye wall....       8.65         NA       9.20       0.47         NA      18.32        090
67255.............  ..............  A                Reinforce/graft eye          8.89         NA       9.92       0.44         NA      19.25        090
                                                      wall.
67299.............  ..............  C                Eye surgery procedure.       0.00       0.00       0.00       0.00       0.00       0.00        YYY
67311.............  ..............  A                Revise eye muscle.....       6.64         NA       6.04       0.37         NA      13.05        090
67312.............  ..............  A                Revise two eye muscles       8.53         NA       6.77       0.43         NA      15.73        090
67314.............  ..............  A                Revise eye muscle.....       7.51         NA       6.57       0.39         NA      14.47        090
67316.............  ..............  A                Revise two eye muscles       9.65         NA       7.52       0.49         NA      17.66        090
67318.............  ..............  A                Revise eye muscle(s)..       7.84         NA       6.95       0.41         NA      15.20        090
67320.............  ..............  A                Revise eye muscle(s)         4.32         NA       1.96       0.22         NA       6.50        ZZZ
                                                      add-on.
67331.............  ..............  A                Eye surgery follow-up        4.05         NA       1.84       0.21         NA       6.10        ZZZ
                                                      add-on.
67332.............  ..............  A                Rerevise eye muscles         4.48         NA       2.03       0.23         NA       6.74        ZZZ
                                                      add-on.
67334.............  ..............  A                Revise eye muscle w/         3.97         NA       1.80       0.20         NA       5.97        ZZZ
                                                      suture.
67335.............  ..............  A                Eye suture during            2.49         NA       1.12       0.13         NA       3.74        ZZZ
                                                      surgery.
67340.............  ..............  A                Revise eye muscle add-       4.92         NA       2.21       0.25         NA       7.38        ZZZ
                                                      on.
67343.............  ..............  A                Release eye tissue....       7.34         NA       6.53       0.37         NA      14.24        090
67345.............  ..............  A                Destroy nerve of eye         2.96       2.59       2.02       0.17       5.72       5.15        010
                                                      muscle.
67350.............  ..............  A                Biopsy eye muscle.....       2.87         NA       1.88       0.15         NA       4.90        000
67399.............  ..............  C                Eye muscle surgery           0.00       0.00       0.00       0.00       0.00       0.00        YYY
                                                      procedure.
67400.............  ..............  A                Explore/biopsy eye           9.75         NA      11.29       0.56         NA      21.60        090
                                                      socket.
67405.............  ..............  A                Explore/drain eye            7.92         NA       9.80       0.44         NA      18.16        090
                                                      socket.
67412.............  ..............  A                Explore/treat eye            9.49         NA      10.96       0.48         NA      20.93        090
                                                      socket.
67413.............  ..............  A                Explore/treat eye            9.99         NA      10.80       0.50         NA      21.29        090
                                                      socket.
67414.............  ..............  A                Explr/decompress eye        11.11         NA      12.07       0.65         NA      23.83        090
                                                      socket.
67415.............  ..............  A                Aspiration, orbital          1.76         NA       0.76       0.09         NA       2.61        000
                                                      contents.
67420.............  ..............  A                Explore/treat eye           20.03         NA      17.44       1.15         NA      38.62        090
                                                      socket.
67430.............  ..............  A                Explore/treat eye           13.37         NA      14.93       0.86         NA      29.16        090
                                                      socket.
67440.............  ..............  A                Explore/drain eye           13.07         NA      14.30       0.70         NA      28.07        090
                                                      socket.
67445.............  ..............  A                Explr/decompress eye        14.40         NA      13.95       0.90         NA      29.25        090
                                                      socket.
67450.............  ..............  A                Explore/biopsy eye          13.49         NA      14.73       0.68         NA      28.90        090
                                                      socket.
67500.............  ..............  A                Inject/treat eye             0.79       0.67       0.29       0.05       1.51       1.13        000
                                                      socket.
67505.............  ..............  A                Inject/treat eye             0.82       0.69       0.31       0.05       1.56       1.18        000
                                                      socket.
67515.............  ..............  A                Inject/treat eye             0.61       0.59       0.38       0.03       1.23       1.02        000
                                                      socket.
67550.............  ..............  A                Insert eye socket           10.17         NA      11.33       0.72         NA      22.22        090
                                                      implant.
67560.............  ..............  A                Revise eye socket           10.58         NA      11.40       0.60         NA      22.58        090
                                                      implant.
67570.............  ..............  A                Decompress optic nerve      13.56         NA      13.62       0.68         NA      27.86        090
67599.............  ..............  C                Orbit surgery                0.00       0.00       0.00       0.00       0.00       0.00        YYY
                                                      procedure.
67700.............  ..............  A                Drainage of eyelid           1.35       6.04       1.27       0.07       7.46       2.69        010
                                                      abscess.
67710.............  ..............  A                Incision of eyelid....       1.02       5.39       1.21       0.05       6.46       2.28        010
67715.............  ..............  A                Incision of eyelid           1.22       5.39       1.29       0.06       6.67       2.57        010
                                                      fold.
67800.............  ..............  A                Remove eyelid lesion..       1.38       1.62       1.04       0.07       3.07       2.49        010
67801.............  ..............  A                Remove eyelid lesions.       1.88       1.97       1.26       0.09       3.94       3.23        010
67805.............  ..............  A                Remove eyelid lesions.       2.22       2.53       1.65       0.11       4.86       3.98        010
67808.............  ..............  A                Remove eyelid                3.79         NA       3.78       0.19         NA       7.76        090
                                                      lesion(s).
67810.............  ..............  A                Biopsy of eyelid......       1.48       3.34       0.68       0.06       4.88       2.22        000
67820.............  ..............  A                Revise eyelashes......       0.89       0.60       0.56       0.04       1.53       1.49        000
67825.............  ..............  A                Revise eyelashes......       1.38       1.74       1.41       0.07       3.19       2.86        010
67830.............  ..............  A                Revise eyelashes......       1.70       5.55       1.50       0.08       7.33       3.28        010
67835.............  ..............  A                Revise eyelashes......       5.55         NA       4.63       0.28         NA      10.46        090
67840.............  ..............  A                Remove eyelid lesion..       2.04       5.49       1.65       0.10       7.63       3.79        010
67850.............  ..............  A                Treat eyelid lesion...       1.69       3.38       1.47       0.07       5.14       3.23        010
67875.............  ..............  A                Closure of eyelid by         1.35       3.31       0.94       0.07       4.73       2.36        000
                                                      suture.
67880.............  ..............  A                Revision of eyelid....       3.79       6.63       3.81       0.19      10.61       7.79        090
67882.............  ..............  A                Revision of eyelid....       5.06       7.65       4.82       0.25      12.96      10.13        090
67900.............  ..............  A                Repair brow defect....       6.13       9.09       5.27       0.38      15.60      11.78        090
67901.............  ..............  A                Repair eyelid defect..       7.39         NA       5.42       0.54         NA      13.35        090
67902.............  ..............  A                Repair eyelid defect..       9.35         NA       5.48       0.60         NA      15.43        090
67903.............  ..............  A                Repair eyelid defect..       6.36       9.59       5.53       0.47      16.42      12.36        090
67904.............  ..............  A                Repair eyelid defect..       6.25       9.66       5.25       0.41      16.32      11.91        090
67906.............  ..............  A                Repair eyelid defect..       6.78       5.39       5.04       0.46      12.63      12.28        090
67908.............  ..............  A                Repair eyelid defect..       5.12       6.65       5.36       0.28      12.05      10.76        090
67909.............  ..............  A                Revise eyelid defect..       5.39       8.05       4.96       0.31      13.75      10.66        090
67911.............  ..............  A                Revise eyelid defect..       5.26         NA       4.79       0.31         NA      10.36        090
67912.............  ..............  A                Correction eyelid w/         5.67      18.98       5.55       0.28      24.93      11.50        090
                                                      implant.
67914.............  ..............  A                Repair eyelid defect..       3.67       6.36       3.06       0.19      10.22       6.92        090
67915.............  ..............  A                Repair eyelid defect..       3.18       6.00       2.81       0.16       9.34       6.15        090
67916.............  ..............  A                Repair eyelid defect..       5.30       8.07       4.77       0.28      13.65      10.35        090
67917.............  ..............  A                Repair eyelid defect..       6.01       8.48       5.08       0.36      14.85      11.45        090
67921.............  ..............  A                Repair eyelid defect..       3.39       6.21       2.90       0.17       9.77       6.46        090
67922.............  ..............  A                Repair eyelid defect..       3.06       5.93       2.76       0.15       9.14       5.97        090
67923.............  ..............  A                Repair eyelid defect..       5.87       8.14       4.98       0.30      14.31      11.15        090
67924.............  ..............  A                Repair eyelid defect..       5.78       8.95       4.69       0.30      15.03      10.77        090
67930.............  ..............  A                Repair eyelid wound...       3.60       5.73       2.18       0.19       9.52       5.97        010
67935.............  ..............  A                Repair eyelid wound...       6.21       8.54       4.42       0.39      15.14      11.02        090
67938.............  ..............  A                Remove eyelid foreign        1.33       5.40       1.26       0.06       6.79       2.65        010
                                                      body.

[[Page 70409]]

 
67950.............  ..............  A                Revision of eyelid....       5.81       8.66       5.23       0.36      14.83      11.40        090
67961.............  ..............  A                Revision of eyelid....       5.68       8.71       5.04       0.33      14.72      11.05        090
67966.............  ..............  A                Revision of eyelid....       6.56       9.16       5.58       0.37      16.09      12.51        090
67971.............  ..............  A                Reconstruction of            9.78         NA       7.30       0.53         NA      17.61        090
                                                      eyelid.
67973.............  ..............  A                Reconstruction of           12.85         NA       9.34       0.75         NA      22.94        090
                                                      eyelid.
67974.............  ..............  A                Reconstruction of           12.82         NA       9.26       0.75         NA      22.83        090
                                                      eyelid.
67975.............  ..............  A                Reconstruction of            9.12         NA       6.97       0.50         NA      16.59        090
                                                      eyelid.
67999.............  ..............  C                Revision of eyelid....       0.00       0.00       0.00       0.00       0.00       0.00        YYY
68020.............  ..............  A                Incise/drain eyelid          1.37       1.41       1.21       0.06       2.84       2.64        010
                                                      lining.
68040.............  ..............  A                Treatment of eyelid          0.85       0.71       0.43       0.04       1.60       1.32        000
                                                      lesions.
68100.............  ..............  A                Biopsy of eyelid             1.35       3.26       0.95       0.07       4.68       2.37        000
                                                      lining.
68110.............  ..............  A                Remove eyelid lining         1.77       4.11       1.65       0.09       5.97       3.51        010
                                                      lesion.
68115.............  ..............  A                Remove eyelid lining         2.36       5.98       1.92       0.12       8.46       4.40        010
                                                      lesion.
68130.............  ..............  A                Remove eyelid lining         4.92       8.74       4.61       0.24      13.90       9.77        090
                                                      lesion.
68135.............  ..............  A                Remove eyelid lining         1.84       1.82       1.65       0.09       3.75       3.58        010
                                                      lesion.
68200.............  ..............  A                Treat eyelid by              0.49       0.54       0.33       0.02       1.05       0.84        000
                                                      injection.
68320.............  ..............  A                Revise/graft eyelid          5.36      11.31       5.54       0.27      16.94      11.17        090
                                                      lining.
68325.............  ..............  A                Revise/graft eyelid          7.35         NA       6.56       0.44         NA      14.35        090
                                                      lining.
68326.............  ..............  A                Revise/graft eyelid          7.14         NA       6.43       0.35         NA      13.92        090
                                                      lining.
68328.............  ..............  A                Revise/graft eyelid          8.17         NA       7.31       0.54         NA      16.02        090
                                                      lining.
68330.............  ..............  A                Revise eyelid lining..       4.82       9.44       4.73       0.24      14.50       9.79        090
68335.............  ..............  A                Revise/graft eyelid          7.18         NA       6.40       0.36         NA      13.94        090
                                                      lining.
68340.............  ..............  A                Separate eyelid              4.16       8.90       4.11       0.21      13.27       8.48        090
                                                      adhesions.
68360.............  ..............  A                Revise eyelid lining..       4.36       8.06       4.19       0.22      12.64       8.77        090
68362.............  ..............  A                Revise eyelid lining..       7.33         NA       6.42       0.36         NA      14.11        090
68371.............  ..............  A                Harvest eye tissue,          4.89         NA       4.74       0.44         NA      10.07        010
                                                      alograft.
68399.............  ..............  C                Eyelid lining surgery.       0.00       0.00       0.00       0.00       0.00       0.00        YYY
68400.............  ..............  A                Incise/drain tear            1.69       5.92       1.83       0.08       7.69       3.60        010
                                                      gland.
68420.............  ..............  A                Incise/drain tear sac.       2.30       6.21       2.11       0.11       8.62       4.52        010
68440.............  ..............  A                Incise tear duct             0.94       2.09       1.27       0.05       3.08       2.26        010
                                                      opening.
68500.............  ..............  A                Removal of tear gland.      11.00         NA       9.76       0.55         NA      21.31        090
68505.............  ..............  A                Partial removal, tear       10.92         NA      10.68       0.55         NA      22.15        090
                                                      gland.
68510.............  ..............  A                Biopsy of tear gland..       4.60       7.35       2.10       0.23      12.18       6.93        000
68520.............  ..............  A                Removal of tear sac...       7.50         NA       7.44       0.37         NA      15.31        090
68525.............  ..............  A                Biopsy of tear sac....       4.42         NA       2.03       0.22         NA       6.67        000
68530.............  ..............  A                Clearance of tear duct       3.65       8.19       2.65       0.18      12.02       6.48        010
68540.............  ..............  A                Remove tear gland           10.58         NA       9.42       0.52         NA      20.52        090
                                                      lesion.
68550.............  ..............  A                Remove tear gland           13.24         NA      11.38       0.80         NA      25.42        090
                                                      lesion.
68700.............  ..............  A                Repair tear ducts.....       6.59         NA       6.00       0.32         NA      12.91        090
68705.............  ..............  A                Revise tear duct             2.06       4.18       1.80       0.10       6.34       3.96        010
                                                      opening.
68720.............  ..............  A                Create tear sac drain.       8.95         NA       7.88       0.44         NA      17.27        090
68745.............  ..............  A                Create tear duct drain       8.62         NA       7.88       0.52         NA      17.02        090
68750.............  ..............  A                Create tear duct drain       8.65         NA       8.29       0.43         NA      17.37        090
68760.............  ..............  A                Close tear duct              1.73       3.55       1.63       0.09       5.37       3.45        010
                                                      opening.
68761.............  ..............  A                Close tear duct              1.36       2.28       1.32       0.06       3.70       2.74        010
                                                      opening.
68770.............  ..............  A                Close tear system            7.01       3.19       3.19       0.35      10.55      10.55        090
                                                      fistula.
68801.............  ..............  A                Dilate tear duct             0.94       1.95       1.48       0.05       2.94       2.47        010
                                                      opening.
68810.............  ..............  A                Probe nasolacrimal           1.90       3.67       2.68       0.10       5.67       4.68        010
                                                      duct.
68811.............  ..............  A                Probe nasolacrimal           2.35         NA       2.42       0.13         NA       4.90        010
                                                      duct.
68815.............  ..............  A                Probe nasolacrimal           3.20       8.26       2.82       0.17      11.63       6.19        010
                                                      duct.
68840.............  ..............  A                Explore/irrigate tear        1.25       1.60       1.12       0.06       2.91       2.43        010
                                                      ducts.
68850.............  ..............  A                Injection for tear sac       0.80       0.88       0.68       0.04       1.72       1.52        000
                                                      x-ray.
68899.............  ..............  C                Tear duct system             0.00       0.00       0.00       0.00       0.00       0.00        YYY
                                                      surgery.
69000.............  ..............  A                Drain external ear           1.45       2.89       1.36       0.12       4.46       2.93        010
                                                      lesion.
69005.............  ..............  A                Drain external ear           2.11       2.94       1.84       0.17       5.22       4.12        010
                                                      lesion.
69020.............  ..............  A                Drain outer ear canal        1.48       4.00       2.07       0.12       5.60       3.67        010
                                                      lesion.
69090.............  ..............  N                Pierce earlobes.......       0.00       0.00       0.00       0.00       0.00       0.00        XXX
69100.............  ..............  A                Biopsy of external ear       0.81       1.71       0.39       0.03       2.55       1.23        000
69105.............  ..............  A                Biopsy of external ear       0.85       2.35       0.77       0.07       3.27       1.69        000
                                                      canal.
69110.............  ..............  A                Remove external ear,         3.43       6.76       4.48       0.30      10.49       8.21        090
                                                      partial.
69120.............  ..............  A                Removal of external          4.04         NA       6.20       0.38         NA      10.62        090
                                                      ear.
69140.............  ..............  A                Remove ear canal             7.96         NA      13.32       0.65         NA      21.93        090
                                                      lesion(s).
69145.............  ..............  A                Remove ear canal             2.62       5.80       3.31       0.21       8.63       6.14        090
                                                      lesion(s).
69150.............  ..............  A                Extensive ear canal         13.41         NA      13.44       1.22         NA      28.07        090
                                                      surgery.
69155.............  ..............  A                Extensive ear/neck          20.77         NA      19.60       1.92         NA      42.29        090
                                                      surgery.
69200.............  ..............  A                Clear outer ear canal.       0.77       2.39       0.55       0.06       3.22       1.38        000
69205.............  ..............  A                Clear outer ear canal.       1.20         NA       1.36       0.10         NA       2.66        010
69210.............  ..............  A                Remove impacted ear          0.61       0.63       0.23       0.05       1.29       0.89        000
                                                      wax.
69220.............  ..............  A                Clean out mastoid            0.83       2.37       0.73       0.07       3.27       1.63        000
                                                      cavity.
69222.............  ..............  A                Clean out mastoid            1.40       3.86       2.07       0.12       5.38       3.59        010
                                                      cavity.
69300.............  ..............  R                Revise external ear...       6.35         NA       4.23       0.72         NA      11.30        YYY
69310.............  ..............  A                Rebuild outer ear           10.77         NA      16.33       0.85         NA      27.95        090
                                                      canal.
69320.............  ..............  A                Rebuild outer ear           16.93         NA      21.90       1.37         NA      40.20        090
                                                      canal.
69399.............  ..............  C                Outer ear surgery            0.00       0.00       0.00       0.00       0.00       0.00        YYY
                                                      procedure.
69400.............  ..............  A                Inflate middle ear           0.83       2.17       0.67       0.07       3.07       1.57        000
                                                      canal.

[[Page 70410]]

 
69401.............  ..............  A                Inflate middle ear           0.63       1.24       0.65       0.05       1.92       1.33        000
                                                      canal.
69405.............  ..............  A                Catheterize middle ear       2.63       3.51       2.32       0.21       6.35       5.16        010
                                                      canal.
69420.............  ..............  A                Incision of eardrum...       1.33       3.16       1.59       0.11       4.60       3.03        010
69421.............  ..............  A                Incision of eardrum...       1.73         NA       2.17       0.15         NA       4.05        010
69424.............  ..............  A                Remove ventilating           0.85       2.19       0.68       0.07       3.11       1.60        000
                                                      tube.
69433.............  ..............  A                Create eardrum opening       1.52       3.10       1.64       0.13       4.75       3.29        010
69436.............  ..............  A                Create eardrum opening       1.96         NA       2.30       0.19         NA       4.45        010
69440.............  ..............  A                Exploration of middle        7.56         NA       8.80       0.61         NA      16.97        090
                                                      ear.
69450.............  ..............  A                Eardrum revision......       5.56         NA       7.05       0.45         NA      13.06        090
69501.............  ..............  A                Mastoidectomy.........       9.06         NA       9.03       0.73         NA      18.82        090
69502.............  ..............  A                Mastoidectomy.........      12.36         NA      11.62       1.00         NA      24.98        090
69505.............  ..............  A                Remove mastoid              12.97         NA      17.24       1.05         NA      31.26        090
                                                      structures.
69511.............  ..............  A                Extensive mastoid           13.50         NA      17.52       1.09         NA      32.11        090
                                                      surgery.
69530.............  ..............  A                Extensive mastoid           19.16         NA      21.69       1.54         NA      42.39        090
                                                      surgery.
69535.............  ..............  A                Remove part of              36.09         NA      32.05       2.92         NA      71.06        090
                                                      temporal bone.
69540.............  ..............  A                Remove ear lesion.....       1.20       3.75       1.98       0.10       5.05       3.28        010
69550.............  ..............  A                Remove ear lesion.....      10.97         NA      14.90       0.89         NA      26.76        090
69552.............  ..............  A                Remove ear lesion.....      19.43         NA      20.73       1.59         NA      41.75        090
69554.............  ..............  A                Remove ear lesion.....      33.11         NA      30.42       2.91         NA      66.44        090
69601.............  ..............  A                Mastoid surgery             13.22         NA      12.71       1.07         NA      27.00        090
                                                      revision.
69602.............  ..............  A                Mastoid surgery             13.56         NA      13.27       1.10         NA      27.93        090
                                                      revision.
69603.............  ..............  A                Mastoid surgery             14.00         NA      18.41       1.14         NA      33.55        090
                                                      revision.
69604.............  ..............  A                Mastoid surgery             14.00         NA      13.73       1.14         NA      28.87        090
                                                      revision.
69605.............  ..............  A                Mastoid surgery             18.46         NA      21.01       1.50         NA      40.97        090
                                                      revision.
69610.............  ..............  A                Repair of eardrum.....       4.42       5.57       3.28       0.36      10.35       8.06        010
69620.............  ..............  A                Repair of eardrum.....       5.88      11.15       6.31       0.48      17.51      12.67        090
69631.............  ..............  A                Repair eardrum               9.85         NA      11.23       0.80         NA      21.88        090
                                                      structures.
69632.............  ..............  A                Rebuild eardrum             12.73         NA      13.51       1.03         NA      27.27        090
                                                      structures.
69633.............  ..............  A                Rebuild eardrum             12.08         NA      13.09       0.98         NA      26.15        090
                                                      structures.
69635.............  ..............  A                Repair eardrum              13.31         NA      16.79       1.08         NA      31.18        090
                                                      structures.
69636.............  ..............  A                Rebuild eardrum             15.20         NA      19.36       1.23         NA      35.79        090
                                                      structures.
69637.............  ..............  A                Rebuild eardrum             15.09         NA      19.28       1.22         NA      35.59        090
                                                      structures.
69641.............  ..............  A                Revise middle ear &         12.69         NA      12.82       1.03         NA      26.54        090
                                                      mastoid.
69642.............  ..............  A                Revise middle ear &         16.81         NA      16.33       1.36         NA      34.50        090
                                                      mastoid.
69643.............  ..............  A                Revise middle ear &         15.30         NA      14.86       1.24         NA      31.40        090
                                                      mastoid.
69644.............  ..............  A                Revise middle ear &         16.94         NA      20.46       1.37         NA      38.77        090
                                                      mastoid.
69645.............  ..............  A                Revise middle ear &         16.36         NA      20.08       1.33         NA      37.77        090
                                                      mastoid.
69646.............  ..............  A                Revise middle ear &         17.96         NA      20.82       1.46         NA      40.24        090
                                                      mastoid.
69650.............  ..............  A                Release middle ear           9.65         NA       9.94       0.78         NA      20.37        090
                                                      bone.
69660.............  ..............  A                Revise middle ear bone      11.88         NA      11.21       0.96         NA      24.05        090
69661.............  ..............  A                Revise middle ear bone      15.72         NA      14.74       1.27         NA      31.73        090
69662.............  ..............  A                Revise middle ear bone      15.42         NA      13.79       1.25         NA      30.46        090
69666.............  ..............  A                Repair middle ear            9.74         NA      10.00       0.79         NA      20.53        090
                                                      structures.
69667.............  ..............  A                Repair middle ear            9.75         NA      10.01       0.79         NA      20.55        090
                                                      structures.
69670.............  ..............  A                Remove mastoid air          11.49         NA      11.74       0.93         NA      24.16        090
                                                      cells.
69676.............  ..............  A                Remove middle ear            9.51         NA      10.78       0.81         NA      21.10        090
                                                      nerve.
69700.............  ..............  A                Close mastoid fistula.       8.22         NA       9.27       0.67         NA      18.16        090
69710.............  ..............  N                Implant/replace              0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      hearing aid.
69711.............  ..............  A                Remove/repair hearing       10.42         NA      10.82       0.83         NA      22.07        090
                                                      aid.
69714.............  ..............  A                Implant temple bone w/      13.98         NA      12.70       1.13         NA      27.81        090
                                                      stimul.
69715.............  ..............  A                Temple bne implnt w/        18.22         NA      15.07       1.48         NA      34.77        090
                                                      stimulat.
69717.............  ..............  A                Temple bone implant         14.96         NA      14.51       0.90         NA      30.37        090
                                                      revision.
69718.............  ..............  A                Revise temple bone          18.47         NA      15.34       3.21         NA      37.02        090
                                                      implant.
69720.............  ..............  A                Release facial nerve..      14.36         NA      14.56       1.16         NA      30.08        090
69725.............  ..............  A                Release facial nerve..      25.34         NA      20.19       2.44         NA      47.97        090
69740.............  ..............  A                Repair facial nerve...      15.94         NA      13.45       1.27         NA      30.66        090
69745.............  ..............  A                Repair facial nerve...      16.66         NA      15.01       1.14         NA      32.81        090
69799.............  ..............  C                Middle ear surgery           0.00       0.00       0.00       0.00       0.00       0.00        YYY
                                                      procedure.
69801.............  ..............  A                Incise inner ear......       8.55         NA       9.49       0.69         NA      18.73        090
69802.............  ..............  A                Incise inner ear......      13.08         NA      12.36       1.06         NA      26.50        090
69805.............  ..............  A                Explore inner ear.....      13.80         NA      11.91       1.12         NA      26.83        090
69806.............  ..............  A                Explore inner ear.....      12.33         NA      11.07       1.00         NA      24.40        090
69820.............  ..............  A                Establish inner ear         10.32         NA      11.25       0.90         NA      22.47        090
                                                      window.
69840.............  ..............  A                Revise inner ear            10.24         NA      13.21       0.79         NA      24.24        090
                                                      window.
69905.............  ..............  A                Remove inner ear......      11.08         NA      11.38       0.90         NA      23.36        090
69910.............  ..............  A                Remove inner ear &          13.61         NA      11.95       1.07         NA      26.63        090
                                                      mastoid.
69915.............  ..............  A                Incise inner ear nerve      21.20         NA      16.51       1.69         NA      39.40        090
69930.............  ..............  A                Implant cochlear            16.78         NA      14.79       1.36         NA      32.93        090
                                                      device.
69949.............  ..............  C                Inner ear surgery            0.00       0.00       0.00       0.00       0.00       0.00        YYY
                                                      procedure.
69950.............  ..............  A                Incise inner ear nerve      25.60         NA      18.95       2.28         NA      46.83        090
69955.............  ..............  A                Release facial nerve..      27.00         NA      21.44       2.48         NA      50.92        090
69960.............  ..............  A                Release inner ear           27.00         NA      20.11       2.17         NA      49.28        090
                                                      canal.
69970.............  ..............  A                Remove inner ear            29.99         NA      23.34       2.41         NA      55.74        090
                                                      lesion.
69979.............  ..............  C                Temporal bone surgery.       0.00       0.00       0.00       0.00       0.00       0.00        YYY
69990.............  ..............  R                Microsurgery add-on...       3.46         NA       1.80       0.89         NA       6.15        ZZZ

[[Page 70411]]

 
70010.............  26............  A                Contrast x-ray of            1.19       0.39       0.39       0.05       1.63       1.63        XXX
                                                      brain.
70010.............  TC............  A                Contrast x-ray of            0.00       4.34         NA       0.22       4.56         NA        XXX
                                                      brain.
70010.............  ..............  A                Contrast x-ray of            1.19       4.73         NA       0.27       6.19         NA        XXX
                                                      brain.
70015.............  26............  A                Contrast x-ray of            1.19       0.39       0.39       0.08       1.66       1.66        XXX
                                                      brain.
70015.............  TC............  A                Contrast x-ray of            0.00       1.35         NA       0.08       1.43         NA        XXX
                                                      brain.
70015.............  ..............  A                Contrast x-ray of            1.19       1.74         NA       0.16       3.09         NA        XXX
                                                      brain.
70030.............  26............  A                X-ray eye for foreign        0.17       0.06       0.06       0.01       0.24       0.24        XXX
                                                      body.
70030.............  TC............  A                X-ray eye for foreign        0.00       0.42         NA       0.02       0.44         NA        XXX
                                                      body.
70030.............  ..............  A                X-ray eye for foreign        0.17       0.48         NA       0.03       0.68         NA        XXX
                                                      body.
70100.............  26............  A                X-ray exam of jaw.....       0.18       0.06       0.06       0.01       0.25       0.25        XXX
70100.............  TC............  A                X-ray exam of jaw.....       0.00       0.52         NA       0.02       0.54         NA        XXX
70100.............  ..............  A                X-ray exam of jaw.....       0.18       0.58         NA       0.03       0.79         NA        XXX
70110.............  26............  A                X-ray exam of jaw.....       0.25       0.08       0.08       0.01       0.34       0.34        XXX
70110.............  TC............  A                X-ray exam of jaw.....       0.00       0.62         NA       0.04       0.66         NA        XXX
70110.............  ..............  A                X-ray exam of jaw.....       0.25       0.70         NA       0.05       1.00         NA        XXX
70120.............  26............  A                X-ray exam of mastoids       0.18       0.06       0.06       0.01       0.25       0.25        XXX
70120.............  TC............  A                X-ray exam of mastoids       0.00       0.62         NA       0.04       0.66         NA        XXX
70120.............  ..............  A                X-ray exam of mastoids       0.18       0.68         NA       0.05       0.91         NA        XXX
70130.............  26............  A                X-ray exam of mastoids       0.34       0.11       0.11       0.02       0.47       0.47        XXX
70130.............  TC............  A                X-ray exam of mastoids       0.00       0.78         NA       0.05       0.83         NA        XXX
70130.............  ..............  A                X-ray exam of mastoids       0.34       0.89         NA       0.07       1.30         NA        XXX
70134.............  26............  A                X-ray exam of middle         0.34       0.11       0.11       0.02       0.47       0.47        XXX
                                                      ear.
70134.............  TC............  A                X-ray exam of middle         0.00       0.73         NA       0.05       0.78         NA        XXX
                                                      ear.
70134.............  ..............  A                X-ray exam of middle         0.34       0.84         NA       0.07       1.25         NA        XXX
                                                      ear.
70140.............  26............  A                X-ray exam of facial         0.19       0.06       0.06       0.01       0.26       0.26        XXX
                                                      bones.
70140.............  TC............  A                X-ray exam of facial         0.00       0.62         NA       0.04       0.66         NA        XXX
                                                      bones.
70140.............  ..............  A                X-ray exam of facial         0.19       0.68         NA       0.05       0.92         NA        XXX
                                                      bones.
70150.............  26............  A                X-ray exam of facial         0.26       0.08       0.08       0.01       0.35       0.35        XXX
                                                      bones.
70150.............  TC............  A                X-ray exam of facial         0.00       0.78         NA       0.05       0.83         NA        XXX
                                                      bones.
70150.............  ..............  A                X-ray exam of facial         0.26       0.86         NA       0.06       1.18         NA        XXX
                                                      bones.
70160.............  26............  A                X-ray exam of nasal          0.17       0.06       0.06       0.01       0.24       0.24        XXX
                                                      bones.
70160.............  TC............  A                X-ray exam of nasal          0.00       0.52         NA       0.02       0.54         NA        XXX
                                                      bones.
70160.............  ..............  A                X-ray exam of nasal          0.17       0.58         NA       0.03       0.78         NA        XXX
                                                      bones.
70170.............  26............  A                X-ray exam of tear           0.30       0.10       0.10       0.01       0.41       0.41        XXX
                                                      duct.
70170.............  TC............  A                X-ray exam of tear           0.00       0.95         NA       0.06       1.01         NA        XXX
                                                      duct.
70170.............  ..............  A                X-ray exam of tear           0.30       1.05         NA       0.07       1.42         NA        XXX
                                                      duct.
70190.............  26............  A                X-ray exam of eye            0.21       0.07       0.07       0.01       0.29       0.29        XXX
                                                      sockets.
70190.............  TC............  A                X-ray exam of eye            0.00       0.62         NA       0.04       0.66         NA        XXX
                                                      sockets.
70190.............  ..............  A                X-ray exam of eye            0.21       0.69         NA       0.05       0.95         NA        XXX
                                                      sockets.
70200.............  26............  A                X-ray exam of eye            0.28       0.09       0.09       0.01       0.38       0.38        XXX
                                                      sockets.
70200.............  TC............  A                X-ray exam of eye            0.00       0.78         NA       0.05       0.83         NA        XXX
                                                      sockets.
70200.............  ..............  A                X-ray exam of eye            0.28       0.87         NA       0.06       1.21         NA        XXX
                                                      sockets.
70210.............  26............  A                X-ray exam of sinuses.       0.17       0.06       0.06       0.01       0.24       0.24        XXX
70210.............  TC............  A                X-ray exam of sinuses.       0.00       0.62         NA       0.04       0.66         NA        XXX
70210.............  ..............  A                X-ray exam of sinuses.       0.17       0.68         NA       0.05       0.90         NA        XXX
70220.............  26............  A                X-ray exam of sinuses.       0.25       0.08       0.08       0.01       0.34       0.34        XXX
70220.............  TC............  A                X-ray exam of sinuses.       0.00       0.78         NA       0.05       0.83         NA        XXX
70220.............  ..............  A                X-ray exam of sinuses.       0.25       0.86         NA       0.06       1.17         NA        XXX
70240.............  26............  A                X-ray exam, pituitary        0.19       0.06       0.06       0.01       0.26       0.26        XXX
                                                      saddle.
70240.............  TC............  A                X-ray exam, pituitary        0.00       0.42         NA       0.02       0.44         NA        XXX
                                                      saddle.
70240.............  ..............  A                X-ray exam, pituitary        0.19       0.48         NA       0.03       0.70         NA        XXX
                                                      saddle.
70250.............  26............  A                X-ray exam of skull...       0.24       0.08       0.08       0.01       0.33       0.33        XXX
70250.............  TC............  A                X-ray exam of skull...       0.00       0.62         NA       0.04       0.66         NA        XXX
70250.............  ..............  A                X-ray exam of skull...       0.24       0.70         NA       0.05       0.99         NA        XXX
70260.............  26............  A                X-ray exam of skull...       0.34       0.11       0.11       0.02       0.47       0.47        XXX
70260.............  TC............  A                X-ray exam of skull...       0.00       0.89         NA       0.06       0.95         NA        XXX
70260.............  ..............  A                X-ray exam of skull...       0.34       1.00         NA       0.08       1.42         NA        XXX
70300.............  26............  A                X-ray exam of teeth...       0.10       0.05       0.05       0.01       0.16       0.16        XXX
70300.............  TC............  A                X-ray exam of teeth...       0.00       0.26         NA       0.02       0.28         NA        XXX
70300.............  ..............  A                X-ray exam of teeth...       0.10       0.31         NA       0.03       0.44         NA        XXX
70310.............  26............  A                X-ray exam of teeth...       0.16       0.08       0.08       0.01       0.25       0.25        XXX
70310.............  TC............  A                X-ray exam of teeth...       0.00       0.42         NA       0.02       0.44         NA        XXX
70310.............  ..............  A                X-ray exam of teeth...       0.16       0.50         NA       0.03       0.69         NA        XXX
70320.............  26............  A                Full mouth x-ray of          0.22       0.08       0.08       0.01       0.31       0.31        XXX
                                                      teeth.
70320.............  TC............  A                Full mouth x-ray of          0.00       0.78         NA       0.05       0.83         NA        XXX
                                                      teeth.
70320.............  ..............  A                Full mouth x-ray of          0.22       0.86         NA       0.06       1.14         NA        XXX
                                                      teeth.
70328.............  26............  A                X-ray exam of jaw            0.18       0.06       0.06       0.01       0.25       0.25        XXX
                                                      joint.
70328.............  TC............  A                X-ray exam of jaw            0.00       0.49         NA       0.02       0.51         NA        XXX
                                                      joint.
70328.............  ..............  A                X-ray exam of jaw            0.18       0.55         NA       0.03       0.76         NA        XXX
                                                      joint.
70330.............  26............  A                X-ray exam of jaw            0.24       0.08       0.08       0.01       0.33       0.33        XXX
                                                      joints.
70330.............  TC............  A                X-ray exam of jaw            0.00       0.84         NA       0.05       0.89         NA        XXX
                                                      joints.
70330.............  ..............  A                X-ray exam of jaw            0.24       0.92         NA       0.06       1.22         NA        XXX
                                                      joints.
70332.............  26............  A                X-ray exam of jaw            0.54       0.20       0.20       0.02       0.76       0.76        XXX
                                                      joint.
70332.............  TC............  A                X-ray exam of jaw            0.00       2.11         NA       0.12       2.23         NA        XXX
                                                      joint.
70332.............  ..............  A                X-ray exam of jaw            0.54       2.31         NA       0.14       2.99         NA        XXX
                                                      joint.

[[Page 70412]]

 
70336.............  26............  A                Magnetic image, jaw          1.48       0.49       0.49       0.07       2.04       2.04        XXX
                                                      joint.
70336.............  TC............  A                Magnetic image, jaw          0.00      11.23         NA       0.59      11.82         NA        XXX
                                                      joint.
70336.............  ..............  A                Magnetic image, jaw          1.48      11.72         NA       0.66      13.86         NA        XXX
                                                      joint.
70350.............  26............  A                X-ray head for               0.17       0.07       0.07       0.01       0.25       0.25        XXX
                                                      orthodontia.
70350.............  TC............  A                X-ray head for               0.00       0.38         NA       0.02       0.40         NA        XXX
                                                      orthodontia.
70350.............  ..............  A                X-ray head for               0.17       0.45         NA       0.03       0.65         NA        XXX
                                                      orthodontia.
70355.............  26............  A                Panoramic x-ray of           0.20       0.07       0.07       0.01       0.28       0.28        XXX
                                                      jaws.
70355.............  TC............  A                Panoramic x-ray of           0.00       0.57         NA       0.04       0.61         NA        XXX
                                                      jaws.
70355.............  ..............  A                Panoramic x-ray of           0.20       0.64         NA       0.05       0.89         NA        XXX
                                                      jaws.
70360.............  26............  A                X-ray exam of neck....       0.17       0.06       0.06       0.01       0.24       0.24        XXX
70360.............  TC............  A                X-ray exam of neck....       0.00       0.42         NA       0.02       0.44         NA        XXX
70360.............  ..............  A                X-ray exam of neck....       0.17       0.48         NA       0.03       0.68         NA        XXX
70370.............  26............  A                Throat x-ray &               0.32       0.10       0.10       0.01       0.43       0.43        XXX
                                                      fluoroscopy.
70370.............  TC............  A                Throat x-ray &               0.00       1.31         NA       0.07       1.38         NA        XXX
                                                      fluoroscopy.
70370.............  ..............  A                Throat x-ray &               0.32       1.41         NA       0.08       1.81         NA        XXX
                                                      fluoroscopy.
70371.............  26............  A                Speech evaluation,           0.84       0.28       0.28       0.04       1.16       1.16        XXX
                                                      complex.
70371.............  TC............  A                Speech evaluation,           0.00       2.11         NA       0.12       2.23         NA        XXX
                                                      complex.
70371.............  ..............  A                Speech evaluation,           0.84       2.39         NA       0.16       3.39         NA        XXX
                                                      complex.
70373.............  26............  A                Contrast x-ray of            0.44       0.14       0.14       0.02       0.60       0.60        XXX
                                                      larynx.
70373.............  TC............  A                Contrast x-ray of            0.00       1.79         NA       0.11       1.90         NA        XXX
                                                      larynx.
70373.............  ..............  A                Contrast x-ray of            0.44       1.93         NA       0.13       2.50         NA        XXX
                                                      larynx.
70380.............  26............  A                X-ray exam of salivary       0.17       0.06       0.06       0.01       0.24       0.24        XXX
                                                      gland.
70380.............  TC............  A                X-ray exam of salivary       0.00       0.67         NA       0.04       0.71         NA        XXX
                                                      gland.
70380.............  ..............  A                X-ray exam of salivary       0.17       0.73         NA       0.05       0.95         NA        XXX
                                                      gland.
70390.............  26............  A                X-ray exam of salivary       0.38       0.12       0.12       0.02       0.52       0.52        XXX
                                                      duct.
70390.............  TC............  A                X-ray exam of salivary       0.00       1.79         NA       0.11       1.90         NA        XXX
                                                      duct.
70390.............  ..............  A                X-ray exam of salivary       0.38       1.91         NA       0.13       2.42         NA        XXX
                                                      duct.
70450.............  26............  A                Ct head/brain w/o dye.       0.85       0.28       0.28       0.04       1.17       1.17        XXX
70450.............  TC............  A                Ct head/brain w/o dye.       0.00       4.73         NA       0.25       4.98         NA        XXX
70450.............  ..............  A                Ct head/brain w/o dye.       0.85       5.01         NA       0.29       6.15         NA        XXX
70460.............  26............  A                Ct head/brain w/dye...       1.13       0.37       0.37       0.05       1.55       1.55        XXX
70460.............  TC............  A                Ct head/brain w/dye...       0.00       5.68         NA       0.30       5.98         NA        XXX
70460.............  ..............  A                Ct head/brain w/dye...       1.13       6.05         NA       0.35       7.53         NA        XXX
70470.............  26............  A                Ct head/brain w/o & w/       1.27       0.42       0.42       0.06       1.75       1.75        XXX
                                                      dye.
70470.............  TC............  A                Ct head/brain w/o & w/       0.00       7.09         NA       0.37       7.46         NA        XXX
                                                      dye.
70470.............  ..............  A                Ct head/brain w/o & w/       1.27       7.51         NA       0.43       9.21         NA        XXX
                                                      dye.
70480.............  26............  A                Ct orbit/ear/fossa w/o       1.28       0.42       0.42       0.06       1.76       1.76        XXX
                                                      dye.
70480.............  TC............  A                Ct orbit/ear/fossa w/o       0.00       4.73         NA       0.25       4.98         NA        XXX
                                                      dye.
70480.............  ..............  A                Ct orbit/ear/fossa w/o       1.28       5.15         NA       0.31       6.74         NA        XXX
                                                      dye.
70481.............  26............  A                Ct orbit/ear/fossa w/        1.38       0.45       0.45       0.06       1.89       1.89        XXX
                                                      dye.
70481.............  TC............  A                Ct orbit/ear/fossa w/        0.00       5.68         NA       0.30       5.98         NA        XXX
                                                      dye.
70481.............  ..............  A                Ct orbit/ear/fossa w/        1.38       6.13         NA       0.36       7.87         NA        XXX
                                                      dye.
70482.............  26............  A                Ct orbit/ear/fossa w/        1.45       0.48       0.48       0.06       1.99       1.99        XXX
                                                      o&w/dye.
70482.............  TC............  A                Ct orbit/ear/fossa w/        0.00       7.09         NA       0.37       7.46         NA        XXX
                                                      o&w/dye.
70482.............  ..............  A                Ct orbit/ear/fossa w/        1.45       7.57         NA       0.43       9.45         NA        XXX
                                                      o&w/dye.
70486.............  26............  A                Ct maxillofacial w/o         1.14       0.37       0.37       0.05       1.56       1.56        XXX
                                                      dye.
70486.............  TC............  A                Ct maxillofacial w/o         0.00       4.73         NA       0.25       4.98         NA        XXX
                                                      dye.
70486.............  ..............  A                Ct maxillofacial w/o         1.14       5.10         NA       0.30       6.54         NA        XXX
                                                      dye.
70487.............  26............  A                Ct maxillofacial w/dye       1.30       0.43       0.43       0.06       1.79       1.79        XXX
70487.............  TC............  A                Ct maxillofacial w/dye       0.00       5.68         NA       0.30       5.98         NA        XXX
70487.............  ..............  A                Ct maxillofacial w/dye       1.30       6.11         NA       0.36       7.77         NA        XXX
70488.............  26............  A                Ct maxillofacial w/o &       1.42       0.46       0.46       0.06       1.94       1.94        XXX
                                                      w/dye.
70488.............  TC............  A                Ct maxillofacial w/o &       0.00       7.09         NA       0.37       7.46         NA        XXX
                                                      w/dye.
70488.............  ..............  A                Ct maxillofacial w/o &       1.42       7.55         NA       0.43       9.40         NA        XXX
                                                      w/dye.
70490.............  26............  A                Ct soft tissue neck w/       1.28       0.42       0.42       0.06       1.76       1.76        XXX
                                                      o dye.
70490.............  TC............  A                Ct soft tissue neck w/       0.00       4.73         NA       0.25       4.98         NA        XXX
                                                      o dye.
70490.............  ..............  A                Ct soft tissue neck w/       1.28       5.15         NA       0.31       6.74         NA        XXX
                                                      o dye.
70491.............  26............  A                Ct soft tissue neck w/       1.38       0.45       0.45       0.06       1.89       1.89        XXX
                                                      dye.
70491.............  TC............  A                Ct soft tissue neck w/       0.00       5.68         NA       0.30       5.98         NA        XXX
                                                      dye.
70491.............  ..............  A                Ct soft tissue neck w/       1.38       6.13         NA       0.36       7.87         NA        XXX
                                                      dye.
70492.............  26............  A                Ct sft tsue nck w/o &        1.45       0.47       0.47       0.06       1.98       1.98        XXX
                                                      w/dye.
70492.............  TC............  A                Ct sft tsue nck w/o &        0.00       7.09         NA       0.37       7.46         NA        XXX
                                                      w/dye.
70492.............  ..............  A                Ct sft tsue nck w/o &        1.45       7.56         NA       0.43       9.44         NA        XXX
                                                      w/dye.
70496.............  26............  A                Ct angiography, head..       1.75       0.57       0.57       0.08       2.40       2.40        XXX
70496.............  TC............  A                Ct angiography, head..       0.00      10.63         NA       0.58      11.21         NA        XXX
70496.............  ..............  A                Ct angiography, head..       1.75      11.20         NA       0.66      13.61         NA        XXX
70498.............  26............  A                Ct angiography, neck..       1.75       0.57       0.57       0.08       2.40       2.40        XXX
70498.............  TC............  A                Ct angiography, neck..       0.00      10.63         NA       0.58      11.21         NA        XXX
70498.............  ..............  A                Ct angiography, neck..       1.75      11.20         NA       0.66      13.61         NA        XXX
70540.............  26............  A                Mri orbit/face/neck w/       1.35       0.44       0.44       0.06       1.85       1.85        XXX
                                                      o dye.
70540.............  TC............  A                Mri orbit/face/neck w/       0.00      11.23         NA       0.39      11.62         NA        XXX
                                                      o dye.
70540.............  ..............  A                Mri orbit/face/neck w/       1.35      11.67         NA       0.45      13.47         NA        XXX
                                                      o dye.
70542.............  26............  A                Mri orbit/face/neck w/       1.62       0.53       0.53       0.07       2.22       2.22        XXX
                                                      dye.
70542.............  TC............  A                Mri orbit/face/neck w/       0.00      13.48         NA       0.47      13.95         NA        XXX
                                                      dye.
70542.............  ..............  A                Mri orbit/face/neck w/       1.62      14.01         NA       0.54      16.17         NA        XXX
                                                      dye.

[[Page 70413]]

 
70543.............  26............  A                Mri orbt/fac/nck w/o &       2.15       0.71       0.71       0.10       2.96       2.96        XXX
                                                      w/dye.
70543.............  TC............  A                Mri orbt/fac/nck w/o &       0.00      24.95         NA       0.84      25.79         NA        XXX
                                                      w/dye.
70543.............  ..............  A                Mri orbt/fac/nck w/o &       2.15      25.66         NA       0.94      28.75         NA        XXX
                                                      w/dye.
70544.............  26............  A                Mr angiography head w/       1.20       0.40       0.40       0.05       1.65       1.65        XXX
                                                      o dye.
70544.............  TC............  A                Mr angiography head w/       0.00      11.23         NA       0.59      11.82         NA        XXX
                                                      o dye.
70544.............  ..............  A                Mr angiography head w/       1.20      11.63         NA       0.64      13.47         NA        XXX
                                                      o dye.
70545.............  26............  A                Mr angiography head w/       1.20       0.39       0.39       0.05       1.64       1.64        XXX
                                                      dye.
70545.............  TC............  A                Mr angiography head w/       0.00      11.23         NA       0.59      11.82         NA        XXX
                                                      dye.
70545.............  ..............  A                Mr angiography head w/       1.20      11.62         NA       0.64      13.46         NA        XXX
                                                      dye.
70546.............  26............  A                Mr angiograph head w/        1.80       0.59       0.59       0.08       2.47       2.47        XXX
                                                      o&w/dye.
70546.............  TC............  A                Mr angiograph head w/        0.00      22.47         NA       0.59      23.06         NA        XXX
                                                      o&w/dye.
70546.............  ..............  A                Mr angiograph head w/        1.80      23.06         NA       0.67      25.53         NA        XXX
                                                      o&w/dye.
70547.............  26............  A                Mr angiography neck w/       1.20       0.39       0.39       0.05       1.64       1.64        XXX
                                                      o dye.
70547.............  TC............  A                Mr angiography neck w/       0.00      11.23         NA       0.59      11.82         NA        XXX
                                                      o dye.
70547.............  ..............  A                Mr angiography neck w/       1.20      11.62         NA       0.64      13.46         NA        XXX
                                                      o dye.
70548.............  26............  A                Mr angiography neck w/       1.20       0.39       0.39       0.05       1.64       1.64        XXX
                                                      dye.
70548.............  TC............  A                Mr angiography neck w/       0.00      11.23         NA       0.59      11.82         NA        XXX
                                                      dye.
70548.............  ..............  A                Mr angiography neck w/       1.20      11.62         NA       0.64      13.46         NA        XXX
                                                      dye.
70549.............  26............  A                Mr angiograph neck w/        1.80       0.59       0.59       0.08       2.47       2.47        XXX
                                                      o&w/dye.
70549.............  TC............  A                Mr angiograph neck w/        0.00      22.47         NA       0.59      23.06         NA        XXX
                                                      o&w/dye.
70549.............  ..............  A                Mr angiograph neck w/        1.80      23.06         NA       0.67      25.53         NA        XXX
                                                      o&w/dye.
70551.............  26............  A                Mri brain w/o dye.....       1.48       0.49       0.49       0.07       2.04       2.04        XXX
70551.............  TC............  A                Mri brain w/o dye.....       0.00      11.23         NA       0.59      11.82         NA        XXX
70551.............  ..............  A                Mri brain w/o dye.....       1.48      11.72         NA       0.66      13.86         NA        XXX
70552.............  26............  A                Mri brain w/dye.......       1.78       0.59       0.59       0.08       2.45       2.45        XXX
70552.............  TC............  A                Mri brain w/dye.......       0.00      13.48         NA       0.70      14.18         NA        XXX
70552.............  ..............  A                Mri brain w/dye.......       1.78      14.07         NA       0.78      16.63         NA        XXX
70553.............  26............  A                Mri brain w/o & w/dye.       2.36       0.78       0.78       0.10       3.24       3.24        XXX
70553.............  TC............  A                Mri brain w/o & w/dye.       0.00      24.95         NA       1.31      26.26         NA        XXX
70553.............  ..............  A                Mri brain w/o & w/dye.       2.36      25.73         NA       1.41      29.50         NA        XXX
70557.............  26............  A                Mri brain w/o dye.....       2.90       1.13       1.13       0.08       4.11       4.11        XXX
70557.............  TC............  C                Mri brain w/o dye.....       0.00       0.00       0.00       0.00       0.00       0.00        XXX
70557.............  ..............  C                Mri brain w/o dye.....       0.00       0.00       0.00       0.00       0.00       0.00        XXX
70558.............  26............  A                Mri brain w/dye.......       3.20       1.24       1.24       0.10       4.54       4.54        XXX
70558.............  TC............  C                Mri brain w/dye.......       0.00       0.00       0.00       0.00       0.00       0.00        XXX
70558.............  ..............  C                Mri brain w/dye.......       0.00       0.00       0.00       0.00       0.00       0.00        XXX
70559.............  26............  A                Mri brain w/o & w/dye.       3.20       1.24       1.24       0.12       4.56       4.56        XXX
70559.............  TC............  C                Mri brain w/o & w/dye.       0.00       0.00       0.00       0.00       0.00       0.00        XXX
70559.............  ..............  C                Mri brain w/o & w/dye.       0.00       0.00       0.00       0.00       0.00       0.00        XXX
71010.............  26............  A                Chest x-ray...........       0.18       0.06       0.06       0.01       0.25       0.25        XXX
71010.............  TC............  A                Chest x-ray...........       0.00       0.47         NA       0.02       0.49         NA        XXX
71010.............  ..............  A                Chest x-ray...........       0.18       0.53         NA       0.03       0.74         NA        XXX
71015.............  26............  A                Chest x-ray...........       0.21       0.07       0.07       0.01       0.29       0.29        XXX
71015.............  TC............  A                Chest x-ray...........       0.00       0.52         NA       0.02       0.54         NA        XXX
71015.............  ..............  A                Chest x-ray...........       0.21       0.59         NA       0.03       0.83         NA        XXX
71020.............  26............  A                Chest x-ray...........       0.22       0.07       0.07       0.01       0.30       0.30        XXX
71020.............  TC............  A                Chest x-ray...........       0.00       0.62         NA       0.04       0.66         NA        XXX
71020.............  ..............  A                Chest x-ray...........       0.22       0.69         NA       0.05       0.96         NA        XXX
71021.............  26............  A                Chest x-ray...........       0.27       0.09       0.09       0.01       0.37       0.37        XXX
71021.............  TC............  A                Chest x-ray...........       0.00       0.73         NA       0.05       0.78         NA        XXX
71021.............  ..............  A                Chest x-ray...........       0.27       0.82         NA       0.06       1.15         NA        XXX
71022.............  26............  A                Chest x-ray...........       0.31       0.10       0.10       0.01       0.42       0.42        XXX
71022.............  TC............  A                Chest x-ray...........       0.00       0.73         NA       0.05       0.78         NA        XXX
71022.............  ..............  A                Chest x-ray...........       0.31       0.83         NA       0.06       1.20         NA        XXX
71023.............  26............  A                Chest x-ray and              0.38       0.13       0.13       0.01       0.52       0.52        XXX
                                                      fluoroscopy.
71023.............  TC............  A                Chest x-ray and              0.00       0.78         NA       0.05       0.83         NA        XXX
                                                      fluoroscopy.
71023.............  ..............  A                Chest x-ray and              0.38       0.91         NA       0.06       1.35         NA        XXX
                                                      fluoroscopy.
71030.............  26............  A                Chest x-ray...........       0.31       0.10       0.10       0.01       0.42       0.42        XXX
71030.............  TC............  A                Chest x-ray...........       0.00       0.78         NA       0.05       0.83         NA        XXX
71030.............  ..............  A                Chest x-ray...........       0.31       0.88         NA       0.06       1.25         NA        XXX
71034.............  26............  A                Chest x-ray and              0.46       0.16       0.16       0.02       0.64       0.64        XXX
                                                      fluoroscopy.
71034.............  TC............  A                Chest x-ray and              0.00       1.44         NA       0.08       1.52         NA        XXX
                                                      fluoroscopy.
71034.............  ..............  A                Chest x-ray and              0.46       1.60         NA       0.10       2.16         NA        XXX
                                                      fluoroscopy.
71035.............  26............  A                Chest x-ray...........       0.18       0.06       0.06       0.01       0.25       0.25        XXX
71035.............  TC............  A                Chest x-ray...........       0.00       0.52         NA       0.02       0.54         NA        XXX
71035.............  ..............  A                Chest x-ray...........       0.18       0.58         NA       0.03       0.79         NA        XXX
71040.............  26............  A                Contrast x-ray of            0.58       0.19       0.19       0.03       0.80       0.80        XXX
                                                      bronchi.
71040.............  TC............  A                Contrast x-ray of            0.00       1.46         NA       0.08       1.54         NA        XXX
                                                      bronchi.
71040.............  ..............  A                Contrast x-ray of            0.58       1.65         NA       0.11       2.34         NA        XXX
                                                      bronchi.
71060.............  26............  A                Contrast x-ray of            0.74       0.24       0.24       0.03       1.01       1.01        XXX
                                                      bronchi.
71060.............  TC............  A                Contrast x-ray of            0.00       2.21         NA       0.13       2.34         NA        XXX
                                                      bronchi.
71060.............  ..............  A                Contrast x-ray of            0.74       2.45         NA       0.16       3.35         NA        XXX
                                                      bronchi.
71090.............  26............  A                X-ray & pacemaker            0.54       0.21       0.21       0.02       0.77       0.77        XXX
                                                      insertion.
71090.............  TC............  A                X-ray & pacemaker            0.00       1.68         NA       0.11       1.79         NA        XXX
                                                      insertion.
71090.............  ..............  A                X-ray & pacemaker            0.54       1.89         NA       0.13       2.56         NA        XXX
                                                      insertion.

[[Page 70414]]

 
71100.............  26............  A                X-ray exam of ribs....       0.22       0.07       0.07       0.01       0.30       0.30        XXX
71100.............  TC............  A                X-ray exam of ribs....       0.00       0.57         NA       0.04       0.61         NA        XXX
71100.............  ..............  A                X-ray exam of ribs....       0.22       0.64         NA       0.05       0.91         NA        XXX
71101.............  26............  A                X-ray exam of ribs/          0.27       0.09       0.09       0.01       0.37       0.37        XXX
                                                      chest.
71101.............  TC............  A                X-ray exam of ribs/          0.00       0.67         NA       0.04       0.71         NA        XXX
                                                      chest.
71101.............  ..............  A                X-ray exam of ribs/          0.27       0.76         NA       0.05       1.08         NA        XXX
                                                      chest.
71110.............  26............  A                X-ray exam of ribs....       0.27       0.09       0.09       0.01       0.37       0.37        XXX
71110.............  TC............  A                X-ray exam of ribs....       0.00       0.78         NA       0.05       0.83         NA        XXX
71110.............  ..............  A                X-ray exam of ribs....       0.27       0.87         NA       0.06       1.20         NA        XXX
71111.............  26............  A                X-ray exam of ribs/          0.32       0.10       0.10       0.01       0.43       0.43        XXX
                                                      chest.
71111.............  TC............  A                X-ray exam of ribs/          0.00       0.89         NA       0.06       0.95         NA        XXX
                                                      chest.
71111.............  ..............  A                X-ray exam of ribs/          0.32       0.99         NA       0.07       1.38         NA        XXX
                                                      chest.
71120.............  26............  A                X-ray exam of                0.20       0.07       0.07       0.01       0.28       0.28        XXX
                                                      breastbone.
71120.............  TC............  A                X-ray exam of                0.00       0.65         NA       0.04       0.69         NA        XXX
                                                      breastbone.
71120.............  ..............  A                X-ray exam of                0.20       0.72         NA       0.05       0.97         NA        XXX
                                                      breastbone.
71130.............  26............  A                X-ray exam of                0.22       0.07       0.07       0.01       0.30       0.30        XXX
                                                      breastbone.
71130.............  TC............  A                X-ray exam of                0.00       0.71         NA       0.04       0.75         NA        XXX
                                                      breastbone.
71130.............  ..............  A                X-ray exam of                0.22       0.78         NA       0.05       1.05         NA        XXX
                                                      breastbone.
71250.............  26............  A                Ct thorax w/o dye.....       1.16       0.38       0.38       0.05       1.59       1.59        XXX
71250.............  TC............  A                Ct thorax w/o dye.....       0.00       5.93         NA       0.31       6.24         NA        XXX
71250.............  ..............  A                Ct thorax w/o dye.....       1.16       6.31         NA       0.36       7.83         NA        XXX
71260.............  26............  A                Ct thorax w/dye.......       1.24       0.41       0.41       0.05       1.70       1.70        XXX
71260.............  TC............  A                Ct thorax w/dye.......       0.00       7.09         NA       0.37       7.46         NA        XXX
71260.............  ..............  A                Ct thorax w/dye.......       1.24       7.50         NA       0.42       9.16         NA        XXX
71270.............  26............  A                Ct thorax w/o & w/dye.       1.38       0.45       0.45       0.06       1.89       1.89        XXX
71270.............  TC............  A                Ct thorax w/o & w/dye.       0.00       8.88         NA       0.46       9.34         NA        XXX
71270.............  ..............  A                Ct thorax w/o & w/dye.       1.38       9.33         NA       0.52      11.23         NA        XXX
71275.............  26............  A                Ct angiography, chest.       1.92       0.63       0.63       0.09       2.64       2.64        XXX
71275.............  TC............  A                Ct angiography, chest.       0.00      12.42         NA       0.39      12.81         NA        XXX
71275.............  ..............  A                Ct angiography, chest.       1.92      13.05         NA       0.48      15.45         NA        XXX
71550.............  26............  A                Mri chest w/o dye.....       1.46       0.48       0.48       0.06       2.00       2.00        XXX
71550.............  TC............  A                Mri chest w/o dye.....       0.00      11.23         NA       0.45      11.68         NA        XXX
71550.............  ..............  A                Mri chest w/o dye.....       1.46      11.71         NA       0.51      13.68         NA        XXX
71551.............  26............  A                Mri chest w/dye.......       1.73       0.57       0.57       0.08       2.38       2.38        XXX
71551.............  TC............  A                Mri chest w/dye.......       0.00      13.48         NA       0.52      14.00         NA        XXX
71551.............  ..............  A                Mri chest w/dye.......       1.73      14.05         NA       0.60      16.38         NA        XXX
71552.............  26............  A                Mri chest w/o & w/dye.       2.26       0.74       0.74       0.10       3.10       3.10        XXX
71552.............  TC............  A                Mri chest w/o & w/dye.       0.00      24.95         NA       0.68      25.63         NA        XXX
71552.............  ..............  A                Mri chest w/o & w/dye.       2.26      25.69         NA       0.78      28.73         NA        XXX
71555.............  26............  R                Mri angio chest w or w/      1.81       0.60       0.60       0.08       2.49       2.49        XXX
                                                      o dye.
71555.............  TC............  R                Mri angio chest w or w/      0.00      11.23         NA       0.59      11.82         NA        XXX
                                                      o dye.
71555.............  ..............  R                Mri angio chest w or w/      1.81      11.83         NA       0.67      14.31         NA        XXX
                                                      o dye.
72010.............  26............  A                X-ray exam of spine...       0.45       0.15       0.15       0.02       0.62       0.62        XXX
72010.............  TC............  A                X-ray exam of spine...       0.00       1.02         NA       0.06       1.08         NA        XXX
72010.............  ..............  A                X-ray exam of spine...       0.45       1.17         NA       0.08       1.70         NA        XXX
72020.............  26............  A                X-ray exam of spine...       0.15       0.05       0.05       0.01       0.21       0.21        XXX
72020.............  TC............  A                X-ray exam of spine...       0.00       0.42         NA       0.02       0.44         NA        XXX
72020.............  ..............  A                X-ray exam of spine...       0.15       0.47         NA       0.03       0.65         NA        XXX
72040.............  26............  A                X-ray exam of neck           0.22       0.07       0.07       0.01       0.30       0.30        XXX
                                                      spine.
72040.............  TC............  A                X-ray exam of neck           0.00       0.60         NA       0.04       0.64         NA        XXX
                                                      spine.
72040.............  ..............  A                X-ray exam of neck           0.22       0.67         NA       0.05       0.94         NA        XXX
                                                      spine.
72050.............  26............  A                X-ray exam of neck           0.31       0.10       0.10       0.01       0.42       0.42        XXX
                                                      spine.
72050.............  TC............  A                X-ray exam of neck           0.00       0.89         NA       0.06       0.95         NA        XXX
                                                      spine.
72050.............  ..............  A                X-ray exam of neck           0.31       0.99         NA       0.07       1.37         NA        XXX
                                                      spine.
72052.............  26............  A                X-ray exam of neck           0.36       0.12       0.12       0.02       0.50       0.50        XXX
                                                      spine.
72052.............  TC............  A                X-ray exam of neck           0.00       1.13         NA       0.06       1.19         NA        XXX
                                                      spine.
72052.............  ..............  A                X-ray exam of neck           0.36       1.25         NA       0.08       1.69         NA        XXX
                                                      spine.
72069.............  26............  A                X-ray exam of trunk          0.22       0.08       0.08       0.01       0.31       0.31        XXX
                                                      spine.
72069.............  TC............  A                X-ray exam of trunk          0.00       0.49         NA       0.02       0.51         NA        XXX
                                                      spine.
72069.............  ..............  A                X-ray exam of trunk          0.22       0.57         NA       0.03       0.82         NA        XXX
                                                      spine.
72070.............  26............  A                X-ray exam of thoracic       0.22       0.07       0.07       0.01       0.30       0.30        XXX
                                                      spine.
72070.............  TC............  A                X-ray exam of thoracic       0.00       0.65         NA       0.04       0.69         NA        XXX
                                                      spine.
72070.............  ..............  A                X-ray exam of thoracic       0.22       0.72         NA       0.05       0.99         NA        XXX
                                                      spine.
72072.............  26............  A                X-ray exam of thoracic       0.22       0.07       0.07       0.01       0.30       0.30        XXX
                                                      spine.
72072.............  TC............  A                X-ray exam of thoracic       0.00       0.73         NA       0.05       0.78         NA        XXX
                                                      spine.
72072.............  ..............  A                X-ray exam of thoracic       0.22       0.80         NA       0.06       1.08         NA        XXX
                                                      spine.
72074.............  26............  A                X-ray exam of thoracic       0.22       0.07       0.07       0.01       0.30       0.30        XXX
                                                      spine.
72074.............  TC............  A                X-ray exam of thoracic       0.00       0.91         NA       0.06       0.97         NA        XXX
                                                      spine.
72074.............  ..............  A                X-ray exam of thoracic       0.22       0.98         NA       0.07       1.27         NA        XXX
                                                      spine.
72080.............  26............  A                X-ray exam of trunk          0.22       0.07       0.07       0.01       0.30       0.30        XXX
                                                      spine.
72080.............  TC............  A                X-ray exam of trunk          0.00       0.67         NA       0.04       0.71         NA        XXX
                                                      spine.
72080.............  ..............  A                X-ray exam of trunk          0.22       0.74         NA       0.05       1.01         NA        XXX
                                                      spine.
72090.............  26............  A                X-ray exam of trunk          0.28       0.09       0.09       0.01       0.38       0.38        XXX
                                                      spine.
72090.............  TC............  A                X-ray exam of trunk          0.00       0.67         NA       0.04       0.71         NA        XXX
                                                      spine.
72090.............  ..............  A                X-ray exam of trunk          0.28       0.76         NA       0.05       1.09         NA        XXX
                                                      spine.

[[Page 70415]]

 
72100.............  26............  A                X-ray exam of lower          0.22       0.07       0.07       0.01       0.30       0.30        XXX
                                                      spine.
72100.............  TC............  A                X-ray exam of lower          0.00       0.67         NA       0.04       0.71         NA        XXX
                                                      spine.
72100.............  ..............  A                X-ray exam of lower          0.22       0.74         NA       0.05       1.01         NA        XXX
                                                      spine.
72110.............  26............  A                X-ray exam of lower          0.31       0.10       0.10       0.01       0.42       0.42        XXX
                                                      spine.
72110.............  TC............  A                X-ray exam of lower          0.00       0.91         NA       0.06       0.97         NA        XXX
                                                      spine.
72110.............  ..............  A                X-ray exam of lower          0.31       1.01         NA       0.07       1.39         NA        XXX
                                                      spine.
72114.............  26............  A                X-ray exam of lower          0.36       0.12       0.12       0.02       0.50       0.50        XXX
                                                      spine.
72114.............  TC............  A                X-ray exam of lower          0.00       1.19         NA       0.06       1.25         NA        XXX
                                                      spine.
72114.............  ..............  A                X-ray exam of lower          0.36       1.31         NA       0.08       1.75         NA        XXX
                                                      spine.
72120.............  26............  A                X-ray exam of lower          0.22       0.07       0.07       0.01       0.30       0.30        XXX
                                                      spine.
72120.............  TC............  A                X-ray exam of lower          0.00       0.89         NA       0.06       0.95         NA        XXX
                                                      spine.
72120.............  ..............  A                X-ray exam of lower          0.22       0.96         NA       0.07       1.25         NA        XXX
                                                      spine.
72125.............  26............  A                Ct neck spine w/o dye.       1.16       0.38       0.38       0.05       1.59       1.59        XXX
72125.............  TC............  A                Ct neck spine w/o dye.       0.00       5.93         NA       0.31       6.24         NA        XXX
72125.............  ..............  A                Ct neck spine w/o dye.       1.16       6.31         NA       0.36       7.83         NA        XXX
72126.............  26............  A                Ct neck spine w/dye...       1.22       0.40       0.40       0.05       1.67       1.67        XXX
72126.............  TC............  A                Ct neck spine w/dye...       0.00       7.09         NA       0.37       7.46         NA        XXX
72126.............  ..............  A                Ct neck spine w/dye...       1.22       7.49         NA       0.42       9.13         NA        XXX
72127.............  26............  A                Ct neck spine w/o & w/       1.27       0.42       0.42       0.06       1.75       1.75        XXX
                                                      dye.
72127.............  TC............  A                Ct neck spine w/o & w/       0.00       8.88         NA       0.46       9.34         NA        XXX
                                                      dye.
72127.............  ..............  A                Ct neck spine w/o & w/       1.27       9.30         NA       0.52      11.09         NA        XXX
                                                      dye.
72128.............  26............  A                Ct chest spine w/o dye       1.16       0.38       0.38       0.05       1.59       1.59        XXX
72128.............  TC............  A                Ct chest spine w/o dye       0.00       5.93         NA       0.31       6.24         NA        XXX
72128.............  ..............  A                Ct chest spine w/o dye       1.16       6.31         NA       0.36       7.83         NA        XXX
72129.............  26............  A                Ct chest spine w/dye..       1.22       0.40       0.40       0.05       1.67       1.67        XXX
72129.............  TC............  A                Ct chest spine w/dye..       0.00       7.09         NA       0.37       7.46         NA        XXX
72129.............  ..............  A                Ct chest spine w/dye..       1.22       7.49         NA       0.42       9.13         NA        XXX
72130.............  26............  A                Ct chest spine w/o & w/      1.27       0.42       0.42       0.06       1.75       1.75        XXX
                                                      dye.
72130.............  TC............  A                Ct chest spine w/o & w/      0.00       8.88         NA       0.46       9.34         NA        XXX
                                                      dye.
72130.............  ..............  A                Ct chest spine w/o & w/      1.27       9.30         NA       0.52      11.09         NA        XXX
                                                      dye.
72131.............  26............  A                Ct lumbar spine w/o          1.16       0.38       0.38       0.05       1.59       1.59        XXX
                                                      dye.
72131.............  TC............  A                Ct lumbar spine w/o          0.00       5.93         NA       0.31       6.24         NA        XXX
                                                      dye.
72131.............  ..............  A                Ct lumbar spine w/o          1.16       6.31         NA       0.36       7.83         NA        XXX
                                                      dye.
72132.............  26............  A                Ct lumbar spine w/dye.       1.22       0.40       0.40       0.05       1.67       1.67        XXX
72132.............  TC............  A                Ct lumbar spine w/dye.       0.00       7.09         NA       0.37       7.46         NA        XXX
72132.............  ..............  A                Ct lumbar spine w/dye.       1.22       7.49         NA       0.42       9.13         NA        XXX
72133.............  26............  A                Ct lumbar spine w/o &        1.27       0.42       0.42       0.06       1.75       1.75        XXX
                                                      w/dye.
72133.............  TC............  A                Ct lumbar spine w/o &        0.00       8.88         NA       0.46       9.34         NA        XXX
                                                      w/dye.
72133.............  ..............  A                Ct lumbar spine w/o &        1.27       9.30         NA       0.52      11.09         NA        XXX
                                                      w/dye.
72141.............  26............  A                Mri neck spine w/o dye       1.60       0.53       0.53       0.07       2.20       2.20        XXX
72141.............  TC............  A                Mri neck spine w/o dye       0.00      11.23         NA       0.59      11.82         NA        XXX
72141.............  ..............  A                Mri neck spine w/o dye       1.60      11.76         NA       0.66      14.02         NA        XXX
72142.............  26............  A                Mri neck spine w/dye..       1.92       0.64       0.64       0.09       2.65       2.65        XXX
72142.............  TC............  A                Mri neck spine w/dye..       0.00      13.48         NA       0.70      14.18         NA        XXX
72142.............  ..............  A                Mri neck spine w/dye..       1.92      14.12         NA       0.79      16.83         NA        XXX
72146.............  26............  A                Mri chest spine w/o          1.60       0.53       0.53       0.07       2.20       2.20        XXX
                                                      dye.
72146.............  TC............  A                Mri chest spine w/o          0.00      12.48         NA       0.64      13.12         NA        XXX
                                                      dye.
72146.............  ..............  A                Mri chest spine w/o          1.60      13.01         NA       0.71      15.32         NA        XXX
                                                      dye.
72147.............  26............  A                Mri chest spine w/dye.       1.92       0.63       0.63       0.09       2.64       2.64        XXX
72147.............  TC............  A                Mri chest spine w/dye.       0.00      13.48         NA       0.70      14.18         NA        XXX
72147.............  ..............  A                Mri chest spine w/dye.       1.92      14.11         NA       0.79      16.82         NA        XXX
72148.............  26............  A                Mri lumbar spine w/o         1.48       0.49       0.49       0.07       2.04       2.04        XXX
                                                      dye.
72148.............  TC............  A                Mri lumbar spine w/o         0.00      12.48         NA       0.64      13.12         NA        XXX
                                                      dye.
72148.............  ..............  A                Mri lumbar spine w/o         1.48      12.97         NA       0.71      15.16         NA        XXX
                                                      dye.
72149.............  26............  A                Mri lumbar spine w/dye       1.78       0.60       0.60       0.08       2.46       2.46        XXX
72149.............  TC............  A                Mri lumbar spine w/dye       0.00      13.48         NA       0.70      14.18         NA        XXX
72149.............  ..............  A                Mri lumbar spine w/dye       1.78      14.08         NA       0.78      16.64         NA        XXX
72156.............  26............  A                Mri neck spine w/o & w/      2.57       0.85       0.85       0.11       3.53       3.53        XXX
                                                      dye.
72156.............  TC............  A                Mri neck spine w/o & w/      0.00      24.95         NA       1.31      26.26         NA        XXX
                                                      dye.
72156.............  ..............  A                Mri neck spine w/o & w/      2.57      25.80         NA       1.42      29.79         NA        XXX
                                                      dye.
72157.............  26............  A                Mri chest spine w/o &        2.57       0.84       0.84       0.11       3.52       3.52        XXX
                                                      w/dye.
72157.............  TC............  A                Mri chest spine w/o &        0.00      24.95         NA       1.31      26.26         NA        XXX
                                                      w/dye.
72157.............  ..............  A                Mri chest spine w/o &        2.57      25.79         NA       1.42      29.78         NA        XXX
                                                      w/dye.
72158.............  26............  A                Mri lumbar spine w/o &       2.36       0.78       0.78       0.10       3.24       3.24        XXX
                                                      w/dye.
72158.............  TC............  A                Mri lumbar spine w/o &       0.00      24.95         NA       1.31      26.26         NA        XXX
                                                      w/dye.
72158.............  ..............  A                Mri lumbar spine w/o &       2.36      25.73         NA       1.41      29.50         NA        XXX
                                                      w/dye.
72159.............  26............  N                Mr angio spine w/o&w/       +1.80       0.69       0.69       0.10       2.59       2.59        XXX
                                                      dye.
72159.............  TC............  N                Mr angio spine w/o&w/       +0.00      12.27      12.27       0.64      12.91      12.91        XXX
                                                      dye.
72159.............  ..............  N                Mr angio spine w/o&w/       +1.80      12.96      12.96       0.74      15.50      15.50        XXX
                                                      dye.
72170.............  26............  A                X-ray exam of pelvis..       0.17       0.06       0.06       0.01       0.24       0.24        XXX
72170.............  TC............  A                X-ray exam of pelvis..       0.00       0.52         NA       0.02       0.54         NA        XXX
72170.............  ..............  A                X-ray exam of pelvis..       0.17       0.58         NA       0.03       0.78         NA        XXX
72190.............  26............  A                X-ray exam of pelvis..       0.21       0.07       0.07       0.01       0.29       0.29        XXX
72190.............  TC............  A                X-ray exam of pelvis..       0.00       0.67         NA       0.04       0.71         NA        XXX
72190.............  ..............  A                X-ray exam of pelvis..       0.21       0.74         NA       0.05       1.00         NA        XXX

[[Page 70416]]

 
72191.............  26............  A                Ct angiograph pelv w/        1.81       0.60       0.60       0.08       2.49       2.49        XXX
                                                      o&w/dye.
72191.............  TC............  A                Ct angiograph pelv w/        0.00      12.06         NA       0.39      12.45         NA        XXX
                                                      o&w/dye.
72191.............  ..............  A                Ct angiograph pelv w/        1.81      12.66         NA       0.47      14.94         NA        XXX
                                                      o&w/dye.
72192.............  26............  A                Ct pelvis w/o dye.....       1.09       0.36       0.36       0.05       1.50       1.50        XXX
72192.............  TC............  A                Ct pelvis w/o dye.....       0.00       5.93         NA       0.31       6.24         NA        XXX
72192.............  ..............  A                Ct pelvis w/o dye.....       1.09       6.29         NA       0.36       7.74         NA        XXX
72193.............  26............  A                Ct pelvis w/dye.......       1.16       0.38       0.38       0.05       1.59       1.59        XXX
72193.............  TC............  A                Ct pelvis w/dye.......       0.00       6.86         NA       0.36       7.22         NA        XXX
72193.............  ..............  A                Ct pelvis w/dye.......       1.16       7.24         NA       0.41       8.81         NA        XXX
72194.............  26............  A                Ct pelvis w/o & w/dye.       1.22       0.40       0.40       0.05       1.67       1.67        XXX
72194.............  TC............  A                Ct pelvis w/o & w/dye.       0.00       8.51         NA       0.43       8.94         NA        XXX
72194.............  ..............  A                Ct pelvis w/o & w/dye.       1.22       8.91         NA       0.48      10.61         NA        XXX
72195.............  26............  A                Mri pelvis w/o dye....       1.46       0.48       0.48       0.06       2.00       2.00        XXX
72195.............  TC............  A                Mri pelvis w/o dye....       0.00      11.23         NA       0.45      11.68         NA        XXX
72195.............  ..............  A                Mri pelvis w/o dye....       1.46      11.71         NA       0.51      13.68         NA        XXX
72196.............  26............  A                Mri pelvis w/dye......       1.73       0.57       0.57       0.08       2.38       2.38        XXX
72196.............  TC............  A                Mri pelvis w/dye......       0.00      13.48         NA       0.52      14.00         NA        XXX
72196.............  ..............  A                Mri pelvis w/dye......       1.73      14.05         NA       0.60      16.38         NA        XXX
72197.............  26............  A                Mri pelvis w/o & w/dye       2.26       0.74       0.74       0.10       3.10       3.10        XXX
72197.............  TC............  A                Mri pelvis w/o & w/dye       0.00      24.95         NA       0.92      25.87         NA        XXX
72197.............  ..............  A                Mri pelvis w/o & w/dye       2.26      25.69         NA       1.02      28.97         NA        XXX
72198.............  26............  A                Mr angio pelvis w/o &        1.80       0.59       0.59       0.08       2.47       2.47        XXX
                                                      w/dye.
72198.............  TC............  A                Mr angio pelvis w/o &        0.00      11.23         NA       0.59      11.82         NA        XXX
                                                      w/dye.
72198.............  ..............  A                Mr angio pelvis w/o &        1.80      11.82         NA       0.67      14.29         NA        XXX
                                                      w/dye.
72200.............  26............  A                X-ray exam sacroiliac        0.17       0.06       0.06       0.01       0.24       0.24        XXX
                                                      joints.
72200.............  TC............  A                X-ray exam sacroiliac        0.00       0.52         NA       0.02       0.54         NA        XXX
                                                      joints.
72200.............  ..............  A                X-ray exam sacroiliac        0.17       0.58         NA       0.03       0.78         NA        XXX
                                                      joints.
72202.............  26............  A                X-ray exam sacroiliac        0.19       0.06       0.06       0.01       0.26       0.26        XXX
                                                      joints.
72202.............  TC............  A                X-ray exam sacroiliac        0.00       0.62         NA       0.04       0.66         NA        XXX
                                                      joints.
72202.............  ..............  A                X-ray exam sacroiliac        0.19       0.68         NA       0.05       0.92         NA        XXX
                                                      joints.
72220.............  26............  A                X-ray exam of tailbone       0.17       0.06       0.06       0.01       0.24       0.24        XXX
72220.............  TC............  A                X-ray exam of tailbone       0.00       0.57         NA       0.04       0.61         NA        XXX
72220.............  ..............  A                X-ray exam of tailbone       0.17       0.63         NA       0.05       0.85         NA        XXX
72240.............  26............  A                Contrast x-ray of neck       0.91       0.29       0.29       0.04       1.24       1.24        XXX
                                                      spine.
72240.............  TC............  A                Contrast x-ray of neck       0.00       4.76         NA       0.25       5.01         NA        XXX
                                                      spine.
72240.............  ..............  A                Contrast x-ray of neck       0.91       5.05         NA       0.29       6.25         NA        XXX
                                                      spine.
72255.............  26............  A                Contrast x-ray, thorax       0.91       0.27       0.27       0.04       1.22       1.22        XXX
                                                      spine.
72255.............  TC............  A                Contrast x-ray, thorax       0.00       4.34         NA       0.22       4.56         NA        XXX
                                                      spine.
72255.............  ..............  A                Contrast x-ray, thorax       0.91       4.61         NA       0.26       5.78         NA        XXX
                                                      spine.
72265.............  26............  A                Contrast x-ray, lower        0.83       0.25       0.25       0.04       1.12       1.12        XXX
                                                      spine.
72265.............  C.............  A                Contrast x-ray, lower        0.00       4.08         NA       0.22       4.30         NA        XXX
                                                      spine.
72265.............  ..............  A                Contrast x-ray, lower        0.83       4.33         NA       0.26       5.42         NA        XXX
                                                      spine.
72270.............  26............  A                Contrast x-ray, spine.       1.33       0.42       0.42       0.06       1.81       1.81        XXX
72270.............  TC............  A                Contrast x-ray, spine.       0.00       6.12         NA       0.33       6.45         NA        XXX
72270.............  ..............  A                Contrast x-ray, spine.       1.33       6.54         NA       0.39       8.26         NA        XXX
72275.............  26............  A                Epidurography.........       0.76       0.20       0.20       0.04       1.00       1.00        XXX
72275.............  TC............  A                Epidurography.........       0.00       2.11         NA       0.22       2.33         NA        XXX
72275.............  ..............  A                Epidurography.........       0.76       2.31         NA       0.26       3.33         NA        XXX
72285.............  26............  A                X-ray c/t spine disk..       1.16       0.36       0.36       0.07       1.59       1.59        XXX
72285.............  TC............  A                X-ray c/t spine disk..       0.00       8.40         NA       0.43       8.83         NA        XXX
72285.............  ..............  A                X-ray c/t spine disk..       1.16       8.76         NA       0.50      10.42         NA        XXX
72295.............  26............  A                X-ray of lower spine         0.83       0.27       0.27       0.06       1.16       1.16        XXX
                                                      disk.
72295.............  TC............  A                X-ray of lower spine         0.00       7.88         NA       0.40       8.28         NA        XXX
                                                      disk.
72295.............  ..............  A                X-ray of lower spine         0.83       8.15         NA       0.46       9.44         NA        XXX
                                                      disk.
73000.............  26............  A                X-ray exam of collar         0.16       0.05       0.05       0.01       0.22       0.22        XXX
                                                      bone.
73000.............  TC............  A                X-ray exam of collar         0.00       0.52         NA       0.02       0.54         NA        XXX
                                                      bone.
73000.............  ..............  A                X-ray exam of collar         0.16       0.57         NA       0.03       0.76         NA        XXX
                                                      bone.
73010.............  26............  A                X-ray exam of shoulder       0.17       0.06       0.06       0.01       0.24       0.24        XXX
                                                      blade.
73010.............  TC............  A                X-ray exam of shoulder       0.00       0.52         NA       0.02       0.54         NA        XXX
                                                      blade.
73010.............  ..............  A                X-ray exam of shoulder       0.17       0.58         NA       0.03       0.78         NA        XXX
                                                      blade.
73020.............  26............  A                X-ray exam of shoulder       0.15       0.05       0.05       0.01       0.21       0.21        XXX
73020.............  TC............  A                X-ray exam of shoulder       0.00       0.47         NA       0.02       0.49         NA        XXX
73020.............  ..............  A                X-ray exam of shoulder       0.15       0.52         NA       0.03       0.70         NA        XXX
73030.............  26............  A                X-ray exam of shoulder       0.18       0.06       0.06       0.01       0.25       0.25        XXX
73030.............  TC............  A                X-ray exam of shoulder       0.00       0.57         NA       0.04       0.61         NA        XXX
73030.............  ..............  A                X-ray exam of shoulder       0.18       0.63         NA       0.05       0.86         NA        XXX
73040.............  26............  A                Contrast x-ray of            0.54       0.18       0.18       0.02       0.74       0.74        XXX
                                                      shoulder.
73040.............  TC............  A                Contrast x-ray of            0.00       2.11         NA       0.12       2.23         NA        XXX
                                                      shoulder.
73040.............  ..............  A                Contrast x-ray of            0.54       2.29         NA       0.14       2.97         NA        XXX
                                                      shoulder.
73050.............  26............  A                X-ray exam of                0.20       0.07       0.07       0.01       0.28       0.28        XXX
                                                      shoulders.
73050.............  TC............  A                X-ray exam of                0.00       0.67         NA       0.04       0.71         NA        XXX
                                                      shoulders.
73050.............  ..............  A                X-ray exam of                0.20       0.74         NA       0.05       0.99         NA        XXX
                                                      shoulders.
73060.............  26............  A                X-ray exam of humerus.       0.17       0.06       0.06       0.01       0.24       0.24        XXX
73060.............  TC............  A                X-ray exam of humerus.       0.00       0.57         NA       0.04       0.61         NA        XXX
73060.............  ..............  A                X-ray exam of humerus.       0.17       0.63         NA       0.05       0.85         NA        XXX

[[Page 70417]]

 
73070.............  26............  A                X-ray exam of elbow...       0.15       0.05       0.05       0.01       0.21       0.21        XXX
73070.............  TC............  A                X-ray exam of elbow...       0.00       0.52         NA       0.02       0.54         NA        XXX
73070.............  ..............  A                X-ray exam of elbow...       0.15       0.57         NA       0.03       0.75         NA        XXX
73080.............  26............  A                X-ray exam of elbow...       0.17       0.06       0.06       0.01       0.24       0.24        XXX
73080.............  TC............  A                X-ray exam of elbow...       0.00       0.57         NA       0.04       0.61         NA        XXX
73080.............  ..............  A                X-ray exam of elbow...       0.17       0.63         NA       0.05       0.85         NA        XXX
73085.............  26............  A                Contrast x-ray of            0.54       0.19       0.19       0.02       0.75       0.75        XXX
                                                      elbow.
73085.............  TC............  A                Contrast x-ray of            0.00       2.11         NA       0.12       2.23         NA        XXX
                                                      elbow.
73085.............  ..............  A                Contrast x-ray of            0.54       2.30         NA       0.14       2.98         NA        XXX
                                                      elbow.
73090.............  26............  A                X-ray exam of forearm.       0.16       0.05       0.05       0.01       0.22       0.22        XXX
73090.............  TC............  A                X-ray exam of forearm.       0.00       0.52         NA       0.02       0.54         NA        XXX
73090.............  ..............  A                X-ray exam of forearm.       0.16       0.57         NA       0.03       0.76         NA        XXX
73092.............  26............  A                X-ray exam of arm,           0.16       0.05       0.05       0.01       0.22       0.22        XXX
                                                      infant.
73092.............  TC............  A                X-ray exam of arm,           0.00       0.49         NA       0.02       0.51         NA        XXX
                                                      infant.
73092.............  ..............  A                X-ray exam of arm,           0.16       0.54         NA       0.03       0.73         NA        XXX
                                                      infant.
73100.............  26............  A                X-ray exam of wrist...       0.16       0.05       0.05       0.01       0.22       0.22        XXX
73100.............  TC............  A                X-ray exam of wrist...       0.00       0.49         NA       0.02       0.51         NA        XXX
73100.............  ..............  A                X-ray exam of wrist...       0.16       0.54         NA       0.03       0.73         NA        XXX
73110.............  26............  A                X-ray exam of wrist...       0.17       0.06       0.06       0.01       0.24       0.24        XXX
73110.............  TC............  A                X-ray exam of wrist...       0.00       0.53         NA       0.02       0.55         NA        XXX
73110.............  ..............  A                X-ray exam of wrist...       0.17       0.59         NA       0.03       0.79         NA        XXX
73115.............  26............  A                Contrast x-ray of            0.54       0.18       0.18       0.02       0.74       0.74        XXX
                                                      wrist.
73115.............  TC............  A                Contrast x-ray of            0.00       1.58         NA       0.10       1.68         NA        XXX
                                                      wrist.
73115.............  ..............  A                Contrast x-ray of            0.54       1.76         NA       0.12       2.42         NA        XXX
                                                      wrist.
73120.............  26............  A                X-ray exam of hand....       0.16       0.05       0.05       0.01       0.22       0.22        XXX
73120.............  TC............  A                X-ray exam of hand....       0.00       0.49         NA       0.02       0.51         NA        XXX
73120.............  ..............  A                X-ray exam of hand....       0.16       0.54         NA       0.03       0.73         NA        XXX
73130.............  26............  A                X-ray exam of hand....       0.17       0.06       0.06       0.01       0.24       0.24        XXX
73130.............  TC............  A                X-ray exam of hand....       0.00       0.53         NA       0.02       0.55         NA        XXX
73130.............  ..............  A                X-ray exam of hand....       0.17       0.59         NA       0.03       0.79         NA        XXX
73140.............  26............  A                X-ray exam of                0.13       0.04       0.04       0.01       0.18       0.18        XXX
                                                      finger(s).
73140.............  TC............  A                X-ray exam of                0.00       0.42         NA       0.02       0.44         NA        XXX
                                                      finger(s).
73140.............  ..............  A                X-ray exam of                0.13       0.46         NA       0.03       0.62         NA        XXX
                                                      finger(s).
73200.............  26............  A                Ct upper extremity w/o       1.09       0.36       0.36       0.05       1.50       1.50        XXX
                                                      dye.
73200.............  TC............  A                Ct upper extremity w/o       0.00       4.97         NA       0.25       5.22         NA        XXX
                                                      dye.
73200.............  ..............  A                Ct upper extremity w/o       1.09       5.33         NA       0.30       6.72         NA        XXX
                                                      dye.
73201.............  26............  A                Ct upper extremity w/        1.16       0.38       0.38       0.05       1.59       1.59        XXX
                                                      dye.
73201.............  TC............  A                Ct upper extremity w/        0.00       5.93         NA       0.31       6.24         NA        XXX
                                                      dye.
73201.............  ..............  A                Ct upper extremity w/        1.16       6.31         NA       0.36       7.83         NA        XXX
                                                      dye.
73202.............  26............  A                Ct uppr extremity w/         1.22       0.40       0.40       0.05       1.67       1.67        XXX
                                                      o&w/dye.
73202.............  TC............  A                Ct uppr extremity w/         0.00       7.44         NA       0.39       7.83         NA        XXX
                                                      o&w/dye.
73202.............  ..............  A                Ct uppr extremity w/         1.22       7.84         NA       0.44       9.50         NA        XXX
                                                      o&w/dye.
73206.............  26............  A                Ct angio upr extrm w/        1.81       0.59       0.59       0.08       2.48       2.48        XXX
                                                      o&w/dye.
73206.............  TC............  A                Ct angio upr extrm w/        0.00      10.99         NA       0.39      11.38         NA        XXX
                                                      o&w/dye.
73206.............  ..............  A                Ct angio upr extrm w/        1.81      11.58         NA       0.47      13.86         NA        XXX
                                                      o&w/dye.
73218.............  26............  A                Mri upper extremity w/       1.35       0.44       0.44       0.06       1.85       1.85        XXX
                                                      o dye.
73218.............  TC............  A                Mri upper extremity w/       0.00      11.23         NA       0.39      11.62         NA        XXX
                                                      o dye.
73218.............  ..............  A                Mri upper extremity w/       1.35      11.67         NA       0.45      13.47         NA        XXX
                                                      o dye.
73219.............  26............  A                Mri upper extremity w/       1.62       0.54       0.54       0.07       2.23       2.23        XXX
                                                      dye.
73219.............  TC............  A                Mri upper extremity w/       0.00      13.48         NA       0.47      13.95         NA        XXX
                                                      dye.
73219.............  ..............  A                Mri upper extremity w/       1.62      14.02         NA       0.54      16.18         NA        XXX
                                                      dye.
73220.............  26............  A                Mri uppr extremity w/        2.15       0.71       0.71       0.10       2.96       2.96        XXX
                                                      o&w/dye.
73220.............  TC............  A                Mri uppr extremity w/        0.00      24.95         NA       0.84      25.79         NA        XXX
                                                      o&w/dye.
73220.............  ..............  A                Mri uppr extremity w/        2.15      25.66         NA       0.94      28.75         NA        XXX
                                                      o&w/dye.
73221.............  26............  A                Mri joint upr extrem w/      1.35       0.44       0.44       0.06       1.85       1.85        XXX
                                                      o dye.
73221.............  TC............  A                Mri joint upr extrem w/      0.00      11.23         NA       0.39      11.62         NA        XXX
                                                      o dye.
73221.............  ..............  A                Mri joint upr extrem w/      1.35      11.67         NA       0.45      13.47         NA        XXX
                                                      o dye.
73222.............  26............  A                Mri joint upr extrem w/      1.62       0.53       0.53       0.07       2.22       2.22        XXX
                                                      dye.
73222.............  TC............  A                Mri joint upr extrem w/      0.00      13.48         NA       0.47      13.95         NA        XXX
                                                      dye.
73222.............  ..............  A                Mri joint upr extrem w/      1.62      14.01         NA       0.54      16.17         NA        XXX
                                                      dye.
73223.............  26............  A                Mri joint upr extr w/        2.15       0.71       0.71       0.10       2.96       2.96        XXX
                                                      o&w/dye.
73223.............  TC............  A                Mri joint upr extr w/        0.00      24.95         NA       0.84      25.79         NA        XXX
                                                      o&w/dye.
73223.............  ..............  A                Mri joint upr extr w/        2.15      25.66         NA       0.94      28.75         NA        XXX
                                                      o&w/dye.
73225.............  26............  N                Mr angio upr extr w/        +1.73       0.67       0.67       0.10       2.50       2.50        XXX
                                                      o&w/dye.
73225.............  TC............  N                Mr angio upr extr w/        +0.00      11.04      11.04       0.59      11.63      11.63        XXX
                                                      o&w/dye.
73225.............  ..............  N                Mr angio upr extr w/        +1.73      11.71      11.71       0.69      14.13      14.13        XXX
                                                      o&w/dye.
73500.............  26............  A                X-ray exam of hip.....       0.17       0.06       0.06       0.01       0.24       0.24        XXX
73500.............  TC............  A                X-ray exam of hip.....       0.00       0.47         NA       0.02       0.49         NA        XXX
73500.............  ..............  A                X-ray exam of hip.....       0.17       0.53         NA       0.03       0.73         NA        XXX
73510.............  26............  A                X-ray exam of hip.....       0.21       0.07       0.07       0.01       0.29       0.29        XXX
73510.............  TC............  A                X-ray exam of hip.....       0.00       0.57         NA       0.04       0.61         NA        XXX
73510.............  ..............  A                X-ray exam of hip.....       0.21       0.64         NA       0.05       0.90         NA        XXX
73520.............  26............  A                X-ray exam of hips....       0.26       0.09       0.09       0.01       0.36       0.36        XXX
73520.............  TC............  A                X-ray exam of hips....       0.00       0.67         NA       0.04       0.71         NA        XXX
73520.............  ..............  A                X-ray exam of hips....       0.26       0.76         NA       0.05       1.07         NA        XXX

[[Page 70418]]

 
73525.............  26............  A                Contrast x-ray of hip.       0.54       0.18       0.18       0.03       0.75       0.75        XXX
73525.............  TC............  A                Contrast x-ray of hip.       0.00       2.11         NA       0.12       2.23         NA        XXX
73525.............  ..............  A                Contrast x-ray of hip.       0.54       2.29         NA       0.15       2.98         NA        XXX
73530.............  26............  A                X-ray exam of hip.....       0.29       0.10       0.10       0.01       0.40       0.40        XXX
73530.............  TC............  A                X-ray exam of hip.....       0.00       0.52         NA       0.02       0.54         NA        XXX
73530.............  ..............  A                X-ray exam of hip.....       0.29       0.62         NA       0.03       0.94         NA        XXX
73540.............  26............  A                X-ray exam of pelvis &       0.20       0.07       0.07       0.01       0.28       0.28        XXX
                                                      hips.
73540.............  TC............  A                X-ray exam of pelvis &       0.00       0.57         NA       0.04       0.61         NA        XXX
                                                      hips.
73540.............  ..............  A                X-ray exam of pelvis &       0.20       0.64         NA       0.05       0.89         NA        XXX
                                                      hips.
73542.............  26............  A                X-ray exam, sacroiliac       0.59       0.16       0.16       0.03       0.78       0.78        XXX
                                                      joint.
73542.............  TC............  A                X-ray exam, sacroiliac       0.00       2.11         NA       0.12       2.23         NA        XXX
                                                      joint.
73542.............  ..............  A                X-ray exam, sacroiliac       0.59       2.27         NA       0.15       3.01         NA        XXX
                                                      joint.
73550.............  26............  A                X-ray exam of thigh...       0.17       0.06       0.06       0.01       0.24       0.24        XXX
73550.............  TC............  A                X-ray exam of thigh...       0.00       0.57         NA       0.04       0.61         NA        XXX
73550.............  ..............  A                X-ray exam of thigh...       0.17       0.63         NA       0.05       0.85         NA        XXX
73560.............  26............  A                X-ray exam of knee, 1        0.17       0.06       0.06       0.01       0.24       0.24        XXX
                                                      or 2.
73560.............  TC............  A                X-ray exam of knee, 1        0.00       0.52         NA       0.02       0.54         NA        XXX
                                                      or 2.
73560.............  ..............  A                X-ray exam of knee, 1        0.17       0.58         NA       0.03       0.78         NA        XXX
                                                      or 2.
73562.............  26............  A                X-ray exam of knee, 3.       0.18       0.06       0.06       0.01       0.25       0.25        XXX
73562.............  TC............  A                X-ray exam of knee, 3.       0.00       0.57         NA       0.04       0.61         NA        XXX
73562.............  ..............  A                X-ray exam of knee, 3.       0.18       0.63         NA       0.05       0.86         NA        XXX
73564.............  26............  A                X-ray exam, knee, 4 or       0.22       0.07       0.07       0.01       0.30       0.30        XXX
                                                      more.
73564.............  TC............  A                X-ray exam, knee, 4 or       0.00       0.62         NA       0.04       0.66         NA        XXX
                                                      more.
73564.............  ..............  A                X-ray exam, knee, 4 or       0.22       0.69         NA       0.05       0.96         NA        XXX
                                                      more.
73565.............  26............  A                X-ray exam of knees...       0.17       0.06       0.06       0.01       0.24       0.24        XXX
73565.............  TC............  A                X-ray exam of knees...       0.00       0.49         NA       0.02       0.51         NA        XXX
73565.............  ..............  A                X-ray exam of knees...       0.17       0.55         NA       0.03       0.75         NA        XXX
73580.............  26............  A                Contrast x-ray of knee       0.54       0.17       0.17       0.03       0.74       0.74        XXX
                                                      joint.
73580.............  TC............  A                Contrast x-ray of knee       0.00       2.63         NA       0.14       2.77         NA        XXX
                                                      joint.
73580.............  ..............  A                Contrast x-ray of knee       0.54       2.80         NA       0.17       3.51         NA        XXX
                                                      joint.
73590.............  26............  A                X-ray exam of lower          0.17       0.06       0.06       0.01       0.24       0.24        XXX
                                                      leg.
73590.............  TC............  A                X-ray exam of lower          0.00       0.52         NA       0.02       0.54         NA        XXX
                                                      leg.
73590.............  ..............  A                X-ray exam of lower          0.17       0.58         NA       0.03       0.78         NA        XXX
                                                      leg.
73592.............  26............  A                X-ray exam of leg,           0.16       0.05       0.05       0.01       0.22       0.22        XXX
                                                      infant.
73592.............  TC............  A                X-ray exam of leg,           0.00       0.49         NA       0.02       0.51         NA        XXX
                                                      infant.
73592.............  ..............  A                X-ray exam of leg,           0.16       0.54         NA       0.03       0.73         NA        XXX
                                                      infant.
73600.............  26............  A                X-ray exam of ankle...       0.16       0.05       0.05       0.01       0.22       0.22        XXX
73600.............  TC............  A                X-ray exam of ankle...       0.00       0.49         NA       0.02       0.51         NA        XXX
73600.............  ..............  A                X-ray exam of ankle...       0.16       0.54         NA       0.03       0.73         NA        XXX
73610.............  26............  A                X-ray exam of ankle...       0.17       0.06       0.06       0.01       0.24       0.24        XXX
73610.............  TC............  A                X-ray exam of ankle...       0.00       0.53         NA       0.02       0.55         NA        XXX
73610.............  ..............  A                X-ray exam of ankle...       0.17       0.59         NA       0.03       0.79         NA        XXX
73615.............  26............  A                Contrast x-ray of            0.54       0.18       0.18       0.03       0.75       0.75        XXX
                                                      ankle.
73615.............  TC............  A                Contrast x-ray of            0.00       2.11         NA       0.12       2.23         NA        XXX
                                                      ankle.
73615.............  ..............  A                Contrast x-ray of            0.54       2.29         NA       0.15       2.98         NA        XXX
                                                      ankle.
73620.............  26............  A                X-ray exam of foot....       0.16       0.05       0.05       0.01       0.22       0.22        XXX
73620.............  TC............  A                X-ray exam of foot....       0.00       0.49         NA       0.02       0.51         NA        XXX
73620.............  ..............  A                X-ray exam of foot....       0.16       0.54         NA       0.03       0.73         NA        XXX
73630.............  26............  A                X-ray exam of foot....       0.17       0.06       0.06       0.01       0.24       0.24        XXX
73630.............  TC............  A                X-ray exam of foot....       0.00       0.53         NA       0.02       0.55         NA        XXX
73630.............  ..............  A                X-ray exam of foot....       0.17       0.59         NA       0.03       0.79         NA        XXX
73650.............  26............  A                X-ray exam of heel....       0.16       0.05       0.05       0.01       0.22       0.22        XXX
73650.............  TC............  A                X-ray exam of heel....       0.00       0.47         NA       0.02       0.49         NA        XXX
73650.............  ..............  A                X-ray exam of heel....       0.16       0.52         NA       0.03       0.71         NA        XXX
73660.............  26............  A                X-ray exam of toe(s)..       0.13       0.04       0.04       0.01       0.18       0.18        XXX
73660.............  TC............  A                X-ray exam of toe(s)..       0.00       0.42         NA       0.02       0.44         NA        XXX
73660.............  ..............  A                X-ray exam of toe(s)..       0.13       0.46         NA       0.03       0.62         NA        XXX
73700.............  26............  A                Ct lower extremity w/o       1.09       0.36       0.36       0.05       1.50       1.50        XXX
                                                      dye.
73700.............  TC............  A                Ct lower extremity w/o       0.00       4.97         NA       0.25       5.22         NA        XXX
                                                      dye.
73700.............  ..............  A                Ct lower extremity w/o       1.09       5.33         NA       0.30       6.72         NA        XXX
                                                      dye.
73701.............  26............  A                Ct lower extremity w/        1.16       0.38       0.38       0.05       1.59       1.59        XXX
                                                      dye.
73701.............  TC............  A                Ct lower extremity w/        0.00       5.93         NA       0.31       6.24         NA        XXX
                                                      dye.
73701.............  ..............  A                Ct lower extremity w/        1.16       6.31         NA       0.36       7.83         NA        XXX
                                                      dye.
73702.............  26............  A                Ct lwr extremity w/o&w/      1.22       0.40       0.40       0.05       1.67       1.67        XXX
                                                      dye.
73702.............  TC............  A                Ct lwr extremity w/o&w/      0.00       7.44         NA       0.39       7.83         NA        XXX
                                                      dye.
73702.............  ..............  A                Ct lwr extremity w/o&w/      1.22       7.84         NA       0.44       9.50         NA        XXX
                                                      dye.
73706.............  26............  A                Ct angio lwr extr w/         1.90       0.62       0.62       0.08       2.60       2.60        XXX
                                                      o&w/dye.
73706.............  TC............  A                Ct angio lwr extr w/         0.00      10.99         NA       0.39      11.38         NA        XXX
                                                      o&w/dye.
73706.............  ..............  A                Ct angio lwr extr w/         1.90      11.61         NA       0.47      13.98         NA        XXX
                                                      o&w/dye.
73718.............  26............  A                Mri lower extremity w/       1.35       0.44       0.44       0.06       1.85       1.85        XXX
                                                      o dye.
73718.............  TC............  A                Mri lower extremity w/       0.00      11.23         NA       0.39      11.62         NA        XXX
                                                      o dye.
73718.............  ..............  A                Mri lower extremity w/       1.35      11.67         NA       0.45      13.47         NA        XXX
                                                      o dye.
73719.............  26............  A                Mri lower extremity w/       1.62       0.53       0.53       0.07       2.22       2.22        XXX
                                                      dye.
73719.............  TC............  A                Mri lower extremity w/       0.00      13.48         NA       0.47      13.95         NA        XXX
                                                      dye.
73719.............  ..............  A                Mri lower extremity w/       1.62      14.01         NA       0.54      16.17         NA        XXX
                                                      dye.

[[Page 70419]]

 
73720.............  26............  A                Mri lwr extremity w/         2.15       0.70       0.70       0.10       2.95       2.95        XXX
                                                      o&w/dye.
73720.............  TC............  A                Mri lwr extremity w/         0.00      24.95         NA       0.84      25.79         NA        XXX
                                                      o&w/dye.
73720.............  ..............  A                Mri lwr extremity w/         2.15      25.65         NA       0.94      28.74         NA        XXX
                                                      o&w/dye.
73721.............  26............  A                Mri jnt of lwr extre w/      1.35       0.44       0.44       0.06       1.85       1.85        XXX
                                                      o dye.
73721.............  TC............  A                Mri jnt of lwr extre w/      0.00      11.23         NA       0.39      11.62         NA        XXX
                                                      o dye.
73721.............  ..............  A                Mri jnt of lwr extre w/      1.35      11.67         NA       0.45      13.47         NA        XXX
                                                      o dye.
73722.............  26............  A                Mri joint of lwr extr        1.62       0.53       0.53       0.07       2.22       2.22        XXX
                                                      w/dye.
73722.............  TC............  A                Mri joint of lwr extr        0.00      13.48         NA       0.47      13.95         NA        XXX
                                                      w/dye.
73722.............  ..............  A                Mri joint of lwr extr        1.62      14.01         NA       0.54      16.17         NA        XXX
                                                      w/dye.
73723.............  26............  A                Mri joint lwr extr w/        2.15       0.71       0.71       0.10       2.96       2.96        XXX
                                                      o&w/dye.
73723.............  TC............  A                Mri joint lwr extr w/        0.00      24.95         NA       0.84      25.79         NA        XXX
                                                      o&w/dye.
73723.............  ..............  A                Mri joint lwr extr w/        2.15      25.66         NA       0.94      28.75         NA        XXX
                                                      o&w/dye.
73725.............  26............  R                Mr ang lwr ext w or w/       1.82       0.60       0.60       0.08       2.50       2.50        XXX
                                                      o dye.
73725.............  TC............  R                Mr ang lwr ext w or w/       0.00      11.23         NA       0.59      11.82         NA        XXX
                                                      o dye.
73725.............  ..............  R                Mr ang lwr ext w or w/       1.82      11.83         NA       0.67      14.32         NA        XXX
                                                      o dye.
74000.............  26............  A                X-ray exam of abdomen.       0.18       0.06       0.06       0.01       0.25       0.25        XXX
74000.............  TC............  A                X-ray exam of abdomen.       0.00       0.52         NA       0.02       0.54         NA        XXX
74000.............  ..............  A                X-ray exam of abdomen.       0.18       0.58         NA       0.03       0.79         NA        XXX
74010.............  26............  A                X-ray exam of abdomen.       0.23       0.08       0.08       0.01       0.32       0.32        XXX
74010.............  TC............  A                X-ray exam of abdomen.       0.00       0.57         NA       0.04       0.61         NA        XXX
74010.............  ..............  A                X-ray exam of abdomen.       0.23       0.65         NA       0.05       0.93         NA        XXX
74020.............  26............  A                X-ray exam of abdomen.       0.27       0.09       0.09       0.01       0.37       0.37        XXX
74020.............  TC............  A                X-ray exam of abdomen.       0.00       0.62         NA       0.04       0.66         NA        XXX
74020.............  ..............  A                X-ray exam of abdomen.       0.27       0.71         NA       0.05       1.03         NA        XXX
74022.............  26............  A                X-ray exam series,           0.32       0.10       0.10       0.01       0.43       0.43        XXX
                                                      abdomen.
74022.............  TC............  A                X-ray exam series,           0.00       0.73         NA       0.05       0.78         NA        XXX
                                                      abdomen.
74022.............  ..............  A                X-ray exam series,           0.32       0.83         NA       0.06       1.21         NA        XXX
                                                      abdomen.
74150.............  26............  A                Ct abdomen w/o dye....       1.19       0.39       0.39       0.05       1.63       1.63        XXX
74150.............  TC............  A                Ct abdomen w/o dye....       0.00       5.68         NA       0.30       5.98         NA        XXX
74150.............  ..............  A                Ct abdomen w/o dye....       1.19       6.07         NA       0.35       7.61         NA        XXX
74160.............  26............  A                Ct abdomen w/dye......       1.27       0.42       0.42       0.06       1.75       1.75        XXX
74160.............  TC............  A                Ct abdomen w/dye......       0.00       6.86         NA       0.36       7.22         NA        XXX
74160.............  ..............  A                Ct abdomen w/dye......       1.27       7.28         NA       0.42       8.97         NA        XXX
74170.............  26............  A                Ct abdomen w/o & w/dye       1.40       0.46       0.46       0.06       1.92       1.92        XXX
74170.............  TC............  A                Ct abdomen w/o & w/dye       0.00       8.51         NA       0.43       8.94         NA        XXX
74170.............  ..............  A                Ct abdomen w/o & w/dye       1.40       8.97         NA       0.49      10.86         NA        XXX
74175.............  26............  A                Ct angio abdom w/o & w/      1.90       0.62       0.62       0.08       2.60       2.60        XXX
                                                      dye.
74175.............  TC............  A                Ct angio abdom w/o & w/      0.00      12.06         NA       0.39      12.45         NA        XXX
                                                      dye.
74175.............  ..............  A                Ct angio abdom w/o & w/      1.90      12.68         NA       0.47      15.05         NA        XXX
                                                      dye.
74181.............  26............  A                Mri abdomen w/o dye...       1.46       0.48       0.48       0.06       2.00       2.00        XXX
74181.............  TC............  A                Mri abdomen w/o dye...       0.00      11.23         NA       0.45      11.68         NA        XXX
74181.............  ..............  A                Mri abdomen w/o dye...       1.46      11.71         NA       0.51      13.68         NA        XXX
74182.............  26............  A                Mri abdomen w/dye.....       1.73       0.57       0.57       0.08       2.38       2.38        XXX
74182.............  TC............  A                Mri abdomen w/dye.....       0.00      13.48         NA       0.52      14.00         NA        XXX
74182.............  ..............  A                Mri abdomen w/dye.....       1.73      14.05         NA       0.60      16.38         NA        XXX
74183.............  26............  A                Mri abdomen w/o & w/         2.26       0.74       0.74       0.10       3.10       3.10        XXX
                                                      dye.
74183.............  TC............  A                Mri abdomen w/o & w/         0.00      24.95         NA       0.92      25.87         NA        XXX
                                                      dye.
74183.............  ..............  A                Mri abdomen w/o & w/         2.26      25.69         NA       1.02      28.97         NA        XXX
                                                      dye.
74185.............  26............  R                Mri angio, abdom w orw/      1.80       0.59       0.59       0.08       2.47       2.47        XXX
                                                      o dye.
74185.............  TC............  R                Mri angio, abdom w orw/      0.00      11.23         NA       0.59      11.82         NA        XXX
                                                      o dye.
74185.............  ..............  R                Mri angio, abdom w orw/      1.80      11.82         NA       0.67      14.29         NA        XXX
                                                      o dye.
74190.............  26............  A                X-ray exam of                0.48       0.16       0.16       0.02       0.66       0.66        XXX
                                                      peritoneum.
74190.............  TC............  A                X-ray exam of                0.00       1.31         NA       0.07       1.38         NA        XXX
                                                      peritoneum.
74190.............  ..............  A                X-ray exam of                0.48       1.47         NA       0.09       2.04         NA        XXX
                                                      peritoneum.
74210.............  26............  A                Contrst x-ray exam of        0.36       0.12       0.12       0.02       0.50       0.50        XXX
                                                      throat.
74210.............  TC............  A                Contrst x-ray exam of        0.00       1.19         NA       0.06       1.25         NA        XXX
                                                      throat.
74210.............  ..............  A                Contrst x-ray exam of        0.36       1.31         NA       0.08       1.75         NA        XXX
                                                      throat.
74220.............  26............  A                Contrast x-ray,              0.46       0.15       0.15       0.02       0.63       0.63        XXX
                                                      esophagus.
74220.............  TC............  A                Contrast x-ray,              0.00       1.19         NA       0.06       1.25         NA        XXX
                                                      esophagus.
74220.............  ..............  A                Contrast x-ray,              0.46       1.34         NA       0.08       1.88         NA        XXX
                                                      esophagus.
74230.............  26............  A                Cine/vid x-ray, throat/      0.53       0.17       0.17       0.02       0.72       0.72        XXX
                                                      esoph.
74230.............  TC............  A                Cine/vid x-ray, throat/      0.00       1.31         NA       0.07       1.38         NA        XXX
                                                      esoph.
74230.............  ..............  A                Cine/vid x-ray, throat/      0.53       1.48         NA       0.09       2.10         NA        XXX
                                                      esoph.
74235.............  26............  A                Remove esophagus             1.19       0.39       0.39       0.05       1.63       1.63        XXX
                                                      obstruction.
74235.............  TC............  C                Remove esophagus             0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      obstruction.
74235.............  ..............  C                Remove esophagus             0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      obstruction.
74240.............  26............  A                X-ray exam, upper gi         0.69       0.23       0.23       0.03       0.95       0.95        XXX
                                                      tract.
74240.............  TC............  A                X-ray exam, upper gi         0.00       1.46         NA       0.08       1.54         NA        XXX
                                                      tract.
74240.............  ..............  A                X-ray exam, upper gi         0.69       1.69         NA       0.11       2.49         NA        XXX
                                                      tract.
74241.............  26............  A                X-ray exam, upper gi         0.69       0.23       0.23       0.03       0.95       0.95        XXX
                                                      tract.
74241.............  TC............  A                X-ray exam, upper gi         0.00       1.49         NA       0.08       1.57         NA        XXX
                                                      tract.
74241.............  ..............  A                X-ray exam, upper gi         0.69       1.72         NA       0.11       2.52         NA        XXX
                                                      tract.
74245.............  26............  A                X-ray exam, upper gi         0.91       0.30       0.30       0.04       1.25       1.25        XXX
                                                      tract.
74245.............  TC............  A                X-ray exam, upper gi         0.00       2.39         NA       0.13       2.52         NA        XXX
                                                      tract.
74245.............  ..............  A                X-ray exam, upper gi         0.91       2.69         NA       0.17       3.77         NA        XXX
                                                      tract.

[[Page 70420]]

 
74246.............  26............  A                Contrst x-ray uppr gi        0.69       0.23       0.23       0.03       0.95       0.95        XXX
                                                      tract.
74246.............  TC............  A                Contrst x-ray uppr gi        0.00       1.64         NA       0.10       1.74         NA        XXX
                                                      tract.
74246.............  ..............  A                Contrst x-ray uppr gi        0.69       1.87         NA       0.13       2.69         NA        XXX
                                                      tract.
74247.............  26............  A                Contrst x-ray uppr gi        0.69       0.23       0.23       0.03       0.95       0.95        XXX
                                                      tract.
74247.............  TC............  A                Contrst x-ray uppr gi        0.00       1.68         NA       0.11       1.79         NA        XXX
                                                      tract.
74247.............  ..............  A                Contrst x-ray uppr gi        0.69       1.91         NA       0.14       2.74         NA        XXX
                                                      tract.
74249.............  26............  A                Contrst x-ray uppr gi        0.91       0.30       0.30       0.04       1.25       1.25        XXX
                                                      tract.
74249.............  TC............  A                Contrst x-ray uppr gi        0.00       2.58         NA       0.14       2.72         NA        XXX
                                                      tract.
74249.............  ..............  A                Contrst x-ray uppr gi        0.91       2.88         NA       0.18       3.97         NA        XXX
                                                      tract.
74250.............  26............  A                X-ray exam of small          0.47       0.15       0.15       0.02       0.64       0.64        XXX
                                                      bowel.
74250.............  TC............  A                X-ray exam of small          0.00       1.31         NA       0.07       1.38         NA        XXX
                                                      bowel.
74250.............  ..............  A                X-ray exam of small          0.47       1.46         NA       0.09       2.02         NA        XXX
                                                      bowel.
74251.............  26............  A                X-ray exam of small          0.69       0.23       0.23       0.03       0.95       0.95        XXX
                                                      bowel.
74251.............  TC............  A                X-ray exam of small          0.00       1.31         NA       0.07       1.38         NA        XXX
                                                      bowel.
74251.............  ..............  A                X-ray exam of small          0.69       1.54         NA       0.10       2.33         NA        XXX
                                                      bowel.
74260.............  26............  A                X-ray exam of small          0.50       0.16       0.16       0.02       0.68       0.68        XXX
                                                      bowel.
74260.............  TC............  A                X-ray exam of small          0.00       1.49         NA       0.08       1.57         NA        XXX
                                                      bowel.
74260.............  ..............  A                X-ray exam of small          0.50       1.65         NA       0.10       2.25         NA        XXX
                                                      bowel.
74270.............  26............  A                Contrast x-ray exam of       0.69       0.23       0.23       0.03       0.95       0.95        XXX
                                                      colon.
74270.............  TC............  A                Contrast x-ray exam of       0.00       1.70         NA       0.11       1.81         NA        XXX
                                                      colon.
74270.............  ..............  A                Contrast x-ray exam of       0.69       1.93         NA       0.14       2.76         NA        XXX
                                                      colon.
74280.............  26............  A                Contrast x-ray exam of       0.99       0.32       0.32       0.04       1.35       1.35        XXX
                                                      colon.
74280.............  TC............  A                Contrast x-ray exam of       0.00       2.24         NA       0.13       2.37         NA        XXX
                                                      colon.
74280.............  ..............  A                Contrast x-ray exam of       0.99       2.56         NA       0.17       3.72         NA        XXX
                                                      colon.
74283.............  26............  A                Contrast x-ray exam of       2.02       0.66       0.66       0.09       2.77       2.77        XXX
                                                      colon.
74283.............  TC............  A                Contrast x-ray exam of       0.00       2.57         NA       0.14       2.71         NA        XXX
                                                      colon.
74283.............  ..............  A                Contrast x-ray exam of       2.02       3.23         NA       0.23       5.48         NA        XXX
                                                      colon.
74290.............  26............  A                Contrast x-ray,              0.32       0.10       0.10       0.01       0.43       0.43        XXX
                                                      gallbladder.
74290.............  TC............  A                Contrast x-ray,              0.00       0.73         NA       0.05       0.78         NA        XXX
                                                      gallbladder.
74290.............  ..............  A                Contrast x-ray,              0.32       0.83         NA       0.06       1.21         NA        XXX
                                                      gallbladder.
74291.............  26............  A                Contrast x-rays,             0.20       0.07       0.07       0.01       0.28       0.28        XXX
                                                      gallbladder.
74291.............  TC............  A                Contrast x-rays,             0.00       0.42         NA       0.02       0.44         NA        XXX
                                                      gallbladder.
74291.............  ..............  A                Contrast x-rays,             0.20       0.49         NA       0.03       0.72         NA        XXX
                                                      gallbladder.
74300.............  26............  A                X-ray bile ducts/            0.36       0.12       0.12       0.02       0.50       0.50        XXX
                                                      pancreas.
74300.............  TC............  C                X-ray bile ducts/            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      pancreas.
74300.............  ..............  C                X-ray bile ducts/            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      pancreas.
74301.............  26............  A                X-rays at surgery add-       0.21       0.07       0.07       0.01       0.29       0.29        ZZZ
                                                      on.
74301.............  TC............  C                X-rays at surgery add-       0.00       0.00       0.00       0.00       0.00       0.00        ZZZ
                                                      on.
74301.............  ..............  C                X-rays at surgery add-       0.00       0.00       0.00       0.00       0.00       0.00        ZZZ
                                                      on.
74305.............  26............  A                X-ray bile ducts/            0.42       0.14       0.14       0.02       0.58       0.58        XXX
                                                      pancreas.
74305.............  TC............  A                X-ray bile ducts/            0.00       0.78         NA       0.05       0.83         NA        XXX
                                                      pancreas.
74305.............  ..............  A                X-ray bile ducts/            0.42       0.92         NA       0.07       1.41         NA        XXX
                                                      pancreas.
74320.............  26............  A                Contrast x-ray of bile       0.54       0.18       0.18       0.02       0.74       0.74        XXX
                                                      ducts.
74320.............  TC............  A                Contrast x-ray of bile       0.00       3.16         NA       0.17       3.33         NA        XXX
                                                      ducts.
74320.............  ..............  A                Contrast x-ray of bile       0.54       3.34         NA       0.19       4.07         NA        XXX
                                                      ducts.
74327.............  26............  A                X-ray bile stone             0.70       0.23       0.23       0.03       0.96       0.96        XXX
                                                      removal.
74327.............  TC............  A                X-ray bile stone             0.00       1.77         NA       0.11       1.88         NA        XXX
                                                      removal.
74327.............  ..............  A                X-ray bile stone             0.70       2.00         NA       0.14       2.84         NA        XXX
                                                      removal.
74328.............  26............  A                X-ray bile duct              0.70       0.23       0.23       0.03       0.96       0.96        XXX
                                                      endoscopy.
74328.............  TC............  A                X-ray bile duct              0.00       3.16         NA       0.17       3.33         NA        XXX
                                                      endoscopy.
74328.............  ..............  A                X-ray bile duct              0.70       3.39         NA       0.20       4.29         NA        XXX
                                                      endoscopy.
74329.............  26............  A                X-ray for pancreas           0.70       0.23       0.23       0.03       0.96       0.96        XXX
                                                      endoscopy.
74329.............  TC............  C                X-ray for pancreas           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      endoscopy.
74329.............  ..............  C                X-ray for pancreas           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      endoscopy.
74330.............  26............  A                X-ray bile/panc              0.90       0.29       0.29       0.04       1.23       1.23        XXX
                                                      endoscopy.
74330.............  TC............  A                X-ray bile/panc              0.00       3.16         NA       0.17       3.33         NA        XXX
                                                      endoscopy.
74330.............  ..............  A                X-ray bile/panc              0.90       3.45         NA       0.21       4.56         NA        XXX
                                                      endoscopy.
74340.............  26............  A                X-ray guide for GI           0.54       0.18       0.18       0.02       0.74       0.74        XXX
                                                      tube.
74340.............  TC............  A                X-ray guide for GI           0.00       2.63         NA       0.14       2.77         NA        XXX
                                                      tube.
74340.............  ..............  A                X-ray guide for GI           0.54       2.81         NA       0.16       3.51         NA        XXX
                                                      tube.
74350.............  26............  A                X-ray guide, stomach         0.76       0.25       0.25       0.03       1.04       1.04        XXX
                                                      tube.
74350.............  TC............  A                X-ray guide, stomach         0.00       3.16         NA       0.17       3.33         NA        XXX
                                                      tube.
74350.............  ..............  A                X-ray guide, stomach         0.76       3.41         NA       0.20       4.37         NA        XXX
                                                      tube.
74355.............  26............  A                X-ray guide,                 0.76       0.25       0.25       0.03       1.04       1.04        XXX
                                                      intestinal tube.
74355.............  TC............  A                X-ray guide,                 0.00       2.63         NA       0.14       2.77         NA        XXX
                                                      intestinal tube.
74355.............  ..............  A                X-ray guide,                 0.76       2.88         NA       0.17       3.81         NA        XXX
                                                      intestinal tube.
74360.............  26............  A                X-ray guide, GI              0.54       0.19       0.19       0.02       0.75       0.75        XXX
                                                      dilation.
74360.............  TC............  A                X-ray guide, GI              0.00       3.16         NA       0.17       3.33         NA        XXX
                                                      dilation.
74360.............  ..............  A                X-ray guide, GI              0.54       3.35         NA       0.19       4.08         NA        XXX
                                                      dilation.
74363.............  26............  A                X-ray, bile duct             0.88       0.29       0.29       0.04       1.21       1.21        XXX
                                                      dilation.
74363.............  TC............  C                X-ray, bile duct             0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      dilation.
74363.............  ..............  C                X-ray, bile duct             0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      dilation.
74400.............  26............  A                Contrst x-ray, urinary       0.49       0.16       0.16       0.02       0.67       0.67        XXX
                                                      tract.
74400.............  TC............  A                Contrst x-ray, urinary       0.00       1.68         NA       0.11       1.79         NA        XXX
                                                      tract.
74400.............  ..............  A                Contrst x-ray, urinary       0.49       1.84         NA       0.13       2.46         NA        XXX
                                                      tract.

[[Page 70421]]

 
74410.............  26............  A                Contrst x-ray, urinary       0.49       0.16       0.16       0.02       0.67       0.67        XXX
                                                      tract.
74410.............  TC............  A                Contrst x-ray, urinary       0.00       1.96         NA       0.11       2.07         NA        XXX
                                                      tract.
74410.............  ..............  A                Contrst x-ray, urinary       0.49       2.12         NA       0.13       2.74         NA        XXX
                                                      tract.
74415.............  26............  A                Contrst x-ray, urinary       0.49       0.16       0.16       0.02       0.67       0.67        XXX
                                                      tract.
74415.............  TC............  A                Contrst x-ray, urinary       0.00       2.13         NA       0.12       2.25         NA        XXX
                                                      tract.
74415.............  ..............  A                Contrst x-ray, urinary       0.49       2.29         NA       0.14       2.92         NA        XXX
                                                      tract.
74420.............  26............  A                Contrst x-ray, urinary       0.36       0.12       0.12       0.02       0.50       0.50        XXX
                                                      tract.
74420.............  TC............  A                Contrst x-ray, urinary       0.00       2.63         NA       0.14       2.77         NA        XXX
                                                      tract.
74420.............  ..............  A                Contrst x-ray, urinary       0.36       2.75         NA       0.16       3.27         NA        XXX
                                                      tract.
74425.............  26............  A                Contrst x-ray, urinary       0.36       0.12       0.12       0.02       0.50       0.50        XXX
                                                      tract.
74425.............  TC............  A                Contrst x-ray, urinary       0.00       1.31         NA       0.07       1.38         NA        XXX
                                                      tract.
74425.............  ..............  A                Contrst x-ray, urinary       0.36       1.43         NA       0.09       1.88         NA        XXX
                                                      tract.
74430.............  26............  A                Contrast x-ray,              0.32       0.10       0.10       0.02       0.44       0.44        XXX
                                                      bladder.
74430.............  TC............  A                Contrast x-ray,              0.00       1.05         NA       0.06       1.11         NA        XXX
                                                      bladder.
74430.............  ..............  A                Contrast x-ray,              0.32       1.15         NA       0.08       1.55         NA        XXX
                                                      bladder.
74440.............  26............  A                X-ray, male genital          0.38       0.12       0.12       0.02       0.52       0.52        XXX
                                                      tract.
74440.............  TC............  A                X-ray, male genital          0.00       1.13         NA       0.06       1.19         NA        XXX
                                                      tract.
74440.............  ..............  A                X-ray, male genital          0.38       1.25         NA       0.08       1.71         NA        XXX
                                                      tract.
74445.............  26............  A                X-ray exam of penis...       1.14       0.37       0.37       0.07       1.58       1.58        XXX
74445.............  TC............  A                X-ray exam of penis...       0.00       1.13         NA       0.06       1.19         NA        XXX
74445.............  ..............  A                X-ray exam of penis...       1.14       1.50         NA       0.13       2.77         NA        XXX
74450.............  26............  A                X-ray, urethra/bladder       0.33       0.11       0.11       0.02       0.46       0.46        XXX
74450.............  TC............  A                X-ray, urethra/bladder       0.00       1.46         NA       0.08       1.54         NA        XXX
74450.............  ..............  A                X-ray, urethra/bladder       0.33       1.57         NA       0.10       2.00         NA        XXX
74455.............  26............  A                X-ray, urethra/bladder       0.33       0.11       0.11       0.02       0.46       0.46        XXX
74455.............  TC............  A                X-ray, urethra/bladder       0.00       1.58         NA       0.10       1.68         NA        XXX
74455.............  ..............  A                X-ray, urethra/bladder       0.33       1.69         NA       0.12       2.14         NA        XXX
74470.............  26............  A                X-ray exam of kidney         0.54       0.18       0.18       0.02       0.74       0.74        XXX
                                                      lesion.
74470.............  TC............  A                X-ray exam of kidney         0.00       1.25         NA       0.07       1.32         NA        XXX
                                                      lesion.
74470.............  ..............  A                X-ray exam of kidney         0.54       1.43         NA       0.09       2.06         NA        XXX
                                                      lesion.
74475.............  26............  A                X-ray control, cath          0.54       0.18       0.18       0.02       0.74       0.74        XXX
                                                      insert.
74475.............  TC............  A                X-ray control, cath          0.00       4.08         NA       0.22       4.30         NA        XXX
                                                      insert.
74475.............  ..............  A                X-ray control, cath          0.54       4.26         NA       0.24       5.04         NA        XXX
                                                      insert.
74480.............  26............  A                X-ray control, cath          0.54       0.18       0.18       0.02       0.74       0.74        XXX
                                                      insert.
74480.............  TC............  A                X-ray control, cath          0.00       4.08         NA       0.22       4.30         NA        XXX
                                                      insert.
74480.............  ..............  A                X-ray control, cath          0.54       4.26         NA       0.24       5.04         NA        XXX
                                                      insert.
74485.............  26............  A                X-ray guide, GU              0.54       0.17       0.17       0.03       0.74       0.74        XXX
                                                      dilation.
74485.............  TC............  A                X-ray guide, GU              0.00       3.16         NA       0.17       3.33         NA        XXX
                                                      dilation.
74485.............  ..............  A                X-ray guide, GU              0.54       3.33         NA       0.20       4.07         NA        XXX
                                                      dilation.
74710.............  26............  A                X-ray measurement of         0.34       0.11       0.11       0.02       0.47       0.47        XXX
                                                      pelvis.
74710.............  TC............  A                X-ray measurement of         0.00       1.05         NA       0.06       1.11         NA        XXX
                                                      pelvis.
74710.............  ..............  A                X-ray measurement of         0.34       1.16         NA       0.08       1.58         NA        XXX
                                                      pelvis.
74740.............  26............  A                X-ray, female genital        0.38       0.13       0.13       0.02       0.53       0.53        XXX
                                                      tract.
74740.............  TC............  A                X-ray, female genital        0.00       1.31         NA       0.07       1.38         NA        XXX
                                                      tract.
74740.............  ..............  A                X-ray, female genital        0.38       1.44         NA       0.09       1.91         NA        XXX
                                                      tract.
74742.............  26............  A                X-ray, fallopian tube.       0.61       0.20       0.20       0.03       0.84       0.84        XXX
74742.............  TC............  C                X-ray, fallopian tube.       0.00       0.00       0.00       0.00       0.00       0.00        XXX
74742.............  ..............  C                X-ray, fallopian tube.       0.00       0.00       0.00       0.00       0.00       0.00        XXX
74775.............  26............  A                X-ray exam of perineum       0.62       0.21       0.21       0.03       0.86       0.86        XXX
74775.............  TC............  A                X-ray exam of perineum       0.00       1.46         NA       0.08       1.54         NA        XXX
74775.............  ..............  A                X-ray exam of perineum       0.62       1.67         NA       0.11       2.40         NA        XXX
75552.............  26............  A                Heart mri for morph w/       1.60       0.53       0.53       0.07       2.20       2.20        XXX
                                                      o dye.
75552.............  TC............  A                Heart mri for morph w/       0.00      11.23         NA       0.59      11.82         NA        XXX
                                                      o dye.
75552.............  ..............  A                Heart mri for morph w/       1.60      11.76         NA       0.66      14.02         NA        XXX
                                                      o dye.
75553.............  26............  A                Heart mri for morph w/       2.00       0.65       0.65       0.07       2.72       2.72        XXX
                                                      dye.
75553.............  TC............  A                Heart mri for morph w/       0.00      11.23         NA       0.59      11.82         NA        XXX
                                                      dye.
75553.............  ..............  A                Heart mri for morph w/       2.00      11.88         NA       0.66      14.54         NA        XXX
                                                      dye.
75554.............  26............  A                Cardiac MRI/function..       1.83       0.64       0.64       0.07       2.54       2.54        XXX
75554.............  TC............  A                Cardiac MRI/function..       0.00      11.23         NA       0.59      11.82         NA        XXX
75554.............  ..............  A                Cardiac MRI/function..       1.83      11.87         NA       0.66      14.36         NA        XXX
75555.............  26............  A                Cardiac MRI/limited          1.74       0.64       0.64       0.07       2.45       2.45        XXX
                                                      study.
75555.............  TC............  A                Cardiac MRI/limited          0.00      11.23         NA       0.59      11.82         NA        XXX
                                                      study.
75555.............  ..............  A                Cardiac MRI/limited          1.74      11.87         NA       0.66      14.27         NA        XXX
                                                      study.
75556.............  ..............  N                Cardiac MRI/flow             0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      mapping.
75600.............  26............  A                Contrast x-ray exam of       0.49       0.19       0.19       0.02       0.70       0.70        XXX
                                                      aorta.
75600.............  TC............  A                Contrast x-ray exam of       0.00      12.64         NA       0.65      13.29         NA        XXX
                                                      aorta.
75600.............  ..............  A                Contrast x-ray exam of       0.49      12.83         NA       0.67      13.99         NA        XXX
                                                      aorta.
75605.............  26............  A                Contrast x-ray exam of       1.14       0.40       0.40       0.05       1.59       1.59        XXX
                                                      aorta.
75605.............  TC............  A                Contrast x-ray exam of       0.00      12.64         NA       0.65      13.29         NA        XXX
                                                      aorta.
75605.............  ..............  A                Contrast x-ray exam of       1.14      13.04         NA       0.70      14.88         NA        XXX
                                                      aorta.
75625.............  26............  A                Contrast x-ray exam of       1.14       0.38       0.38       0.06       1.58       1.58        XXX
                                                      aorta.
75625.............  TC............  A                Contrast x-ray exam of       0.00      12.64         NA       0.65      13.29         NA        XXX
                                                      aorta.
75625.............  ..............  A                Contrast x-ray exam of       1.14      13.02         NA       0.71      14.87         NA        XXX
                                                      aorta.
75630.............  26............  A                X-ray aorta, leg             1.79       0.61       0.61       0.11       2.51       2.51        XXX
                                                      arteries.
75630.............  TC............  A                X-ray aorta, leg             0.00      13.17         NA       0.69      13.86         NA        XXX
                                                      arteries.

[[Page 70422]]

 
75630.............  ..............  A                X-ray aorta, leg             1.79      13.78         NA       0.80      16.37         NA        XXX
                                                      arteries.
75635.............  26............  A                Ct angio abdominal           2.40       0.79       0.79       0.11       3.30       3.30        XXX
                                                      arteries.
75635.............  TC............  A                Ct angio abdominal           0.00      15.96         NA       0.39      16.35         NA        XXX
                                                      arteries.
75635.............  ..............  A                Ct angio abdominal           2.40      16.75         NA       0.50      19.65         NA        XXX
                                                      arteries.
75650.............  26............  A                Artery x-rays, head &        1.49       0.49       0.49       0.07       2.05       2.05        XXX
                                                      neck.
75650.............  TC............  A                Artery x-rays, head &        0.00      12.64         NA       0.65      13.29         NA        XXX
                                                      neck.
75650.............  ..............  A                Artery x-rays, head &        1.49      13.13         NA       0.72      15.34         NA        XXX
                                                      neck.
75658.............  26............  A                Artery x-rays, arm....       1.31       0.47       0.47       0.07       1.85       1.85        XXX
75658.............  TC............  A                Artery x-rays, arm....       0.00      12.64         NA       0.65      13.29         NA        XXX
75658.............  ..............  A                Artery x-rays, arm....       1.31      13.11         NA       0.72      15.14         NA        XXX
75660.............  26............  A                Artery x-rays, head &        1.31       0.44       0.44       0.06       1.81       1.81        XXX
                                                      neck.
75660.............  TC............  A                Artery x-rays, head &        0.00      12.64         NA       0.65      13.29         NA        XXX
                                                      neck.
75660.............  ..............  A                Artery x-rays, head &        1.31      13.08         NA       0.71      15.10         NA        XXX
                                                      neck.
75662.............  26............  A                Artery x-rays, head &        1.66       0.59       0.59       0.06       2.31       2.31        XXX
                                                      neck.
75662.............  TC............  A                Artery x-rays, head &        0.00      12.64         NA       0.65      13.29         NA        XXX
                                                      neck.
75662.............  ..............  A                Artery x-rays, head &        1.66      13.23         NA       0.71      15.60         NA        XXX
                                                      neck.
75665.............  26............  A                Artery x-rays, head &        1.31       0.44       0.44       0.09       1.84       1.84        XXX
                                                      neck.
75665.............  TC............  A                Artery x-rays, head &        0.00      12.64         NA       0.65      13.29         NA        XXX
                                                      neck.
75665.............  ..............  A                Artery x-rays, head &        1.31      13.08         NA       0.74      15.13         NA        XXX
                                                      neck.
75671.............  26............  A                Artery x-rays, head &        1.66       0.55       0.55       0.07       2.28       2.28        XXX
                                                      neck.
75671.............  TC............  A                Artery x-rays, head &        0.00      12.64         NA       0.65      13.29         NA        XXX
                                                      neck.
75671.............  ..............  A                Artery x-rays, head &        1.66      13.19         NA       0.72      15.57         NA        XXX
                                                      neck.
75676.............  26............  A                Artery x-rays, neck...       1.31       0.44       0.44       0.07       1.82       1.82        XXX
75676.............  TC............  A                Artery x-rays, neck...       0.00      12.64         NA       0.65      13.29         NA        XXX
75676.............  ..............  A                Artery x-rays, neck...       1.31      13.08         NA       0.72      15.11         NA        XXX
75680.............  26............  A                Artery x-rays, neck...       1.66       0.55       0.55       0.07       2.28       2.28        XXX
75680.............  TC............  A                Artery x-rays, neck...       0.00      12.64         NA       0.65      13.29         NA        XXX
75680.............  ..............  A                Artery x-rays, neck...       1.66      13.19         NA       0.72      15.57         NA        XXX
75685.............  26............  A                Artery x-rays, spine..       1.31       0.43       0.43       0.06       1.80       1.80        XXX
75685.............  TC............  A                Artery x-rays, spine..       0.00      12.64         NA       0.65      13.29         NA        XXX
75685.............  ..............  A                Artery x-rays, spine..       1.31      13.07         NA       0.71      15.09         NA        XXX
75705.............  26............  A                Artery x-rays, spine..       2.18       0.73       0.73       0.13       3.04       3.04        XXX
75705.............  TC............  A                Artery x-rays, spine..       0.00      12.64         NA       0.65      13.29         NA        XXX
75705.............  ..............  A                Artery x-rays, spine..       2.18      13.37         NA       0.78      16.33         NA        XXX
75710.............  26............  A                Artery x-rays, arm/leg       1.14       0.39       0.39       0.07       1.60       1.60        XXX
75710.............  TC............  A                Artery x-rays, arm/leg       0.00      12.64         NA       0.65      13.29         NA        XXX
75710.............  ..............  A                Artery x-rays, arm/leg       1.14      13.03         NA       0.72      14.89         NA        XXX
75716.............  26............  A                Artery x-rays, arms/         1.31       0.43       0.43       0.07       1.81       1.81        XXX
                                                      legs.
75716.............  TC............  A                Artery x-rays, arms/         0.00      12.64         NA       0.65      13.29         NA        XXX
                                                      legs.
75716.............  ..............  A                Artery x-rays, arms/         1.31      13.07         NA       0.72      15.10         NA        XXX
                                                      legs.
75722.............  26............  A                Artery x-rays, kidney.       1.14       0.40       0.40       0.05       1.59       1.59        XXX
75722.............  TC............  A                Artery x-rays, kidney.       0.00      12.64         NA       0.65      13.29         NA        XXX
75722.............  ..............  A                Artery x-rays, kidney.       1.14      13.04         NA       0.70      14.88         NA        XXX
75724.............  26............  A                Artery x-rays, kidneys       1.49       0.56       0.56       0.05       2.10       2.10        XXX
75724.............  TC............  A                Artery x-rays, kidneys       0.00      12.64         NA       0.65      13.29         NA        XXX
75724.............  ..............  A                Artery x-rays, kidneys       1.49      13.20         NA       0.70      15.39         NA        XXX
75726.............  26............  A                Artery x-rays, abdomen       1.14       0.37       0.37       0.05       1.56       1.56        XXX
75726.............  TC............  A                Artery x-rays, abdomen       0.00      12.64         NA       0.65      13.29         NA        XXX
75726.............  ..............  A                Artery x-rays, abdomen       1.14      13.01         NA       0.70      14.85         NA        XXX
75731.............  26............  A                Artery x-rays, adrenal       1.14       0.37       0.37       0.06       1.57       1.57        XXX
                                                      gland.
75731.............  TC............  A                Artery x-rays, adrenal       0.00      12.64         NA       0.65      13.29         NA        XXX
                                                      gland.
75731.............  ..............  A                Artery x-rays, adrenal       1.14      13.01         NA       0.71      14.86         NA        XXX
                                                      gland.
75733.............  26............  A                Artery x-rays,               1.31       0.44       0.44       0.06       1.81       1.81        XXX
                                                      adrenals.
75733.............  TC............  A                Artery x-rays,               0.00      12.64         NA       0.65      13.29         NA        XXX
                                                      adrenals.
75733.............  ..............  A                Artery x-rays,               1.31      13.08         NA       0.71      15.10         NA        XXX
                                                      adrenals.
75736.............  26............  A                Artery x-rays, pelvis.       1.14       0.38       0.38       0.06       1.58       1.58        XXX
75736.............  TC............  A                Artery x-rays, pelvis.       0.00      12.64         NA       0.65      13.29         NA        XXX
75736.............  ..............  A                Artery x-rays, pelvis.       1.14      13.02         NA       0.71      14.87         NA        XXX
75741.............  26............  A                Artery x-rays, lung...       1.31       0.43       0.43       0.06       1.80       1.80        XXX
75741.............  TC............  A                Artery x-rays, lung...       0.00      12.64         NA       0.65      13.29         NA        XXX
75741.............  ..............  A                Artery x-rays, lung...       1.31      13.07         NA       0.71      15.09         NA        XXX
75743.............  26............  A                Artery x-rays, lungs..       1.66       0.54       0.54       0.07       2.27       2.27        XXX
75743.............  TC............  A                Artery x-rays, lungs..       0.00      12.64         NA       0.65      13.29         NA        XXX
75743.............  ..............  A                Artery x-rays, lungs..       1.66      13.18         NA       0.72      15.56         NA        XXX
75746.............  26............  A                Artery x-rays, lung...       1.14       0.38       0.38       0.05       1.57       1.57        XXX
75746.............  TC............  A                Artery x-rays, lung...       0.00      12.64         NA       0.65      13.29         NA        XXX
75746.............  ..............  A                Artery x-rays, lung...       1.14      13.02         NA       0.70      14.86         NA        XXX
75756.............  26............  A                Artery x-rays, chest..       1.14       0.45       0.45       0.04       1.63       1.63        XXX
75756.............  TC............  A                Artery x-rays, chest..       0.00      12.64         NA       0.65      13.29         NA        XXX
75756.............  ..............  A                Artery x-rays, chest..       1.14      13.09         NA       0.69      14.92         NA        XXX
75774.............  26............  A                Artery x-ray, each           0.36       0.12       0.12       0.02       0.50       0.50        ZZZ
                                                      vessel.
75774.............  TC............  A                Artery x-ray, each           0.00      12.64         NA       0.65      13.29         NA        ZZZ
                                                      vessel.
75774.............  ..............  A                Artery x-ray, each           0.36      12.76         NA       0.67      13.79         NA        ZZZ
                                                      vessel.
75790.............  26............  A                Visualize A-V shunt...       1.84       0.60       0.60       0.09       2.53       2.53        XXX
75790.............  TC............  A                Visualize A-V shunt...       0.00       1.35         NA       0.08       1.43         NA        XXX

[[Page 70423]]

 
75790.............  ..............  A                Visualize A-V shunt...       1.84       1.95         NA       0.17       3.96         NA        XXX
75801.............  26............  A                Lymph vessel x-ray,          0.81       0.27       0.27       0.08       1.16       1.16        XXX
                                                      arm/leg.
75801.............  TC............  A                Lymph vessel x-ray,          0.00       5.43         NA       0.29       5.72         NA        XXX
                                                      arm/leg.
75801.............  ..............  A                Lymph vessel x-ray,          0.81       5.70         NA       0.37       6.88         NA        XXX
                                                      arm/leg.
75803.............  26............  A                Lymph vessel x-              1.17       0.38       0.38       0.05       1.60       1.60        XXX
                                                      ray,arms/legs.
75803.............  TC............  A                Lymph vessel x-              0.00       5.43         NA       0.29       5.72         NA        XXX
                                                      ray,arms/legs.
75803.............  ..............  A                Lymph vessel x-              1.17       5.81         NA       0.34       7.32         NA        XXX
                                                      ray,arms/legs.
75805.............  26............  A                Lymph vessel x-ray,          0.81       0.27       0.27       0.05       1.13       1.13        XXX
                                                      trunk.
75805.............  TC............  A                Lymph vessel x-ray,          0.00       6.12         NA       0.33       6.45         NA        XXX
                                                      trunk.
75805.............  ..............  A                Lymph vessel x-ray,          0.81       6.39         NA       0.38       7.58         NA        XXX
                                                      trunk.
75807.............  26............  A                Lymph vessel x-ray,          1.17       0.38       0.38       0.05       1.60       1.60        XXX
                                                      trunk.
75807.............  TC............  C                Lymph vessel x-ray,          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      trunk.
75807.............  ..............  C                Lymph vessel x-ray,          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      trunk.
75809.............  26............  A                Nonvascular shunt, x-        0.47       0.15       0.15       0.02       0.64       0.64        XXX
                                                      ray.
75809.............  TC............  A                Nonvascular shunt, x-        0.00       0.78         NA       0.05       0.83         NA        XXX
                                                      ray.
75809.............  ..............  A                Nonvascular shunt, x-        0.47       0.93         NA       0.07       1.47         NA        XXX
                                                      ray.
75810.............  26............  A                Vein x-ray, spleen/          1.14       0.37       0.37       0.05       1.56       1.56        XXX
                                                      liver.
75810.............  TC............  A                Vein x-ray, spleen/          0.00      12.64         NA       0.65      13.29         NA        XXX
                                                      liver.
75810.............  ..............  A                Vein x-ray, spleen/          1.14      13.01         NA       0.70      14.85         NA        XXX
                                                      liver.
75820.............  26............  A                Vein x-ray, arm/leg...       0.70       0.23       0.23       0.03       0.96       0.96        XXX
75820.............  TC............  A                Vein x-ray, arm/leg...       0.00       0.95         NA       0.06       1.01         NA        XXX
75820.............  ..............  A                Vein x-ray, arm/leg...       0.70       1.18         NA       0.09       1.97         NA        XXX
75822.............  26............  A                Vein x-ray, arms/legs.       1.06       0.35       0.35       0.05       1.46       1.46        XXX
75822.............  TC............  A                Vein x-ray, arms/legs.       0.00       1.48         NA       0.08       1.56         NA        XXX
75822.............  ..............  A                Vein x-ray, arms/legs.       1.06       1.83         NA       0.13       3.02         NA        XXX
75825.............  26............  A                Vein x-ray, trunk.....       1.14       0.37       0.37       0.07       1.58       1.58        XXX
75825.............  TC............  A                Vein x-ray, trunk.....       0.00      12.64         NA       0.65      13.29         NA        XXX
75825.............  ..............  A                Vein x-ray, trunk.....       1.14      13.01         NA       0.72      14.87         NA        XXX
75827.............  26............  A                Vein x-ray, chest.....       1.14       0.37       0.37       0.05       1.56       1.56        XXX
75827.............  TC............  A                Vein x-ray, chest.....       0.00      12.64         NA       0.65      13.29         NA        XXX
75827.............  ..............  A                Vein x-ray, chest.....       1.14      13.01         NA       0.70      14.85         NA        XXX
75831.............  26............  A                Vein x-ray, kidney....       1.14       0.37       0.37       0.06       1.57       1.57        XXX
75831.............  TC............  A                Vein x-ray, kidney....       0.00      12.64         NA       0.65      13.29         NA        XXX
75831.............  ..............  A                Vein x-ray, kidney....       1.14      13.01         NA       0.71      14.86         NA        XXX
75833.............  26............  A                Vein x-ray, kidneys...       1.49       0.49       0.49       0.09       2.07       2.07        XXX
75833.............  TC............  A                Vein x-ray, kidneys...       0.00      12.64         NA       0.65      13.29         NA        XXX
75833.............  ..............  A                Vein x-ray, kidneys...       1.49      13.13         NA       0.74      15.36         NA        XXX
75840.............  26............  A                Vein x-ray, adrenal          1.14       0.38       0.38       0.07       1.59       1.59        XXX
                                                      gland.
75840.............  TC............  A                Vein x-ray, adrenal          0.00      12.64         NA       0.65      13.29         NA        XXX
                                                      gland.
75840.............  ..............  A                Vein x-ray, adrenal          1.14      13.02         NA       0.72      14.88         NA        XXX
                                                      gland.
75842.............  26............  A                Vein x-ray, adrenal          1.49       0.48       0.48       0.07       2.04       2.04        XXX
                                                      glands.
75842.............  TC............  A                Vein x-ray, adrenal          0.00      12.64         NA       0.65      13.29         NA        XXX
                                                      glands.
75842.............  ..............  A                Vein x-ray, adrenal          1.49      13.12         NA       0.72      15.33         NA        XXX
                                                      glands.
75860.............  26............  A                Vein x-ray, neck......       1.14       0.39       0.39       0.04       1.57       1.57        XXX
75860.............  TC............  A                Vein x-ray, neck......       0.00      12.64         NA       0.65      13.29         NA        XXX
75860.............  ..............  A                Vein x-ray, neck......       1.14      13.03         NA       0.69      14.86         NA        XXX
75870.............  26............  A                Vein x-ray, skull.....       1.14       0.39       0.39       0.05       1.58       1.58        XXX
75870.............  TC............  A                Vein x-ray, skull.....       0.00      12.64         NA       0.65      13.29         NA        XXX
75870.............  ..............  A                Vein x-ray, skull.....       1.14      13.03         NA       0.70      14.87         NA        XXX
75872.............  26............  A                Vein x-ray, skull.....       1.14       0.37       0.37       0.14       1.65       1.65        XXX
75872.............  TC............  A                Vein x-ray, skull.....       0.00      12.64         NA       0.65      13.29         NA        XXX
75872.............  ..............  A                Vein x-ray, skull.....       1.14      13.01         NA       0.79      14.94         NA        XXX
75880.............  26............  A                Vein x-ray, eye socket       0.70       0.23       0.23       0.03       0.96       0.96        XXX
75880.............  TC............  A                Vein x-ray, eye socket       0.00       0.95         NA       0.06       1.01         NA        XXX
75880.............  ..............  A                Vein x-ray, eye socket       0.70       1.18         NA       0.09       1.97         NA        XXX
75885.............  26............  A                Vein x-ray, liver.....       1.44       0.47       0.47       0.06       1.97       1.97        XXX
75885.............  TC............  A                Vein x-ray, liver.....       0.00      12.64         NA       0.65      13.29         NA        XXX
75885.............  ..............  A                Vein x-ray, liver.....       1.44      13.11         NA       0.71      15.26         NA        XXX
75887.............  26............  A                Vein x-ray, liver.....       1.44       0.47       0.47       0.06       1.97       1.97        XXX
75887.............  TC............  A                Vein x-ray, liver.....       0.00      12.64         NA       0.65      13.29         NA        XXX
75887.............  ..............  A                Vein x-ray, liver.....       1.44      13.11         NA       0.71      15.26         NA        XXX
75889.............  26............  A                Vein x-ray, liver.....       1.14       0.37       0.37       0.05       1.56       1.56        XXX
75889.............  TC............  A                Vein x-ray, liver.....       0.00      12.64         NA       0.65      13.29         NA        XXX
75889.............  ..............  A                Vein x-ray, liver.....       1.14      13.01         NA       0.70      14.85         NA        XXX
75891.............  26............  A                Vein x-ray, liver.....       1.14       0.37       0.37       0.05       1.56       1.56        XXX
75891.............  TC............  A                Vein x-ray, liver.....       0.00      12.64         NA       0.65      13.29         NA        XXX
75891.............  ..............  A                Vein x-ray, liver.....       1.14      13.01         NA       0.70      14.85         NA        XXX
75893.............  26............  A                Venous sampling by           0.54       0.18       0.18       0.02       0.74       0.74        XXX
                                                      catheter.
75893.............  TC............  A                Venous sampling by           0.00      12.64         NA       0.65      13.29         NA        XXX
                                                      catheter.
75893.............  ..............  A                Venous sampling by           0.54      12.82         NA       0.67      14.03         NA        XXX
                                                      catheter.
75894.............  26............  A                X-rays, transcath            1.31       0.43       0.43       0.08       1.82       1.82        XXX
                                                      therapy.
75894.............  TC............  A                X-rays, transcath            0.00      24.20         NA       1.27      25.47         NA        XXX
                                                      therapy.
75894.............  ..............  A                X-rays, transcath            1.31      24.63         NA       1.35      27.29         NA        XXX
                                                      therapy.
75896.............  26............  A                X-rays, transcath            1.31       0.45       0.45       0.05       1.81       1.81        XXX
                                                      therapy.
75896.............  TC............  A                X-rays, transcath            0.00      21.05         NA       1.10      22.15         NA        XXX
                                                      therapy.

[[Page 70424]]

 
75896.............  ..............  A                X-rays, transcath            1.31      21.50         NA       1.15      23.96         NA        XXX
                                                      therapy.
75898.............  26............  A                Follow-up angiography.       1.65       0.55       0.55       0.07       2.27       2.27        XXX
75898.............  TC............  A                Follow-up angiography.       0.00       1.05         NA       0.06       1.11         NA        XXX
75898.............  ..............  A                Follow-up angiography.       1.65       1.60         NA       0.13       3.38         NA        XXX
75900.............  26............  A                Intravascular cath           0.49       0.16       0.16       0.03       0.68       0.68        XXX
                                                      exchange.
75900.............  TC............  C                Intravascular cath           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      exchange.
75900.............  ..............  C                Intravascular cath           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      exchange.
75901.............  26............  A                Remove cva device            0.49       0.16       0.16       0.02       0.67       0.67        XXX
                                                      obstruct.
75901.............  TC............  A                Remove cva device            0.00       1.31         NA       0.83       2.14         NA        XXX
                                                      obstruct.
75901.............  ..............  A                Remove cva device            0.49       1.47         NA       0.85       2.81         NA        XXX
                                                      obstruct.
75902.............  26............  A                Remove cva lumen             0.39       0.13       0.13       0.02       0.54       0.54        XXX
                                                      obstruct.
75902.............  TC............  A                Remove cva lumen             0.00       1.31         NA       0.83       2.14         NA        XXX
                                                      obstruct.
75902.............  ..............  A                Remove cva lumen             0.39       1.44         NA       0.85       2.68         NA        XXX
                                                      obstruct.
75940.............  26............  A                X-ray placement, vein        0.54       0.18       0.18       0.04       0.76       0.76        XXX
                                                      filter.
75940.............  TC............  A                X-ray placement, vein        0.00      12.64         NA       0.65      13.29         NA        XXX
                                                      filter.
75940.............  ..............  A                X-ray placement, vein        0.54      12.82         NA       0.69      14.05         NA        XXX
                                                      filter.
75945.............  26............  A                Intravascular us......       0.40       0.14       0.14       0.04       0.58       0.58        XXX
75945.............  TC............  A                Intravascular us......       0.00       4.57         NA       0.24       4.81         NA        XXX
75945.............  ..............  A                Intravascular us......       0.40       4.71         NA       0.28       5.39         NA        XXX
75946.............  26............  A                Intravascular us add-        0.40       0.14       0.14       0.05       0.59       0.59        ZZZ
                                                      on.
75946.............  TC............  C                Intravascular us add-        0.00       0.00       0.00       0.00       0.00       0.00        ZZZ
                                                      on.
75946.............  ..............  C                Intravascular us add-        0.00       0.00       0.00       0.00       0.00       0.00        ZZZ
                                                      on.
75952.............  26............  A                Endovasc repair abdom        4.49       1.49       1.49       0.43       6.41       6.41        XXX
                                                      aorta.
75952.............  TC............  C                Endovasc repair abdom        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      aorta.
75952.............  ..............  C                Endovasc repair abdom        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      aorta.
75953.............  26............  A                Abdom aneurysm endovas       1.36       0.45       0.45       0.13       1.94       1.94        XXX
                                                      rpr.
75953.............  TC............  C                Abdom aneurysm endovas       0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      rpr.
75953.............  ..............  C                Abdom aneurysm endovas       0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      rpr.
75954.............  26............  A                Iliac aneurysm endovas       2.25       0.78       0.78       0.15       3.18       3.18        XXX
                                                      rpr.
75954.............  TC............  C                Iliac aneurysm endovas       0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      rpr.
75954.............  ..............  C                Iliac aneurysm endovas       0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      rpr.
75956.............  26............  A                Xray, endovasc thor ao       7.00       2.71       2.71       0.69      10.40      10.40        XXX
                                                      repr.
75956.............  TC............  C                Xray, endovasc thor ao       0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      repr.
75956.............  ..............  C                Xray, endovasc thor ao       0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      repr.
75957.............  26............  A                Xray, endovasc thor ao       6.00       2.32       2.32       0.59       8.91       8.91        XXX
                                                      repr.
75957.............  TC............  C                Xray, endovasc thor ao       0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      repr.
75957.............  ..............  C                Xray, endovasc thor ao       0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      repr.
75958.............  26............  A                Xray, place prox ext         4.00       1.55       1.55       0.39       5.94       5.94        XXX
                                                      thor ao.
75958.............  TC............  C                Xray, place prox ext         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      thor ao.
75958.............  ..............  C                Xray, place prox ext         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      thor ao.
75959.............  26............  A                Xray, place dist ext         3.50       1.36       1.36       0.34       5.20       5.20        XXX
                                                      thor ao.
75959.............  TC............  C                Xray, place dist ext         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      thor ao.
75959.............  ..............  C                Xray, place dist ext         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      thor ao.
75960.............  26............  A                Transcath iv stent           0.82       0.28       0.28       0.05       1.15       1.15        XXX
                                                      rs&i.
75960.............  TC............  A                Transcath iv stent           0.00      14.94         NA       0.77      15.71         NA        XXX
                                                      rs&i.
75960.............  ..............  A                Transcath iv stent           0.82      15.22         NA       0.82      16.86         NA        XXX
                                                      rs&i.
75961.............  26............  A                Retrieval, broken            4.24       1.39       1.39       0.18       5.81       5.81        XXX
                                                      catheter.
75961.............  TC............  A                Retrieval, broken            0.00      10.53         NA       0.55      11.08         NA        XXX
                                                      catheter.
75961.............  ..............  A                Retrieval, broken            4.24      11.92         NA       0.73      16.89         NA        XXX
                                                      catheter.
75962.............  26............  A                Repair arterial              0.54       0.18       0.18       0.03       0.75       0.75        XXX
                                                      blockage.
75962.............  TC............  A                Repair arterial              0.00      15.79         NA       0.83      16.62         NA        XXX
                                                      blockage.
75962.............  ..............  A                Repair arterial              0.54      15.97         NA       0.86      17.37         NA        XXX
                                                      blockage.
75964.............  26............  A                Repair artery                0.36       0.12       0.12       0.03       0.51       0.51        ZZZ
                                                      blockage, each.
75964.............  TC............  A                Repair artery                0.00       8.41         NA       0.43       8.84         NA        ZZZ
                                                      blockage, each.
75964.............  ..............  A                Repair artery                0.36       8.53         NA       0.46       9.35         NA        ZZZ
                                                      blockage, each.
75966.............  26............  A                Repair arterial              1.31       0.46       0.46       0.06       1.83       1.83        XXX
                                                      blockage.
75966.............  TC............  A                Repair arterial              0.00      15.79         NA       0.83      16.62         NA        XXX
                                                      blockage.
75966.............  ..............  A                Repair arterial              1.31      16.25         NA       0.89      18.45         NA        XXX
                                                      blockage.
75968.............  26............  A                Repair artery                0.36       0.13       0.13       0.02       0.51       0.51        ZZZ
                                                      blockage, each.
75968.............  TC............  A                Repair artery                0.00       8.41         NA       0.43       8.84         NA        ZZZ
                                                      blockage, each.
75968.............  ..............  A                Repair artery                0.36       8.54         NA       0.45       9.35         NA        ZZZ
                                                      blockage, each.
75970.............  26............  A                Vascular biopsy.......       0.83       0.28       0.28       0.04       1.15       1.15        XXX
75970.............  TC............  A                Vascular biopsy.......       0.00      11.57         NA       0.60      12.17         NA        XXX
75970.............  ..............  A                Vascular biopsy.......       0.83      11.85         NA       0.64      13.32         NA        XXX
75978.............  26............  A                Repair venous blockage       0.54       0.18       0.18       0.02       0.74       0.74        XXX
75978.............  TC............  A                Repair venous blockage       0.00      15.79         NA       0.83      16.62         NA        XXX
75978.............  ..............  A                Repair venous blockage       0.54      15.97         NA       0.85      17.36         NA        XXX
75980.............  26............  A                Contrast xray exam           1.44       0.47       0.47       0.06       1.97       1.97        XXX
                                                      bile duct.
75980.............  TC............  A                Contrast xray exam           0.00       5.43         NA       0.29       5.72         NA        XXX
                                                      bile duct.
75980.............  ..............  A                Contrast xray exam           1.44       5.90         NA       0.35       7.69         NA        XXX
                                                      bile duct.
75982.............  26............  A                Contrast xray exam           1.44       0.47       0.47       0.06       1.97       1.97        XXX
                                                      bile duct.
75982.............  TC............  C                Contrast xray exam           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      bile duct.
75982.............  ..............  C                Contrast xray exam           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      bile duct.
75984.............  26............  A                Xray control catheter        0.72       0.23       0.23       0.03       0.98       0.98        XXX
                                                      change.
75984.............  TC............  A                Xray control catheter        0.00       1.96         NA       0.11       2.07         NA        XXX
                                                      change.

[[Page 70425]]

 
75984.............  ..............  A                Xray control catheter        0.72       2.19         NA       0.14       3.05         NA        XXX
                                                      change.
75989.............  26............  A                Abscess drainage under       1.19       0.39       0.39       0.05       1.63       1.63        XXX
                                                      x-ray.
75989.............  TC............  A                Abscess drainage under       0.00       3.16         NA       0.17       3.33         NA        XXX
                                                      x-ray.
75989.............  ..............  A                Abscess drainage under       1.19       3.55         NA       0.22       4.96         NA        XXX
                                                      x-ray.
75992.............  26............  A                Atherectomy, x-ray           0.54       0.19       0.19       0.03       0.76       0.76        XXX
                                                      exam.
75992.............  TC............  A                Atherectomy, x-ray           0.00      15.79         NA       0.83      16.62         NA        XXX
                                                      exam.
75992.............  ..............  A                Atherectomy, x-ray           0.54      15.98         NA       0.86      17.38         NA        XXX
                                                      exam.
75993.............  26............  A                Atherectomy, x-ray           0.36       0.13       0.13       0.02       0.51       0.51        ZZZ
                                                      exam.
75993.............  TC............  C                Atherectomy, x-ray           0.00       0.00       0.00       0.00       0.00       0.00        ZZZ
                                                      exam.
75993.............  ..............  C                Atherectomy, x-ray           0.00       0.00       0.00       0.00       0.00       0.00        ZZZ
                                                      exam.
75994.............  26............  A                Atherectomy, x-ray           1.31       0.46       0.46       0.07       1.84       1.84        XXX
                                                      exam.
75994.............  TC............  C                Atherectomy, x-ray           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      exam.
75994.............  ..............  C                Atherectomy, x-ray           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      exam.
75995.............  26............  A                Atherectomy, x-ray           1.31       0.47       0.47       0.05       1.83       1.83        XXX
                                                      exam.
75995.............  TC............  C                Atherectomy, x-ray           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      exam.
75995.............  ..............  C                Atherectomy, x-ray           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      exam.
75996.............  26............  A                Atherectomy, x-ray           0.36       0.12       0.12       0.02       0.50       0.50        ZZZ
                                                      exam.
75996.............  TC............  C                Atherectomy, x-ray           0.00       0.00       0.00       0.00       0.00       0.00        ZZZ
                                                      exam.
75996.............  ..............  C                Atherectomy, x-ray           0.00       0.00       0.00       0.00       0.00       0.00        ZZZ
                                                      exam.
75998.............  26............  A                Fluoroguide for vein         0.38       0.13       0.13       0.01       0.52       0.52        ZZZ
                                                      device.
75998.............  TC............  A                Fluoroguide for vein         0.00       1.31         NA       0.10       1.41         NA        ZZZ
                                                      device.
75998.............  ..............  A                Fluoroguide for vein         0.38       1.44         NA       0.11       1.93         NA        ZZZ
                                                      device.
76000.............  26............  A                Fluoroscope                  0.17       0.05       0.05       0.01       0.23       0.23        XXX
                                                      examination.
76000.............  TC............  A                Fluoroscope                  0.00       1.31         NA       0.07       1.38         NA        XXX
                                                      examination.
76000.............  ..............  A                Fluoroscope                  0.17       1.36         NA       0.08       1.61         NA        XXX
                                                      examination.
76001.............  26............  A                Fluoroscope exam,            0.67       0.22       0.22       0.05       0.94       0.94        XXX
                                                      extensive.
76001.............  TC............  A                Fluoroscope exam,            0.00       2.63         NA       0.14       2.77         NA        XXX
                                                      extensive.
76001.............  ..............  A                Fluoroscope exam,            0.67       2.85         NA       0.19       3.71         NA        XXX
                                                      extensive.
76003.............  26............  A                Needle localization by       0.54       0.17       0.17       0.02       0.73       0.73        XXX
                                                      x-ray.
76003.............  TC............  A                Needle localization by       0.00       1.31         NA       0.07       1.38         NA        XXX
                                                      x-ray.
76003.............  ..............  A                Needle localization by       0.54       1.48         NA       0.09       2.11         NA        XXX
                                                      x-ray.
76005.............  26............  A                Fluoroguide for spine        0.60       0.15       0.15       0.03       0.78       0.78        XXX
                                                      inject.
76005.............  TC............  A                Fluoroguide for spine        0.00       1.31         NA       0.07       1.38         NA        XXX
                                                      inject.
76005.............  ..............  A                Fluoroguide for spine        0.60       1.46         NA       0.10       2.16         NA        XXX
                                                      inject.
76006.............  ..............  A                X-ray stress view.....       0.41       0.18       0.18       0.06       0.65       0.65        XXX
76010.............  26............  A                X-ray, nose to rectum.       0.18       0.06       0.06       0.01       0.25       0.25        XXX
76010.............  TC............  A                X-ray, nose to rectum.       0.00       0.52         NA       0.02       0.54         NA        XXX
76010.............  ..............  A                X-ray, nose to rectum.       0.18       0.58         NA       0.03       0.79         NA        XXX
76012.............  26............  A                Percut vertebroplasty        1.31       0.47       0.47       0.10       1.88       1.88        XXX
                                                      fluor.
76012.............  TC............  C                Percut vertebroplasty        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      fluor.
76012.............  ..............  C                Percut vertebroplasty        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      fluor.
76013.............  26............  A                Percut vertebroplasty,       1.38       0.48       0.48       0.07       1.93       1.93        XXX
                                                      ct.
76013.............  TC............  C                Percut vertebroplasty,       0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      ct.
76013.............  ..............  C                Percut vertebroplasty,       0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      ct.
76020.............  26............  A                X-rays for bone age...       0.19       0.06       0.06       0.01       0.26       0.26        XXX
76020.............  TC............  A                X-rays for bone age...       0.00       0.52         NA       0.02       0.54         NA        XXX
76020.............  ..............  A                X-rays for bone age...       0.19       0.58         NA       0.03       0.80         NA        XXX
76040.............  26............  A                X-rays, bone                 0.27       0.09       0.09       0.01       0.37       0.37        XXX
                                                      evaluation.
76040.............  TC............  A                X-rays, bone                 0.00       0.78         NA       0.05       0.83         NA        XXX
                                                      evaluation.
76040.............  ..............  A                X-rays, bone                 0.27       0.87         NA       0.06       1.20         NA        XXX
                                                      evaluation.
76061.............  26............  A                X-rays, bone survey...       0.45       0.15       0.15       0.02       0.62       0.62        XXX
76061.............  TC............  A                X-rays, bone survey...       0.00       1.00         NA       0.06       1.06         NA        XXX
76061.............  ..............  A                X-rays, bone survey...       0.45       1.15         NA       0.08       1.68         NA        XXX
76062.............  26............  A                X-rays, bone survey...       0.54       0.18       0.18       0.02       0.74       0.74        XXX
76062.............  TC............  A                X-rays, bone survey...       0.00       1.44         NA       0.08       1.52         NA        XXX
76062.............  ..............  A                X-rays, bone survey...       0.54       1.62         NA       0.10       2.26         NA        XXX
76065.............  26............  A                X-rays, bone                 0.70       0.23       0.23       0.03       0.96       0.96        XXX
                                                      evaluation.
76065.............  TC............  A                X-rays, bone                 0.00       0.73         NA       0.05       0.78         NA        XXX
                                                      evaluation.
76065.............  ..............  A                X-rays, bone                 0.70       0.96         NA       0.08       1.74         NA        XXX
                                                      evaluation.
76066.............  26............  A                Joint survey, single         0.31       0.10       0.10       0.02       0.43       0.43        XXX
                                                      view.
76066.............  TC............  A                Joint survey, single         0.00       1.11         NA       0.06       1.17         NA        XXX
                                                      view.
76066.............  ..............  A                Joint survey, single         0.31       1.21         NA       0.08       1.60         NA        XXX
                                                      view.
76070.............  26............  A                Ct bone density, axial       0.25       0.08       0.08       0.01       0.34       0.34        XXX
76070.............  TC............  A                Ct bone density, axial       0.00       2.96         NA       0.16       3.12         NA        XXX
76070.............  ..............  A                Ct bone density, axial       0.25       3.04         NA       0.17       3.46         NA        XXX
76071.............  26............  A                Ct bone density,             0.22       0.07       0.07       0.01       0.30       0.30        XXX
                                                      peripheral.
76071.............  TC............  A                Ct bone density,             0.00       2.96         NA       0.05       3.01         NA        XXX
                                                      peripheral.
76071.............  ..............  A                Ct bone density,             0.22       3.03         NA       0.06       3.31         NA        XXX
                                                      peripheral.
76075.............  26............  A                Dxa bone density,            0.30       0.10       0.10       0.01       0.41       0.41        XXX
                                                      axial.
76075.............  TC............  A                Dxa bone density,            0.00       3.10         NA       0.17       3.27         NA        XXX
                                                      axial.
76075.............  ..............  A                Dxa bone density,            0.30       3.20         NA       0.18       3.68         NA        XXX
                                                      axial.
76076.............  26............  A                Dxa bone density/            0.22       0.08       0.08       0.01       0.31       0.31        XXX
                                                      peripheral.
76076.............  TC............  A                Dxa bone density/            0.00       0.75         NA       0.05       0.80         NA        XXX
                                                      peripheral.
76076.............  ..............  A                Dxa bone density/            0.22       0.83         NA       0.06       1.11         NA        XXX
                                                      peripheral.
76077.............  26............  A                Dxa bone density/v-          0.17       0.06       0.06       0.01       0.24       0.24        XXX
                                                      fracture.

[[Page 70426]]

 
76077.............  TC............  A                Dxa bone density/v-          0.00       0.75         NA       0.05       0.80         NA        XXX
                                                      fracture.
76077.............  ..............  A                Dxa bone density/v-          0.17       0.81         NA       0.06       1.04         NA        XXX
                                                      fracture.
76078.............  26............  A                Radiographic                 0.20       0.07       0.07       0.01       0.28       0.28        XXX
                                                      absorptiometry.
76078.............  TC............  A                Radiographic                 0.00       0.75         NA       0.05       0.80         NA        XXX
                                                      absorptiometry.
76078.............  ..............  A                Radiographic                 0.20       0.82         NA       0.06       1.08         NA        XXX
                                                      absorptiometry.
76080.............  26............  A                X-ray exam of fistula.       0.54       0.18       0.18       0.02       0.74       0.74        XXX
76080.............  TC............  A                X-ray exam of fistula.       0.00       1.05         NA       0.06       1.11         NA        XXX
76080.............  ..............  A                X-ray exam of fistula.       0.54       1.23         NA       0.08       1.85         NA        XXX
76082.............  26............  A                Computer mammogram add-      0.06       0.02       0.02       0.01       0.09       0.09        ZZZ
                                                      on.
76082.............  TC............  A                Computer mammogram add-      0.00       0.42         NA       0.01       0.43         NA        ZZZ
                                                      on.
76082.............  ..............  A                Computer mammogram add-      0.06       0.44         NA       0.02       0.52         NA        ZZZ
                                                      on.
76083.............  26............  A                Computer mammogram add-      0.06       0.02       0.02       0.01       0.09       0.09        ZZZ
                                                      on.
76083.............  TC............  A                Computer mammogram add-      0.00       0.42         NA       0.01       0.43         NA        ZZZ
                                                      on.
76083.............  ..............  A                Computer mammogram add-      0.06       0.44         NA       0.02       0.52         NA        ZZZ
                                                      on.
76086.............  26............  A                X-ray of mammary duct.       0.36       0.12       0.12       0.02       0.50       0.50        XXX
76086.............  TC............  A                X-ray of mammary duct.       0.00       2.63         NA       0.14       2.77         NA        XXX
76086.............  ..............  A                X-ray of mammary duct.       0.36       2.75         NA       0.16       3.27         NA        XXX
76088.............  26............  A                X-ray of mammary ducts       0.45       0.15       0.15       0.02       0.62       0.62        XXX
76088.............  TC............  A                X-ray of mammary ducts       0.00       3.67         NA       0.19       3.86         NA        XXX
76088.............  ..............  A                X-ray of mammary ducts       0.45       3.82         NA       0.21       4.48         NA        XXX
76090.............  26............  A                Mammogram, one breast.       0.70       0.23       0.23       0.03       0.96       0.96        XXX
76090.............  TC............  A                Mammogram, one breast.       0.00       1.05         NA       0.06       1.11         NA        XXX
76090.............  ..............  A                Mammogram, one breast.       0.70       1.28         NA       0.09       2.07         NA        XXX
76091.............  26............  A                Mammogram, both              0.87       0.28       0.28       0.04       1.19       1.19        XXX
                                                      breasts.
76091.............  TC............  A                Mammogram, both              0.00       1.31         NA       0.07       1.38         NA        XXX
                                                      breasts.
76091.............  ..............  A                Mammogram, both              0.87       1.59         NA       0.11       2.57         NA        XXX
                                                      breasts.
76092.............  26............  A                Mammogram, screening..       0.70       0.23       0.23       0.03       0.96       0.96        XXX
76092.............  TC............  A                Mammogram, screening..       0.00       1.23         NA       0.07       1.30         NA        XXX
76092.............  ..............  A                Mammogram, screening..       0.70       1.46         NA       0.10       2.26         NA        XXX
76093.............  26............  A                Magnetic image, breast       1.63       0.53       0.53       0.07       2.23       2.23        XXX
76093.............  TC............  A                Magnetic image, breast       0.00      17.67         NA       0.92      18.59         NA        XXX
76093.............  ..............  A                Magnetic image, breast       1.63      18.20         NA       0.99      20.82         NA        XXX
76094.............  26............  A                Magnetic image, both         1.63       0.53       0.53       0.07       2.23       2.23        XXX
                                                      breasts.
76094.............  TC............  A                Magnetic image, both         0.00      23.98         NA       1.24      25.22         NA        XXX
                                                      breasts.
76094.............  ..............  A                Magnetic image, both         1.63      24.51         NA       1.31      27.45         NA        XXX
                                                      breasts.
76095.............  26............  A                Stereotactic breast          1.59       0.52       0.52       0.09       2.20       2.20        XXX
                                                      biopsy.
76095.............  TC............  A                Stereotactic breast          0.00       7.18         NA       0.37       7.55         NA        XXX
                                                      biopsy.
76095.............  ..............  A                Stereotactic breast          1.59       7.70         NA       0.46       9.75         NA        XXX
                                                      biopsy.
76096.............  26............  A                X-ray of needle wire,        0.56       0.18       0.18       0.02       0.76       0.76        XXX
                                                      breast.
76096.............  TC............  A                X-ray of needle wire,        0.00       1.31         NA       0.07       1.38         NA        XXX
                                                      breast.
76096.............  ..............  A                X-ray of needle wire,        0.56       1.49         NA       0.09       2.14         NA        XXX
                                                      breast.
76098.............  26............  A                X-ray exam, breast           0.16       0.05       0.05       0.01       0.22       0.22        XXX
                                                      specimen.
76098.............  TC............  A                X-ray exam, breast           0.00       0.42         NA       0.02       0.44         NA        XXX
                                                      specimen.
76098.............  ..............  A                X-ray exam, breast           0.16       0.47         NA       0.03       0.66         NA        XXX
                                                      specimen.
76100.............  26............  A                X-ray exam of body           0.58       0.19       0.19       0.03       0.80       0.80        XXX
                                                      section.
76100.............  TC............  A                X-ray exam of body           0.00       1.25         NA       0.07       1.32         NA        XXX
                                                      section.
76100.............  ..............  A                X-ray exam of body           0.58       1.44         NA       0.10       2.12         NA        XXX
                                                      section.
76101.............  26............  A                Complex body section x-      0.58       0.19       0.19       0.03       0.80       0.80        XXX
                                                      ray.
76101.............  TC............  A                Complex body section x-      0.00       1.42         NA       0.08       1.50         NA        XXX
                                                      ray.
76101.............  ..............  A                Complex body section x-      0.58       1.61         NA       0.11       2.30         NA        XXX
                                                      ray.
76102.............  26............  A                Complex body section x-      0.58       0.19       0.19       0.03       0.80       0.80        XXX
                                                      rays.
76102.............  TC............  A                Complex body section x-      0.00       1.74         NA       0.11       1.85         NA        XXX
                                                      rays.
76102.............  ..............  A                Complex body section x-      0.58       1.93         NA       0.14       2.65         NA        XXX
                                                      rays.
76120.............  26............  A                Cine/video x-rays.....       0.38       0.13       0.13       0.02       0.53       0.53        XXX
76120.............  TC............  A                Cine/video x-rays.....       0.00       1.05         NA       0.06       1.11         NA        XXX
76120.............  ..............  A                Cine/video x-rays.....       0.38       1.18         NA       0.08       1.64         NA        XXX
76125.............  26............  A                Cine/video x-rays add-       0.27       0.09       0.09       0.01       0.37       0.37        ZZZ
                                                      on.
76125.............  TC............  A                Cine/video x-rays add-       0.00       0.78         NA       0.05       0.83         NA        ZZZ
                                                      on.
76125.............  ..............  A                Cine/video x-rays add-       0.27       0.87         NA       0.06       1.20         NA        ZZZ
                                                      on.
76140.............  ..............  I                X-ray consultation....       0.00       0.00       0.00       0.00       0.00       0.00        XXX
76150.............  ..............  A                X-ray exam, dry              0.00       0.42         NA       0.02       0.44         NA        XXX
                                                      process.
76350.............  ..............  C                Special x-ray contrast       0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      study.
76355.............  26............  A                Ct scan for                  1.21       0.40       0.40       0.05       1.66       1.66        XXX
                                                      localization.
76355.............  TC............  A                Ct scan for                  0.00       8.28         NA       0.42       8.70         NA        XXX
                                                      localization.
76355.............  ..............  A                Ct scan for                  1.21       8.68         NA       0.47      10.36         NA        XXX
                                                      localization.
76360.............  26............  A                Ct scan for needle           1.16       0.38       0.38       0.05       1.59       1.59        XXX
                                                      biopsy.
76360.............  TC............  A                Ct scan for needle           0.00       8.28         NA       0.42       8.70         NA        XXX
                                                      biopsy.
76360.............  ..............  A                Ct scan for needle           1.16       8.66         NA       0.47      10.29         NA        XXX
                                                      biopsy.
76362.............  26............  A                Ct guide for tissue          3.99       1.30       1.30       0.18       5.47       5.47        XXX
                                                      ablation.
76362.............  TC............  A                Ct guide for tissue          0.00       8.28         NA       1.46       9.74         NA        XXX
                                                      ablation.
76362.............  ..............  A                Ct guide for tissue          3.99       9.58         NA       1.64      15.21         NA        XXX
                                                      ablation.
76370.............  26............  A                Ct scan for therapy          0.85       0.28       0.28       0.04       1.17       1.17        XXX
                                                      guide.
76370.............  TC............  A                Ct scan for therapy          0.00       2.96         NA       0.16       3.12         NA        XXX
                                                      guide.
76370.............  ..............  A                Ct scan for therapy          0.85       3.24         NA       0.20       4.29         NA        XXX
                                                      guide.
76376.............  26............  A                3d render w/o                0.20       0.07       0.07       0.02       0.29       0.29        XXX
                                                      postprocess.

[[Page 70427]]

 
76376.............  TC............  A                3d render w/o                0.00       3.43         NA       0.08       3.51         NA        XXX
                                                      postprocess.
76376.............  ..............  A                3d render w/o                0.20       3.50         NA       0.10       3.80         NA        XXX
                                                      postprocess.
76377.............  26............  A                3d rendering w/              0.79       0.27       0.27       0.08       1.14       1.14        XXX
                                                      postprocess.
76377.............  TC............  A                3d rendering w/              0.00       3.43         NA       0.31       3.74         NA        XXX
                                                      postprocess.
76377.............  ..............  A                3d rendering w/              0.79       3.70         NA       0.39       4.88         NA        XXX
                                                      postprocess.
76380.............  26............  A                CAT scan follow-up           0.98       0.32       0.32       0.04       1.34       1.34        XXX
                                                      study.
76380.............  TC............  A                CAT scan follow-up           0.00       3.51         NA       0.18       3.69         NA        XXX
                                                      study.
76380.............  ..............  A                CAT scan follow-up           0.98       3.83         NA       0.22       5.03         NA        XXX
                                                      study.
76390.............  26............  N                Mr spectroscopy.......      +1.40       0.47       0.47       0.07       1.94       1.94        XXX
76390.............  TC............  N                Mr spectroscopy.......      +0.00      11.04      11.04       0.59      11.63      11.63        XXX
76390.............  ..............  N                Mr spectroscopy.......      +1.40      11.51      11.51       0.66      13.57      13.57        XXX
76393.............  26............  A                Mr guidance for needle       1.50       0.50       0.50       0.09       2.09       2.09        XXX
                                                      place.
76393.............  TC............  A                Mr guidance for needle       0.00      11.23         NA       0.55      11.78         NA        XXX
                                                      place.
76393.............  ..............  A                Mr guidance for needle       1.50      11.73         NA       0.64      13.87         NA        XXX
                                                      place.
76394.............  26............  A                Mri for tissue               4.24       1.38       1.38       0.24       5.86       5.86        XXX
                                                      ablation.
76394.............  TC............  A                Mri for tissue               0.00      11.23         NA       1.57      12.80         NA        XXX
                                                      ablation.
76394.............  ..............  A                Mri for tissue               4.24      12.61         NA       1.81      18.66         NA        XXX
                                                      ablation.
76400.............  26............  A                Magnetic image, bone         1.60       0.52       0.52       0.07       2.19       2.19        XXX
                                                      marrow.
76400.............  TC............  A                Magnetic image, bone         0.00      11.23         NA       0.59      11.82         NA        XXX
                                                      marrow.
76400.............  ..............  A                Magnetic image, bone         1.60      11.75         NA       0.66      14.01         NA        XXX
                                                      marrow.
76496.............  26............  C                Fluoroscopic procedure       0.00       0.00       0.00       0.00       0.00       0.00        XXX
76496.............  TC............  C                Fluoroscopic procedure       0.00       0.00       0.00       0.00       0.00       0.00        XXX
76496.............  ..............  C                Fluoroscopic procedure       0.00       0.00       0.00       0.00       0.00       0.00        XXX
76497.............  26............  C                Ct procedure..........       0.00       0.00       0.00       0.00       0.00       0.00        XXX
76497.............  TC............  C                Ct procedure..........       0.00       0.00       0.00       0.00       0.00       0.00        XXX
76497.............  ..............  C                Ct procedure..........       0.00       0.00       0.00       0.00       0.00       0.00        XXX
76498.............  26............  C                Mri procedure.........       0.00       0.00       0.00       0.00       0.00       0.00        XXX
76498.............  TC............  C                Mri procedure.........       0.00       0.00       0.00       0.00       0.00       0.00        XXX
76498.............  ..............  C                Mri procedure.........       0.00       0.00       0.00       0.00       0.00       0.00        XXX
76499.............  26............  C                Radiographic procedure       0.00       0.00       0.00       0.00       0.00       0.00        XXX
76499.............  TC............  C                Radiographic procedure       0.00       0.00       0.00       0.00       0.00       0.00        XXX
76499.............  ..............  C                Radiographic procedure       0.00       0.00       0.00       0.00       0.00       0.00        XXX
76506.............  26............  A                Echo exam of head.....       0.63       0.24       0.24       0.06       0.93       0.93        XXX
76506.............  TC............  A                Echo exam of head.....       0.00       1.42         NA       0.08       1.50         NA        XXX
76506.............  ..............  A                Echo exam of head.....       0.63       1.66         NA       0.14       2.43         NA        XXX
76510.............  26............  A                Ophth us, b & quant a.       1.55       0.68       0.68       0.03       2.26       2.26        XXX
76510.............  TC............  A                Ophth us, b & quant a.       0.00       2.19         NA       0.07       2.26         NA        XXX
76510.............  ..............  A                Ophth us, b & quant a.       1.55       2.87         NA       0.10       4.52         NA        XXX
76511.............  26............  A                Ophth us, quant a only       0.94       0.40       0.40       0.03       1.37       1.37        XXX
76511.............  TC............  A                Ophth us, quant a only       0.00       2.04         NA       0.07       2.11         NA        XXX
76511.............  ..............  A                Ophth us, quant a only       0.94       2.44         NA       0.10       3.48         NA        XXX
76512.............  26............  A                Ophth us, b w/non-           0.94       0.42       0.42       0.02       1.38       1.38        XXX
                                                      quant a.
76512.............  TC............  A                Ophth us, b w/non-           0.00       1.82         NA       0.10       1.92         NA        XXX
                                                      quant a.
76512.............  ..............  A                Ophth us, b w/non-           0.94       2.24         NA       0.12       3.30         NA        XXX
                                                      quant a.
76513.............  26............  A                Echo exam of eye,            0.66       0.29       0.29       0.02       0.97       0.97        XXX
                                                      water bath.
76513.............  TC............  A                Echo exam of eye,            0.00       1.52         NA       0.10       1.62         NA        XXX
                                                      water bath.
76513.............  ..............  A                Echo exam of eye,            0.66       1.81         NA       0.12       2.59         NA        XXX
                                                      water bath.
76514.............  26............  A                Echo exam of eye,            0.17       0.08       0.08       0.01       0.26       0.26        XXX
                                                      thickness.
76514.............  TC............  A                Echo exam of eye,            0.00       0.05         NA       0.01       0.06         NA        XXX
                                                      thickness.
76514.............  ..............  A                Echo exam of eye,            0.17       0.13         NA       0.02       0.32         NA        XXX
                                                      thickness.
76516.............  26............  A                Echo exam of eye......       0.54       0.24       0.24       0.01       0.79       0.79        XXX
76516.............  TC............  A                Echo exam of eye......       0.00       1.22         NA       0.07       1.29         NA        XXX
76516.............  ..............  A                Echo exam of eye......       0.54       1.46         NA       0.08       2.08         NA        XXX
76519.............  26............  A                Echo exam of eye......       0.54       0.24       0.24       0.01       0.79       0.79        XXX
76519.............  TC............  A                Echo exam of eye......       0.00       1.31         NA       0.07       1.38         NA        XXX
76519.............  ..............  A                Echo exam of eye......       0.54       1.55         NA       0.08       2.17         NA        XXX
76529.............  26............  A                Echo exam of eye......       0.57       0.24       0.24       0.02       0.83       0.83        XXX
76529.............  TC............  A                Echo exam of eye......       0.00       1.13         NA       0.08       1.21         NA        XXX
76529.............  ..............  A                Echo exam of eye......       0.57       1.37         NA       0.10       2.04         NA        XXX
76536.............  26............  A                Us exam of head and          0.56       0.18       0.18       0.02       0.76       0.76        XXX
                                                      neck.
76536.............  TC............  A                Us exam of head and          0.00       1.42         NA       0.08       1.50         NA        XXX
                                                      neck.
76536.............  ..............  A                Us exam of head and          0.56       1.60         NA       0.10       2.26         NA        XXX
                                                      neck.
76604.............  26............  A                Us exam, chest, b-scan       0.55       0.18       0.18       0.02       0.75       0.75        XXX
76604.............  TC............  A                Us exam, chest, b-scan       0.00       1.31         NA       0.07       1.38         NA        XXX
76604.............  ..............  A                Us exam, chest, b-scan       0.55       1.49         NA       0.09       2.13         NA        XXX
76645.............  26............  A                Us exam, breast(s)....       0.54       0.18       0.18       0.02       0.74       0.74        XXX
76645.............  TC............  A                Us exam, breast(s)....       0.00       1.05         NA       0.06       1.11         NA        XXX
76645.............  ..............  A                Us exam, breast(s)....       0.54       1.23         NA       0.08       1.85         NA        XXX
76700.............  26............  A                Us exam, abdom,              0.81       0.27       0.27       0.04       1.12       1.12        XXX
                                                      complete.
76700.............  TC............  A                Us exam, abdom,              0.00       1.98         NA       0.11       2.09         NA        XXX
                                                      complete.
76700.............  ..............  A                Us exam, abdom,              0.81       2.25         NA       0.15       3.21         NA        XXX
                                                      complete.
76705.............  26............  A                Echo exam of abdomen..       0.59       0.19       0.19       0.03       0.81       0.81        XXX
76705.............  TC............  A                Echo exam of abdomen..       0.00       1.42         NA       0.08       1.50         NA        XXX
76705.............  ..............  A                Echo exam of abdomen..       0.59       1.61         NA       0.11       2.31         NA        XXX
76770.............  26............  A                Us exam abdo back            0.74       0.24       0.24       0.03       1.01       1.01        XXX
                                                      wall, comp.

[[Page 70428]]

 
76770.............  TC............  A                Us exam abdo back            0.00       1.98         NA       0.11       2.09         NA        XXX
                                                      wall, comp.
76770.............  ..............  A                Us exam abdo back            0.74       2.22         NA       0.14       3.10         NA        XXX
                                                      wall, comp.
76775.............  26............  A                Us exam abdo back            0.58       0.19       0.19       0.03       0.80       0.80        XXX
                                                      wall, lim.
76775.............  TC............  A                Us exam abdo back            0.00       1.42         NA       0.08       1.50         NA        XXX
                                                      wall, lim.
76775.............  ..............  A                Us exam abdo back            0.58       1.61         NA       0.11       2.30         NA        XXX
                                                      wall, lim.
76778.............  26............  A                Us exam kidney               0.74       0.24       0.24       0.03       1.01       1.01        XXX
                                                      transplant.
76778.............  TC............  A                Us exam kidney               0.00       1.98         NA       0.11       2.09         NA        XXX
                                                      transplant.
76778.............  ..............  A                Us exam kidney               0.74       2.22         NA       0.14       3.10         NA        XXX
                                                      transplant.
76800.............  26............  A                Us exam, spinal canal.       1.13       0.34       0.34       0.05       1.52       1.52        XXX
76800.............  TC............  A                Us exam, spinal canal.       0.00       1.42         NA       0.08       1.50         NA        XXX
76800.............  ..............  A                Us exam, spinal canal.       1.13       1.76         NA       0.13       3.02         NA        XXX
76801.............  26............  A                Ob us < 14 wks, single       0.99       0.34       0.34       0.04       1.37       1.37        XXX
                                                      fetus.
76801.............  TC............  A                Ob us < 14 wks, single       0.00       2.11         NA       0.12       2.23         NA        XXX
                                                      fetus.
76801.............  ..............  A                Ob us < 14 wks, single       0.99       2.45         NA       0.16       3.60         NA        XXX
                                                      fetus.
76802.............  26............  A                Ob us < 14 wks, add'l        0.83       0.29       0.29       0.04       1.16       1.16        ZZZ
                                                      fetus.
76802.............  TC............  A                Ob us < 14 wks, add'l        0.00       1.05         NA       0.12       1.17         NA        ZZZ
                                                      fetus.
76802.............  ..............  A                Ob us < 14 wks, add'l        0.83       1.34         NA       0.16       2.33         NA        ZZZ
                                                      fetus.
76805.............  26............  A                Ob us >/= 14 wks, sngl       0.99       0.34       0.34       0.04       1.37       1.37        XXX
                                                      fetus.
76805.............  TC............  A                Ob us >/= 14 wks, sngl       0.00       2.11         NA       0.12       2.23         NA        XXX
                                                      fetus.
76805.............  ..............  A                Ob us >/= 14 wks, sngl       0.99       2.45         NA       0.16       3.60         NA        XXX
                                                      fetus.
76810.............  26............  A                Ob us >/= 14 wks, addl       0.98       0.34       0.34       0.04       1.36       1.36        ZZZ
                                                      fetus.
76810.............  TC............  A                Ob us >/= 14 wks, addl       0.00       1.05         NA       0.22       1.27         NA        ZZZ
                                                      fetus.
76810.............  ..............  A                Ob us >/= 14 wks, addl       0.98       1.39         NA       0.26       2.63         NA        ZZZ
                                                      fetus.
76811.............  26............  A                Ob us, detailed, sngl        1.90       0.71       0.71       0.09       2.70       2.70        XXX
                                                      fetus.
76811.............  TC............  A                Ob us, detailed, sngl        0.00       3.54         NA       0.43       3.97         NA        XXX
                                                      fetus.
76811.............  ..............  A                Ob us, detailed, sngl        1.90       4.25         NA       0.52       6.67         NA        XXX
                                                      fetus.
76812.............  26............  A                Ob us, detailed, addl        1.78       0.66       0.66       0.08       2.52       2.52        ZZZ
                                                      fetus.
76812.............  TC............  A                Ob us, detailed, addl        0.00       1.05         NA       0.41       1.46         NA        ZZZ
                                                      fetus.
76812.............  ..............  A                Ob us, detailed, addl        1.78       1.71         NA       0.49       3.98         NA        ZZZ
                                                      fetus.
76815.............  26............  A                Ob us, limited,              0.65       0.23       0.23       0.03       0.91       0.91        XXX
                                                      fetus(s).
76815.............  TC............  A                Ob us, limited,              0.00       1.42         NA       0.08       1.50         NA        XXX
                                                      fetus(s).
76815.............  ..............  A                Ob us, limited,              0.65       1.65         NA       0.11       2.41         NA        XXX
                                                      fetus(s).
76816.............  26............  A                Ob us, follow-up, per        0.85       0.32       0.32       0.04       1.21       1.21        XXX
                                                      fetus.
76816.............  TC............  A                Ob us, follow-up, per        0.00       1.11         NA       0.06       1.17         NA        XXX
                                                      fetus.
76816.............  ..............  A                Ob us, follow-up, per        0.85       1.43         NA       0.10       2.38         NA        XXX
                                                      fetus.
76817.............  26............  A                Transvaginal us,             0.75       0.26       0.26       0.03       1.04       1.04        XXX
                                                      obstetric.
76817.............  TC............  A                Transvaginal us,             0.00       1.52         NA       0.06       1.58         NA        XXX
                                                      obstetric.
76817.............  ..............  A                Transvaginal us,             0.75       1.78         NA       0.09       2.62         NA        XXX
                                                      obstetric.
76818.............  26............  A                Fetal biophys profile        1.05       0.39       0.39       0.05       1.49       1.49        XXX
                                                      w/nst.
76818.............  TC............  A                Fetal biophys profile        0.00       1.61         NA       0.10       1.71         NA        XXX
                                                      w/nst.
76818.............  ..............  A                Fetal biophys profile        1.05       2.00         NA       0.15       3.20         NA        XXX
                                                      w/nst.
76819.............  26............  A                Fetal biophys profil w/      0.77       0.28       0.28       0.03       1.08       1.08        XXX
                                                      o nst.
76819.............  TC............  A                Fetal biophys profil w/      0.00       1.61         NA       0.10       1.71         NA        XXX
                                                      o nst.
76819.............  ..............  A                Fetal biophys profil w/      0.77       1.89         NA       0.13       2.79         NA        XXX
                                                      o nst.
76820.............  26............  A                Umbilical artery echo.       0.50       0.19       0.19       0.03       0.72       0.72        XXX
76820.............  TC............  A                Umbilical artery echo.       0.00       1.61         NA       0.12       1.73         NA        XXX
76820.............  ..............  A                Umbilical artery echo.       0.50       1.80         NA       0.15       2.45         NA        XXX
76821.............  26............  A                Middle cerebral artery       0.70       0.27       0.27       0.03       1.00       1.00        XXX
                                                      echo.
76821.............  TC............  A                Middle cerebral artery       0.00       1.61         NA       0.12       1.73         NA        XXX
                                                      echo.
76821.............  ..............  A                Middle cerebral artery       0.70       1.88         NA       0.15       2.73         NA        XXX
                                                      echo.
76825.............  26............  A                Echo exam of fetal           1.67       0.60       0.60       0.07       2.34       2.34        XXX
                                                      heart.
76825.............  TC............  A                Echo exam of fetal           0.00       1.98         NA       0.11       2.09         NA        XXX
                                                      heart.
76825.............  ..............  A                Echo exam of fetal           1.67       2.58         NA       0.18       4.43         NA        XXX
                                                      heart.
76826.............  26............  A                Echo exam of fetal           0.83       0.29       0.29       0.03       1.15       1.15        XXX
                                                      heart.
76826.............  TC............  A                Echo exam of fetal           0.00       0.71         NA       0.05       0.76         NA        XXX
                                                      heart.
76826.............  ..............  A                Echo exam of fetal           0.83       1.00         NA       0.08       1.91         NA        XXX
                                                      heart.
76827.............  26............  A                Echo exam of fetal           0.58       0.21       0.21       0.02       0.81       0.81        XXX
                                                      heart.
76827.............  TC............  A                Echo exam of fetal           0.00       1.72         NA       0.12       1.84         NA        XXX
                                                      heart.
76827.............  ..............  A                Echo exam of fetal           0.58       1.93         NA       0.14       2.65         NA        XXX
                                                      heart.
76828.............  26............  A                Echo exam of fetal           0.56       0.22       0.22       0.03       0.81       0.81        XXX
                                                      heart.
76828.............  TC............  A                Echo exam of fetal           0.00       1.11         NA       0.08       1.19         NA        XXX
                                                      heart.
76828.............  ..............  A                Echo exam of fetal           0.56       1.33         NA       0.11       2.00         NA        XXX
                                                      heart.
76830.............  26............  A                Transvaginal us, non-        0.69       0.23       0.23       0.03       0.95       0.95        XXX
                                                      ob.
76830.............  TC............  A                Transvaginal us, non-        0.00       1.52         NA       0.10       1.62         NA        XXX
                                                      ob.
76830.............  ..............  A                Transvaginal us, non-        0.69       1.75         NA       0.13       2.57         NA        XXX
                                                      ob.
76831.............  26............  A                Echo exam, uterus.....       0.72       0.25       0.25       0.03       1.00       1.00        XXX
76831.............  TC............  A                Echo exam, uterus.....       0.00       1.52         NA       0.10       1.62         NA        XXX
76831.............  ..............  A                Echo exam, uterus.....       0.72       1.77         NA       0.13       2.62         NA        XXX
76856.............  26............  A                Us exam, pelvic,             0.69       0.23       0.23       0.03       0.95       0.95        XXX
                                                      complete.
76856.............  TC............  A                Us exam, pelvic,             0.00       1.52         NA       0.10       1.62         NA        XXX
                                                      complete.
76856.............  ..............  A                Us exam, pelvic,             0.69       1.75         NA       0.13       2.57         NA        XXX
                                                      complete.
76857.............  26............  A                Us exam, pelvic,             0.38       0.12       0.12       0.02       0.52       0.52        XXX
                                                      limited.
76857.............  TC............  A                Us exam, pelvic,             0.00       1.71         NA       0.06       1.77         NA        XXX
                                                      limited.
76857.............  ..............  A                Us exam, pelvic,             0.38       1.83         NA       0.08       2.29         NA        XXX
                                                      limited.
76870.............  26............  A                Us exam, scrotum......       0.64       0.21       0.21       0.03       0.88       0.88        XXX

[[Page 70429]]

 
76870.............  TC............  A                Us exam, scrotum......       0.00       1.52         NA       0.10       1.62         NA        XXX
76870.............  ..............  A                Us exam, scrotum......       0.64       1.73         NA       0.13       2.50         NA        XXX
76872.............  26............  A                Us, transrectal.......       0.69       0.22       0.22       0.04       0.95       0.95        XXX
76872.............  TC............  A                Us, transrectal.......       0.00       2.03         NA       0.10       2.13         NA        XXX
76872.............  ..............  A                Us, transrectal.......       0.69       2.25         NA       0.14       3.08         NA        XXX
76873.............  26............  A                Echograp trans r, pros       1.55       0.50       0.50       0.09       2.14       2.14        XXX
                                                      study.
76873.............  TC............  A                Echograp trans r, pros       0.00       2.11         NA       0.16       2.27         NA        XXX
                                                      study.
76873.............  ..............  A                Echograp trans r, pros       1.55       2.61         NA       0.25       4.41         NA        XXX
                                                      study.
76880.............  26............  A                Us exam, extremity....       0.59       0.19       0.19       0.03       0.81       0.81        XXX
76880.............  TC............  A                Us exam, extremity....       0.00       1.42         NA       0.08       1.50         NA        XXX
76880.............  ..............  A                Us exam, extremity....       0.59       1.61         NA       0.11       2.31         NA        XXX
76885.............  26............  A                Us exam infant hips,         0.74       0.24       0.24       0.03       1.01       1.01        XXX
                                                      dynamic.
76885.............  TC............  A                Us exam infant hips,         0.00       1.52         NA       0.10       1.62         NA        XXX
                                                      dynamic.
76885.............  ..............  A                Us exam infant hips,         0.74       1.76         NA       0.13       2.63         NA        XXX
                                                      dynamic.
76886.............  26............  A                Us exam infant hips,         0.62       0.20       0.20       0.03       0.85       0.85        XXX
                                                      static.
76886.............  TC............  A                Us exam infant hips,         0.00       1.42         NA       0.08       1.50         NA        XXX
                                                      static.
76886.............  ..............  A                Us exam infant hips,         0.62       1.62         NA       0.11       2.35         NA        XXX
                                                      static.
76930.............  26............  A                Echo guide,                  0.67       0.25       0.25       0.02       0.94       0.94        XXX
                                                      cardiocentesis.
76930.............  TC............  A                Echo guide,                  0.00       1.52         NA       0.10       1.62         NA        XXX
                                                      cardiocentesis.
76930.............  ..............  A                Echo guide,                  0.67       1.77         NA       0.12       2.56         NA        XXX
                                                      cardiocentesis.
76932.............  26............  A                Echo guide for heart         0.67       0.25       0.25       0.02       0.94       0.94        XXX
                                                      biopsy.
76932.............  TC............  A                Echo guide for heart         0.00       1.52         NA       0.10       1.62         NA        XXX
                                                      biopsy.
76932.............  ..............  A                Echo guide for heart         0.67       1.77         NA       0.12       2.56         NA        XXX
                                                      biopsy.
76936.............  26............  A                Echo guide for artery        1.99       0.66       0.66       0.13       2.78       2.78        XXX
                                                      repair.
76936.............  TC............  A                Echo guide for artery        0.00       6.31         NA       0.34       6.65         NA        XXX
                                                      repair.
76936.............  ..............  A                Echo guide for artery        1.99       6.97         NA       0.47       9.43         NA        XXX
                                                      repair.
76937.............  26............  A                Us guide, vascular           0.30       0.10       0.10       0.03       0.43       0.43        ZZZ
                                                      access.
76937.............  TC............  A                Us guide, vascular           0.00       0.38         NA       0.10       0.48         NA        ZZZ
                                                      access.
76937.............  ..............  A                Us guide, vascular           0.30       0.48         NA       0.13       0.91         NA        ZZZ
                                                      access.
76940.............  26............  A                Us guide, tissue             2.00       0.65       0.65       0.31       2.96       2.96        XXX
                                                      ablation.
76940.............  TC............  A                Us guide, tissue             0.00       1.52         NA       0.29       1.81         NA        XXX
                                                      ablation.
76940.............  ..............  A                Us guide, tissue             2.00       2.17         NA       0.60       4.77         NA        XXX
                                                      ablation.
76941.............  26............  A                Echo guide for               1.34       0.47       0.47       0.07       1.88       1.88        XXX
                                                      transfusion.
76941.............  TC............  A                Echo guide for               0.00       1.53         NA       0.08       1.61         NA        XXX
                                                      transfusion.
76941.............  ..............  A                Echo guide for               1.34       2.00         NA       0.15       3.49         NA        XXX
                                                      transfusion.
76942.............  26............  A                Echo guide for biopsy.       0.67       0.22       0.22       0.03       0.92       0.92        XXX
76942.............  TC............  A                Echo guide for biopsy.       0.00       2.82         NA       0.10       2.92         NA        XXX
76942.............  ..............  A                Echo guide for biopsy.       0.67       3.04         NA       0.13       3.84         NA        XXX
76945.............  26............  A                Echo guide, villus           0.67       0.22       0.22       0.03       0.92       0.92        XXX
                                                      sampling.
76945.............  TC............  A                Echo guide, villus           0.00       1.53         NA       0.08       1.61         NA        XXX
                                                      sampling.
76945.............  ..............  A                Echo guide, villus           0.67       1.75         NA       0.11       2.53         NA        XXX
                                                      sampling.
76946.............  26............  A                Echo guide for               0.38       0.14       0.14       0.02       0.54       0.54        XXX
                                                      amniocentesis.
76946.............  TC............  A                Echo guide for               0.00       1.52         NA       0.10       1.62         NA        XXX
                                                      amniocentesis.
76946.............  ..............  A                Echo guide for               0.38       1.66         NA       0.12       2.16         NA        XXX
                                                      amniocentesis.
76948.............  26............  A                Echo guide, ova              0.38       0.13       0.13       0.02       0.53       0.53        XXX
                                                      aspiration.
76948.............  TC............  A                Echo guide, ova              0.00       1.52         NA       0.10       1.62         NA        XXX
                                                      aspiration.
76948.............  ..............  A                Echo guide, ova              0.38       1.65         NA       0.12       2.15         NA        XXX
                                                      aspiration.
76950.............  26............  A                Echo guidance                0.58       0.19       0.19       0.03       0.80       0.80        XXX
                                                      radiotherapy.
76950.............  TC............  A                Echo guidance                0.00       1.31         NA       0.07       1.38         NA        XXX
                                                      radiotherapy.
76950.............  ..............  A                Echo guidance                0.58       1.50         NA       0.10       2.18         NA        XXX
                                                      radiotherapy.
76965.............  26............  A                Echo guidance                1.34       0.43       0.43       0.08       1.85       1.85        XXX
                                                      radiotherapy.
76965.............  TC............  A                Echo guidance                0.00       5.59         NA       0.29       5.88         NA        XXX
                                                      radiotherapy.
76965.............  ..............  A                Echo guidance                1.34       6.02         NA       0.37       7.73         NA        XXX
                                                      radiotherapy.
76970.............  26............  A                Ultrasound exam follow-      0.40       0.13       0.13       0.02       0.55       0.55        XXX
                                                      up.
76970.............  TC............  A                Ultrasound exam follow-      0.00       1.05         NA       0.06       1.11         NA        XXX
                                                      up.
76970.............  ..............  A                Ultrasound exam follow-      0.40       1.18         NA       0.08       1.66         NA        XXX
                                                      up.
76975.............  26............  A                GI endoscopic                0.81       0.28       0.28       0.04       1.13       1.13        XXX
                                                      ultrasound.
76975.............  TC............  A                GI endoscopic                0.00       1.52         NA       0.10       1.62         NA        XXX
                                                      ultrasound.
76975.............  ..............  A                GI endoscopic                0.81       1.80         NA       0.14       2.75         NA        XXX
                                                      ultrasound.
76977.............  26............  A                Us bone density              0.05       0.02       0.02       0.01       0.08       0.08        XXX
                                                      measure.
76977.............  TC............  A                Us bone density              0.00       0.82         NA       0.05       0.87         NA        XXX
                                                      measure.
76977.............  ..............  A                Us bone density              0.05       0.84         NA       0.06       0.95         NA        XXX
                                                      measure.
76986.............  26............  A                Ultrasound guide             1.20       0.40       0.40       0.13       1.73       1.73        XXX
                                                      intraoper.
76986.............  TC............  A                Ultrasound guide             0.00       2.63         NA       0.14       2.77         NA        XXX
                                                      intraoper.
76986.............  ..............  A                Ultrasound guide             1.20       3.03         NA       0.27       4.50         NA        XXX
                                                      intraoper.
76999.............  26............  C                Echo examination             0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      procedure.
76999.............  TC............  C                Echo examination             0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      procedure.
76999.............  ..............  C                Echo examination             0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      procedure.
77261.............  ..............  A                Radiation therapy            1.39       0.51       0.51       0.07       1.97       1.97        XXX
                                                      planning.
77262.............  ..............  A                Radiation therapy            2.11       0.75       0.75       0.11       2.97       2.97        XXX
                                                      planning.
77263.............  ..............  A                Radiation therapy            3.14       1.11       1.11       0.16       4.41       4.41        XXX
                                                      planning.
77280.............  26............  A                Set radiation therapy        0.70       0.22       0.22       0.04       0.96       0.96        XXX
                                                      field.
77280.............  TC............  A                Set radiation therapy        0.00       3.48         NA       0.18       3.66         NA        XXX
                                                      field.
77280.............  ..............  A                Set radiation therapy        0.70       3.70         NA       0.22       4.62         NA        XXX
                                                      field.
77285.............  26............  A                Set radiation therapy        1.05       0.34       0.34       0.05       1.44       1.44        XXX
                                                      field.

[[Page 70430]]

 
77285.............  TC............  A                Set radiation therapy        0.00       5.59         NA       0.30       5.89         NA        XXX
                                                      field.
77285.............  ..............  A                Set radiation therapy        1.05       5.93         NA       0.35       7.33         NA        XXX
                                                      field.
77290.............  26............  A                Set radiation therapy        1.56       0.50       0.50       0.08       2.14       2.14        XXX
                                                      field.
77290.............  TC............  A                Set radiation therapy        0.00       6.53         NA       0.35       6.88         NA        XXX
                                                      field.
77290.............  ..............  A                Set radiation therapy        1.56       7.03         NA       0.43       9.02         NA        XXX
                                                      field.
77295.............  26............  A                Set radiation therapy        4.56       1.46       1.46       0.23       6.25       6.25        XXX
                                                      field.
77295.............  TC............  A                Set radiation therapy        0.00      28.01         NA       1.48      29.49         NA        XXX
                                                      field.
77295.............  ..............  A                Set radiation therapy        4.56      29.47         NA       1.71      35.74         NA        XXX
                                                      field.
77299.............  26............  C                Radiation therapy            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      planning.
77299.............  TC............  C                Radiation therapy            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      planning.
77299.............  ..............  C                Radiation therapy            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      planning.
77300.............  26............  A                Radiation therapy dose       0.62       0.20       0.20       0.03       0.85       0.85        XXX
                                                      plan.
77300.............  TC............  A                Radiation therapy dose       0.00       1.34         NA       0.07       1.41         NA        XXX
                                                      plan.
77300.............  ..............  A                Radiation therapy dose       0.62       1.54         NA       0.10       2.26         NA        XXX
                                                      plan.
77301.............  26............  A                Radiotherapy dose            7.99       2.57       2.57       0.40      10.96      10.96        XXX
                                                      plan, imrt.
77301.............  TC............  A                Radiotherapy dose            0.00      28.01         NA       1.48      29.49         NA        XXX
                                                      plan, imrt.
77301.............  ..............  A                Radiotherapy dose            7.99      30.58         NA       1.88      40.45         NA        XXX
                                                      plan, imrt.
77305.............  26............  A                Teletx isodose plan          0.70       0.23       0.23       0.04       0.97       0.97        XXX
                                                      simple.
77305.............  TC............  A                Teletx isodose plan          0.00       1.87         NA       0.11       1.98         NA        XXX
                                                      simple.
77305.............  ..............  A                Teletx isodose plan          0.70       2.10         NA       0.15       2.95         NA        XXX
                                                      simple.
77310.............  26............  A                Teletx isodose plan          1.05       0.34       0.34       0.05       1.44       1.44        XXX
                                                      intermed.
77310.............  TC............  A                Teletx isodose plan          0.00       2.34         NA       0.13       2.47         NA        XXX
                                                      intermed.
77310.............  ..............  A                Teletx isodose plan          1.05       2.68         NA       0.18       3.91         NA        XXX
                                                      intermed.
77315.............  26............  A                Teletx isodose plan          1.56       0.50       0.50       0.08       2.14       2.14        XXX
                                                      complex.
77315.............  TC............  A                Teletx isodose plan          0.00       2.67         NA       0.14       2.81         NA        XXX
                                                      complex.
77315.............  ..............  A                Teletx isodose plan          1.56       3.17         NA       0.22       4.95         NA        XXX
                                                      complex.
77321.............  26............  A                Special teletx port          0.95       0.30       0.30       0.05       1.30       1.30        XXX
                                                      plan.
77321.............  TC............  A                Special teletx port          0.00       4.05         NA       0.21       4.26         NA        XXX
                                                      plan.
77321.............  ..............  A                Special teletx port          0.95       4.35         NA       0.26       5.56         NA        XXX
                                                      plan.
77326.............  26............  A                Brachytx isodose calc        0.93       0.30       0.30       0.05       1.28       1.28        XXX
                                                      simp.
77326.............  TC............  A                Brachytx isodose calc        0.00       2.37         NA       0.13       2.50         NA        XXX
                                                      simp.
77326.............  ..............  A                Brachytx isodose calc        0.93       2.67         NA       0.18       3.78         NA        XXX
                                                      simp.
77327.............  26............  A                Brachytx isodose calc        1.39       0.44       0.44       0.07       1.90       1.90        XXX
                                                      interm.
77327.............  TC............  A                Brachytx isodose calc        0.00       3.48         NA       0.18       3.66         NA        XXX
                                                      interm.
77327.............  ..............  A                Brachytx isodose calc        1.39       3.92         NA       0.25       5.56         NA        XXX
                                                      interm.
77328.............  26............  A                Brachytx isodose plan        2.09       0.67       0.67       0.11       2.87       2.87        XXX
                                                      compl.
77328.............  TC............  A                Brachytx isodose plan        0.00       4.97         NA       0.25       5.22         NA        XXX
                                                      compl.
77328.............  ..............  A                Brachytx isodose plan        2.09       5.64         NA       0.36       8.09         NA        XXX
                                                      compl.
77331.............  26............  A                Special radiation            0.87       0.28       0.28       0.04       1.19       1.19        XXX
                                                      dosimetry.
77331.............  TC............  A                Special radiation            0.00       0.50         NA       0.02       0.52         NA        XXX
                                                      dosimetry.
77331.............  ..............  A                Special radiation            0.87       0.78         NA       0.06       1.71         NA        XXX
                                                      dosimetry.
77332.............  26............  A                Radiation treatment          0.54       0.17       0.17       0.03       0.74       0.74        XXX
                                                      aid(s).
77332.............  TC............  A                Radiation treatment          0.00       1.34         NA       0.07       1.41         NA        XXX
                                                      aid(s).
77332.............  ..............  A                Radiation treatment          0.54       1.51         NA       0.10       2.15         NA        XXX
                                                      aid(s).
77333.............  26............  A                Radiation treatment          0.84       0.27       0.27       0.04       1.15       1.15        XXX
                                                      aid(s).
77333.............  TC............  A                Radiation treatment          0.00       1.90         NA       0.11       2.01         NA        XXX
                                                      aid(s).
77333.............  ..............  A                Radiation treatment          0.84       2.17         NA       0.15       3.16         NA        XXX
                                                      aid(s).
77334.............  26............  A                Radiation treatment          1.24       0.40       0.40       0.06       1.70       1.70        XXX
                                                      aid(s).
77334.............  TC............  A                Radiation treatment          0.00       3.26         NA       0.17       3.43         NA        XXX
                                                      aid(s).
77334.............  ..............  A                Radiation treatment          1.24       3.66         NA       0.23       5.13         NA        XXX
                                                      aid(s).
77336.............  ..............  A                Radiation physics            0.00       2.99         NA       0.16       3.15         NA        XXX
                                                      consult.
77370.............  ..............  A                Radiation physics            0.00       3.50         NA       0.18       3.68         NA        XXX
                                                      consult.
77399.............  26............  C                External radiation           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      dosimetry.
77399.............  TC............  C                External radiation           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      dosimetry.
77399.............  ..............  C                External radiation           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      dosimetry.
77401.............  ..............  A                Radiation treatment          0.00       1.78         NA       0.11       1.89         NA        XXX
                                                      delivery.
77402.............  ..............  A                Radiation treatment          0.00       1.78         NA       0.11       1.89         NA        XXX
                                                      delivery.
77403.............  ..............  A                Radiation treatment          0.00       1.78         NA       0.11       1.89         NA        XXX
                                                      delivery.
77404.............  ..............  A                Radiation treatment          0.00       1.78         NA       0.11       1.89         NA        XXX
                                                      delivery.
77406.............  ..............  A                Radiation treatment          0.00       1.78         NA       0.11       1.89         NA        XXX
                                                      delivery.
77407.............  ..............  A                Radiation treatment          0.00       2.10         NA       0.12       2.22         NA        XXX
                                                      delivery.
77408.............  ..............  A                Radiation treatment          0.00       2.10         NA       0.12       2.22         NA        XXX
                                                      delivery.
77409.............  ..............  A                Radiation treatment          0.00       2.10         NA       0.12       2.22         NA        XXX
                                                      delivery.
77411.............  ..............  A                Radiation treatment          0.00       2.10         NA       0.12       2.22         NA        XXX
                                                      delivery.
77412.............  ..............  A                Radiation treatment          0.00       2.34         NA       0.13       2.47         NA        XXX
                                                      delivery.
77413.............  ..............  A                Radiation treatment          0.00       2.34         NA       0.13       2.47         NA        XXX
                                                      delivery.
77414.............  ..............  A                Radiation treatment          0.00       2.34         NA       0.13       2.47         NA        XXX
                                                      delivery.
77416.............  ..............  A                Radiation treatment          0.00       2.34         NA       0.13       2.47         NA        XXX
                                                      delivery.
77417.............  ..............  A                Radiology port film(s)       0.00       0.59         NA       0.04       0.63         NA        XXX
77418.............  ..............  A                Radiation tx delivery,       0.00      18.07         NA       0.13      18.20         NA        XXX
                                                      imrt.
77421.............  26............  A                Stereoscopic x-ray           0.39       0.13       0.13       0.02       0.54       0.54        XXX
                                                      guidance.
77421.............  TC............  A                Stereoscopic x-ray           0.00       3.36         NA       0.10       3.46         NA        XXX
                                                      guidance.
77421.............  ..............  A                Stereoscopic x-ray           0.39       3.49         NA       0.12       4.00         NA        XXX
                                                      guidance.
77422.............  ..............  A                Neutron beam tx,             0.00       1.71         NA       0.13       1.84         NA        XXX
                                                      simple.
77423.............  ..............  A                Neutron beam tx,             0.00       2.26         NA       0.13       2.39         NA        XXX
                                                      complex.

[[Page 70431]]

 
77427.............  ..............  A                Radiation tx                 3.31       1.06       1.06       0.17       4.54       4.54        XXX
                                                      management, x5.
77431.............  ..............  A                Radiation therapy            1.81       0.68       0.68       0.09       2.58       2.58        XXX
                                                      management.
77432.............  ..............  A                Stereotactic radiation       7.92       2.91       2.91       0.41      11.24      11.24        XXX
                                                      trmt.
77470.............  26............  A                Special radiation            2.09       0.67       0.67       0.11       2.87       2.87        XXX
                                                      treatment.
77470.............  TC............  A                Special radiation            0.00      11.18         NA       0.59      11.77         NA        XXX
                                                      treatment.
77470.............  ..............  A                Special radiation            2.09      11.85         NA       0.70      14.64         NA        XXX
                                                      treatment.
77499.............  26............  C                Radiation therapy            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      management.
77499.............  TC............  C                Radiation therapy            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      management.
77499.............  ..............  C                Radiation therapy            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      management.
77520.............  ..............  C                Proton trmt, simple w/       0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      o comp.
77522.............  ..............  C                Proton trmt, simple w/       0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      comp.
77523.............  ..............  C                Proton trmt,                 0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      intermediate.
77525.............  ..............  C                Proton treatment,            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      complex.
77600.............  26............  R                Hyperthermia treatment       1.56       0.50       0.50       0.08       2.14       2.14        XXX
77600.............  TC............  R                Hyperthermia treatment       0.00       3.06         NA       0.16       3.22         NA        XXX
77600.............  ..............  R                Hyperthermia treatment       1.56       3.56         NA       0.24       5.36         NA        XXX
77605.............  26............  R                Hyperthermia treatment       2.09       0.66       0.66       0.16       2.91       2.91        XXX
77605.............  TC............  R                Hyperthermia treatment       0.00       4.07         NA       0.22       4.29         NA        XXX
77605.............  ..............  R                Hyperthermia treatment       2.09       4.73         NA       0.38       7.20         NA        XXX
77610.............  26............  R                Hyperthermia treatment       1.56       0.51       0.51       0.08       2.15       2.15        XXX
77610.............  TC............  R                Hyperthermia treatment       0.00       3.06         NA       0.16       3.22         NA        XXX
77610.............  ..............  R                Hyperthermia treatment       1.56       3.57         NA       0.24       5.37         NA        XXX
77615.............  26............  R                Hyperthermia treatment       2.09       0.66       0.66       0.11       2.86       2.86        XXX
77615.............  TC............  R                Hyperthermia treatment       0.00       4.07         NA       0.22       4.29         NA        XXX
77615.............  ..............  R                Hyperthermia treatment       2.09       4.73         NA       0.33       7.15         NA        XXX
77620.............  26............  R                Hyperthermia treatment       1.56       0.52       0.52       0.20       2.28       2.28        XXX
77620.............  TC............  R                Hyperthermia treatment       0.00       3.06         NA       0.16       3.22         NA        XXX
77620.............  ..............  R                Hyperthermia treatment       1.56       3.58         NA       0.36       5.50         NA        XXX
77750.............  26............  A                Infuse radioactive           4.90       1.58       1.58       0.25       6.73       6.73        090
                                                      materials.
77750.............  TC............  A                Infuse radioactive           0.00       1.33         NA       0.07       1.40         NA        090
                                                      materials.
77750.............  ..............  A                Infuse radioactive           4.90       2.91         NA       0.32       8.13         NA        090
                                                      materials.
77761.............  26............  A                Apply intrcav radiat         3.80       1.09       1.09       0.19       5.08       5.08        090
                                                      simple.
77761.............  TC............  A                Apply intrcav radiat         0.00       2.51         NA       0.14       2.65         NA        090
                                                      simple.
77761.............  ..............  A                Apply intrcav radiat         3.80       3.60         NA       0.33       7.73         NA        090
                                                      simple.
77762.............  26............  A                Apply intrcav radiat         5.71       1.84       1.84       0.29       7.84       7.84        090
                                                      interm.
77762.............  TC............  A                Apply intrcav radiat         0.00       3.62         NA       0.19       3.81         NA        090
                                                      interm.
77762.............  ..............  A                Apply intrcav radiat         5.71       5.46         NA       0.48      11.65         NA        090
                                                      interm.
77763.............  26............  A                Apply intrcav radiat         8.56       2.75       2.75       0.43      11.74      11.74        090
                                                      compl.
77763.............  TC............  A                Apply intrcav radiat         0.00       4.50         NA       0.23       4.73         NA        090
                                                      compl.
77763.............  ..............  A                Apply intrcav radiat         8.56       7.25         NA       0.66      16.47         NA        090
                                                      compl.
77776.............  26............  A                Apply interstit radiat       4.65       0.95       0.95       0.44       6.04       6.04        090
                                                      simpl.
77776.............  TC............  A                Apply interstit radiat       0.00       2.19         NA       0.13       2.32         NA        090
                                                      simpl.
77776.............  ..............  A                Apply interstit radiat       4.65       3.14         NA       0.57       8.36         NA        090
                                                      simpl.
77777.............  26............  A                Apply interstit radiat       7.47       2.38       2.38       0.39      10.24      10.24        090
                                                      inter.
77777.............  TC............  A                Apply interstit radiat       0.00       4.24         NA       0.22       4.46         NA        090
                                                      inter.
77777.............  ..............  A                Apply interstit radiat       7.47       6.62         NA       0.61      14.70         NA        090
                                                      inter.
77778.............  26............  A                Apply interstit radiat      11.17       3.58       3.58       0.57      15.32      15.32        090
                                                      compl.
77778.............  TC............  A                Apply interstit radiat       0.00       5.14         NA       0.27       5.41         NA        090
                                                      compl.
77778.............  ..............  A                Apply interstit radiat      11.17       8.72         NA       0.84      20.73         NA        090
                                                      compl.
77781.............  26............  A                High intensity               1.66       0.53       0.53       0.08       2.27       2.27        090
                                                      brachytherapy.
77781.............  TC............  A                High intensity               0.00      20.36         NA       1.06      21.42         NA        090
                                                      brachytherapy.
77781.............  ..............  A                High intensity               1.66      20.89         NA       1.14      23.69         NA        090
                                                      brachytherapy.
77782.............  26............  A                High intensity               2.49       0.80       0.80       0.13       3.42       3.42        090
                                                      brachytherapy.
77782.............  TC............  A                High intensity               0.00      20.36         NA       1.06      21.42         NA        090
                                                      brachytherapy.
77782.............  ..............  A                High intensity               2.49      21.16         NA       1.19      24.84         NA        090
                                                      brachytherapy.
77783.............  26............  A                High intensity               3.72       1.19       1.19       0.19       5.10       5.10        090
                                                      brachytherapy.
77783.............  TC............  A                High intensity               0.00      20.36         NA       1.06      21.42         NA        090
                                                      brachytherapy.
77783.............  ..............  A                High intensity               3.72      21.55         NA       1.25      26.52         NA        090
                                                      brachytherapy.
77784.............  26............  A                High intensity               5.60       1.80       1.80       0.29       7.69       7.69        090
                                                      brachytherapy.
77784.............  TC............  A                High intensity               0.00      20.36         NA       1.06      21.42         NA        090
                                                      brachytherapy.
77784.............  ..............  A                High intensity               5.60      22.16         NA       1.35      29.11         NA        090
                                                      brachytherapy.
77789.............  26............  A                Apply surface                1.12       0.37       0.37       0.06       1.55       1.55        000
                                                      radiation.
77789.............  TC............  A                Apply surface                0.00       0.45         NA       0.02       0.47         NA        000
                                                      radiation.
77789.............  ..............  A                Apply surface                1.12       0.82         NA       0.08       2.02         NA        000
                                                      radiation.
77790.............  26............  A                Radiation handling....       1.05       0.34       0.34       0.05       1.44       1.44        XXX
77790.............  TC............  A                Radiation handling....       0.00       0.50         NA       0.02       0.52         NA        XXX
77790.............  ..............  A                Radiation handling....       1.05       0.84         NA       0.07       1.96         NA        XXX
77799.............  26............  C                Radium/radioisotope          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      therapy.
77799.............  TC............  C                Radium/radioisotope          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      therapy.
77799.............  ..............  C                Radium/radioisotope          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      therapy.
78000.............  26............  A                Thyroid, single uptake       0.19       0.06       0.06       0.01       0.26       0.26        XXX
78000.............  TC............  A                Thyroid, single uptake       0.00       0.97         NA       0.06       1.03         NA        XXX
78000.............  ..............  A                Thyroid, single uptake       0.19       1.03         NA       0.07       1.29         NA        XXX
78001.............  26............  A                Thyroid, multiple            0.26       0.09       0.09       0.01       0.36       0.36        XXX
                                                      uptakes.
78001.............  TC............  A                Thyroid, multiple            0.00       1.31         NA       0.07       1.38         NA        XXX
                                                      uptakes.

[[Page 70432]]

 
78001.............  ..............  A                Thyroid, multiple            0.26       1.40         NA       0.08       1.74         NA        XXX
                                                      uptakes.
78003.............  26............  A                Thyroid suppress/            0.33       0.11       0.11       0.01       0.45       0.45        XXX
                                                      stimul.
78003.............  TC............  A                Thyroid suppress/            0.00       0.97         NA       0.06       1.03         NA        XXX
                                                      stimul.
78003.............  ..............  A                Thyroid suppress/            0.33       1.08         NA       0.07       1.48         NA        XXX
                                                      stimul.
78006.............  26............  A                Thyroid imaging with         0.49       0.16       0.16       0.02       0.67       0.67        XXX
                                                      uptake.
78006.............  TC............  A                Thyroid imaging with         0.00       2.39         NA       0.13       2.52         NA        XXX
                                                      uptake.
78006.............  ..............  A                Thyroid imaging with         0.49       2.55         NA       0.15       3.19         NA        XXX
                                                      uptake.
78007.............  26............  A                Thyroid image, mult          0.50       0.17       0.17       0.02       0.69       0.69        XXX
                                                      uptakes.
78007.............  TC............  A                Thyroid image, mult          0.00       2.58         NA       0.14       2.72         NA        XXX
                                                      uptakes.
78007.............  ..............  A                Thyroid image, mult          0.50       2.75         NA       0.16       3.41         NA        XXX
                                                      uptakes.
78010.............  26............  A                Thyroid imaging.......       0.39       0.13       0.13       0.02       0.54       0.54        XXX
78010.............  TC............  A                Thyroid imaging.......       0.00       1.83         NA       0.11       1.94         NA        XXX
78010.............  ..............  A                Thyroid imaging.......       0.39       1.96         NA       0.13       2.48         NA        XXX
78011.............  26............  A                Thyroid imaging with         0.45       0.15       0.15       0.02       0.62       0.62        XXX
                                                      flow.
78011.............  TC............  A                Thyroid imaging with         0.00       2.42         NA       0.13       2.55         NA        XXX
                                                      flow.
78011.............  ..............  A                Thyroid imaging with         0.45       2.57         NA       0.15       3.17         NA        XXX
                                                      flow.
78015.............  26............  A                Thyroid met imaging...       0.67       0.23       0.23       0.03       0.93       0.93        XXX
78015.............  TC............  A                Thyroid met imaging...       0.00       2.58         NA       0.14       2.72         NA        XXX
78015.............  ..............  A                Thyroid met imaging...       0.67       2.81         NA       0.17       3.65         NA        XXX
78016.............  26............  A                Thyroid met imaging/         0.82       0.28       0.28       0.03       1.13       1.13        XXX
                                                      studies.
78016.............  TC............  A                Thyroid met imaging/         0.00       3.49         NA       0.18       3.67         NA        XXX
                                                      studies.
78016.............  ..............  A                Thyroid met imaging/         0.82       3.77         NA       0.21       4.80         NA        XXX
                                                      studies.
78018.............  26............  A                Thyroid met imaging,         0.86       0.30       0.30       0.04       1.20       1.20        XXX
                                                      body.
78018.............  TC............  A                Thyroid met imaging,         0.00       5.44         NA       0.29       5.73         NA        XXX
                                                      body.
78018.............  ..............  A                Thyroid met imaging,         0.86       5.74         NA       0.33       6.93         NA        XXX
                                                      body.
78020.............  26............  A                Thyroid met uptake....       0.60       0.21       0.21       0.02       0.83       0.83        ZZZ
78020.............  TC............  A                Thyroid met uptake....       0.00       1.31         NA       0.14       1.45         NA        ZZZ
78020.............  ..............  A                Thyroid met uptake....       0.60       1.52         NA       0.16       2.28         NA        ZZZ
78070.............  26............  A                Parathyroid nuclear          0.82       0.28       0.28       0.04       1.14       1.14        XXX
                                                      imaging.
78070.............  TC............  A                Parathyroid nuclear          0.00       4.28         NA       0.11       4.39         NA        XXX
                                                      imaging.
78070.............  ..............  A                Parathyroid nuclear          0.82       4.56         NA       0.15       5.53         NA        XXX
                                                      imaging.
78075.............  26............  A                Adrenal nuclear              0.74       0.26       0.26       0.03       1.03       1.03        XXX
                                                      imaging.
78075.............  TC............  A                Adrenal nuclear              0.00       5.44         NA       0.29       5.73         NA        XXX
                                                      imaging.
78075.............  ..............  A                Adrenal nuclear              0.74       5.70         NA       0.32       6.76         NA        XXX
                                                      imaging.
78099.............  26............  C                Endocrine nuclear            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      procedure.
78099.............  TC............  C                Endocrine nuclear            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      procedure.
78099.............  ..............  C                Endocrine nuclear            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      procedure.
78102.............  26............  A                Bone marrow imaging,         0.55       0.19       0.19       0.02       0.76       0.76        XXX
                                                      ltd.
78102.............  TC............  A                Bone marrow imaging,         0.00       2.05         NA       0.12       2.17         NA        XXX
                                                      ltd.
78102.............  ..............  A                Bone marrow imaging,         0.55       2.24         NA       0.14       2.93         NA        XXX
                                                      ltd.
78103.............  26............  A                Bone marrow imaging,         0.75       0.26       0.26       0.03       1.04       1.04        XXX
                                                      mult.
78103.............  TC............  A                Bone marrow imaging,         0.00       3.18         NA       0.17       3.35         NA        XXX
                                                      mult.
78103.............  ..............  A                Bone marrow imaging,         0.75       3.44         NA       0.20       4.39         NA        XXX
                                                      mult.
78104.............  26............  A                Bone marrow imaging,         0.80       0.27       0.27       0.03       1.10       1.10        XXX
                                                      body.
78104.............  TC............  A                Bone marrow imaging,         0.00       4.08         NA       0.22       4.30         NA        XXX
                                                      body.
78104.............  ..............  A                Bone marrow imaging,         0.80       4.35         NA       0.25       5.40         NA        XXX
                                                      body.
78110.............  26............  A                Plasma volume, single.       0.19       0.07       0.07       0.01       0.27       0.27        XXX
78110.............  TC............  A                Plasma volume, single.       0.00       0.95         NA       0.06       1.01         NA        XXX
78110.............  ..............  A                Plasma volume, single.       0.19       1.02         NA       0.07       1.28         NA        XXX
78111.............  26............  A                Plasma volume,               0.22       0.08       0.08       0.01       0.31       0.31        XXX
                                                      multiple.
78111.............  TC............  A                Plasma volume,               0.00       2.58         NA       0.14       2.72         NA        XXX
                                                      multiple.
78111.............  ..............  A                Plasma volume,               0.22       2.66         NA       0.15       3.03         NA        XXX
                                                      multiple.
78120.............  26............  A                Red cell mass, single.       0.23       0.08       0.08       0.01       0.32       0.32        XXX
78120.............  TC............  A                Red cell mass, single.       0.00       1.74         NA       0.11       1.85         NA        XXX
78120.............  ..............  A                Red cell mass, single.       0.23       1.82         NA       0.12       2.17         NA        XXX
78121.............  26............  A                Red cell mass,               0.32       0.11       0.11       0.01       0.44       0.44        XXX
                                                      multiple.
78121.............  TC............  A                Red cell mass,               0.00       2.92         NA       0.14       3.06         NA        XXX
                                                      multiple.
78121.............  ..............  A                Red cell mass,               0.32       3.03         NA       0.15       3.50         NA        XXX
                                                      multiple.
78122.............  26............  A                Blood volume..........       0.45       0.16       0.16       0.02       0.63       0.63        XXX
78122.............  TC............  A                Blood volume..........       0.00       4.61         NA       0.24       4.85         NA        XXX
78122.............  ..............  A                Blood volume..........       0.45       4.77         NA       0.26       5.48         NA        XXX
78130.............  26............  A                Red cell survival            0.61       0.21       0.21       0.03       0.85       0.85        XXX
                                                      study.
78130.............  TC............  A                Red cell survival            0.00       2.86         NA       0.14       3.00         NA        XXX
                                                      study.
78130.............  ..............  A                Red cell survival            0.61       3.07         NA       0.17       3.85         NA        XXX
                                                      study.
78135.............  26............  A                Red cell survival            0.64       0.22       0.22       0.03       0.89       0.89        XXX
                                                      kinetics.
78135.............  TC............  A                Red cell survival            0.00       4.88         NA       0.25       5.13         NA        XXX
                                                      kinetics.
78135.............  ..............  A                Red cell survival            0.64       5.10         NA       0.28       6.02         NA        XXX
                                                      kinetics.
78140.............  26............  A                Red cell sequestration       0.61       0.20       0.20       0.03       0.84       0.84        XXX
78140.............  TC............  A                Red cell sequestration       0.00       3.94         NA       0.21       4.15         NA        XXX
78140.............  ..............  A                Red cell sequestration       0.61       4.14         NA       0.24       4.99         NA        XXX
78185.............  26............  A                Spleen imaging........       0.40       0.14       0.14       0.02       0.56       0.56        XXX
78185.............  TC............  A                Spleen imaging........       0.00       2.37         NA       0.13       2.50         NA        XXX
78185.............  ..............  A                Spleen imaging........       0.40       2.51         NA       0.15       3.06         NA        XXX
78190.............  26............  A                Platelet survival,           1.09       0.39       0.39       0.08       1.56       1.56        XXX
                                                      kinetics.
78190.............  TC............  A                Platelet survival,           0.00       5.73         NA       0.30       6.03         NA        XXX
                                                      kinetics.

[[Page 70433]]

 
78190.............  ..............  A                Platelet survival,           1.09       6.12         NA       0.38       7.59         NA        XXX
                                                      kinetics.
78191.............  26............  A                Platelet survival.....       0.61       0.20       0.20       0.03       0.84       0.84        XXX
78191.............  TC............  A                Platelet survival.....       0.00       7.36         NA       0.37       7.73         NA        XXX
78191.............  ..............  A                Platelet survival.....       0.61       7.56         NA       0.40       8.57         NA        XXX
78195.............  26............  A                Lymph system imaging..       1.20       0.41       0.41       0.06       1.67       1.67        XXX
78195.............  TC............  A                Lymph system imaging..       0.00       4.08         NA       0.22       4.30         NA        XXX
78195.............  ..............  A                Lymph system imaging..       1.20       4.49         NA       0.28       5.97         NA        XXX
78199.............  26............  C                Blood/lymph nuclear          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      exam.
78199.............  TC............  C                Blood/lymph nuclear          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      exam.
78199.............  ..............  C                Blood/lymph nuclear          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      exam.
78201.............  26............  A                Liver imaging.........       0.44       0.15       0.15       0.02       0.61       0.61        XXX
78201.............  TC............  A                Liver imaging.........       0.00       2.37         NA       0.13       2.50         NA        XXX
78201.............  ..............  A                Liver imaging.........       0.44       2.52         NA       0.15       3.11         NA        XXX
78202.............  26............  A                Liver imaging with           0.51       0.17       0.17       0.02       0.70       0.70        XXX
                                                      flow.
78202.............  TC............  A                Liver imaging with           0.00       2.89         NA       0.14       3.03         NA        XXX
                                                      flow.
78202.............  ..............  A                Liver imaging with           0.51       3.06         NA       0.16       3.73         NA        XXX
                                                      flow.
78205.............  26............  A                Liver imaging (3D)....       0.71       0.24       0.24       0.03       0.98       0.98        XXX
78205.............  TC............  A                Liver imaging (3D)....       0.00       5.93         NA       0.31       6.24         NA        XXX
78205.............  ..............  A                Liver imaging (3D)....       0.71       6.17         NA       0.34       7.22         NA        XXX
78206.............  26............  A                Liver image (3d) with        0.96       0.33       0.33       0.04       1.33       1.33        XXX
                                                      flow.
78206.............  TC............  A                Liver image (3d) with        0.00       5.93         NA       0.11       6.04         NA        XXX
                                                      flow.
78206.............  ..............  A                Liver image (3d) with        0.96       6.26         NA       0.15       7.37         NA        XXX
                                                      flow.
78215.............  26............  A                Liver and spleen             0.49       0.16       0.16       0.02       0.67       0.67        XXX
                                                      imaging.
78215.............  TC............  A                Liver and spleen             0.00       2.95         NA       0.14       3.09         NA        XXX
                                                      imaging.
78215.............  ..............  A                Liver and spleen             0.49       3.11         NA       0.16       3.76         NA        XXX
                                                      imaging.
78216.............  26............  A                Liver & spleen image/        0.57       0.19       0.19       0.02       0.78       0.78        XXX
                                                      flow.
78216.............  TC............  A                Liver & spleen image/        0.00       3.49         NA       0.18       3.67         NA        XXX
                                                      flow.
78216.............  ..............  A                Liver & spleen image/        0.57       3.68         NA       0.20       4.45         NA        XXX
                                                      flow.
78220.............  26............  A                Liver function study..       0.49       0.16       0.16       0.02       0.67       0.67        XXX
78220.............  TC............  A                Liver function study..       0.00       3.73         NA       0.19       3.92         NA        XXX
78220.............  ..............  A                Liver function study..       0.49       3.89         NA       0.21       4.59         NA        XXX
78223.............  26............  A                Hepatobiliary imaging.       0.84       0.28       0.28       0.04       1.16       1.16        XXX
78223.............  TC............  A                Hepatobiliary imaging.       0.00       3.67         NA       0.19       3.86         NA        XXX
78223.............  ..............  A                Hepatobiliary imaging.       0.84       3.95         NA       0.23       5.02         NA        XXX
78230.............  26............  A                Salivary gland imaging       0.45       0.15       0.15       0.02       0.62       0.62        XXX
78230.............  TC............  A                Salivary gland imaging       0.00       2.19         NA       0.13       2.32         NA        XXX
78230.............  ..............  A                Salivary gland imaging       0.45       2.34         NA       0.15       2.94         NA        XXX
78231.............  26............  A                Serial salivary              0.52       0.18       0.18       0.02       0.72       0.72        XXX
                                                      imaging.
78231.............  TC............  A                Serial salivary              0.00       3.18         NA       0.17       3.35         NA        XXX
                                                      imaging.
78231.............  ..............  A                Serial salivary              0.52       3.36         NA       0.19       4.07         NA        XXX
                                                      imaging.
78232.............  26............  A                Salivary gland               0.47       0.16       0.16       0.02       0.65       0.65        XXX
                                                      function exam.
78232.............  TC............  A                Salivary gland               0.00       3.55         NA       0.18       3.73         NA        XXX
                                                      function exam.
78232.............  ..............  A                Salivary gland               0.47       3.71         NA       0.20       4.38         NA        XXX
                                                      function exam.
78258.............  26............  A                Esophageal motility          0.74       0.25       0.25       0.03       1.02       1.02        XXX
                                                      study.
78258.............  TC............  A                Esophageal motility          0.00       2.89         NA       0.14       3.03         NA        XXX
                                                      study.
78258.............  ..............  A                Esophageal motility          0.74       3.14         NA       0.17       4.05         NA        XXX
                                                      study.
78261.............  26............  A                Gastric mucosa imaging       0.69       0.24       0.24       0.03       0.96       0.96        XXX
78261.............  TC............  A                Gastric mucosa imaging       0.00       4.11         NA       0.22       4.33         NA        XXX
78261.............  ..............  A                Gastric mucosa imaging       0.69       4.35         NA       0.25       5.29         NA        XXX
78262.............  26............  A                Gastroesophageal             0.68       0.23       0.23       0.03       0.94       0.94        XXX
                                                      reflux exam.
78262.............  TC............  A                Gastroesophageal             0.00       4.26         NA       0.22       4.48         NA        XXX
                                                      reflux exam.
78262.............  ..............  A                Gastroesophageal             0.68       4.49         NA       0.25       5.42         NA        XXX
                                                      reflux exam.
78264.............  26............  A                Gastric emptying study       0.78       0.26       0.26       0.03       1.07       1.07        XXX
78264.............  TC............  A                Gastric emptying study       0.00       4.14         NA       0.22       4.36         NA        XXX
78264.............  ..............  A                Gastric emptying study       0.78       4.40         NA       0.25       5.43         NA        XXX
78267.............  ..............  X                Breath tst attain/anal       0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      c-14.
78268.............  ..............  X                Breath test analysis,        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      c-14.
78270.............  26............  A                Vit B-12 absorption          0.20       0.07       0.07       0.01       0.28       0.28        XXX
                                                      exam.
78270.............  TC............  A                Vit B-12 absorption          0.00       1.55         NA       0.10       1.65         NA        XXX
                                                      exam.
78270.............  ..............  A                Vit B-12 absorption          0.20       1.62         NA       0.11       1.93         NA        XXX
                                                      exam.
78271.............  26............  A                Vit b-12 absrp exam,         0.20       0.07       0.07       0.01       0.28       0.28        XXX
                                                      int fac.
78271.............  TC............  A                Vit b-12 absrp exam,         0.00       1.64         NA       0.10       1.74         NA        XXX
                                                      int fac.
78271.............  ..............  A                Vit b-12 absrp exam,         0.20       1.71         NA       0.11       2.02         NA        XXX
                                                      int fac.
78272.............  26............  A                Vit B-12 absorp,             0.27       0.09       0.09       0.01       0.37       0.37        XXX
                                                      combined.
78272.............  TC............  A                Vit B-12 absorp,             0.00       2.33         NA       0.13       2.46         NA        XXX
                                                      combined.
78272.............  ..............  A                Vit B-12 absorp,             0.27       2.42         NA       0.14       2.83         NA        XXX
                                                      combined.
78278.............  26............  A                Acute GI blood loss          0.99       0.33       0.33       0.04       1.36       1.36        XXX
                                                      imaging.
78278.............  TC............  A                Acute GI blood loss          0.00       4.88         NA       0.25       5.13         NA        XXX
                                                      imaging.
78278.............  ..............  A                Acute GI blood loss          0.99       5.21         NA       0.29       6.49         NA        XXX
                                                      imaging.
78282.............  26............  A                GI protein loss exam..       0.38       0.13       0.13       0.02       0.53       0.53        XXX
78282.............  TC............  C                GI protein loss exam..       0.00       0.00       0.00       0.00       0.00       0.00        XXX
78282.............  ..............  C                GI protein loss exam..       0.00       0.00       0.00       0.00       0.00       0.00        XXX
78290.............  26............  A                Meckel's divert exam..       0.68       0.23       0.23       0.03       0.94       0.94        XXX
78290.............  TC............  A                Meckel's divert exam..       0.00       3.06         NA       0.16       3.22         NA        XXX
78290.............  ..............  A                Meckel's divert exam..       0.68       3.29         NA       0.19       4.16         NA        XXX

[[Page 70434]]

 
78291.............  26............  A                Leveen/shunt patency         0.88       0.30       0.30       0.04       1.22       1.22        XXX
                                                      exam.
78291.............  TC............  A                Leveen/shunt patency         0.00       3.07         NA       0.16       3.23         NA        XXX
                                                      exam.
78291.............  ..............  A                Leveen/shunt patency         0.88       3.37         NA       0.20       4.45         NA        XXX
                                                      exam.
78299.............  26............  C                GI nuclear procedure..       0.00       0.00       0.00       0.00       0.00       0.00        XXX
78299.............  TC............  C                GI nuclear procedure..       0.00       0.00       0.00       0.00       0.00       0.00        XXX
78299.............  ..............  C                GI nuclear procedure..       0.00       0.00       0.00       0.00       0.00       0.00        XXX
78300.............  26............  A                Bone imaging, limited        0.62       0.21       0.21       0.03       0.86       0.86        XXX
                                                      area.
78300.............  TC............  A                Bone imaging, limited        0.00       2.49         NA       0.14       2.63         NA        XXX
                                                      area.
78300.............  ..............  A                Bone imaging, limited        0.62       2.70         NA       0.17       3.49         NA        XXX
                                                      area.
78305.............  26............  A                Bone imaging, multiple       0.83       0.28       0.28       0.04       1.15       1.15        XXX
                                                      areas.
78305.............  TC............  A                Bone imaging, multiple       0.00       3.67         NA       0.19       3.86         NA        XXX
                                                      areas.
78305.............  ..............  A                Bone imaging, multiple       0.83       3.95         NA       0.23       5.01         NA        XXX
                                                      areas.
78306.............  26............  A                Bone imaging, whole          0.86       0.29       0.29       0.04       1.19       1.19        XXX
                                                      body.
78306.............  TC............  A                Bone imaging, whole          0.00       4.28         NA       0.22       4.50         NA        XXX
                                                      body.
78306.............  ..............  A                Bone imaging, whole          0.86       4.57         NA       0.26       5.69         NA        XXX
                                                      body.
78315.............  26............  A                Bone imaging, 3 phase.       1.02       0.34       0.34       0.04       1.40       1.40        XXX
78315.............  TC............  A                Bone imaging, 3 phase.       0.00       4.79         NA       0.25       5.04         NA        XXX
78315.............  ..............  A                Bone imaging, 3 phase.       1.02       5.13         NA       0.29       6.44         NA        XXX
78320.............  26............  A                Bone imaging (3D).....       1.04       0.36       0.36       0.04       1.44       1.44        XXX
78320.............  TC............  A                Bone imaging (3D).....       0.00       5.93         NA       0.31       6.24         NA        XXX
78320.............  ..............  A                Bone imaging (3D).....       1.04       6.29         NA       0.35       7.68         NA        XXX
78350.............  26............  A                Bone mineral, single         0.22       0.07       0.07       0.01       0.30       0.30        XXX
                                                      photon.
78350.............  TC............  A                Bone mineral, single         0.00       0.75         NA       0.05       0.80         NA        XXX
                                                      photon.
78350.............  ..............  A                Bone mineral, single         0.22       0.82         NA       0.06       1.10         NA        XXX
                                                      photon.
78351.............  ..............  N                Bone mineral, dual          +0.30       1.72       0.12       0.01       2.03       0.43        XXX
                                                      photon.
78399.............  26............  C                Musculoskeletal              0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      nuclear exam.
78399.............  TC............  C                Musculoskeletal              0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      nuclear exam.
78399.............  ..............  C                Musculoskeletal              0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      nuclear exam.
78414.............  26............  A                Non-imaging heart            0.45       0.16       0.16       0.02       0.63       0.63        XXX
                                                      function.
78414.............  TC............  C                Non-imaging heart            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      function.
78414.............  ..............  C                Non-imaging heart            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      function.
78428.............  26............  A                Cardiac shunt imaging.       0.78       0.29       0.29       0.03       1.10       1.10        XXX
78428.............  TC............  A                Cardiac shunt imaging.       0.00       2.26         NA       0.13       2.39         NA        XXX
78428.............  ..............  A                Cardiac shunt imaging.       0.78       2.55         NA       0.16       3.49         NA        XXX
78445.............  26............  A                Vascular flow imaging.       0.49       0.17       0.17       0.02       0.68       0.68        XXX
78445.............  TC............  A                Vascular flow imaging.       0.00       1.87         NA       0.11       1.98         NA        XXX
78445.............  ..............  A                Vascular flow imaging.       0.49       2.04         NA       0.13       2.66         NA        XXX
78456.............  26............  A                Acute venous thrombus        1.00       0.34       0.34       0.04       1.38       1.38        XXX
                                                      image.
78456.............  TC............  A                Acute venous thrombus        0.00       3.99         NA       0.29       4.28         NA        XXX
                                                      image.
78456.............  ..............  A                Acute venous thrombus        1.00       4.33         NA       0.33       5.66         NA        XXX
                                                      image.
78457.............  26............  A                Venous thrombosis            0.77       0.26       0.26       0.03       1.06       1.06        XXX
                                                      imaging.
78457.............  TC............  A                Venous thrombosis            0.00       2.67         NA       0.14       2.81         NA        XXX
                                                      imaging.
78457.............  ..............  A                Venous thrombosis            0.77       2.93         NA       0.17       3.87         NA        XXX
                                                      imaging.
78458.............  26............  A                Ven thrombosis images,       0.90       0.32       0.32       0.04       1.26       1.26        XXX
                                                      bilat.
78458.............  TC............  A                Ven thrombosis images,       0.00       4.03         NA       0.21       4.24         NA        XXX
                                                      bilat.
78458.............  ..............  A                Ven thrombosis images,       0.90       4.35         NA       0.25       5.50         NA        XXX
                                                      bilat.
78459.............  26............  A                Heart muscle imaging         1.50       0.57       0.57       0.05       2.12       2.12        XXX
                                                      (PET).
78459.............  TC............  C                Heart muscle imaging         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      (PET).
78459.............  ..............  C                Heart muscle imaging         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      (PET).
78460.............  26............  A                Heart muscle blood,          0.86       0.29       0.29       0.04       1.19       1.19        XXX
                                                      single.
78460.............  TC............  A                Heart muscle blood,          0.00       2.37         NA       0.13       2.50         NA        XXX
                                                      single.
78460.............  ..............  A                Heart muscle blood,          0.86       2.66         NA       0.17       3.69         NA        XXX
                                                      single.
78461.............  26............  A                Heart muscle blood,          1.23       0.43       0.43       0.05       1.71       1.71        XXX
                                                      multiple.
78461.............  TC............  A                Heart muscle blood,          0.00       4.73         NA       0.25       4.98         NA        XXX
                                                      multiple.
78461.............  ..............  A                Heart muscle blood,          1.23       5.16         NA       0.30       6.69         NA        XXX
                                                      multiple.
78464.............  26............  A                Heart image (3d),            1.09       0.38       0.38       0.04       1.51       1.51        XXX
                                                      single.
78464.............  TC............  A                Heart image (3d),            0.00       7.09         NA       0.37       7.46         NA        XXX
                                                      single.
78464.............  ..............  A                Heart image (3d),            1.09       7.47         NA       0.41       8.97         NA        XXX
                                                      single.
78465.............  26............  A                Heart image (3d),            1.46       0.52       0.52       0.05       2.03       2.03        XXX
                                                      multiple.
78465.............  TC............  A                Heart image (3d),            0.00      11.82         NA       0.62      12.44         NA        XXX
                                                      multiple.
78465.............  ..............  A                Heart image (3d),            1.46      12.34         NA       0.67      14.47         NA        XXX
                                                      multiple.
78466.............  26............  A                Heart infarct image...       0.69       0.24       0.24       0.03       0.96       0.96        XXX
78466.............  TC............  A                Heart infarct image...       0.00       2.63         NA       0.14       2.77         NA        XXX
78466.............  ..............  A                Heart infarct image...       0.69       2.87         NA       0.17       3.73         NA        XXX
78468.............  26............  A                Heart infarct image          0.80       0.27       0.27       0.03       1.10       1.10        XXX
                                                      (ef).
78468.............  TC............  A                Heart infarct image          0.00       3.67         NA       0.19       3.86         NA        XXX
                                                      (ef).
78468.............  ..............  A                Heart infarct image          0.80       3.94         NA       0.22       4.96         NA        XXX
                                                      (ef).
78469.............  26............  A                Heart infarct image          0.92       0.31       0.31       0.03       1.26       1.26        XXX
                                                      (3D).
78469.............  TC............  A                Heart infarct image          0.00       5.24         NA       0.28       5.52         NA        XXX
                                                      (3D).
78469.............  ..............  A                Heart infarct image          0.92       5.55         NA       0.31       6.78         NA        XXX
                                                      (3D).
78472.............  26............  A                Gated heart, planar,         0.98       0.34       0.34       0.04       1.36       1.36        XXX
                                                      single.
78472.............  TC............  A                Gated heart, planar,         0.00       5.53         NA       0.30       5.83         NA        XXX
                                                      single.
78472.............  ..............  A                Gated heart, planar,         0.98       5.87         NA       0.34       7.19         NA        XXX
                                                      single.
78473.............  26............  A                Gated heart, multiple.       1.47       0.51       0.51       0.06       2.04       2.04        XXX
78473.............  TC............  A                Gated heart, multiple.       0.00       8.28         NA       0.42       8.70         NA        XXX

[[Page 70435]]

 
78473.............  ..............  A                Gated heart, multiple.       1.47       8.79         NA       0.48      10.74         NA        XXX
78478.............  26............  A                Heart wall motion add-       0.62       0.23       0.23       0.02       0.87       0.87        XXX
                                                      on.
78478.............  TC............  A                Heart wall motion add-       0.00       1.56         NA       0.10       1.66         NA        XXX
                                                      on.
78478.............  ..............  A                Heart wall motion add-       0.62       1.79         NA       0.12       2.53         NA        XXX
                                                      on.
78480.............  26............  A                Heart function add-on.       0.62       0.22       0.22       0.02       0.86       0.86        XXX
78480.............  TC............  A                Heart function add-on.       0.00       1.56         NA       0.10       1.66         NA        XXX
78480.............  ..............  A                Heart function add-on.       0.62       1.78         NA       0.12       2.52         NA        XXX
78481.............  26............  A                Heart first pass,            0.98       0.36       0.36       0.03       1.37       1.37        XXX
                                                      single.
78481.............  TC............  A                Heart first pass,            0.00       5.24         NA       0.28       5.52         NA        XXX
                                                      single.
78481.............  ..............  A                Heart first pass,            0.98       5.60         NA       0.31       6.89         NA        XXX
                                                      single.
78483.............  26............  A                Heart first pass,            1.47       0.54       0.54       0.05       2.06       2.06        XXX
                                                      multiple.
78483.............  TC............  A                Heart first pass,            0.00       7.89         NA       0.41       8.30         NA        XXX
                                                      multiple.
78483.............  ..............  A                Heart first pass,            1.47       8.43         NA       0.46      10.36         NA        XXX
                                                      multiple.
78491.............  26............  A                Heart image (pet),           1.50       0.59       0.59       0.06       2.15       2.15        XXX
                                                      single.
78491.............  TC............  C                Heart image (pet),           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      single.
78491.............  ..............  C                Heart image (pet),           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      single.
78492.............  26............  A                Heart image (pet),           1.87       0.74       0.74       0.07       2.68       2.68        XXX
                                                      multiple.
78492.............  TC............  C                Heart image (pet),           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      multiple.
78492.............  ..............  C                Heart image (pet),           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      multiple.
78494.............  26............  A                Heart image, spect....       1.19       0.42       0.42       0.05       1.66       1.66        XXX
78494.............  TC............  A                Heart image, spect....       0.00       7.09         NA       0.30       7.39         NA        XXX
78494.............  ..............  A                Heart image, spect....       1.19       7.51         NA       0.35       9.05         NA        XXX
78496.............  26............  A                Heart first pass add-        0.50       0.18       0.18       0.02       0.70       0.70        ZZZ
                                                      on.
78496.............  TC............  A                Heart first pass add-        0.00       7.09         NA       0.30       7.39         NA        ZZZ
                                                      on.
78496.............  ..............  A                Heart first pass add-        0.50       7.27         NA       0.32       8.09         NA        ZZZ
                                                      on.
78499.............  26............  C                Cardiovascular nuclear       0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      exam.
78499.............  TC............  C                Cardiovascular nuclear       0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      exam.
78499.............  ..............  C                Cardiovascular nuclear       0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      exam.
78580.............  26............  A                Lung perfusion imaging       0.74       0.25       0.25       0.03       1.02       1.02        XXX
78580.............  TC............  A                Lung perfusion imaging       0.00       3.44         NA       0.18       3.62         NA        XXX
78580.............  ..............  A                Lung perfusion imaging       0.74       3.69         NA       0.21       4.64         NA        XXX
78584.............  26............  A                Lung V/Q image single        0.99       0.33       0.33       0.04       1.36       1.36        XXX
                                                      breath.
78584.............  TC............  A                Lung V/Q image single        0.00       3.21         NA       0.17       3.38         NA        XXX
                                                      breath.
78584.............  ..............  A                Lung V/Q image single        0.99       3.54         NA       0.21       4.74         NA        XXX
                                                      breath.
78585.............  26............  A                Lung V/Q imaging......       1.09       0.36       0.36       0.05       1.50       1.50        XXX
78585.............  TC............  A                Lung V/Q imaging......       0.00       5.66         NA       0.30       5.96         NA        XXX
78585.............  ..............  A                Lung V/Q imaging......       1.09       6.02         NA       0.35       7.46         NA        XXX
78586.............  26............  A                Aerosol lung image,          0.40       0.13       0.13       0.02       0.55       0.55        XXX
                                                      single.
78586.............  TC............  A                Aerosol lung image,          0.00       2.60         NA       0.14       2.74         NA        XXX
                                                      single.
78586.............  ..............  A                Aerosol lung image,          0.40       2.73         NA       0.16       3.29         NA        XXX
                                                      single.
78587.............  26............  A                Aerosol lung image,          0.49       0.17       0.17       0.02       0.68       0.68        XXX
                                                      multiple.
78587.............  TC............  A                Aerosol lung image,          0.00       2.81         NA       0.14       2.95         NA        XXX
                                                      multiple.
78587.............  ..............  A                Aerosol lung image,          0.49       2.98         NA       0.16       3.63         NA        XXX
                                                      multiple.
78588.............  26............  A                Perfusion lung image..       1.09       0.36       0.36       0.05       1.50       1.50        XXX
78588.............  TC............  A                Perfusion lung image..       0.00       3.21         NA       0.18       3.39         NA        XXX
78588.............  ..............  A                Perfusion lung image..       1.09       3.57         NA       0.23       4.89         NA        XXX
78591.............  26............  A                Vent image, 1 breath,        0.40       0.13       0.13       0.02       0.55       0.55        XXX
                                                      1 proj.
78591.............  TC............  A                Vent image, 1 breath,        0.00       2.86         NA       0.14       3.00         NA        XXX
                                                      1 proj.
78591.............  ..............  A                Vent image, 1 breath,        0.40       2.99         NA       0.16       3.55         NA        XXX
                                                      1 proj.
78593.............  26............  A                Vent image, 1 proj,          0.49       0.16       0.16       0.02       0.67       0.67        XXX
                                                      gas.
78593.............  TC............  A                Vent image, 1 proj,          0.00       3.46         NA       0.18       3.64         NA        XXX
                                                      gas.
78593.............  ..............  A                Vent image, 1 proj,          0.49       3.62         NA       0.20       4.31         NA        XXX
                                                      gas.
78594.............  26............  A                Vent image, mult proj,       0.53       0.18       0.18       0.02       0.73       0.73        XXX
                                                      gas.
78594.............  TC............  A                Vent image, mult proj,       0.00       4.99         NA       0.25       5.24         NA        XXX
                                                      gas.
78594.............  ..............  A                Vent image, mult proj,       0.53       5.17         NA       0.27       5.97         NA        XXX
                                                      gas.
78596.............  26............  A                Lung differential            1.27       0.42       0.42       0.05       1.74       1.74        XXX
                                                      function.
78596.............  TC............  A                Lung differential            0.00       7.09         NA       0.37       7.46         NA        XXX
                                                      function.
78596.............  ..............  A                Lung differential            1.27       7.51         NA       0.42       9.20         NA        XXX
                                                      function.
78599.............  26............  C                Respiratory nuclear          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      exam.
78599.............  TC............  C                Respiratory nuclear          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      exam.
78599.............  ..............  C                Respiratory nuclear          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      exam.
78600.............  26............  A                Brain imaging, ltd           0.44       0.15       0.15       0.02       0.61       0.61        XXX
                                                      static.
78600.............  TC............  A                Brain imaging, ltd           0.00       2.89         NA       0.14       3.03         NA        XXX
                                                      static.
78600.............  ..............  A                Brain imaging, ltd           0.44       3.04         NA       0.16       3.64         NA        XXX
                                                      static.
78601.............  26............  A                Brain imaging, ltd w/        0.51       0.17       0.17       0.02       0.70       0.70        XXX
                                                      flow.
78601.............  TC............  A                Brain imaging, ltd w/        0.00       3.41         NA       0.18       3.59         NA        XXX
                                                      flow.
78601.............  ..............  A                Brain imaging, ltd w/        0.51       3.58         NA       0.20       4.29         NA        XXX
                                                      flow.
78605.............  26............  A                Brain imaging,               0.53       0.18       0.18       0.02       0.73       0.73        XXX
                                                      complete.
78605.............  TC............  A                Brain imaging,               0.00       3.41         NA       0.18       3.59         NA        XXX
                                                      complete.
78605.............  ..............  A                Brain imaging,               0.53       3.59         NA       0.20       4.32         NA        XXX
                                                      complete.
78606.............  26............  A                Brain imaging, compl w/      0.64       0.21       0.21       0.03       0.88       0.88        XXX
                                                      flow.
78606.............  TC............  A                Brain imaging, compl w/      0.00       3.88         NA       0.21       4.09         NA        XXX
                                                      flow.
78606.............  ..............  A                Brain imaging, compl w/      0.64       4.09         NA       0.24       4.97         NA        XXX
                                                      flow.
78607.............  26............  A                Brain imaging (3D)....       1.23       0.43       0.43       0.05       1.71       1.71        XXX
78607.............  TC............  A                Brain imaging (3D)....       0.00       6.57         NA       0.35       6.92         NA        XXX

[[Page 70436]]

 
78607.............  ..............  A                Brain imaging (3D)....       1.23       7.00         NA       0.40       8.63         NA        XXX
78608.............  26............  A                Brain imaging (PET)...       1.50       0.51       0.51       0.06       2.07       2.07        XXX
78608.............  TC............  C                Brain imaging (PET)...       0.00       0.00       0.00       0.00       0.00       0.00        XXX
78608.............  ..............  C                Brain imaging (PET)...       0.00       0.00       0.00       0.00       0.00       0.00        XXX
78609.............  26............  A                Brain imaging (PET)...       1.50       0.51       0.51       0.06       2.07       2.07        XXX
78609.............  TC............  C                Brain imaging (PET)...       0.00       0.00       0.00       0.00       0.00       0.00        XXX
78609.............  ..............  C                Brain imaging (PET)...       0.00       0.00       0.00       0.00       0.00       0.00        XXX
78610.............  26............  A                Brain flow imaging           0.30       0.11       0.11       0.01       0.42       0.42        XXX
                                                      only.
78610.............  TC............  A                Brain flow imaging           0.00       1.58         NA       0.10       1.68         NA        XXX
                                                      only.
78610.............  ..............  A                Brain flow imaging           0.30       1.69         NA       0.11       2.10         NA        XXX
                                                      only.
78615.............  26............  A                Cerebral vascular flow       0.42       0.15       0.15       0.02       0.59       0.59        XXX
                                                      image.
78615.............  TC............  A                Cerebral vascular flow       0.00       3.86         NA       0.21       4.07         NA        XXX
                                                      image.
78615.............  ..............  A                Cerebral vascular flow       0.42       4.01         NA       0.23       4.66         NA        XXX
                                                      image.
78630.............  26............  A                Cerebrospinal fluid          0.68       0.23       0.23       0.03       0.94       0.94        XXX
                                                      scan.
78630.............  TC............  A                Cerebrospinal fluid          0.00       5.05         NA       0.27       5.32         NA        XXX
                                                      scan.
78630.............  ..............  A                Cerebrospinal fluid          0.68       5.28         NA       0.30       6.26         NA        XXX
                                                      scan.
78635.............  26............  A                CSF ventriculography..       0.61       0.23       0.23       0.02       0.86       0.86        XXX
78635.............  TC............  A                CSF ventriculography..       0.00       2.55         NA       0.14       2.69         NA        XXX
78635.............  ..............  A                CSF ventriculography..       0.61       2.78         NA       0.16       3.55         NA        XXX
78645.............  26............  A                CSF shunt evaluation..       0.57       0.19       0.19       0.02       0.78       0.78        XXX
78645.............  TC............  A                CSF shunt evaluation..       0.00       3.44         NA       0.18       3.62         NA        XXX
78645.............  ..............  A                CSF shunt evaluation..       0.57       3.63         NA       0.20       4.40         NA        XXX
78647.............  26............  A                Cerebrospinal fluid          0.90       0.31       0.31       0.04       1.25       1.25        XXX
                                                      scan.
78647.............  TC............  A                Cerebrospinal fluid          0.00       5.93         NA       0.31       6.24         NA        XXX
                                                      scan.
78647.............  ..............  A                Cerebrospinal fluid          0.90       6.24         NA       0.35       7.49         NA        XXX
                                                      scan.
78650.............  26............  A                CSF leakage imaging...       0.61       0.21       0.21       0.03       0.85       0.85        XXX
78650.............  TC............  A                CSF leakage imaging...       0.00       4.65         NA       0.24       4.89         NA        XXX
78650.............  ..............  A                CSF leakage imaging...       0.61       4.86         NA       0.27       5.74         NA        XXX
78660.............  26............  A                Nuclear exam of tear         0.53       0.18       0.18       0.02       0.73       0.73        XXX
                                                      flow.
78660.............  TC............  A                Nuclear exam of tear         0.00       2.13         NA       0.12       2.25         NA        XXX
                                                      flow.
78660.............  ..............  A                Nuclear exam of tear         0.53       2.31         NA       0.14       2.98         NA        XXX
                                                      flow.
78699.............  26............  C                Nervous system nuclear       0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      exam.
78699.............  TC............  C                Nervous system nuclear       0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      exam.
78699.............  ..............  C                Nervous system nuclear       0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      exam.
78700.............  26............  A                Kidney imaging, static       0.45       0.15       0.15       0.02       0.62       0.62        XXX
78700.............  TC............  A                Kidney imaging, static       0.00       3.06         NA       0.16       3.22         NA        XXX
78700.............  ..............  A                Kidney imaging, static       0.45       3.21         NA       0.18       3.84         NA        XXX
78701.............  26............  A                Kidney imaging with          0.49       0.16       0.16       0.02       0.67       0.67        XXX
                                                      flow.
78701.............  TC............  A                Kidney imaging with          0.00       3.57         NA       0.18       3.75         NA        XXX
                                                      flow.
78701.............  ..............  A                Kidney imaging with          0.49       3.73         NA       0.20       4.42         NA        XXX
                                                      flow.
78704.............  26............  A                Imaging renogram......       0.74       0.25       0.25       0.03       1.02       1.02        XXX
78704.............  TC............  A                Imaging renogram......       0.00       3.96         NA       0.21       4.17         NA        XXX
78704.............  ..............  A                Imaging renogram......       0.74       4.21         NA       0.24       5.19         NA        XXX
78707.............  26............  A                Kidney flow/function         0.96       0.32       0.32       0.04       1.32       1.32        XXX
                                                      image.
78707.............  TC............  A                Kidney flow/function         0.00       4.48         NA       0.23       4.71         NA        XXX
                                                      image.
78707.............  ..............  A                Kidney flow/function         0.96       4.80         NA       0.27       6.03         NA        XXX
                                                      image.
78708.............  26............  A                Kidney flow/function         1.21       0.41       0.41       0.05       1.67       1.67        XXX
                                                      image.
78708.............  TC............  A                Kidney flow/function         0.00       4.48         NA       0.23       4.71         NA        XXX
                                                      image.
78708.............  ..............  A                Kidney flow/function         1.21       4.89         NA       0.28       6.38         NA        XXX
                                                      image.
78709.............  26............  A                Kidney flow/function         1.41       0.47       0.47       0.06       1.94       1.94        XXX
                                                      image.
78709.............  TC............  A                Kidney flow/function         0.00       4.48         NA       0.23       4.71         NA        XXX
                                                      image.
78709.............  ..............  A                Kidney flow/function         1.41       4.95         NA       0.29       6.65         NA        XXX
                                                      image.
78710.............  26............  A                Kidney imaging (3D)...       0.66       0.22       0.22       0.03       0.91       0.91        XXX
78710.............  TC............  A                Kidney imaging (3D)...       0.00       5.93         NA       0.31       6.24         NA        XXX
78710.............  ..............  A                Kidney imaging (3D)...       0.66       6.15         NA       0.34       7.15         NA        XXX
78715.............  26............  A                Renal vascular flow          0.30       0.11       0.11       0.01       0.42       0.42        XXX
                                                      exam.
78715.............  TC............  A                Renal vascular flow          0.00       1.58         NA       0.10       1.68         NA        XXX
                                                      exam.
78715.............  ..............  A                Renal vascular flow          0.30       1.69         NA       0.11       2.10         NA        XXX
                                                      exam.
78725.............  26............  A                Kidney function study.       0.38       0.13       0.13       0.02       0.53       0.53        XXX
78725.............  TC............  A                Kidney function study.       0.00       1.79         NA       0.11       1.90         NA        XXX
78725.............  ..............  A                Kidney function study.       0.38       1.92         NA       0.13       2.43         NA        XXX
78730.............  26............  A                Urinary bladder              0.36       0.12       0.12       0.02       0.50       0.50        XXX
                                                      retention.
78730.............  TC............  A                Urinary bladder              0.00       1.46         NA       0.08       1.54         NA        XXX
                                                      retention.
78730.............  ..............  A                Urinary bladder              0.36       1.58         NA       0.10       2.04         NA        XXX
                                                      retention.
78740.............  26............  A                Ureteral reflux study.       0.57       0.19       0.19       0.03       0.79       0.79        XXX
78740.............  TC............  A                Ureteral reflux study.       0.00       2.13         NA       0.12       2.25         NA        XXX
78740.............  ..............  A                Ureteral reflux study.       0.57       2.32         NA       0.15       3.04         NA        XXX
78760.............  26............  A                Testicular imaging....       0.66       0.22       0.22       0.03       0.91       0.91        XXX
78760.............  TC............  A                Testicular imaging....       0.00       2.69         NA       0.14       2.83         NA        XXX
78760.............  ..............  A                Testicular imaging....       0.66       2.91         NA       0.17       3.74         NA        XXX
78761.............  26............  A                Testicular imaging/          0.71       0.24       0.24       0.03       0.98       0.98        XXX
                                                      flow.
78761.............  TC............  A                Testicular imaging/          0.00       3.21         NA       0.17       3.38         NA        XXX
                                                      flow.
78761.............  ..............  A                Testicular imaging/          0.71       3.45         NA       0.20       4.36         NA        XXX
                                                      flow.
78799.............  26............  C                Genitourinary nuclear        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      exam.
78799.............  TC............  C                Genitourinary nuclear        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      exam.

[[Page 70437]]

 
78799.............  ..............  C                Genitourinary nuclear        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      exam.
78800.............  26............  A                Tumor imaging, limited       0.66       0.22       0.22       0.04       0.92       0.92        XXX
                                                      area.
78800.............  TC............  A                Tumor imaging, limited       0.00       3.41         NA       0.18       3.59         NA        XXX
                                                      area.
78800.............  ..............  A                Tumor imaging, limited       0.66       3.63         NA       0.22       4.51         NA        XXX
                                                      area.
78801.............  26............  A                Tumor imaging, mult          0.79       0.27       0.27       0.05       1.11       1.11        XXX
                                                      areas.
78801.............  TC............  A                Tumor imaging, mult          0.00       4.23         NA       0.22       4.45         NA        XXX
                                                      areas.
78801.............  ..............  A                Tumor imaging, mult          0.79       4.50         NA       0.27       5.56         NA        XXX
                                                      areas.
78802.............  26............  A                Tumor imaging, whole         0.86       0.29       0.29       0.04       1.19       1.19        XXX
                                                      body.
78802.............  TC............  A                Tumor imaging, whole         0.00       5.55         NA       0.30       5.85         NA        XXX
                                                      body.
78802.............  ..............  A                Tumor imaging, whole         0.86       5.84         NA       0.34       7.04         NA        XXX
                                                      body.
78803.............  26............  A                Tumor imaging (3D)....       1.09       0.38       0.38       0.05       1.52       1.52        XXX
78803.............  TC............  A                Tumor imaging (3D)....       0.00       6.57         NA       0.35       6.92         NA        XXX
78803.............  ..............  A                Tumor imaging (3D)....       1.09       6.95         NA       0.40       8.44         NA        XXX
78804.............  26............  A                Tumor imaging, whole         1.07       0.37       0.37       0.04       1.48       1.48        XXX
                                                      body.
78804.............  TC............  A                Tumor imaging, whole         0.00      11.09         NA       0.30      11.39         NA        XXX
                                                      body.
78804.............  ..............  A                Tumor imaging, whole         1.07      11.46         NA       0.34      12.87         NA        XXX
                                                      body.
78805.............  26............  A                Abscess imaging, ltd         0.73       0.25       0.25       0.03       1.01       1.01        XXX
                                                      area.
78805.............  TC............  A                Abscess imaging, ltd         0.00       3.41         NA       0.18       3.59         NA        XXX
                                                      area.
78805.............  ..............  A                Abscess imaging, ltd         0.73       3.66         NA       0.21       4.60         NA        XXX
                                                      area.
78806.............  26............  A                Abscess imaging, whole       0.86       0.29       0.29       0.04       1.19       1.19        XXX
                                                      body.
78806.............  TC............  A                Abscess imaging, whole       0.00       6.45         NA       0.35       6.80         NA        XXX
                                                      body.
78806.............  ..............  A                Abscess imaging, whole       0.86       6.74         NA       0.39       7.99         NA        XXX
                                                      body.
78807.............  26............  A                Nuclear localization/        1.09       0.39       0.39       0.04       1.52       1.52        XXX
                                                      abscess.
78807.............  TC............  A                Nuclear localization/        0.00       6.57         NA       0.35       6.92         NA        XXX
                                                      abscess.
78807.............  ..............  A                Nuclear localization/        1.09       6.96         NA       0.39       8.44         NA        XXX
                                                      abscess.
78811.............  26............  A                Tumor imaging (pet),         1.54       0.53       0.53       0.11       2.18       2.18        XXX
                                                      limited.
78811.............  TC............  C                Tumor imaging (pet),         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      limited.
78811.............  ..............  C                Tumor imaging (pet),         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      limited.
78812.............  26............  A                Tumor image (pet)/skul-      1.93       0.66       0.66       0.11       2.70       2.70        XXX
                                                      thigh.
78812.............  TC............  C                Tumor image (pet)/skul-      0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      thigh.
78812.............  ..............  C                Tumor image (pet)/skul-      0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      thigh.
78813.............  26............  A                Tumor image (pet) full       2.00       0.69       0.69       0.11       2.80       2.80        XXX
                                                      body.
78813.............  TC............  C                Tumor image (pet) full       0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      body.
78813.............  ..............  C                Tumor image (pet) full       0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      body.
78814.............  26............  A                Tumor image pet/ct,          2.20       0.76       0.76       0.11       3.07       3.07        XXX
                                                      limited.
78814.............  TC............  C                Tumor image pet/ct,          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      limited.
78814.............  ..............  C                Tumor image pet/ct,          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      limited.
78815.............  26............  A                Tumorimage pet/ct skul-      2.44       0.84       0.84       0.11       3.39       3.39        XXX
                                                      thigh.
78815.............  TC............  C                Tumorimage pet/ct skul-      0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      thigh.
78815.............  ..............  C                Tumorimage pet/ct skul-      0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      thigh.
78816.............  26............  A                Tumor image pet/ct           2.50       0.86       0.86       0.11       3.47       3.47        XXX
                                                      full body.
78816.............  TC............  C                Tumor image pet/ct           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      full body.
78816.............  ..............  C                Tumor image pet/ct           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      full body.
78890.............  26............  B                Nuclear medicine data       +0.05       0.02       0.02       0.01       0.08       0.08        XXX
                                                      proc.
78890.............  TC............  B                Nuclear medicine data       +0.00       1.31         NA       0.06       1.37         NA        XXX
                                                      proc.
78890.............  ..............  B                Nuclear medicine data       +0.05       1.33         NA       0.07       1.45         NA        XXX
                                                      proc.
78891.............  26............  B                Nuclear med data proc.      +0.10       0.04       0.04       0.01       0.15       0.15        XXX
78891.............  TC............  B                Nuclear med data proc.      +0.00       2.63         NA       0.13       2.76         NA        XXX
78891.............  ..............  B                Nuclear med data proc.      +0.10       2.67         NA       0.14       2.91         NA        XXX
78999.............  26............  C                Nuclear diagnostic           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      exam.
78999.............  TC............  C                Nuclear diagnostic           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      exam.
78999.............  ..............  C                Nuclear diagnostic           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      exam.
79005.............  26............  A                Nuclear rx, oral admin       1.80       0.60       0.60       0.08       2.48       2.48        XXX
79005.............  TC............  A                Nuclear rx, oral admin       0.00       2.63         NA       0.14       2.77         NA        XXX
79005.............  ..............  A                Nuclear rx, oral admin       1.80       3.23         NA       0.22       5.25         NA        XXX
79101.............  26............  A                Nuclear rx, iv admin..       1.96       0.67       0.67       0.08       2.71       2.71        XXX
79101.............  TC............  A                Nuclear rx, iv admin..       0.00       2.63         NA       0.14       2.77         NA        XXX
79101.............  ..............  A                Nuclear rx, iv admin..       1.96       3.30         NA       0.22       5.48         NA        XXX
79200.............  26............  A                Nuclear rx, intracav         1.99       0.69       0.69       0.09       2.77       2.77        XXX
                                                      admin.
79200.............  TC............  A                Nuclear rx, intracav         0.00       2.63         NA       0.14       2.77         NA        XXX
                                                      admin.
79200.............  ..............  A                Nuclear rx, intracav         1.99       3.32         NA       0.23       5.54         NA        XXX
                                                      admin.
79300.............  26............  A                Nuclr rx, interstit          1.60       0.56       0.56       0.13       2.29       2.29        XXX
                                                      colloid.
79300.............  TC............  C                Nuclr rx, interstit          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      colloid.
79300.............  ..............  C                Nuclr rx, interstit          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      colloid.
79403.............  26............  A                Hematopoietic nuclear        2.25       0.89       0.89       0.10       3.24       3.24        XXX
                                                      tx.
79403.............  TC............  A                Hematopoietic nuclear        0.00       4.28         NA       0.14       4.42         NA        XXX
                                                      tx.
79403.............  ..............  A                Hematopoietic nuclear        2.25       5.17         NA       0.24       7.66         NA        XXX
                                                      tx.
79440.............  26............  A                Nuclear rx, intra-           1.99       0.72       0.72       0.08       2.79       2.79        XXX
                                                      articular.
79440.............  TC............  A                Nuclear rx, intra-           0.00       2.63         NA       0.14       2.77         NA        XXX
                                                      articular.
79440.............  ..............  A                Nuclear rx, intra-           1.99       3.35         NA       0.22       5.56         NA        XXX
                                                      articular.
79445.............  26............  A                Nuclear rx, intra-           2.40       0.82       0.82       0.12       3.34       3.34        XXX
                                                      arterial.
79445.............  TC............  C                Nuclear rx, intra-           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      arterial.
79445.............  ..............  C                Nuclear rx, intra-           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      arterial.
79999.............  26............  C                Nuclear medicine             0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      therapy.
79999.............  TC............  C                Nuclear medicine             0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      therapy.

[[Page 70438]]

 
79999.............  ..............  C                Nuclear medicine             0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      therapy.
80500.............  ..............  A                Lab pathology                0.37       0.21       0.16       0.01       0.59       0.54        XXX
                                                      consultation.
80502.............  ..............  A                Lab pathology                1.33       0.54       0.54       0.04       1.91       1.91        XXX
                                                      consultation.
83020.............  26............  A                Hemoglobin                   0.37       0.15       0.15       0.01       0.53       0.53        XXX
                                                      electrophoresis.
83912.............  26............  A                Genetic examination...       0.37       0.12       0.12       0.01       0.50       0.50        XXX
84165.............  26............  A                Protein e-phoresis,          0.37       0.14       0.14       0.01       0.52       0.52        XXX
                                                      serum.
84166.............  26............  A                Protein e-phoresis/          0.37       0.14       0.14       0.01       0.52       0.52        XXX
                                                      urine/csf.
84181.............  26............  A                Western blot test.....       0.37       0.14       0.14       0.01       0.52       0.52        XXX
84182.............  26............  A                Protein, western blot        0.37       0.16       0.16       0.02       0.55       0.55        XXX
                                                      test.
85060.............  ..............  A                Blood smear                  0.45       0.18       0.18       0.02       0.65       0.65        XXX
                                                      interpretation.
85097.............  ..............  A                Bone marrow                  0.94       1.92       0.41       0.04       2.90       1.39        XXX
                                                      interpretation.
85390.............  26............  A                Fibrinolysins screen..       0.37       0.13       0.13       0.01       0.51       0.51        XXX
85396.............  ..............  A                Clotting assay, whole        0.37         NA       0.16       0.04         NA       0.57        XXX
                                                      blood.
85576.............  26............  A                Blood platelet               0.37       0.16       0.16       0.01       0.54       0.54        XXX
                                                      aggregation.
86077.............  ..............  A                Physician blood bank         0.94       0.39       0.39       0.03       1.36       1.36        XXX
                                                      service.
86078.............  ..............  A                Physician blood bank         0.94       0.46       0.40       0.03       1.43       1.37        XXX
                                                      service.
86079.............  ..............  A                Physician blood bank         0.94       0.45       0.41       0.03       1.42       1.38        XXX
                                                      service.
86255.............  26............  A                Fluorescent antibody,        0.37       0.15       0.15       0.01       0.53       0.53        XXX
                                                      screen.
86256.............  26............  A                Fluorescent antibody,        0.37       0.15       0.15       0.01       0.53       0.53        XXX
                                                      titer.
86320.............  26............  A                Serum                        0.37       0.15       0.15       0.01       0.53       0.53        XXX
                                                      immunoelectrophoresis.
86325.............  26............  A                Other                        0.37       0.13       0.13       0.01       0.51       0.51        XXX
                                                      immunoelectrophoresis.
86327.............  26............  A                Immunoelectrophoresis        0.42       0.18       0.18       0.02       0.62       0.62        XXX
                                                      assay.
86334.............  26............  A                Immunofix e-phoresis,        0.37       0.15       0.15       0.01       0.53       0.53        XXX
                                                      serum.
86335.............  26............  A                Immunfix e-phorsis/          0.37       0.14       0.14       0.01       0.52       0.52        XXX
                                                      urine/csf.
86485.............  ..............  C                Skin test, candida....       0.00       0.00       0.00       0.00       0.00       0.00        XXX
86490.............  ..............  A                Coccidioidomycosis           0.00       0.29         NA       0.02       0.31         NA        XXX
                                                      skin test.
86510.............  ..............  A                Histoplasmosis skin          0.00       0.32         NA       0.02       0.34         NA        XXX
                                                      test.
86580.............  ..............  A                TB intradermal test...       0.00       0.25         NA       0.02       0.27         NA        XXX
87164.............  26............  A                Dark field examination       0.37       0.12       0.12       0.01       0.50       0.50        XXX
87207.............  26............  A                Smear, special stain..       0.37       0.16       0.16       0.01       0.54       0.54        XXX
88104.............  26............  A                Cytopathology, fluids.       0.56       0.24       0.24       0.02       0.82       0.82        XXX
88104.............  TC............  A                Cytopathology, fluids.       0.00       0.61         NA       0.02       0.63         NA        XXX
88104.............  ..............  A                Cytopathology, fluids.       0.56       0.85         NA       0.04       1.45         NA        XXX
88106.............  26............  A                Cytopathology, fluids.       0.56       0.24       0.24       0.02       0.82       0.82        XXX
88106.............  TC............  A                Cytopathology, fluids.       0.00       1.11         NA       0.02       1.13         NA        XXX
88106.............  ..............  A                Cytopathology, fluids.       0.56       1.35         NA       0.04       1.95         NA        XXX
88107.............  26............  A                Cytopathology, fluids.       0.76       0.33       0.33       0.03       1.12       1.12        XXX
88107.............  TC............  A                Cytopathology, fluids.       0.00       1.21         NA       0.02       1.23         NA        XXX
88107.............  ..............  A                Cytopathology, fluids.       0.76       1.54         NA       0.05       2.35         NA        XXX
88108.............  26............  A                Cytopath, concentrate        0.56       0.24       0.24       0.02       0.82       0.82        XXX
                                                      tech.
88108.............  TC............  A                Cytopath, concentrate        0.00       0.97         NA       0.02       0.99         NA        XXX
                                                      tech.
88108.............  ..............  A                Cytopath, concentrate        0.56       1.21         NA       0.04       1.81         NA        XXX
                                                      tech.
88112.............  26............  A                Cytopath, cell enhance       1.18       0.51       0.51       0.02       1.71       1.71        XXX
                                                      tech.
88112.............  TC............  A                Cytopath, cell enhance       0.00       1.46         NA       0.02       1.48         NA        XXX
                                                      tech.
88112.............  ..............  A                Cytopath, cell enhance       1.18       1.97         NA       0.04       3.19         NA        XXX
                                                      tech.
88125.............  26............  A                Forensic cytopathology       0.26       0.11       0.11       0.01       0.38       0.38        XXX
88125.............  TC............  A                Forensic cytopathology       0.00       0.16         NA       0.01       0.17         NA        XXX
88125.............  ..............  A                Forensic cytopathology       0.26       0.27         NA       0.02       0.55         NA        XXX
88141.............  ..............  A                Cytopath, c/v,               0.42       0.15       0.15       0.02       0.59       0.59        XXX
                                                      interpret.
88160.............  26............  A                Cytopath smear, other        0.50       0.21       0.21       0.02       0.73       0.73        XXX
                                                      source.
88160.............  TC............  A                Cytopath smear, other        0.00       0.62         NA       0.02       0.64         NA        XXX
                                                      source.
88160.............  ..............  A                Cytopath smear, other        0.50       0.83         NA       0.04       1.37         NA        XXX
                                                      source.
88161.............  26............  A                Cytopath smear, other        0.50       0.21       0.21       0.02       0.73       0.73        XXX
                                                      source.
88161.............  TC............  A                Cytopath smear, other        0.00       0.73         NA       0.02       0.75         NA        XXX
                                                      source.
88161.............  ..............  A                Cytopath smear, other        0.50       0.94         NA       0.04       1.48         NA        XXX
                                                      source.
88162.............  26............  A                Cytopath smear, other        0.76       0.33       0.33       0.03       1.12       1.12        XXX
                                                      source.
88162.............  TC............  A                Cytopath smear, other        0.00       0.69         NA       0.02       0.71         NA        XXX
                                                      source.
88162.............  ..............  A                Cytopath smear, other        0.76       1.02         NA       0.05       1.83         NA        XXX
                                                      source.
88172.............  26............  A                Cytopathology eval of        0.60       0.26       0.26       0.02       0.88       0.88        XXX
                                                      fna.
88172.............  TC............  A                Cytopathology eval of        0.00       0.47         NA       0.02       0.49         NA        XXX
                                                      fna.
88172.............  ..............  A                Cytopathology eval of        0.60       0.73         NA       0.04       1.37         NA        XXX
                                                      fna.
88173.............  26............  A                Cytopath eval, fna,          1.39       0.59       0.59       0.05       2.03       2.03        XXX
                                                      report.
88173.............  TC............  A                Cytopath eval, fna,          0.00       1.55         NA       0.02       1.57         NA        XXX
                                                      report.
88173.............  ..............  A                Cytopath eval, fna,          1.39       2.14         NA       0.07       3.60         NA        XXX
                                                      report.
88182.............  26............  A                Cell marker study.....       0.77       0.33       0.33       0.03       1.13       1.13        XXX
88182.............  TC............  A                Cell marker study.....       0.00       1.65         NA       0.04       1.69         NA        XXX
88182.............  ..............  A                Cell marker study.....       0.77       1.98         NA       0.07       2.82         NA        XXX
88184.............  ..............  A                Flowcytometry/ tc, 1         0.00       1.32         NA       0.02       1.34         NA        XXX
                                                      marker.
88185.............  ..............  A                Flowcytometry/tc, add-       0.00       0.64         NA       0.02       0.66         NA        ZZZ
                                                      on.
88187.............  ..............  A                Flowcytometry/read, 2-       1.36       0.45       0.45       0.01       1.82       1.82        XXX
                                                      8.
88188.............  ..............  A                Flowcytometry/read, 9-       1.69       0.57       0.57       0.01       2.27       2.27        XXX
                                                      15.
88189.............  ..............  A                Flowcytometry/read, 16       2.23       0.75       0.75       0.01       2.99       2.99        XXX
                                                      & >.
88199.............  26............  C                Cytopathology                0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      procedure.
88199.............  TC............  C                Cytopathology                0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      procedure.
88199.............  ..............  C                Cytopathology                0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      procedure.

[[Page 70439]]

 
88291.............  ..............  A                Cyto/molecular report.       0.52       0.17       0.17       0.02       0.71       0.71        XXX
88299.............  ..............  C                Cytogenetic study.....       0.00       0.00       0.00       0.00       0.00       0.00        XXX
88300.............  26............  A                Surgical path, gross..       0.08       0.03       0.03       0.01       0.12       0.12        XXX
88300.............  TC............  A                Surgical path, gross..       0.00       0.42         NA       0.01       0.43         NA        XXX
88300.............  ..............  A                Surgical path, gross..       0.08       0.45         NA       0.02       0.55         NA        XXX
88302.............  26............  A                Tissue exam by               0.13       0.06       0.06       0.01       0.20       0.20        XXX
                                                      pathologist.
88302.............  TC............  A                Tissue exam by               0.00       0.97         NA       0.02       0.99         NA        XXX
                                                      pathologist.
88302.............  ..............  A                Tissue exam by               0.13       1.03         NA       0.03       1.19         NA        XXX
                                                      pathologist.
88304.............  26............  A                Tissue exam by               0.22       0.09       0.09       0.01       0.32       0.32        XXX
                                                      pathologist.
88304.............  TC............  A                Tissue exam by               0.00       1.23         NA       0.02       1.25         NA        XXX
                                                      pathologist.
88304.............  ..............  A                Tissue exam by               0.22       1.32         NA       0.03       1.57         NA        XXX
                                                      pathologist.
88305.............  26............  A                Tissue exam by               0.75       0.33       0.33       0.03       1.11       1.11        XXX
                                                      pathologist.
88305.............  TC............  A                Tissue exam by               0.00       1.58         NA       0.04       1.62         NA        XXX
                                                      pathologist.
88305.............  ..............  A                Tissue exam by               0.75       1.91         NA       0.07       2.73         NA        XXX
                                                      pathologist.
88307.............  26............  A                Tissue exam by               1.59       0.68       0.68       0.06       2.33       2.33        XXX
                                                      pathologist.
88307.............  TC............  A                Tissue exam by               0.00       2.48         NA       0.06       2.54         NA        XXX
                                                      pathologist.
88307.............  ..............  A                Tissue exam by               1.59       3.16         NA       0.12       4.87         NA        XXX
                                                      pathologist.
88309.............  26............  A                Tissue exam by               2.28       0.97       0.97       0.08       3.33       3.33        XXX
                                                      pathologist.
88309.............  TC............  A                Tissue exam by               0.00       3.43         NA       0.06       3.49         NA        XXX
                                                      pathologist.
88309.............  ..............  A                Tissue exam by               2.28       4.40         NA       0.14       6.82         NA        XXX
                                                      pathologist.
88311.............  26............  A                Decalcify tissue......       0.24       0.10       0.10       0.01       0.35       0.35        XXX
88311.............  TC............  A                Decalcify tissue......       0.00       0.13         NA       0.01       0.14         NA        XXX
88311.............  ..............  A                Decalcify tissue......       0.24       0.23         NA       0.02       0.49         NA        XXX
88312.............  26............  A                Special stains........       0.54       0.23       0.23       0.02       0.79       0.79        XXX
88312.............  TC............  A                Special stains........       0.00       1.29         NA       0.01       1.30         NA        XXX
88312.............  ..............  A                Special stains........       0.54       1.52         NA       0.03       2.09         NA        XXX
88313.............  26............  A                Special stains........       0.24       0.10       0.10       0.01       0.35       0.35        XXX
88313.............  TC............  A                Special stains........       0.00       1.15         NA       0.01       1.16         NA        XXX
88313.............  ..............  A                Special stains........       0.24       1.25         NA       0.02       1.51         NA        XXX
88314.............  26............  A                Histochemical stain...       0.45       0.19       0.19       0.02       0.66       0.66        XXX
88314.............  TC............  A                Histochemical stain...       0.00       1.88         NA       0.02       1.90         NA        XXX
88314.............  ..............  A                Histochemical stain...       0.45       2.07         NA       0.04       2.56         NA        XXX
88318.............  26............  A                Chemical                     0.42       0.18       0.18       0.02       0.62       0.62        XXX
                                                      histochemistry.
88318.............  TC............  A                Chemical                     0.00       1.47         NA       0.01       1.48         NA        XXX
                                                      histochemistry.
88318.............  ..............  A                Chemical                     0.42       1.65         NA       0.03       2.10         NA        XXX
                                                      histochemistry.
88319.............  26............  A                Enzyme histochemistry.       0.53       0.22       0.22       0.02       0.77       0.77        XXX
88319.............  TC............  A                Enzyme histochemistry.       0.00       3.20         NA       0.02       3.22         NA        XXX
88319.............  ..............  A                Enzyme histochemistry.       0.53       3.42         NA       0.04       3.99         NA        XXX
88321.............  ..............  A                Microslide                   1.30       0.79       0.56       0.05       2.14       1.91        XXX
                                                      consultation.
88323.............  26............  A                Microslide                   1.35       0.57       0.57       0.05       1.97       1.97        XXX
                                                      consultation.
88323.............  TC............  A                Microslide                   0.00       1.21         NA       0.02       1.23         NA        XXX
                                                      consultation.
88323.............  ..............  A                Microslide                   1.35       1.78         NA       0.07       3.20         NA        XXX
                                                      consultation.
88325.............  ..............  A                Comprehensive review         2.22       2.94       0.95       0.07       5.23       3.24        XXX
                                                      of data.
88329.............  ..............  A                Path consult introp...       0.67       0.65       0.29       0.02       1.34       0.98        XXX
88331.............  26............  A                Path consult intraop,        1.19       0.51       0.51       0.04       1.74       1.74        XXX
                                                      1 bloc.
88331.............  TC............  A                Path consult intraop,        0.00       0.59         NA       0.04       0.63         NA        XXX
                                                      1 bloc.
88331.............  ..............  A                Path consult intraop,        1.19       1.10         NA       0.08       2.37         NA        XXX
                                                      1 bloc.
88332.............  26............  A                Path consult intraop,        0.59       0.25       0.25       0.02       0.86       0.86        XXX
                                                      add'l.
88332.............  TC............  A                Path consult intraop,        0.00       0.21         NA       0.02       0.23         NA        XXX
                                                      add'l.
88332.............  ..............  A                Path consult intraop,        0.59       0.46         NA       0.04       1.09         NA        XXX
                                                      add'l.
88333.............  26............  A                Intraop cyto path            1.20       0.53       0.53       0.04       1.77       1.77        XXX
                                                      consult, 1.
88333.............  TC............  A                Intraop cyto path            0.00       0.55         NA       0.04       0.59         NA        XXX
                                                      consult, 1.
88333.............  ..............  A                Intraop cyto path            1.20       1.08         NA       0.08       2.36         NA        XXX
                                                      consult, 1.
88334.............  26............  A                Intraop cyto path            0.59       0.26       0.26       0.02       0.87       0.87        XXX
                                                      consult, 2.
88334.............  TC............  A                Intraop cyto path            0.00       0.34         NA       0.02       0.36         NA        XXX
                                                      consult, 2.
88334.............  ..............  A                Intraop cyto path            0.59       0.60         NA       0.04       1.23         NA        XXX
                                                      consult, 2.
88342.............  26............  A                Immunohistochemistry..       0.85       0.36       0.36       0.03       1.24       1.24        XXX
88342.............  TC............  A                Immunohistochemistry..       0.00       1.10         NA       0.02       1.12         NA        XXX
88342.............  ..............  A                Immunohistochemistry..       0.85       1.46         NA       0.05       2.36         NA        XXX
88346.............  26............  A                Immunofluorescent            0.86       0.36       0.36       0.03       1.25       1.25        XXX
                                                      study.
88346.............  TC............  A                Immunofluorescent            0.00       1.21         NA       0.02       1.23         NA        XXX
                                                      study.
88346.............  ..............  A                Immunofluorescent            0.86       1.57         NA       0.05       2.48         NA        XXX
                                                      study.
88347.............  26............  A                Immunofluorescent            0.86       0.35       0.35       0.03       1.24       1.24        XXX
                                                      study.
88347.............  TC............  A                Immunofluorescent            0.00       0.91         NA       0.02       0.93         NA        XXX
                                                      study.
88347.............  ..............  A                Immunofluorescent            0.86       1.26         NA       0.05       2.17         NA        XXX
                                                      study.
88348.............  26............  A                Electron microscopy...       1.51       0.64       0.64       0.06       2.21       2.21        XXX
88348.............  TC............  A                Electron microscopy...       0.00       8.74         NA       0.07       8.81         NA        XXX
88348.............  ..............  A                Electron microscopy...       1.51       9.38         NA       0.13      11.02         NA        XXX
88349.............  26............  A                Scanning electron            0.76       0.33       0.33       0.03       1.12       1.12        XXX
                                                      microscopy.
88349.............  TC............  A                Scanning electron            0.00       3.24         NA       0.06       3.30         NA        XXX
                                                      microscopy.
88349.............  ..............  A                Scanning electron            0.76       3.57         NA       0.09       4.42         NA        XXX
                                                      microscopy.
88355.............  26............  A                Analysis, skeletal           1.85       0.79       0.79       0.07       2.71       2.71        XXX
                                                      muscle.
88355.............  TC............  A                Analysis, skeletal           0.00       8.00         NA       0.06       8.06         NA        XXX
                                                      muscle.
88355.............  ..............  A                Analysis, skeletal           1.85       8.79         NA       0.13      10.77         NA        XXX
                                                      muscle.
88356.............  26............  A                Analysis, nerve.......       3.02       1.26       1.26       0.12       4.40       4.40        XXX

[[Page 70440]]

 
88356.............  TC............  A                Analysis, nerve.......       0.00       2.93         NA       0.07       3.00         NA        XXX
88356.............  ..............  A                Analysis, nerve.......       3.02       4.19         NA       0.19       7.40         NA        XXX
88358.............  26............  A                Analysis, tumor.......       0.95       0.40       0.40       0.10       1.45       1.45        XXX
88358.............  TC............  A                Analysis, tumor.......       0.00       0.44         NA       0.07       0.51         NA        XXX
88358.............  ..............  A                Analysis, tumor.......       0.95       0.84         NA       0.17       1.96         NA        XXX
88360.............  26............  A                Tumor immunohistochem/       1.10       0.47       0.47       0.06       1.63       1.63        XXX
                                                      manual.
88360.............  TC............  A                Tumor immunohistochem/       0.00       1.26         NA       0.02       1.28         NA        XXX
                                                      manual.
88360.............  ..............  A                Tumor immunohistochem/       1.10       1.73         NA       0.08       2.91         NA        XXX
                                                      manual.
88361.............  26............  A                Tumor immunohistochem/       1.18       0.49       0.49       0.10       1.77       1.77        XXX
                                                      comput.
88361.............  TC............  A                Tumor immunohistochem/       0.00       2.54         NA       0.07       2.61         NA        XXX
                                                      comput.
88361.............  ..............  A                Tumor immunohistochem/       1.18       3.03         NA       0.17       4.38         NA        XXX
                                                      comput.
88362.............  26............  A                Nerve teasing                2.17       0.92       0.92       0.09       3.18       3.18        XXX
                                                      preparations.
88362.............  TC............  A                Nerve teasing                0.00       3.78         NA       0.06       3.84         NA        XXX
                                                      preparations.
88362.............  ..............  A                Nerve teasing                2.17       4.70         NA       0.15       7.02         NA        XXX
                                                      preparations.
88365.............  26............  A                Insitu hybridization         1.20       0.51       0.51       0.03       1.74       1.74        XXX
                                                      (fish).
88365.............  TC............  A                Insitu hybridization         0.00       1.62         NA       0.02       1.64         NA        XXX
                                                      (fish).
88365.............  ..............  A                Insitu hybridization         1.20       2.13         NA       0.05       3.38         NA        XXX
                                                      (fish).
88367.............  26............  A                Insitu hybridization,        1.30       0.54       0.54       0.06       1.90       1.90        XXX
                                                      auto.
88367.............  TC............  A                Insitu hybridization,        0.00       3.50         NA       0.06       3.56         NA        XXX
                                                      auto.
88367.............  ..............  A                Insitu hybridization,        1.30       4.04         NA       0.12       5.46         NA        XXX
                                                      auto.
88368.............  26............  A                Insitu hybridization,        1.40       0.60       0.60       0.06       2.06       2.06        XXX
                                                      manual.
88368.............  TC............  A                Insitu hybridization,        0.00       1.80         NA       0.06       1.86         NA        XXX
                                                      manual.
88368.............  ..............  A                Insitu hybridization,        1.40       2.40         NA       0.12       3.92         NA        XXX
                                                      manual.
88371.............  26............  A                Protein, western blot        0.37       0.13       0.13       0.01       0.51       0.51        XXX
                                                      tissue.
88372.............  26............  A                Protein analysis w/          0.37       0.16       0.16       0.01       0.54       0.54        XXX
                                                      probe.
88380.............  26............  C                Microdissection.......       0.00       0.00       0.00       0.00       0.00       0.00        XXX
88380.............  TC............  C                Microdissection.......       0.00       0.00       0.00       0.00       0.00       0.00        XXX
88380.............  ..............  C                Microdissection.......       0.00       0.00       0.00       0.00       0.00       0.00        XXX
88384.............  26............  C                Eval molecular probes,       0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      11-50.
88384.............  TC............  C                Eval molecular probes,       0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      11-50.
88384.............  ..............  C                Eval molecular probes,       0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      11-50.
88385.............  26............  A                Eval molecul probes,         1.50       0.65       0.65       0.06       2.21       2.21        XXX
                                                      51-250.
88385.............  TC............  C                Eval molecul probes,         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      51-250.
88385.............  ..............  C                Eval molecul probes,         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      51-250.
88386.............  26............  A                Eval molecul probes,         1.88       0.82       0.82       0.08       2.78       2.78        XXX
                                                      251-500.
88386.............  TC............  C                Eval molecul probes,         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      251-500.
88386.............  ..............  C                Eval molecul probes,         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      251-500.
88399.............  26............  C                Surgical pathology           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      procedure.
88399.............  TC............  C                Surgical pathology           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      procedure.
88399.............  ..............  C                Surgical pathology           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      procedure.
89049.............  ..............  A                Chct for mal                 1.40       3.56       0.27       0.06       5.02       1.73        XXX
                                                      hyperthermia.
89060.............  26............  A                Exam,synovial fluid          0.37       0.16       0.16       0.01       0.54       0.54        XXX
                                                      crystals.
89100.............  ..............  A                Sample intestinal            0.60       1.84       0.21       0.03       2.47       0.84        XXX
                                                      contents.
89105.............  ..............  A                Sample intestinal            0.50       2.23       0.17       0.02       2.75       0.69        XXX
                                                      contents.
89130.............  ..............  A                Sample stomach               0.45       1.75       0.13       0.02       2.22       0.60        XXX
                                                      contents.
89132.............  ..............  A                Sample stomach               0.19       1.55       0.06       0.01       1.75       0.26        XXX
                                                      contents.
89135.............  ..............  A                Sample stomach               0.79       1.90       0.25       0.04       2.73       1.08        XXX
                                                      contents.
89136.............  ..............  A                Sample stomach               0.21       1.74       0.09       0.01       1.96       0.31        XXX
                                                      contents.
89140.............  ..............  A                Sample stomach               0.94       2.09       0.27       0.04       3.07       1.25        XXX
                                                      contents.
89141.............  ..............  A                Sample stomach               0.85       2.80       0.33       0.03       3.68       1.21        XXX
                                                      contents.
89220.............  ..............  A                Sputum specimen              0.00       0.43         NA       0.02       0.45         NA        XXX
                                                      collection.
89230.............  ..............  A                Collect sweat for test       0.00       0.11         NA       0.02       0.13         NA        XXX
89240.............  ..............  C                Pathology lab                0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      procedure.
90281.............  ..............  I                Human ig, im..........       0.00       0.00       0.00       0.00       0.00       0.00        XXX
90283.............  ..............  I                Human ig, iv..........       0.00       0.00       0.00       0.00       0.00       0.00        XXX
90287.............  ..............  I                Botulinum antitoxin...       0.00       0.00       0.00       0.00       0.00       0.00        XXX
90288.............  ..............  I                Botulism ig, iv.......       0.00       0.00       0.00       0.00       0.00       0.00        XXX
90291.............  ..............  I                Cmv ig, iv............       0.00       0.00       0.00       0.00       0.00       0.00        XXX
90296.............  ..............  E                Diphtheria antitoxin..       0.00       0.00       0.00       0.00       0.00       0.00        XXX
90371.............  ..............  E                Hep b ig, im..........       0.00       0.00       0.00       0.00       0.00       0.00        XXX
90375.............  ..............  E                Rabies ig, im/sc......       0.00       0.00       0.00       0.00       0.00       0.00        XXX
90376.............  ..............  E                Rabies ig, heat              0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      treated.
90378.............  ..............  X                Rsv ig, im, 50mg......       0.00       0.00       0.00       0.00       0.00       0.00        XXX
90379.............  ..............  I                Rsv ig, iv............       0.00       0.00       0.00       0.00       0.00       0.00        XXX
90384.............  ..............  I                Rh ig, full-dose, im..       0.00       0.00       0.00       0.00       0.00       0.00        XXX
90385.............  ..............  E                Rh ig, minidose, im...       0.00       0.00       0.00       0.00       0.00       0.00        XXX
90386.............  ..............  I                Rh ig, iv.............       0.00       0.00       0.00       0.00       0.00       0.00        XXX
90389.............  ..............  I                Tetanus ig, im........       0.00       0.00       0.00       0.00       0.00       0.00        XXX
90393.............  ..............  E                Vaccina ig, im........       0.00       0.00       0.00       0.00       0.00       0.00        XXX
90396.............  ..............  E                Varicella-zoster ig,         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      im.
90399.............  ..............  I                Immune globulin.......       0.00       0.00       0.00       0.00       0.00       0.00        XXX
90465.............  ..............  A                Immune admin 1 inj, <        0.17       0.31         NA       0.01       0.49         NA        XXX
                                                      8 yrs.
90466.............  ..............  A                Immune admin addl inj,       0.15       0.13         NA       0.01       0.29         NA        ZZZ
                                                      < 8 y.
90467.............  ..............  R                Immune admin o or n, <       0.17       0.17       0.09       0.01       0.35       0.27        XXX
                                                      8 yrs.
90468.............  ..............  R                Immune admin o/n, addl       0.15       0.11       0.06       0.01       0.27       0.22        ZZZ
                                                      < 8 y.

[[Page 70441]]

 
90471.............  ..............  A                Immunization admin....       0.17       0.31         NA       0.01       0.49         NA        XXX
90472.............  ..............  A                Immunization admin,          0.15       0.13         NA       0.01       0.29         NA        ZZZ
                                                      each add.
90473.............  ..............  R                Immune admin oral/           0.17       0.19       0.07       0.01       0.37       0.25        XXX
                                                      nasal.
90474.............  ..............  R                Immune admin oral/           0.15       0.10       0.06       0.01       0.26       0.22        ZZZ
                                                      nasal addl.
90476.............  ..............  E                Adenovirus vaccine,          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      type 4.
90477.............  ..............  E                Adenovirus vaccine,          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      type 7.
90581.............  ..............  E                Anthrax vaccine, sc...       0.00       0.00       0.00       0.00       0.00       0.00        XXX
90585.............  ..............  E                Bcg vaccine, percut...       0.00       0.00       0.00       0.00       0.00       0.00        XXX
90586.............  ..............  E                Bcg vaccine,                 0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      intravesical.
90632.............  ..............  E                Hep a vaccine, adult         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      im.
90633.............  ..............  E                Hep a vacc, ped/adol,        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      2 dose.
90634.............  ..............  E                Hep a vacc, ped/adol,        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      3 dose.
90636.............  ..............  E                Hep a/hep b vacc,            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      adult im.
90645.............  ..............  E                Hib vaccine, hboc, im.       0.00       0.00       0.00       0.00       0.00       0.00        XXX
90646.............  ..............  E                Hib vaccine, prp-d, im       0.00       0.00       0.00       0.00       0.00       0.00        XXX
90647.............  ..............  E                Hib vaccine, prp-omp,        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      im.
90648.............  ..............  E                Hib vaccine, prp-t, im       0.00       0.00       0.00       0.00       0.00       0.00        XXX
90649.............  ..............  E                H papilloma vacc 3           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      dose im.
90655.............  ..............  X                Flu vaccine no preserv       0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      6-35m.
90656.............  ..............  X                Flu vaccine no preserv       0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      3 & >.
90657.............  ..............  X                Flu vaccine, 6-35 mo,        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      im.
90658.............  ..............  X                Flu vaccine age 3 &          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      over, im.
90660.............  ..............  X                Flu vaccine, nasal....       0.00       0.00       0.00       0.00       0.00       0.00        XXX
90665.............  ..............  E                Lyme disease vaccine,        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      im.
90669.............  ..............  N                Pneumococcal vacc, ped       0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      <5.
90675.............  ..............  E                Rabies vaccine, im....       0.00       0.00       0.00       0.00       0.00       0.00        XXX
90676.............  ..............  E                Rabies vaccine, id....       0.00       0.00       0.00       0.00       0.00       0.00        XXX
90680.............  ..............  E                Rotovirus vacc 3 dose,       0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      oral.
90690.............  ..............  E                Typhoid vaccine, oral.       0.00       0.00       0.00       0.00       0.00       0.00        XXX
90691.............  ..............  E                Typhoid vaccine, im...       0.00       0.00       0.00       0.00       0.00       0.00        XXX
90692.............  ..............  E                Typhoid vaccine, h-p,        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      sc/id.
90693.............  ..............  E                Typhoid vaccine, akd,        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      sc.
90698.............  ..............  E                Dtap-hib-ip vaccine,         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      im.
90700.............  ..............  E                Dtap vaccine, < 7 yrs,       0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      im.
90701.............  ..............  E                Dtp vaccine, im.......       0.00       0.00       0.00       0.00       0.00       0.00        XXX
90702.............  ..............  E                Dt vaccine < 7, im....       0.00       0.00       0.00       0.00       0.00       0.00        XXX
90703.............  ..............  E                Tetanus vaccine, im...       0.00       0.00       0.00       0.00       0.00       0.00        XXX
90704.............  ..............  E                Mumps vaccine, sc.....       0.00       0.00       0.00       0.00       0.00       0.00        XXX
90705.............  ..............  E                Measles vaccine, sc...       0.00       0.00       0.00       0.00       0.00       0.00        XXX
90706.............  ..............  E                Rubella vaccine, sc...       0.00       0.00       0.00       0.00       0.00       0.00        XXX
90707.............  ..............  E                Mmr vaccine, sc.......       0.00       0.00       0.00       0.00       0.00       0.00        XXX
90708.............  ..............  E                Measles-rubella              0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      vaccine, sc.
90710.............  ..............  E                Mmrv vaccine, sc......       0.00       0.00       0.00       0.00       0.00       0.00        XXX
90712.............  ..............  E                Oral poliovirus              0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      vaccine.
90713.............  ..............  E                Poliovirus, ipv, sc/im       0.00       0.00       0.00       0.00       0.00       0.00        XXX
90714.............  ..............  E                Td vaccine no prsrv >/       0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      = 7 im.
90715.............  ..............  E                Tdap vaccine >7 im....       0.00       0.00       0.00       0.00       0.00       0.00        XXX
90716.............  ..............  E                Chicken pox vaccine,         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      sc.
90717.............  ..............  E                Yellow fever vaccine,        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      sc.
90718.............  ..............  E                Td vaccine > 7, im....       0.00       0.00       0.00       0.00       0.00       0.00        XXX
90719.............  ..............  E                Diphtheria vaccine, im       0.00       0.00       0.00       0.00       0.00       0.00        XXX
90720.............  ..............  E                Dtp/hib vaccine, im...       0.00       0.00       0.00       0.00       0.00       0.00        XXX
90721.............  ..............  E                Dtap/hib vaccine, im..       0.00       0.00       0.00       0.00       0.00       0.00        XXX
90723.............  ..............  I                Dtap-hep b-ipv               0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      vaccine, im.
90725.............  ..............  E                Cholera vaccine,             0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      injectable.
90727.............  ..............  E                Plague vaccine, im....       0.00       0.00       0.00       0.00       0.00       0.00        XXX
90732.............  ..............  X                Pneumococcal vaccine..       0.00       0.00       0.00       0.00       0.00       0.00        XXX
90733.............  ..............  E                Meningococcal vaccine,       0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      sc.
90734.............  ..............  E                Meningococcal vaccine,       0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      im.
90735.............  ..............  E                Encephalitis vaccine,        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      sc.
90736.............  ..............  E                Zoster vacc, sc.......       0.00       0.00       0.00       0.00       0.00       0.00        XXX
90740.............  ..............  X                Hepb vacc, ill pat 3         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      dose im.
90743.............  ..............  X                Hep b vacc, adol, 2          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      dose, im.
90744.............  ..............  X                Hepb vacc ped/adol 3         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      dose im.
90746.............  ..............  X                Hep b vaccine, adult,        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      im.
90747.............  ..............  X                Hepb vacc, ill pat 4         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      dose im.
90748.............  ..............  I                Hep b/hib vaccine, im.       0.00       0.00       0.00       0.00       0.00       0.00        XXX
90749.............  ..............  E                Vaccine toxoid........       0.00       0.00       0.00       0.00       0.00       0.00        XXX
90760.............  ..............  A                Hydration iv infusion,       0.17       1.43       1.43       0.07       1.67       1.67        XXX
                                                      init.
90761.............  ..............  A                Hydrate iv infusion,         0.09       0.40       0.40       0.04       0.53       0.53        ZZZ
                                                      add-on.
90765.............  ..............  A                Ther/proph/diag iv           0.21       1.76       1.76       0.07       2.04       2.04        XXX
                                                      inf, init.
90766.............  ..............  A                Ther/proph/dg iv inf,        0.18       0.46       0.46       0.04       0.68       0.68        ZZZ
                                                      add-on.
90767.............  ..............  A                Tx/proph/dg addl seq         0.19       0.89       0.89       0.04       1.12       1.12        ZZZ
                                                      iv inf.
90768.............  ..............  A                Ther/diag concurrent         0.17       0.44       0.44       0.04       0.65       0.65        ZZZ
                                                      inf.
90772.............  ..............  A                Ther/proph/diag inj,         0.17       0.31       0.31       0.01       0.49       0.49        XXX
                                                      sc/im.

[[Page 70442]]

 
90773.............  ..............  A                Ther/proph/diag inj,         0.17       0.32       0.32       0.02       0.51       0.51        XXX
                                                      ia.
90774.............  ..............  A                Ther/proph/diag inj,         0.18       1.30       1.30       0.04       1.52       1.52        XXX
                                                      iv push.
90775.............  ..............  A                Ther/proph/diag inj          0.10       0.57       0.57       0.04       0.71       0.71        ZZZ
                                                      add-on.
90779.............  ..............  C                Ther/prop/diag inj/inf       0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      proc.
90801.............  ..............  A                Psy dx interview......       2.80       1.17       0.93       0.06       4.03       3.79        XXX
90802.............  ..............  A                Intac psy dx interview       3.01       1.20       0.98       0.07       4.28       4.06        XXX
90804.............  ..............  A                Psytx, office, 20-30         1.21       0.49       0.38       0.03       1.73       1.62        XXX
                                                      min.
90805.............  ..............  A                Psytx, off, 20-30 min        1.37       0.50       0.42       0.03       1.90       1.82        XXX
                                                      w/e&m.
90806.............  ..............  A                Psytx, off, 45-50 min.       1.86       0.70       0.60       0.04       2.60       2.50        XXX
90807.............  ..............  A                Psytx, off, 45-50 min        2.02       0.70       0.63       0.05       2.77       2.70        XXX
                                                      w/e&m.
90808.............  ..............  A                Psytx, office, 75-80         2.79       1.03       0.90       0.06       3.88       3.75        XXX
                                                      min.
90809.............  ..............  A                Psytx, off, 75-80, w/        2.95       1.00       0.92       0.07       4.02       3.94        XXX
                                                      e&m.
90810.............  ..............  A                Intac psytx, off, 20-        1.32       0.51       0.42       0.04       1.87       1.78        XXX
                                                      30 min.
90811.............  ..............  A                Intac psytx, 20-30, w/       1.48       0.57       0.46       0.04       2.09       1.98        XXX
                                                      e&m.
90812.............  ..............  A                Intac psytx, off, 45-        1.97       0.79       0.64       0.04       2.80       2.65        XXX
                                                      50 min.
90813.............  ..............  A                Intac psytx, 45-50 min       2.13       0.77       0.67       0.05       2.95       2.85        XXX
                                                      w/e&m.
90814.............  ..............  A                Intac psytx, off, 75-        2.90       1.10       0.98       0.06       4.06       3.94        XXX
                                                      80 min.
90815.............  ..............  A                Intac psytx, 75-80 w/        3.06       1.05       0.95       0.07       4.18       4.08        XXX
                                                      e&m.
90816.............  ..............  A                Psytx, hosp, 20-30 min       1.25         NA       0.46       0.03         NA       1.74        XXX
90817.............  ..............  A                Psytx, hosp, 20-30 min       1.41         NA       0.46       0.03         NA       1.90        XXX
                                                      w/e&m.
90818.............  ..............  A                Psytx, hosp, 45-50 min       1.89         NA       0.69       0.04         NA       2.62        XXX
90819.............  ..............  A                Psytx, hosp, 45-50 min       2.05         NA       0.65       0.05         NA       2.75        XXX
                                                      w/e&m.
90821.............  ..............  A                Psytx, hosp, 75-80 min       2.83         NA       1.01       0.06         NA       3.90        XXX
90822.............  ..............  A                Psytx, hosp, 75-80 min       2.99         NA       0.95       0.08         NA       4.02        XXX
                                                      w/e&m.
90823.............  ..............  A                Intac psytx, hosp, 20-       1.36         NA       0.48       0.03         NA       1.87        XXX
                                                      30 min.
90824.............  ..............  A                Intac psytx, hsp 20-30       1.52         NA       0.49       0.04         NA       2.05        XXX
                                                      w/e&m.
90826.............  ..............  A                Intac psytx, hosp, 45-       2.01         NA       0.72       0.05         NA       2.78        XXX
                                                      50 min.
90827.............  ..............  A                Intac psytx, hsp 45-50       2.16         NA       0.68       0.05         NA       2.89        XXX
                                                      w/e&m.
90828.............  ..............  A                Intac psytx, hosp, 75-       2.94         NA       1.06       0.06         NA       4.06        XXX
                                                      80 min.
90829.............  ..............  A                Intac psytx, hsp 75-80       3.10         NA       0.98       0.07         NA       4.15        XXX
                                                      w/e&m.
90845.............  ..............  A                Psychoanalysis........       1.79       0.58       0.55       0.04       2.41       2.38        XXX
90846.............  ..............  R                Family psytx w/o             1.83       0.65       0.65       0.04       2.52       2.52        XXX
                                                      patient.
90847.............  ..............  R                Family psytx w/patient       2.21       0.82       0.76       0.05       3.08       3.02        XXX
90849.............  ..............  R                Multiple family group        0.59       0.27       0.24       0.02       0.88       0.85        XXX
                                                      psytx.
90853.............  ..............  A                Group psychotherapy...       0.59       0.25       0.23       0.01       0.85       0.83        XXX
90857.............  ..............  A                Intac group psytx.....       0.63       0.29       0.25       0.01       0.93       0.89        XXX
90862.............  ..............  A                Medication management.       0.95       0.40       0.32       0.02       1.37       1.29        XXX
90865.............  ..............  A                Narcosynthesis........       2.84       1.36       0.91       0.12       4.32       3.87        XXX
90870.............  ..............  A                Electroconvulsive            1.88       1.94       0.59       0.04       3.86       2.51        000
                                                      therapy.
90875.............  ..............  N                Psychophysiological         +1.20       0.90       0.46       0.04       2.14       1.70        XXX
                                                      therapy.
90876.............  ..............  N                Psychophysiological         +1.90       1.16       0.73       0.05       3.11       2.68        XXX
                                                      therapy.
90880.............  ..............  A                Hypnotherapy..........       2.19       1.04       0.69       0.05       3.28       2.93        XXX
90882.............  ..............  N                Environmental                0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      manipulation.
90885.............  ..............  B                Psy evaluation of           +0.97       0.37       0.37       0.02       1.36       1.36        XXX
                                                      records.
90887.............  ..............  B                Consultation with           +1.48       0.82       0.56       0.04       2.34       2.08        XXX
                                                      family.
90889.............  ..............  B                Preparation of report.       0.00       0.00       0.00       0.00       0.00       0.00        XXX
90899.............  ..............  C                Psychiatric service/         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      therapy.
90901.............  ..............  A                Biofeedback train, any       0.41       0.65       0.14       0.02       1.08       0.57        000
                                                      meth.
90911.............  ..............  A                Biofeedback peri/uro/        0.89       1.56       0.31       0.06       2.51       1.26        000
                                                      rectal.
90918.............  ..............  I                ESRD related services,     +11.16       6.13       6.13       0.36      17.65      17.65        XXX
                                                      month.
90919.............  ..............  I                ESRD related services,      +8.53       4.01       4.01       0.29      12.83      12.83        XXX
                                                      month.
90920.............  ..............  I                ESRD related services,      +7.26       3.76       3.76       0.23      11.25      11.25        XXX
                                                      month.
90921.............  ..............  I                ESRD related services,      +4.46       2.45       2.45       0.14       7.05       7.05        XXX
                                                      month.
90922.............  ..............  I                ESRD related services,      +0.37       0.21       0.21       0.01       0.59       0.59        XXX
                                                      day.
90923.............  ..............  I                Esrd related services,      +0.28       0.13       0.13       0.01       0.42       0.42        XXX
                                                      day.
90924.............  ..............  I                Esrd related services,      +0.24       0.12       0.12       0.01       0.37       0.37        XXX
                                                      day.
90925.............  ..............  I                Esrd related services,      +0.15       0.08       0.08       0.01       0.24       0.24        XXX
                                                      day.
90935.............  ..............  A                Hemodialysis, one            1.22         NA       0.67       0.04         NA       1.93        000
                                                      evaluation.
90937.............  ..............  A                Hemodialysis, repeated       2.11         NA       0.97       0.07         NA       3.15        000
                                                      eval.
90940.............  ..............  X                Hemodialysis access          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      study.
90945.............  ..............  A                Dialysis, one                1.28         NA       0.69       0.04         NA       2.01        000
                                                      evaluation.
90947.............  ..............  A                Dialysis, repeated           2.16         NA       0.99       0.07         NA       3.22        000
                                                      eval.
90989.............  ..............  X                Dialysis training,           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      complete.
90993.............  ..............  X                Dialysis training,           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      incompl.
90997.............  ..............  A                Hemoperfusion.........       1.84         NA       0.66       0.06         NA       2.56        000
90999.............  ..............  C                Dialysis procedure....       0.00       0.00       0.00       0.00       0.00       0.00        XXX
91000.............  26............  A                Esophageal intubation.       0.73       0.25       0.25       0.03       1.01       1.01        000
91000.............  TC............  A                Esophageal intubation.       0.00       0.08         NA       0.01       0.09         NA        000
91000.............  ..............  A                Esophageal intubation.       0.73       0.33         NA       0.04       1.10         NA        000
91010.............  26............  A                Esophagus motility           1.25       0.44       0.44       0.06       1.75       1.75        000
                                                      study.
91010.............  TC............  A                Esophagus motility           0.00       3.98         NA       0.06       4.04         NA        000
                                                      study.
91010.............  ..............  A                Esophagus motility           1.25       4.42         NA       0.12       5.79         NA        000
                                                      study.
91011.............  26............  A                Esophagus motility           1.50       0.53       0.53       0.07       2.10       2.10        000
                                                      study.
91011.............  TC............  A                Esophagus motility           0.00       4.71         NA       0.06       4.77         NA        000
                                                      study.
91011.............  ..............  A                Esophagus motility           1.50       5.24         NA       0.13       6.87         NA        000
                                                      study.

[[Page 70443]]

 
91012.............  26............  A                Esophagus motility           1.46       0.51       0.51       0.06       2.03       2.03        000
                                                      study.
91012.............  TC............  A                Esophagus motility           0.00       5.26         NA       0.07       5.33         NA        000
                                                      study.
91012.............  ..............  A                Esophagus motility           1.46       5.77         NA       0.13       7.36         NA        000
                                                      study.
91020.............  26............  A                Gastric motility             1.44       0.49       0.49       0.07       2.00       2.00        000
                                                      studies.
91020.............  TC............  A                Gastric motility             0.00       4.04         NA       0.06       4.10         NA        000
                                                      studies.
91020.............  ..............  A                Gastric motility             1.44       4.53         NA       0.13       6.10         NA        000
                                                      studies.
91022.............  26............  A                Duodenal motility            1.44       0.51       0.51       0.07       2.02       2.02        000
                                                      study.
91022.............  TC............  A                Duodenal motility            0.00       3.90         NA       0.06       3.96         NA        000
                                                      study.
91022.............  ..............  A                Duodenal motility            1.44       4.41         NA       0.13       5.98         NA        000
                                                      study.
91030.............  26............  A                Acid perfusion of            0.91       0.32       0.32       0.04       1.27       1.27        000
                                                      esophagus.
91030.............  TC............  A                Acid perfusion of            0.00       2.12         NA       0.02       2.14         NA        000
                                                      esophagus.
91030.............  ..............  A                Acid perfusion of            0.91       2.44         NA       0.06       3.41         NA        000
                                                      esophagus.
91034.............  26............  A                Gastroesophageal             0.97       0.34       0.34       0.06       1.37       1.37        000
                                                      reflux test.
91034.............  TC............  A                Gastroesophageal             0.00       4.91         NA       0.06       4.97         NA        000
                                                      reflux test.
91034.............  ..............  A                Gastroesophageal             0.97       5.25         NA       0.12       6.34         NA        000
                                                      reflux test.
91035.............  26............  A                G-esoph reflx tst w/         1.59       0.56       0.56       0.06       2.21       2.21        000
                                                      electrod.
91035.............  TC............  A                G-esoph reflx tst w/         0.00      10.27         NA       0.06      10.33         NA        000
                                                      electrod.
91035.............  ..............  A                G-esoph reflx tst w/         1.59      10.83         NA       0.12      12.54         NA        000
                                                      electrod.
91037.............  26............  A                Esoph imped function         0.97       0.34       0.34       0.06       1.37       1.37        000
                                                      test.
91037.............  TC............  A                Esoph imped function         0.00       2.60         NA       0.06       2.66         NA        000
                                                      test.
91037.............  ..............  A                Esoph imped function         0.97       2.94         NA       0.12       4.03         NA        000
                                                      test.
91038.............  26............  A                Esoph imped funct test       1.10       0.39       0.39       0.06       1.55       1.55        000
                                                      > 1h.
91038.............  TC............  A                Esoph imped funct test       0.00       1.84         NA       0.06       1.90         NA        000
                                                      > 1h.
91038.............  ..............  A                Esoph imped funct test       1.10       2.23         NA       0.12       3.45         NA        000
                                                      > 1h.
91040.............  26............  A                Esoph balloon                0.97       0.34       0.34       0.06       1.37       1.37        000
                                                      distension tst.
91040.............  TC............  A                Esoph balloon                0.00      10.82         NA       0.06      10.88         NA        000
                                                      distension tst.
91040.............  ..............  A                Esoph balloon                0.97      11.16         NA       0.12      12.25         NA        000
                                                      distension tst.
91052.............  26............  A                Gastric analysis test.       0.79       0.28       0.28       0.03       1.10       1.10        000
91052.............  TC............  A                Gastric analysis test.       0.00       2.18         NA       0.02       2.20         NA        000
91052.............  ..............  A                Gastric analysis test.       0.79       2.46         NA       0.05       3.30         NA        000
91055.............  26............  A                Gastric intubation for       0.94       0.27       0.27       0.05       1.26       1.26        000
                                                      smear.
91055.............  TC............  A                Gastric intubation for       0.00       2.68         NA       0.02       2.70         NA        000
                                                      smear.
91055.............  ..............  A                Gastric intubation for       0.94       2.95         NA       0.07       3.96         NA        000
                                                      smear.
91060.............  26............  A                Gastric saline load          0.45       0.14       0.14       0.03       0.62       0.62        000
                                                      test.
91060.............  TC............  A                Gastric saline load          0.00       1.83         NA       0.02       1.85         NA        000
                                                      test.
91060.............  ..............  A                Gastric saline load          0.45       1.97         NA       0.05       2.47         NA        000
                                                      test.
91065.............  26............  A                Breath hydrogen test..       0.20       0.07       0.07       0.01       0.28       0.28        000
91065.............  TC............  A                Breath hydrogen test..       0.00       1.39         NA       0.02       1.41         NA        000
91065.............  ..............  A                Breath hydrogen test..       0.20       1.46         NA       0.03       1.69         NA        000
91100.............  ..............  A                Pass intestine               1.08       2.80       0.28       0.07       3.95       1.43        000
                                                      bleeding tube.
91105.............  ..............  A                Gastric intubation           0.37       2.11       0.09       0.03       2.51       0.49        000
                                                      treatment.
91110.............  26............  A                Gi tract capsule             3.64       1.28       1.28       0.09       5.01       5.01        XXX
                                                      endoscopy.
91110.............  TC............  A                Gi tract capsule             0.00      20.96         NA       0.07      21.03         NA        XXX
                                                      endoscopy.
91110.............  ..............  A                Gi tract capsule             3.64      22.24         NA       0.16      26.04         NA        XXX
                                                      endoscopy.
91120.............  26............  A                Rectal sensation test.       0.97       0.34       0.34       0.07       1.38       1.38        XXX
91120.............  TC............  A                Rectal sensation test.       0.00      10.67         NA       0.04      10.71         NA        XXX
91120.............  ..............  A                Rectal sensation test.       0.97      11.01         NA       0.11      12.09         NA        XXX
91122.............  26............  A                Anal pressure record..       1.77       0.60       0.60       0.13       2.50       2.50        000
91122.............  TC............  A                Anal pressure record..       0.00       4.51         NA       0.08       4.59         NA        000
91122.............  ..............  A                Anal pressure record..       1.77       5.11         NA       0.21       7.09         NA        000
91123.............  ..............  B                Irrigate fecal               0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      impaction.
91132.............  26............  A                Electrogastrography...       0.52       0.18       0.18       0.02       0.72       0.72        XXX
91132.............  TC............  C                Electrogastrography...       0.00       0.00       0.00       0.00       0.00       0.00        XXX
91132.............  ..............  C                Electrogastrography...       0.00       0.00       0.00       0.00       0.00       0.00        XXX
91133.............  26............  A                Electrogastrography w/       0.66       0.23       0.23       0.03       0.92       0.92        XXX
                                                      test.
91133.............  TC............  C                Electrogastrography w/       0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      test.
91133.............  ..............  C                Electrogastrography w/       0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      test.
91299.............  26............  C                Gastroenterology             0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      procedure.
91299.............  TC............  C                Gastroenterology             0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      procedure.
91299.............  ..............  C                Gastroenterology             0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      procedure.
92002.............  ..............  A                Eye exam, new patient.       0.88       0.97       0.34       0.02       1.87       1.24        XXX
92004.............  ..............  A                Eye exam, new patient.       1.67       1.70       0.68       0.04       3.41       2.39        XXX
92012.............  ..............  A                Eye exam established         0.67       1.03       0.29       0.02       1.72       0.98        XXX
                                                      pat.
92014.............  ..............  A                Eye exam & treatment..       1.10       1.41       0.47       0.03       2.54       1.60        XXX
92015.............  ..............  N                Refraction............      +0.38       1.49       0.15       0.01       1.88       0.54        XXX
92018.............  ..............  A                New eye exam &               2.50         NA       1.07       0.07         NA       3.64        XXX
                                                      treatment.
92019.............  ..............  A                Eye exam & treatment..       1.31         NA       0.56       0.03         NA       1.90        XXX
92020.............  ..............  A                Special eye evaluation       0.37       0.34       0.16       0.01       0.72       0.54        XXX
92060.............  26............  A                Special eye evaluation       0.69       0.29       0.29       0.02       1.00       1.00        XXX
92060.............  TC............  A                Special eye evaluation       0.00       0.44         NA       0.01       0.45         NA        XXX
92060.............  ..............  A                Special eye evaluation       0.69       0.73         NA       0.03       1.45         NA        XXX
92065.............  26............  A                Orthoptic/pleoptic           0.37       0.15       0.15       0.01       0.53       0.53        XXX
                                                      training.
92065.............  TC............  A                Orthoptic/pleoptic           0.00       0.38         NA       0.01       0.39         NA        XXX
                                                      training.
92065.............  ..............  A                Orthoptic/pleoptic           0.37       0.53         NA       0.02       0.92         NA        XXX
                                                      training.
92070.............  ..............  A                Fitting of contact           0.70       1.07       0.32       0.02       1.79       1.04        XXX
                                                      lens.

[[Page 70444]]

 
92081.............  26............  A                Visual field                 0.36       0.15       0.15       0.01       0.52       0.52        XXX
                                                      examination(s).
92081.............  TC............  A                Visual field                 0.00       0.79         NA       0.01       0.80         NA        XXX
                                                      examination(s).
92081.............  ..............  A                Visual field                 0.36       0.94         NA       0.02       1.32         NA        XXX
                                                      examination(s).
92082.............  26............  A                Visual field                 0.44       0.19       0.19       0.01       0.64       0.64        XXX
                                                      examination(s).
92082.............  TC............  A                Visual field                 0.00       1.04         NA       0.01       1.05         NA        XXX
                                                      examination(s).
92082.............  ..............  A                Visual field                 0.44       1.23         NA       0.02       1.69         NA        XXX
                                                      examination(s).
92083.............  26............  A                Visual field                 0.50       0.22       0.22       0.01       0.73       0.73        XXX
                                                      examination(s).
92083.............  TC............  A                Visual field                 0.00       1.21         NA       0.01       1.22         NA        XXX
                                                      examination(s).
92083.............  ..............  A                Visual field                 0.50       1.43         NA       0.02       1.95         NA        XXX
                                                      examination(s).
92100.............  A.............  ...............  Serial tonometry             0.92       1.35       0.36       0.02       2.29       1.30        XXX
                                                      exam(s).
92120.............  ..............  A                Tonography & eye             0.81       1.07       0.32       0.02       1.90       1.15        XXX
                                                      evaluation.
92130.............  ..............  A                Water provocation            0.81       1.28       0.37       0.02       2.11       1.20        XXX
                                                      tonography.
92135.............  26............  A                Opthalmic dx imaging..       0.35       0.15       0.15       0.01       0.51       0.51        XXX
92135.............  TC............  A                Opthalmic dx imaging..       0.00       0.64         NA       0.01       0.65         NA        XXX
92135.............  ..............  A                Opthalmic dx imaging..       0.35       0.79         NA       0.02       1.16         NA        XXX
92136.............  26............  A                Ophthalmic biometry...       0.54       0.24       0.24       0.01       0.79       0.79        XXX
92136.............  TC............  A                Ophthalmic biometry...       0.00       1.41         NA       0.07       1.48         NA        XXX
92136.............  ..............  A                Ophthalmic biometry...       0.54       1.65         NA       0.08       2.27         NA        XXX
92140.............  ..............  A                Glaucoma provocative         0.50       0.99       0.21       0.01       1.50       0.72        XXX
                                                      tests.
92225.............  ..............  A                Special eye exam,            0.38       0.22       0.16       0.01       0.61       0.55        XXX
                                                      initial.
92226.............  ..............  A                Special eye exam,            0.33       0.21       0.14       0.01       0.55       0.48        XXX
                                                      subsequent.
92230.............  ..............  A                Eye exam with photos..       0.60       1.53       0.20       0.02       2.15       0.82        XXX
92235.............  26............  A                Eye exam with photos..       0.81       0.37       0.37       0.02       1.20       1.20        XXX
92235.............  TC............  A                Eye exam with photos..       0.00       2.25         NA       0.06       2.31         NA        XXX
92235.............  ..............  A                Eye exam with photos..       0.81       2.62         NA       0.08       3.51         NA        XXX
92240.............  26............  A                Icg angiography.......       1.10       0.50       0.50       0.03       1.63       1.63        XXX
92240.............  TC............  A                Icg angiography.......       0.00       5.62         NA       0.06       5.68         NA        XXX
92240.............  ..............  A                Icg angiography.......       1.10       6.12         NA       0.09       7.31         NA        XXX
92250.............  26............  A                Eye exam with photos..       0.44       0.19       0.19       0.01       0.64       0.64        XXX
92250.............  TC............  A                Eye exam with photos..       0.00       1.34         NA       0.01       1.35         NA        XXX
92250.............  ..............  A                Eye exam with photos..       0.44       1.53         NA       0.02       1.99         NA        XXX
92260.............  ..............  A                Ophthalmoscopy/              0.20       0.26       0.09       0.01       0.47       0.30        XXX
                                                      dynamometry.
92265.............  26............  A                Eye muscle evaluation.       0.81       0.28       0.28       0.04       1.13       1.13        XXX
92265.............  TC............  A                Eye muscle evaluation.       0.00       1.21         NA       0.02       1.23         NA        XXX
92265.............  ..............  A                Eye muscle evaluation.       0.81       1.49         NA       0.06       2.36         NA        XXX
92270.............  26............  A                Electro-oculography...       0.81       0.33       0.33       0.03       1.17       1.17        XXX
92270.............  TC............  A                Electro-oculography...       0.00       1.20         NA       0.02       1.22         NA        XXX
92270.............  ..............  A                Electro-oculography...       0.81       1.53         NA       0.05       2.39         NA        XXX
92275.............  26............  A                Electroretinography...       1.01       0.43       0.43       0.03       1.47       1.47        XXX
92275.............  TC............  A                Electroretinography...       0.00       1.51         NA       0.02       1.53         NA        XXX
92275.............  ..............  A                Electroretinography...       1.01       1.94         NA       0.05       3.00         NA        XXX
92283.............  26............  A                Color vision                 0.17       0.07       0.07       0.01       0.25       0.25        XXX
                                                      examination.
92283.............  TC............  A                Color vision                 0.00       0.77         NA       0.01       0.78         NA        XXX
                                                      examination.
92283.............  ..............  A                Color vision                 0.17       0.84         NA       0.02       1.03         NA        XXX
                                                      examination.
92284.............  26............  A                Dark adaptation eye          0.24       0.08       0.08       0.01       0.33       0.33        XXX
                                                      exam.
92284.............  TC............  A                Dark adaptation eye          0.00       1.81         NA       0.01       1.82         NA        XXX
                                                      exam.
92284.............  ..............  A                Dark adaptation eye          0.24       1.89         NA       0.02       2.15         NA        XXX
                                                      exam.
92285.............  26............  A                Eye photography.......       0.20       0.09       0.09       0.01       0.30       0.30        XXX
92285.............  TC............  A                Eye photography.......       0.00       0.90         NA       0.01       0.91         NA        XXX
92285.............  ..............  A                Eye photography.......       0.20       0.99         NA       0.02       1.21         NA        XXX
92286.............  26............  A                Internal eye                 0.66       0.29       0.29       0.02       0.97       0.97        XXX
                                                      photography.
92286.............  TC............  A                Internal eye                 0.00       2.77         NA       0.02       2.79         NA        XXX
                                                      photography.
92286.............  ..............  A                Internal eye                 0.66       3.06         NA       0.04       3.76         NA        XXX
                                                      photography.
92287.............  ..............  A                Internal eye                 0.81       2.39       0.31       0.02       3.22       1.14        XXX
                                                      photography.
92310.............  ..............  N                Contact lens fitting..      +1.17       1.12       0.45       0.04       2.33       1.66        XXX
92311.............  ..............  A                Contact lens fitting..       1.08       1.09       0.35       0.03       2.20       1.46        XXX
92312.............  ..............  A                Contact lens fitting..       1.26       1.08       0.50       0.03       2.37       1.79        XXX
92313.............  ..............  A                Contact lens fitting..       0.92       1.06       0.29       0.02       2.00       1.23        XXX
92314.............  ..............  N                Prescription of             +0.69       0.94       0.27       0.01       1.64       0.97        XXX
                                                      contact lens.
92315.............  ..............  A                Prescription of              0.45       0.85       0.16       0.01       1.31       0.62        XXX
                                                      contact lens.
92316.............  ..............  A                Prescription of              0.68       0.91       0.29       0.02       1.61       0.99        XXX
                                                      contact lens.
92317.............  ..............  A                Prescription of              0.45       0.94       0.15       0.01       1.40       0.61        XXX
                                                      contact lens.
92325.............  ..............  A                Modification of              0.00       0.40         NA       0.01       0.41         NA        XXX
                                                      contact lens.
92326.............  ..............  A                Replacement of contact       0.00       1.63         NA       0.06       1.69         NA        XXX
                                                      lens.
92340.............  ..............  N                Fitting of spectacles.      +0.37       0.70       0.14       0.01       1.08       0.52        XXX
92341.............  ..............  N                Fitting of spectacles.      +0.47       0.74       0.18       0.01       1.22       0.66        XXX
92342.............  ..............  N                Fitting of spectacles.      +0.53       0.76       0.21       0.01       1.30       0.75        XXX
92352.............  ..............  B                Special spectacles          +0.37       0.68       0.14       0.01       1.06       0.52        XXX
                                                      fitting.
92353.............  ..............  B                Special spectacles          +0.50       0.73       0.19       0.02       1.25       0.71        XXX
                                                      fitting.
92354.............  ..............  B                Special spectacles          +0.00       8.89         NA       0.10       8.99         NA        XXX
                                                      fitting.
92355.............  ..............  B                Special spectacles          +0.00       4.34         NA       0.01       4.35         NA        XXX
                                                      fitting.
92358.............  ..............  B                Eye prosthesis service      +0.00       0.97         NA       0.05       1.02         NA        XXX
92370.............  ..............  N                Repair & adjust             +0.32       0.55       0.13       0.02       0.89       0.47        XXX
                                                      spectacles.
92371.............  ..............  B                Repair & adjust             +0.00       0.62         NA       0.02       0.64         NA        XXX
                                                      spectacles.
92499.............  26............  C                Eye service or               0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      procedure.

[[Page 70445]]

 
92499.............  TC............  C                Eye service or               0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      procedure.
92499.............  ..............  C                Eye service or               0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      procedure.
92502.............  ..............  A                Ear and throat               1.51         NA       1.11       0.05         NA       2.67        000
                                                      examination.
92504.............  ..............  A                Ear microscopy               0.18       0.50       0.09       0.01       0.69       0.28        XXX
                                                      examination.
92506.............  ..............  A                Speech/hearing               0.86       2.60       0.40       0.03       3.49       1.29        XXX
                                                      evaluation.
92507.............  ..............  A                Speech/hearing therapy       0.52       1.11       0.23       0.02       1.65       0.77        XXX
92508.............  ..............  A                Speech/hearing therapy       0.26       0.51       0.12       0.01       0.78       0.39        XXX
92511.............  ..............  A                Nasopharyngoscopy.....       0.84       3.32       0.78       0.03       4.19       1.65        000
92512.............  ..............  A                Nasal function studies       0.55       1.14       0.18       0.02       1.71       0.75        XXX
92516.............  ..............  A                Facial nerve function        0.43       1.20       0.22       0.01       1.64       0.66        XXX
                                                      test.
92520.............  ..............  A                Laryngeal function           0.75       0.51       0.39       0.03       1.29       1.17        XXX
                                                      studies.
92526.............  ..............  A                Oral function therapy.       0.55       1.64       0.20       0.02       2.21       0.77        XXX
92531.............  ..............  B                Spontaneous nystagmus        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      study.
92532.............  ..............  B                Positional nystagmus         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      test.
92533.............  ..............  B                Caloric vestibular           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      test.
92534.............  ..............  B                Optokinetic nystagmus        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      test.
92541.............  26............  A                Spontaneous nystagmus        0.40       0.19       0.19       0.02       0.61       0.61        XXX
                                                      test.
92541.............  TC............  A                Spontaneous nystagmus        0.00       0.84         NA       0.02       0.86         NA        XXX
                                                      test.
92541.............  ..............  A                Spontaneous nystagmus        0.40       1.03         NA       0.04       1.47         NA        XXX
                                                      test.
92542.............  26............  A                Positional nystagmus         0.33       0.16       0.16       0.01       0.50       0.50        XXX
                                                      test.
92542.............  TC............  A                Positional nystagmus         0.00       0.98         NA       0.02       1.00         NA        XXX
                                                      test.
92542.............  ..............  A                Positional nystagmus         0.33       1.14         NA       0.03       1.50         NA        XXX
                                                      test.
92543.............  26............  A                Caloric vestibular           0.10       0.05       0.05       0.01       0.16       0.16        XXX
                                                      test.
92543.............  TC............  A                Caloric vestibular           0.00       0.52         NA       0.01       0.53         NA        XXX
                                                      test.
92543.............  ..............  A                Caloric vestibular           0.10       0.57         NA       0.02       0.69         NA        XXX
                                                      test.
92544.............  26............  A                Optokinetic nystagmus        0.26       0.12       0.12       0.01       0.39       0.39        XXX
                                                      test.
92544.............  TC............  A                Optokinetic nystagmus        0.00       0.78         NA       0.02       0.80         NA        XXX
                                                      test.
92544.............  ..............  A                Optokinetic nystagmus        0.26       0.90         NA       0.03       1.19         NA        XXX
                                                      test.
92545.............  26............  A                Oscillating tracking         0.23       0.11       0.11       0.01       0.35       0.35        XXX
                                                      test.
92545.............  TC............  A                Oscillating tracking         0.00       0.69         NA       0.02       0.71         NA        XXX
                                                      test.
92545.............  ..............  A                Oscillating tracking         0.23       0.80         NA       0.03       1.06         NA        XXX
                                                      test.
92546.............  26............  A                Sinusoidal rotational        0.29       0.13       0.13       0.01       0.43       0.43        XXX
                                                      test.
92546.............  TC............  A                Sinusoidal rotational        0.00       1.86         NA       0.02       1.88         NA        XXX
                                                      test.
92546.............  ..............  A                Sinusoidal rotational        0.29       1.99         NA       0.03       2.31         NA        XXX
                                                      test.
92547.............  ..............  A                Supplemental                 0.00       0.08         NA       0.06       0.14         NA        ZZZ
                                                      electrical test.
92548.............  26............  A                Posturography.........       0.50       0.26       0.26       0.02       0.78       0.78        XXX
92548.............  TC............  A                Posturography.........       0.00       2.00         NA       0.13       2.13         NA        XXX
92548.............  ..............  A                Posturography.........       0.50       2.26         NA       0.15       2.91         NA        XXX
92551.............  ..............  N                Pure tone hearing            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      test, air.
92552.............  ..............  A                Pure tone audiometry,        0.00       0.44         NA       0.04       0.48         NA        XXX
                                                      air.
92553.............  ..............  A                Audiometry, air & bone       0.00       0.66         NA       0.06       0.72         NA        XXX
92555.............  ..............  A                Speech threshold             0.00       0.38         NA       0.04       0.42         NA        XXX
                                                      audiometry.
92556.............  ..............  A                Speech audiometry,           0.00       0.57         NA       0.06       0.63         NA        XXX
                                                      complete.
92557.............  ..............  A                Comprehensive hearing        0.00       1.19         NA       0.12       1.31         NA        XXX
                                                      test.
92559.............  ..............  N                Group audiometric            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      testing.
92560.............  ..............  N                Bekesy audiometry,           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      screen.
92561.............  ..............  A                Bekesy audiometry,           0.00       0.72         NA       0.06       0.78         NA        XXX
                                                      diagnosis.
92562.............  ..............  A                Loudness balance test.       0.00       0.41         NA       0.04       0.45         NA        XXX
92563.............  ..............  A                Tone decay hearing           0.00       0.38         NA       0.04       0.42         NA        XXX
                                                      test.
92564.............  ..............  A                Sisi hearing test.....       0.00       0.47         NA       0.05       0.52         NA        XXX
92565.............  ..............  A                Stenger test, pure           0.00       0.40         NA       0.04       0.44         NA        XXX
                                                      tone.
92567.............  ..............  A                Tympanometry..........       0.00       0.52         NA       0.06       0.58         NA        XXX
92568.............  ..............  A                Acoustic refl                0.00       0.38         NA       0.04       0.42         NA        XXX
                                                      threshold tst.
92569.............  ..............  A                Acoustic reflex decay        0.00       0.41         NA       0.04       0.45         NA        XXX
                                                      test.
92571.............  ..............  A                Filtered speech              0.00       0.39         NA       0.04       0.43         NA        XXX
                                                      hearing test.
92572.............  ..............  A                Staggered spondaic           0.00       0.09         NA       0.01       0.10         NA        XXX
                                                      word test.
92573.............  ..............  A                Lombard test..........       0.00       0.35         NA       0.04       0.39         NA        XXX
92575.............  ..............  A                Sensorineural acuity         0.00       0.30         NA       0.02       0.32         NA        XXX
                                                      test.
92576.............  ..............  A                Synthetic sentence           0.00       0.44         NA       0.05       0.49         NA        XXX
                                                      test.
92577.............  ..............  A                Stenger test, speech..       0.00       0.72         NA       0.07       0.79         NA        XXX
92579.............  ..............  A                Visual audiometry            0.00       0.73         NA       0.06       0.79         NA        XXX
                                                      (vra).
92582.............  ..............  A                Conditioning play            0.00       0.73         NA       0.06       0.79         NA        XXX
                                                      audiometry.
92583.............  ..............  A                Select picture               0.00       0.89         NA       0.08       0.97         NA        XXX
                                                      audiometry.
92584.............  ..............  A                Electrocochleography..       0.00       2.48         NA       0.21       2.69         NA        XXX
92585.............  26............  A                Auditor evoke potent,        0.50       0.21       0.21       0.03       0.74       0.74        XXX
                                                      compre.
92585.............  TC............  A                Auditor evoke potent,        0.00       1.86         NA       0.14       2.00         NA        XXX
                                                      compre.
92585.............  ..............  A                Auditor evoke potent,        0.50       2.07         NA       0.17       2.74         NA        XXX
                                                      compre.
92586.............  ..............  A                Auditor evoke potent,        0.00       1.86         NA       0.14       2.00         NA        XXX
                                                      limit.
92587.............  26............  A                Evoked auditory test..       0.13       0.06       0.06       0.01       0.20       0.20        XXX
92587.............  TC............  A                Evoked auditory test..       0.00       1.31         NA       0.11       1.42         NA        XXX
92587.............  ..............  A                Evoked auditory test..       0.13       1.37         NA       0.12       1.62         NA        XXX
92588.............  26............  A                Evoked auditory test..       0.36       0.16       0.16       0.01       0.53       0.53        XXX
92588.............  TC............  A                Evoked auditory test..       0.00       1.47         NA       0.13       1.60         NA        XXX
92588.............  ..............  A                Evoked auditory test..       0.36       1.63         NA       0.14       2.13         NA        XXX
92590.............  ..............  N                Hearing aid exam, one        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      ear.

[[Page 70446]]

 
92591.............  ..............  N                Hearing aid exam, both       0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      ears.
92592.............  ..............  N                Hearing aid check, one       0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      ear.
92593.............  ..............  N                Hearing aid check,           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      both ears.
92594.............  ..............  N                Electro hearng aid           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      test, one.
92595.............  ..............  N                Electro hearng aid           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      tst, both.
92596.............  ..............  A                Ear protector                0.00       0.59         NA       0.06       0.65         NA        XXX
                                                      evaluation.
92597.............  ..............  A                Oral speech device           0.86       1.69       0.45       0.03       2.58       1.34        XXX
                                                      eval.
92601.............  ..............  A                Cochlear implt f/up          0.00       3.51         NA       0.07       3.58         NA        XXX
                                                      exam < 7.
92602.............  ..............  A                Reprogram cochlear           0.00       2.39         NA       0.07       2.46         NA        XXX
                                                      implt < 7.
92603.............  ..............  A                Cochlear implt f/up          0.00       2.15         NA       0.07       2.22         NA        XXX
                                                      exam 7 >.
92604.............  ..............  A                Reprogram cochlear           0.00       1.35         NA       0.07       1.42         NA        XXX
                                                      implt 7 >.
92605.............  ..............  B                Eval for nonspeech           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      device rx.
92606.............  ..............  B                Non-speech device            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      service.
92607.............  ..............  A                Ex for speech device         0.00       3.09         NA       0.05       3.14         NA        XXX
                                                      rx, 1hr.
92608.............  ..............  A                Ex for speech device         0.00       0.55         NA       0.05       0.60         NA        XXX
                                                      rx addl.
92609.............  ..............  A                Use of speech device         0.00       1.59         NA       0.04       1.63         NA        XXX
                                                      service.
92610.............  ..............  A                Evaluate swallowing          0.00       3.44         NA       0.08       3.52         NA        XXX
                                                      function.
92611.............  ..............  A                Motion fluoroscopy/          0.00       3.44         NA       0.08       3.52         NA        XXX
                                                      swallow.
92612.............  ..............  A                Endoscopy swallow tst        1.27       2.75       0.66       0.04       4.06       1.97        XXX
                                                      (fees).
92613.............  ..............  A                Endoscopy swallow tst        0.71       0.40       0.39       0.05       1.16       1.15        XXX
                                                      (fees).
92614.............  ..............  A                Laryngoscopic sensory        1.27       2.51       0.66       0.04       3.82       1.97        XXX
                                                      test.
92615.............  ..............  A                Eval laryngoscopy            0.63       0.35       0.35       0.05       1.03       1.03        XXX
                                                      sense tst.
92616.............  ..............  A                Fees w/laryngeal sense       1.88       3.40       0.99       0.06       5.34       2.93        XXX
                                                      test.
92617.............  ..............  A                Interprt fees/               0.79       0.44       0.44       0.05       1.28       1.28        XXX
                                                      laryngeal test.
92620.............  ..............  A                Auditory function, 60        0.00       1.14         NA       0.06       1.20         NA        XXX
                                                      min.
92621.............  ..............  A                Auditory function, +         0.00       0.25         NA       0.06       0.31         NA        ZZZ
                                                      15 min.
92625.............  ..............  A                Tinnitus assessment...       0.00       1.12         NA       0.06       1.18         NA        XXX
92626.............  ..............  A                Eval aud rehab status.       0.00       0.55         NA       0.06       0.61         NA        XXX
92627.............  ..............  A                Eval aud status rehab        0.00       0.55         NA       0.06       0.61         NA        XXX
                                                      add-on.
92630.............  ..............  I                Aud rehab pre-ling           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      hear loss.
92633.............  ..............  I                Aud rehab postling           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      hear loss.
92700.............  ..............  C                Ent procedure/service.       0.00       0.00       0.00       0.00       0.00       0.00        XXX
92950.............  ..............  A                Heart/lung                   3.79       4.21       0.97       0.28       8.28       5.04        000
                                                      resuscitation cpr.
92953.............  ..............  A                Temporary external           0.23         NA       0.07       0.02         NA       0.32        000
                                                      pacing.
92960.............  ..............  A                Cardioversion                2.25       6.33       1.17       0.07       8.65       3.49        000
                                                      electric, ext.
92961.............  ..............  A                Cardioversion,               4.59         NA       2.09       0.29         NA       6.97        000
                                                      electric, int.
92970.............  ..............  A                Cardioassist, internal       3.51         NA       1.06       0.16         NA       4.73        000
92971.............  ..............  A                Cardioassist, external       1.77         NA       0.85       0.06         NA       2.68        000
92973.............  ..............  A                Percut coronary              3.28         NA       1.29       0.23         NA       4.80        ZZZ
                                                      thrombectomy.
92974.............  ..............  A                Cath place, cardio           3.00         NA       1.18       0.21         NA       4.39        ZZZ
                                                      brachytx.
92975.............  ..............  A                Dissolve clot, heart         7.24         NA       2.82       0.50         NA      10.56        000
                                                      vessel.
92977.............  ..............  A                Dissolve clot, heart         0.00       8.07         NA       0.46       8.53         NA        XXX
                                                      vessel.
92978.............  26............  A                Intravasc us, heart          1.80       0.71       0.71       0.06       2.57       2.57        ZZZ
                                                      add-on.
92978.............  TC............  A                Intravasc us, heart          0.00       4.57         NA       0.24       4.81         NA        ZZZ
                                                      add-on.
92978.............  ..............  A                Intravasc us, heart          1.80       5.28         NA       0.30       7.38         NA        ZZZ
                                                      add-on.
92979.............  26............  A                Intravasc us, heart          1.44       0.56       0.56       0.06       2.06       2.06        ZZZ
                                                      add-on.
92979.............  TC............  A                Intravasc us, heart          0.00       2.30         NA       0.13       2.43         NA        ZZZ
                                                      add-on.
92979.............  ..............  A                Intravasc us, heart          1.44       2.86         NA       0.19       4.49         NA        ZZZ
                                                      add-on.
92980.............  ..............  A                Insert intracoronary        14.82         NA       6.07       1.03         NA      21.92        000
                                                      stent.
92981.............  ..............  A                Insert intracoronary         4.16         NA       1.63       0.29         NA       6.08        ZZZ
                                                      stent.
92982.............  ..............  A                Coronary artery             10.96         NA       4.54       0.76         NA      16.26        000
                                                      dilation.
92984.............  ..............  A                Coronary artery              2.97         NA       1.16       0.21         NA       4.34        ZZZ
                                                      dilation.
92986.............  ..............  A                Revision of aortic          21.77         NA      11.86       1.51         NA      35.14        090
                                                      valve.
92987.............  ..............  A                Revision of mitral          22.67         NA      12.25       1.59         NA      36.51        090
                                                      valve.
92990.............  ..............  A                Revision of pulmonary       17.31         NA       9.82       1.20         NA      28.33        090
                                                      valve.
92992.............  ..............  C                Revision of heart            0.00       0.00       0.00       0.00       0.00       0.00        090
                                                      chamber.
92993.............  ..............  C                Revision of heart            0.00       0.00       0.00       0.00       0.00       0.00        090
                                                      chamber.
92995.............  ..............  A                Coronary atherectomy..      12.07         NA       4.97       0.84         NA      17.88        000
92996.............  ..............  A                Coronary atherectomy         3.26         NA       1.27       0.10         NA       4.63        ZZZ
                                                      add-on.
92997.............  ..............  A                Pul art balloon repr,       11.98         NA       4.83       0.40         NA      17.21        000
                                                      percut.
92998.............  ..............  A                Pul art balloon repr,        5.99         NA       2.21       0.28         NA       8.48        ZZZ
                                                      percut.
93000.............  ..............  A                Electrocardiogram,           0.17       0.51         NA       0.03       0.71         NA        XXX
                                                      complete.
93005.............  ..............  A                Electrocardiogram,           0.00       0.45         NA       0.02       0.47         NA        XXX
                                                      tracing.
93010.............  ..............  A                Electrocardiogram            0.17       0.06       0.06       0.01       0.24       0.24        XXX
                                                      report.
93012.............  ..............  A                Transmission of ecg...       0.00       6.03         NA       0.18       6.21         NA        XXX
93014.............  ..............  A                Report on transmitted        0.52       0.19       0.19       0.02       0.73       0.73        XXX
                                                      ecg.
93015.............  ..............  A                Cardiovascular stress        0.75       1.96         NA       0.14       2.85         NA        XXX
                                                      test.
93016.............  ..............  A                Cardiovascular stress        0.45       0.17       0.17       0.02       0.64       0.64        XXX
                                                      test.
93017.............  ..............  A                Cardiovascular stress        0.00       1.68         NA       0.11       1.79         NA        XXX
                                                      test.
93018.............  ..............  A                Cardiovascular stress        0.30       0.11       0.11       0.01       0.42       0.42        XXX
                                                      test.
93024.............  26............  A                Cardiac drug stress          1.17       0.45       0.45       0.04       1.66       1.66        XXX
                                                      test.
93024.............  TC............  A                Cardiac drug stress          0.00       1.12         NA       0.08       1.20         NA        XXX
                                                      test.
93024.............  ..............  A                Cardiac drug stress          1.17       1.57         NA       0.12       2.86         NA        XXX
                                                      test.
93025.............  26............  A                Microvolt t-wave             0.75       0.29       0.29       0.03       1.07       1.07        XXX
                                                      assess.
93025.............  TC............  A                Microvolt t-wave             0.00       7.32         NA       0.11       7.43         NA        XXX
                                                      assess.

[[Page 70447]]

 
93025.............  ..............  A                Microvolt t-wave             0.75       7.61         NA       0.14       8.50         NA        XXX
                                                      assess.
93040.............  ..............  A                Rhythm ECG with report       0.16       0.20         NA       0.02       0.38         NA        XXX
93041.............  ..............  A                Rhythm ECG, tracing...       0.00       0.15         NA       0.01       0.16         NA        XXX
93042.............  ..............  A                Rhythm ECG, report....       0.16       0.05       0.05       0.01       0.22       0.22        XXX
93224.............  ..............  A                ECG monitor/report, 24       0.52       3.62         NA       0.24       4.38         NA        XXX
                                                      hrs.
93225.............  ..............  A                ECG monitor/record, 24       0.00       1.24         NA       0.08       1.32         NA        XXX
                                                      hrs.
93226.............  ..............  A                ECG monitor/report, 24       0.00       2.19         NA       0.14       2.33         NA        XXX
                                                      hrs.
93227.............  ..............  A                ECG monitor/review, 24       0.52       0.19       0.19       0.02       0.73       0.73        XXX
                                                      hrs.
93230.............  ..............  A                ECG monitor/report, 24       0.52       3.90         NA       0.26       4.68         NA        XXX
                                                      hrs.
93231.............  ..............  A                Ecg monitor/record, 24       0.00       1.52         NA       0.11       1.63         NA        XXX
                                                      hrs.
93232.............  ..............  A                ECG monitor/report, 24       0.00       2.19         NA       0.13       2.32         NA        XXX
                                                      hrs.
93233.............  ..............  A                ECG monitor/review, 24       0.52       0.19       0.19       0.02       0.73       0.73        XXX
                                                      hrs.
93235.............  ..............  A                ECG monitor/report, 24       0.45       2.79         NA       0.16       3.40         NA        XXX
                                                      hrs.
93236.............  ..............  A                ECG monitor/report, 24       0.00       2.63         NA       0.14       2.77         NA        XXX
                                                      hrs.
93237.............  ..............  A                ECG monitor/review, 24       0.45       0.16       0.16       0.02       0.63       0.63        XXX
                                                      hrs.
93268.............  ..............  A                ECG record/review.....       0.52       7.46         NA       0.28       8.26         NA        XXX
93270.............  ..............  A                ECG recording.........       0.00       1.24         NA       0.08       1.32         NA        XXX
93271.............  ..............  A                Ecg/monitoring and           0.00       6.03         NA       0.18       6.21         NA        XXX
                                                      analysis.
93272.............  ..............  A                Ecg/review, interpret        0.52       0.19       0.19       0.02       0.73       0.73        XXX
                                                      only.
93278.............  26............  A                ECG/signal-averaged...       0.25       0.10       0.10       0.01       0.36       0.36        XXX
93278.............  TC............  A                ECG/signal-averaged...       0.00       1.15         NA       0.11       1.26         NA        XXX
93278.............  ..............  A                ECG/signal-averaged...       0.25       1.25         NA       0.12       1.62         NA        XXX
93303.............  26............  A                Echo transthoracic....       1.30       0.48       0.48       0.04       1.82       1.82        XXX
93303.............  TC............  A                Echo transthoracic....       0.00       3.87         NA       0.23       4.10         NA        XXX
93303.............  ..............  A                Echo transthoracic....       1.30       4.35         NA       0.27       5.92         NA        XXX
93304.............  26............  A                Echo transthoracic....       0.75       0.28       0.28       0.02       1.05       1.05        XXX
93304.............  TC............  A                Echo transthoracic....       0.00       1.95         NA       0.13       2.08         NA        XXX
93304.............  ..............  A                Echo transthoracic....       0.75       2.23         NA       0.15       3.13         NA        XXX
93307.............  26............  A                Echo exam of heart....       0.92       0.35       0.35       0.03       1.30       1.30        XXX
93307.............  TC............  A                Echo exam of heart....       0.00       3.87         NA       0.23       4.10         NA        XXX
93307.............  ..............  A                Echo exam of heart....       0.92       4.22         NA       0.26       5.40         NA        XXX
93308.............  26............  A                Echo exam of heart....       0.53       0.20       0.20       0.02       0.75       0.75        XXX
93308.............  TC............  A                Echo exam of heart....       0.00       1.95         NA       0.13       2.08         NA        XXX
93308.............  ..............  A                Echo exam of heart....       0.53       2.15         NA       0.15       2.83         NA        XXX
93312.............  26............  A                Echo transesophageal..       2.20       0.79       0.79       0.08       3.07       3.07        XXX
93312.............  TC............  A                Echo transesophageal..       0.00       3.79         NA       0.29       4.08         NA        XXX
93312.............  ..............  A                Echo transesophageal..       2.20       4.58         NA       0.37       7.15         NA        XXX
93313.............  ..............  A                Echo transesophageal..       0.95         NA       0.21       0.06         NA       1.22        XXX
93314.............  26............  A                Echo transesophageal..       1.25       0.47       0.47       0.04       1.76       1.76        XXX
93314.............  TC............  A                Echo transesophageal..       0.00       3.79         NA       0.29       4.08         NA        XXX
93314.............  ..............  A                Echo transesophageal..       1.25       4.26         NA       0.33       5.84         NA        XXX
93315.............  26............  A                Echo transesophageal..       2.78       1.01       1.01       0.09       3.88       3.88        XXX
93315.............  TC............  C                Echo transesophageal..       0.00       0.00       0.00       0.00       0.00       0.00        XXX
93315.............  ..............  C                Echo transesophageal..       0.00       0.00       0.00       0.00       0.00       0.00        XXX
93316.............  ..............  A                Echo transesophageal..       0.95         NA       0.24       0.05         NA       1.24        XXX
93317.............  26............  A                Echo transesophageal..       1.83       0.67       0.67       0.08       2.58       2.58        XXX
93317.............  TC............  C                Echo transesophageal..       0.00       0.00       0.00       0.00       0.00       0.00        XXX
93317.............  ..............  C                Echo transesophageal..       0.00       0.00       0.00       0.00       0.00       0.00        XXX
93318.............  26............  A                Echo transesophageal         2.20       0.48       0.48       0.14       2.82       2.82        XXX
                                                      intraop.
93318.............  TC............  C                Echo transesophageal         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      intraop.
93318.............  ..............  C                Echo transesophageal         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      intraop.
93320.............  26............  A                Doppler echo exam,           0.38       0.15       0.15       0.01       0.54       0.54        ZZZ
                                                      heart.
93320.............  TC............  A                Doppler echo exam,           0.00       1.71         NA       0.12       1.83         NA        ZZZ
                                                      heart.
93320.............  ..............  A                Doppler echo exam,           0.38       1.86         NA       0.13       2.37         NA        ZZZ
                                                      heart.
93321.............  26............  A                Doppler echo exam,           0.15       0.06       0.06       0.01       0.22       0.22        ZZZ
                                                      heart.
93321.............  TC............  A                Doppler echo exam,           0.00       1.11         NA       0.08       1.19         NA        ZZZ
                                                      heart.
93321.............  ..............  A                Doppler echo exam,           0.15       1.17         NA       0.09       1.41         NA        ZZZ
                                                      heart.
93325.............  26............  A                Doppler color flow add-      0.07       0.03       0.03       0.01       0.11       0.11        ZZZ
                                                      on.
93325.............  TC............  A                Doppler color flow add-      0.00       2.91         NA       0.21       3.12         NA        ZZZ
                                                      on.
93325.............  ..............  A                Doppler color flow add-      0.07       2.94         NA       0.22       3.23         NA        ZZZ
                                                      on.
93350.............  26............  A                Echo transthoracic....       1.48       0.57       0.57       0.05       2.10       2.10        XXX
93350.............  TC............  A                Echo transthoracic....       0.00       1.77         NA       0.13       1.90         NA        XXX
93350.............  ..............  A                Echo transthoracic....       1.48       2.34         NA       0.18       4.00         NA        XXX
93501.............  26............  A                Right heart                  3.02       1.15       1.15       0.21       4.38       4.38        000
                                                      catheterization.
93501.............  TC............  A                Right heart                  0.00      16.95         NA       1.05      18.00         NA        000
                                                      catheterization.
93501.............  ..............  A                Right heart                  3.02      18.10         NA       1.26      22.38         NA        000
                                                      catheterization.
93503.............  ..............  A                Insert/place heart           2.91         NA       0.68       0.20         NA       3.79        000
                                                      catheter.
93505.............  26............  A                Biopsy of heart lining       4.37       1.68       1.68       0.30       6.35       6.35        000
93505.............  TC............  A                Biopsy of heart lining       0.00       1.99         NA       0.16       2.15         NA        000
93505.............  ..............  A                Biopsy of heart lining       4.37       3.67         NA       0.46       8.50         NA        000
93508.............  26............  A                Cath placement,              4.09       2.09       2.09       0.28       6.46       6.46        000
                                                      angiography.
93508.............  TC............  A                Cath placement,              0.00      12.64         NA       0.65      13.29         NA        000
                                                      angiography.
93508.............  ..............  A                Cath placement,              4.09      14.73         NA       0.93      19.75         NA        000
                                                      angiography.
93510.............  26............  A                Left heart                   4.32       2.18       2.18       0.30       6.80       6.80        000
                                                      catheterization.
93510.............  TC............  A                Left heart                   0.00      37.06         NA       2.31      39.37         NA        000
                                                      catheterization.

[[Page 70448]]

 
93510.............  ..............  A                Left heart                   4.32      39.24         NA       2.61      46.17         NA        000
                                                      catheterization.
93511.............  26............  A                Left heart                   5.02       2.45       2.45       0.35       7.82       7.82        000
                                                      catheterization.
93511.............  TC............  A                Left heart                   0.00      36.07         NA       2.24      38.31         NA        000
                                                      catheterization.
93511.............  ..............  A                Left heart                   5.02      38.52         NA       2.59      46.13         NA        000
                                                      catheterization.
93514.............  26............  A                Left heart                   7.04       3.13       3.13       0.49      10.66      10.66        000
                                                      catheterization.
93514.............  TC............  C                Left heart                   0.00       0.00       0.00       0.00       0.00       0.00        000
                                                      catheterization.
93514.............  ..............  R                Left heart                   7.04      39.09      39.09       2.74      48.87      48.87        000
                                                      catheterization.
93524.............  26............  A                Left heart                   6.94       3.18       3.18       0.48      10.60      10.60        000
                                                      catheterization.
93524.............  TC............  A                Left heart                   0.00      47.14         NA       2.95      50.09         NA        000
                                                      catheterization.
93524.............  ..............  A                Left heart                   6.94      50.32         NA       3.43      60.69         NA        000
                                                      catheterization.
93526.............  26............  A                Rt & Lt heart                5.98       2.82       2.82       0.42       9.22       9.22        000
                                                      catheters.
93526.............  TC............  A                Rt & Lt heart                0.00      48.43         NA       3.04      51.47         NA        000
                                                      catheters.
93526.............  ..............  A                Rt & Lt heart                5.98      51.25         NA       3.46      60.69         NA        000
                                                      catheters.
93527.............  26............  A                Rt & Lt heart                7.27       3.32       3.32       0.51      11.10      11.10        000
                                                      catheters.
93527.............  TC............  A                Rt & Lt heart                0.00      47.14         NA       2.95      50.09         NA        000
                                                      catheters.
93527.............  ..............  A                Rt & Lt heart                7.27      50.46         NA       3.46      61.19         NA        000
                                                      catheters.
93528.............  26............  A                Rt & Lt heart                8.99       4.04       4.04       0.62      13.65      13.65        000
                                                      catheters.
93528.............  TC............  A                Rt & Lt heart                0.00      47.14         NA       2.95      50.09         NA        000
                                                      catheters.
93528.............  ..............  A                Rt & Lt heart                8.99      51.18         NA       3.57      63.74         NA        000
                                                      catheters.
93529.............  26............  A                Rt, lt heart                 4.79       2.28       2.28       0.33       7.40       7.40        000
                                                      catheterization.
93529.............  TC............  A                Rt, lt heart                 0.00      47.14         NA       2.95      50.09         NA        000
                                                      catheterization.
93529.............  ..............  A                Rt, lt heart                 4.79      49.42         NA       3.28      57.49         NA        000
                                                      catheterization.
93530.............  26............  A                Rt heart cath,               4.22       1.94       1.94       0.29       6.45       6.45        000
                                                      congenital.
93530.............  TC............  A                Rt heart cath,               0.00      16.95         NA       1.05      18.00         NA        000
                                                      congenital.
93530.............  ..............  A                Rt heart cath,               4.22      18.89         NA       1.34      24.45         NA        000
                                                      congenital.
93531.............  26............  A                R & l heart cath,            8.34       3.59       3.59       0.58      12.51      12.51        000
                                                      congenital.
93531.............  TC............  A                R & l heart cath,            0.00      48.43         NA       3.04      51.47         NA        000
                                                      congenital.
93531.............  ..............  A                R & l heart cath,            8.34      52.02         NA       3.62      63.98         NA        000
                                                      congenital.
93532.............  26............  A                R & l heart cath,            9.99       4.26       4.26       0.69      14.94      14.94        000
                                                      congenital.
93532.............  TC............  C                R & l heart cath,            0.00       0.00       0.00       0.00       0.00       0.00        000
                                                      congenital.
93532.............  ..............  C                R & l heart cath,            0.00       0.00       0.00       0.00       0.00       0.00        000
                                                      congenital.
93533.............  26............  A                R & l heart cath,            6.69       2.80       2.80       0.47       9.96       9.96        000
                                                      congenital.
93533.............  TC............  C                R & l heart cath,            0.00       0.00       0.00       0.00       0.00       0.00        000
                                                      congenital.
93533.............  ..............  C                R & l heart cath,            0.00       0.00       0.00       0.00       0.00       0.00        000
                                                      congenital.
93539.............  ..............  A                Injection, cardiac           0.40         NA       0.16       0.01         NA       0.57        000
                                                      cath.
93540.............  ..............  A                Injection, cardiac           0.43         NA       0.17       0.01         NA       0.61        000
                                                      cath.
93541.............  ..............  A                Injection for lung           0.29         NA       0.11       0.01         NA       0.41        000
                                                      angiogram.
93542.............  ..............  A                Injection for heart x-       0.29         NA       0.11       0.01         NA       0.41        000
                                                      rays.
93543.............  ..............  A                Injection for heart x-       0.29         NA       0.11       0.01         NA       0.41        000
                                                      rays.
93544.............  ..............  A                Injection for                0.25         NA       0.10       0.01         NA       0.36        000
                                                      aortography.
93545.............  ..............  A                Inject for coronary x-       0.40         NA       0.16       0.01         NA       0.57        000
                                                      rays.
93555.............  26............  A                Imaging, cardiac cath.       0.81       0.32       0.32       0.03       1.16       1.16        XXX
93555.............  TC............  A                Imaging, cardiac cath.       0.00       6.29         NA       0.34       6.63         NA        XXX
93555.............  ..............  A                Imaging, cardiac cath.       0.81       6.61         NA       0.37       7.79         NA        XXX
93556.............  26............  A                Imaging, cardiac cath.       0.83       0.32       0.32       0.03       1.18       1.18        XXX
93556.............  TC............  A                Imaging, cardiac cath.       0.00       9.92         NA       0.51      10.43         NA        XXX
93556.............  ..............  A                Imaging, cardiac cath.       0.83      10.24         NA       0.54      11.61         NA        XXX
93561.............  26............  A                Cardiac output               0.50       0.16       0.16       0.02       0.68       0.68        000
                                                      measurement.
93561.............  TC............  A                Cardiac output               0.00       0.52         NA       0.06       0.58         NA        000
                                                      measurement.
93561.............  ..............  A                Cardiac output               0.50       0.68         NA       0.08       1.26         NA        000
                                                      measurement.
93562.............  26............  A                Cardiac output               0.16       0.05       0.05       0.01       0.22       0.22        000
                                                      measurement.
93562.............  TC............  A                Cardiac output               0.00       0.32         NA       0.04       0.36         NA        000
                                                      measurement.
93562.............  ..............  A                Cardiac output               0.16       0.37         NA       0.05       0.58         NA        000
                                                      measurement.
93571.............  26............  A                Heart flow reserve           1.80       0.68       0.68       0.06       2.54       2.54        ZZZ
                                                      measure.
93571.............  TC............  A                Heart flow reserve           0.00       4.57         NA       0.24       4.81         NA        ZZZ
                                                      measure.
93571.............  ..............  A                Heart flow reserve           1.80       5.25         NA       0.30       7.35         NA        ZZZ
                                                      measure.
93572.............  26............  A                Heart flow reserve           1.44       0.50       0.50       0.04       1.98       1.98        ZZZ
                                                      measure.
93572.............  TC............  C                Heart flow reserve           0.00       0.00       0.00       0.00       0.00       0.00        ZZZ
                                                      measure.
93572.............  ..............  C                Heart flow reserve           0.00       0.00       0.00       0.00       0.00       0.00        ZZZ
                                                      measure.
93580.............  ..............  A                Transcath closure of        17.97         NA       7.40       1.25         NA      26.62        000
                                                      asd.
93581.............  ..............  A                Transcath closure of        24.39         NA       9.42       1.71         NA      35.52        000
                                                      vsd.
93600.............  26............  A                Bundle of His                2.12       0.83       0.83       0.16       3.11       3.11        000
                                                      recording.
93600.............  TC............  A                Bundle of His                0.00       1.96         NA       0.13       2.09         NA        000
                                                      recording.
93600.............  ..............  A                Bundle of His                2.12       2.79         NA       0.29       5.20         NA        000
                                                      recording.
93602.............  26............  A                Intra-atrial recording       2.12       0.82       0.82       0.17       3.11       3.11        000
93602.............  TC............  A                Intra-atrial recording       0.00       1.11         NA       0.07       1.18         NA        000
93602.............  ..............  A                Intra-atrial recording       2.12       1.93         NA       0.24       4.29         NA        000
93603.............  26............  A                Right ventricular            2.12       0.81       0.81       0.18       3.11       3.11        000
                                                      recording.
93603.............  TC............  A                Right ventricular            0.00       1.68         NA       0.11       1.79         NA        000
                                                      recording.
93603.............  ..............  A                Right ventricular            2.12       2.49         NA       0.29       4.90         NA        000
                                                      recording.
93609.............  26............  A                Map tachycardia, add-        4.99       1.96       1.96       0.35       7.30       7.30        ZZZ
                                                      on.
93609.............  TC............  A                Map tachycardia, add-        0.00       2.73         NA       0.17       2.90         NA        ZZZ
                                                      on.
93609.............  ..............  A                Map tachycardia, add-        4.99       4.69         NA       0.52      10.20         NA        ZZZ
                                                      on.
93610.............  26............  A                Intra-atrial pacing...       3.02       1.16       1.16       0.24       4.42       4.42        000
93610.............  TC............  A                Intra-atrial pacing...       0.00       1.35         NA       0.10       1.45         NA        000

[[Page 70449]]

 
93610.............  ..............  A                Intra-atrial pacing...       3.02       2.51         NA       0.34       5.87         NA        000
93612.............  26............  A                Intraventricular             3.02       1.16       1.16       0.25       4.43       4.43        000
                                                      pacing.
93612.............  TC............  A                Intraventricular             0.00       1.61         NA       0.11       1.72         NA        000
                                                      pacing.
93612.............  ..............  A                Intraventricular             3.02       2.77         NA       0.36       6.15         NA        000
                                                      pacing.
93613.............  ..............  A                Electrophys map 3d,          6.99         NA       2.77       0.49         NA      10.25        ZZZ
                                                      add-on.
93615.............  26............  A                Esophageal recording..       0.99       0.27       0.27       0.03       1.29       1.29        000
93615.............  TC............  A                Esophageal recording..       0.00       0.32         NA       0.02       0.34         NA        000
93615.............  ..............  A                Esophageal recording..       0.99       0.59         NA       0.05       1.63         NA        000
93616.............  26............  A                Esophageal recording..       1.49       0.43       0.43       0.09       2.01       2.01        000
93616.............  TC............  C                Esophageal recording..       0.00       0.00       0.00       0.00       0.00       0.00        000
93616.............  ..............  C                Esophageal recording..       0.00       0.00       0.00       0.00       0.00       0.00        000
93618.............  26............  A                Heart rhythm pacing...       4.25       1.67       1.67       0.30       6.22       6.22        000
93618.............  TC............  A                Heart rhythm pacing...       0.00       3.97         NA       0.24       4.21         NA        000
93618.............  ..............  A                Heart rhythm pacing...       4.25       5.64         NA       0.54      10.43         NA        000
93619.............  26............  A                Electrophysiology            7.31       3.19       3.19       0.51      11.01      11.01        000
                                                      evaluation.
93619.............  TC............  A                Electrophysiology            0.00       7.72         NA       0.47       8.19         NA        000
                                                      evaluation.
93619.............  ..............  A                Electrophysiology            7.31      10.91         NA       0.98      19.20         NA        000
                                                      evaluation.
93620.............  26............  A                Electrophysiology           11.57       4.85       4.85       0.80      17.22      17.22        000
                                                      evaluation.
93620.............  TC............  C                Electrophysiology            0.00       0.00       0.00       0.00       0.00       0.00        000
                                                      evaluation.
93620.............  ..............  C                Electrophysiology            0.00       0.00       0.00       0.00       0.00       0.00        000
                                                      evaluation.
93621.............  26............  A                Electrophysiology            2.10       0.82       0.82       0.15       3.07       3.07        ZZZ
                                                      evaluation.
93621.............  TC............  C                Electrophysiology            0.00       0.00       0.00       0.00       0.00       0.00        ZZZ
                                                      evaluation.
93621.............  ..............  C                Electrophysiology            0.00       0.00       0.00       0.00       0.00       0.00        ZZZ
                                                      evaluation.
93622.............  26............  A                Electrophysiology            3.10       1.21       1.21       0.22       4.53       4.53        ZZZ
                                                      evaluation.
93622.............  TC............  C                Electrophysiology            0.00       0.00       0.00       0.00       0.00       0.00        ZZZ
                                                      evaluation.
93622.............  ..............  C                Electrophysiology            0.00       0.00       0.00       0.00       0.00       0.00        ZZZ
                                                      evaluation.
93623.............  26............  A                Stimulation, pacing          2.85       1.11       1.11       0.20       4.16       4.16        ZZZ
                                                      heart.
93623.............  TC............  C                Stimulation, pacing          0.00       0.00       0.00       0.00       0.00       0.00        ZZZ
                                                      heart.
93623.............  ..............  C                Stimulation, pacing          0.00       0.00       0.00       0.00       0.00       0.00        ZZZ
                                                      heart.
93624.............  26............  A                Electrophysiologic           4.80       2.20       2.20       0.33       7.33       7.33        000
                                                      study.
93624.............  TC............  A                Electrophysiologic           0.00       1.99         NA       0.13       2.12         NA        000
                                                      study.
93624.............  ..............  A                Electrophysiologic           4.80       4.19         NA       0.46       9.45         NA        000
                                                      study.
93631.............  26............  A                Heart pacing, mapping.       7.59       2.78       2.78       0.97      11.34      11.34        000
93631.............  TC............  C                Heart pacing, mapping.       0.00       0.00       0.00       0.00       0.00       0.00        000
93631.............  ..............  C                Heart pacing, mapping.       0.00       0.00       0.00       0.00       0.00       0.00        000
93640.............  26............  A                Evaluation heart             3.51       1.36       1.36       0.24       5.11       5.11        000
                                                      device.
93640.............  TC............  A                Evaluation heart             0.00       7.19         NA       0.42       7.61         NA        000
                                                      device.
93640.............  ..............  A                Evaluation heart             3.51       8.55         NA       0.66      12.72         NA        000
                                                      device.
93641.............  26............  A                Electrophysiology            5.92       2.32       2.32       0.41       8.65       8.65        000
                                                      evaluation.
93641.............  TC............  A                Electrophysiology            0.00       7.19         NA       0.42       7.61         NA        000
                                                      evaluation.
93641.............  ..............  A                Electrophysiology            5.92       9.51         NA       0.83      16.26         NA        000
                                                      evaluation.
93642.............  26............  A                Electrophysiology            4.88       2.22       2.22       0.15       7.25       7.25        000
                                                      evaluation.
93642.............  TC............  A                Electrophysiology            0.00       7.19         NA       0.42       7.61         NA        000
                                                      evaluation.
93642.............  ..............  A                Electrophysiology            4.88       9.41         NA       0.57      14.86         NA        000
                                                      evaluation.
93650.............  ..............  A                Ablate heart dysrhythm      10.49         NA       4.44       0.73         NA      15.66        000
                                                      focus.
93651.............  ..............  A                Ablate heart dysrhythm      16.23         NA       6.34       1.13         NA      23.70        000
                                                      focus.
93652.............  ..............  A                Ablate heart dysrhythm      17.65         NA       6.90       1.23         NA      25.78        000
                                                      focus.
93660.............  26............  A                Tilt table evaluation.       1.89       0.74       0.74       0.06       2.69       2.69        000
93660.............  TC............  A                Tilt table evaluation.       0.00       1.68         NA       0.02       1.70         NA        000
93660.............  ..............  A                Tilt table evaluation.       1.89       2.42         NA       0.08       4.39         NA        000
93662.............  26............  A                Intracardiac ecg (ice)       2.80       1.11       1.11       0.09       4.00       4.00        ZZZ
93662.............  TC............  C                Intracardiac ecg (ice)       0.00       0.00       0.00       0.00       0.00       0.00        ZZZ
93662.............  ..............  C                Intracardiac ecg (ice)       0.00       0.00       0.00       0.00       0.00       0.00        ZZZ
93668.............  ..............  N                Peripheral vascular          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      rehab.
93701.............  26............  A                Bioimpedance, thoracic       0.17       0.07       0.07       0.01       0.25       0.25        XXX
93701.............  TC............  A                Bioimpedance, thoracic       0.00       0.91         NA       0.01       0.92         NA        XXX
93701.............  ..............  A                Bioimpedance, thoracic       0.17       0.98         NA       0.02       1.17         NA        XXX
93720.............  ..............  A                Total body                   0.17       0.76         NA       0.07       1.00         NA        XXX
                                                      plethysmography.
93721.............  ..............  A                Plethysmography              0.00       0.71         NA       0.06       0.77         NA        XXX
                                                      tracing.
93722.............  ..............  A                Plethysmography report       0.17       0.05       0.05       0.01       0.23       0.23        XXX
93724.............  26............  A                Analyze pacemaker            4.88       1.92       1.92       0.15       6.95       6.95        000
                                                      system.
93724.............  TC............  A                Analyze pacemaker            0.00       3.97         NA       0.24       4.21         NA        000
                                                      system.
93724.............  ..............  A                Analyze pacemaker            4.88       5.89         NA       0.39      11.16         NA        000
                                                      system.
93727.............  ..............  A                Analyze ilr system....       0.52       0.20       0.20       0.02       0.74       0.74        XXX
93731.............  26............  A                Analyze pacemaker            0.45       0.17       0.17       0.01       0.63       0.63        XXX
                                                      system.
93731.............  TC............  A                Analyze pacemaker            0.00       0.49         NA       0.04       0.53         NA        XXX
                                                      system.
93731.............  ..............  A                Analyze pacemaker            0.45       0.66         NA       0.05       1.16         NA        XXX
                                                      system.
93732.............  26............  A                Analyze pacemaker            0.92       0.35       0.35       0.03       1.30       1.30        XXX
                                                      system.
93732.............  TC............  A                Analyze pacemaker            0.00       0.51         NA       0.04       0.55         NA        XXX
                                                      system.
93732.............  ..............  A                Analyze pacemaker            0.92       0.86         NA       0.07       1.85         NA        XXX
                                                      system.
93733.............  26............  A                Telephone analy,             0.17       0.07       0.07       0.01       0.25       0.25        XXX
                                                      pacemaker.
93733.............  TC............  A                Telephone analy,             0.00       0.73         NA       0.06       0.79         NA        XXX
                                                      pacemaker.
93733.............  ..............  A                Telephone analy,             0.17       0.80         NA       0.07       1.04         NA        XXX
                                                      pacemaker.
93734.............  26............  A                Analyze pacemaker            0.38       0.15       0.15       0.01       0.54       0.54        XXX
                                                      system.
93734.............  TC............  A                Analyze pacemaker            0.00       0.35         NA       0.02       0.37         NA        XXX
                                                      system.

[[Page 70450]]

 
93734.............  ..............  A                Analyze pacemaker            0.38       0.50         NA       0.03       0.91         NA        XXX
                                                      system.
93735.............  26............  A                Analyze pacemaker            0.74       0.28       0.28       0.02       1.04       1.04        XXX
                                                      system.
93735.............  TC............  A                Analyze pacemaker            0.00       0.44         NA       0.04       0.48         NA        XXX
                                                      system.
93735.............  ..............  A                Analyze pacemaker            0.74       0.72         NA       0.06       1.52         NA        XXX
                                                      system.
93736.............  26............  A                Telephonic analy,            0.15       0.06       0.06       0.01       0.22       0.22        XXX
                                                      pacemaker.
93736.............  TC............  A                Telephonic analy,            0.00       0.63         NA       0.06       0.69         NA        XXX
                                                      pacemaker.
93736.............  ..............  A                Telephonic analy,            0.15       0.69         NA       0.07       0.91         NA        XXX
                                                      pacemaker.
93740.............  26............  B                Temperature gradient        +0.16       0.04       0.04       0.01       0.21       0.21        XXX
                                                      studies.
93740.............  TC............  B                Temperature gradient        +0.00       0.15         NA       0.01       0.16         NA        XXX
                                                      studies.
93740.............  ..............  B                Temperature gradient        +0.16       0.19         NA       0.02       0.37         NA        XXX
                                                      studies.
93741.............  26............  A                Analyze ht pace device       0.80       0.31       0.31       0.03       1.14       1.14        XXX
                                                      sngl.
93741.............  TC............  A                Analyze ht pace device       0.00       0.67         NA       0.04       0.71         NA        XXX
                                                      sngl.
93741.............  ..............  A                Analyze ht pace device       0.80       0.98         NA       0.07       1.85         NA        XXX
                                                      sngl.
93742.............  26............  A                Analyze ht pace device       0.91       0.36       0.36       0.03       1.30       1.30        XXX
                                                      sngl.
93742.............  TC............  A                Analyze ht pace device       0.00       0.67         NA       0.04       0.71         NA        XXX
                                                      sngl.
93742.............  ..............  A                Analyze ht pace device       0.91       1.03         NA       0.07       2.01         NA        XXX
                                                      sngl.
93743.............  26............  A                Analyze ht pace device       1.03       0.40       0.40       0.03       1.46       1.46        XXX
                                                      dual.
93743.............  TC............  A                Analyze ht pace device       0.00       0.73         NA       0.04       0.77         NA        XXX
                                                      dual.
93743.............  ..............  A                Analyze ht pace device       1.03       1.13         NA       0.07       2.23         NA        XXX
                                                      dual.
93744.............  26............  A                Analyze ht pace device       1.18       0.46       0.46       0.04       1.68       1.68        XXX
                                                      dual.
93744.............  TC............  A                Analyze ht pace device       0.00       0.67         NA       0.04       0.71         NA        XXX
                                                      dual.
93744.............  ..............  A                Analyze ht pace device       1.18       1.13         NA       0.08       2.39         NA        XXX
                                                      dual.
93745.............  26............  C                Set-up cardiovert-           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      defibrill.
93745.............  TC............  C                Set-up cardiovert-           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      defibrill.
93745.............  ..............  C                Set-up cardiovert-           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      defibrill.
93760.............  ..............  N                Cephalic thermogram...       0.00       0.00       0.00       0.00       0.00       0.00        XXX
93762.............  ..............  N                Peripheral thermogram.       0.00       0.00       0.00       0.00       0.00       0.00        XXX
93770.............  26............  B                Measure venous              +0.16       0.05       0.05       0.01       0.22       0.22        XXX
                                                      pressure.
93770.............  TC............  B                Measure venous              +0.00       0.03         NA       0.01       0.04         NA        XXX
                                                      pressure.
93770.............  ..............  B                Measure venous              +0.16       0.08         NA       0.02       0.26         NA        XXX
                                                      pressure.
93784.............  ..............  A                Ambulatory BP                0.38       1.55         NA       0.03       1.96         NA        XXX
                                                      monitoring.
93786.............  ..............  A                Ambulatory BP                0.00       0.91         NA       0.01       0.92         NA        XXX
                                                      recording.
93788.............  ..............  A                Ambulatory BP analysis       0.00       0.51         NA       0.01       0.52         NA        XXX
93790.............  ..............  A                Review/report BP             0.38       0.13       0.13       0.01       0.52       0.52        XXX
                                                      recording.
93797.............  ..............  A                Cardiac rehab.........       0.18       0.30       0.07       0.01       0.49       0.26        000
93798.............  ..............  A                Cardiac rehab/monitor.       0.28       0.46       0.11       0.01       0.75       0.40        000
93799.............  26............  C                Cardiovascular               0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      procedure.
93799.............  TC............  C                Cardiovascular               0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      procedure.
93799.............  ..............  C                Cardiovascular               0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      procedure.
93875.............  26............  A                Extracranial study....       0.22       0.08       0.08       0.01       0.31       0.31        XXX
93875.............  TC............  A                Extracranial study....       0.00       2.26         NA       0.11       2.37         NA        XXX
93875.............  ..............  A                Extracranial study....       0.22       2.34         NA       0.12       2.68         NA        XXX
93880.............  26............  A                Extracranial study....       0.60       0.20       0.20       0.04       0.84       0.84        XXX
93880.............  TC............  A                Extracranial study....       0.00       5.37         NA       0.35       5.72         NA        XXX
93880.............  ..............  A                Extracranial study....       0.60       5.57         NA       0.39       6.56         NA        XXX
93882.............  26............  A                Extracranial study....       0.40       0.14       0.14       0.04       0.58       0.58        XXX
93882.............  TC............  A                Extracranial study....       0.00       3.37         NA       0.22       3.59         NA        XXX
93882.............  ..............  A                Extracranial study....       0.40       3.51         NA       0.26       4.17         NA        XXX
93886.............  26............  A                Intracranial study....       0.94       0.37       0.37       0.06       1.37       1.37        XXX
93886.............  TC............  A                Intracranial study....       0.00       6.39         NA       0.39       6.78         NA        XXX
93886.............  ..............  A                Intracranial study....       0.94       6.76         NA       0.45       8.15         NA        XXX
93888.............  26............  A                Intracranial study....       0.62       0.23       0.23       0.05       0.90       0.90        XXX
93888.............  TC............  A                Intracranial study....       0.00       4.02         NA       0.27       4.29         NA        XXX
93888.............  ..............  A                Intracranial study....       0.62       4.25         NA       0.32       5.19         NA        XXX
93890.............  26............  A                Tcd, vasoreactivity          1.00       0.40       0.40       0.06       1.46       1.46        XXX
                                                      study.
93890.............  TC............  A                Tcd, vasoreactivity          0.00       4.51         NA       0.39       4.90         NA        XXX
                                                      study.
93890.............  ..............  A                Tcd, vasoreactivity          1.00       4.91         NA       0.45       6.36         NA        XXX
                                                      study.
93892.............  26............  A                Tcd, emboli detect w/o       1.15       0.46       0.46       0.06       1.67       1.67        XXX
                                                      inj.
93892.............  TC............  A                Tcd, emboli detect w/o       0.00       4.71         NA       0.39       5.10         NA        XXX
                                                      inj.
93892.............  ..............  A                Tcd, emboli detect w/o       1.15       5.17         NA       0.45       6.77         NA        XXX
                                                      inj.
93893.............  26............  A                Tcd, emboli detect w/        1.15       0.46       0.46       0.06       1.67       1.67        XXX
                                                      inj.
93893.............  TC............  A                Tcd, emboli detect w/        0.00       4.58         NA       0.39       4.97         NA        XXX
                                                      inj.
93893.............  ..............  A                Tcd, emboli detect w/        1.15       5.04         NA       0.45       6.64         NA        XXX
                                                      inj.
93922.............  26............  A                Extremity study.......       0.25       0.08       0.08       0.02       0.35       0.35        XXX
93922.............  TC............  A                Extremity study.......       0.00       2.61         NA       0.13       2.74         NA        XXX
93922.............  ..............  A                Extremity study.......       0.25       2.69         NA       0.15       3.09         NA        XXX
93923.............  26............  A                Extremity study.......       0.45       0.15       0.15       0.04       0.64       0.64        XXX
93923.............  TC............  A                Extremity study.......       0.00       3.89         NA       0.22       4.11         NA        XXX
93923.............  ..............  A                Extremity study.......       0.45       4.04         NA       0.26       4.75         NA        XXX
93924.............  26............  A                Extremity study.......       0.50       0.17       0.17       0.05       0.72       0.72        XXX
93924.............  TC............  A                Extremity study.......       0.00       4.63         NA       0.25       4.88         NA        XXX
93924.............  ..............  A                Extremity study.......       0.50       4.80         NA       0.30       5.60         NA        XXX
93925.............  26............  A                Lower extremity study.       0.58       0.20       0.20       0.04       0.82       0.82        XXX
93925.............  TC............  A                Lower extremity study.       0.00       6.60         NA       0.35       6.95         NA        XXX
93925.............  ..............  A                Lower extremity study.       0.58       6.80         NA       0.39       7.77         NA        XXX

[[Page 70451]]

 
93926.............  26............  A                Lower extremity study.       0.39       0.13       0.13       0.04       0.56       0.56        XXX
93926.............  TC............  A                Lower extremity study.       0.00       3.93         NA       0.23       4.16         NA        XXX
93926.............  ..............  A                Lower extremity study.       0.39       4.06         NA       0.27       4.72         NA        XXX
93930.............  26............  A                Upper extremity study.       0.46       0.16       0.16       0.04       0.66       0.66        XXX
93930.............  TC............  A                Upper extremity study.       0.00       5.21         NA       0.37       5.58         NA        XXX
93930.............  ..............  A                Upper extremity study.       0.46       5.37         NA       0.41       6.24         NA        XXX
93931.............  26............  A                Upper extremity study.       0.31       0.10       0.10       0.03       0.44       0.44        XXX
93931.............  TC............  A                Upper extremity study.       0.00       3.39         NA       0.24       3.63         NA        XXX
93931.............  ..............  A                Upper extremity study.       0.31       3.49         NA       0.27       4.07         NA        XXX
93965.............  26............  A                Extremity study.......       0.35       0.12       0.12       0.02       0.49       0.49        XXX
93965.............  TC............  A                Extremity study.......       0.00       2.68         NA       0.12       2.80         NA        XXX
93965.............  ..............  A                Extremity study.......       0.35       2.80         NA       0.14       3.29         NA        XXX
93970.............  26............  A                Extremity study.......       0.68       0.23       0.23       0.06       0.97       0.97        XXX
93970.............  TC............  A                Extremity study.......       0.00       5.03         NA       0.40       5.43         NA        XXX
93970.............  ..............  A                Extremity study.......       0.68       5.26         NA       0.46       6.40         NA        XXX
93971.............  26............  A                Extremity study.......       0.45       0.15       0.15       0.03       0.63       0.63        XXX
93971.............  TC............  A                Extremity study.......       0.00       3.45         NA       0.27       3.72         NA        XXX
93971.............  ..............  A                Extremity study.......       0.45       3.60         NA       0.30       4.35         NA        XXX
93975.............  26............  A                Vascular study........       1.80       0.60       0.60       0.13       2.53       2.53        XXX
93975.............  TC............  A                Vascular study........       0.00       7.05         NA       0.43       7.48         NA        XXX
93975.............  ..............  A                Vascular study........       1.80       7.65         NA       0.56      10.01         NA        XXX
93976.............  26............  A                Vascular study........       1.21       0.40       0.40       0.05       1.66       1.66        XXX
93976.............  TC............  A                Vascular study........       0.00       3.94         NA       0.30       4.24         NA        XXX
93976.............  ..............  A                Vascular study........       1.21       4.34         NA       0.35       5.90         NA        XXX
93978.............  26............  A                Vascular study........       0.65       0.22       0.22       0.06       0.93       0.93        XXX
93978.............  TC............  A                Vascular study........       0.00       4.30         NA       0.37       4.67         NA        XXX
93978.............  ..............  A                Vascular study........       0.65       4.52         NA       0.43       5.60         NA        XXX
93979.............  26............  A                Vascular study........       0.44       0.15       0.15       0.03       0.62       0.62        XXX
93979.............  TC............  A                Vascular study........       0.00       3.07         NA       0.24       3.31         NA        XXX
93979.............  ..............  A                Vascular study........       0.44       3.22         NA       0.27       3.93         NA        XXX
93980.............  26............  A                Penile vascular study.       1.25       0.41       0.41       0.08       1.74       1.74        XXX
93980.............  TC............  A                Penile vascular study.       0.00       2.45         NA       0.34       2.79         NA        XXX
93980.............  ..............  A                Penile vascular study.       1.25       2.86         NA       0.42       4.53         NA        XXX
93981.............  26............  A                Penile vascular study.       0.44       0.14       0.14       0.02       0.60       0.60        XXX
93981.............  TC............  A                Penile vascular study.       0.00       2.74         NA       0.31       3.05         NA        XXX
93981.............  ..............  A                Penile vascular study.       0.44       2.88         NA       0.33       3.65         NA        XXX
93990.............  26............  A                Doppler flow testing..       0.25       0.09       0.09       0.03       0.37       0.37        XXX
93990.............  TC............  A                Doppler flow testing..       0.00       3.91         NA       0.23       4.14         NA        XXX
93990.............  ..............  A                Doppler flow testing..       0.25       4.00         NA       0.26       4.51         NA        XXX
94010.............  26............  A                Breathing capacity           0.17       0.05       0.05       0.01       0.23       0.23        XXX
                                                      test.
94010.............  TC............  A                Breathing capacity           0.00       0.62         NA       0.02       0.64         NA        XXX
                                                      test.
94010.............  ..............  A                Breathing capacity           0.17       0.67         NA       0.03       0.87         NA        XXX
                                                      test.
94014.............  ..............  A                Patient recorded             0.52       0.76         NA       0.03       1.31         NA        XXX
                                                      spirometry.
94015.............  ..............  A                Patient recorded             0.00       0.59         NA       0.01       0.60         NA        XXX
                                                      spirometry.
94016.............  ..............  A                Review patient               0.52       0.17       0.17       0.02       0.71       0.71        XXX
                                                      spirometry.
94060.............  26............  A                Evaluation of wheezing       0.31       0.09       0.09       0.01       0.41       0.41        XXX
94060.............  TC............  A                Evaluation of wheezing       0.00       0.98         NA       0.06       1.04         NA        XXX
94060.............  ..............  A                Evaluation of wheezing       0.31       1.07         NA       0.07       1.45         NA        XXX
94070.............  26............  A                Evaluation of wheezing       0.60       0.18       0.18       0.03       0.81       0.81        XXX
94070.............  TC............  A                Evaluation of wheezing       0.00       0.64         NA       0.10       0.74         NA        XXX
94070.............  ..............  A                Evaluation of wheezing       0.60       0.82         NA       0.13       1.55         NA        XXX
94150.............  26............  B                Vital capacity test...      +0.07       0.03       0.03       0.01       0.11       0.11        XXX
94150.............  TC............  B                Vital capacity test...      +0.00       0.44         NA       0.01       0.45         NA        XXX
94150.............  ..............  B                Vital capacity test...      +0.07       0.47         NA       0.02       0.56         NA        XXX
94200.............  26............  A                Lung function test           0.11       0.03       0.03       0.01       0.15       0.15        XXX
                                                      (MBC/MVV).
94200.............  TC............  A                Lung function test           0.00       0.41         NA       0.02       0.43         NA        XXX
                                                      (MBC/MVV).
94200.............  ..............  A                Lung function test           0.11       0.44         NA       0.03       0.58         NA        XXX
                                                      (MBC/MVV).
94240.............  26............  A                Residual lung capacity       0.26       0.08       0.08       0.01       0.35       0.35        XXX
94240.............  TC............  A                Residual lung capacity       0.00       0.58         NA       0.05       0.63         NA        XXX
94240.............  ..............  A                Residual lung capacity       0.26       0.66         NA       0.06       0.98         NA        XXX
94250.............  26............  A                Expired gas collection       0.11       0.03       0.03       0.01       0.15       0.15        XXX
94250.............  TC............  A                Expired gas collection       0.00       0.61         NA       0.01       0.62         NA        XXX
94250.............  ..............  A                Expired gas collection       0.11       0.64         NA       0.02       0.77         NA        XXX
94260.............  26............  A                Thoracic gas volume...       0.13       0.04       0.04       0.01       0.18       0.18        XXX
94260.............  TC............  A                Thoracic gas volume...       0.00       0.54         NA       0.04       0.58         NA        XXX
94260.............  ..............  A                Thoracic gas volume...       0.13       0.58         NA       0.05       0.76         NA        XXX
94350.............  26............  A                Lung nitrogen washout        0.26       0.08       0.08       0.01       0.35       0.35        XXX
                                                      curve.
94350.............  TC............  A                Lung nitrogen washout        0.00       0.68         NA       0.04       0.72         NA        XXX
                                                      curve.
94350.............  ..............  A                Lung nitrogen washout        0.26       0.76         NA       0.05       1.07         NA        XXX
                                                      curve.
94360.............  26............  A                Measure airflow              0.26       0.08       0.08       0.01       0.35       0.35        XXX
                                                      resistance.
94360.............  TC............  A                Measure airflow              0.00       0.62         NA       0.06       0.68         NA        XXX
                                                      resistance.
94360.............  ..............  A                Measure airflow              0.26       0.70         NA       0.07       1.03         NA        XXX
                                                      resistance.
94370.............  26............  A                Breath airway closing        0.26       0.08       0.08       0.01       0.35       0.35        XXX
                                                      volume.
94370.............  TC............  A                Breath airway closing        0.00       0.64         NA       0.02       0.66         NA        XXX
                                                      volume.
94370.............  ..............  A                Breath airway closing        0.26       0.72         NA       0.03       1.01         NA        XXX
                                                      volume.

[[Page 70452]]

 
94375.............  26............  A                Respiratory flow             0.31       0.09       0.09       0.01       0.41       0.41        XXX
                                                      volume loop.
94375.............  TC............  A                Respiratory flow             0.00       0.51         NA       0.02       0.53         NA        XXX
                                                      volume loop.
94375.............  ..............  A                Respiratory flow             0.31       0.60         NA       0.03       0.94         NA        XXX
                                                      volume loop.
94400.............  26............  A                CO2 breathing response       0.40       0.12       0.12       0.03       0.55       0.55        XXX
                                                      curve.
94400.............  TC............  A                CO2 breathing response       0.00       0.72         NA       0.06       0.78         NA        XXX
                                                      curve.
94400.............  ..............  A                CO2 breathing response       0.40       0.84         NA       0.09       1.33         NA        XXX
                                                      curve.
94450.............  26............  A                Hypoxia response curve       0.40       0.12       0.12       0.02       0.54       0.54        XXX
94450.............  TC............  A                Hypoxia response curve       0.00       0.73         NA       0.02       0.75         NA        XXX
94450.............  ..............  A                Hypoxia response curve       0.40       0.85         NA       0.04       1.29         NA        XXX
94452.............  26............  A                Hast w/report.........       0.31       0.09       0.09       0.02       0.42       0.42        XXX
94452.............  TC............  A                Hast w/report.........       0.00       0.93         NA       0.02       0.95         NA        XXX
94452.............  ..............  A                Hast w/report.........       0.31       1.02         NA       0.04       1.37         NA        XXX
94453.............  26............  A                Hast w/oxygen titrate.       0.40       0.12       0.12       0.02       0.54       0.54        XXX
94453.............  TC............  A                Hast w/oxygen titrate.       0.00       1.39         NA       0.02       1.41         NA        XXX
94453.............  ..............  A                Hast w/oxygen titrate.       0.40       1.51         NA       0.04       1.95         NA        XXX
94620.............  26............  A                Pulmonary stress test/       0.64       0.20       0.20       0.03       0.87       0.87        XXX
                                                      simple.
94620.............  TC............  A                Pulmonary stress test/       0.00       2.30         NA       0.10       2.40         NA        XXX
                                                      simple.
94620.............  ..............  A                Pulmonary stress test/       0.64       2.50         NA       0.13       3.27         NA        XXX
                                                      simple.
94621.............  26............  A                Pulm stress test/            1.42       0.44       0.44       0.06       1.92       1.92        XXX
                                                      complex.
94621.............  TC............  A                Pulm stress test/            0.00       1.77         NA       0.10       1.87         NA        XXX
                                                      complex.
94621.............  ..............  A                Pulm stress test/            1.42       2.21         NA       0.16       3.79         NA        XXX
                                                      complex.
94640.............  ..............  A                Airway inhalation            0.00       0.30         NA       0.02       0.32         NA        XXX
                                                      treatment.
94642.............  ..............  C                Aerosol inhalation           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      treatment.
94656.............  ..............  A                Initial ventilator           1.22       1.16       0.32       0.06       2.44       1.60        XXX
                                                      mgmt.
94657.............  ..............  A                Continued ventilator         0.83       0.98       0.25       0.04       1.85       1.12        XXX
                                                      mgmt.
94660.............  ..............  A                Pos airway pressure,         0.76       0.65       0.23       0.04       1.45       1.03        XXX
                                                      CPAP.
94662.............  ..............  A                Neg press ventilation,       0.76         NA       0.23       0.03         NA       1.02        XXX
                                                      cnp.
94664.............  ..............  A                Evaluate pt use of           0.00       0.31         NA       0.04       0.35         NA        XXX
                                                      inhaler.
94667.............  ..............  A                Chest wall                   0.00       0.52         NA       0.05       0.57         NA        XXX
                                                      manipulation.
94668.............  ..............  A                Chest wall                   0.00       0.45         NA       0.02       0.47         NA        XXX
                                                      manipulation.
94680.............  26............  A                Exhaled air analysis,        0.26       0.08       0.08       0.01       0.35       0.35        XXX
                                                      o2.
94680.............  TC............  A                Exhaled air analysis,        0.00       1.79         NA       0.06       1.85         NA        XXX
                                                      o2.
94680.............  ..............  A                Exhaled air analysis,        0.26       1.87         NA       0.07       2.20         NA        XXX
                                                      o2.
94681.............  26............  A                Exhaled air analysis,        0.20       0.06       0.06       0.01       0.27       0.27        XXX
                                                      o2/co2.
94681.............  TC............  A                Exhaled air analysis,        0.00       2.47         NA       0.12       2.59         NA        XXX
                                                      o2/co2.
94681.............  ..............  A                Exhaled air analysis,        0.20       2.53         NA       0.13       2.86         NA        XXX
                                                      o2/co2.
94690.............  26............  A                Exhaled air analysis..       0.07       0.02       0.02       0.01       0.10       0.10        XXX
94690.............  TC............  A                Exhaled air analysis..       0.00       1.98         NA       0.04       2.02         NA        XXX
94690.............  ..............  A                Exhaled air analysis..       0.07       2.00         NA       0.05       2.12         NA        XXX
94720.............  26............  A                Monoxide diffusing           0.26       0.08       0.08       0.01       0.35       0.35        XXX
                                                      capacity.
94720.............  TC............  A                Monoxide diffusing           0.00       0.92         NA       0.06       0.98         NA        XXX
                                                      capacity.
94720.............  ..............  A                Monoxide diffusing           0.26       1.00         NA       0.07       1.33         NA        XXX
                                                      capacity.
94725.............  26............  A                Membrane diffusion           0.26       0.08       0.08       0.01       0.35       0.35        XXX
                                                      capacity.
94725.............  TC............  A                Membrane diffusion           0.00       2.84         NA       0.12       2.96         NA        XXX
                                                      capacity.
94725.............  ..............  A                Membrane diffusion           0.26       2.92         NA       0.13       3.31         NA        XXX
                                                      capacity.
94750.............  26............  A                Pulmonary compliance         0.23       0.07       0.07       0.01       0.31       0.31        XXX
                                                      study.
94750.............  TC............  A                Pulmonary compliance         0.00       1.27         NA       0.04       1.31         NA        XXX
                                                      study.
94750.............  ..............  A                Pulmonary compliance         0.23       1.34         NA       0.05       1.62         NA        XXX
                                                      study.
94760.............  ..............  T                Measure blood oxygen         0.00       0.04         NA       0.02       0.06         NA        XXX
                                                      level.
94761.............  ..............  T                Measure blood oxygen         0.00       0.07         NA       0.06       0.13         NA        XXX
                                                      level.
94762.............  ..............  A                Measure blood oxygen         0.00       0.47         NA       0.10       0.57         NA        XXX
                                                      level.
94770.............  26............  A                Exhaled carbon dioxide       0.15       0.04       0.04       0.01       0.20       0.20        XXX
                                                      test.
94770.............  TC............  A                Exhaled carbon dioxide       0.00       0.71         NA       0.07       0.78         NA        XXX
                                                      test.
94770.............  ..............  A                Exhaled carbon dioxide       0.15       0.75         NA       0.08       0.98         NA        XXX
                                                      test.
94772.............  26............  C                Breath recording,            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      infant.
94772.............  TC............  C                Breath recording,            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      infant.
94772.............  ..............  C                Breath recording,            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      infant.
94799.............  26............  C                Pulmonary service/           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      procedure.
94799.............  TC............  C                Pulmonary service/           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      procedure.
94799.............  ..............  C                Pulmonary service/           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      procedure.
95004.............  ..............  A                Percut allergy skin          0.00       0.10         NA       0.01       0.11         NA        XXX
                                                      tests.
95010.............  ..............  A                Percut allergy titrate       0.15       0.32       0.06       0.01       0.48       0.22        XXX
                                                      test.
95015.............  ..............  A                Id allergy titrate-          0.15       0.14       0.06       0.01       0.30       0.22        XXX
                                                      drug/bug.
95024.............  ..............  A                Id allergy test, drug/       0.00       0.15         NA       0.01       0.16         NA        XXX
                                                      bug.
95027.............  ..............  A                Id allergy titrate-          0.00       0.15         NA       0.01       0.16         NA        XXX
                                                      airborne.
95028.............  ..............  A                Id allergy test-             0.00       0.23         NA       0.01       0.24         NA        XXX
                                                      delayed type.
95044.............  ..............  A                Allergy patch tests...       0.00       0.20         NA       0.01       0.21         NA        XXX
95052.............  ..............  A                Photo patch test......       0.00       0.25         NA       0.01       0.26         NA        XXX
95056.............  ..............  A                Photosensitivity tests       0.00       0.17         NA       0.01       0.18         NA        XXX
95060.............  ..............  A                Eye allergy tests.....       0.00       0.35         NA       0.02       0.37         NA        XXX
95065.............  ..............  A                Nose allergy test.....       0.00       0.20         NA       0.01       0.21         NA        XXX
95070.............  ..............  A                Bronchial allergy            0.00       2.29         NA       0.02       2.31         NA        XXX
                                                      tests.
95071.............  ..............  A                Bronchial allergy            0.00       2.93         NA       0.02       2.95         NA        XXX
                                                      tests.
95075.............  ..............  A                Ingestion challenge          0.95       0.82       0.38       0.03       1.80       1.36        XXX
                                                      test.
95078.............  ..............  A                Provocative testing...       0.00       0.25         NA       0.02       0.27         NA        XXX

[[Page 70453]]

 
95115.............  ..............  A                Immunotherapy, one           0.00       0.39         NA       0.02       0.41         NA        XXX
                                                      injection.
95117.............  ..............  A                Immunotherapy                0.00       0.50         NA       0.02       0.52         NA        XXX
                                                      injections.
95120.............  ..............  I                Immunotherapy, one           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      injection.
95125.............  ..............  I                Immunotherapy, many          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      antigens.
95130.............  ..............  I                Immunotherapy, insect        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      venom.
95131.............  ..............  I                Immunotherapy, insect        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      venoms.
95132.............  ..............  I                Immunotherapy, insect        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      venoms.
95133.............  ..............  I                Immunotherapy, insect        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      venoms.
95134.............  ..............  I                Immunotherapy, insect        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      venoms.
95144.............  ..............  A                Antigen therapy              0.06       0.19       0.02       0.01       0.26       0.09        XXX
                                                      services.
95145.............  ..............  A                Antigen therapy              0.06       0.32       0.02       0.01       0.39       0.09        XXX
                                                      services.
95146.............  ..............  A                Antigen therapy              0.06       0.44       0.03       0.01       0.51       0.10        XXX
                                                      services.
95147.............  ..............  A                Antigen therapy              0.06       0.42       0.02       0.01       0.49       0.09        XXX
                                                      services.
95148.............  ..............  A                Antigen therapy              0.06       0.58       0.03       0.01       0.65       0.10        XXX
                                                      services.
95149.............  ..............  A                Antigen therapy              0.06       0.80       0.03       0.01       0.87       0.10        XXX
                                                      services.
95165.............  ..............  A                Antigen therapy              0.06       0.19       0.02       0.01       0.26       0.09        XXX
                                                      services.
95170.............  ..............  A                Antigen therapy              0.06       0.13       0.03       0.01       0.20       0.10        XXX
                                                      services.
95180.............  ..............  A                Rapid desensitization.       2.01       2.04       0.93       0.04       4.09       2.98        XXX
95199.............  ..............  C                Allergy immunology           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      services.
95250.............  ..............  A                Glucose monitoring,          0.00       4.11         NA       0.01       4.12         NA        XXX
                                                      cont.
95251.............  ..............  A                Gluc monitor, cont,          0.52       0.19       0.19       0.02       0.73       0.73        XXX
                                                      phys i&r.
95805.............  26............  A                Multiple sleep latency       1.88       0.66       0.66       0.09       2.63       2.63        XXX
                                                      test.
95805.............  TC............  A                Multiple sleep latency       0.00      16.65         NA       0.34      16.99         NA        XXX
                                                      test.
95805.............  ..............  A                Multiple sleep latency       1.88      17.31         NA       0.43      19.62         NA        XXX
                                                      test.
95806.............  26............  A                Sleep study,                 1.66       0.54       0.54       0.08       2.28       2.28        XXX
                                                      unattended.
95806.............  TC............  A                Sleep study,                 0.00       2.80         NA       0.31       3.11         NA        XXX
                                                      unattended.
95806.............  ..............  A                Sleep study,                 1.66       3.34         NA       0.39       5.39         NA        XXX
                                                      unattended.
95807.............  26............  A                Sleep study, attended.       1.66       0.53       0.53       0.08       2.27       2.27        XXX
95807.............  TC............  A                Sleep study, attended.       0.00      11.35         NA       0.42      11.77         NA        XXX
95807.............  ..............  A                Sleep study, attended.       1.66      11.88         NA       0.50      14.04         NA        XXX
95808.............  26............  A                Polysomnography, 1-3..       2.65       0.92       0.92       0.13       3.70       3.70        XXX
95808.............  TC............  A                Polysomnography, 1-3..       0.00      12.31         NA       0.42      12.73         NA        XXX
95808.............  ..............  A                Polysomnography, 1-3..       2.65      13.23         NA       0.55      16.43         NA        XXX
95810.............  26............  A                Polysomnography, 4 or        3.52       1.18       1.18       0.17       4.87       4.87        XXX
                                                      more.
95810.............  TC............  A                Polysomnography, 4 or        0.00      16.36         NA       0.42      16.78         NA        XXX
                                                      more.
95810.............  ..............  A                Polysomnography, 4 or        3.52      17.54         NA       0.59      21.65         NA        XXX
                                                      more.
95811.............  26............  A                Polysomnography w/cpap       3.79       1.27       1.27       0.18       5.24       5.24        XXX
95811.............  TC............  A                Polysomnography w/cpap       0.00      17.97         NA       0.43      18.40         NA        XXX
95811.............  ..............  A                Polysomnography w/cpap       3.79      19.24         NA       0.61      23.64         NA        XXX
95812.............  26............  A                Eeg, 41-60 minutes....       1.08       0.45       0.45       0.06       1.59       1.59        XXX
95812.............  TC............  A                Eeg, 41-60 minutes....       0.00       3.59         NA       0.11       3.70         NA        XXX
95812.............  ..............  A                Eeg, 41-60 minutes....       1.08       4.04         NA       0.17       5.29         NA        XXX
95813.............  26............  A                Eeg, over 1 hour......       1.73       0.70       0.70       0.09       2.52       2.52        XXX
95813.............  TC............  A                Eeg, over 1 hour......       0.00       4.33         NA       0.11       4.44         NA        XXX
95813.............  ..............  A                Eeg, over 1 hour......       1.73       5.03         NA       0.20       6.96         NA        XXX
95816.............  26............  A                Eeg, awake and drowsy.       1.08       0.46       0.46       0.06       1.60       1.60        XXX
95816.............  TC............  A                Eeg, awake and drowsy.       0.00       3.26         NA       0.10       3.36         NA        XXX
95816.............  ..............  A                Eeg, awake and drowsy.       1.08       3.72         NA       0.16       4.96         NA        XXX
95819.............  26............  A                Eeg, awake and asleep.       1.08       0.46       0.46       0.06       1.60       1.60        XXX
95819.............  TC............  A                Eeg, awake and asleep.       0.00       2.53         NA       0.10       2.63         NA        XXX
95819.............  ..............  A                Eeg, awake and asleep.       1.08       2.99         NA       0.16       4.23         NA        XXX
95822.............  26............  A                Eeg, coma or sleep           1.08       0.46       0.46       0.06       1.60       1.60        XXX
                                                      only.
95822.............  TC............  A                Eeg, coma or sleep           0.00       4.15         NA       0.13       4.28         NA        XXX
                                                      only.
95822.............  ..............  A                Eeg, coma or sleep           1.08       4.61         NA       0.19       5.88         NA        XXX
                                                      only.
95824.............  26............  A                Eeg, cerebral death          0.74       0.31       0.31       0.04       1.09       1.09        XXX
                                                      only.
95824.............  TC............  C                Eeg, cerebral death          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      only.
95824.............  ..............  C                Eeg, cerebral death          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      only.
95827.............  26............  A                Eeg, all night               1.08       0.41       0.41       0.05       1.54       1.54        XXX
                                                      recording.
95827.............  TC............  A                Eeg, all night               0.00       2.30         NA       0.14       2.44         NA        XXX
                                                      recording.
95827.............  ..............  A                Eeg, all night               1.08       2.71         NA       0.19       3.98         NA        XXX
                                                      recording.
95829.............  26............  A                Surgery                      6.20       2.32       2.32       0.48       9.00       9.00        XXX
                                                      electrocorticogram.
95829.............  TC............  A                Surgery                      0.00      28.77         NA       0.02      28.79         NA        XXX
                                                      electrocorticogram.
95829.............  ..............  A                Surgery                      6.20      31.09         NA       0.50      37.79         NA        XXX
                                                      electrocorticogram.
95830.............  ..............  A                Insert electrodes for        1.70       3.30       0.73       0.11       5.11       2.54        XXX
                                                      EEG.
95831.............  ..............  A                Limb muscle testing,         0.28       0.46       0.13       0.01       0.75       0.42        XXX
                                                      manual.
95832.............  ..............  A                Hand muscle testing,         0.29       0.33       0.12       0.02       0.64       0.43        XXX
                                                      manual.
95833.............  ..............  A                Body muscle testing,         0.47       0.58       0.23       0.02       1.07       0.72        XXX
                                                      manual.
95834.............  ..............  A                Body muscle testing,         0.60       0.63       0.28       0.03       1.26       0.91        XXX
                                                      manual.
95851.............  ..............  A                Range of motion              0.16       0.36       0.08       0.01       0.53       0.25        XXX
                                                      measurements.
95852.............  ..............  A                Range of motion              0.11       0.26       0.05       0.01       0.38       0.17        XXX
                                                      measurements.
95857.............  ..............  A                Tensilon test.........       0.53       0.60       0.23       0.02       1.15       0.78        XXX
95860.............  26............  A                Muscle test, one limb.       0.96       0.42       0.42       0.05       1.43       1.43        XXX
95860.............  TC............  A                Muscle test, one limb.       0.00       1.00         NA       0.02       1.02         NA        XXX
95860.............  ..............  A                Muscle test, one limb.       0.96       1.42         NA       0.07       2.45         NA        XXX
95861.............  26............  A                Muscle test, 2 limbs..       1.54       0.68       0.68       0.07       2.29       2.29        XXX

[[Page 70454]]

 
95861.............  TC............  A                Muscle test, 2 limbs..       0.00       0.73         NA       0.06       0.79         NA        XXX
95861.............  ..............  A                Muscle test, 2 limbs..       1.54       1.41         NA       0.13       3.08         NA        XXX
95863.............  26............  A                Muscle test, 3 limbs..       1.87       0.80       0.80       0.09       2.76       2.76        XXX
95863.............  TC............  A                Muscle test, 3 limbs..       0.00       0.94         NA       0.06       1.00         NA        XXX
95863.............  ..............  A                Muscle test, 3 limbs..       1.87       1.74         NA       0.15       3.76         NA        XXX
95864.............  26............  A                Muscle test, 4 limbs..       1.99       0.87       0.87       0.09       2.95       2.95        XXX
95864.............  TC............  A                Muscle test, 4 limbs..       0.00       1.79         NA       0.12       1.91         NA        XXX
95864.............  ..............  A                Muscle test, 4 limbs..       1.99       2.66         NA       0.21       4.86         NA        XXX
95865.............  26............  A                Muscle test, larynx...       1.57       0.77       0.77       0.08       2.42       2.42        XXX
95865.............  TC............  A                Muscle test, larynx...       0.00       0.68         NA       0.03       0.71         NA        XXX
95865.............  ..............  A                Muscle test, larynx...       1.57       1.45         NA       0.11       3.13         NA        XXX
95866.............  26............  A                Muscle test,                 1.25       0.56       0.56       0.07       1.88       1.88        XXX
                                                      hemidiaphragm.
95866.............  TC............  A                Muscle test,                 0.00       0.20         NA       0.03       0.23         NA        XXX
                                                      hemidiaphragm.
95866.............  ..............  A                Muscle test,                 1.25       0.76         NA       0.10       2.11         NA        XXX
                                                      hemidiaphragm.
95867.............  26............  A                Muscle test cran nerv        0.79       0.35       0.35       0.03       1.17       1.17        XXX
                                                      unilat.
95867.............  TC............  A                Muscle test cran nerv        0.00       0.58         NA       0.04       0.62         NA        XXX
                                                      unilat.
95867.............  ..............  A                Muscle test cran nerv        0.79       0.93         NA       0.07       1.79         NA        XXX
                                                      unilat.
95868.............  26............  A                Muscle test cran nerve       1.18       0.51       0.51       0.05       1.74       1.74        XXX
                                                      bilat.
95868.............  TC............  A                Muscle test cran nerve       0.00       0.70         NA       0.05       0.75         NA        XXX
                                                      bilat.
95868.............  ..............  A                Muscle test cran nerve       1.18       1.21         NA       0.10       2.49         NA        XXX
                                                      bilat.
95869.............  26............  A                Muscle test, thor            0.37       0.16       0.16       0.02       0.55       0.55        XXX
                                                      paraspinal.
95869.............  TC............  A                Muscle test, thor            0.00       0.21         NA       0.02       0.23         NA        XXX
                                                      paraspinal.
95869.............  ..............  A                Muscle test, thor            0.37       0.37         NA       0.04       0.78         NA        XXX
                                                      paraspinal.
95870.............  26............  A                Muscle test,                 0.37       0.16       0.16       0.02       0.55       0.55        XXX
                                                      nonparaspinal.
95870.............  TC............  A                Muscle test,                 0.00       0.21         NA       0.02       0.23         NA        XXX
                                                      nonparaspinal.
95870.............  ..............  A                Muscle test,                 0.37       0.37         NA       0.04       0.78         NA        XXX
                                                      nonparaspinal.
95872.............  26............  A                Muscle test, one fiber       1.50       0.63       0.63       0.08       2.21       2.21        XXX
95872.............  TC............  A                Muscle test, one fiber       0.00       0.60         NA       0.05       0.65         NA        XXX
95872.............  ..............  A                Muscle test, one fiber       1.50       1.23         NA       0.13       2.86         NA        XXX
95873.............  26............  A                Guide nerv destr, elec       0.37       0.16       0.16       0.02       0.55       0.55        ZZZ
                                                      stim.
95873.............  TC............  A                Guide nerv destr, elec       0.00       0.20         NA       0.02       0.22         NA        ZZZ
                                                      stim.
95873.............  ..............  A                Guide nerv destr, elec       0.37       0.36         NA       0.04       0.77         NA        ZZZ
                                                      stim.
95874.............  26............  A                Guide nerv destr,            0.37       0.17       0.17       0.02       0.56       0.56        ZZZ
                                                      needle emg.
95874.............  TC............  A                Guide nerv destr,            0.00       0.20         NA       0.02       0.22         NA        ZZZ
                                                      needle emg.
95874.............  ..............  A                Guide nerv destr,            0.37       0.37         NA       0.04       0.78         NA        ZZZ
                                                      needle emg.
95875.............  26............  A                Limb exercise test....       1.10       0.47       0.47       0.05       1.62       1.62        XXX
95875.............  TC............  A                Limb exercise test....       0.00       0.98         NA       0.06       1.04         NA        XXX
95875.............  ..............  A                Limb exercise test....       1.10       1.45         NA       0.11       2.66         NA        XXX
95900.............  26............  A                Motor nerve conduction       0.42       0.18       0.18       0.02       0.62       0.62        XXX
                                                      test.
95900.............  TC............  A                Motor nerve conduction       0.00       1.08         NA       0.02       1.10         NA        XXX
                                                      test.
95900.............  ..............  A                Motor nerve conduction       0.42       1.26         NA       0.04       1.72         NA        XXX
                                                      test.
95903.............  26............  A                Motor nerve conduction       0.60       0.26       0.26       0.03       0.89       0.89        XXX
                                                      test.
95903.............  TC............  A                Motor nerve conduction       0.00       0.93         NA       0.02       0.95         NA        XXX
                                                      test.
95903.............  ..............  A                Motor nerve conduction       0.60       1.19         NA       0.05       1.84         NA        XXX
                                                      test.
95904.............  26............  A                Sense nerve conduction       0.34       0.15       0.15       0.02       0.51       0.51        XXX
                                                      test.
95904.............  TC............  A                Sense nerve conduction       0.00       0.94         NA       0.02       0.96         NA        XXX
                                                      test.
95904.............  ..............  A                Sense nerve conduction       0.34       1.09         NA       0.04       1.47         NA        XXX
                                                      test.
95920.............  26............  A                Intraop nerve test add-      2.11       0.93       0.93       0.16       3.20       3.20        ZZZ
                                                      on.
95920.............  TC............  A                Intraop nerve test add-      0.00       1.31         NA       0.07       1.38         NA        ZZZ
                                                      on.
95920.............  ..............  A                Intraop nerve test add-      2.11       2.24         NA       0.23       4.58         NA        ZZZ
                                                      on.
95921.............  26............  A                Autonomic nerv               0.90       0.33       0.33       0.04       1.27       1.27        XXX
                                                      function test.
95921.............  TC............  A                Autonomic nerv               0.00       0.38         NA       0.02       0.40         NA        XXX
                                                      function test.
95921.............  ..............  A                Autonomic nerv               0.90       0.71         NA       0.06       1.67         NA        XXX
                                                      function test.
95922.............  26............  A                Autonomic nerv               0.96       0.40       0.40       0.05       1.41       1.41        XXX
                                                      function test.
95922.............  TC............  A                Autonomic nerv               0.00       0.38         NA       0.02       0.40         NA        XXX
                                                      function test.
95922.............  ..............  A                Autonomic nerv               0.96       0.78         NA       0.07       1.81         NA        XXX
                                                      function test.
95923.............  26............  A                Autonomic nerv               0.90       0.38       0.38       0.05       1.33       1.33        XXX
                                                      function test.
95923.............  TC............  A                Autonomic nerv               0.00       1.56         NA       0.02       1.58         NA        XXX
                                                      function test.
95923.............  ..............  A                Autonomic nerv               0.90       1.94         NA       0.07       2.91         NA        XXX
                                                      function test.
95925.............  26............  A                Somatosensory testing.       0.54       0.22       0.22       0.04       0.80       0.80        XXX
95925.............  TC............  A                Somatosensory testing.       0.00       0.91         NA       0.06       0.97         NA        XXX
95925.............  ..............  A                Somatosensory testing.       0.54       1.13         NA       0.10       1.77         NA        XXX
95926.............  26............  A                Somatosensory testing.       0.54       0.23       0.23       0.03       0.80       0.80        XXX
95926.............  TC............  A                Somatosensory testing.       0.00       0.91         NA       0.06       0.97         NA        XXX
95926.............  ..............  A                Somatosensory testing.       0.54       1.14         NA       0.09       1.77         NA        XXX
95927.............  26............  A                Somatosensory testing.       0.54       0.25       0.25       0.04       0.83       0.83        XXX
95927.............  TC............  A                Somatosensory testing.       0.00       0.91         NA       0.06       0.97         NA        XXX
95927.............  ..............  A                Somatosensory testing.       0.54       1.16         NA       0.10       1.80         NA        XXX
95928.............  26............  A                C motor evoked, uppr         1.50       0.65       0.65       0.06       2.21       2.21        XXX
                                                      limbs.
95928.............  TC............  A                C motor evoked, uppr         0.00       2.38         NA       0.03       2.41         NA        XXX
                                                      limbs.
95928.............  ..............  A                C motor evoked, uppr         1.50       3.03         NA       0.09       4.62         NA        XXX
                                                      limbs.
95929.............  26............  A                C motor evoked, lwr          1.50       0.65       0.65       0.06       2.21       2.21        XXX
                                                      limbs.
95929.............  TC............  A                C motor evoked, lwr          0.00       2.57         NA       0.03       2.60         NA        XXX
                                                      limbs.
95929.............  ..............  A                C motor evoked, lwr          1.50       3.22         NA       0.09       4.81         NA        XXX
                                                      limbs.
95930.............  26............  A                Visual evoked                0.35       0.15       0.15       0.02       0.52       0.52        XXX
                                                      potential test.

[[Page 70455]]

 
95930.............  TC............  A                Visual evoked                0.00       2.10         NA       0.01       2.11         NA        XXX
                                                      potential test.
95930.............  ..............  A                Visual evoked                0.35       2.25         NA       0.03       2.63         NA        XXX
                                                      potential test.
95933.............  26............  A                Blink reflex test.....       0.59       0.24       0.24       0.04       0.87       0.87        XXX
95933.............  TC............  A                Blink reflex test.....       0.00       0.78         NA       0.06       0.84         NA        XXX
95933.............  ..............  A                Blink reflex test.....       0.59       1.02         NA       0.10       1.71         NA        XXX
95934.............  26............  A                H-reflex test.........       0.51       0.22       0.22       0.02       0.75       0.75        XXX
95934.............  TC............  A                H-reflex test.........       0.00       0.21         NA       0.02       0.23         NA        XXX
95934.............  ..............  A                H-reflex test.........       0.51       0.43         NA       0.04       0.98         NA        XXX
95936.............  26............  A                H-reflex test.........       0.55       0.24       0.24       0.03       0.82       0.82        XXX
95936.............  TC............  A                H-reflex test.........       0.00       0.21         NA       0.02       0.23         NA        XXX
95936.............  ..............  A                H-reflex test.........       0.55       0.45         NA       0.05       1.05         NA        XXX
95937.............  26............  A                Neuromuscular junction       0.65       0.27       0.27       0.08       1.00       1.00        XXX
                                                      test.
95937.............  TC............  A                Neuromuscular junction       0.00       0.34         NA       0.02       0.36         NA        XXX
                                                      test.
95937.............  ..............  A                Neuromuscular junction       0.65       0.61         NA       0.10       1.36         NA        XXX
                                                      test.
95950.............  26............  A                Ambulatory eeg               1.51       0.64       0.64       0.08       2.23       2.23        XXX
                                                      monitoring.
95950.............  TC............  A                Ambulatory eeg               0.00       3.30         NA       0.43       3.73         NA        XXX
                                                      monitoring.
95950.............  ..............  A                Ambulatory eeg               1.51       3.94         NA       0.51       5.96         NA        XXX
                                                      monitoring.
95951.............  26............  A                EEG monitoring/              5.99       2.56       2.56       0.32       8.87       8.87        XXX
                                                      videorecord.
95951.............  TC............  C                EEG monitoring/              0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      videorecord.
95951.............  ..............  C                EEG monitoring/              0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      videorecord.
95953.............  26............  A                EEG monitoring/              3.08       1.29       1.29       0.17       4.54       4.54        XXX
                                                      computer.
95953.............  TC............  A                EEG monitoring/              0.00       6.35         NA       0.43       6.78         NA        XXX
                                                      computer.
95953.............  ..............  A                EEG monitoring/              3.08       7.64         NA       0.60      11.32         NA        XXX
                                                      computer.
95954.............  26............  A                EEG monitoring/giving        2.45       1.04       1.04       0.13       3.62       3.62        XXX
                                                      drugs.
95954.............  TC............  A                EEG monitoring/giving        0.00       3.19         NA       0.06       3.25         NA        XXX
                                                      drugs.
95954.............  ..............  A                EEG monitoring/giving        2.45       4.23         NA       0.19       6.87         NA        XXX
                                                      drugs.
95955.............  26............  A                EEG during surgery....       1.01       0.36       0.36       0.05       1.42       1.42        XXX
95955.............  TC............  A                EEG during surgery....       0.00       1.97         NA       0.17       2.14         NA        XXX
95955.............  ..............  A                EEG during surgery....       1.01       2.33         NA       0.22       3.56         NA        XXX
95956.............  26............  A                Eeg monitoring, cable/       3.08       1.30       1.30       0.16       4.54       4.54        XXX
                                                      radio.
95956.............  TC............  A                Eeg monitoring, cable/       0.00      14.15         NA       0.43      14.58         NA        XXX
                                                      radio.
95956.............  ..............  A                Eeg monitoring, cable/       3.08      15.45         NA       0.59      19.12         NA        XXX
                                                      radio.
95957.............  26............  A                EEG digital analysis..       1.98       0.85       0.85       0.11       2.94       2.94        XXX
95957.............  TC............  A                EEG digital analysis..       0.00       1.70         NA       0.12       1.82         NA        XXX
95957.............  ..............  A                EEG digital analysis..       1.98       2.55         NA       0.23       4.76         NA        XXX
95958.............  26............  A                EEG monitoring/              4.24       1.75       1.75       0.21       6.20       6.20        XXX
                                                      function test.
95958.............  TC............  A                EEG monitoring/              0.00       1.75         NA       0.13       1.88         NA        XXX
                                                      function test.
95958.............  ..............  A                EEG monitoring/              4.24       3.50         NA       0.34       8.08         NA        XXX
                                                      function test.
95961.............  26............  A                Electrode stimulation,       2.97       1.32       1.32       0.48       4.77       4.77        XXX
                                                      brain.
95961.............  TC............  A                Electrode stimulation,       0.00       1.31         NA       0.07       1.38         NA        XXX
                                                      brain.
95961.............  ..............  A                Electrode stimulation,       2.97       2.63         NA       0.55       6.15         NA        XXX
                                                      brain.
95962.............  26............  A                Electrode stim, brain        3.21       1.39       1.39       0.32       4.92       4.92        ZZZ
                                                      add-on.
95962.............  TC............  A                Electrode stim, brain        0.00       1.31         NA       0.07       1.38         NA        ZZZ
                                                      add-on.
95962.............  ..............  A                Electrode stim, brain        3.21       2.70         NA       0.39       6.30         NA        ZZZ
                                                      add-on.
95965.............  26............  A                Meg, spontaneous......       7.99       3.43       3.43       0.46      11.88      11.88        XXX
95965.............  TC............  C                Meg, spontaneous......       0.00       0.00       0.00       0.00       0.00       0.00        XXX
95965.............  ..............  C                Meg, spontaneous......       0.00       0.00       0.00       0.00       0.00       0.00        XXX
95966.............  26............  A                Meg, evoked, single...       3.99       1.71       1.71       0.19       5.89       5.89        XXX
95966.............  TC............  C                Meg, evoked, single...       0.00       0.00       0.00       0.00       0.00       0.00        XXX
95966.............  ..............  C                Meg, evoked, single...       0.00       0.00       0.00       0.00       0.00       0.00        XXX
95967.............  26............  A                Meg, evoked, each            3.49       1.18       1.18       0.16       4.83       4.83        ZZZ
                                                      add'l.
95967.............  TC............  C                Meg, evoked, each            0.00       0.00       0.00       0.00       0.00       0.00        ZZZ
                                                      add'l.
95967.............  ..............  C                Meg, evoked, each            0.00       0.00       0.00       0.00       0.00       0.00        ZZZ
                                                      add'l.
95970.............  ..............  A                Analyze neurostim, no        0.45       0.85       0.14       0.03       1.33       0.62        XXX
                                                      prog.
95971.............  ..............  A                Analyze neurostim,           0.78       0.68       0.22       0.07       1.53       1.07        XXX
                                                      simple.
95972.............  ..............  A                Analyze neurostim,           1.50       1.21       0.49       0.14       2.85       2.13        XXX
                                                      complex.
95973.............  ..............  A                Analyze neurostim,           0.92       0.62       0.34       0.07       1.61       1.33        ZZZ
                                                      complex.
95974.............  ..............  A                Cranial neurostim,           3.00       1.70       1.30       0.16       4.86       4.46        XXX
                                                      complex.
95975.............  ..............  A                Cranial neurostim,           1.70       0.89       0.73       0.12       2.71       2.55        ZZZ
                                                      complex.
95978.............  ..............  A                Analyze neurostim            3.50       1.94       1.30       0.18       5.62       4.98        XXX
                                                      brain/1h.
95979.............  ..............  A                Analyz neurostim brain       1.64       0.87       0.69       0.08       2.59       2.41        ZZZ
                                                      addon.
95990.............  ..............  A                Spin/brain pump refil        0.00       1.50         NA       0.06       1.56         NA        XXX
                                                      & main.
95991.............  ..............  A                Spin/brain pump refil        0.77       1.46       0.17       0.06       2.29       1.00        XXX
                                                      & main.
95999.............  ..............  C                Neurological procedure       0.00       0.00       0.00       0.00       0.00       0.00        XXX
96000.............  ..............  A                Motion analysis, video/      1.80         NA       0.53       0.11         NA       2.44        XXX
                                                      3d.
96001.............  ..............  A                Motion test w/ft press       2.15         NA       0.66       0.10         NA       2.91        XXX
                                                      meas.
96002.............  ..............  A                Dynamic surface emg...       0.41         NA       0.15       0.02         NA       0.58        XXX
96003.............  ..............  A                Dynamic fine wire emg.       0.37         NA       0.12       0.02         NA       0.51        XXX
96004.............  ..............  A                Phys review of motion        2.14       0.94       0.94       0.11       3.19       3.19        XXX
                                                      tests.
96101.............  ..............  A                Psycho testing by            1.86       0.65       0.63       0.05       2.56       2.54        XXX
                                                      psych/phys.
96102.............  ..............  A                Psycho testing by            0.50       0.66       0.17       0.01       1.17       0.68        XXX
                                                      technician.
96103.............  ..............  A                Psycho testing admin         0.51       0.21       0.17       0.02       0.74       0.70        XXX
                                                      by comp.
96105.............  ..............  A                Assessment of aphasia.       0.00       1.77         NA       0.18       1.95         NA        XXX
96110.............  ..............  A                Developmental test,          0.00       0.18         NA       0.18       0.36         NA        XXX
                                                      lim.
96111.............  ..............  A                Developmental test,          2.60       1.05         NA       0.18       3.83         NA        XXX
                                                      extend.

[[Page 70456]]

 
96116.............  ..............  A                Neurobehavioral status       1.86       0.83       0.64       0.18       2.87       2.68        XXX
                                                      exam.
96118.............  ..............  A                Neuropsych tst by            1.86       1.39       0.63       0.18       3.43       2.67        XXX
                                                      psych/phys.
96119.............  ..............  A                Neuropsych testing by        0.55       1.02       0.19       0.18       1.75       0.92        XXX
                                                      tech.
96120.............  ..............  A                Neuropsych tst admin w/      0.51       0.74       0.17       0.02       1.27       0.70        XXX
                                                      comp.
96150.............  ..............  A                Assess hlth/behave,          0.50       0.18       0.18       0.01       0.69       0.69        XXX
                                                      init.
96151.............  ..............  A                Assess hlth/behave,          0.48       0.18       0.17       0.01       0.67       0.66        XXX
                                                      subseq.
96152.............  ..............  A                Intervene hlth/behave,       0.46       0.17       0.16       0.01       0.64       0.63        XXX
                                                      indiv.
96153.............  ..............  A                Intervene hlth/behave,       0.10       0.04       0.03       0.01       0.15       0.14        XXX
                                                      group.
96154.............  ..............  A                Interv hlth/behav, fam       0.45       0.17       0.16       0.01       0.63       0.62        XXX
                                                      w/pt.
96155.............  ..............  N                Interv hlth/behav fam       +0.44       0.18       0.17       0.02       0.64       0.63        XXX
                                                      no pt.
96401.............  ..............  A                Chemo, anti-neopl, sq/       0.21       1.53       1.53       0.01       1.75       1.75        XXX
                                                      im.
96402.............  ..............  A                Chemo hormon antineopl       0.19       0.74       0.74       0.01       0.94       0.94        XXX
                                                      sq/im.
96405.............  ..............  A                Chemo intralesional,         0.52       2.78       0.24       0.03       3.33       0.79        000
                                                      up to 7.
96406.............  ..............  A                Chemo intralesional          0.80       3.08       0.29       0.03       3.91       1.12        000
                                                      over 7.
96409.............  ..............  A                Chemo, iv push, sngl         0.24       2.93       2.93       0.06       3.23       3.23        XXX
                                                      drug.
96411.............  ..............  A                Chemo, iv push, addl         0.20       1.61       1.61       0.06       1.87       1.87        ZZZ
                                                      drug.
96413.............  ..............  A                Chemo, iv infusion, 1        0.28       4.20       4.20       0.08       4.56       4.56        XXX
                                                      hr.
96415.............  ..............  A                Chemo, iv infusion,          0.19       0.77       0.77       0.07       1.03       1.03        ZZZ
                                                      addl hr.
96416.............  ..............  A                Chemo prolong infuse w/      0.21       4.61       4.61       0.08       4.90       4.90        XXX
                                                      pump.
96417.............  ..............  A                Chemo iv infus each          0.21       1.95       1.95       0.07       2.23       2.23        ZZZ
                                                      addl seq.
96420.............  ..............  A                Chemo, ia, push              0.17       2.66         NA       0.08       2.91         NA        XXX
                                                      tecnique.
96422.............  ..............  A                Chemo ia infusion up         0.17       4.84         NA       0.08       5.09         NA        XXX
                                                      to 1 hr.
96423.............  ..............  A                Chemo ia infuse each         0.17       1.89         NA       0.02       2.08         NA        ZZZ
                                                      addl hr.
96425.............  ..............  A                Chemotherapy,infusion        0.17       4.48         NA       0.08       4.73         NA        XXX
                                                      method.
96440.............  ..............  A                Chemotherapy,                2.37       8.04       1.23       0.17      10.58       3.77        000
                                                      intracavitary.
96445.............  ..............  A                Chemotherapy,                2.20       8.05       1.18       0.14      10.39       3.52        000
                                                      intracavitary.
96450.............  ..............  A                Chemotherapy, into CNS       1.53       6.96       1.29       0.09       8.58       2.91        000
96521.............  ..............  A                Refill/maint, portable       0.21       3.77       3.77       0.06       4.04       4.04        XXX
                                                      pump.
96522.............  ..............  A                Refill/maint pump/           0.21       2.65       2.65       0.06       2.92       2.92        XXX
                                                      resvr syst.
96523.............  ..............  T                Irrig drug delivery          0.04       0.69       0.69       0.01       0.74       0.74        XXX
                                                      device.
96542.............  ..............  A                Chemotherapy injection       0.75       4.24       0.66       0.07       5.06       1.48        XXX
96549.............  ..............  C                Chemotherapy,                0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      unspecified.
96567.............  ..............  A                Photodynamic tx, skin.       0.00       1.96         NA       0.04       2.00         NA        XXX
96570.............  ..............  A                Photodynamic tx, 30          1.10         NA       0.37       0.11         NA       1.58        ZZZ
                                                      min.
96571.............  ..............  A                Photodynamic tx, addl        0.55         NA       0.19       0.03         NA       0.77        ZZZ
                                                      15 min.
96900.............  ..............  A                Ultraviolet light            0.00       0.44         NA       0.02       0.46         NA        XXX
                                                      therapy.
96902.............  ..............  B                Trichogram............      +0.41       0.18       0.16       0.01       0.60       0.58        XXX
96910.............  ..............  A                Photochemotherapy with       0.00       0.99         NA       0.04       1.03         NA        XXX
                                                      UV-B.
96912.............  ..............  A                Photochemotherapy with       0.00       1.26         NA       0.05       1.31         NA        XXX
                                                      UV-A.
96913.............  ..............  A                Photochemotherapy, UV-       0.00       1.68         NA       0.10       1.78         NA        XXX
                                                      A or B.
96920.............  ..............  A                Laser tx, skin < 250         1.15       2.54       0.56       0.02       3.71       1.73        000
                                                      sq cm.
96921.............  ..............  A                Laser tx, skin 250-500       1.17       2.61       0.57       0.03       3.81       1.77        000
                                                      sq cm.
96922.............  ..............  A                Laser tx, skin > 500         2.10       3.49       0.62       0.04       5.63       2.76        000
                                                      sq cm.
96999.............  ..............  C                Dermatological               0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      procedure.
97001.............  ..............  A                Pt evaluation.........       1.20       0.75       0.45       0.05       2.00       1.70        XXX
97002.............  ..............  A                Pt re-evaluation......       0.60       0.44       0.23       0.02       1.06       0.85        XXX
97003.............  ..............  A                Ot evaluation.........       1.20       0.88       0.40       0.06       2.14       1.66        XXX
97004.............  ..............  A                Ot re-evaluation......       0.60       0.67       0.19       0.02       1.29       0.81        XXX
97005.............  ..............  I                Athletic train eval...       0.00       0.00       0.00       0.00       0.00       0.00        XXX
97006.............  ..............  I                Athletic train reeval.       0.00       0.00       0.00       0.00       0.00       0.00        XXX
97010.............  ..............  B                Hot or cold packs           +0.06       0.05         NA       0.01       0.12         NA        XXX
                                                      therapy.
97012.............  ..............  A                Mechanical traction          0.25       0.13         NA       0.01       0.39         NA        XXX
                                                      therapy.
97014.............  ..............  I                Electric stimulation        +0.18       0.19       0.19       0.01       0.38       0.38        XXX
                                                      therapy.
97016.............  ..............  A                Vasopneumatic device         0.18       0.18         NA       0.01       0.37         NA        XXX
                                                      therapy.
97018.............  ..............  A                Paraffin bath therapy.       0.06       0.10         NA       0.01       0.17         NA        XXX
97022.............  ..............  A                Whirlpool therapy.....       0.17       0.21         NA       0.01       0.39         NA        XXX
97024.............  ..............  A                Diathermy eg,                0.06       0.07         NA       0.01       0.14         NA        XXX
                                                      microwave.
97026.............  ..............  A                Infrared therapy......       0.06       0.06         NA       0.01       0.13         NA        XXX
97028.............  ..............  A                Ultraviolet therapy...       0.08       0.07         NA       0.01       0.16         NA        XXX
97032.............  ..............  A                Electrical stimulation       0.25       0.16         NA       0.01       0.42         NA        XXX
97033.............  ..............  A                Electric current             0.26       0.27         NA       0.01       0.54         NA        XXX
                                                      therapy.
97034.............  ..............  A                Contrast bath therapy.       0.21       0.15         NA       0.01       0.37         NA        XXX
97035.............  ..............  A                Ultrasound therapy....       0.21       0.10         NA       0.01       0.32         NA        XXX
97036.............  ..............  A                Hydrotherapy..........       0.28       0.32         NA       0.01       0.61         NA        XXX
97039.............  ..............  C                Physical therapy             0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      treatment.
97110.............  ..............  A                Therapeutic exercises.       0.45       0.27         NA       0.02       0.74         NA        XXX
97112.............  ..............  A                Neuromuscular                0.45       0.31         NA       0.01       0.77         NA        XXX
                                                      reeducation.
97113.............  ..............  A                Aquatic therapy/             0.44       0.39         NA       0.01       0.84         NA        XXX
                                                      exercises.
97116.............  ..............  A                Gait training therapy.       0.40       0.24         NA       0.01       0.65         NA        XXX
97124.............  ..............  A                Massage therapy.......       0.35       0.23         NA       0.01       0.59         NA        XXX
97139.............  ..............  C                Physical medicine            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      procedure.
97140.............  ..............  A                Manual therapy........       0.43       0.25         NA       0.01       0.69         NA        XXX
97150.............  ..............  A                Group therapeutic            0.27       0.18         NA       0.01       0.46         NA        XXX
                                                      procedures.
97530.............  ..............  A                Therapeutic activities       0.44       0.32         NA       0.01       0.77         NA        XXX
97532.............  ..............  A                Cognitive skills             0.44       0.20         NA       0.01       0.65         NA        XXX
                                                      development.

[[Page 70457]]

 
97533.............  ..............  A                Sensory integration...       0.44       0.24         NA       0.01       0.69         NA        XXX
97535.............  ..............  A                Self care mngment            0.45       0.33         NA       0.01       0.79         NA        XXX
                                                      training.
97537.............  ..............  A                Community/work               0.45       0.26         NA       0.01       0.72         NA        XXX
                                                      reintegration.
97542.............  ..............  A                Wheelchair mngment           0.45       0.28         NA       0.01       0.74         NA        XXX
                                                      training.
97545.............  ..............  R                Work hardening........       0.00       0.00       0.00       0.00       0.00       0.00        XXX
97546.............  ..............  R                Work hardening add-on.       0.00       0.00       0.00       0.00       0.00       0.00        ZZZ
97597.............  ..............  A                Active wound care/20         0.58       0.66         NA       0.05       1.29         NA        XXX
                                                      cm or <.
97598.............  ..............  A                Active wound care > 20       0.80       0.79         NA       0.05       1.64         NA        XXX
                                                      cm.
97602.............  ..............  B                Wound(s) care non-           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      selective.
97605.............  ..............  A                Neg press wound tx, <        0.55       0.34       0.22       0.02       0.91       0.79        XXX
                                                      50 cm.
97606.............  ..............  A                Neg press wound tx, >        0.60       0.90       0.41       0.03       1.53       1.04        XXX
                                                      50 cm.
97750.............  ..............  A                Physical performance         0.45       0.32         NA       0.02       0.79         NA        XXX
                                                      test.
97755.............  ..............  A                Assistive technology         0.62       0.28         NA       0.02       0.92         NA        XXX
                                                      assess.
97760.............  ..............  A                Orthotic mgmt and            0.45       0.34       0.20       0.03       0.82       0.68        XXX
                                                      training.
97761.............  ..............  A                Prosthetic training...       0.45       0.28       0.19       0.02       0.75       0.66        XXX
97762.............  ..............  A                C/o for orthotic/            0.25       0.42       0.19       0.02       0.69       0.46        XXX
                                                      prosth use.
97799.............  ..............  C                Physical medicine            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      procedure.
97802.............  ..............  A                Medical nutrition,           0.00       0.47         NA       0.01       0.48         NA        XXX
                                                      indiv, in.
97803.............  ..............  A                Med nutrition, indiv,        0.00       0.47         NA       0.01       0.48         NA        XXX
                                                      subseq.
97804.............  ..............  A                Medical nutrition,           0.00       0.18         NA       0.01       0.19         NA        XXX
                                                      group.
97810.............  ..............  N                Acupunct w/o stimul 15      +0.60       0.38       0.23       0.03       1.01       0.86        XXX
                                                      min.
97811.............  ..............  N                Acupunct w/o stimul         +0.50       0.25       0.19       0.03       0.78       0.72        ZZZ
                                                      addl 15m.
97813.............  ..............  N                Acupunct w/stimul 15        +0.65       0.40       0.25       0.03       1.08       0.93        XXX
                                                      min.
97814.............  ..............  N                Acupunct w/stimul addl      +0.55       0.30       0.21       0.03       0.88       0.79        ZZZ
                                                      15m.
98925.............  ..............  A                Osteopathic                  0.45       0.32       0.14       0.02       0.79       0.61        000
                                                      manipulation.
98926.............  ..............  A                Osteopathic                  0.65       0.41       0.25       0.03       1.09       0.93        000
                                                      manipulation.
98927.............  ..............  A                Osteopathic                  0.87       0.50       0.29       0.03       1.40       1.19        000
                                                      manipulation.
98928.............  ..............  A                Osteopathic                  1.03       0.59       0.34       0.04       1.66       1.41        000
                                                      manipulation.
98929.............  ..............  A                Osteopathic                  1.19       0.67       0.37       0.05       1.91       1.61        000
                                                      manipulation.
98940.............  ..............  A                Chiropractic                 0.45       0.23       0.12       0.01       0.69       0.58        000
                                                      manipulation.
98941.............  ..............  A                Chiropractic                 0.65       0.30       0.17       0.01       0.96       0.83        000
                                                      manipulation.
98942.............  ..............  A                Chiropractic                 0.87       0.36       0.23       0.02       1.25       1.12        000
                                                      manipulation.
98943.............  ..............  N                Chiropractic                +0.40       0.24       0.16       0.01       0.65       0.57        XXX
                                                      manipulation.
98960.............  ..............  N                Self-mgmt educ &             0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      train, 1 pt.
98961.............  ..............  N                Self-mgmt educ/train,        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      2-4 pt.
98962.............  ..............  N                Self-mgmt educ/train,        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      5-8 pt.
99000.............  ..............  B                Specimen handling.....       0.00       0.00       0.00       0.00       0.00       0.00        XXX
99001.............  ..............  B                Specimen handling.....       0.00       0.00       0.00       0.00       0.00       0.00        XXX
99002.............  ..............  B                Device handling.......       0.00       0.00       0.00       0.00       0.00       0.00        XXX
99024.............  ..............  B                Postop follow-up visit       0.00       0.00       0.00       0.00       0.00       0.00        XXX
99026.............  ..............  N                In-hospital on call          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      service.
99027.............  ..............  N                Out-of-hosp on call          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      service.
99050.............  ..............  B                Medical services after       0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      hrs.
99051.............  ..............  B                Med serv, eve/wkend/         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      holiday.
99053.............  ..............  B                Med serv 10pm-8am, 24        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      hr fac.
99056.............  ..............  B                Med service out of           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      office.
99058.............  ..............  B                Office emergency care.       0.00       0.00       0.00       0.00       0.00       0.00        XXX
99060.............  ..............  B                Out of office emerg          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      med serv.
99070.............  ..............  B                Special supplies......       0.00       0.00       0.00       0.00       0.00       0.00        XXX
99071.............  ..............  B                Patient education            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      materials.
99075.............  ..............  N                Medical testimony.....       0.00       0.00       0.00       0.00       0.00       0.00        XXX
99078.............  ..............  B                Group health education       0.00       0.00       0.00       0.00       0.00       0.00        XXX
99080.............  ..............  B                Special reports or           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      forms.
99082.............  ..............  C                Unusual physician            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      travel.
99090.............  ..............  B                Computer data analysis       0.00       0.00       0.00       0.00       0.00       0.00        XXX
99091.............  ..............  B                Collect/review data          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      from pt.
99100.............  ..............  B                Special anesthesia           0.00       0.00       0.00       0.00       0.00       0.00        ZZZ
                                                      service.
99116.............  ..............  B                Anesthesia with              0.00       0.00       0.00       0.00       0.00       0.00        ZZZ
                                                      hypothermia.
99135.............  ..............  B                Special anesthesia           0.00       0.00       0.00       0.00       0.00       0.00        ZZZ
                                                      procedure.
99140.............  ..............  B                Emergency anesthesia..       0.00       0.00       0.00       0.00       0.00       0.00        ZZZ
99143.............  ..............  C                Mod cs by same phys, <       0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      5 yrs.
99144.............  ..............  C                Mod cs by same phys, 5       0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      yrs +.
99145.............  ..............  C                Mod cs by same phys          0.00       0.00       0.00       0.00       0.00       0.00        ZZZ
                                                      add-on.
99148.............  ..............  C                Mod cs diff phys < 5         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      yrs.
99149.............  ..............  C                Mod cs diff phys 5 yrs       0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      +.
99150.............  ..............  C                Mod cs diff phys add-        0.00       0.00       0.00       0.00       0.00       0.00        ZZZ
                                                      on.
99170.............  ..............  A                Anogenital exam, child       1.75       1.77       0.55       0.08       3.60       2.38        000
99172.............  ..............  N                Ocular function screen       0.00       0.00       0.00       0.00       0.00       0.00        XXX
99173.............  ..............  N                Visual acuity screen..       0.00       0.00       0.00       0.00       0.00       0.00        XXX
99175.............  ..............  A                Induction of vomiting.       0.00       1.39         NA       0.10       1.49         NA        XXX
99183.............  ..............  A                Hyperbaric oxygen            2.34       3.25       0.72       0.16       5.75       3.22        XXX
                                                      therapy.
99185.............  ..............  A                Regional hypothermia..       0.00       0.64         NA       0.04       0.68         NA        XXX
99186.............  ..............  A                Total body hypothermia       0.00       1.79         NA       0.45       2.24         NA        XXX
99190.............  ..............  X                Special pump services.       0.00       0.00       0.00       0.00       0.00       0.00        XXX
99191.............  ..............  X                Special pump services.       0.00       0.00       0.00       0.00       0.00       0.00        XXX

[[Page 70458]]

 
99192.............  ..............  X                Special pump services.       0.00       0.00       0.00       0.00       0.00       0.00        XXX
99195.............  ..............  A                Phlebotomy............       0.00       0.44         NA       0.02       0.46         NA        XXX
99199.............  ..............  C                Special service/proc/        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      report.
99201.............  ..............  A                Office/outpatient            0.45       0.49       0.15       0.03       0.97       0.63        XXX
                                                      visit, new.
99202.............  ..............  A                Office/outpatient            0.88       0.79       0.31       0.05       1.72       1.24        XXX
                                                      visit, new.
99203.............  ..............  A                Office/outpatient            1.34       1.13       0.48       0.09       2.56       1.91        XXX
                                                      visit, new.
99204.............  ..............  A                Office/outpatient            2.00       1.50       0.71       0.12       3.62       2.83        XXX
                                                      visit, new.
99205.............  ..............  A                Office/outpatient            2.67       1.78       0.95       0.15       4.60       3.77        XXX
                                                      visit, new.
99211.............  ..............  A                Office/outpatient            0.17       0.39       0.06       0.01       0.57       0.24        XXX
                                                      visit, est.
99212.............  ..............  A                Office/outpatient            0.45       0.54       0.16       0.03       1.02       0.64        XXX
                                                      visit, est.
99213.............  ..............  A                Office/outpatient            0.67       0.69       0.24       0.03       1.39       0.94        XXX
                                                      visit, est.
99214.............  ..............  A                Office/outpatient            1.10       1.03       0.41       0.05       2.18       1.56        XXX
                                                      visit, est.
99215.............  ..............  A                Office/outpatient            1.77       1.32       0.65       0.08       3.17       2.50        XXX
                                                      visit, est.
99217.............  ..............  A                Observation care             1.28         NA       0.53       0.06         NA       1.87        XXX
                                                      discharge.
99218.............  ..............  A                Observation care......       1.28         NA       0.44       0.06         NA       1.78        XXX
99219.............  ..............  A                Observation care......       2.14         NA       0.72       0.10         NA       2.96        XXX
99220.............  ..............  A                Observation care......       2.99         NA       1.03       0.14         NA       4.16        XXX
99221.............  ..............  A                Initial hospital care.       1.28         NA       0.45       0.07         NA       1.80        XXX
99222.............  ..............  A                Initial hospital care.       2.14         NA       0.74       0.10         NA       2.98        XXX
99223.............  ..............  A                Initial hospital care.       2.99         NA       1.03       0.13         NA       4.15        XXX
99231.............  ..............  A                Subsequent hospital          0.64         NA       0.23       0.03         NA       0.90        XXX
                                                      care.
99232.............  ..............  A                Subsequent hospital          1.06         NA       0.37       0.04         NA       1.47        XXX
                                                      care.
99233.............  ..............  A                Subsequent hospital          1.51         NA       0.52       0.06         NA       2.09        XXX
                                                      care.
99234.............  ..............  A                Observ/hosp same date.       2.56         NA       0.89       0.13         NA       3.58        XXX
99235.............  ..............  A                Observ/hosp same date.       3.41         NA       1.15       0.16         NA       4.72        XXX
99236.............  ..............  A                Observ/hosp same date.       4.26         NA       1.44       0.19         NA       5.89        XXX
99238.............  ..............  A                Hospital discharge day       1.28         NA       0.54       0.05         NA       1.87        XXX
99239.............  ..............  A                Hospital discharge day       1.75         NA       0.73       0.07         NA       2.55        XXX
99241.............  ..............  A                Office consultation...       0.64       0.64       0.22       0.05       1.33       0.91        XXX
99242.............  ..............  A                Office consultation...       1.29       1.04       0.46       0.10       2.43       1.85        XXX
99243.............  ..............  A                Office consultation...       1.72       1.39       0.63       0.13       3.24       2.48        XXX
99244.............  ..............  A                Office consultation...       2.58       1.83       0.92       0.16       4.57       3.66        XXX
99245.............  ..............  A                Office consultation...       3.42       2.28       1.24       0.21       5.91       4.87        XXX
99251.............  ..............  A                Initial inpatient            0.66         NA       0.24       0.05         NA       0.95        XXX
                                                      consult.
99252.............  ..............  A                Initial inpatient            1.32         NA       0.50       0.09         NA       1.91        XXX
                                                      consult.
99253.............  ..............  A                Initial inpatient            1.82         NA       0.68       0.11         NA       2.61        XXX
                                                      consult.
99254.............  ..............  A                Initial inpatient            2.64         NA       0.98       0.13         NA       3.75        XXX
                                                      consult.
99255.............  ..............  A                Initial inpatient            3.64         NA       1.35       0.18         NA       5.17        XXX
                                                      consult.
99281.............  ..............  A                Emergency dept visit..       0.33         NA       0.09       0.02         NA       0.44        XXX
99282.............  ..............  A                Emergency dept visit..       0.55         NA       0.14       0.04         NA       0.73        XXX
99283.............  ..............  A                Emergency dept visit..       1.24         NA       0.31       0.09         NA       1.64        XXX
99284.............  ..............  A                Emergency dept visit..       1.95         NA       0.47       0.14         NA       2.56        XXX
99285.............  ..............  A                Emergency dept visit..       3.06         NA       0.72       0.23         NA       4.01        XXX
99288.............  ..............  B                Direct advanced life         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      support.
99289.............  ..............  A                Ped crit care                4.79         NA       1.45       0.24         NA       6.48        XXX
                                                      transport.
99290.............  ..............  A                Ped crit care                2.40         NA       0.81       0.12         NA       3.33        ZZZ
                                                      transport addl.
99291.............  ..............  A                Critical care, first         3.99       2.58       1.28       0.21       6.78       5.48        XXX
                                                      hour.
99292.............  ..............  A                Critical care, add'l         2.00       0.90       0.64       0.11       3.01       2.75        ZZZ
                                                      30 min.
99293.............  ..............  A                Ped critical care,          15.98         NA       4.76       1.12         NA      21.86        XXX
                                                      initial.
99294.............  ..............  A                Ped critical care,           7.99         NA       2.41       0.45         NA      10.85        XXX
                                                      subseq.
99295.............  ..............  A                Neonate crit care,          18.46         NA       5.39       1.16         NA      25.01        XXX
                                                      initial.
99296.............  ..............  A                Neonate critical care        7.99         NA       2.55       0.32         NA      10.86        XXX
                                                      subseq.
99298.............  ..............  A                Ic for lbw infant <          2.75         NA       0.93       0.17         NA       3.85        XXX
                                                      1500 gm.
99299.............  ..............  A                Ic, lbw infant 1500-         2.50         NA       0.86       0.16         NA       3.52        XXX
                                                      2500 gm.
99300.............  ..............  A                Ic, infant pbw 2501-         2.40         NA       0.84       2.40         NA       5.64        XXX
                                                      5000 gm.
99304.............  ..............  A                Nursing facility care,       1.20       0.49       0.49       0.05       1.74       1.74        XXX
                                                      init.
99305.............  ..............  A                Nursing facility care,       1.61       0.63       0.63       0.07       2.31       2.31        XXX
                                                      init.
99306.............  ..............  A                Nursing facility care,       2.01       0.75       0.75       0.09       2.85       2.85        XXX
                                                      init.
99307.............  ..............  A                Nursing fac care,            0.60       0.27       0.27       0.03       0.90       0.90        XXX
                                                      subseq.
99308.............  ..............  A                Nursing fac care,            1.00       0.45       0.45       0.04       1.49       1.49        XXX
                                                      subseq.
99309.............  ..............  A                Nursing fac care,            1.42       0.62       0.62       0.06       2.10       2.10        XXX
                                                      subseq.
99310.............  ..............  A                Nursing fac care,            1.77       0.78       0.78       0.08       2.63       2.63        XXX
                                                      subseq.
99315.............  ..............  A                Nursing fac discharge        1.13       0.45       0.45       0.05       1.63       1.63        XXX
                                                      day.
99316.............  ..............  A                Nursing fac discharge        1.50       0.59       0.59       0.06       2.15       2.15        XXX
                                                      day.
99318.............  ..............  A                Annual nursing fac           1.20       0.49       0.49       0.05       1.74       1.74        XXX
                                                      assessmnt.
99324.............  ..............  A                Domicil/r-home visit         1.01       0.49       0.38       0.05       1.55       1.44        XXX
                                                      new pat.
99325.............  ..............  A                Domicil/r-home visit         1.52       0.68       0.55       0.07       2.27       2.14        XXX
                                                      new pat.
99326.............  ..............  A                Domicil/r-home visit         2.27       0.92       0.78       0.10       3.29       3.15        XXX
                                                      new pat.
99327.............  ..............  A                Domicil/r-home visit         3.03       1.17       1.05       0.13       4.33       4.21        XXX
                                                      new pat.
99328.............  ..............  A                Domicil/r-home visit         3.78       1.42       1.31       0.16       5.36       5.25        XXX
                                                      new pat.
99334.............  ..............  A                Domicil/r-home visit         0.76       0.40       0.26       0.04       1.20       1.06        XXX
                                                      est pat.
99335.............  ..............  A                Domicil/r-home visit         1.26       0.58       0.43       0.06       1.90       1.75        XXX
                                                      est pat.
99336.............  ..............  A                Domicil/r-home visit         2.02       0.82       0.66       0.09       2.93       2.77        XXX
                                                      est pat.
99337.............  ..............  A                Domicil/r-home visit         3.03       1.15       0.98       0.13       4.31       4.14        XXX
                                                      est pat.
99339.............  ..............  B                Domicil/r-home care          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      supervis.

[[Page 70459]]

 
99340.............  ..............  I                Domicil/r-home care          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      supervis.
99341.............  ..............  A                Home visit, new              1.01       0.48         NA       0.05       1.54         NA        XXX
                                                      patient.
99342.............  ..............  A                Home visit, new              1.52       0.68         NA       0.07       2.27         NA        XXX
                                                      patient.
99343.............  ..............  A                Home visit, new              2.27       0.94         NA       0.10       3.31         NA        XXX
                                                      patient.
99344.............  ..............  A                Home visit, new              3.03       1.18         NA       0.13       4.34         NA        XXX
                                                      patient.
99345.............  ..............  A                Home visit, new              3.78       1.43         NA       0.16       5.37         NA        XXX
                                                      patient.
99347.............  ..............  A                Home visit, est              0.76       0.40         NA       0.04       1.20         NA        XXX
                                                      patient.
99348.............  ..............  A                Home visit, est              1.26       0.58         NA       0.06       1.90         NA        XXX
                                                      patient.
99349.............  ..............  A                Home visit, est              2.02       0.83         NA       0.09       2.94         NA        XXX
                                                      patient.
99350.............  ..............  A                Home visit, est              3.03       1.18         NA       0.13       4.34         NA        XXX
                                                      patient.
99354.............  ..............  A                Prolonged service,           1.77       0.77       0.66       0.08       2.62       2.51        ZZZ
                                                      office.
99355.............  ..............  A                Prolonged service,           1.77       0.75       0.62       0.07       2.59       2.46        ZZZ
                                                      office.
99356.............  ..............  A                Prolonged service,           1.71         NA       0.62       0.07         NA       2.40        ZZZ
                                                      inpatient.
99357.............  ..............  A                Prolonged service,           1.71         NA       0.63       0.08         NA       2.42        ZZZ
                                                      inpatient.
99358.............  ..............  B                Prolonged serv, w/o          0.00       0.00       0.00       0.00       0.00       0.00        ZZZ
                                                      contact.
99359.............  ..............  B                Prolonged serv, w/o          0.00       0.00       0.00       0.00       0.00       0.00        ZZZ
                                                      contact.
99360.............  ..............  X                Physician standby            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      services.
99361.............  ..............  B                Physician/team               0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      conference.
99362.............  ..............  B                Physician/team               0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      conference.
99371.............  ..............  B                Physician phone              0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      consultation.
99372.............  ..............  B                Physician phone              0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      consultation.
99373.............  ..............  B                Physician phone              0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      consultation.
99374.............  ..............  B                Home health care            +1.10       0.70       0.42       0.05       1.85       1.57        XXX
                                                      supervision.
99375.............  ..............  I                Home health care            +1.73       1.55       1.55       0.07       3.35       3.35        XXX
                                                      supervision.
99377.............  ..............  B                Hospice care                +1.10       0.70       0.42       0.05       1.85       1.57        XXX
                                                      supervision.
99378.............  ..............  I                Hospice care                +1.73       1.95       1.95       0.07       3.75       3.75        XXX
                                                      supervision.
99379.............  ..............  B                Nursing fac care            +1.10       0.70       0.42       0.04       1.84       1.56        XXX
                                                      supervision.
99380.............  ..............  B                Nursing fac care            +1.73       0.99       0.66       0.06       2.78       2.45        XXX
                                                      supervision.
99381.............  ..............  N                Prev visit, new,            +1.19       1.50       0.45       0.05       2.74       1.69        XXX
                                                      infant.
99382.............  ..............  N                Prev visit, new, age 1-     +1.36       1.54       0.52       0.05       2.95       1.93        XXX
                                                      4.
99383.............  ..............  N                Prev visit, new, age 5-     +1.36       1.48       0.52       0.05       2.89       1.93        XXX
                                                      11.
99384.............  ..............  N                Prev visit, new, age        +1.53       1.55       0.59       0.06       3.14       2.18        XXX
                                                      12-17.
99385.............  ..............  N                Prev visit, new, age        +1.53       1.55       0.59       0.06       3.14       2.18        XXX
                                                      18-39.
99386.............  ..............  N                Prev visit, new, age        +1.88       1.75       0.72       0.07       3.70       2.67        XXX
                                                      40-64.
99387.............  ..............  N                Prev visit, new, 65 &       +2.06       1.88       0.79       0.07       4.01       2.92        XXX
                                                      over.
99391.............  ..............  N                Prev visit, est,            +1.02       1.02       0.39       0.04       2.08       1.45        XXX
                                                      infant.
99392.............  ..............  N                Prev visit, est, age 1-     +1.19       1.09       0.45       0.05       2.33       1.69        XXX
                                                      4.
99393.............  ..............  N                Prev visit, est, age 5-     +1.19       1.06       0.45       0.05       2.30       1.69        XXX
                                                      11.
99394.............  ..............  N                Prev visit, est, age        +1.36       1.13       0.52       0.05       2.54       1.93        XXX
                                                      12-17.
99395.............  ..............  N                Prev visit, est, age        +1.36       1.16       0.52       0.05       2.57       1.93        XXX
                                                      18-39.
99396.............  ..............  N                Prev visit, est, age        +1.53       1.25       0.59       0.06       2.84       2.18        XXX
                                                      40-64.
99397.............  ..............  N                Prev visit, est, 65 &       +1.71       1.36       0.66       0.06       3.13       2.43        XXX
                                                      over.
99401.............  ..............  N                Preventive counseling,      +0.48       0.62       0.19       0.01       1.11       0.68        XXX
                                                      indiv.
99402.............  ..............  N                Preventive counseling,      +0.98       0.87       0.37       0.02       1.87       1.37        XXX
                                                      indiv.
99403.............  ..............  N                Preventive counseling,      +1.46       1.09       0.56       0.04       2.59       2.06        XXX
                                                      indiv.
99404.............  ..............  N                Preventive counseling,      +1.95       1.32       0.75       0.05       3.32       2.75        XXX
                                                      indiv.
99411.............  ..............  N                Preventive counseling,      +0.15       0.18       0.06       0.01       0.34       0.22        XXX
                                                      group.
99412.............  ..............  N                Preventive counseling,      +0.25       0.25       0.10       0.01       0.51       0.36        XXX
                                                      group.
99420.............  ..............  N                Health risk assessment       0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      test.
99429.............  ..............  N                Unlisted preventive          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      service.
99431.............  ..............  A                Initial care, normal         1.17         NA       0.38       0.05         NA       1.60        XXX
                                                      newborn.
99432.............  ..............  A                Newborn care, not in         1.26       0.93       0.40       0.07       2.26       1.73        XXX
                                                      hosp.
99433.............  ..............  A                Normal newborn care/         0.62         NA       0.20       0.02         NA       0.84        XXX
                                                      hospital.
99435.............  ..............  A                Newborn discharge day        1.50         NA       0.59       0.06         NA       2.15        XXX
                                                      hosp.
99436.............  ..............  A                Attendance, birth.....       1.50         NA       0.47       0.06         NA       2.03        XXX
99440.............  ..............  A                Newborn resuscitation.       2.93         NA       0.93       0.12         NA       3.98        XXX
99450.............  ..............  N                Life/disability              0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      evaluation.
99455.............  ..............  R                Disability examination       0.00       0.00       0.00       0.00       0.00       0.00        XXX
99456.............  ..............  R                Disability examination       0.00       0.00       0.00       0.00       0.00       0.00        XXX
99499.............  ..............  C                Unlisted e&m service..       0.00       0.00       0.00       0.00       0.00       0.00        XXX
99500.............  ..............  I                Home visit, prenatal..       0.00       0.00       0.00       0.00       0.00       0.00        XXX
99501.............  ..............  I                Home visit, postnatal.       0.00       0.00       0.00       0.00       0.00       0.00        XXX
99502.............  ..............  I                Home visit, nb care...       0.00       0.00       0.00       0.00       0.00       0.00        XXX
99503.............  ..............  I                Home visit, resp             0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      therapy.
99504.............  ..............  I                Home visit mech              0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      ventilator.
99505.............  ..............  I                Home visit, stoma care       0.00       0.00       0.00       0.00       0.00       0.00        XXX
99506.............  ..............  I                Home visit, im               0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      injection.
99507.............  ..............  I                Home visit, cath             0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      maintain.
99509.............  ..............  I                Home visit day life          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      activity.
99510.............  ..............  I                Home visit, sing/m/fam       0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      couns.
99511.............  ..............  I                Home visit, fecal/           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      enema mgmt.
99512.............  ..............  I                Home visit for               0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      hemodialysis.
99600.............  ..............  I                Home visit nos........       0.00       0.00       0.00       0.00       0.00       0.00        XXX
99601.............  ..............  I                Home infusion/visit, 2       0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      hrs.
99602.............  ..............  I                Home infusion, each          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      add'l hr.

[[Page 70460]]

 
A4890.............  ..............  R                Repair/maint cont hemo       0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      equip.
D0150.............  ..............  R                Comprehensve oral            0.00       0.00       0.00       0.00       0.00       0.00        YYY
                                                      evaluation.
D0240.............  ..............  R                Intraoral occlusal           0.00       0.00       0.00       0.00       0.00       0.00        YYY
                                                      film.
D0250.............  ..............  R                Extraoral first film..       0.00       0.00       0.00       0.00       0.00       0.00        YYY
D0260.............  ..............  R                Extraoral ea                 0.00       0.00       0.00       0.00       0.00       0.00        YYY
                                                      additional film.
D0270.............  ..............  R                Dental bitewing single       0.00       0.00       0.00       0.00       0.00       0.00        YYY
                                                      film.
D0272.............  ..............  R                Dental bitewings two         0.00       0.00       0.00       0.00       0.00       0.00        YYY
                                                      films.
D0274.............  ..............  R                Dental bitewings four        0.00       0.00       0.00       0.00       0.00       0.00        YYY
                                                      films.
D0277.............  ..............  R                Vert bitewings-sev to        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      eight.
D0416.............  ..............  R                Viral culture.........       0.00       0.00       0.00       0.00       0.00       0.00        XXX
D0421.............  ..............  R                Gen tst suscept oral         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      disease.
D0431.............  ..............  R                Diag tst detect mucos        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      abnorm.
D0460.............  ..............  R                Pulp vitality test....       0.00       0.00       0.00       0.00       0.00       0.00        YYY
D0472.............  ..............  R                Gross exam, prep &           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      report.
D0473.............  ..............  R                Micro exam, prep &           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      report.
D0474.............  ..............  R                Micro w exam of surg         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      margins.
D0475.............  ..............  R                Decalcification              0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      procedure.
D0476.............  ..............  R                Spec stains for              0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      microorganis.
D0477.............  ..............  R                Spec stains not for          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      microorg.
D0478.............  ..............  R                Immunohistochemical          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      stains.
D0479.............  ..............  R                Tissue in-situ               0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      hybridization.
D0480.............  ..............  R                Cytopath smear prep &        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      report.
D0481.............  ..............  R                Electron microscopy          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      diagnost.
D0482.............  ..............  R                Direct                       0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      immunofluorescence.
D0483.............  ..............  R                Indirect                     0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      immunofluorescence.
D0484.............  ..............  R                Consult slides prep          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      elsewher.
D0485.............  ..............  R                Consult inc prep of          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      slides.
D0502.............  ..............  R                Other oral pathology         0.00       0.00       0.00       0.00       0.00       0.00        YYY
                                                      procedu.
D0999.............  ..............  R                Unspecified diagnostic       0.00       0.00       0.00       0.00       0.00       0.00        YYY
                                                      proce.
D1510.............  ..............  R                Space maintainer fxd         0.00       0.00       0.00       0.00       0.00       0.00        YYY
                                                      unilat.
D1515.............  ..............  R                Fixed bilat space            0.00       0.00       0.00       0.00       0.00       0.00        YYY
                                                      maintainer.
D1520.............  ..............  R                Remove unilat space          0.00       0.00       0.00       0.00       0.00       0.00        YYY
                                                      maintain.
D1525.............  ..............  R                Remove bilat space           0.00       0.00       0.00       0.00       0.00       0.00        YYY
                                                      maintain.
D1550.............  ..............  R                Recement space               0.00       0.00       0.00       0.00       0.00       0.00        YYY
                                                      maintainer.
D2999.............  ..............  R                Dental unspec                0.00       0.00       0.00       0.00       0.00       0.00        YYY
                                                      restorative pr.
D3460.............  ..............  R                Endodontic endosseous        0.00       0.00       0.00       0.00       0.00       0.00        YYY
                                                      implan.
D3999.............  ..............  R                Endodontic procedure..       0.00       0.00       0.00       0.00       0.00       0.00        YYY
D4260.............  ..............  R                Osseous surgery per          0.00       0.00       0.00       0.00       0.00       0.00        YYY
                                                      quadrant.
D4263.............  ..............  R                Bone replce graft            0.00       0.00       0.00       0.00       0.00       0.00        YYY
                                                      first site.
D4264.............  ..............  R                Bone replce graft each       0.00       0.00       0.00       0.00       0.00       0.00        YYY
                                                      add.
D4268.............  ..............  R                Surgical revision            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      procedure.
D4270.............  ..............  R                Pedicle soft tissue          0.00       0.00       0.00       0.00       0.00       0.00        YYY
                                                      graft pr.
D4271.............  ..............  R                Free soft tissue graft       0.00       0.00       0.00       0.00       0.00       0.00        YYY
                                                      proc.
D4273.............  ..............  R                Subepithelial tissue         0.00       0.00       0.00       0.00       0.00       0.00        YYY
                                                      graft.
D4355.............  ..............  R                Full mouth debridement       0.00       0.00       0.00       0.00       0.00       0.00        YYY
D4381.............  ..............  R                Localized delivery           0.00       0.00       0.00       0.00       0.00       0.00        YYY
                                                      antimicro.
D5911.............  ..............  R                Facial moulage               0.00       0.00       0.00       0.00       0.00       0.00        YYY
                                                      sectional.
D5912.............  ..............  R                Facial moulage               0.00       0.00       0.00       0.00       0.00       0.00        YYY
                                                      complete.
D5951.............  ..............  R                Feeding aid...........       0.00       0.00       0.00       0.00       0.00       0.00        YYY
D5983.............  ..............  R                Radiation applicator..       0.00       0.00       0.00       0.00       0.00       0.00        YYY
D5984.............  ..............  R                Radiation shield......       0.00       0.00       0.00       0.00       0.00       0.00        YYY
D5985.............  ..............  R                Radiation cone locator       0.00       0.00       0.00       0.00       0.00       0.00        YYY
D5987.............  ..............  R                Commissure splint.....       0.00       0.00       0.00       0.00       0.00       0.00        YYY
D6920.............  ..............  R                Dental connector bar..       0.00       0.00       0.00       0.00       0.00       0.00        YYY
D7111.............  ..............  R                Extraction coronal           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      remnants.
D7140.............  ..............  R                Extraction erupted           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      tooth/exr.
D7210.............  ..............  R                Rem imp tooth w              0.00       0.00       0.00       0.00       0.00       0.00        YYY
                                                      mucoper flp.
D7220.............  ..............  R                Impact tooth remov           0.00       0.00       0.00       0.00       0.00       0.00        YYY
                                                      soft tiss.
D7230.............  ..............  R                Impact tooth remov           0.00       0.00       0.00       0.00       0.00       0.00        YYY
                                                      part bony.
D7240.............  ..............  R                Impact tooth remov           0.00       0.00       0.00       0.00       0.00       0.00        YYY
                                                      comp bony.
D7241.............  ..............  R                Impact tooth rem bony        0.00       0.00       0.00       0.00       0.00       0.00        YYY
                                                      w/comp.
D7250.............  ..............  R                Tooth root removal....       0.00       0.00       0.00       0.00       0.00       0.00        YYY
D7260.............  ..............  R                Oral antral fistula          0.00       0.00       0.00       0.00       0.00       0.00        YYY
                                                      closure.
D7261.............  ..............  R                Primary closure sinus        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      perf.
D7283.............  ..............  R                Place device impacted        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      tooth.
D7288.............  ..............  R                Brush biopsy..........       0.00       0.00       0.00       0.00       0.00       0.00        XXX
D7291.............  ..............  R                Transseptal fiberotomy       0.00       0.00       0.00       0.00       0.00       0.00        YYY
D7321.............  ..............  R                Alveoloplasty not w/         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      extracts.
D7511.............  ..............  R                Incision/drain abscess       0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      intra.
D7521.............  ..............  R                Incision/drain abscess       0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      extra.
D7940.............  ..............  R                Reshaping bone               0.00       0.00       0.00       0.00       0.00       0.00        YYY
                                                      orthognathic.
D9110.............  ..............  R                Tx dental pain minor         0.00       0.00       0.00       0.00       0.00       0.00        YYY
                                                      proc.
D9230.............  ..............  R                Analgesia.............       0.00       0.00       0.00       0.00       0.00       0.00        YYY
D9248.............  ..............  R                Sedation (non-iv).....       0.00       0.00       0.00       0.00       0.00       0.00        XXX
D9630.............  ..............  R                Other drugs/                 0.00       0.00       0.00       0.00       0.00       0.00        YYY
                                                      medicaments.

[[Page 70461]]

 
D9930.............  ..............  R                Treatment of                 0.00       0.00       0.00       0.00       0.00       0.00        YYY
                                                      complications.
D9940.............  ..............  R                Dental occlusal guard.       0.00       0.00       0.00       0.00       0.00       0.00        YYY
D9950.............  ..............  R                Occlusion analysis....       0.00       0.00       0.00       0.00       0.00       0.00        YYY
D9951.............  ..............  R                Limited occlusal             0.00       0.00       0.00       0.00       0.00       0.00        YYY
                                                      adjustment.
D9952.............  ..............  R                Complete occlusal            0.00       0.00       0.00       0.00       0.00       0.00        YYY
                                                      adjustment.
G0008.............  ..............  X                Admin influenza virus        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      vac.
G0009.............  ..............  X                Admin pneumococcal           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      vaccine.
G0010.............  ..............  X                Admin hepatitis b            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      vaccine.
G0027.............  ..............  X                Semen analysis........       0.00       0.00       0.00       0.00       0.00       0.00        XXX
G0101.............  ..............  A                CA screen;pelvic/            0.45       0.52       0.17       0.02       0.99       0.64        XXX
                                                      breast exam.
G0102.............  ..............  A                Prostate ca screening;       0.17       0.39       0.06       0.01       0.57       0.24        XXX
                                                      dre.
G0103.............  ..............  X                Psa, total screening..       0.00       0.00       0.00       0.00       0.00       0.00        XXX
G0104.............  ..............  A                CA screen;flexi              0.96       2.28       0.50       0.08       3.32       1.54        000
                                                      sigmoidscope.
G0105.............  53............  A                Colorectal scrn; hi          0.96       2.28       0.50       0.08       3.32       1.54        000
                                                      risk ind.
G0105.............  ..............  A                Colorectal scrn; hi          3.69       6.16       1.47       0.30      10.15       5.46        000
                                                      risk ind.
G0106.............  26............  A                Colon CA screen;barium       0.99       0.32       0.32       0.04       1.35       1.35        XXX
                                                      enema.
G0106.............  TC............  A                Colon CA screen;barium       0.00       2.24         NA       0.13       2.37         NA        XXX
                                                      enema.
G0106.............  ..............  A                Colon CA screen;barium       0.99       2.56         NA       0.17       3.72         NA        XXX
                                                      enema.
G0107.............  ..............  X                CA screen; fecal blood       0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      test.
G0108.............  ..............  A                Diab manage trn per          0.00       0.83         NA       0.01       0.84         NA        XXX
                                                      indiv.
G0109.............  ..............  A                Diab manage trn ind/         0.00       0.48         NA       0.01       0.49         NA        XXX
                                                      group.
G0117.............  ..............  T                Glaucoma scrn hgh risk       0.45       0.72       0.19       0.01       1.18       0.65        XXX
                                                      direc.
G0118.............  ..............  T                Glaucoma scrn hgh risk       0.17       0.53       0.06       0.01       0.71       0.24        XXX
                                                      direc.
G0120.............  26............  A                Colon ca scrn; barium        0.99       0.32       0.32       0.04       1.35       1.35        XXX
                                                      enema.
G0120.............  TC............  A                Colon ca scrn; barium        0.00       2.24         NA       0.13       2.37         NA        XXX
                                                      enema.
G0120.............  ..............  A                Colon ca scrn; barium        0.99       2.56         NA       0.17       3.72         NA        XXX
                                                      enema.
G0121.............  53............  A                Colon ca scrn not hi         0.96       2.28       0.50       0.08       3.32       1.54        000
                                                      rsk ind.
G0121.............  ..............  A                Colon ca scrn not hi         3.69       6.16       1.47       0.30      10.15       5.46        000
                                                      rsk ind.
G0122.............  26............  N                Colon ca scrn; barium       +0.99       0.38       0.38       0.05       1.42       1.42        XXX
                                                      enema.
G0122.............  TC............  N                Colon ca scrn; barium       +0.00       2.20       2.20       0.13       2.33       2.33        XXX
                                                      enema.
G0122.............  ..............  N                Colon ca scrn; barium       +0.99       2.58       2.58       0.18       3.75       3.75        XXX
                                                      enema.
G0123.............  ..............  X                Screen cerv/vag thin         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      layer.
G0124.............  ..............  A                Screen c/v thin layer        0.42       0.15       0.15       0.02       0.59       0.59        XXX
                                                      by MD.
G0127.............  ..............  R                Trim nail(s)..........       0.17       0.25       0.07       0.01       0.43       0.25        000
G0128.............  ..............  R                CORF skilled nursing         0.08       0.03       0.03       0.01       0.12       0.12        XXX
                                                      service.
G0130.............  26............  A                Single energy x-ray          0.22       0.07       0.07       0.01       0.30       0.30        XXX
                                                      study.
G0130.............  TC............  A                Single energy x-ray          0.00       0.80         NA       0.05       0.85         NA        XXX
                                                      study.
G0130.............  ..............  A                Single energy x-ray          0.22       0.87         NA       0.06       1.15         NA        XXX
                                                      study.
G0141.............  ..............  A                Scr c/v cyto,autosys         0.42       0.15       0.15       0.02       0.59       0.59        XXX
                                                      and md.
G0143.............  ..............  X                Scr c/v                      0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      cyto,thinlayer,rescr.
G0144.............  ..............  X                Scr c/v                      0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      cyto,thinlayer,rescr.
G0145.............  ..............  X                Scr c/v                      0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      cyto,thinlayer,rescr.
G0147.............  ..............  X                Scr c/v cyto,                0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      automated sys.
G0148.............  ..............  X                Scr c/v cyto, autosys,       0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      rescr.
G0166.............  ..............  A                Extrnl counterpulse,         0.07       3.58       0.03       0.01       3.66       0.11        XXX
                                                      per tx.
G0168.............  ..............  A                Wound closure by             0.45       1.94       0.22       0.03       2.42       0.70        000
                                                      adhesive.
G0173.............  ..............  X                Linear acc stereo            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      radsur com.
G0175.............  ..............  X                OPPS Service,sched           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      team conf.
G0176.............  ..............  X                OPPS/PHP;activity            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      therapy.
G0177.............  ..............  X                OPPS/PHP; train & educ       0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      serv.
G0179.............  ..............  A                MD recertification HHA       0.45       1.03         NA       0.02       1.50         NA        XXX
                                                      PT.
G0180.............  ..............  A                MD certification HHA         0.67       1.26         NA       0.03       1.96         NA        XXX
                                                      patient.
G0181.............  ..............  A                Home health care             1.73       1.48         NA       0.07       3.28         NA        XXX
                                                      supervision.
G0182.............  ..............  A                Hospice care                 1.73       1.66         NA       0.07       3.46         NA        XXX
                                                      supervision.
G0186.............  ..............  C                Dstry eye lesn,fdr           0.00       0.00       0.00       0.00       0.00       0.00        YYY
                                                      vssl tech.
G0202.............  26............  A                Screeningmammographydi       0.70       0.23       0.23       0.03       0.96       0.96        XXX
                                                      gital.
G0202.............  TC............  A                Screeningmammographydi       0.00       2.55         NA       0.07       2.62         NA        XXX
                                                      gital.
G0202.............  ..............  A                Screeningmammographydi       0.70       2.78         NA       0.10       3.58         NA        XXX
                                                      gital.
G0204.............  26............  A                Diagnosticmammographyd       0.87       0.28       0.28       0.04       1.19       1.19        XXX
                                                      igital.
G0204.............  TC............  A                Diagnosticmammographyd       0.00       2.51         NA       0.07       2.58         NA        XXX
                                                      igital.
G0204.............  ..............  A                Diagnosticmammographyd       0.87       2.79         NA       0.11       3.77         NA        XXX
                                                      igital.
G0206.............  26............  A                Diagnosticmammographyd       0.70       0.23       0.23       0.03       0.96       0.96        XXX
                                                      igital.
G0206.............  TC............  A                Diagnosticmammographyd       0.00       2.03         NA       0.06       2.09         NA        XXX
                                                      igital.
G0206.............  ..............  A                Diagnosticmammographyd       0.70       2.26         NA       0.09       3.05         NA        XXX
                                                      igital.
G0219.............  26............  N                PET img wholbod melano       0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      nonco.
G0219.............  TC............  N                PET img wholbod melano       0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      nonco.
G0219.............  ..............  N                PET img wholbod melano       0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      nonco.
G0235.............  26............  N                PET not otherwise            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      specified.
G0235.............  TC............  N                PET not otherwise            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      specified.
G0235.............  ..............  N                PET not otherwise            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      specified.
G0237.............  ..............  A                Therapeutic procd strg       0.00       0.47         NA       0.02       0.49         NA        XXX
                                                      endur.
G0238.............  ..............  A                Oth resp proc, indiv..       0.00       0.49         NA       0.02       0.51         NA        XXX
G0239.............  ..............  A                Oth resp proc, group..       0.00       0.33         NA       0.02       0.35         NA        XXX
G0243.............  ..............  X                Multisour photon stero       0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      treat.
G0245.............  ..............  R                Initial foot exam pt         0.88       0.79       0.31       0.04       1.71       1.23        XXX
                                                      lops.

[[Page 70462]]

 
G0246.............  ..............  R                Followup eval of foot        0.45       0.54       0.16       0.02       1.01       0.63        XXX
                                                      pt lop.
G0247.............  ..............  R                Routine footcare pt w        0.50       0.52       0.21       0.02       1.04       0.73        ZZZ
                                                      lops.
G0248.............  ..............  R                Demonstrate use home         0.00       6.63         NA       0.01       6.64         NA        XXX
                                                      inr mon.
G0249.............  ..............  R                Provide test                 0.00       3.97         NA       0.01       3.98         NA        XXX
                                                      material,equipm.
G0250.............  ..............  R                MD review interpret of       0.18       0.06       0.06       0.01       0.25       0.25        XXX
                                                      test.
G0251.............  ..............  E                Linear acc based stero       0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      radio.
G0255.............  26............  N                Current percep               0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      threshold tst.
G0255.............  TC............  N                Current percep               0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      threshold tst.
G0255.............  ..............  N                Current percep               0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      threshold tst.
G0257.............  ..............  E                Unsched dialysis ESRD        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      pt hos.
G0259.............  ..............  E                Inject for sacroiliac        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      joint.
G0260.............  ..............  E                Inj for sacroiliac jt        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      anesth.
G0265.............  ..............  X                Cryopresevation              0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      Freeze+stora.
G0266.............  ..............  X                Thawing + expansion          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      froz cel.
G0267.............  ..............  X                Bone marrow or psc           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      harvest.
G0268.............  ..............  A                Removal of impacted          0.61       0.63       0.24       0.02       1.26       0.87        000
                                                      wax md.
G0269.............  ..............  B                Occlusive device in          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      vein art.
G0270.............  ..............  A                MNT subs tx for change       0.00       0.47         NA       0.01       0.48         NA        XXX
                                                      dx.
G0271.............  ..............  A                Group MNT 2 or more 30       0.00       0.18         NA       0.01       0.19         NA        XXX
                                                      mins.
G0275.............  ..............  A                Renal angio, cardiac         0.25         NA       0.10       0.01         NA       0.36        ZZZ
                                                      cath.
G0278.............  ..............  A                Iliac art                    0.25         NA       0.10       0.01         NA       0.36        ZZZ
                                                      angio,cardiac cath.
G0281.............  ..............  A                Elec stim unattend for       0.18       0.11         NA       0.01       0.30         NA        XXX
                                                      press.
G0282.............  ..............  N                Elect stim wound care        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      not pd.
G0283.............  ..............  A                Elec stim other than         0.18       0.11         NA       0.01       0.30         NA        XXX
                                                      wound.
G0288.............  ..............  A                Recon, CTA for surg          0.00      10.64         NA       0.18      10.82         NA        XXX
                                                      plan.
G0289.............  ..............  A                Arthro, loose body +         1.48         NA       0.80       0.26         NA       2.54        ZZZ
                                                      chondro.
G0290.............  ..............  E                Drug-eluting stents,         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      single.
G0291.............  ..............  E                Drug-eluting                 0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      stents,each add.
G0293.............  ..............  E                Non-cov surg proc,clin       0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      trial.
G0294.............  ..............  E                Non-cov proc, clinical       0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      trial.
G0295.............  ..............  N                Electromagnetic              0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      therapy onc.
G0297.............  ..............  X                Insert single chamber/       0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      cd.
G0298.............  ..............  X                Insert dual chamber/cd       0.00       0.00       0.00       0.00       0.00       0.00        XXX
G0299.............  ..............  X                Inser/repos single           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      icd+leads.
G0300.............  ..............  X                Insert reposit lead          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      dual+gen.
G0302.............  ..............  X                Pre-op service LVRS          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      complete.
G0303.............  ..............  X                Pre-op service LVRS 10-      0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      15dos.
G0304.............  ..............  X                Pre-op service LVRS 1-       0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      9 dos.
G0305.............  ..............  X                Post op service LVRS         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      min 6.
G0306.............  ..............  X                CBC/diffwbc w/o              0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      platelet.
G0307.............  ..............  X                CBC without platelet..       0.00       0.00       0.00       0.00       0.00       0.00        XXX
G0308.............  ..............  A                ESRD related svc 4+mo       12.74       8.56       8.56       0.42      21.72      21.72        XXX
                                                      < 2yrs.
G0309.............  ..............  A                ESRD related svc 2-3mo      10.61       7.12       7.12       0.36      18.09      18.09        XXX
                                                      <2yrs.
G0310.............  ..............  A                ESRD related svc 1 vst       8.49       5.70       5.70       0.28      14.47      14.47        XXX
                                                      <2yrs.
G0311.............  ..............  A                ESRD related svs 4+mo        9.73       4.73       4.73       0.34      14.80      14.80        XXX
                                                      2-11yr.
G0312.............  ..............  A                ESRD relate svs 2-3 mo       8.11       3.93       3.93       0.29      12.33      12.33        XXX
                                                      2-11y.
G0313.............  ..............  A                ESRD related svs 1 mon       6.49       3.15       3.15       0.22       9.86       9.86        XXX
                                                      2-11y.
G0314.............  ..............  A                ESRD related svs 4+ mo       8.28       4.43       4.43       0.27      12.98      12.98        XXX
                                                      12-19.
G0315.............  ..............  A                ESRD related svs 2-3mo/      6.90       3.68       3.68       0.23      10.81      10.81        XXX
                                                      12-19.
G0316.............  ..............  A                ESRD related svs 1vis/       5.52       2.95       2.95       0.17       8.64       8.64        XXX
                                                      12-19y.
G0317.............  ..............  A                ESRD related svs 4+mo        5.09       2.87       2.87       0.17       8.13       8.13        XXX
                                                      20+yrs.
G0318.............  ..............  A                ESRD related svs 2-3         4.24       2.39       2.39       0.14       6.77       6.77        XXX
                                                      mo 20+y.
G0319.............  ..............  A                ESRD related svs             3.39       1.91       1.91       0.11       5.41       5.41        XXX
                                                      1visit 20+y.
G0320.............  ..............  A                ESD related svs home        10.61       7.12       7.12       0.36      18.09      18.09        XXX
                                                      undr 2.
G0321.............  ..............  A                ESRDrelatedsvs home mo       8.11       3.93       3.93       0.29      12.33      12.33        XXX
                                                      2-11y.
G0322.............  ..............  A                ESRD related svs hom         6.90       3.68       3.68       0.23      10.81      10.81        XXX
                                                      mo12-19.
G0323.............  ..............  A                ESRD related svs home        4.24       2.39       2.39       0.14       6.77       6.77        XXX
                                                      mo 20+.
G0324.............  ..............  A                ESRD relate svs home/        0.35       0.24       0.24       0.01       0.60       0.60        XXX
                                                      dy <2yr.
G0325.............  ..............  A                ESRD relate home/day/        0.23       0.12       0.12       0.01       0.36       0.36        XXX
                                                      2-11yr.
G0326.............  ..............  A                ESRD relate home/dy 12-      0.27       0.13       0.13       0.01       0.41       0.41        XXX
                                                      19yr.
G0327.............  ..............  A                ESRD relate home/dy          0.14       0.08       0.08       0.01       0.23       0.23        XXX
                                                      20+yrs.
G0328.............  ..............  X                Fecal blood scrn             0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      immunoassay.
G0329.............  ..............  A                Electromagntic tx for        0.06       0.14       0.02       0.01       0.21       0.09        XXX
                                                      ulcers.
G0337.............  ..............  X                Hospice evaluation          +1.34       0.51       0.51       0.09       1.94       1.94        XXX
                                                      preelecti.
G0339.............  ..............  C                Robot lin-radsurg com,       0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      first.
G0340.............  ..............  C                Robt lin-radsurg             0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      fractx 2-5.
G0341.............  ..............  A                Percutaneous islet           6.98       5.75       2.60       0.48      13.21      10.06        000
                                                      celltrans.
G0342.............  ..............  A                Laparoscopy islet cell      11.92         NA       5.31       1.46         NA      18.69        090
                                                      trans.
G0343.............  ..............  A                Laparotomy islet cell       19.85         NA       8.78       2.06         NA      30.69        090
                                                      transp.
G0344.............  ..............  A                Initial preventive           1.34       1.13       0.48       0.10       2.57       1.92        XXX
                                                      exam.
G0364.............  ..............  A                Bone marrow aspirate         0.16       0.14       0.06       0.04       0.34       0.26        ZZZ
                                                      &biopsy.
G0365.............  26............  A                Vessel mapping hemo          0.25       0.09       0.09       0.02       0.36       0.36        XXX
                                                      access.
G0365.............  TC............  A                Vessel mapping hemo          0.00       3.91         NA       0.23       4.14         NA        XXX
                                                      access.
G0365.............  ..............  A                Vessel mapping hemo          0.25       4.00         NA       0.25       4.50         NA        XXX
                                                      access.
G0366.............  ..............  A                EKG for initial              0.17       0.51         NA       0.03       0.71         NA        XXX
                                                      prevent exam.

[[Page 70463]]

 
G0367.............  ..............  A                EKG tracing for              0.00       0.45         NA       0.02       0.47         NA        XXX
                                                      initial prev.
G0368.............  ..............  A                EKG interpret & report       0.17       0.06       0.06       0.01       0.24       0.24        XXX
                                                      preve.
G0372.............  ..............  A                MD service required          0.17       0.39       0.06       0.01       0.57       0.24        XXX
                                                      for PMD.
G0375.............  ..............  A                Smoke/tobacco                0.24       0.09       0.09       0.01       0.34       0.34        XXX
                                                      counselng 3-10.
G0376.............  ..............  A                Smoke/tobacco                0.48       0.18       0.17       0.01       0.67       0.66        XXX
                                                      counseling >10.
G0378.............  ..............  X                Hospital observation         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      per hr.
G0379.............  ..............  X                Direct admit hospital        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      observ.
G3001.............  ..............  X                Admin + supply,              0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      tositumomab.
G9001.............  ..............  X                MCCD, initial rate....       0.00       0.00       0.00       0.00       0.00       0.00        XXX
G9002.............  ..............  X                MCCD,maintenance rate.       0.00       0.00       0.00       0.00       0.00       0.00        XXX
G9003.............  ..............  X                MCCD, risk adj hi,           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      initial.
G9004.............  ..............  X                MCCD, risk adj lo,           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      initial.
G9005.............  ..............  X                MCCD, risk adj,              0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      maintenance.
G9006.............  ..............  X                MCCD, Home monitoring.       0.00       0.00       0.00       0.00       0.00       0.00        XXX
G9007.............  ..............  X                MCCD, sch team conf...       0.00       0.00       0.00       0.00       0.00       0.00        XXX
G9008.............  ..............  X                Mccd,phys coor-care          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      ovrsght.
G9009.............  ..............  X                MCCD, risk adj, level        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      3.
G9010.............  ..............  X                MCCD, risk adj, level        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      4.
G9011.............  ..............  X                MCCD, risk adj, level        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      5.
G9012.............  ..............  X                Other Specified Case         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      Mgmt.
G9013.............  ..............  N                ESRD demo bundle level       0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      I.
G9014.............  ..............  N                ESRD demo bundle-level       0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      II.
G9016.............  ..............  N                Demo-smoking cessation       0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      coun.
G9017.............  ..............  X                Amantadine HCL 100mg         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      oral.
G9018.............  ..............  X                Zanamivir,inhalation         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      pwd 10m.
G9019.............  ..............  X                Oseltamivir phosphate        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      75mg.
G9020.............  ..............  X                Rimantadine HCL 100mg        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      oral.
G9021.............  ..............  X                Chemo assess nausea          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      vomit L1.
G9022.............  ..............  X                Chemo assess nausea          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      vomit L2.
G9023.............  ..............  X                Chemo assess nausea          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      vomit L3.
G9024.............  ..............  X                Chemo assess nausea          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      vomit L4.
G9025.............  ..............  X                Chemo assessment pain        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      level1.
G9026.............  ..............  X                Chemo assessment pain        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      level2.
G9027.............  ..............  X                Chemo assessment pain        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      level3.
G9028.............  ..............  X                Chemo assessment pain        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      level4.
G9029.............  ..............  X                Chemo assess for             0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      fatigue L1.
G9030.............  ..............  X                Chemo assess for             0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      fatigue L2.
G9031.............  ..............  X                Chemo assess for             0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      fatigue L3.
G9032.............  ..............  X                Chemo assess for             0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      fatigue L4.
G9033.............  ..............  X                Amantadine HCL oral          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      brand.
G9034.............  ..............  X                Zanamivir, inh pwdr,         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      brand.
G9035.............  ..............  X                Oseltamivir phosp,           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      brand.
G9036.............  ..............  X                Rimantadine HCL, brand       0.00       0.00       0.00       0.00       0.00       0.00        XXX
G9041.............  ..............  X                Low vision rehab             0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      occupationa.
G9042.............  ..............  X                Low vision rehab             0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      orient/mobi.
G9043.............  ..............  X                Low vision lowvision         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      therapi.
G9044.............  ..............  X                Low vision rehabilate        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      teache.
M0064.............  ..............  A                Visit for drug               0.37       0.34       0.12       0.01       0.72       0.50        XXX
                                                      monitoring.
P3001.............  ..............  A                Screening pap smear by       0.42       0.15       0.15       0.02       0.59       0.59        XXX
                                                      phys.
Q0035.............  26............  A                Cardiokymography......       0.17       0.06       0.06       0.01       0.24       0.24        XXX
Q0035.............  TC............  A                Cardiokymography......       0.00       0.39         NA       0.02       0.41         NA        XXX
Q0035.............  ..............  A                Cardiokymography......       0.17       0.45         NA       0.03       0.65         NA        XXX
Q0091.............  ..............  A                Obtaining screen pap         0.37       0.67       0.14       0.02       1.06       0.53        XXX
                                                      smear.
Q0092.............  ..............  A                Set up port xray             0.00       0.32         NA       0.01       0.33         NA        XXX
                                                      equipment.
Q3001.............  ..............  C                Brachytherapy                0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      Radioelements.
Q3014.............  ..............  X                Telehealth facility          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      fee.
R0070.............  ..............  C                Transport portable x-        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      ray.
R0075.............  ..............  C                Transport port x-ray         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      multipl.
R0076.............  ..............  B                Transport portable EKG       0.00       0.00       0.00       0.00       0.00       0.00        XXX
V5299.............  ..............  R                Hearing service.......       0.00       0.00       0.00       0.00       0.00       0.00       XXX
--------------------------------------------------------------------------------------------------------------------------------------------------------
\1\ CPT codes and descriptions only are copyright 2005 American Medical Association. All Rights Reserved.
\2\ Copyright 2005 American Dental Association. All rights reserved.
\3\ +Indicates RVUs are not used for Medicare payment.








Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / 
Rules and Regulations

    --------------------
\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.

                                                          Addendum C.--Codes With Interim RVUs
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                             Physician     Non-                  Mal-       Non-
CPT \1\  HCPCS \2\        Mod            Status            Description          work     Facility   Facility   practice   Facility   Facility    Global
                                                                              RVUs \3\   PE RVUs    PE RVUs      RVUs      Total      Total
--------------------------------------------------------------------------------------------------------------------------------------------------------
15040.............  ..............  A                Harvest cultured skin        2.00       4.57       1.13       0.24       6.81       3.37        000
                                                      graft.
15110.............  ..............  A                Epidrm autogrft trnk/        9.50      10.70       7.02       1.31      21.51      17.83        090
                                                      arm/leg.
15111.............  ..............  A                Epidrm autogrft t/a/l        1.85       1.29       0.79       0.26       3.40       2.90        ZZZ
                                                      add-on.

[[Page 70464]]

 
15115.............  ..............  A                Epidrm a-grft face/nck/      9.81       9.25       7.37       1.15      20.21      18.33        090
                                                      hf/g.
15116.............  ..............  A                Epidrm a-grft f/n/hf/g       2.50       1.58       1.12       0.33       4.41       3.95        ZZZ
                                                      addl.
15130.............  ..............  A                Derm autograft, trnk/        7.00       9.89       6.36       0.97      17.86      14.33        090
                                                      arm/leg.
15131.............  ..............  A                Derm autograft t/a/l         1.50       1.07       0.64       0.21       2.78       2.35        ZZZ
                                                      add-on.
15135.............  ..............  A                Derm autograft face/        10.50       9.90       8.15       1.23      21.63      19.88        090
                                                      nck/hf/g.
15136.............  ..............  A                Derm autograft, f/n/hf/      1.50       0.89       0.67       0.20       2.59       2.37        ZZZ
                                                      g add.
15150.............  ..............  A                Cult epiderm grft t/         8.25       8.48       6.46       1.14      17.87      15.85        090
                                                      arm/leg.
15151.............  ..............  A                Cult epiderm grft t/a/       2.00       1.31       0.85       0.28       3.59       3.13        ZZZ
                                                      l addl.
15152.............  ..............  A                Cult epiderm graft t/a/      2.50       1.56       1.06       0.35       4.41       3.91        ZZZ
                                                      l +%.
15155.............  ..............  A                Cult epiderm graft, f/       9.00       7.84       6.98       1.05      17.89      17.03        090
                                                      n/hf/g.
15156.............  ..............  A                Cult epidrm grft f/n/        2.75       1.56       1.24       0.36       4.67       4.35        ZZZ
                                                      hfg add.
15157.............  ..............  A                Cult epiderm grft f/n/       3.00       1.78       1.35       0.39       5.17       4.74        ZZZ
                                                      hfg +%.
15170.............  ..............  A                Acell graft trunk/arms/      5.00       3.84       2.37       0.55       9.39       7.92        090
                                                      legs.
15171.............  ..............  A                Acell graft t/arm/leg        1.55       0.68       0.62       0.19       2.42       2.36        ZZZ
                                                      add-on.
15175.............  ..............  A                Acellular graft, f/n/        7.00       5.44       4.01       0.82      13.26      11.83        090
                                                      hf/g.
15176.............  ..............  A                Acell graft, f/n/hf/g        2.45       1.11       0.99       0.29       3.85       3.73        ZZZ
                                                      add-on.
15300.............  ..............  A                Apply skinallogrft, t/       3.99       3.21       2.24       0.49       7.69       6.72        090
                                                      arm/lg.
15301.............  ..............  A                Apply sknallogrft t/a/       1.00       0.47       0.40       0.14       1.61       1.54        ZZZ
                                                      l addl.
15320.............  ..............  A                Apply skin allogrft f/       4.70       3.63       2.54       0.58       8.91       7.82        090
                                                      n/hf/g.
15321.............  ..............  A                Aply sknallogrft f/n/        1.50       0.69       0.59       0.21       2.40       2.30        ZZZ
                                                      hfg add.
15330.............  ..............  A                Aply acell alogrft t/        3.99       3.20       2.23       0.49       7.68       6.71        090
                                                      arm/leg.
15331.............  ..............  A                Aply acell grft t/a/l        1.00       0.46       0.40       0.14       1.60       1.54        ZZZ
                                                      add-on.
15335.............  ..............  A                Apply acell graft, f/n/      4.50       3.48       2.45       0.55       8.53       7.50        090
                                                      hf/g.
15336.............  ..............  A                Aply acell grft f/n/hf/      1.43       0.69       0.57       0.20       2.32       2.20        ZZZ
                                                      g add.
15340.............  ..............  A                Apply cult skin              3.72       4.01       2.76       0.41       8.14       6.89        010
                                                      substitute.
15341.............  ..............  A                Apply cult skin sub          0.50       0.61       0.20       0.06       1.17       0.76        ZZZ
                                                      add-on.
15360.............  ..............  A                Apply cult derm sub, t/      3.87       4.48       3.09       0.43       8.78       7.39        090
                                                      a/l.
15361.............  ..............  A                Aply cult derm sub t/a/      1.15       0.58       0.46       0.14       1.87       1.75        ZZZ
                                                      l add.
15365.............  ..............  A                Apply cult derm sub f/       4.15       4.56       3.20       0.46       9.17       7.81        090
                                                      n/hf/g.
15366.............  ..............  A                Apply cult derm f/hf/g       1.45       0.70       0.58       0.17       2.32       2.20        ZZZ
                                                      add.
15420.............  ..............  A                Apply skin xgraft, f/n/      4.50       4.79       3.80       0.52       9.81       8.82        090
                                                      hf/g.
15421.............  ..............  A                Apply skn xgrft f/n/hf/      1.50       1.32       0.62       0.21       3.03       2.33        ZZZ
                                                      g add.
15430.............  ..............  A                Apply acellular              5.75       6.92       6.63       0.66      13.33      13.04        090
                                                      xenograft.
15431.............  ..............  C                Apply acellular xgraft       0.00       0.00       0.00       0.00       0.00       0.00        ZZZ
                                                      add.
22010.............  ..............  A                I&d, p-spine, c/t/cerv-     11.05         NA       8.91       1.73         NA      21.69        090
                                                      thor.
22015.............  ..............  A                I&d, p-spine, l/s/ls..      10.94         NA       8.85       1.71         NA      21.50        090
22523.............  ..............  A                Percut kyphoplasty,          8.94         NA       5.92       1.43         NA      16.29        010
                                                      thor.
22524.............  ..............  A                Percut kyphoplasty,          8.54         NA       5.71       1.36         NA      15.61        010
                                                      lumbar.
22525.............  ..............  A                Percut kyphoplasty,          4.47         NA       2.28       0.72         NA       7.47        ZZZ
                                                      add-on.
28890.............  ..............  A                High energy eswt,            3.30       5.73       2.09       0.41       9.44       5.80        090
                                                      plantar f.
32503.............  ..............  A                Resect apical lung          30.00         NA      15.11       4.37         NA      49.48        090
                                                      tumor.
32504.............  ..............  A                Resect apical lung tum/     34.80         NA      16.72       5.07         NA      56.59        090
                                                      chest.
33507.............  ..............  A                Repair art, intramural      30.00         NA      13.68       4.05         NA      47.73        090
33548.............  ..............  A                Restore/remodel,            37.97         NA      19.35       5.51         NA      62.83        090
                                                      ventricle.
33768.............  ..............  A                Cavopulmonary shunting       8.00         NA       2.67       1.19         NA      11.86        ZZZ
33880.............  ..............  A                Endovasc taa repr incl      33.00         NA      13.51       2.74         NA      49.25        090
                                                      subcl.
33881.............  ..............  A                Endovasc taa repr w/o       28.00         NA      11.99       2.32         NA      42.31        090
                                                      subcl.
33883.............  ..............  A                Insert endovasc             20.00         NA       9.21       2.10         NA      31.31        090
                                                      prosth, taa.
33884.............  ..............  A                Endovasc prosth, taa,        8.20         NA       2.58       0.86         NA      11.64        ZZZ
                                                      add-on.
33886.............  ..............  A                Endovasc prosth,            17.00         NA       8.25       1.79         NA      27.04        090
                                                      delayed.
33889.............  ..............  A                Artery transpose/           15.92         NA       5.19       2.17         NA      23.28        000
                                                      endovas taa.
33891.............  ..............  A                Car-car bp grft/            20.00         NA       6.98       2.72         NA      29.70        000
                                                      endovas taa.
33925.............  ..............  A                Rpr pul art unifocal w/     29.50         NA      14.70       4.60         NA      48.80        090
                                                      o cpb.
33926.............  ..............  A                Repr pul art, unifocal      42.00         NA      17.73       6.20         NA      65.93        090
                                                      w/cpb.
36598.............  ..............  T                Inj w/fluor, eval cv         0.74       2.65       2.65       0.05       3.44       3.44        000
                                                      device.
37184.............  ..............  A                Prim art mech                8.66      71.90       3.36       0.55      81.11      12.57        000
                                                      thrombectomy.
37185.............  ..............  A                Prim art m-thrombect         3.28      22.95       1.11       0.21      26.44       4.60        ZZZ
                                                      add-on.
37186.............  ..............  A                Sec art m-thrombect          4.92      49.53       1.66       0.32      54.77       6.90        ZZZ
                                                      add-on.
37187.............  ..............  A                Venous mech                  8.03      70.38       3.15       0.51      78.92      11.69        000
                                                      thrombectomy.
37188.............  ..............  A                Venous m-thrombectomy        5.71      62.15       2.37       0.37      68.23       8.45        000
                                                      add-on.
37718.............  ..............  A                Ligate/strip short leg       6.76         NA       4.07       0.14         NA      10.97        090
                                                      vein.
37722.............  ..............  A                Ligate/strip long leg        7.79         NA       4.42       0.86         NA      13.07        090
                                                      vein.
43770.............  ..............  A                Lap, place gastr            16.71         NA       7.73       2.18         NA      26.62        090
                                                      adjust band.
43771.............  ..............  A                Lap, revise adjust          19.50         NA       8.61       2.54         NA      30.65        090
                                                      gast band.
43772.............  ..............  A                Lap, remove adjust          15.00         NA       6.44       1.92         NA      23.36        090
                                                      gast band.
43773.............  ..............  A                Lap, change adjust          19.50         NA       8.61       2.55         NA      30.66        090
                                                      gast band.
43774.............  ..............  A                Lap remov adj gast          15.00         NA       6.58       1.84         NA      23.42        090
                                                      band/port.
43845.............  ..............  A                Gastroplasty duodenal       31.00      10.80      10.80       4.05      45.85      45.85        090
                                                      switch.
43886.............  ..............  A                Revise gastric port,         4.00         NA       3.14       0.25         NA       7.39        090
                                                      open.
43887.............  ..............  A                Remove gastric port,         3.95         NA       2.78       0.51         NA       7.24        090
                                                      open.
43888.............  ..............  A                Change gastric port,         5.80         NA       3.77       0.70         NA      10.27        090
                                                      open.
44180.............  ..............  A                Lap, enterolysis......      14.42         NA       6.25       1.85         NA      22.52        090
44186.............  ..............  A                Lap, jejunostomy......       9.77         NA       4.80       1.27         NA      15.84        090
44187.............  ..............  A                Lap, ileo/jejuno-stomy      15.93         NA       8.29       1.95         NA      26.17        090
44188.............  ..............  A                Lap, colostomy........      17.61         NA       8.87       2.23         NA      28.71        090

[[Page 70465]]

 
44213.............  ..............  A                Lap, mobil splenic fl        3.50         NA       1.22       0.44         NA       5.16        ZZZ
                                                      add-on.
44227.............  ..............  A                Lap, close enterostomy      26.50         NA      10.65       3.37         NA      40.52        090
45395.............  ..............  A                Lap, removal of rectum      30.50         NA      13.71       3.62         NA      47.83        090
45397.............  ..............  A                Lap, remove rectum w/       34.00         NA      14.30       3.66         NA      51.96        090
                                                      pouch.
45400.............  ..............  A                Laparoscopic                18.06         NA       7.85       2.02         NA      27.93        090
                                                      proctopexy.
45402.............  ..............  A                Lap proctopexy w/sig        25.04         NA      10.01       2.81         NA      37.86        090
                                                      resect.
45499.............  ..............  C                Laparoscope proc,            0.00       0.00       0.00       0.00       0.00       0.00        YYY
                                                      rectum.
45990.............  ..............  A                Surg dx exam,                1.80         NA       0.79       0.17         NA       2.76        000
                                                      anorectal.
46505.............  ..............  A                Chemodenervation anal        2.86       3.05       1.97       0.14       6.05       4.97        010
                                                      musc.
46710.............  ..............  A                Repr per/vag pouch          16.00         NA       7.77       1.38         NA      25.15        090
                                                      sngl proc.
46712.............  ..............  A                Repr per/vag pouch dbl      34.00         NA      15.08       3.66         NA      52.74        090
                                                      proc.
50250.............  ..............  A                Cryoablate renal mass       19.97         NA       9.18       1.39         NA      30.54        090
                                                      open.
50382.............  ..............  A                Change ureter stent,         5.50      36.22       1.87       0.34      42.06       7.71        000
                                                      percut.
50384.............  ..............  A                Remove ureter stent,         5.00      35.32       1.71       0.31      40.63       7.02        000
                                                      percut.
50387.............  ..............  A                Change ext/int ureter        2.00      18.26       0.67       0.12      20.38       2.79        000
                                                      stent.
50389.............  ..............  A                Remove renal tube w/         1.10      12.78       0.37       0.07      13.95       1.54        000
                                                      fluoro.
50592.............  ..............  A                Perc rf ablate renal         6.75     149.45       2.99       0.43     156.63      10.17        010
                                                      tumor.
51999.............  ..............  C                Laparoscope proc,            0.00       0.00       0.00       0.00       0.00       0.00        YYY
                                                      bladder.
57295.............  ..............  A                Change vaginal graft..       7.45         NA       4.44       0.91         NA      12.80        090
58110.............  ..............  A                Bx done w/colposcopy         0.77       0.55       0.31       0.09       1.41       1.17        ZZZ
                                                      add-on.
61630.............  ..............  N                Intracranial                 0.00       0.00       0.00       0.00       0.00       0.00        090
                                                      angioplasty.
61635.............  ..............  N                Intracran angioplsty w/      0.00       0.00       0.00       0.00       0.00       0.00        090
                                                      stent.
61640.............  ..............  N                Dilate ic vasospasm,         0.00       0.00       0.00       0.00       0.00       0.00        000
                                                      init.
61641.............  ..............  N                Dilate ic vasospasm          0.00       0.00       0.00       0.00       0.00       0.00        ZZZ
                                                      add-on.
61642.............  ..............  N                Dilate ic vasospasm          0.00       0.00       0.00       0.00       0.00       0.00        ZZZ
                                                      add-on.
64650.............  ..............  A                Chemodenerv eccrine          0.70       0.87       0.30       0.06       1.63       1.06        000
                                                      glands.
64653.............  ..............  A                Chemodenerv eccrine          0.88       0.92       0.38       0.08       1.88       1.34        000
                                                      glands.
67901.............  ..............  A                Repair eyelid defect..       7.39         NA       5.42       0.54         NA      13.35        090
67902.............  ..............  A                Repair eyelid defect..       9.35         NA       5.48       0.60         NA      15.43        090
75956.............  26............  A                Xray, endovasc thor ao       7.00       2.71       2.71       0.69      10.40      10.40        XXX
                                                      repr.
75957.............  26............  A                Xray, endovasc thor ao       6.00       2.32       2.32       0.59       8.91       8.91        XXX
                                                      repr.
75958.............  26............  A                Xray, place prox ext         4.00       1.55       1.55       0.39       5.94       5.94        XXX
                                                      thor ao.
75959.............  26............  A                Xray, place dist ext         3.50       1.36       1.36       0.34       5.20       5.20        XXX
                                                      thor ao.
76376.............  26............  A                3d render w/o                0.20       0.07       0.07       0.02       0.29       0.29        XXX
                                                      postprocess.
76377.............  26............  A                3d rendering w/              0.79       0.27       0.27       0.08       1.14       1.14        XXX
                                                      postprocess.
77421.............  26............  A                Stereoscopic x-ray           0.39       0.13       0.13       0.02       0.54       0.54        XXX
                                                      guidance.
77422.............  ..............  A                Neutron beam tx,             0.00       1.71         NA       0.13       1.84         NA        XXX
                                                      simple.
77423.............  ..............  A                Neutron beam tx,             0.00       2.26         NA       0.13       2.39         NA        XXX
                                                      complex.
88333.............  26............  A                Intraop cyto path            1.20       0.53       0.53       0.04       1.77       1.77        XXX
                                                      consult, 1.
88334.............  26............  A                Intraop cyto path            0.59       0.26       0.26       0.02       0.87       0.87        XXX
                                                      consult, 2.
88384.............  26............  C                Eval molecular probes,       0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      11-50.
88385.............  26............  A                Eval molecul probes,         1.50       0.65       0.65       0.06       2.21       2.21        XXX
                                                      51-250.
88386.............  26............  A                Eval molecul probes,         1.88       0.82       0.82       0.08       2.78       2.78        XXX
                                                      251-500.
89049.............  ..............  A                Chct for mal                 1.40       3.56       0.27       0.06       5.02       1.73        XXX
                                                      hyperthermia.
90760.............  ..............  A                Hydration iv infusion,       0.17       1.43       1.43       0.07       1.67       1.67        XXX
                                                      init.
90761.............  ..............  A                Hydrate iv infusion,         0.09       0.40       0.40       0.04       0.53       0.53        ZZZ
                                                      add-on.
90765.............  ..............  A                Ther/proph/diag iv           0.21       1.76       1.76       0.07       2.04       2.04        XXX
                                                      inf, init.
90766.............  ..............  A                Ther/proph/dg iv inf,        0.18       0.46       0.46       0.04       0.68       0.68        ZZZ
                                                      add-on.
90767.............  ..............  A                Tx/proph/dg addl seq         0.19       0.89       0.89       0.04       1.12       1.12        ZZZ
                                                      iv inf.
90768.............  ..............  A                Ther/diag concurrent         0.17       0.44       0.44       0.04       0.65       0.65        ZZZ
                                                      inf.
90772.............  ..............  A                Ther/proph/diag inj,         0.17       0.31       0.31       0.01       0.49       0.49        XXX
                                                      sc/im.
90773.............  ..............  A                Ther/proph/diag inj,         0.17       0.32       0.32       0.02       0.51       0.51        XXX
                                                      ia.
90774.............  ..............  A                Ther/proph/diag inj,         0.18       1.30       1.30       0.04       1.52       1.52        XXX
                                                      iv push.
90775.............  ..............  A                Ther/proph/diag inj          0.10       0.57       0.57       0.04       0.71       0.71        ZZZ
                                                      add-on.
90779.............  ..............  C                Ther/prop/diag inj/inf       0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      proc.
91022.............  26............  A                Duodenal motility            1.44       0.51       0.51       0.07       2.02       2.02        000
                                                      study.
92520.............  ..............  A                Laryngeal function           0.75       0.51       0.39       0.03       1.29       1.17        XXX
                                                      studies.
92626.............  ..............  A                Eval aud rehab status.       0.00       0.55         NA       0.06       0.61         NA        XXX
92627.............  ..............  A                Eval aud status rehab        0.00       0.55         NA       0.06       0.61         NA        XXX
                                                      add-on.
92630.............  ..............  I                Aud rehab pre-ling           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      hear loss.
92633.............  ..............  I                Aud rehab postling           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      hear loss.
95251.............  ..............  A                Gluc monitor, cont,          0.52       0.19       0.19       0.02       0.73       0.73        XXX
                                                      phys i&r.
95865.............  26............  A                Muscle test, larynx...       1.57       0.77       0.77       0.08       2.42       2.42        XXX
95866.............  26............  A                Muscle test,                 1.25       0.56       0.56       0.07       1.88       1.88        XXX
                                                      hemidiaphragm.
95873.............  26............  A                Guide nerv destr, elec       0.37       0.16       0.16       0.02       0.55       0.55        ZZZ
                                                      stim.
95874.............  26............  A                Guide nerv destr,            0.37       0.17       0.17       0.02       0.56       0.56        ZZZ
                                                      needle emg.
96101.............  ..............  A                Psycho testing by            1.86       0.65       0.63       0.05       2.56       2.54        XXX
                                                      psych/phys.
96102.............  ..............  A                Psycho testing by            0.50       0.66       0.17       0.01       1.17       0.68        XXX
                                                      technician.
96103.............  ..............  A                Psycho testing admin         0.51       0.21       0.17       0.02       0.74       0.70        XXX
                                                      by comp.
96116.............  ..............  A                Neurobehavioral status       1.86       0.83       0.64       0.18       2.87       2.68        XXX
                                                      exam.
96118.............  ..............  A                Neuropsych tst by            1.86       1.39       0.63       0.18       3.43       2.67        XXX
                                                      psych/phys.
96119.............  ..............  A                Neuropsych testing by        0.55       1.02       0.19       0.18       1.75       0.92        XXX
                                                      tech.
96120.............  ..............  A                Neuropsych tst admin w/      0.51       0.74       0.17       0.02       1.27       0.70        XXX
                                                      comp.
96401.............  ..............  A                Chemo, anti-neopl, sq/       0.21       1.53       1.53       0.01       1.75       1.75        XXX
                                                      im.
96402.............  ..............  A                Chemo hormon antineopl       0.19       0.74       0.74       0.01       0.94       0.94        XXX
                                                      sq/im.

[[Page 70466]]

 
96409.............  ..............  A                Chemo, iv push, sngl         0.24       2.93       2.93       0.06       3.23       3.23        XXX
                                                      drug.
96411.............  ..............  A                Chemo, iv push, addl         0.20       1.61       1.61       0.06       1.87       1.87        ZZZ
                                                      drug.
96413.............  ..............  A                Chemo, iv infusion, 1        0.28       4.20       4.20       0.08       4.56       4.56        XXX
                                                      hr.
96415.............  ..............  A                Chemo, iv infusion,          0.19       0.77       0.77       0.07       1.03       1.03        ZZZ
                                                      addl hr.
96416.............  ..............  A                Chemo prolong infuse w/      0.21       4.61       4.61       0.08       4.90       4.90        XXX
                                                      pump.
96417.............  ..............  A                Chemo iv infus each          0.21       1.95       1.95       0.07       2.23       2.23        ZZZ
                                                      addl seq.
96450.............  ..............  A                Chemotherapy, into CNS       1.53       6.96       1.29       0.09       8.58       2.91        000
96521.............  ..............  A                Refill/maint, portable       0.21       3.77       3.77       0.06       4.04       4.04        XXX
                                                      pump.
96522.............  ..............  A                Refill/maint pump/           0.21       2.65       2.65       0.06       2.92       2.92        XXX
                                                      resvr syst.
96523.............  ..............  T                Irrig drug delivery          0.04       0.69       0.69       0.01       0.74       0.74        XXX
                                                      device.
96542.............  ..............  A                Chemotherapy injection       0.75       4.24       0.66       0.07       5.06       1.48        XXX
97760.............  ..............  A                Orthotic mgmt and            0.45       0.34       0.20       0.03       0.82       0.68        XXX
                                                      training.
97761.............  ..............  A                Prosthetic training...       0.45       0.28       0.19       0.02       0.75       0.66        XXX
97762.............  ..............  A                C/o for orthotic/            0.25       0.42       0.19       0.02       0.69       0.46        XXX
                                                      prosth use.
98960.............  ..............  N                Self-mgmt educ &             0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      train, 1 pt.
98961.............  ..............  N                Self-mgmt educ/train,        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      2-4 pt.
98962.............  ..............  N                Self-mgmt educ/train,        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      5-8 pt.
99143.............  ..............  C                Mod cs by same phys, <       0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      5 yrs.
99144.............  ..............  C                Mod cs by same phys, 5       0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      yrs +.
99145.............  ..............  C                Mod cs by same phys          0.00       0.00       0.00       0.00       0.00       0.00        ZZZ
                                                      add-on.
99148.............  ..............  C                Mod cs diff phys < 5         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      yrs.
99149.............  ..............  C                Mod cs diff phys 5 yrs       0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      +.
99150.............  ..............  C                Mod cs diff phys add-        0.00       0.00       0.00       0.00       0.00       0.00        ZZZ
                                                      on.
99300.............  ..............  A                Ic, infant pbw 2501-         2.40         NA       0.84       2.40         NA       5.64        XXX
                                                      5000 gm.
99304.............  ..............  A                Nursing facility care,       1.20       0.49       0.49       0.05       1.74       1.74        XXX
                                                      init.
99305.............  ..............  A                Nursing facility care,       1.61       0.63       0.63       0.07       2.31       2.31        XXX
                                                      init.
99306.............  ..............  A                Nursing facility care,       2.01       0.75       0.75       0.09       2.85       2.85        XXX
                                                      init.
99307.............  ..............  A                Nursing fac care,            0.60       0.27       0.27       0.03       0.90       0.90        XXX
                                                      subseq.
99308.............  ..............  A                Nursing fac care,            1.00       0.45       0.45       0.04       1.49       1.49        XXX
                                                      subseq.
99309.............  ..............  A                Nursing fac care,            1.42       0.62       0.62       0.06       2.10       2.10        XXX
                                                      subseq.
99310.............  ..............  A                Nursing fac care,            1.77       0.78       0.78       0.08       2.63       2.63        XXX
                                                      subseq.
99318.............  ..............  A                Annual nursing fac           1.20       0.49       0.49       0.05       1.74       1.74        XXX
                                                      assessmnt.
99324.............  ..............  A                Domicil/r-home visit         1.01       0.49       0.38       0.05       1.55       1.44        XXX
                                                      new pat.
99325.............  ..............  A                Domicil/r-home visit         1.52       0.68       0.55       0.07       2.27       2.14        XXX
                                                      new pat.
99326.............  ..............  A                Domicil/r-home visit         2.27       0.92       0.78       0.10       3.29       3.15        XXX
                                                      new pat.
99327.............  ..............  A                Domicil/r-home visit         3.03       1.17       1.05       0.13       4.33       4.21        XXX
                                                      new pat.
99328.............  ..............  A                Domicil/r-home visit         3.78       1.42       1.31       0.16       5.36       5.25        XXX
                                                      new pat.
99334.............  ..............  A                Domicil/r-home visit         0.76       0.40       0.26       0.04       1.20       1.06        XXX
                                                      est pat.
99335.............  ..............  A                Domicil/r-home visit         1.26       0.58       0.43       0.06       1.90       1.75        XXX
                                                      est pat.
99336.............  ..............  A                Domicil/r-home visit         2.02       0.82       0.66       0.09       2.93       2.77        XXX
                                                      est pat.
99337.............  ..............  A                Domicil/r-home visit         3.03       1.15       0.98       0.13       4.31       4.14        XXX
                                                      est pat.
99339.............  ..............  B                Domicil/r-home care          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                      supervis.
99340.............  ..............  I                Domicil/r-home care          0.00       0.00       0.00       0.00       0.00       0.00       XXX
                                                      supervis.
--------------------------------------------------------------------------------------------------------------------------------------------------------
\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.








Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / 
Rules and Regulations


               Addendum D.--2006 Geographic Practice Cost Indices by Medicare Carrier and Locality
----------------------------------------------------------------------------------------------------------------
                                                                                         Work      PE       MP
         Carrier                    Locality                   Locality Name             GPCI     GPCI     GPCI
----------------------------------------------------------------------------------------------------------------
00510....................  00.......................  Alabama........................    1.000    0.846    0.752
00831....................  01.......................  Alaska.........................    1.017    1.103    1.029
00832....................  00.......................  Arizona........................    1.000    0.992    1.069
00520....................  13.......................  Arkansas.......................    1.000    0.831    0.438
31140....................  03.......................  Marin/Napa/Solano, CA..........    1.035    1.340    0.651
31140....................  05.......................  San Francisco, CA..............    1.060    1.543    0.651
31140....................  06.......................  San Mateo, CA..................    1.073    1.536    0.639
31140....................  07.......................  Oakland/Berkley, CA............    1.054    1.371    0.651
31140....................  09.......................  Santa Clara, CA................    1.083    1.540    0.604
31146....................  17.......................  Ventura, CA....................    1.028    1.179    0.744
31146....................  18.......................  Los Angeles, CA................    1.041    1.156    0.954
31146....................  26.......................  Anaheim/Santa Ana, CA..........    1.034    1.236    0.954
31140....................  99.......................  Rest of California*............    1.007    1.053    0.733
31146....................  99.......................  Rest of California*............    1.007    1.053    0.733
00824....................  01.......................  Colorado.......................    1.000    1.014    0.803
00591....................  00.......................  Connecticut....................    1.038    1.170    0.900
00903....................  01.......................  DC + MD/VA Suburbs.............    1.048    1.250    0.926
00902....................  01.......................  Delaware.......................    1.012    1.018    0.892
00590....................  03.......................  Fort Lauderdale, FL............    1.000    0.988    1.703
00590....................  04.......................  Miami, FL......................    1.000    1.046    2.269
00590....................  99.......................  Rest of Florida................    1.000    0.934    1.272

[[Page 70467]]

 
00511....................  01.......................  Atlanta, GA....................    1.010    1.089    0.966
00511....................  99.......................  Rest of Georgia................    1.000    0.872    0.966
00833....................  01.......................  Hawaii/Guam....................    1.005    1.111    0.800
05130....................  00.......................  Idaho..........................    1.000    0.868    0.459
00952....................  12.......................  East St. Louis, IL.............    1.000    0.939    1.750
00952....................  15.......................  Suburban Chicago, IL...........    1.018    1.115    1.652
00952....................  16.......................  Chicago, IL....................    1.025    1.126    1.867
00952....................  99.......................  Rest of Illinois...............    1.000    0.872    1.193
00630....................  00.......................  Indiana........................    1.000    0.906    0.436
00826....................  00.......................  Iowa...........................    1.000    0.868    0.589
00650....................  00.......................  Kansas*........................    1.000    0.878    0.721
00660....................  00.......................  Kentucky.......................    1.000    0.854    0.873
00528....................  01.......................  New Orleans, LA................    1.000    0.946    1.197
00528....................  99.......................  Rest of Louisiana..............    1.000    0.847    1.058
31142....................  03.......................  Southern Maine.................    1.000    1.013    0.637
31142....................  99.......................  Rest of Maine..................    1.000    0.886    0.637
00901....................  01.......................  Baltimore/Surr. Cntys, MD......    1.012    1.078    0.947
00901....................  99.......................  Rest of Maryland...............    1.000    0.980    0.760
31143....................  01.......................  Metropolitan Boston............    1.030    1.329    0.823
31143....................  99.......................  Rest of Massachusetts..........    1.007    1.103    0.823
00953....................  01.......................  Detroit, MI....................    1.037    1.054    2.744
00953....................  99.......................  Rest of Michigan...............    1.000    0.921    1.518
00954....................  00.......................  Minnesota......................    1.000    1.005    0.410
00512....................  00.......................  Mississippi....................    1.000    0.839    0.722
00740....................  02.......................  Metropolitan Kansas City, MO...    1.000    0.975    0.946
00523....................  01.......................  Metropolitan St. Louis, MO.....    1.000    0.955    0.941
00523....................  99.......................  Rest of Missouri*..............    1.000    0.802    0.892
00740....................  99.......................  Rest of Missouri*..............    1.000    0.802    0.892
00751....................  01.......................  Montana........................    1.000    0.844    0.904
00655....................  00.......................  Nebraska.......................    1.000    0.875    0.454
00834....................  00.......................  Nevada.........................    1.003    1.043    1.068
31144....................  40.......................  New Hampshire..................    1.000    1.027    0.942
00805....................  01.......................  Northern NJ....................    1.058    1.220    0.973
00805....................  99.......................  Rest of New Jersey.............    1.043    1.119    0.973
00521....................  05.......................  New Mexico.....................    1.000    0.887    0.895
00801....................  99.......................  Rest of New York...............    1.000    0.917    0.677
00803....................  01.......................  Manhattan, NY..................    1.065    1.298    1.504
00803....................  02.......................  NYC Suburbs/Long I., NY........    1.052    1.280    1.785
00803....................  03.......................  Poughkpsie/N NYC Suburbs, NY...    1.014    1.074    1.167
14330....................  04.......................  Queens, NY.....................    1.032    1.228    1.710
05535....................  00.......................  North Carolina.................    1.000    0.920    0.640
00820....................  01.......................  North Dakota...................    1.000    0.860    0.602
00883....................  00.......................  Ohio...........................    1.000    0.933    0.976
00522....................  00.......................  Oklahoma.......................    1.000    0.854    0.382
00835....................  01.......................  Portland, OR...................    1.002    1.057    0.441
00835....................  99.......................  Rest of Oregon.................    1.000    0.925    0.441
00865....................  01.......................  Metropolitan Philadelphia, PA..    1.016    1.104    1.386
00865....................  99.......................  Rest of Pennsylvania...........    1.000    0.902    0.806
00973....................  20.......................  Puerto Rico....................    1.000    0.698    0.261
00524....................  01.......................  Rhode Island...................    1.045    0.989    0.909
00880....................  01.......................  South Carolina.................    1.000    0.893    0.394
00820....................  02.......................  South Dakota...................    1.000    0.876    0.365
05440....................  35.......................  Tennessee......................    1.000    0.879    0.631
00900....................  09.......................  Brazoria, TX...................    1.020    0.961    1.298
00900....................  11.......................  Dallas, TX.....................    1.009    1.062    1.061
00900....................  15.......................  Galveston, TX..................    1.000    0.952    1.298
00900....................  18.......................  Houston, TX....................    1.016    1.014    1.297
00900....................  20.......................  Beaumont, TX...................    1.000    0.860    1.298
00900....................  28.......................  Fort Worth, TX.................    1.000    0.989    1.061
00900....................  31.......................  Austin, TX.....................    1.000    1.046    0.986
00900....................  99.......................  Rest of Texas..................    1.000    0.865    1.138
00823....................  09.......................  Utah...........................    1.000    0.937    0.662
31145....................  50.......................  Vermont........................    1.000    0.968    0.514
00973....................  50.......................  Virgin Islands.................    1.000    1.014    1.003
00904....................  00.......................  Virginia.......................    1.000    0.940    0.579
00836....................  02.......................  Seattle (King Cnty), WA........    1.014    1.131    0.819
00836....................  99.......................  Rest of Washington.............    1.000    0.978    0.819
00884....................  16.......................  West Virginia..................    1.000    0.819    1.547
00951....................  00.......................  Wisconsin......................    1.000    0.918    0.790
00825....................  21.......................  Wyoming........................    1.000    0.853   0.935
----------------------------------------------------------------------------------------------------------------
For 2005 & 2006, if the work GPCI falls below a 1.0 index, the work GPCI equals 1.0.

[[Page 70468]]

 
* States are served by more than one carrier.


                         Addendum E.--2006 GAFs
------------------------------------------------------------------------
                                                                   2006
      Carrier            Locality            Locality name         GAF
------------------------------------------------------------------------
31140.............  09...............  Santa Clara, CA.........    1.265
31140.............  06...............  San Mateo, CA...........    1.259
31140.............  05...............  San Francisco, CA.......    1.256
00803.............  01...............  Manhattan, NY...........    1.184
00803.............  02...............  NYC Suburbs/Long I., NY.    1.180
31140.............  07...............  Oakland/Berkley, CA.....    1.177
31140.............  03...............  Marin/Napa/Solano, CA...    1.154
31143.............  01...............  Metropolitan Boston.....    1.153
14330.............  04...............  Queens, NY..............    1.144
00903.............  01...............  DC + MD/VA Suburbs......    1.132
00805.............  01...............  Northern NJ.............    1.126
31146.............  26...............  Anaheim/Santa Ana, CA...    1.119
00953.............  01...............  Detroit, MI.............    1.111
00952.............  16...............  Chicago, IL.............    1.102
00591.............  00...............  Connecticut.............    1.091
31146.............  18...............  Los Angeles, CA.........    1.088
00952.............  15...............  Suburban Chicago, IL....    1.085
31146.............  17...............  Ventura, CA.............    1.083
00805.............  99...............  Rest of New Jersey......    1.074
00865.............  01...............  Metropolitan                1.069
                                        Philadelphia, PA.
00590.............  04...............  Miami, FL...............    1.069
00836.............  02...............  Seattle (King Cnty), WA.    1.058
00831.............  01...............  Alaska..................    1.055
00803.............  03...............  Poughkpsie/N NYC            1.046
                                        Suburbs, NY.
00833.............  01...............  Hawaii/Guam.............    1.044
00511.............  01...............  Atlanta, GA.............    1.043
31143.............  99...............  Rest of Massachusetts...    1.042
00901.............  01...............  Baltimore/Surr. Cntys,      1.039
                                        MD.
00900.............  11...............  Dallas, TX..............    1.034
00900.............  18...............  Houston, TX.............    1.026
00834.............  00...............  Nevada..................    1.023
00590.............  03...............  Fort Lauderdale, FL.....    1.022
00900.............  31...............  Austin, TX..............    1.020
31146.............  99...............  Rest of California*.....    1.017
31140.............  99...............  Rest of California*.....    1.017
31144.............  40...............  New Hampshire...........    1.010
00902.............  01...............  Delaware................    1.010
00973.............  50...............  Virgin Islands..........    1.007
00900.............  09...............  Brazoria, TX............    1.005
00835.............  01...............  Portland, OR............    1.005
00952.............  12...............  East St. Louis, IL......    1.003
00832.............  00...............  Arizona.................    0.999
00824.............  01...............  Colorado................    0.999
00900.............  28...............  Fort Worth, TX..........    0.998
31142.............  03...............  Southern Maine..........    0.992
00900.............  15...............  Galveston, TX...........    0.991
00740.............  02...............  Metropolitan Kansas         0.987
                                        City, MO.
00953.............  99...............  Rest of Michigan........    0.986
00836.............  99...............  Rest of Washington......    0.984
00528.............  01...............  New Orleans, LA.........    0.984
00901.............  99...............  Rest of Maryland........    0.982
00590.............  99...............  Rest of Florida.........    0.982
00954.............  00...............  Minnesota...............    0.980
00523.............  01...............  Metropolitan St. Louis,     0.978
                                        MO.
00883.............  00...............  Ohio....................    0.970
31145.............  50...............  Vermont.................    0.968
00823.............  09...............  Utah....................    0.960
00904.............  00...............  Virginia................    0.958
00951.............  00...............  Wisconsin...............    0.956
00952.............  99...............  Rest of Illinois........    0.952
00801.............  99...............  Rest of New York........    0.952
05535.............  00...............  North Carolina..........    0.951
00900.............  20...............  Beaumont, TX............    0.951
00865.............  99...............  Rest of Pennsylvania....    0.950
00900.............  99...............  Rest of Texas...........    0.947
00521.............  05...............  New Mexico..............    0.947
00835.............  99...............  Rest of Oregon..........    0.946
00511.............  99...............  Rest of Georgia.........    0.943
00740.............  99...............  Rest of Missouri*.......    0.910

[[Page 70469]]

 
00884.............  16...............  West Virginia...........    0.942
00630.............  00...............  Indiana.................    0.937
31142.............  99...............  Rest of Maine...........    0.936
00650.............  00...............  Kansas*.................    0.936
00528.............  99...............  Rest of Louisiana.......    0.936
00825.............  21...............  Wyoming.................    0.934
05440.............  35...............  Tennessee...............    0.933
00660.............  00...............  Kentucky................    0.932
00880.............  01...............  South Carolina..........    0.930
00870.............  01...............  Rhode Island............    0.930
00751.............  01...............  Montana.................    0.928
00826.............  00...............  Iowa....................    0.927
00655.............  00...............  Nebraska................    0.925
00820.............  01...............  North Dakota............    0.924
00510.............  00...............  Alabama.................    0.923
05130.............  00...............  Idaho...................    0.922
00820.............  02...............  South Dakota............    0.922
00512.............  00...............  Mississippi.............    0.919
00522.............  00...............  Oklahoma................    0.913
00740.............  99...............  Rest of Missouri*.......    0.910
00523.............  99...............  Rest of Missouri*.......    0.910
00520.............  13...............  Arkansas................    0.905
00973.............  20...............  Puerto Rico.............   0.840
------------------------------------------------------------------------
* States are served by more than one carrier.


                                 Addendum F.--Revised Single Drug Category List
----------------------------------------------------------------------------------------------------------------
                                                                                                  Recalculated
              HCPCS                                      Long description                            weights
----------------------------------------------------------------------------------------------------------------
J0150............................  INJECTION, ADENOSINE FOR THERAPEUTIC USE, 6 MG.............        0.00069828
J0152............................  INJECTION, ADENOSINE FOR DIAGNOSTIC USE, 30 MG.............        0.00458348
J0170............................  INJECTION, ADRENALIN, EPINEPHRINE, 1 ML AMPULE.............        0.00007878
J0207............................  INJECTION, AMIFOSTINE, 500 MG..............................        0.00016059
J0215............................  INJECTION, ALEFACEPT, 0.5 MG...............................        0.00083178
J0280............................  INJECTION, AMINOPHYLLIN, 250 MG............................        0.00081886
J0290............................  INJECTION, AMPICILLIN SODIUM, 500 MG.......................        0.00012626
J0475............................  INJECTION, BACLOFEN, 10 MG.................................        0.00024582
J0540............................  INJECTION, PENICILLIN G BENZATHINE AND PENICILLIN G                0.00007191
                                    PROCAINE, 1,200,000 UNITS.
J0550............................  INJECTION, PENICILLIN G BENZATHINE AND PENICILLIN G                0.00001826
                                    PROCAINE, 2,400,000 UNITS.
J0570............................  INJECTION, PENICILLIN G BENZATHINE, 1,200,000 UNITS........        0.00004593
J0585............................  BOTULINUM TOXIN TYPE A, PER UNIT...........................        0.03734001
J0587............................  BOTULINUM TOXIN TYPE B, PER 100 UNITS......................        0.00150333
J0600............................  INJECTION, EDETATE CALCIUM DISODIUM, 1000 MG...............        0.00004448
J0637............................  INJECTION, CASPOFUNGIN ACETATE, 5 MG.......................        0.00008462
J0640............................  INJECTION, LEUCOVORIN CALCIUM, PER 50 MG...................        0.01061886
J0670............................  INJECTION, MEPIVACAINE HYDROCHLORIDE, PER 10 ML............        0.00038303
J0690............................  INJECTION, CEFAZOLIN SODIUM, 500 MG........................        0.00042306
J0692............................  INJECTION, CEFEPIME HYDROCHLORIDE, 500 MG..................        0.00024785
J0696............................  INJECTION, CEFTRIAXONE SODIUM, PER 250 MG..................        0.00667188
J0698............................  INJECTION, CEFOTAXIME SODIUM, PER GM.......................        0.00014842
J0702............................  INJECTION, BETAMETHASONE ACETATE & BETAMETHASONE SODIUM            0.00287002
                                    PHOSPHATE, PER 3 MG.
J0704............................  INJECTION, BETAMETHASONE SODIUM PHOSPHATE, PER 4 MG........        0.00056918
J0735............................  INJECTION, CLONIDINE HYDROCHLORIDE, 1 MG...................        0.00034065
J0800............................  INJECTION, CORTICOTROPIN, 40 UNITS.........................        0.00363050
J0895............................  INJECTION, DEFEROXAMINE MESYLATE, 500 MG...................        0.00024388
J1000............................  INJECTION, DEPO-ESTRADIOL CYPIONATE, 5 MG..................        0.00020962
J1020............................  INJECTION, METHYLPREDNISOLONE ACETATE, 20 MG...............        0.00127016
J1030............................  INJECTION, METHYLPREDNISOLONE ACETATE, 40 MG...............        0.00591680
J1040............................  INJECTION, METHYLPREDNISOLONE ACETATE, 80 MG...............        0.00526505
J1051............................  INJECTION, MEDROXYPROGESTERONE ACETATE, 50 MG..............        0.00006510
J1094............................  INJECTION, DEXAMETHASONE ACETATE, 1 MG.....................        0.00350405
J1100............................  INJECTION, DEXAMETHASONE SODIUM PHOSPHATE, 1MG.............        0.05478551
J1190............................  INJECTION, DEXRAZOXANE HYDROCHLORIDE, PER 250 MG...........        0.00002438
J1200............................  INJECTION, DIPHENHYDRAMINE HCL, 50 MG......................        0.00215958
J1212............................  INJECTION, DMSO, DIMETHYL SULFOXIDE, 50%, 50 ML............        0.00008455
J1245............................  INJECTION, DIPYRIDAMOLE, PER 10 MG.........................        0.00382235
J1250............................  INJECTION, DOBUTAMINE HYDROCHLORIDE, PER 250 MG............        0.00053051
J1260............................  INJECTION, DOLASETRON MESYLATE, 10 MG......................        0.01732829
J1335............................  INJECTION, ERTAPENEM SODIUM, 500 MG........................        0.00013230

[[Page 70470]]

 
J1440............................  INJECTION, FILGRASTIM (G-CSF), 300 MCG.....................        0.00193096
J1441............................  INJECTION, FILGRASTIM (G-CSF), 480 MCG.....................        0.00406386
J1450............................  INJECTION FLUCONAZOLE, 200 MG..............................        0.00001605
J1580............................  INJECTION, GARAMYCIN, GENTAMICIN, 80 MG....................        0.00039839
J1600............................  INJECTION, GOLD SODIUM THIOMALATE, 50 MG...................        0.00005600
J1626............................  INJECTION, GRANISETRON HYDROCHLORIDE, 100 MCG..............        0.01480082
J1631............................  INJECTION, HALOPERIDOL DECANOATE, PER 50 MG................        0.00020651
J1642............................  INJECTION, HEPARIN SODIUM, (HEPARIN LOCK FLUSH), PER 10            0.06406943
                                    UNITS.
J1644............................  INJECTION, HEPARIN SODIUM, PER 1000 UNITS..................        0.00353690
J1645............................  INJECTION, DALTEPARIN SODIUM, PER 2500 IU..................        0.00011497
J1650............................  INJECTION, ENOXAPARIN SODIUM, 10 MG........................        0.00135285
J1655............................  INJECTION, TINZAPARIN SODIUM, 1000 IU......................        0.00047054
J1720............................  INJECTION, HYDROCORTISONE SODIUM SUCCINATE, 100 MG.........        0.00013295
J1745............................  INJECTION INFLIXIMAB, 10 MG................................        0.02755927
J1750............................  INJECTION, IRON DEXTRAN, 50 MG.............................        0.00245914
J1756............................  INJECTION, IRON SUCROSE, 1 MG..............................        0.01024469
J1885............................  INJECTION, KETOROLAC TROMETHAMINE, PER 15 MG...............        0.00329270
J1940............................  INJECTION, FUROSEMIDE, 20 MG...............................        0.00065208
J1956............................  INJECTION, LEVOFLOXACIN, 250 MG............................        0.00008608
J2001............................  INJECTION, LIDOCAINE HCL FOR INTRAVENOUS INFUSION, 10 MG...        0.00077337
J2010............................  INJECTION, LINCOMYCIN HCL, 300 MG..........................        0.00062307
J2150............................  INJECTION, MANNITOL, 25% IN 50 ML..........................        0.00029139
J2260............................  INJECTION, MILRINONE LACTATE, 5 MG.........................        0.00004947
J2300............................  INJECTION, NALBUPHINE HYDROCHLORIDE, PER 10 MG.............        0.00026276
J2325............................  INJECTION, NESIRITIDE, 0.1 MG..............................        0.00027338
J2353............................  INJECTION, OCTREOTIDE, DEPOT FORM FOR INTRAMUSCULAR                0.00194628
                                    INJECTION, 1 MG.
J2354............................  INJECTION, OCTREOTIDE, NON-DEPOT SUBCUTANEOUS OR                   0.00008391
                                    INTRAVENOUS INJECTION, 25 MCG.
J2405............................  INJECTION, ONDANSETRON HYDROCHLORIDE, PER 1 MG.............        0.01369661
J2430............................  INJECTION, PAMIDRONATE DISODIUM, PER 30 MG.................        0.00156404
J2505............................  INJECTION, PEGFILGRASTIM, 6 MG.............................        0.00064954
J2550............................  INJECTION, PROMETHAZINE HCL, 50 MG.........................        0.00068512
J2680............................  INJECTION, FLUPHENAZINE DECANOATE, 25 MG...................        0.00015076
J2765............................  INJECTION, METOCLOPRAMIDE HCL, 10 MG.......................        0.00011107
J2780............................  INJECTION, RANITIDINE HYDROCHLORIDE, 25 MG.................        0.00088333
J2820............................  INJECTION, SARGRAMOSTIM (GM-CSF), 50 MCG...................        0.00217374
J2912............................  INJECTION, SODIUM CHLORIDE, 0.9%, PER 2 ML.................        0.00678337
J2916............................  INJECTION, SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE              0.00060984
                                    INJECTION, 12.5 MG.
J2920............................  INJECTION, METHYLPREDNISOLONE SODIUM SUCCINATE, 40 MG......        0.00031153
J2930............................  INJECTION, METHYLPREDNISOLONE SODIUM SUCCINATE, 125 MG.....        0.00077009
J2997............................  INJECTION, ALTEPLASE RECOMBINANT, 1 MG.....................        0.00012209
J3260............................  INJECTION, TOBRAMYCIN SULFATE, 80 MG.......................        0.00018247
J3301............................  INJECTION, TRIAMCINOLONE ACETONIDE, PER 10MG...............        0.02161210
J3302............................  INJECTION, TRIAMCINOLONE DIACETATE, PER 5MG................        0.00172788
J3303............................  INJECTION, TRIAMCINOLONE HEXACETONIDE, PER 5MG.............        0.00094370
J3315............................  INJECTION, TRIPTORELIN PAMOATE, 3.75 MG....................        0.00000712
J3370............................  INJECTION, VANCOMYCIN HCL, 500 MG..........................        0.00083980
J3396............................  INJECTION, VERTEPORFIN, 0.1 MG.............................        0.05425250
J3410............................  INJECTION, HYDROXYZINE HCL, 25 MG..........................        0.00040904
J3420............................  INJECTION, VITAMIN B-12 CYANOCOBALAMIN, UP TO 1000 MCG.....        0.01200091
J3475............................  INJECTION, MAGNESIUM SULFATE, PER 500 MG...................        0.00108238
J3480............................  INJECTION, POTASSIUM CHLORIDE, PER 2 MEQ...................        0.00215178
J3487............................  INJECTION, ZOLEDRONIC ACID, 1 MG...........................        0.00335651
J7030............................  INFUSION, NORMAL SALINE SOLUTION , 1000 CC.................        0.00102582
J7040............................  INFUSION, NORMAL SALINE SOLUTION, STERILE (500 ML=1 UNIT)..        0.00242568
J7042............................  5% DEXTROSE/NORMAL SALINE (500 ML = 1 UNIT)................        0.00049750
J7050............................  INFUSION, NORMAL SALINE SOLUTION , 250 CC..................        0.00990901
J7060............................  5% DEXTROSE/WATER (500 ML = 1 UNIT)........................        0.00102607
J7070............................  INFUSION, D5W, 1000 CC.....................................        0.00015855
J7120............................  RINGERS LACTATE INFUSION, 1000 CC..........................        0.00016938
J7318............................  HYALURONAN (SODIUM HYALURONATE) OR DERIVATIVE, INTRA-              0.00340613
                                    ARTICULAR INJECTION, 1 MG.
J9000............................  DOXORUBICIN HCL, 10 MG.....................................        0.00235266
J9001............................  DOXORUBICIN HYDROCHLORIDE, ALL LIPID FORMULATIONS, 10 MG...        0.00032456
J9031............................  BCG (INTRAVESICAL) PER INSTILLATION........................        0.00049146
J9040............................  BLEOMYCIN SULFATE, 15 UNITS................................        0.00003718
J9045............................  CARBOPLATIN, 50 MG.........................................        0.00568694
J9050............................  CARMUSTINE, 100 MG.........................................        0.00000887
J9060............................  CISPLATIN, POWDER OR S0LUTION, PER 10 MG...................        0.00095159
J9062............................  CISPLATIN, 50 MG...........................................        0.00025368
J9065............................  INJECTION, CLADRIBINE, PER 1 MG............................        0.00008122
J9070............................  CYCLOPHOSPHAMIDE, 100 MG...................................        0.00062537
J9080............................  CYCLOPHOSPHAMIDE, 200 MG...................................        0.00004956

[[Page 70471]]

 
J9090............................  CYCLOPHOSPHAMIDE, 500 MG...................................        0.00008105
J9091............................  CYCLOPHOSPHAMIDE, 1.0 GRAM.................................        0.00005036
J9092............................  CYCLOPHOSPHAMIDE, 2.0 GRAM.................................        0.00000528
J9093............................  CYCLOPHOSPHAMIDE, LYOPHILIZED, 100 MG......................        0.00092452
J9094............................  CYCLOPHOSPHAMIDE, LYOPHILIZED, 200 MG......................        0.00009167
J9095............................  CYCLOPHOSPHAMIDE, LYOPHILIZED, 500 MG......................        0.00017653
J9096............................  CYCLOPHOSPHAMIDE, LYOPHILIZED, 1.0 GRAM....................        0.00013943
J9097............................  CYCLOPHOSPHAMIDE, LYOPHILIZED, 2.0 GRAM....................        0.00001356
J9098............................  CYTARABINE LIPOSOME, 10 MG.................................        0.00000815
J9100............................  CYTARABINE, 100 MG.........................................        0.00012978
J9110............................  CYTARABINE, 500 MG.........................................        0.00002071
J9130............................  DACARBAZINE, 100 MG........................................        0.00009406
J9140............................  DACARBAZINE, 200 MG........................................        0.00007007
J9150............................  DAUNORUBICIN, 10 MG........................................        0.00000488
J9170............................  DOCETAXEL, 20 MG...........................................        0.00256588
J9178............................  INJECTION, EPIRUBICIN HCL, 2 MG............................        0.00121617
J9181............................  ETOPOSIDE, 10 MG...........................................        0.00230896
J9182............................  ETOPOSIDE, 100 MG..........................................        0.00052981
J9185............................  FLUDARABINE PHOSPHATE, 50 MG...............................        0.00030572
J9190............................  FLUOROURACIL, 500 MG.......................................        0.00395219
J9200............................  FLOXURIDINE, 500 MG........................................        0.00000408
J9201............................  GEMCITABINE HCL, 200 MG....................................        0.00494962
J9202............................  GOSERELIN ACETATE IMPLANT, PER 3.6 MG......................        0.00287887
J9206............................  IRINOTECAN, 20 MG..........................................        0.00318310
J9208............................  IFOSFAMIDE, 1 GM...........................................        0.00007873
J9209............................  MESNA, 200 MG..............................................        0.00036778
J9211............................  IDARUBICIN HYDROCHLORIDE, 5 MG.............................        0.00000318
J9213............................  INTERFERON, ALFA-2A, RECOMBINANT, 3 MILLION UNITS..........        0.00008062
J9214............................  INTERFERON, ALFA-2B, RECOMBINANT, 1 MILLION UNITS..........        0.00673538
J9219............................  LEUPROLIDE ACETATE IMPLANT, 65 MG..........................        0.00006510
J9245............................  INJECTION, MELPHALAN HYDROCHLORIDE, 50 MG..................        0.00000158
J9250............................  METHOTREXATE SODIUM, 5 MG..................................        0.00186241
J9260............................  METHOTREXATE SODIUM, 50 MG.................................        0.00051323
J9263............................  INJECTION, OXALIPLATIN, 0.5 MG.............................        0.07300568
J9265............................  PACLITAXEL, 30 MG..........................................        0.00555323
J9268............................  PENTOSTATIN, PER 10 MG.....................................        0.00000643
J9280............................  MITOMYCIN, 5 MG............................................        0.00004067
J9290............................  MITOMYCIN, 20 MG...........................................        0.00003473
J9291............................  MITOMYCIN, 40 MG...........................................        0.00006128
J9293............................  INJECTION, MITOXANTRONE HYDROCHLORIDE, PER 5 MG............        0.00025058
J9310............................  RITUXIMAB, 100 MG..........................................        0.00408558
J9320............................  STREPTOZOCIN, 1 GM.........................................        0.00000671
J9340............................  THIOTEPA, 15 MG............................................        0.00002446
J9350............................  TOPOTECAN, 4 MG............................................        0.00018223
J9355............................  TRASTUZUMAB, 10 MG.........................................        0.00542012
J9360............................  VINBLASTINE SULFATE, 1 MG..................................        0.00035725
J9370............................  VINCRISTINE SULFATE, 1 MG..................................        0.00019702
J9375............................  VINCRISTINE SULFATE, 2 MG..................................        0.00011487
J9390............................  VINORELBINE TARTRATE, PER 10 MG............................        0.00110762
J9395............................  INJECTION, FULVESTRANT, 25 MG..............................        0.00126358
J9600............................  PORFIMER SODIUM, 75 MG.....................................        0.00000030
J0885............................  INJECTION, EPOETIN ALPHA, (FOR NON ESRD USE), PER 1000             0.25074794
                                    UNITS.
J0881............................  INJECTION, DARBEPOETIN ALFA, 1 MCG (NON-ESRD USE)..........        0.15914222
Q3025............................  INJECTION, INTERFERON BETA-1A, 11 MCG FOR INTRAMUSCULAR USE        0.00078070
----------------------------------------------------------------------------------------------------------------


         Addendum G.--Revised New Drugs for CAP Bidding for 2006
                       [Effective January 1, 2006]
------------------------------------------------------------------------
             HCPCS                           Long description
------------------------------------------------------------------------
J0128..........................  Abarelix injection.
J0180..........................  Agalsidase beta injection.
J0278..........................  Amikacin.
J0878..........................  Daptomycin injection.
J1751..........................  Iron Dextran 165.
J1752..........................  Iron Dextran 267.
J1931..........................  Laronidase injection.
J2357..........................  Omalizumab injection.
J2469..........................  Palonosetron HCl.
J2503..........................  Pegaptanib.
J2794..........................  Risperidone, long acting.
J9035..........................  Bevacizumab injection.
J9041..........................  Bortezomib injection.
J9055..........................  Cetuximab injection.
J9225..........................  Histrelin implant.
J9264..........................  Paclitaxel protein bound particles.
J9305..........................  Pemetrexed injection.
------------------------------------------------------------------------


[[Page 70472]]


    Addendum H.--List of CPT \1\/HCPCS Codes Used to Describe Certain
   Designated Health Service Categories \2\ Under Section 1877 of the
                           Social Security Act
 [Effective Date: All codes are effective January 1, 2006, except those
   followed by an asterisk. Codes followed by an asterisk will become
                     effective on January 1, 2007.]
------------------------------------------------------------------------
 
------------------------------------------------------------------------
                      CLINICAL LABORATORY SERVICES
 
Include CPT codes for all clinical laboratory services in the 80000
 series, except EXCLUDE CPT codes for the following blood component
 collection services: .
86890.................................  Autologous blood process
86891.................................  Autologous blood, op salvage
86927.................................  Plasma, fresh frozen
86930.................................  Frozen blood prep
86931.................................  Frozen blood thaw
86932.................................  Frozen blood freeze/thaw
86945.................................  Blood product/irradiation
86950.................................  Leukacyte transfusion
86965.................................  Pooling blood platelets
86985.................................  Split blood or products
Include the following CPT and HCPCS level 2 codes for other clinical
 laboratory services: .
0026T.................................  Measure remnant lipoproteins
0030T.................................  Antiprothrombin antibody
0041T.................................  Detect ur infect agnt w/cpas
0043T.................................  Co expired gas analysis
0058T.................................  Cryopreservation, ovary tiss
0059T.................................  Cryopreservation, oocyte
0064T.................................  Spectroscop eval expired gas
0085T.................................  Breath test heart reject
0087T.................................  Sperm eval hyaluronan
0103T.................................  Holotranscobalamin
0104T.................................  At rest cardio gas rebreathe
0111T.................................  RBC membranes fatty acids
0140T.................................  Exhaled breath condensate ph
36415.................................  Routine venipuncture
78267.................................  Breath test attain/anal c-14
78268.................................  Breath test analysis c-14
G0027.................................  Semen analysis
G0103.................................  Psa, total screening
G0107.................................  CA screen; fecal blood test
G0123.................................  Screen cerv/vag thin layer
G0124.................................  Screen c/v thin layer by MD
G0141.................................  Scr c/v cyto,autosys and md
G0143.................................  Scr c/v cyto,thinlayer,rescr
G0144.................................  Scr c/v cyto,thinlayer,rescr
G0145.................................  Scr c/v cyto,thinlayer,rescr
G0147.................................  Scr c/v cyto, automated sys
G0148.................................  Scr c/v cyto, autosys, rescr
G0306.................................  CBC/diffwbc w/o platelet
G0307.................................  CBC without platelet
G0328.................................  Fecal blood scrn immunoassay
P2028.................................  Cephalin floculation test
P2029.................................  Congo red blood test
P2033.................................  Blood thymol turbidity
P2038.................................  Blood mucoprotein
P3000.................................  Screen pap by tech w md supv
P3001.................................  Screening pap smear by phys
P9612.................................  Catheterize for urine spec
P9615.................................  Urine specimen collect mult
Q0111.................................  Wet mounts/ w preparations
Q0112.................................  Potassium hydroxide preps
Q0113.................................  Pinworm examinations
Q0114.................................  Fern test
Q0115.................................  Post-coital mucous exam
 
  PHYSICAL THERAPY, OCCUPATIONAL THERAPY, AND SPEECH-LANGUAGE PATHOLOGY
 
Include the following CPT and HCPCS codes for the physical therapy/
 occupational therapy/speech-language pathology services: .
0019T.................................  Extracorp shock wv tx,ms nos
0029T.................................  Magnetic tx for incontinence
64550.................................  Apply neurostimulator
90901.................................  Biofeedback train, any meth
90911.................................  Biofeedback peri/uro/rectal
92506.................................  Speech/hearing evaluation
92507.................................  Speech/hearing therapy
92508.................................  Speech/hearing therapy
92526.................................  Oral function therapy
92597.................................  Oral speech device eval
92607.................................  Ex for speech device rx, 1hr
92608.................................  Ex for speech device rx addl
92609.................................  Use of speech device service
92610.................................  Evaluate swallowing function
92611.................................  Motion fluoroscopy/swallow
92612.................................  Endoscopy swallow tst (fees)
92614.................................  Laryngoscopic sensory test
92616.................................  Fees w/laryngeal sense test
93797.................................  Cardiac rehab
93798.................................  Cardiac rehab/monitor
94667.................................  Chest wall manipulation
94668.................................  Chest wall manipulation
95831.................................  Limb muscle testing, manual
95832.................................  Hand muscle testing, manual
95833.................................  Body muscle testing, manual
95834.................................  Body muscle testing, manual
95851.................................  Range of motion measurements
95852.................................  Range of motion measurements
96000.................................  Motion analysis, video/3d
96001.................................  Motion test w/ft press meas
96002.................................  Dynamic surface emg
96003.................................  Dynamic fine wire emg
96105.................................  Assessment of aphasia
96110.................................  Developmental test, lim
96111.................................  Developmental test, extend
97001.................................  Pt evaluation
97002.................................  Pt re-evaluation
97003.................................  Ot evaluation
97004.................................  Ot re-evaluation
97010.................................  Hot or cold packs therapy
97012.................................  Mechanical traction therapy
97016.................................  Vasopneumatic device therapy
97018.................................  Paraffin bath therapy
97022.................................  Whirlpool therapy
97024.................................  Diathermy eg, microwave
97026.................................  Infrared therapy
97028.................................  Ultraviolet therapy
97032.................................  Electrical stimulation
97033.................................  Electric current therapy
97034.................................  Contrast bath therapy
97035.................................  Ultrasound therapy
97036.................................  Hydrotherapy
97039.................................  Physical therapy treatment
97110.................................  Therapeutic exercises
97112.................................  Neuromuscular reeducation
97113.................................  Aquatic therapy/exercises
97116.................................  Gait training therapy
97124.................................  Massage therapy
97139.................................  Physical medicine procedure
97140.................................  Manual therapy
97150.................................  Group therapeutic procedures
97530.................................  Therapeutic activities
97532.................................  Cognitive skills development
97533.................................  Sensory integration
97535.................................  Self care mngment training
97537.................................  Community/work reintegration
97542.................................  Wheelchair mngment training
97545.................................  Work hardening
97546.................................  Work hardening add-on
97597.................................  Active wound care/20cm or <
97598.................................  Active wound care > 20cm
97602.................................  Wound(s) care nonselective
97605.................................  Neg press wound tx, < 50 cm
97606.................................  Neg press wound tx, > 50 cm
97750.................................  Physical performance test
97755.................................  Assistive technology assess
97760.................................  Orthotic mgmt and training
97761.................................  Prosthetic training
97762.................................  C/O for orthotic/prosth use
97799.................................  Physical medicine procedure
G0281.................................  Elec stim unattend for press
G0283.................................  Elec stim other than wound
G0329.................................  Electromagntic tx for ulcers
 
               RADIOLOGY AND CERTAIN OTHER IMAGING SERVICES
 
Include the following CPT and HCPCS codes: .............................
0028T.................................  Dexa body composition study
0042T.................................  Ct perfusion w/contrast, cbf
0067T.................................  Ct colonography;dx
51798.................................  Us urine capacity measure
70100.................................  X-ray exam of jaw
70110.................................  X-ray exam of jaw
70120.................................  X-ray exam of mastoids
70130.................................  X-ray exam of mastoids
70134.................................  X-ray exam of middle ear
70140.................................  X-ray exam of facial bones
70150.................................  X-ray exam of facial bones
70160.................................  X-ray exam of nasal bones
70190.................................  X-ray exam of eye sockets
70200.................................  X-ray exam of eye sockets
70210.................................  X-ray exam of sinuses
70220.................................  X-ray exam of sinuses
70240.................................  X-ray exam, pituitary saddle
70250.................................  X-ray exam of skull
70260.................................  X-ray exam of skull
70300.................................  X-ray exam of teeth
70310.................................  X-ray exam of teeth
70320.................................  Full mouth x-ray of teeth
70328.................................  X-ray exam of jaw joint
70330.................................  X-ray exam of jaw joints
70336.................................  Magnetic image, jaw joint
70350.................................  X-ray head for orthodontia
70355.................................  Panoramic x-ray of jaws
70360.................................  X-ray exam of neck
70370.................................  Throat x-ray & fluoroscopy
70371.................................  Speech evaluation, complex
70380.................................  X-ray exam of salivary gland
70450.................................  Ct head/brain w/o dye
70460.................................  Ct head/brain w/dye
70470.................................  Ct head/brain w/o & w/dye
70480.................................  Ct orbit/ear/fossa w/o dye
70481.................................  Ct orbit/ear/fossa w/dye
70482.................................  Ct orbit/ear/fossa w/o&w/dye
70486.................................  Ct maxillofacial w/o dye
70487.................................  Ct maxillofacial w/dye
70488.................................  Ct maxillofacial w/o & w/dye
70490.................................  Ct soft tissue neck w/o dye
70491.................................  Ct soft tissue neck w/dye
70492.................................  Ct sft tsue nck w/o & w/dye
70496.................................  Ct angiography, head
70498.................................  Ct angiography, neck
70540.................................  Mri orbit/face/neck w/o dye
70542.................................  Mri orbit/face/neck w/dye
70543.................................  Mri orbt/fac/nck w/o & w/dye
70544.................................  Mr angiography head w/o dye
70545.................................  Mr angiography head w/dye
70546.................................  Mr angiograph head w/o&w/dye
70547.................................  Mr angiography neck w/o dye
70548.................................  Mr angiography neck w/dye
70549.................................  Mr angiograph neck w/o&w/dye
70551.................................  Mri brain w/o dye
70552.................................  Mri brain w/dye
70553.................................  Mri brain w/o & w/dye
71010.................................  Chest x-ray
71015.................................  Chest x-ray
71020.................................  Chest x-ray
71021.................................  Chest x-ray
71022.................................  Chest x-ray

[[Page 70473]]

 
71023.................................  Chest x-ray and fluoroscopy
71030.................................  Chest x-ray
71034.................................  Chest x-ray and fluoroscopy
71035.................................  Chest x-ray
71100.................................  X-ray exam of ribs
71101.................................  X-ray exam of ribs/chest
71110.................................  X-ray exam of ribs
71111.................................  X-ray exam of ribs/chest
71120.................................  X-ray exam of breastbone
71130.................................  X-ray exam of breastbone
71250.................................  Ct thorax w/o dye
71260.................................  Ct thorax w/dye
71270.................................  Ct thorax w/o & w/dye
71275.................................  Ct angiography, chest
71550.................................  Mri chest w/o dye
71551.................................  Mri chest w/dye
71552.................................  Mri chest w/o & w/dye
71555.................................  Mri angio chest w or w/o dye
72010.................................  X-ray exam of spine
72020.................................  X-ray exam of spine
72040.................................  X-ray exam of neck spine
72050.................................  X-ray exam of neck spine
72052.................................  X-ray exam of neck spine
72069.................................  X-ray exam of trunk spine
72070.................................  X-ray exam of thoracic spine
72072.................................  X-ray exam of thoracic spine
72074.................................  X-ray exam of thoracic spine
72080.................................  X-ray exam of trunk spine
72090.................................  X-ray exam of trunk spine
72100.................................  X-ray exam of lower spine
72110.................................  X-ray exam of lower spine
72114.................................  X-ray exam of lower spine
72120.................................  X-ray exam of lower spine
72125.................................  Ct neck spine w/o dye
72126.................................  Ct neck spine w/dye
72127.................................  Ct neck spine w/o & w/dye
72128.................................  Ct chest spine w/o dye
72129.................................  Ct chest spine w/dye
72130.................................  Ct chest spine w/o & w/dye
72131.................................  Ct lumbar spine w/o dye
72132.................................  Ct lumbar spine w/dye
72133.................................  Ct lumbar spine w/o & w/dye
72141.................................  Mri neck spine w/o dye
72142.................................  Mri neck spine w/dye
72146.................................  Mri chest spine w/o dye
72147.................................  Mri chest spine w/dye
72148.................................  Mri lumbar spine w/o dye
72149.................................  Mri lumbar spine w/dye
72156.................................  Mri neck spine w/o & w/dye
72157.................................  Mri chest spine w/o & w/dye
72158.................................  Mri lumbar spine w/o & w/dye
72170.................................  X-ray exam of pelvis
72190.................................  X-ray exam of pelvis
72191.................................  Ct angiograph pelv w/o&w/dye
72192.................................  Ct pelvis w/o dye
72193.................................  Ct pelvis w/dye
72194.................................  Ct pelvis w/o & w/dye
72195.................................  Mri pelvis w/o dye
72196.................................  Mri pelvis w/dye
72197.................................  Mri pelvis w/o & w/dye
72198.................................  Mr angio pelvis w/o & w/dye
72200.................................  X-ray exam sacroiliac joints
72202.................................  X-ray exam sacroiliac joints
72220.................................  X-ray exam of tailbone
73000.................................  X-ray exam of collar bone
73010.................................  X-ray exam of shoulder blade
73020.................................  X-ray exam of shoulder
73030.................................  X-ray exam of shoulder
73050.................................  X-ray exam of shoulders
73060.................................  X-ray exam of humerus
73070.................................  X-ray exam of elbow
73080.................................  X-ray exam of elbow
73090.................................  X-ray exam of forearm
73092.................................  X-ray exam of arm, infant
73100.................................  X-ray exam of wrist
73110.................................  X-ray exam of wrist
73120.................................  X-ray exam of hand
73130.................................  X-ray exam of hand
73140.................................  X-ray exam of finger(s)
73200.................................  Ct upper extremity w/o dye
73201.................................  Ct upper extremity w/dye
73202.................................  Ct uppr extremity w/o&w/dye
73206.................................  Ct angio upr extrm w/o&w/dye
73218.................................  Mri upper extremity w/o dye
73219.................................  Mri upper extremity w/dye
73220.................................  Mri uppr extremity w/o&w/dye
73221.................................  Mri joint upr extrem w/o dye
73222.................................  Mri joint upr extrem w/dye
73223.................................  Mri joint upr extr w/o&w/dye
73500.................................  X-ray exam of hip
73510.................................  X-ray exam of hip
73520.................................  X-ray exam of hips
73540.................................  X-ray exam of pelvis & hips
73550.................................  X-ray exam of thigh
73560.................................  X-ray exam of knee, 1 or 2
73562.................................  X-ray exam of knee, 3
73564.................................  X-ray exam, knee, 4 or more
73565.................................  X-ray exam of knees
73590.................................  X-ray exam of lower leg
73592.................................  X-ray exam of leg, infant
73600.................................  X-ray exam of ankle
73610.................................  X-ray exam of ankle
73620.................................  X-ray exam of foot
73630.................................  X-ray exam of foot
73650.................................  X-ray exam of heel
73660.................................  X-ray exam of toe(s)
73700.................................  Ct lower extremity w/o dye
73701.................................  Ct lower extremity w/dye
73702.................................  Ct lwr extremity w/o&w/dye
73706.................................  Ct angio lwr extr w/o&w/dye
73718.................................  Mri lower extremity w/o dye
73719.................................  Mri lower extremity w/dye
73720.................................  Mri lwr extremity w/o&w/dye
73721.................................  Mri jnt of lwr extre w/o dye
73722.................................  Mri joint of lwr extr w/dye
73723.................................  Mri joint lwr extr w/o&w/dye
73725.................................  Mr ang lwr ext w or w/o dye
74000.................................  X-ray exam of abdomen
74010.................................  X-ray exam of abdomen
74020.................................  X-ray exam of abdomen
74022.................................  X-ray exam series, abdomen
74150.................................  Ct abdomen w/o dye
74160.................................  Ct abdomen w/dye
74170.................................  Ct abdomen w/o & w/dye
74175.................................  Ct angio abdom w/o & w/dye
74181.................................  Mri abdomen w/o dye
74182.................................  Mri abdomen w/dye
74183.................................  Mri abdomen w/o & w/dye
74185.................................  Mri angio, abdom w orw/o dye
74210.................................  Contrst x-ray exam of throat
74220.................................  Contrast x-ray, esophagus
74230.................................  Cine/vid x-ray, throat/esoph
74240.................................  X-ray exam, upper gi tract
74241.................................  X-ray exam, upper gi tract
74245.................................  X-ray exam, upper gi tract
74246.................................  Contrst x-ray uppr gi tract
74247.................................  Contrst x-ray uppr gi tract
74249.................................  Contrst x-ray uppr gi tract
74250.................................  X-ray exam of small bowel
74290.................................  Contrast x-ray, gallbladder
74291.................................  Contrast x-rays, gallbladder
74710.................................  X-ray measurement of pelvis
75552.................................  Heart mri for morph w/o dye
75553.................................  Heart mri for morph w/dye
75554.................................  Cardiac MRI/function
75555.................................  Cardiac MRI/limited study
75635.................................  Ct angio abdominal arteries
76000.................................  Fluoroscope examination
76006.................................  X-ray stress view
76010.................................  X-ray, nose to rectum
76020.................................  X-rays for bone age
76040.................................  X-rays, bone evaluation
76061.................................  X-rays, bone survey
76062.................................  X-rays, bone survey
76065.................................  X-rays, bone evaluation
76066.................................  Joint survey, single view
76070.................................  Ct bone density, axial
76071.................................  Ct bone density, peripheral
76075.................................  Dxa bone density, axial
76076.................................  Dxa bone density/peripheral
76077.................................  Dxa bone density/v-fracture
76078.................................  Radiographic absorptiometry
76082.................................  Computer mammogram add-on
76083.................................  Computer mammogram add-on
76090.................................  Mammogram, one breast
76091.................................  Mammogram, both breasts
76092.................................  Mammogram, screening
76093.................................  Magnetic image, breast
76094.................................  Magnetic image, both breasts
76100.................................  X-ray exam of body section
76101.................................  Complex body section x-ray
76102.................................  Complex body section x-rays
76120.................................  Cine/video x-rays
76125.................................  Cine/video x-rays add-on
76150.................................  X-ray exam, dry process
76370.................................  Ct scan for therapy guide
76376.................................  3d render w/o postprocess
76377.................................  3d rendering w/postprocess
76380.................................  CAT scan follow-up study
76400.................................  Magnetic image, bone marrow
76499.................................  Radiographic procedure
76506.................................  Echo exam of head
76510.................................  Ophth us, b & quant a
76511.................................  Ophth us, quant a only
76512.................................  Ophth us, b w/non-quant a
76513.................................  Echo exam of eye, water bath
76514.................................  Echo exam of eye, thickness
76516.................................  Echo exam of eye
76519.................................  Echo exam of eye
76536.................................  Us exam of head and neck
76604.................................  Us exam, chest, b-scan
76645.................................  Us exam, breast(s)
76700.................................  Us exam, abdom, complete
76705.................................  Echo exam of abdomen
76770.................................  Us exam abdo back wall, comp
76775.................................  Us exam abdo back wall, lim
76778.................................  Us exam kidney transplant
76800.................................  Us exam, spinal canal
76801.................................  Ob us < 14 wks, single fetus
76802.................................  Ob us < 14 wks, add'l fetus
76805.................................  Ob us >/= 14 wks, sngl fetus
76810.................................  Ob us >/= 14 wks, addl fetus
76811.................................  Ob us, detailed, sngl fetus
76812.................................  Ob us, detailed, addl fetus
76815.................................  Ob us, limited, fetus(s)
76816.................................  Ob us, follow-up, per fetus
76818.................................  Fetal biophys profile w/nst
76819.................................  Fetal biophys profil w/o nst
76820.................................  Umbilical artery echo
76821.................................  Middle cerebral artery echo
76825.................................  Echo exam of fetal heart
76826.................................  Echo exam of fetal heart
76827.................................  Echo exam of fetal heart
76828.................................  Echo exam of fetal heart
76856.................................  Us exam, pelvic, complete
76857.................................  Us exam, pelvic, limited

[[Page 70474]]

 
76870.................................  Us exam, scrotum
76880.................................  Us exam, extremity
76885.................................  Us exam infant hips, dynamic
76886.................................  Us exam infant hips, static
76970.................................  Ultrasound exam follow-up
76977.................................  Us bone density measure
76999.................................  Echo examination procedure
78000*................................  Thyroid, single uptake
78001*................................  Thyroid, multiple uptakes
78003*................................  Thyroid suppress/stimul
78006*................................  Thyroid imaging with uptake
78007*................................  Thyroid image, mult uptakes
78010*................................  Thyroid imaging
78011*................................  Thyroid imaging with flow
78015*................................  Thyroid met imaging
78016*................................  Thyroid met imaging/studies
78018*................................  Thyroid met imaging, body
78020*................................  Thyroid met uptake
78070*................................  Parathyroid nuclear imaging
78075*................................  Adrenal nuclear imaging
78099*................................  Endocrine nuclear procedure
78102*................................  Bone marrow imaging, ltd
78103*................................  Bone marrow imaging, mult
78104*................................  Bone marrow imaging, body
78110*................................  Plasma volume, single
78111*................................  Plasma volume, multiple
78120*................................  Red cell mass, single
78121*................................  Red cell mass, multiple
78122*................................  Blood volume
78130*................................  Red cell survival study
78135*................................  Red cell survival kinetics
78140*................................  Red cell sequestration
78185*................................  Spleen imaging
78190*................................  Platelet survival, kinetics
78191*................................  Platelet survival
78195*................................  Lymph system imaging
78199*................................  Blood/lymph nuclear exam
78201*................................  Liver imaging
78202*................................  Liver imaging with flow
78205*................................  Liver imaging (3D)
78206*................................  Liver image (3d) with flow
78215*................................  Liver and spleen imaging
78216*................................  Liver & spleen image/flow
78220*................................  Liver function study
78223*................................  Hepatobiliary imaging
78230*................................  Salivary gland imaging
78231*................................  Serial salivary imaging
78232*................................  Salivary gland function exam
78258*................................  Esophageal motility study
78261*................................  Gastric mucosa imaging
78262*................................  Gastroesophageal reflux exam
78264*................................  Gastric emptying study
78270*................................  Vit B-12 absorption exam
78271*................................  Vit B-12 absrp exam, int fac
78272*................................  Vit B-12 absorp, combined
78278*................................  Acute GI blood loss imaging
78282*................................  GI protein loss exam
78290*................................  Meckel's divert exam
78291*................................  Leveen/shunt patency exam
78299*................................  GI nuclear procedure
78300*................................  Bone imaging, limited area
78305*................................  Bone imaging, multiple areas
78306*................................  Bone imaging, whole body
78315*................................  Bone imaging, 3 phase
78320*................................  Bone imaging (3D)
78350.................................  Bone mineral, single photon
78399*................................  Musculoskeletal nuclear exam
78414*................................  Non-imaging heart function
78428*................................  Cardiac shunt imaging
78445*................................  Vascular flow imaging
78456*................................  Acute venous thrombus image
78457*................................  Venous thrombosis imaging
78458*................................  Ven thrombosis images, bilat
78459*................................  Heart muscle imaging (PET)
78460*................................  Heart muscle blood, single
78461*................................  Heart muscle blood, multiple
78464*................................  Heart image (3d), single
78465*................................  Heart image (3d), multiple
78466*................................  Heart infarct image
78468*................................  Heart infarct image (ef)
78469*................................  Heart infarct image (3D)
78472*................................  Gated heart, planar, single
78473*................................  Gated heart, multiple
78478*................................  Heart wall motion add-on
78480*................................  Heart function add-on
78481*................................  Heart first pass, single
78483*................................  Heart first pass, multiple
78491*................................  Heart image (pet), single
78492*................................  Heart image (pet), multiple
78494*................................  Heart image, spect
78496*................................  Heart first pass add-on
78499*................................  Cardiovascular nuclear exam
78580*................................  Lung perfusion imaging
78584*................................  Lung V/Q image single breath
78585*................................  Lung V/Q imaging
78586*................................  Aerosol lung image, single
78587*................................  Aerosol lung image, multiple
78588*................................  Perfusion lung image
78591*................................  Vent image, 1 breath, 1 proj
78593*................................  Vent image, 1 proj, gas
78594*................................  Vent image, mult proj, gas
78596*................................  Lung differential function
78599*................................  Respiratory nuclear exam
78600*................................  Brain imaging, ltd static
78601*................................  Brain imaging, ltd w/flow
78605*................................  Brain imaging, complete
78606*................................  Brain imaging, compl w/flow
78607*................................  Brain imaging (3D)
78608*................................  Brain imaging (PET)
78609*................................  Brain imaging (PET)
78610*................................  Brain flow imaging only
78615*................................  Cerebral vascular flow image
78630*................................  Cerebrospinal fluid scan
78635*................................  CSF ventriculography
78645*................................  CSF shunt evaluation
78647*................................  Cerebrospinal fluid scan
78650*................................  CSF leakage imaging
78660*................................  Nuclear exam of tear flow
78699*................................  Nervous system nuclear exam
78700*................................  Kidney imaging, static
78701*................................  Kidney imaging with flow
78704*................................  Imaging renogram
78707*................................  Kidney flow/function image
78708*................................  Kidney flow/function image
78709*................................  Kidney flow/function image
78710*................................  Kidney imaging (3D)
78715*................................  Renal vascular flow exam
78725*................................  Kidney function study
78730*................................  Urinary bladder retention
78740*................................  Ureteral reflux study
78760*................................  Testicular imaging
78761*................................  Testicular imaging/flow
78799*................................  Genitourinary nuclear exam
78800*................................  Tumor imaging, limited area
78801*................................  Tumor imaging, mult areas
78802*................................  Tumor imaging, whole body
78803*................................  Tumor imaging (3D)
78804*................................  Tumor imaging, whole body
78805*................................  Abscess imaging, ltd area
78806*................................  Abscess imaging, whole body
78807*................................  Nuclear localization/abscess
78811*................................  Tumor imaging (pet), limited
78812*................................  Tumor image (pet)/skul-thigh
78813*................................  Tumor image (pet) full body
78814*................................  Tumor image pet/ct, limited
78815*................................  Tumor image pet/ct skul-thigh
78816*................................  Tumor image pet/ct full body
78890*................................  Nuclear medicine data proc
78891*................................  Nuclear med data proc
78999*................................  Nuclear diagnostic exam
91110.................................  Gi tract capsule endoscopy
93303.................................  Echo transthoracic
93304.................................  Echo transthoracic
93307.................................  Echo exam of heart
93308.................................  Echo exam of heart
93320.................................  Doppler echo exam, heart [if
                                         used in conjunction with 93303-
                                         93308]
93321.................................  Doppler echo exam, heart [if
                                         used in conjunction with 93303-
                                         93308]
93325.................................  Doppler color flow add-on [if
                                         used in conjunction with 93303-
                                         93308]
93875.................................  Extracranial study
93880.................................  Extracranial study
93882.................................  Extracranial study
93886.................................  Intracranial study
93888.................................  Intracranial study
93890.................................  Tcd, vasoreactivity study
93892.................................  Tcd, emboli detect w/o inj
93922.................................  Extremity study
93923.................................  Extremity study
93924.................................  Extremity study
93925.................................  Lower extremity study
93926.................................  Lower extremity study
93930.................................  Upper extremity study
93931.................................  Upper extremity study
93965.................................  Extremity study
93970.................................  Extremity study
93971.................................  Extremity study
93975.................................  Vascular study
93976.................................  Vascular study
93978.................................  Vascular study
93979.................................  Vascular study
93980.................................  Penile vascular study
93981.................................  Penile vascular study
93990.................................  Doppler flow testing
A4641*................................  Diagnostic imaging agent
A4642*................................  Satumomab pendetide per dose
A9500*................................  Technetium TC 99m sestamibi
A9502*................................  Technetium TC99M tetrofosmin
A9503*................................  Technetium TC 99m medronate
A9504*................................  Technetium tc 99m apcitide
A9505*................................  Thallous chloride TL 201/mci
A9507*................................  Indium/111 capromab pendetid
A9508*................................  Iobenguane sulfate I-131
A9510*................................  Technetium TC99m Disofenin
A9511*................................  Technetium TC 99m depreotide
A9512*................................  Technetiumtc99mpertechnetate
A9513*................................  Technetium tc-99m mebrofenin
A9514*................................  Technetiumtc99m pyrophosphate
A9515*................................  Technetium tc-99m pentetate
A9516*................................  I-123 sodium iodide capsule
A9519*................................  Technetiumtc-99mmacroag albu
A9520*................................  Technetiumtc-99m sulfur clld
A9521*................................  Technetiumtc-99m exametazine
A9522*................................  Indium111ibritumomabtiuxetan
A9524*................................  Iodinated I-131 serumalbumin
A9526*................................  Ammonia N-13, per dose
A9528*................................  Dx I131 so iodide cap millic
A9529*................................  Dx I131 so iodide sol millic
A9531*................................  Dx I131 so iodide microcurie

[[Page 70475]]

 
A9533*................................  I-131 tositumomab diagnostic
A9700*................................  Echocardiography contrast
G0130.................................  Single energy x-ray study
G0202.................................  Screeningmammographydigital
G0204.................................  Diagnosticmammographydigital
G0206.................................  Diagnosticmammographydigital
G0288.................................  Recon, CTA for surg plan
Q0092.................................  Set up port xray equipment
Q3000*................................  Rubidium RB-82
Q3002*................................  Gallium ga 67
Q3003*................................  Technetium tc99m bicisate
Q3004*................................  Xenon xe 133
Q3005*................................  Technetium tc99m mertiatide
Q3006*................................  Technetium tc99m glucepatate
Q3007*................................  Sodium phosphate p32
Q3008*................................  Indium 111-in pentetreotide
Q3009*................................  Technetium tc99m oxidronate
Q3010*................................  Technetium tc99mlabeledrbcs
Q3011*................................  Chromic phosphate p32
Q3012*................................  Cyanocobalamin cobalt co57
Q9945*................................  LOCM<=149mg/ml iodine, 1 ml
Q9946*................................  LOCM 150-199mg/ml iodine,1ml
Q9947*................................  LOCM 200-249mg/ml iodine,1ml
Q9948*................................  LOCM 250-299mg/ml/iodine,1ml
Q9949*................................  LOCM 300-349mg/ml iodine,1ml
Q9950*................................  LOCM 350-399mg/ml iodine,1ml
Q9951*................................  LOCM>=400 mg/ml iodine,1ml
Q9952*................................  Inj Gad-base MR contrast, ml
Q9953*................................  Inj Fe-base MR contrast, ml
Q9954*................................  Oral MR contrast, 100ml
Q9955*................................  Inj perflexane lip micros, ml
Q9956*................................  Inj octafluoropropane mic,ml
Q9957*................................  Inj perflutren lip micros, ml
R0070.................................  Transport portable x-ray
R0075.................................  Transport port x-ray multipl
 
                 RADIATION THERAPY SERVICES AND SUPPLIES
 
Include the following CPT and HCPCS codes: .............................
0073T.................................  Delivery, comp imrt
0082T.................................  Stereotactic rad delivery
0083T.................................  Stereotactic rad tx mngmt
19296.................................  Place po breast cath for rad
19297.................................  Place breast cath for rad
19298.................................  Place breast rad tube/caths
31643.................................  Diag bronchoscope/catheter
55859.................................  Percut/needle insert, pros
57155.................................  Insert uteri tandems/ovoids
58346.................................  Insert heyman uteri capsule
61770.................................  Incise skull for treatment
61793.................................  Focus radiation beam
77261.................................  Radiation therapy planning
77262.................................  Radiation therapy planning
77263.................................  Radiation therapy planning
77280.................................  Set radiation therapy field
77285.................................  Set radiation therapy field
77290.................................  Set radiation therapy field
77295.................................  Set radiation therapy field
77299.................................  Radiation therapy planning
77300.................................  Radiation therapy dose plan
77301.................................  Radiotherapy dose plan, imrt
77305.................................  Teletx isodose plan simple
77310.................................  Teletx isodose plan intermed
77315.................................  Teletx isodose plan complex
77321.................................  Special teletx port plan
77326.................................  Brachytx isodose calc simp
77327.................................  Brachytx isodose calc interm
77328.................................  Brachytx isodose plan compl
77331.................................  Special radiation dosimetry
77332.................................  Radiation treatment aid(s)
77333.................................  Radiation treatment aid(s)
77334.................................  Radiation treatment aid(s)
77336.................................  Radiation physics consult
77370.................................  Radiation physics consult
77399.................................  External radiation dosimetry
77401.................................  Radiation treatment delivery
77402.................................  Radiation treatment delivery
77403.................................  Radiation treatment delivery
77404.................................  Radiation treatment delivery
77406.................................  Radiation treatment delivery
77407.................................  Radiation treatment delivery
77408.................................  Radiation treatment delivery
77409.................................  Radiation treatment delivery
77411.................................  Radiation treatment delivery
77412.................................  Radiation treatment delivery
77413.................................  Radiation treatment delivery
77414.................................  Radiation treatment delivery
77416.................................  Radiation treatment delivery
77417.................................  Radiology port film(s)
77418.................................  Radiation tx delivery, imrt
77421.................................  Stereoscopic x-ray guidance
77422.................................  Neutron beam tx, single
77423.................................  Neutron beam tx, complex
77427.................................  Radiation tx management, x5
77431.................................  Radiation therapy management
77432.................................  Stereotactic radiation trmt
77470.................................  Special radiation treatment
77499.................................  Radiation therapy management
77520.................................  Proton trmt, simple w/o comp
77522.................................  Proton trmt, simple w/comp
77523.................................  Proton trmt, intermediate
77525.................................  Proton treatment, complex
77600.................................  Hyperthermia treatment
77605.................................  Hyperthermia treatment
77610.................................  Hyperthermia treatment
77615.................................  Hyperthermia treatment
77620.................................  Hyperthermia treatment
77750.................................  Infuse radioactive materials
77761.................................  Apply intrcav radiat simple
77762.................................  Apply intrcav radiat interm
77763.................................  Apply intrcav radiat compl
77776.................................  Apply interstit radiat simpl
77777.................................  Apply interstit radiat inter
77778.................................  Apply interstit radiat compl
77781.................................  High intensity brachytherapy
77782.................................  High intensity brachytherapy
77783.................................  High intensity brachytherapy
77784.................................  High intensity brachytherapy
77789.................................  Apply surface radiation
77790.................................  Radiation handling
77799.................................  Radium/radioisotope therapy
79005*................................  Nuclear rx, oral admin
79101*................................  Nuclear rx, iv admin
79200*................................  Nuclear rx, intracav admin
79300*................................  Nuclr rx, interstit colloid
79403*................................  Hematopoietic nuclear tx
79440*................................  Nuclear rx, intra-articular
79445*................................  Nuclear rx, intra-arterial
79999*................................  Nuclear medicine therapy
92974.................................  Cath place, cardio brachytx
A9517*................................  Th I131 so iodide cap millic
A9523*................................  Yttrium90ibritumomabtiuxetan
A9530*................................  Th I131 so iodide sol millic
A9532*................................  I-125 serum albumin micro
A9534*................................  I-131 tositumomab therapeut
A9600*................................  Strontium-89 chloride
A9605*................................  Samarium sm153 lexidronamm
A9699*................................  Noc therapeutic radiopharm
G0173.................................  Stereo radiosurgery,complete
G0243.................................  Multisour photon stero treat
G0251.................................  Linear acc based stero radio
G0339.................................  Robot lin-radsurg com, first
G0340.................................  Robt lin-radsurg fractx 2-5
Q3001*................................  Brachytherapy radioelements
Q3007*................................  Sodium phosphate p32
Q3011*................................  Chromic phosphate p32
 
                   EPO AND OTHER DIALYSIS-RELATED DRUGS
 
The physician self-referral prohibition does not apply to the following
 codes for EPO and other dialysis-related drugs furnished in or by an
 ESRD facility if the conditions in Sec.   411.355(g) are satisfied: .
J0630.................................  Calcitonin salmon injection
J0636.................................  Inj calcitriol per 0.1 mcg
J0882.................................  Darbepoetin alfa, esrd use
J0886.................................  Epoetin alfa, esrd
J0895.................................  Deferoxamine mesylate inj
J1270.................................  Injection, doxercalciferol
J1751.................................  Iron dextran 165 injection
J1752.................................  Iron dextran 267 injection
J1756.................................  Iron sucrose injection
J1955.................................  Inj levocarnitine per 1 gm
J2501.................................  Paricalcitol
J2916.................................  Na ferric gluconate complex
J2993.................................  Reteplase injection
J2995.................................  Inj streptokinase /250000 IU
J2997.................................  Alteplase recombinant
J3364.................................  Urokinase 5000 IU injection
P9041.................................  Albumin (human),5%, 50ml
P9045.................................  Albumin (human), 5%, 250ml
P9046.................................  Albumin (human), 25%, 20ml
P9047.................................  Albumin (human), 25%, 50ml
 
          PREVENTIVE SCREENING TESTS, IMMUNIZATIONS AND VACCINES
 
The physician self-referral prohibition does not apply to the following
 tests if they are performed for screening purposes and satisfy the
 conditions in Sec.   411.355(h): .
76083.................................  Computer mammogram add-on
76092.................................  Mammogram, screening
80061.................................  Lipid panel [only when billed
                                         with one of the following ICD-9-
                                         CM codes: V81.0, V81.1, or
                                         V.81.2]
82465.................................  Assay, bld/serum cholesterol
                                         [only when billed with one of
                                         the following ICD-9-CM codes:
                                         V81.0, V81.1, or V.81.2]
82947.................................  Assay, glucose, blood quant
                                         [only when billed with ICD-9-CM
                                         code V77.1]
82950.................................  Glucose test [only when billed
                                         with ICD-9-CM code V77.1]
82951.................................  Glucose tolerance test (GTT)
                                         [only when billed with ICD-9-CM
                                         code V77.1]
83718.................................  Assay of lipoprotein [only when
                                         billed with one of the
                                         following ICD-9-CM codes:
                                         V81.0, V81.1, or V.81.2]
84478.................................  Assay of triglycerides [only
                                         when billed with one of the
                                         following ICD-9-CM codes:
                                         V81.0, V81.1, or V.81.2]
G0103.................................  Psa, total screening
G0107.................................  CA screen; fecal blood test
G0123.................................  Screen cerv/vag thin layer
G0124.................................  Screen c/v thin layer by MD
G0141.................................  Scr c/v cyto,autosys and md
G0143.................................  Scr c/v cyto,thinlayer,rescr
G0144.................................  Scr c/v cyto,thinlayer,rescr
G0145.................................  Scr c/v cyto,thinlayer,rescr

[[Page 70476]]

 
G0147.................................  Scr c/v cyto, automated sys
G0148.................................  Scr c/v cyto, autosys, rescr
G0202.................................  Screening mammographydigital
G0328.................................  Fecal blood scrn immunoassay
P3000.................................  Screen pap by tech w md supv
P3001.................................  Screening pap smear by phys
The physician self-referral prohibition does not apply to the following
 immunization and vaccine codes if they satisfy the conditions in Sec.
 411.355(h):.
90655.................................  Flu vaccine no preserv 6-35m
90656.................................  Flu vaccine no preserv 3 & >
90657.................................  Flu vaccine, 6-35 mo, im
90658.................................  Flu vaccine age 3 & over, im
90732.................................  Pneumococcal vaccine
90740.................................  Hepb vacc, ill pat 3 dose im
90743.................................  Hep b vacc, adol, 2 dose, im
90744.................................  Hepb vacc ped/adol 3 dose im
90746.................................  Hep b vaccine, adult, im
90747.................................  Hepb vacc, ill pat 4 dose im
------------------------------------------------------------------------
\1\ CPT codes and descriptions only are copyright 2005 American Medical
  Association. All rights are reserved and applicable FARS/DFARS clauses
  apply.
\2\ This list does not include codes for the following designated health
  service (DHS) categories: durable medical equipment and supplies;
  parenteral and enteral nutrients, equipment and supplies; prosthetics,
  orthotics, and prosthetic devices and supplies; home health services;
  outpatient prescription drugs; and inpatient and outpatient hospital
  services. For the definitions of these DHS categories, refer to 42 CFR
  411.351. For more information, refer to http://cms.hhs.gov/medlearn/refphys.asp.
* Nuclear medicine services and supplies assigned an asterisk will be
  subject to the physician self-referral prohibition effective January
  1, 2007.

[FR Doc. 05-22160 Filed 11-2-05; 5:07 pm]
BILLING CODE 4120-01-P


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