[Federal Register Volume 72, Number 227 (Tuesday, November 27, 2007)]
[Rules and Regulations]
[Pages 66222-66578]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 07-5506]



[[Page 66221]]

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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 Parts 409, 410, et al.



Medicare Program; Revisions to Payment Policies Under the Physician Fee 
Schedule, and Other Part B Payment Policies for CY 2008; Revisions to 
the Payment Policies of Ambulance Services Under the Ambulance Fee 
Schedule for CY 2008; and the Amendment of the E-Prescribing Exemption 
for Computer Generated Facsimile Transmissions; Final Rule

Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / 
Rules and Regulations

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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

42 CFR Parts 409, 410, 411, 413, 414, 415, 418, 423, 424, 482, 484, 
and 485

[CMS-1385-FC]
RIN 0938-AO65


Medicare Program; Revisions to Payment Policies Under the 
Physician Fee Schedule, and Other Part B Payment Policies for CY 2008; 
Revisions to the Payment Policies of Ambulance Services Under the 
Ambulance Fee Schedule for CY 2008; and the Amendment of the E-
Prescribing Exemption for Computer Generated Facsimile Transmissions

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

ACTION: Final rule with comment period.

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SUMMARY: This final rule with comment period addresses certain 
provisions of the Tax Relief and Health Care Act of 2006, as well as 
making other proposed changes to Medicare Part B payment policy. We are 
making these changes to ensure that our payment systems are updated to 
reflect changes in medical practice and the relative value of services. 
This final rule with comment period also discusses refinements to 
resource-based practice expense (PE) relative value units (RVUs); 
geographic practice cost indices (GPCI) changes; malpractice RVUs; 
requests for additions to the list of telehealth services; several 
coding issues including additional codes from the 5-Year Review; 
payment for covered outpatient drugs and biologicals; the competitive 
acquisition program (CAP); clinical lab fee schedule issues; payment 
for renal dialysis services; performance standards for independent 
diagnostic testing facilities; expiration of the physician scarcity 
area (PSA) bonus payment; conforming and clarifying changes for 
comprehensive outpatient rehabilitation facilities (CORFs); a process 
for updating the drug compendia; physician self referral issues; 
beneficiary signature for ambulance transport services; durable medical 
equipment (DME) update; the chiropractic services demonstration; a 
Medicare economic index (MEI) data change; technical corrections; 
standards and requirements related to therapy services under Medicare 
Parts A and B; revisions to the ambulance fee schedule; the ambulance 
inflation factor for CY 2008; and amending the e-prescribing exemption 
for computer-generated facsimile transmissions. We are also finalizing 
the calendar year (CY) 2007 interim RVUs and are issuing interim RVUs 
for new and revised procedure codes for CY 2008.
    As required by the statute, we are announcing that the physician 
fee schedule update for CY 2008 is -10.1 percent, the initial estimate 
for the sustainable growth rate for CY 2008 is -0.1 percent, and the 
conversion factor (CF) for CY 2008 is $34.0682.

DATES: Effective Date: The provisions of this final rule with comment 
period are effective January 1, 2008, except for the amendments to 
Sec.  409.17 and Sec.  409.23 which are effective July 1, 2008, and the 
amendments to Sec.  423.160 which is effective January 1, 2009.
    Comment Date: Comments will be considered if we receive them at one 
of the addresses provided below, no later than 5 p.m. e.s.t. on 
December 31, 2007.

ADDRESSES: In commenting, please refer to file code CMS-1385-FC. 
Because of staff and resource limitations, we cannot accept comments by 
facsimile (FAX) transmission.
    You may submit comments in one of three ways (no duplicates, 
please):
    1. Electronically. You may submit electronic comments on specific 
issues in this regulation to http://www.cms.hhs.gov/eRulemaking. Click 
on the link ``Submit electronic comments on CMS regulations with an 
open comment period.'' (Attachments should be in Microsoft Word, 
WordPerfect, or Excel; however, we prefer Microsoft Word.)
    2. By mail. You may mail written comments (one original and two 
copies) to the following address ONLY: Centers for Medicare & Medicaid 
Services, Department of Health and Human Services, Attention: CMS-1385-
FC, P.O. Box 8020, Baltimore, MD 21244-8020.
    Please allow sufficient time for mailed comments to be received 
before the close of the comment period.
    3. By express or overnight mail. You may send written comments (one 
original and two copies) to the following address ONLY: Centers for 
Medicare & Medicaid Services, Department of Health and Human Services, 
Attention: CMS-1385-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 (HHH) Building, 200 Independence 
Avenue, SW., Washington, DC 20201; or 7500 Security Boulevard, 
Baltimore, MD 21244-1850.
    (Because access to the interior of the HHH Building is not readily 
available to persons without Federal Government identification, 
commenters are encouraged to leave their comments in the CMS drop slots 
located in the main lobby of the building. A stamp-in clock is 
available for persons wishing to retain a proof of filing by stamping 
in and retaining an extra copy of the comments being filed.)
    Comments mailed to the addresses indicated as appropriate for hand 
or courier delivery may be delayed and received after the comment 
period.
    Submission of comments on paperwork requirements. You may submit 
comments on this document's paperwork requirements by mailing your 
comments to the addresses provided at the end of the ``Collection of 
Information Requirements'' section in this document.
    For information on viewing public comments, see the beginning of 
the SUPPLEMENTARY INFORMATION section.

FOR FURTHER INFORMATION CONTACT:  Pam West, (410) 786-2302 for issues 
related to practice expense and comprehensive outpatient rehabilitation 
facilities.
    Rick Ensor, (410) 786-5617 for issues related to practice expense 
methodology.
    Stephanie Monroe, (410) 786-6864 for issues related to the 
geographic practice cost index and malpractice RVUs.
    Craig Dobyski, (410) 786-4584 for issues related to list of 
telehealth services.
    Ken Marsalek, (410) 786-4502 for issues related to the DRA imaging 
cap.
    Catherine Jansto, (410) 786-7762 for issues related to payment for 
covered outpatient drugs and biologicals.
    Edmund Kasaitis (410) 786-0477 for issues related to the 
Competitive Acquisition Program (CAP) for part B drugs.
    Anita Greenberg (410) 786-4601 for issues related to the clinical 
laboratory fee schedule.
    Henry Richter, (410) 786-4562 for issues related to payments for 
end-stage renal disease facilities.
    August Nemec (410) 786-0612 for issues related to independent 
diagnostic testing facilities.
    Kate Tillman (410) 786-9252 or Brijit Burton (410) 786-7364 for 
issues related to the drug compendia.

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    David Walczak (410) 786-4475 for issues related to reassignment and 
physician self-referral rules for diagnostic tests and beneficiary 
signature for ambulance transport.
    Lisa Ohrin (410) 786-4565 or Joanne Sinsheimer (410) 786-4620 for 
issues related to physician self-referral rules.
    Bob Kuhl (410) 786-4597 for issues related to the DME update.
    Rachel Nelson (410) 786-1175 for issues related to the physician 
quality reporting system for CY 2008.
    Maria Ciccanti (410) 786-3107 for issues related to the reporting 
of anemia quality indicators.
    James Menas (410) 786-4507 for issues related to payment for 
physician pathology services.
    Dorothy Shannon, (410) 786-3396 for issues related to the 
outpatient therapy caps.
    Drew Morgan, (410) 786-2543 for issues related to the E-Prescribing 
Exemption for Computer Generated Facsimile Transmissions.
    Roechel Kujawa (410) 786-9111 or Anne Tayloe (410) 786-4546 for 
issues related to the ambulance fee schedule.
    Diane Milstead, (410) 786-3355 or Gaysha Brooks (410) 786-9649 for 
all other issues.

SUPPLEMENTARY INFORMATION:
    Submitting Comments: We welcome comments from the public on the 
following issues: Interim Relative Value Units (RVUs) for selected 
codes identified in Addendum C and the physician self-referral 
designated health services (DHS) procedures listed in Addendum I. You 
can assist us by referencing the file code [CMS-1385-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 the comment period are available for viewing by the public, 
including any personally identifiable or confidential business 
information that is included in a comment. We post all comments 
received before the close of the comment period on the following Web 
site as soon as possible after they have been received: http://www.cms.hhs.gov/eRulemaking. Click on the link ``Electronic Comments on 
CMS Regulations'' on that Web site to view public comments.
    Comments received timely will also be available for public 
inspection as they are received, generally beginning approximately 3 
weeks after publication of a document, at the headquarters of the 
Centers for Medicare & Medicaid Services, 7500 Security Boulevard, 
Baltimore, Maryland 21244, Monday through Friday of each week from 8:30 
a.m. to 4 p.m. To schedule an appointment to view public comments, 
phone 1-800-743-3951.
    This Federal Register document is also available from the Federal 
Register online database through Government Printing Office 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 also be found on the 
CMS homepage. You can access this data by using the following 
directions:
    1. Go to the following Web site: http://www.cms.hhs.gov/PhysicianFeeSched/.
    2. Select ``PFS Federal Regulation Notices.''
    To assist readers in referencing sections contained in this 
preamble, we are providing the following table of contents. Some of the 
issues discussed in this preamble affect the payment policies, but do 
not require changes to the regulations in the Code of Federal 
Regulations. Information on the regulation's impact appears throughout 
the preamble and is not exclusively in section VI.

Table of Contents

I. Background
    A. Development of the Relative Value System
    B. Components of the Fee Schedule Payment Amounts
    C. Most Recent Changes to Fee Schedule
II. Provisions of the Final Rule Related to the Physician Fee 
Schedule
    A. Resource Based Practice Expense (PE) Relative Value Units 
(RVUs)
    1. Current Methodology
    2. PE Proposals for CY 2008
    B. Geographic Practice Cost Indices (GPCIs)
    1. GPCI Update
    2. Payment Localities
    C. Malpractice (MP) RVUs (TC/PC issue)
    D. Medicare Telehealth Services
    E. Specific Coding Issues Related to PFS
    1. Reduction in the Technical Component (TC) Payment for Imaging 
Services Under the PFS to the Outpatient Department (OPD) Payment 
Amount
    2. Application of Multiple Procedure Payment Reduction for Mohs 
Micrographic Surgery (CPT Codes 17311 Through 17315)
    3. Payment for Intravenous Immune Globulin (IVIG) Add On Code 
for Preadmission Related Services
    4. Reporting of Cardiac Rehabilitation Services
    F. Part B Drug Payment
    1. Average Sales Price (ASP) Issues
    2. Competitive Acquisition Program (CAP) Issues
    G. Issues Related to the Clinical Lab Fee Schedule
    1. Date of Service for the Technical Component (TC) of Physician 
Pathology Services (Sec.  414.510)
    2. New Clinical Diagnostic Laboratory Test (Sec.  414.508)
    H. Revisions Related to Payment for Renal Dialysis Services 
Furnished by End-Stage Renal Disease (ESRD) Facilities
    1. Growth Update to the Drug Add-On Adjustment to the Composite 
Rates
    2. Update to the Geographic Adjustment to the Composite Rates
    I. Independent Diagnostic Testing Facility (IDTF) Issues
    1. Revisions of Existing IDTF Performance Standards
    2. New IDTF Standards
    J. Expiration of MMA Section 413 Provisions for Physician 
Scarcity Area (PSA)
    K. Comprehensive Outpatient Rehabilitation Facility (CORF) 
Issues
    1. Requirements for Coverage of CORF Services Plan of Treatment 
(Sec.  410.105(c))
    2. Included Services (Sec.  410.100)
    3. Physician Services (Sec.  410.100(a))
    4. Clarifications of CORF Respiratory Therapy Services
    5. Social and Psychological Services
    6. Nursing Care Services
    7. Drugs and Biologicals
    8. Supplies and DME
    9. Clarifications and Payment Updates for Other CORF Services
    10. Cost Based Payment (Sec.  413.1)
    11. Payment for Comprehensive Outpatient Rehabilitation Facility 
(CORF) Services
    12. Vaccines
    L. Compendia for Determination of Medically Accepted Indications 
for Off Label Uses of Drugs and Biologicals in an Anti-Cancer 
Chemotherapeutic Regimen (Sec.  414.930)
    1. Background
    2. Process for Determining Changes to the Compendia List
    M. Physician Self Referral Issues
    1. General
    2. Changes to Reassignment and Physician Self Referral Rules 
Relating to Diagnostic Tests (Anti Markup Provision)
    N. Beneficiary Signature for Ambulance Transport Services
    O. Update to Fee Schedules for Class III DME for CYs 2007 and 
2008
    1. Background
    2. Update to Fee Schedule
    P. Discussion of Chiropractic Services Demonstration
    Q. Technical Corrections
    1. Particular Services Excluded From Coverage (Sec.  411.15(a))
    2. Medical Nutrition Therapy (Sec.  410.132(a))
    3. Payment Exception: Pediatric Patient Mix (Sec.  413.184)
    4. Diagnostic X ray Tests, Diagnostic Laboratory Tests, and 
Other Diagnostic Tests: Conditions (Sec.  410.32(a)(1))
    R. Other Issues
    1. Recalls and Replacement Devices
    2. Therapy Standards and Requirements
    3. Amendment to the Exemption for Computer Generated Facsimile 
Transmission from the National Council for Prescription Drug 
Programs (NCPDP) SCRIPT Standard for Transmitting Prescription and 
Certain Prescription Related Information for Part D Eligible 
Individuals

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    S. Division B of the Tax Relief and Health Care Act of 2006--
Medicare Improvements and Extension Act of 2006 (Pub. L. 109-432) 
(MIEA-TRHCA)
    1. Section 101(b)--Physician Quality Reporting Initiative (PQRI)
    2. Section 110--Reporting of Hemoglobin or Hematocrit for Part B 
Cancer Anti-Anemia Drugs (Sec.  414.707(b))
    3. Section 104--Extension of Treatment of Certain Physician 
Pathology Services Under Medicare
    4. Section 201--Extension of Therapy Cap Exception Process
    5. Section 101(d)--Physician Assistance and Quality Initiative 
(PAQI) Fund
III. Revisions to the Payment Policies of Ambulance Services Under 
the Fee Schedule for Ambulance Services; Ambulatory Inflation Factor 
Update for CY 2007
    A. History of Medicare Ambulance Services
    1. Statutory Coverage of Ambulance Services
    2. Medicare Regulations for Ambulance Services
    3. Transition to National Fee Schedule
    B. Ambulance Inflation Factor (AIF) During the Transition Period
    C. Ambulance Inflation Factor (AIF) for CY 2008
    D. Revisions to the Publication of the Ambulance Fee Schedule 
(Sec.  414.620)
IV. Refinement of Relative Value Units for Calendar Year 2008 and 
Response to Public Comments on Interim Relative Value Units for 2007
    A. Summary of Issues Discussed Related to the Adjustment of 
Relative Value Units
    B. Process for Establishing Work Relative Value Units for the 
Physician Fee Schedule
    C. 5 Year Review of Work RVUs
    1. Additional Codes from the 5-Year Review of Work RVUs
    2. Anesthesia Coding (Part of 5-Year Review)
    3. Budget Neutrality Adjustment
    D. Work Relative Value Unit Refinements of Interim Relative 
Value Units (Interim 2007 Codes)
    E. 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 
2008 (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 2008 CPT Codes'')
    F. Discussion of Codes and RUC/HCPAC Recommendations
    G. Additional Coding Issues
    H. 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 2008
V. Physician Self-Referral Prohibition: Annual Update to the List of 
CPT/HCPCS Codes
VI. Physician Fee Schedule Update for CY 2008
    A. Physician Fee Schedule Update
    B. The Percentage Change in the Medicare Economic Index (MEI)
    C. The Update Adjustment Factor (UAF)
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 2008
    D. Revised Sustainable Growth Rate for 2007
    E. Final Sustainable Growth Rate for 2006
    F. Calculation of 2008, 2007, and 2006 Sustainable Growth Rates
VIII. Anesthesia and Physician Fee Schedule Conversion Factors for 
CY 2008
    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 and Delay in Effective Date
XII. Collection of Information Requirements
XIII. Response to Comments
XIV. Regulatory Impact Analysis
Regulation Text
Addendum A--Explanation and Use of Addendum B
Addendum B--2008 Relative Value Units and Related Information Used 
in Determining Medicare Payments for 2007
Addendum C--Codes With Interim RVUS
Addendum D--2008 Geographic Adjustment Factors (GAFs)
Addendum E--2008 Geographic Practice Cost Indices (GPCIs) by State 
and Medicare Locality
Addendum F--CPT/HCPCS Imaging Codes Defined by Section 5102(b) of 
the DRA
Addendum G--FY 2008 Wage Index for Urban Areas Based on CBSA Labor 
Market Areas
Addendum H--FY 2008 Wage Index Based on CBSA Labor Market Areas for 
Rural Areas
Addendum I--Updated List of CPT/HCPCS Codes Used To Describe Certain 
Designated Health Services Under the Physician Self-Referral 
Provision

Acronyms

    In addition, because of the many organizations and terms to which 
we refer by acronym in this final rule with comment period, we are 
listing these acronyms and their corresponding terms in alphabetical 
order below:

AAA Abdominal aortic aneurysm
AAP Average acquisition price
ACOTE Accreditation Council for Occupational Therapy Education
ACR American College of Radiology
AFROC Association of Freestanding Radiation Oncology Centers
AHFS-DI American Hospital Formulary Service--Drug Information
AHRQ Agency for Healthcare Research and Quality (HHS)
AIF Ambulance inflation factor
AMA American Medical Association
AMA-DE American Medical Association Drug Evaluations
AMP Average manufacturer price
AOTA American Occupational Therapy Association
APC Ambulatory payment classification
APTA American Physical Therapy Association
ASA American Society of Anesthesiologists
ASC Ambulatory surgical center
ASP Average sales price
ASTRO American Society for Therapeutic Radiology and Oncology
ATA American Telemedicine Association
AWP Average wholesale price
BBA Balanced Budget Act of 1997 (Pub. L. 105-33)
BBRA [Medicare, Medicaid and State Child Health Insurance Program] 
Balanced Budget Refinement Act of 1999 (Pub. L. 106-113)
BIPA Medicare, Medicaid, and SCHIP Benefits Improvement Protection 
Act of 2000
BLS Bureau of Labor Statistics
BMD Bone mineral density
BMI Body mass index
BMM Bone mass measurement
BN Budget neutrality
BSA Body surface area
CAD Computer aided detection
CAH Critical access hospital
CAP Competitive acquisition program
CBSA Core-Based Statistical Area
CEM Cardiac event monitoring
CF Conversion factor
CFR Code of Federal Regulations
CMA California Medical Association
CMS Centers for Medicare & Medicaid Services
CNS Clinical nurse specialist
CORF Comprehensive Outpatient Rehabilitation Facility
COTA Certified Occupational Therapy Assistant
CPEP Clinical Practice Expert Panel
CPI Consumer Price Index
CPI-U Consumer price index for urban customers
CPT (Physicians') Current Procedural Terminology (4th Edition, 2002, 
copyrighted by the American Medical Association)
CRT-D Cardiac resynchronization therapy defibrillator
CT Computed tomography
CTA Computed tomographic angiography
CY Calendar year
DEXA Dual energy x-ray absorptiometry
DHS Designated health services
DME Durable medical equipment
DMEPOS Durable medical equipment, prosthetics, orthotics, and 
supplies
DO Doctor of Osteopathy
DRA Deficit Reduction Act of 2005 (Pub. L. 109-432)
E/M Evaluation and management
ECI Employment cost index
EHR Electronic health record
EPC [Duke] Evidence-based Practice Centers
EPO Erythopoeitin
ESRD End stage renal disease
F&C Facts and Comparisons
FAW Furnish as written

[[Page 66225]]

FAX Facsimile
FDA Food and Drug Administration (HHS)
FMR Fair market rents
FQHC Federally qualified health center
FR Federal Register
GAF Geographic adjustment factor
GAO General Accounting Office
GII Global Insight, Inc.
GPO Group purchasing organization
GPCI Geographic practice cost index
HCPAC Health Care Professional Advisory Committee
HCPCS Healthcare Common Procedure Coding System
HCRIS Healthcare Cost Report Information System
HIPAA Health Insurance Portability and Accountability Act of 1996 
(Pub. L. 104-191)
HHA Home health agency
HHS [Department of] Health and Human Services
HIT Health information technology
HMO Health maintenance organization
HPSA Health Professional Shortage Area
HRSA Health Resources Services Administration (HHS)
HUD [Department of] Housing and Urban Development
ICD Implantable cardioverter-defibrillator
ICF Intermediate care facilities
IDTF Independent diagnostic testing facility
IFC Interim final rule with comment period
IOTED International Occupational Therapy Eligibility Determination
IPPE Initial preventive physical examination
IPPS Inpatient prospective payment system
IV Intravenous
IVIG Intravenous immune globulin
IWPUT Intra-service work per unit of time
JCAAI Joint Council of Allergy, Asthma, and Immunology
LPN Licensed practical nurse
MA Medicare Advantage
MA-PD Medicare Advantage Prescription Drug Plans
MD Medical doctor
MedCAC Medicare Evidence Development and Coverage Advisory Committee 
(formerly the Medicare Coverage Advisory Committee (MCAC))
MedPAC Medicare Payment Advisory Commission
MEI Medicare Economic Index
MIEA-TRHCA Medicare Improvements and Extension Act of 2006 (That is, 
Division B of the Tax Relief and Health Care Act of 2006 (TRHCA)
MMA Medicare Prescription Drug, Improvement, and Modernization Act 
of 2003 (Pub. L. 108-173)
MNT Medical nutrition therapy
MP Malpractice
MRA Magnetic resonance angiography
MRI Magnetic resonance imaging
MSA Metropolitan statistical area
MSP Medicare Secondary Payer
MSVP Multi-specialty visit package
NBCOT National Board for Certification in Occupational Therapy, Inc.
NCCN National Comprehensive Cancer Network
NCPDP National Council for Prescription Drug Programs
NCQDIS National Coalition of Quality Diagnostic Imaging Services
NDC National drug code
NEMC New England Medical Center
NISTA National Institute of Standards and Technology Act
NLA National limitation amount
NP Nurse practitioner
NPP Nonphysician practitioners
NQF National Quality Forum
NTTAA National Technology Transfer and Advancement Act of 1995 (Pub. 
L. 104-113)
OACT [CMS'] Office of the Actuary
OBRA Omnibus Budget Reconciliation Act
OIG Office of Inspector General
OMB Office of Management and Budget
OPD Outpatient Department
OPPS Outpatient prospective payment system
OPT Outpatient physical therapy
OSCAR Online Survey and Certification and Reporting
PA Physician assistant
PC Professional component
PCF Patient compensation fund
PDP Prescription Drug Plan
PE Practice Expense
PE/HR Practice expense per hour
PEAC Practice Expense Advisory Committee
PECOS Provider Enrollment, Chain, and Ownership System
PERC Practice Expense Review Committee
PET Positron emission tomography
PFS Physician Fee Schedule
PLI Professional liability insurance
PPI Producer price index
PPS Prospective payment system
PQRI Physician Quality Reporting Initiative
PRA Paperwork Reduction Act
PSA Physician scarcity areas
PT Physical therapy
PT/INR Prothrombin time, international normalized ratio
RFA Regulatory Flexibility Act
RHC Rural health clinic
RIA Regulatory impact analysis
RN Registered nurse
RT Respiratory therapist
RUC [AMA's Specialty Society] Relative (Value) Update Committee
RVU Relative value unit
SBA Small Business Administration
SGR Sustainable growth rate
SLP Speech--language pathology
SLPs Speech--language pathologists
SMS [AMA's] Socioeconomic Monitoring System
SNF Skilled nursing facility
STS Society of Thoracic Surgeons
TA Technology Assessment
TC Technical Component
TENS Transcutaneous electric nerve stimulator
TRHCA Tax Relief and Health Care Act of 2006 (Pub. L. 109-432)
USP-DI United States Pharmacopoeia-Drug Information
WAC Wholesale acquisition cost
WAMP Widely available market price
Wet AMD Exudative age-related macular degeneration
WFOT World Federation of Occupational Therapists

I. Background

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

A. Development of the Relative Value System

1. Work RVUs
    The concepts and methodology underlying the PFS were enacted as 
part of the Omnibus Budget Reconciliation Act (OBRA) of 1989, Pub. L. 
101-239, and OBRA 1990, (Pub. L. 101-508). The final rule, published 
November 25, 1991 (56 FR 59502), set forth the fee schedule for payment 
for physicians' services beginning January 1, 1992. Initially, only the 
physician work RVUs were resource-based, and the PE and malpractice 
RVUs were based on average allowable charges.
    The physician work RVUs established for the implementation of the 
fee schedule in January 1992 were developed with extensive input from 
the physician community. A research team at the Harvard School of 
Public Health developed the original physician work RVUs for most codes 
in a cooperative agreement with the Department of Health and Human 
Services (HHS). In constructing the code-specific vignettes for the 
original physician work RVUs, Harvard worked with panels of experts, 
both inside and outside the Federal government, and obtained input from 
numerous physician specialty groups.
    Section 1848(b)(2)(B) of the Act specifies that the RVUs for 
anesthesia services are based on RVUs from a uniform relative value 
guide. We established a separate conversion factor (CF) for anesthesia 
services, and we continue to utilize time units as a factor in 
determining payment for these services. As a result, there is a 
separate formula used to calculate payment 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).

[[Page 66226]]

2. Practice Expense Relative Value Units (PE RVUs)
    Section 121 of the Social Security Act Amendments of 1994 (Pub. L. 
103-32), enacted on October 31, 1994, amended section 1848(c)(2)(C)(ii) 
of the Act and required us to develop resource-based PE RVUs for each 
physician's service beginning in 1998. We were to consider general 
categories of expenses (such as office rent and wages of personnel, but 
excluding malpractice expenses) comprising PEs.
    Section 4505(a) of the Balanced Budget Act of 1997 (BBA) (Pub. L. 
105 33), amended section 1848(c)(2)(C)(ii) of the Act to delay 
implementation of the resource based PE RVU system until January 1, 
1999. In addition, section 4505(b) of the BBA provided for a 4-year 
transition period from charge based PE RVUs to resource-based RVUs.
    We established the resource based PE RVUs for each physician's 
service in a final rule, published November 2, 1998 (63 FR 58814), 
effective for services furnished in 1999. Based on the requirement to 
transition to a 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 (RNs)) nominated by 
physician specialty societies and other groups. The CPEP panels 
identified the direct inputs required for each physician's service in 
both the office setting and out-of-office setting. We have since 
refined and revised these inputs based on recommendations from the RUC. 
The AMA's SMS data provided aggregate specialty-specific information on 
hours worked and PEs.
    Separate PE RVUs are established for procedures that can be 
performed in both a nonfacility setting, such as a physician's office, 
and a facility setting, such as a hospital outpatient department. The 
difference between the facility and nonfacility RVUs reflects the fact 
that a facility typically receives separate payment from Medicare for 
its costs of providing the service, apart from payment under the PFS. 
The nonfacility RVUs reflect all of the direct and indirect PEs of 
providing a particular service.
    Section 212 of the Balanced Budget Refinement Act of 1999 (BBRA) 
(Pub. L. 106-113) directed the Secretary of Health and Human Services 
(the Secretary) to establish a process under which we accept and use, 
to the maximum extent practicable and consistent with sound data 
practices, data collected or developed by entities and organizations to 
supplement the data we normally collect in determining the PE 
component. On May 3, 2000, we published the interim final rule (65 FR 
25664) that set forth the criteria for the submission of these 
supplemental PE survey data. The criteria were modified in response to 
comments received, and published in the Federal Register (65 FR 65376) 
as part of a November 1, 2000 final rule. The PFS final rules published 
in 2001 and 2003, respectively, (66 FR 55246 and 68 FR 63196) extended 
the period during which we would accept these supplemental data through 
March 1, 2005.
    In the CY 2007 PFS final rule with comment period (71 FR 69624), we 
revised the methodology for calculating PE RVUs beginning in CY 2007 
and provided for a 4-year transition for the new PE RVUs under this new 
methodology. We will continue to reexamine this policy and proposed 
necessary revisions through future rulemaking.
3. Resource-Based Malpractice (MP) RVUs
    Section 4505(f) of the BBA amended section 1848(c) of the Act to 
require us to implement resource-based malpractice (MP) RVUs for 
services furnished on or after 2000. The resource-based MP RVUs were 
implemented in the PFS final rule published November 2, 1999 (64 FR 
59380). The MP RVUs were based on malpractice insurance premium data 
collected from commercial and physician-owned insurers from all the 
States, the District of Columbia, and Puerto Rico.
4. Refinements to the RVUs
    Section 1848(c)(2)(B)(i) of the Act requires that we review RVUs no 
less often than every 5 years. The first 5-Year Review of the physician 
work RVUs was effective in 1997, published on November 22, 1996 (61 FR 
59489). The second 5-Year Review went into effect in 2002, published in 
the CY 2002 PFS final rule (66 FR 55246). The third 5-Year Review of 
physician work RVUs went into effect on January 1, 2007 and was 
published in the CY 2007 PFS final rule with comment period (71 FR 
69624) (although we note that certain additional proposals relating to 
the third 5-Year Review are addressed in the CY 2008 PFS proposed rule 
and in this final rule with comment period).
    In 1999, the AMA's RUC established the Practice Expense Advisory 
Committee (PEAC) for the purpose of refining the direct PE inputs. 
Through March 2004, the PEAC provided recommendations to CMS for over 
7,600 codes (all but a few hundred of the codes currently listed in the 
AMA's Current Procedural Terminology (CPT) codes). As part of the CY 
2007 PFS final rule with comment period (71 FR 69624), we implemented a 
new methodology for determining resource-based PE RVUs and are 
transitioning this over a 4-year period.
    In the CY 2005 PFS final rule with comment period (69 FR 66236), we 
implemented the first 5-Year Review of the malpractice RVUs (69 FR 
66263).
5. Adjustments to RVUs are Budget Neutral
    Section 1848(c)(2)(B)(ii)(II) of the Act provides that adjustments 
in RVUs for a year may not cause total PFS payments to differ by more 
than $20 million from what they would have been if the adjustments were 
not made. In accordance with section 1848(c)(2)(B)(ii)(II) of the Act, 
if adjustments to RVUs cause expenditures to change by more than $20 
million, we make adjustments to ensure that expenditures do not 
increase or decrease by more than $20 million.
    As explained in the CY 2007 PFS final rule with comment period (71 
FR 69624), due to the increase in work RVUs resulting from the third 5-
Year Review of physician work RVUs, we are applying a separate budget 
neutrality (BN) adjustor to the work RVUs for services furnished during 
2007. This approach is consistent with the method we use to make BN 
adjustments to the PE RVUs to reflect the changes in these PE RVUs.

B. Components of the Fee Schedule Payment Amounts

    To calculate the payment for every physician service, the 
components of the fee schedule (physician work, PE, and MP RVUs) are 
adjusted by a geographic practice cost index (GPCI). The GPCIs reflect 
the relative costs of physician work, PE, and malpractice insurance in 
an area compared to the national average costs for each component.
    Payments are converted to dollar amounts through the application of 
a CF, which is calculated by the Office of the Actuary (OACT) and is 
updated annually for inflation.
    The formula for calculating the Medicare fee schedule amount for a 
given service and fee schedule area can be expressed as:

[[Page 66227]]

    Payment = [(RVU work x budget neutrality adjuster x work GPCI) + 
(RVU PE x PE GPCI) + (MP RVU x MP GPCI)] x CF.

C. Most Recent Changes to the Fee Schedule

    The CY 2007 PFS final rule with comment period (71 FR 69624) 
addressed certain provisions of the Deficit Reduction Act of 2005 (Pub. 
L. 109-432) (DRA) and made other changes to Medicare Part B payment 
policy to ensure that our payment systems are updated to reflect 
changes in medical practice and the relative value of services. This 
final rule with comment period also discussed GPCI changes; requests 
for additions to the list of telehealth services; payment for covered 
outpatient drugs and biologicals; payment for renal dialysis services; 
policies related to private contracts and opt-out; policies related to 
bone mass measurement (BMM) services, independent diagnostic testing 
facilities (IDTFs), the physician self-referral prohibition; laboratory 
billing for the technical component (TC) of physician pathology 
services; the clinical laboratory fee schedule; certification of 
advanced practice nurses; health information technology, the health 
care information transparency initiative; updated the list of certain 
services subject to the physician self-referral prohibitions, finalized 
ASP reporting requirements, and codified Medicare's longstanding policy 
that payment of bad debts associated with services paid under a fee 
schedule/charge-based system is not allowable.
    We also finalized the CY 2006 interim RVUs and issued interim RVUs 
for new and revised procedure codes for CY 2007.
    In addition, the CY 2007 PFS final rule with comment period 
included revisions to payment policies under the fee schedule for 
ambulance services and announced the ambulance inflation factor (AIF) 
update for CY 2007.
    In accordance with section 1848(d)(1)(E)(i) of the Act, we also 
announced that the PFS update for CY 2007 is -5.0 percent, the initial 
estimate for the sustainable growth rate (SGR) for CY 2007 is 1.8 
percent and the CF for CY 2007 is $35.9848. However, subsequent to 
publication of the CY 2007 PFS final rule with comment period, section 
101(a) of Division B, Title I of the Tax Relief and Health Care Act of 
2006 (Pub. L. 109-432) (MIEA-TRHCA), which was enacted on December 20, 
2006, amended section 1848(d) of the Act. [Division B of the Tax Relief 
and Health Care Act of 2006 is entitled Medicare and Other Health 
Provisions and its short title is the Medicare Improvements and 
Extension Act of 2006. Therefore, the law is hereinafter referred to as 
``MIEA-TRHCA''.] As a result of this statutory change, the CF of 
$37.8975 was maintained for CY 2007.

II. Provisions of the Final Rule Related to the Physician Fee Schedule

    In response to the CY 2008 PFS proposed rule (72 FR 38122), we 
received approximately 27,000 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 anesthesia coding and the 5-Year 
Review, the physician self-referral provisions and the technical 
correction to Sec.  410.32(a)(1) concerning an exception to the 
requirement that diagnostic services (including x-rays) must be ordered 
by the treating physician. To the extent that comments were outside the 
scope of the proposed rule, they are not addressed in this final rule 
with comment period.
    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 CY 2008 PFS 
proposed rule (72 FR 38122). More detailed background information for 
each issue can be found in the CY 2008 PFS proposed rule.

A. Resource Based Practice Expense (PE) Relative Value Units (RVUs)

    Practice expense (PE) is the portion of the resources used in 
furnishing the service that reflects the general categories of 
physician and practitioner expenses, such as office rent and personnel 
wages but excluding malpractice expenses, as specified in section 
1848(c)(1)(B) of the Act.
    Section 121 of the Social Security Amendments of 1994 (Pub. L. 103-
432), enacted on October 31, 1994, required CMS to develop a 
methodology for a resource-based system for determining PE RVUs for 
each physician's service. Until that time, PE RVUs were based on 
historical allowed charges. This legislation required that the revised 
PE methodology must consider the staff, equipment, and supplies used in 
the provision of various medical and surgical services in various 
settings beginning in 1998. The Secretary has interpreted this to mean 
that Medicare payments for each service would be based on the relative 
PE resources typically involved with furnishing the service.
    The initial implementation of resource-based PE RVUs was delayed 
from January 1, 1998, until January 1, 1999, by section 4505(a) of the 
BBA. In addition, section 4505(b) of the BBA required that the new 
payment methodology be phased in over 4 years, effective for services 
furnished in CY 1999, and fully effective in CY 2002. The first step 
toward implementation of the statute was to adjust the PE values for 
certain services for CY 1998. Section 4505(d) of the BBA required that, 
in developing the resource-based PE RVUs, the Secretary must:
    <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 and actual data on equipment utilization.
    <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 PE.
    In CY 1999, we began the 4-year transition to resource-based PE 
RVUs utilizing a ``top-down'' methodology whereby we allocated 
aggregate specialty-specific practice costs to individual procedures. 
The specialty-specific PEs were derived from the American Medical 
Association's (AMA's) Socioeconomic Monitoring Survey (SMS). In 
addition, under section 212 of the BBRA, we established a process 
extending through March 2005 to supplement the SMS data with data 
submitted by a specialty. The aggregate PEs for a given specialty were 
then allocated to the services furnished by that specialty on the basis 
of the direct input data (that is, the staff time, equipment, and 
supplies) and work RVUs assigned to each CPT code.
    For CY 2007, we implemented a new methodology for calculating PE 
RVUs. Under this new methodology, we use the same data sources for 
calculating PE, but instead of using the ``top-down'' approach to 
calculate the direct PE RVUs, under which the aggregate direct and 
indirect costs for each specialty are allocated to each individual 
service, we now utilize a ``bottom-up'' approach to

[[Page 66228]]

calculate the direct costs. Under the ``bottom-up'' approach, we 
determine the direct PE by adding the costs of the resources (that is, 
the clinical staff, equipment, and supplies) typically required to 
furnish each service. The costs of the resources are calculated using 
the refined direct PE inputs assigned to each CPT code in our PE 
database, which are based on our review of recommendations received 
from the AMA's Relative Value Update Committee (RUC). For a more 
detailed explanation of the PE methodology see the Five-Year Review of 
Work RVUs Under the PFS and Proposed Changes to the PE Methodology 
proposed notice (71 FR 37242) and the CY 2007 PFS final rule with 
comment period (71 FR 69629).
1. Current Methodology
a. Data Sources for Calculating Practice Expense
    The AMA's SMS survey data and supplemental survey data from the 
specialties of cardio-thoracic surgery, vascular surgery, physical and 
occupational therapy, independent laboratories, allergy/immunology, 
cardiology, dermatology, gastroenterology, radiology, independent 
diagnostic testing facilities (IDTFs), radiation oncology, and urology 
are used to develop the PE per hour (PE/HR) for each specialty. For 
those specialties for which we do not have PE/HR, the appropriate PE/HR 
is obtained from a crosswalk to a similar specialty.
    The AMA developed the SMS survey in 1981 and discontinued it in 
1999. Beginning in 2002, we incorporated the 1999 SMS survey data into 
our calculation of the PE RVUs, using a 5-year average of SMS survey 
data. (See the Revisions to Payment Policies and Five-Year Review of 
and Adjustments to the Relative Value Units Under the Physician Fee 
Schedule for CY 2002 final rule (66 FR 55246, November 1, 2002) 
(hereinafter referred to as CY 2002 PFS final rule).) The SMS PE survey 
data are adjusted to a common year, 2005. The SMS data provide the 
following six categories of PE costs:
    <bullet> Clinical payroll expenses, which are payroll expenses 
(including fringe benefits) for nonphysician clinical 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 expenses 
depreciation, leases, and rent of medical equipment used in the 
diagnosis or treatment of patients.
    <bullet> All other expenses, which include expenses for legal 
services, accounting, office management, professional association 
memberships, and any professional expenses not previously mentioned in 
this section.
    In accordance with section 212 of the BBRA, we established a 
process to supplement the SMS data for a specialty with data collected 
by entities and organizations other than the AMA (that is, the 
specialty itself). (See the Criteria for Submitting Supplemental 
Practice Expense Survey Data interim final rule with comment period, 
(65 FR 25664, May 3, 2000).) Originally, the deadline to submit 
supplementary survey data was through August 1, 2001. In the CY 2002 
PFS final rule (66 FR 55246), the deadline was extended through August 
1, 2003. To ensure maximum opportunity for specialties to submit 
supplementary survey data, we extended the deadline to submit surveys 
until March 1, 2005 in the Revisions to Payment Policies Under the 
Physician Fee Schedule for CY 2004 final rule, (November 7, 2003; 68 FR 
63196) (hereinafter referred to as CY 2004 PFS final rule).
    The direct cost data for individual services were originally 
developed by the Clinical Practice Expert Panels (CPEP). The CPEP data 
include the supplies, equipment, and staff times specific to each 
procedure. The CPEPs consisted of panels of physicians, practice 
administrators, and nonphysicians (for example, RNs) who were nominated 
by physician specialty societies and other groups. There were 15 CPEPs 
consisting of 180 members from more than 61 specialties and 
subspecialties. Approximately 50 percent of the panelists were 
physicians.
    The CPEPs identified specific inputs involved in each physician's 
service provided in an office or facility setting. The inputs 
identified were the quantity and type of nonphysician labor, medical 
supplies, and medical equipment.
    In 1999, the AMA's RUC established the Practice Expense Advisory 
Committee (PEAC). From 1999 to March 2004, the PEAC, a multi-specialty 
committee, reviewed the original CPEP inputs and provided us with 
recommendations for refining these direct PE inputs for existing CPT 
codes. Through its last meeting in March 2004, the PEAC provided 
recommendations for over 7,600 codes which we have reviewed and 
accepted. As a result, the current PE inputs differ markedly from those 
originally recommended by the CPEPs. The PEAC has now been replaced by 
the Practice Expense Review Committee (PERC), which acts to assist the 
RUC in recommending PE inputs.
b. Allocation of PE to Services
    The aggregate level specialty-specific PEs are derived from the 
AMA's SMS survey and supplementary survey data. To establish PE RVUs 
for specific services, it is necessary to establish the direct and 
indirect PE associated with each service.
    (i) Direct costs. The direct costs are determined by adding the 
costs of the resources (that is, the clinical staff, equipment, and 
supplies) typically required to provide the service. The costs of these 
resources are calculated from the refined direct PE inputs in our PE 
database. These direct inputs are then scaled to the current aggregate 
pool of direct PE RVUs. The aggregate pool of direct PE RVUs can be 
derived using the following formula: (PE RVUs * physician CF) * 
(average direct percentage from SMS/(Supplemental PE/HR data)).
    (ii) Indirect costs. The SMS and supplementary survey data are the 
source for the specialty-specific aggregate indirect costs used in our 
PE calculations. We then allocate the indirect costs to the code level 
on the basis of the direct costs specifically associated with a code 
and the maximum of either the clinical labor costs or the physician 
work RVUs. For calculation of the 2008 PE RVUs, we are using the 2006 
procedure-specific utilization data crosswalked to 2007 services. To 
arrive at the indirect PE costs:
    <bullet> We apply a specialty-specific indirect percentage factor 
to the direct expenses to recognize the varying proportion that 
indirect costs represent of total costs by specialty. For a given 
service, the specific indirect percentage factor to apply to the direct 
costs for the purpose of the indirect allocation is calculated as the 
weighted average of the ratio of the indirect to direct costs (based on 
the survey data) for the specialties that furnish the service. For 
example, if a service is furnished by a single specialty with indirect 
PEs that were 75 percent of total PEs, the indirect percentage factor 
to apply to the direct costs for the purposes of the indirect

[[Page 66229]]

allocation would be (0.75/0.25) = 3.0. The indirect percentage factor 
is then applied to the service level adjusted indirect PE allocators.
    <bullet> We use the specialty-specific PE/HR from the SMS survey 
data, as well as the supplemental surveys for cardio-thoracic surgery, 
vascular surgery, physical and occupational therapy, independent 
laboratories, allergy/immunology, cardiology, dermatology, radiology, 
gastroenterology, IDTFs, radiation oncology and urology. (Note: For 
radiation oncology, the data represent the combined survey data from 
the American Society for Therapeutic Radiology and Oncology (ASTRO) and 
the Association of Freestanding Radiation Oncology Centers (AFROC).) We 
incorporate this PE/HR into the calculation of indirect costs using an 
index which reflects the relationship between each specialty's indirect 
scaling factor and the overall indirect scaling factor for the entire 
PFS. For example, if a specialty had an indirect practice cost index of 
2.00, this specialty would have an indirect scaling factor that was 
twice the overall average indirect scaling factor. If a specialty had 
an indirect practice cost index of 0.50, this specialty would have an 
indirect scaling factor that was half the overall average indirect 
scaling factor.
    <bullet> When the clinical labor portion of the direct PE RVU is 
greater than the physician work RVU for a particular service, the 
indirect costs are allocated based upon the direct costs and the 
clinical labor costs. For example, if a service has no physician work 
and 1.10 direct PE RVUs, and the clinical labor portion of the direct 
PE RVUs is 0.65 RVUs, we would use the 1.10 direct PE RVUs and the 0.65 
clinical labor portions of the direct PE RVUs to allocate the indirect 
PE for that service.
c. Facility/Nonfacility Costs
    Procedures that can be furnished in a physician's office, as well 
as in a hospital or facility setting, have two PE RVUs: facility and 
nonfacility. The nonfacility setting includes physicians' offices, 
patients' homes, freestanding imaging centers, and independent 
pathology labs. Facility settings include hospitals, ambulatory 
surgical centers (ASCs), and skilled nursing facilities (SNFs). The 
methodology for calculating PE RVUs is the same for both, facility and 
nonfacility RVUs, but is applied independently to yield two separate PE 
RVUs. Because the PEs for services provided in a facility setting are 
generally included in the payment to the facility (rather than the 
payment to the physician under the PFS), the PE RVUs are generally 
lower for services provided in the facility setting.
d. Services With Technical Components (TCs) and Professional Components 
(PCs)
    Diagnostic services are generally comprised of two components; a 
professional component (PC) and a technical component (TC), which may 
be furnished independently or by different providers. When services 
have TC, PC, and global components that can be billed separately, the 
payment for the global component equals the sum of the payment for the 
TC and PCs. This is a result of using a weighted average of the ratio 
of indirect to direct costs across all the specialties that furnish the 
global components, TCs, and PCs; that is, we apply the same weighted 
average indirect percentage factor to allocate indirect expenses to the 
global components, PC, and TCs for a service. (The direct PE RVUs for 
the TC and PCs sum to the global under the bottom-up methodology.)
e. Transition Period
    As discussed in the CY 2007 PFS final rule with comment period (71 
FR 69674), we are implementing the change in the methodology for 
calculating PE RVUs over a 4-year period. During this transition 
period, the PE RVUs will be calculated on the basis of a blend of RVUs 
calculated using our methodology described previously in this section 
(weighted by 25 percent during CY 2007, 50 percent during CY 2008, 75 
percent during CY 2009, and 100 percent thereinafter), and the CY 2006 
PE RVUs for each existing code. PE RVUs for codes that are new during 
this period will be calculated using only the current PE methodology, 
and will be paid at the fully transitioned rate.
f. PE RVU Methodology
    The following is a description of the PE RVU methodology.
(i) Setup File
    First, we create a setup file for the PE methodology. The setup 
file contains the direct cost inputs, the utilization for each 
procedure code at the specialty and facility/nonfacility place of 
service level, and the specialty-specific survey PE per physician hour 
data.
(ii) Calculate the Direct Cost PE RVUs

Sum the Costs of Each Direct Input

    Step 1: Sum the direct costs of the inputs for each service. The 
direct costs consist of the costs of the direct inputs for clinical 
labor, medical supplies, and medical equipment. The clinical labor cost 
is the sum of the cost of all the staff types associated with the 
service; it is the product of the time for each staff type and the wage 
rate for that staff type. The medical supplies cost is the sum of the 
supplies associated with the service; it is the product of the quantity 
of each supply and the cost of the supply. The medical equipment cost 
is the sum of the cost of the equipment associated with the service; it 
is the product of the number of minutes each piece of equipment is used 
in the service and the equipment cost per minute. The equipment cost 
per minute is calculated as described at the end of this section.

Apply a BN Adjustment to the Direct Inputs

    Step 2: Calculate the current aggregate pool of direct PE costs. To 
do this, multiply the current aggregate pool of total direct and 
indirect PE costs (that is, the current aggregate PE RVUs multiplied by 
the CF) by the average direct PE percentage from the SMS and 
supplementary specialty survey data.
    Step 3: Calculate the aggregate pool of direct costs. To do this, 
for all PFS services, sum the product of the direct costs for each 
service from Step 1 and the utilization data for that service.
    Step 4: Using the results of Step 2 and Step 3 calculate a direct 
PE BN adjustment so that the proposed aggregate direct cost pool does 
not exceed the current aggregate direct cost pool and apply it to the 
direct costs from Step 1 for each service.
    Step 5: Convert the results of Step 4 to an RVU scale for each 
service. To do this, divide the results of Step 4 by the Medicare PFS 
CF.
(iii) Create the Indirect PE RVUs

Create Indirect Allocators

    Step 6: Based on the SMS and supplementary specialty survey data, 
calculate direct and indirect PE percentages for each physician 
specialty.
    Step 7: Calculate direct and indirect PE percentages at the service 
level by taking a weighted average of the results of Step 6 for the 
specialties that furnish the service. Note that for services with a TC 
and PCs we are calculating the direct and indirect percentages across 
the global components, PCs and TCs. That is, the direct and indirect 
percentages for a given service (for example, echocardiogram) do not 
vary by the PC, TC and global component.
    Step 8: Calculate the service level allocators for the indirect PEs 
based on the percentages calculated in Step 7. The indirect PEs are 
allocated based on the three components: the direct PE

[[Page 66230]]

RVU, the clinical PE RVU and the work RVU.
    For most services the indirect allocator is: indirect percentage * 
(direct PE RVU/direct percentage) + work RVU.
    There are two situations where this formula is modified:
    <bullet> If the service is a global service (that is, a service 
with global, professional and technical components), then the indirect 
allocator is: indirect percentage * (direct PERVU/direct percentage) + 
clinical PE RVU + work RVU.
    <bullet> If the clinical labor PE RVU exceeds the work RVU (and the 
service is not a global service), then the indirect allocator is: 
indirect percentage * (direct PERVU/direct percentage) + clinical PE 
RVU.
    (Note that for global services the indirect allocator is based on 
both the work RVU and the clinical labor PE RVU. We do this to 
recognize that, for the professional service, indirect PEs will be 
allocated using the work RVUs, and for the TC service, indirect PEs 
will be allocated using the direct PE RVU and the clinical labor PE 
RVU. This also allows the global component RVUs to equal the sum of the 
PC and TC RVUs.)
    For presentation purposes in the examples in Table 1, the formulas 
were divided into two parts for each service. The first part does not 
vary by service and is the indirect percentage * (direct PE RVU/direct 
percentage). The second part is either the work RVU, clinical PE RVU, 
or both depending on whether the service is a global service and 
whether the clinical PE RVU exceeds the work RVU (as described earlier 
in this step.)

Apply a BN Adjustment to the Indirect Allocators

    Step 9: Calculate the current aggregate pool of indirect PE RVUs by 
multiplying the current aggregate pool of PE RVUs by the average 
indirect PE percentage from the physician specialty survey data. This 
is similar to the Step 2 calculation for the direct PE RVUs.
    Step 10: Calculate an aggregate pool of proposed indirect PE RVUs 
for all PFS services by adding the product of the indirect PE 
allocators for a service from Step 8 and the utilization data for that 
service. This is similar to the Step 3 calculation for the direct PE 
RVUs.
    Step 11: Using the results of Step 9 and Step 10, calculate an 
indirect PE adjustment so that the aggregate indirect allocation does 
not exceed the available aggregate indirect PE RVUs and apply it to 
indirect allocators calculated in Step 8. This is similar to the Step 4 
calculation for the direct PE RVUs.

Calculate the Indirect Practice Cost Index

    Step 12: Using the results of Step 11, calculate aggregate pools of 
specialty-specific adjusted indirect PE allocators for all PFS services 
for a specialty by adding the product of the adjusted indirect PE 
allocator for each service and the utilization data for that service.
    Step 13: Using the specialty-specific indirect PE/HR data, 
calculate specialty-specific aggregate pools of indirect PE for all PFS 
services for that specialty by adding the product of the indirect PE/HR 
for the specialty, the physician time for the service, and the 
specialty's utilization for the service.
    Step 14: Using the results of Step 12 and Step 13, calculate the 
specialty-specific indirect PE scaling factors as under the current 
methodology.
    Step 15: Using the results of Step 14, calculate an indirect 
practice cost index at the specialty level by dividing each specialty-
specific indirect scaling factor by the average indirect scaling factor 
for the entire PFS.
    Step 16: Calculate the indirect practice cost index at the service 
level to ensure the capture of all indirect costs. Calculate a weighted 
average of the practice cost index values for the specialties that 
furnish the service. Note: For services with TC and PCs, we calculate 
the indirect practice cost index across the global components, PCs and 
TCs. Under this method, the indirect practice cost index for a given 
service (for example, echocardiogram) does not vary by the PC, TC and 
global components.
    Step 17: Apply the service level indirect practice cost index 
calculated in Step 16 to the service level adjusted indirect allocators 
calculated in Step 11 to get the indirect PE RVU.
(iv) Calculate the Final PE RVUs
    Step 18: Add the direct PE RVUs from Step 6 to the indirect PE RVUs 
from Step 17.
    Step 19: Calculate and apply the final PE BN adjustment by 
comparing the results of Step 18 to the current pool of PE RVUs. This 
final BN adjustment is required primarily because certain specialties 
are excluded from the PE RVU calculation for rate-setting purposes, but 
all specialties are included for purposes of calculating the final BN 
adjustment. (See ``Specialties excluded from rate-setting calculation'' 
below in this section.)
(v) Setup File Information
    <bullet> Specialties excluded from rate-setting calculation: For 
the purposes of calculating the PE RVUs, we exclude certain specialties 
such as midlevel practitioners paid at a percentage of the PFS, 
audiology, and low volume specialties from the calculation. These 
specialties are included for the purposes of calculating the BN 
adjustment.
    <bullet> Crosswalk certain low volume physician specialties: 
Crosswalk the utilization of certain specialties with relatively low 
PFS utilization to the associated specialties.
    <bullet> Physical therapy utilization: Crosswalk the utilization 
associated with all physical therapy services to the specialty of 
physical therapy.
    <bullet> Identify professional and technical services not 
identified under the usual TC and 26 modifier: Flag the services that 
are PC and TC services, but do not use TC and 26 modifiers (for 
example, electrocardiograms). This flag associates the PC and TC with 
the associated global code for use in creating the indirect PE RVU. For 
example, the professional service code 93010 is associated with the 
global code 93000.
    <bullet> Payment modifiers: Payment modifiers are accounted for in 
the creation of the file. For example, services billed with the 
assistant at surgery modifier are paid 16 percent of the PFS amount for 
that service; therefore, the utilization file is modified to only 
account for 16 percent of any service that contains the assistant at 
surgery modifier.
    <bullet> Work RVUs: The setup file contains the work RVUs from this 
final rule with comment period.
(vi) Equipment Cost Per Minute =
    The equipment cost per minute is calculated as:
    (1/(minutes per year * usage)) * price * ((interest rate/(1-(1/((1 
+ interest rate) * life of equipment)))) + maintenance)

Where:

minutes per year = maximum minutes per year if usage were continuous 
(that is, usage = 1); 150,000 minutes.
usage = equipment utilization assumption; 0.5.
price = price of the particular piece of equipment.
interest rate = 0.11.
life of equipment = useful life of the particular piece of equipment.
maintenance = factor for maintenance; 0.05.

[[Page 66231]]



                                                              Table 1.--Calculation of PE RVUs Under Methodology for Selected Codes
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                                              99213        33533       71020       71020TC      7102026       93000        93005        93010
                                                                                          ------------------------------------------------------------------------------------------------------
                                                                                                           CABG,
                                        Step               Source            Formula          Office     arterial,  Chest x-ray  Chest x-ray  Chest x-ray      ECG,         ECG,     ECG, report
                                                                                            visit, est    single    nonfacility  nonfacility  nonfacility    complete     tracing    nonfacility
                                                                                           nonfacility   facility                                          nonfacility  nonfacility
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
(1) Labor cost (Lab)...........  Step 1............  AMA..............  .................       $13.32      $77.52        $5.74        $5.74            $        $6.12        $6.12            $
(2) Supply cost (Sup)..........  Step 1............  AMA..............  .................        $2.98       $7.34        $3.39        $3.39            $        $1.19        $1.19            $
(3) Equipment cost (Eqp).......  Step 1............  AMA..............  .................        $0.19       $0.65        $8.17        $8.17            $        $0.12        $0.12            $
(4) Direct cost (Dir)..........  Step 1............  .................  =(1)+(2)+(3).....       $16.50      $85.51       $17.31       $17.31            $        $7.43        $7.60            $
(5) Direct adjustment (Dir Adj)  Steps 2-4.........  See footnote \1\.  .................        0.592       0.592        0.592        0.592        0.592        0.592        0.592        0.592
(6) Adjusted labor.............  Steps 2-4.........  =Lab * Dir Adj...  =(1) * (5).......        $7.89      $45.89        $3.40        $3.40            $        $3.62        $3.62            $
(7) Adjusted supplies..........  Steps 2-4.........  =Sup * Dir Adj...  =(2) * (5).......        $1.77       $4.35        $2.01        $2.01            $        $0.71        $0.71            $
(8) Adjusted equipment.........  Steps 2-4.........  =Eqp *Dir Adj....  =(3) * (5).......        $0.12       $0.39        $4.84        $4.84            $        $0.07        $0.07            $
(9) Adjusted direct............  Steps 2-4.........  .................  =(6)+(7)+(8).....        $9.77      $50.62       $10.25       $10.25            $        $4.40        $4.40            $
(10) Conversion Factor (CF)....  Step 5............  MFS..............  .................     $34.0682    $34.0682     $34.0682     $34.0682     $34.0682     $34.0682     $34.0682     $34.0682
(11) Adj. labor cost converted.  Step 5............  =(Lab * Dir Adj)/  =(6)/(10)........         0.23        1.35         0.10         0.10  ...........         0.11         0.11  ...........
                                                      CF.
(12) Adj. supply cost converted  Step 5............  =(Sup * Dir Adj)/  =(7)/(10)........         0.05        0.13         0.06         0.06  ...........         0.02         0.02  ...........
                                                      CF.
(13) Adj. equip cost converted.  Step 5............  =(Eqp * Dir Adj)/  =(8)/(10)........         0.00        0.01         0.14         0.14  ...........         0.00         0.00  ...........
                                                      CF.
(14) Adj. direct cost converted  Step 5............  .................  =(11)+(12)+(13)..         0.29        1.49         0.30         0.30  ...........         0.13         0.13  ...........
(15) Wrk RVU * Wrk Scaler......  Setup File........  MFS..............  0.8806...........         0.81       29.62         0.19        0.00-         0.19         0.15         0.00         0.15
(16) Dir--pct..................  Steps 6, 7........  Surveys..........  .................        33.8%       32.6%        40.7%        40.7%        40.7%        37.7%        37.7%        37.7%
(17) Ind--pct..................  Steps 6, 7........  Surveys..........  .................        66.2%       67.4%        59.3%        59.3%        59.3%        62.3%        62.3%        62.3%
 (18) Ind. Alloc. formula (1st   Step 8............  See Step 8.......  .................  ((14)/(16))      ((14)/  ((14)/(16))  ((14)/(16))  ((14)/(16))  ((14)/(16))  ((14)/(16))  ((14)/(16))
 part).                                                                                         * (17)     (16)) *       * (17)       * (17)       * (17)       * (17)       * (17)       * (17)
                                                                                                              (17)
(19) Ind. Alloc. (1st part)....  Step 8............  .................  See (18).........         0.56        3.07         0.44         0.44  ...........         0.21         0.21  ...........
(20) Ind. Alloc. formulas (2nd   Step 8............  See Step 8.......  .................         (15)        (15)    (15)+(11)         (11)         (15)    (15)+(11)         (11)         (15)
 part).
(21) Ind. Alloc. (2nd part)....  Step 8............  .................  See (20).........         0.81       29.62         0.29         0.10         0.19         0.26         0.11         0.15
(22) Indirect Allocator          Step 8............  .................  =(19)+(21).......         1.37       32.70         0.73         0.54         0.19         0.47         0.32         0.15
 (1st+2nd).
(23) Indirect Adjustment (Ind    Steps 9-11........  See footnote \2\.  .................        0.362       0.362        0.362        0.362        0.362        0.362        0.362        0.362
 Adj).
(24) Adjusted Indirect           Steps 9-11........  =Ind Alloc * Ind   .................         0.50       11.84         0.26         0.19         0.07         0.17         0.12         0.05
 Allocator.                                           Adj.
(25) Ind. Practice Cost Index    Steps 12-16.......  See Steps 12-16..  .................        0.968       0.942        1.054        1.054        1.054        1.280        1.280        1.280
 (PCI).
(26) Adjusted Indirect.........  Step 17...........  = Adj. Ind Alloc   =(24) * (25).....         0.48       11.15         0.28         0.21         0.07         0.22         0.15         0.07
                                                      * PCI.
(27) PE RVU....................  Steps 18-19.......  =(Adj Dir+Adj      =((14)+(26)) *            0.77       12.64         0.58         0.51         0.07         0.35         0.28        0.07
                                                      Ind) * budn.       budn.
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
\1\ The direct adj = [current pe rvus * CF * avg dir pct] / [sum direct inputs] = [Step 2] / [Step 3].
\2\ The indirect adj = [current pe rvus * avg ind pct] / [sum of ind allocators] = [Step 9] / [Step 10.


[[Page 66232]]

Comments Related to PE Methodology

    Comment: Several commenters recommend that the unadjusted work RVUs 
be used in the allocation of the indirect PE RVUs.
    Response: The decision to use the budget neutralized work RVUs in 
the calculation of indirect PEs appropriately maintains the current 
relationships between the work, PE, and professional liability 
payments. We also believe it is important to apply the revised, budget 
neutralized work RVUs consistently within the PFS framework. It would 
not be consistent to apply one set of work RVUs for work payments, but 
a different set for purposes of calculating indirect PEs. Therefore, we 
will base the calculation of both the work payments and the indirect PE 
payments on the adjusted work RVUs, and maintain the current overall 
relationships between work, PE, and professional liability. The PE RVUs 
in Addendum B and throughout the rest of this rule reflect this policy.
    Comment: Several commenters commended CMS on the bottom up approach 
to calculating resource based PE RVUs. Commenters expressed gratitude 
for the transparency and straight forward nature of the revised 
methodology.
    Response: We appreciate the support for the revised bottom up 
practice methodology and agree that the bottom up methodology is a more 
straight forward methodology then its predecessor.
    Comment: Some commenters contend that the approach of basing PE 
calculations on the weighted average of all specialties furnishing a 
service is flawed and should be replaced with an approach that bases 
the specialty weighted factors upon specialties that represent 95 
percent of the total utilization of each respective service.
    Response: This issue was fully addressed in the comment and 
response section of the CY 2007 PFS final rule with comment period (71 
FR 69641), and we did not make any further proposals relating to this 
policy in the CY 2008 PFS proposed rule. Thus, these comments are 
outside the scope of the CY 2008 PFS proposed rule.
    Comment: One commenter stated that the use of direct PEs in the 
allocation of indirect PEs unfairly penalizes PC only billers that do 
not have any direct costs. Additionally, this commenter contends that 
the use of only the work RVU in the allocation of indirect PEs for this 
situation underestimates the indirect PEs for PC only billers.
    Response: The resource-based PE methodology uses both the work RVU 
and the direct cost PE RVU in the allocation of indirect PEs. For PC 
only billers, which do not have any direct costs, indirect costs will 
only be allocated based upon the work RVUs. There is no provision 
within the current methodology to allocate the indirect PEs 
differently, and we made no proposals in the CY 2008 PFS proposed rule 
regarding this allocation. Additionally, we note that a review of 
comments on past regulations confirms that the physician community 
believes that the work RVUs ``over allocate'' the indirect PEs. Thus, 
there appear to be differing views regarding the effect of this 
allocation. We will continue to allocate the indirect PEs of PC only 
services on the work RVUs.
    Comment: One commenter recommended that, for procedures that have 
supply costs in excess of 40 to 50 percent of total direct costs, all 
supply costs be passed through and exempt from the direct adjustment 
factor.
    Response: The resource-based PE methodology converts the direct 
costs for a service, obtained from the direct cost database, into PE 
RVUs by comparing the service specific aggregate costs to the aggregate 
pool of costs available for expenditure on direct costs. Because the 
aggregate direct costs for all services contained in the direct cost 
database exceed the aggregate pool of available direct dollars, a 
direct cost adjustment must be applied to scale the database to the 
pool. Irrespective of the percentage of total direct costs for a 
specific service represented by supplies, this adjustment will still be 
applied. If this adjustment were not applied to certain services, the 
system would either not be budget neutral or RVUs for all other 
services would have to be reduced to offset these exemptions. We did 
not make any proposals relating to this adjustment. Moreover, we see no 
methodological reason to exempt any services regardless of the 
percentage of their direct costs represented by supplies from the 
adjustments that apply to all direct costs.
g. Discussion of Equipment Usage Percentage
    In the CY 2008 PFS proposed rule (72 FR 38132), we included a 
discussion about our use of the equipment usage assumption of 50 
percent, and stated that we continue to receive requests that we refine 
this usage percentage. Some groups and individuals state that this 
usage percentage should be in the range of 70 to 80 percent while 
others contend that the current utilization rate is too high at 50 
percent and should be refined downward to a lower usage percentage.
    If the equipment usage percentage is set too high, the result would 
be insufficient allowance at the service level for the practice costs 
associated with equipment. If the equipment usage percentage is set too 
low, the result would be an excessive allowance for the PE costs of 
equipment at the service level. Although we acknowledged the 50 percent 
across the board usage rate that we currently apply for all equipment 
does not capture the actual usage rates for all equipment, we indicated 
we do not believe that we have sufficient empirical evidence to justify 
an alternative proposal on this issue. Therefore, we requested that 
commenters submit information relating to alternative percentages and 
approaches that differentially classify equipment into mutually 
exclusive categories with category specific usage rate assumptions. In 
addition, we requested any empirical data that would assist us in these 
efforts.
h. Equipment Interest Rate
    As part of our calculation of the PE equipment costs, we consider 
several factors, for example, the useful life of each piece of 
equipment and the typical interest that would be incurred in the 
purchase of the equipment. We updated the assigned useful life for all 
the equipment in our PE input database in the CY 2005 PFS final rule 
with comment period. However, we have used the same interest rate of 11 
percent since the inception of the resource based PE methodology in 
1999. There has been much discussion regarding whether this is still 
the appropriate interest rate to utilize in the calculation of the 
equipment costs. The majority of comments on the CY 2007 PFS final rule 
with comment period requested an interest rate of prime plus 2 percent 
while a small number of commenters requested an interest rate 
significantly lower than prime plus 2 percent.
    In the CY 2008 PFS proposed rule (72 FR 38132), we discussed the 
basis for the current interest rate of 11 percent and indicated that, 
based on our analysis of the revised SBA interest rate data, we believe 
11 percent continues to be an appropriate assumption; therefore, we 
stated would retain the interest rate used in the calculation of 
equipment costs at 11 percent.

Comments Concerning Equipment Usage and Interest Rate

    Comment: Several commenters, including several specialty societies, 
MedPAC, and the AMA RUC offered recommendations regarding the 11 
percent interest rate and the 50 percent utilization rate used to 
calculate the

[[Page 66233]]

price per minute for each piece of equipment. The recommendations 
received regarding the proposed 11 percent interest rate were generally 
favorable with the majority of commenters recommending that we monitor 
the interest rate annually to ensure that the appropriate percentage is 
utilized in the calculation of the equipment costs.
    The commenters' recommendations about making adjustments to the 50 
percent utilization rate varied. Certain commenters recommended we do 
nothing until stronger empirical evidence is available, while other 
commenters recommended a decrease in the utilization assumptions, and 
some commenters recommended an increase in the utilization assumption. 
The particular changes recommended in the utilization assumptions were, 
in most cases, directly related to a specific code. Virtually all 
comments received support an on going process of obtaining reliable 
empirical data to utilize in the calculation of equipment costs in the 
future.
    Response: As discussed in detail in the CY 2007 PFS final rule with 
comment period (71 FR 69650), we agree with commenters that both the 
equipment interest rate and the equipment utilization rate should 
continue to be examined for accuracy. We are committed to working with 
all interested parties to define the most accurate utilization and 
interest rate information for equipment used in the provision of 
physicians' services. Since we did not propose a specific change, we 
will maintain the assumptions of a 50-percent equipment utilization 
rate and an 11-percent equipment interest rate in the calculation of 
the PE RVUs published in Addendum B of this final rule with comment 
period. We will continue to monitor the appropriateness of these 
assumptions, and evaluate whether changes should be proposed in light 
of the data available.
    Comment: A few commenters recommended that the equipment 
utilization rate associated with preventive services be reduced since 
much of the equipment associated with preventive services is procedure 
specific and thus not utilized at as high a rate as other medical 
equipment.
    Response: Similar to our response regarding the equipment 
utilization rate associated with the entire universe of medical 
equipment, we do not believe that we have any strong empirical evidence 
to suggest a change in the current equipment utilization rate 
associated with preventive services. We are committed to continue 
working with all interested parties to identify the most accurate 
utilization rate information for equipment used in the provision of 
physicians' services.
2. PE Proposals for CY 2008
a. Radiology Practice Expense Per Hour
    The American College of Radiology (ACR) presented CMS with 
information regarding the PE/HR that was used in the PE methodology for 
radiology in the CY 2007 PFS final rule with comment period. ACR 
suggested that we change our methodology in a way that would weight the 
survey data to provide an alternative method of representing large and 
small practices. We agreed to take their approach to our contractor, 
the Lewin Group, for further analysis. (We note that the Lewin Group, 
in its initial analysis of the ACR survey data, had also raised 
concerns about the representation of small high cost entities in the 
ACR survey data.) The Lewin Group reviewed ACR's approach and concluded 
that weighting the ACR survey by practice size more appropriately 
accounts for the small high cost entities in the final PE/HR. After 
reviewing both the ACR inquiry and the Lewin response, we also agreed 
that ACR's approach more appropriately identifies the PE/HR for 
radiology.
    For these reasons, we proposed to revise the PE/HR associated with 
radiology using the survey data weighted by practice size and included 
this revised PE/HR in Table 2 of the CY 2008 PFS proposed rule which 
identified the PE/HR for all specialties.
    Comment: Several commenters, including the AMA's RUC, expressed 
concern over the proposed increase in the PE/HR for radiology whereby 
the PE/HR associated with this specialty would be developed based upon 
a revised practice size weighting methodology. Commenters believed that 
it is inappropriate to refine the current weighting methodology 
because: (1) This weighting methodology was not done for all 
specialties; and (2) some specialties requested to survey their 
memberships after the deadline to submit supplemental survey data and 
were denied this opportunity by CMS. Several other commenters commended 
CMS on their ability to review this potential problem and offer a 
timely resolution to the affected specialty.
    Response: The American College of Radiology approached CMS with 
questions regarding the weighting methodology that were used in the 
development of their PE/HR. Specifically, ACR believed that small high 
cost practices that primarily furnish professional only services were 
severely underrepresented in the published PE/HR. Therefore, we 
forwarded ACR's concerns to our contractor for further review. Upon 
review of ACR's concerns, our contractor concluded that their initial 
PE/HR recommendation to CMS was not fully representative of these 
smaller high cost practices. For this reason, our contractor 
recommended a revised weighting approach that would fairly represent 
these small high cost practices. We agree with both the ACR and our 
contractor and will finalize our proposal to use the revised PE/HR for 
radiology.
    Additionally, we do not believe that these revisions to the PE/HR 
for radiology constitute a submission of data after the deadline. No 
new data were submitted. Rather, we view this as a revision to the 
weighting methodology in order to address a unique situation.
    Comment: Several commenters recommended that all pain management 
services be crosswalked to the interventional pain management specialty 
as opposed to using the actual data which currently report the 
anesthesiology specialty furnishing a significant portion of the pain 
management services. According to the comments received, anesthesiology 
is listed as the primary specialty on many pain management services and 
since the PE/HR associated with anesthesiology is lower than 
interventional pain management, pain management services are being 
inappropriately valued.
    Response: Physicians self-designate their respective specialty for 
purposes of Medicare enrollment. If commenters believe that physicians 
are incorrectly self-designating their specialty as anesthesiology when 
it would be more appropriate for them to designate interventional pain 
management, commenters should work with their respective specialty 
organizations to ensure physicians appropriately designate the correct 
specialty. If the specialty of a certain percentage of the physicians 
furnishing the pain management service is actually anesthesiology, we 
believe that weighting the various PE/HR for all specialties that 
furnish these services, as we currently do, is the appropriate 
methodology to establish the final PE/HR for pain management services.
    Comment: One commenter recommends that only the PE/HR associated 
with ophthalmology be used in the establishment of RVUs for CPT code 
66984, Extracapsular cataract removal with insertion of intraocular 
lens prosthesis (one stage procedure), manual or mechanical technique 
(e.g., irrigation and aspiration or

[[Page 66234]]

phacoemulsification). The commenter contends that the 14 percent of the 
utilization that is associated with optometry is in error as 
optometrist would only be involved in the post-operative care of these 
patients and not the surgical procedure.
    Response: Although we did not make any proposals in the CY 2008 PFS 
proposed rule regarding this issue, we agree that, generally, 
optometrists will not be involved in the surgical procedure. As stated 
by the commenter, and supported by the utilization data, there are a 
significant number of services for which optometrists are involved in 
the post-operative care of CPT code 66984. The resource-based PE 
methodology appropriately adjusts for those services identified with 
modifier 55 (post-operative care only). Since there are PEs associated 
with the post-operative care of CPT code 66984, and since we adjust the 
utilization for those services that are identified as the post-
operative care only of CPT code 66984, we believe the current 
methodology appropriately reflects the correct weighted specialty mix 
associated with this service.
    Comment: One commenter recommended that the PE/HR for CPT codes 
22862, Revision including replacement of total disc arthroplasty 
(artificial disc) anterior approach, lumbar, single interspace, and 
22865, Removal of total disc arthroplasty (artificial disc) anterior 
approach, lumbar, single interspace, be crosswalked to orthopedic 
surgery as opposed to the all physician PE/HR. The commenter contended 
this is similar to the crosswalk change from all physicians to 
orthopedic surgery that was reflected in the PE methodology in the 
proposed rule for CPT code 22857, Total disc arthroplasty (artificial 
disc), anterior approach, including discectomy to prepare interspace 
(other than for decompression), lumbar, single interspace.
    Response: CPT codes 22862 and 22865 were new for CY 2007 and absent 
specific information with respect to the specialty performing the 
services, we had crosswalked these codes to the all physician PE/HR. We 
agree with the commenter that these codes are of a similar nature to 
CPT code 22857. They are part of the same orthopedic family of codes 
and should be treated consistently when applying the PE methodology. 
Therefore, we will assign the orthopedic surgery PE/HR to CPT codes 
22862 and 22865 as opposed to the all physician PE/HR.
    Comment: Several commenters conveyed support for the Physician 
Practice Information Survey which is currently being administered 
throughout the nation and encouraged CMS to use this practice cost 
information to update the current PE/HR data that is being utilized in 
the development of resourced-based PE RVUs.
    Response: The Physician Practice Information Survey is a practice 
cost survey that is being conducted by the AMA with support from 
various specialty societies and CMS. We look forward to analyzing the 
results of the AMA data collection efforts for possible inclusion in 
the resource-based PE methodology in future rulemaking cycles.
b. RUC Recommendations for Direct PE Inputs and Other PE Input Issues
    In the CY 2008 PFS proposed rule (72 FR 38133), we proposed the 
following concerning direct PE inputs.
(i) RUC Recommendations
    In 2004, the AMA's Relative Value Update Committee (RUC) 
established a new committee, the Practice Expense Review Committee 
(PERC), to assist the RUC in recommending direct PE inputs (clinical 
staff, supplies, and equipment) for new and existing CPT codes, a 
process that was previously accomplished by the Practice Expense 
Advisory Committee (PEAC).
    The PERC reviewed the PE inputs for nearly 300 existing codes at 
its meetings held in February 2007 and April 2007. (A list of these 
reviewed codes can be found in Addendum C of the CY 2008 PFS proposed 
rule.)
    In the CY 2007 PFS final rule with comment period, we addressed 
several issues concerning direct PE inputs and encouraged specialty 
societies to pursue further review of these inputs through the RUC/PERC 
process. The following discussions summarize the PERC recommendations 
regarding these issues:

Cardiac Catheterization Procedures

    As discussed in the CY 2008 PFS proposed rule, the PERC considered 
recommendations for new or updated PE inputs for the family of CPT 
codes 93501 through 93556 for cardiac catheterization. The American 
College of Cardiology (ACC), in cooperation with the Society of Cardiac 
Angiography and Interventions (SCA&I) and the Cardiovascular Outpatient 
Center Alliance (COCA), developed PE inputs for the nonfacility setting 
for 13 of the 28 CPT codes in this family.
    We proposed to accept the PERC recommendations for the direct PE 
inputs for the nonfacility setting for the CPT codes 93501, 93505, 
93508, 93510, 93526, 93539, 93540, 93542, 93543, 93544, 93545, 93555, 
and 93556.
    In addition, we proposed that the PE for the following CPT codes 
will not be valued or applicable to the nonfacility setting: 93503, 
93511, 93514, 93524, 93527, 93528, 93529, 93530, 93531, 93532, 93533, 
93561, 93562, 93571, and 93572.
    Comment: We received comments from the ACC and the SCA&I thanking 
us for our consideration of the PERC recommendations for 13 CPT codes 
for cardiac catheterization procedures performed in the nonfacility 
setting and for accepting their request not to establish nonfacility PE 
RVUs for the remaining 15 procedures in the cardiac catheterization 
family.
    Response: We appreciate the commenters' support and have accepted 
the PERC recommendations for the 13 cardiac catheterization procedures 
and have changed our PE database to reflect the PE inputs. For the 15 
remaining codes, we will finalize the proposal and attach the ``NA'' 
indicator to them.
    Comment: We received comments from COCA, a national organization 
representing nonfacility medical cardiology practices that conducted a 
``Direct Cost Study'' purporting to demonstrate that the major problem 
with the 2006 RUC estimates of direct PE costs for nonfacility 
outpatient cardiac catheterization was an inadequate list of direct 
patient care activities. In addition, COCA contends that the total RUC 
estimates of clinical labor time were so low as to lack credibility. 
The commenter contends that a significant amount of the data from its 
Direct Cost Study were not incorporated into the PE recommendations 
that were jointly prepared and presented at the April 2007 RUC meeting 
with ACC and SCA&I for the cardiac catheterization procedures. In 
addition to the inadequate clinical labor inputs, the commenter 
believes that the RUC process does not allow for the inclusion of 
safety devices, such as crash carts, as direct PE inputs because these 
are not used in the typical case; rather, these are considered indirect 
PE. COCA has requested that we review the data from the Direct Cost 
Study and revise the current proposed PE RVUs for these procedures to 
values that reflect more appropriately the direct and indirect costs of 
providing these services. As an alternative solution, COCA asks that we 
tie reimbursement for these services to a reasonable percentage of the 
hospital APC.
    We also heard from many cardiology practices that provide cardiac 
catheterizations in the nonfacility

[[Page 66235]]

setting. They had similar comments and indicated their support for 
COCA's request that we review the cost study data and revise the PE 
RVUs to more appropriately value the cardiac catheterization procedures 
when performed in the nonfacility setting.
    Response: While we understand COCA's and the other commenters' 
concerns about the decrease in the PE RVUs for the cardiac 
catheterization procedures, we want to clarify that the PE inputs for 
these procedures were fully considered by the RUC process. The RUC has 
identified standard descriptions of clinical staff activities that the 
specialty societies follow as they prepare their recommendations for 
direct PE inputs believed to be typical to a service and the RUC has 
established standard values for some of these clinical activities. The 
RUC does not deviate from accepted standard unless the specialty 
society presents compelling evidence to substantiate that the variance 
is typical to the practice for each procedure. In the past, the RUC has 
recommended, and we agreed, that the crash cart would be included as 
equipment necessary to perform the services of cardiopulmonary 
resuscitation, CPT 92950, but is not necessary to perform other 
services, even though many physicians have purchased and maintain crash 
carts as part of their medical practices. Since the crash cart is only 
specified as required for use in CPT 92950, it is considered as 
indirect PE for all other procedures. We note that COCA's request in 
the alternative to make payment for these procedures based on a 
percentage of the OPPS APC is not feasible. The PFS and the OPPS APC 
payment amounts are determined by different payment methodologies that 
are specified in the statute. We rely on the RUC process to assist us 
in establishing the typical PE inputs that are necessary to provide 
physician services. This is because the specialty-developed PE 
recommendations that are presented to the RUC are all subject to the 
same multi-specialty scrutiny. We agree with the PERC's direct PE 
recommendations for the 13 cardiac catheterization codes in the 
nonfacility setting and we will accept the RUC PE recommendations for 
these 13 procedures. However, we are sympathetic to the concerns raised 
by COCA and echoed by other commenters about the extent to which the 
data from the Direct Cost Study were considered in the RUC process and 
we ask that the RUC provide another opportunity for the review of the 
direct PE inputs for these cardiac catheterization procedures to ensure 
that the data from the COCA Direct Cost Study is afforded appropriate 
and adequate consideration.

Obstetric/Gynecologic PE

    As discussed in the CY 2008 PFS proposed rule, we agreed with the 
PERC recommendation to add a non-sterile sheet (drape) 40 in by 60 in 
(supply code SB006) priced at $0.222 to the pelvic exam pack resulting 
in the new price of $1.172. This change affected 236 CPT codes for 
obstetric/gynecologic services containing the pelvic exam pack. We also 
proposed to accept the PERC recommendations to standardize the 
equipment used in post-operative visits to include both a power table 
and fiberoptic light in the PE database for 70 obstetric/gynecologic 
codes.
    Comment: We received a comment from the society representing 
gynecologic oncologists commending us for making the above changes to 
the pelvic exam pack and for standardizing the equipment used in 
follow-up visits. The society believes these changes enable gynecologic 
oncologists to account for the additional costs incurred in their 
practice specialty.
    Response: We appreciate the specialty society's comments and we 
will adopt the PERC recommended inputs as proposed.

Dual Energy X-Ray Absorptiometry (DEXA)

    The PERC recommended revisions to the direct PE inputs for CPT 
codes 77080, 77081, and 77082 to comply with established PERC 
standards, and more appropriately reflect the resources used to furnish 
these services. We agreed with these PERC recommendations.
    Comment: We received several comments thanking us for accepting the 
RUC's PE recommendations for the DEXA codes. We also received comments 
from several device manufacturers and specialty societies representing 
gynecologists, endocrinologists, rheumatologists, and radiologists 
informing us that the PE recommendations passed by the RUC, which we 
had proposed to accept in the proposed rule, contained a mistake as to 
the correct DEXA equipment that is typically used to perform the 
procedure represented by CPT code 77080. The RUC's PE recommendations 
listed the DEXA equipment as that using a ``pencil beam'' technology, 
priced at $41,000. However, the correct DEXA equipment used for CPT 
77080 uses the ``fan-beam'' technology and is priced at $85,000.
    Response: We were sympathetic to the concerns expressed by the 
commenters about the listing of the incorrect DEXA equipment, and we 
worked with the RUC staff to arrange for this equipment error to be 
reconsidered by the RUC at its September 2007 meeting. The RUC agreed 
to the specialty society's recommended change in the DXA equipment for 
CPT 77080. We agree with the recommendations from the specialty 
societies and the RUC and we have corrected our PE database to reflect 
that the fan-beam DEXA equipment is typically used for CPT 77080. In 
addition, a price of $3,000, with documentation, was presented for the 
spinal phantom used in this procedure. We have also accepted this price 
and have changed the PE database accordingly.
    Comment: We received many comments expressing concerns about the 
cuts to the PE RVUs for these DEXA services. These commenters believe 
the cuts are a result of the new PE methodology and may result in 
access problems for patients because physicians will no longer be able 
to afford to provide these services in the office setting. One 
commenter asked us to identify and make available to the public the 
inputs used to derive the indirect PE RVUs.
    Response: We are aware that the PE RVUs for these DEXA services 
were negatively impacted by the change in the PE methodology, as were 
those for many other services in which the previous PE RVUs were not 
based on the PE resources used to furnish the service. Because the new 
PE methodology now utilizes these resources, it is important to make 
certain that the PE direct inputs actually reflect the typical 
resources that are used to provide each service. The methodology for 
determining the indirect PE RVUs, including a description of each step 
in the calculation, is detailed earlier in this section. We share the 
commenters concerns about beneficiary access to DEXA services and will 
continue to monitor this issue.

Computer-Aided Detection (CAD) Codes

    The specialty society for radiological services reviewed the direct 
inputs for CPT codes 77051 and 77052 and recommended that no changes to 
the PE inputs were needed. The PERC concurred with this decision and we 
are in agreement.
    Comment: We received a comment from the society representing 
radiologists conveying their appreciation for accepting the unchanged 
direct PE inputs for CAD services.
    Response: We appreciate the commenter's support and will maintain 
the PE inputs as proposed.

[[Page 66236]]

Nuclear Medicine Services

    The specialty society representing nuclear medicine and the PERC 
recommended that the direct PE inputs for 2 CPT codes contained CPEP 
inputs and needed to be updated to agree with 2004 PEAC-approved 
inputs. However, in reviewing the PE database, we discovered that there 
were 4 other related codes which also had CPEP inputs which should be 
updated. We made the appropriate adjustments to substitute the PEAC 
inputs for the CPEP for CPT codes 78600, 78607, 78206, 78647, 78803 and 
78807.
    The specialty society also noted that for 7 CPT codes, revision of 
x-ray related supplies was required, including the number of x-ray 
films, developer solution, and film jackets. The PERC forwarded these 
recommendations and we made the appropriate changes to the PE database 
for the following CPT codes: 78600, 78601, 78605, 78606, 78607, 78610 
and 78615.
    Comment: The specialty society representing nuclear medicine 
expressed appreciation for acceptance of their recommended inputs and 
indicated it will continue to monitor the nuclear medicine codes and 
provide inputs and refinements as necessary and appropriate.
    Response: We appreciate the specialty society's comments and we 
will adopt the PERC recommended inputs as proposed.

Transcatheter Placement of Stent(s)

    At the request of the specialty societies representing radiology 
and interventional radiology, the PERC considered and approved direct 
PE inputs for the nonfacility setting for 3 CPT codes, 37205, 37206, 
and 75960, for transcatheter placement of stent(s). Among the supplies, 
a ``vascular stent deployment system'', valued at $1,645, was noted by 
the society as the typical stent used for CPT codes 37205 and 37206 
requiring 2 such stents for the placement in the initial vessel and 1 
stent for each subsequent vessel, respectively. We reviewed a published 
clinical research study that was forwarded by the specialty society. 
The study indicated that 1 stent was typical for the procedure of CPT 
code 37205. As discussed in the CY 2008 PFS proposed rule (72 FR 
38134), absent any further verification from the specialty, we included 
only 1 stent in the PE database for this code.
    Comment: Commenters, representing specialty societies for 
radiology, interventional radiology and vascular surgery appreciated 
the proposal assigning direct PE inputs for the nonfacility setting for 
these three CPT codes. However, these commenters expressed concern that 
the number of stents had been reduced. One commenter agreed that two 
stents may not be typical but requested guidance on how the cost of the 
additional stent could be billed; another of the commenters asked that 
we reconsider this decision or at a minimum include the ``average'' of 
1.5 stents. One of the commenters also noted that several studies 
clearly establish that these peripheral stent services are safely 
performed in the nonfacility environment, with nearly all of the 
procedures in the studies resulting in short observation stays, 
typically of less than 4 hours.
    Response: Based on a review of the literature and other information 
provided by the commenters we will revise the PE database for CPT code 
37205 to reflect 1.5 stents.
    Comment: Two commenters, representing manufacturers, expressly 
urged us to consider the safety issues surrounding the proposal to 
value these procedures in the nonfacility setting and believe that this 
conflicts with the decision to exclude these procedures from the 
ambulatory surgical center (ASC) list. One of these commenters 
acknowledged that, while we have no specific policy to identify which 
procedures can be safely performed in a physician's office, we do have 
some safety standards for ASCs. The commenter requested that the ASC 
standards be extended to the physician office. This commenter also 
referenced studies that demonstrate complications can be associated 
with these procedures, and suggested that these risks need to be 
addressed by appropriate safety or quality standards.
    Response: We appreciate the commenters' viewpoint. However, as the 
commenters acknowledged, we have no established policy to designate 
procedures that can be ``safely'' performed in the physician office 
setting. The purpose of the PFS is to establish proper payment for 
procedures furnished by physicians and other health professionals. 
Several medical specialty societies recommended the valuation of these 
services in the nonfacility setting, which suggests to us that these 
procedures are being furnished in nonfacility settings on a regular 
basis. These societies provided the recommended PE inputs involved in 
furnishing the typical service in a nonfacility setting, and these 
inputs were reviewed, accepted and recommended by the RUC. We also note 
that, as indicated in the previous comment, one commenter provided 
literature from studies to support that these services are safely 
performed in the nonfacility environment. Because it appears these 
procedures are being furnished regularly in nonfacility settings, we 
believe it is appropriate to value them for payment in those settings. 
Therefore, we will value these procedures in the nonfacility setting as 
proposed.
    Comment: One commenter noted that payment for CPT code 75960, the 
supervision and interpretation service associated with the 2 CPT codes 
discussed above for the transcatheter placement of stent(s), is still 
shown as carrier-priced in the Addendum of the proposed rule.
    Response: We regret the error. The Addendum and PFS database have 
been corrected to reflect the appropriate RVUs.
(ii) Remote Cardiac Event Monitoring
    In the CY 2007 PFS final rule with comment period, direct PE inputs 
for remote cardiac event monitoring (CEM) services represented by CPT 
codes 93012, 93225, 93226, 93231, 93232, 93270, 93271, 93733, and 93736 
were revised on an interim basis to reflect the unique circumstances 
surrounding the provision of these services. Unlike most physicians' 
services, CEM services are furnished primarily by specialized IDTFs 
that, due to the nature of CEM services, must operate on a 24/7 basis. 
The specialty group representing suppliers that furnish CEM services 
believes that these services require additional direct PE inputs, such 
as telephone line charges associated with trans-telephonic 
transmissions and fees associated with providing Web access for storage 
and transmission of clinical information to the patient's physician. We 
continue to work with the specialty group regarding the specific direct 
PE inputs, as well as the components for the indirect PE allocation, 
based on surveys conducted by the specialty group. To clarify and 
further the results of our discussions with and information provided 
by, the specialty group, we requested comments in the CY 2008 PFS 
proposed rule on the appropriateness of the above-mentioned direct PE 
inputs. In addition, we invited comments on any additional direct 
inputs and components of the indirect PE allocations which would be 
appropriate for these services, along with supporting documentation to 
justify their inclusion for PE purposes.
    Comment: We received comments from medical societies, provider 
organizations and a device manufacturer thanking us for working with 
these organizations to develop direct PE for

[[Page 66237]]

these services that do not fit the typical physician service model. 
Several comments supported the specific PE proposals supplied by the 
specialty group representing providers that furnish CEM services, and 
urged us to adopt them. A medical society representing cardiologists 
requested to work with us and the remote CEM provider groups to gather 
and review any additional necessary data prior to adoption of 
additional direct PE inputs.
    The CEM provider group specifically proposed that we add telephone 
transmission costs to the direct PE inputs for CPT codes for CEM, 93012 
and 93271 and the CPT codes for pacemaker monitoring, 93733, and 93736. 
The group also identified expenses for Web-based storage, maintenance 
and access to clinical information to be allocated to the CEM and 
pacemaker monitoring CPT codes, as well as the holter monitoring CPT 
codes 93226 and 93232. In addition to these supply PE recommendations, 
the CEM provider group proposed equipment time-in-use increases for the 
holter monitors, cardiac event monitors and for INR monitors (which are 
discussed later in this section).
    Response: We carefully reviewed the information supplied by all of 
the commenters and believe that it would be valuable for the commenters 
to work together, including the cardiology specialty society, before we 
establish further direct PE inputs for these cardiac monitoring 
services. In addition, we would like to make the CEM providers aware 
that it appears the assignment we made in CY 2007 of 43,200 time-in-use 
minutes for the looping CEM monitor used in CPT code 93271 (typically 
used for a 30-day period) pays back the cost of this CEM monitor, that 
is valued at $995, in less than 5 months, even though the CEM monitor 
has an established 4-year useful life. As we discuss later in the 
Prothrombin Time, International Normalized Ratio (PT/INR) section, we 
believe that the time-in-use assigned to any one device should not 
exceed its useful life. We will review this time-in-use assignment for 
CEM monitors during our CY 2009 rulemaking.
(iii) Prothrombin Time, International Normalized Ratio (PTI/NR)
    As discussed in the CY 2008 PFS proposed rule, based on comments 
received and subsequent discussions with entities that furnish these 
PT/INR services, we adjusted the time in use for the home monitor 
equipment for G0249 Provision of test materials and equipment for home 
INR monitoring to patient with mechanical heart valve(s) who meets 
Medicare coverage criteria; includes provision of materials for use in 
the home and reporting pwiof [prothrombin] test results to physician; 
per four tests to 1440 minutes to reflect that the monitor is dedicated 
for use 24 hours a day and unavailable for others receiving this 
service. We invited comments on this change, as well as comments on any 
additional direct inputs which would be appropriate to this service, 
along with supporting documentation to justify their inclusion for PE 
purposes.
    Comment: We received comments from specialty societies, provider 
groups, and individuals expressing their appreciation of our attempt to 
correct the problem concerning the application of PE methodology for 
the PT/INR service, but noted their concern that changing the INR home 
monitor time-in-use minutes from 32 to 1440 does not have a rational 
basis nor does it provide for an adequate recoupment of the cost of the 
device. These commenters requested that we assign a more realistic 
figure to capture the 28-day period that the patient is required to use 
the monitor. One commenter noted that using the current 1440 minutes, 
it would take 11.7 years to recoup the $2000 price of the equipment 
which has an assigned life of 4 years. The commenters suggested several 
alternative methodologies to calculate the time-in-use for the INR 
monitor. One method suggests multiplying the 1-day time, 1440 minutes, 
by 4, which represents the number of tests conducted in the 28-day 
period, to equal 5,760 minutes. This method would take 3 years to get 
back the $2000 value of the INR monitor. Another proposal suggests 
multiplying the 1-day 1440 minutes by 28 days which is the actual time 
the patient has the equipment. This method yields 40,300 minutes and 
the commenter admittedly states this method greatly overestimates the 
value of the INR monitor because it would take just 5 months to recoup 
the $2000 price. One commenter suggested that we simply amortize the 
price of the equipment, $2,000, over the useful life of 4 years. 
Another commenter's suggestion uses the annual minutes figure of 
150,000 that we use in our formula for deriving per minute equipment 
costs, and divides it by 28 (days) to arrive at 5,753 minutes. This 
method recoups the INR monitor price in 3 years.
    Other commenters voiced concerns about the valuation of the INR 
home monitor and offered alternatives to capture the cost of the 
device. One commenter suggested that we treat the cost of the INR home 
monitor as a one-time upfront cost and include this price in HCPCS code 
G0248 that is used to report the demonstration of the INR monitor to 
the patient, at the initial use. Another commenter recommended that the 
INR home monitor be removed from the PE for both G0248 and G0249 and be 
considered under the DME benefit.
    Response: We understand the concerns expressed by the commenters 
and appreciate their suggested alternatives that we could use to more 
appropriately cover the costs of the INR home monitor. Further, we 
agree that the 1440 minutes we assigned for CY 2007 seems too low 
considering that the patient uses the INR home monitor for 28 days, not 
just one. After reviewing all of the suggested alternatives, we 
eliminated the two proposals asking us to change the mechanism of 
payment for the INR home monitor. We, therefore, considered the various 
suggestions for establishing a more appropriate time-in-use value for 
the INR home monitor. We believe the proposal that best reflects the 
policy we use to determine the time-in-use for equipment items where 
the actual minutes-in-use exceed the assigned useful life is the 
commenter's suggestion to amortize the $2000 INR monitor over its 4-
year life. Using this method, 4,315 minutes is the necessary time-in-
use figure to recover the purchase price of the equipment in 4 years. 
We will replace the 1440 minutes assigned for CY 2007 with 4,315 
minutes as the time-in-use for the INR home monitor and will change the 
PE database accordingly.
(iv) Positron Emission Tomography (PET) Codes Clinical Labor Time
    We received comments from the specialty society representing 
nuclear medicine regarding a discrepancy in the clinical labor time for 
CPT codes 78811, 78812, and 78813 which are PET codes for tumor 
imaging. The specialty noted that the clinical labor time indicated in 
the PE database differs by 7 minutes from the time that was previously 
recommended by the PERC in April 2004. We agreed with the specialty 
society that the PE database labor inputs for these 3 PET codes are 
incorrect and we made the appropriate adjustments to the PE database.
    Comment: The specialty society representing nuclear medicine 
expressed appreciation for acceptance of its recommended inputs and 
indicated it will continue to monitor the nuclear medicine codes and 
provide inputs and refinements as necessary and appropriate.
    Response: We thank the specialty society for reviewing the direct 
inputs for their related procedures in the PE

[[Page 66238]]

database that we post as a download with each proposed and final rule 
on our Web site (www.cms.hhs.gov/PhysicianFeeSchedule/PFSFRN). We will 
adopt the recommended inputs as proposed.
(v) Nuclear Medicine PE Supplies
    The specialty society representing nuclear medicine commented that 
the PE database currently contains supply items that are inappropriate 
for certain procedures and provided the information to make the 
corrections. For respiratory imaging procedures represented by CPT 
codes 78587, 78591, 78593, 78594, 78630, 78660, 78291, and 78195, the 
specialty society noted specific IV supply items to be deleted from 
procedures where they are not required. For a thyroid imaging procedure 
represented by CPT code 78020, x-ray supply items were recommended for 
deletion. In addition, the society recommended adding supply items for 
respiratory imaging procedures, including nose clips, masks, and 
nebulizer kits, as appropriate, to CPT codes 78584, 78585, 78591, 
78593, 78594, 78586, 78587, 78588, and 78596. For a kidney function 
study represented by CPT code 78725, injection supply items were noted 
as missing and the specialty society requested that these be added. We 
proposed to accept these direct PE input corrections and revised our PE 
database accordingly.
    Comment: The specialty society voiced its gratitude for the 
acceptance of their recommended inputs.
    Response: We thank the specialty society for its interest in 
assuring the accuracy of the PE inputs in the procedures provided by 
their members. We will adopt the PERC recommended inputs as proposed.
(vi) Arthroscopic Procedure Nonfacility Inputs
    In the CY 2008 PFS proposed rule (72 FR 38135), we included a 
discussion about the establishment of nonfacility direct PE inputs for 
the arthroscopic procedures represented by CPT codes 29805, 29830, 
29840, 29870, and 29900. Absent specific recommendations from the RUC 
and because some physicians are already performing these procedures in 
the office setting, we specifically requested comments regarding the 
appropriateness of establishing nonfacility PE inputs for these 
arthroscopic procedures when they are provided in the office setting. 
We also invited comments as to the specific direct PE inputs, following 
the RUC approved standardized format, that are typical in the provision 
of each above listed arthroscopic procedure furnished in the 
physician's office. We indicated we will review these comments to 
determine whether or not it is appropriate to propose on an interim 
basis PE inputs for these codes in the nonfacility setting in our final 
rule.
    Comment: We received comments from the specialty society 
representing orthopedic surgeons in opposition to the establishment of 
nonfacility PE for the arthroscopic procedures because they believe 
these procedures are not safely performed in the office setting. The 
specialty society indicated that one of these codes, CPT 29900, 
Arthroscopy, metacarpophalangeal joint, diagnostic, includes synovial 
biopsy, was surveyed by the RUC in April 2001 and, at that time, the 
RUC recommended this service only as a facility-based procedure. The 
RUC supported the AAOS concerns and recommended that the PE RVUs for 
the nonfacility setting remain designated as ``NA.'' The specialty 
society believes that if the arthroscopic procedures were valued in the 
nonfacility setting, untrained physicians may begin to perform them 
and, as a result, patients will face significant risks. The specialty 
society believes that only credentialed physicians should perform these 
procedures and that this process can only be ensured in the facility-
based setting. The specialty society also asserts the facility-based 
setting is the safest setting for these procedures because it affords 
the physician more clinical options for dealing with any complications 
that may arise. In addition, if the procedure is furnished in the 
nonfacility setting, there would be no way to address any treatable 
lesion that is found and a patient would need to be seen in the 
facility setting to undergo a second procedure.
    Because the specialty society's position was established by an 
expert panel, the society states that it will reconsider its position 
if evidence is presented establishing the safety and efficacy of these 
procedures in the office setting and if a method is established to 
ensure that only qualified physicians perform these procedures in the 
office setting.
    We also received comments from orthopedic practices and individual 
physicians--the majority of which indicated they are members of the 
orthopedic specialty society--all stating that they are currently 
performing these procedures in the nonfacility setting. These comments 
requested that we establish PE inputs for the arthroscopic procedures 
because this would allow patients greater access to these services in 
more convenient settings and, because it would establish payment that 
would more fairly compensate them for the resources they use to provide 
these services in the office location. A product manufacturer supported 
the views of the physicians who requested the establishment of 
nonfacility PE for the nonfacility setting.
    These physicians note that the safety of the in-office procedures 
is well documented in the literature, and provided us with citations of 
articles going back to the mid-1990s. We also received suggested PE 
inputs including clinical labor, supplies and equipment that are 
typically used when these procedures are provided in the nonfacility 
setting.
    Response: We appreciate the concern expressed by the commenters 
opposing the establishment of PE for the office setting and are 
sympathetic to those supporting the assignment of PE for these codes. 
We are also dismayed that the parties involved on each side of this 
issue have not been able to resolve these issues to date. We have 
decided that the most prudent course of action is to defer proposing 
nonfacility inputs for these arthroscopic procedures in this final 
rule. We are hopeful that the specialty society and its physician 
colleagues who provide these services in the nonfacility setting will 
be able to discuss the issues of mutual concern regarding the safety of 
performing these procedures in the office setting. We are hopeful that 
this issue can be resolved and that the physicians performing these 
services in the nonfacility setting will be given the opportunity to 
have a multi-specialty review by the RUC. We are aware that this 
decision to refer this issue back to the specialty society and the RUC 
postpones the establishment of nonfacility PE values for these 
procedures until CY 2009, at the soonest, and that a review by the RUC 
process is not guaranteed. However, given the apparent level of 
dissension within the specialty, we believe that the specialty society, 
its physician colleagues, and the RUC should first be given an 
opportunity to resolve these important issues.
(vii) Nonfacility Inputs for CPT Code 52327
    As discussed in the CY 2008 PFS proposed rule we indicated that the 
society representing urologists requested that we remove all of the 
nonfacility PE inputs for CPT code 52327, Cystourethroscopy (including 
ureteral catheterization); with subureteric injection of implant 
material. The specialty society reasoned that the nonfacility PE value 
is inappropriate since the procedure is never performed in the 
physician office;

[[Page 66239]]

it is specific to the pediatric population; and, as such, is always 
performed with general anesthesia. We agreed with the specialty society 
that this procedure is incorrectly valued for the nonfacility setting 
and proposed to accept its recommendation to remove the nonfacility 
direct PE inputs, revising the PE database accordingly.
    Comment: The specialty society thanked us for accepting its 
recommendation to remove the nonfacility PE for this procedure. 
However, the society indicated that a review of the PE database on our 
Web site indicated that these inputs were still included and suggested 
that they be deleted.
    Response: We appreciate the commenter's attention to detail and 
have removed the PE inputs from the PE database.
(viii) Maxillofacial Prosthetics
    We have been working with the society representing maxillofacial 
prosthetists since 2005 to establish nonfacility direct inputs for the 
prosthetic services represented by the CPT code series, 21076 through 
21087. The current PE database reflects the labor, supplies, and 
equipment needed to perform each procedure. However, we do not have 
pricing information and documentation for many supply items. The 
society provided information and documentation for equipment prices, 
but because specific time-in-use information was not provided, we 
developed time in use in 2006 for each equipment item in each 
procedure. For CY 2007, these equipment inputs were utilized under the 
new PE methodology to calculate the nonfacility PE RVUs for these 
procedures. Although we have asked the specialty society to provide the 
supply pricing information and time in use data for each equipment item 
for each procedure, we have not received the requested information to 
date. Consequently, unless such information is provided, the PE 
database will continue to have no prices associated with these 
supplies. Therefore, in the CY 2008 PFS proposed rule, we proposed to 
cap the time in use for each equipment item at 25 minutes until 
specific information is received regarding the actual time in use. 
Tables listing the needed information for were included in the proposed 
rule.
    Comment: The specialty society representing the maxillofacial 
prosthetists supplied us with some of the requested information. The 
society provided us with the time-in-use data for every piece of 
equipment for each of the procedures in the CPT code series 21076 
through 21087. The specialty also provided prices for the supply items 
used in this code series; however, it did not provide any documentation 
to support these prices.
    Response: We appreciate the information provided by the specialty, 
especially that in relation to the equipment time-in-use. The 
recommended equipment times were compared with the total clinical labor 
time for each procedure and times that were greater were reduced to 
equal the labor time, in accordance with our usual allocation policy. 
Capping the equipment time-in-use to match the labor time affected 4 
pieces of equipment in every procedure including: the dental chair, 
ceiling light, air compressor, and delivery unit. For 3 of these codes, 
the time-in-use for a 5th piece of equipment, the washout and curing 
unit, was also capped. We will accept the specialty's equipment time-
in-use information, with the aforementioned variances, and have changed 
the PE database accordingly.
    We regret that documentation for the supply prices was not 
forwarded. We did, however, receive a catalog documented pricing for 
articulating paper/ribbon that was submitted by a different specialty 
in reference to another CPT code, and have entered this price in the PE 
database for 8 of the 10 codes in this family, as appropriate. The 
specialty is reminded that our policy for accepting prices for supplies 
or equipment in the PE database requires the submission of acceptable 
documentation, the definition of which is specified below the table 
that appeared in the proposed rule listing the outstanding prices for 
supply items needing documentation. We will continue to work with the 
specialty as it collects and forwards this important information.
(ix) Requests for Increases in Supply Prices
    We received a request from the specialty society for obstetrics and 
gynecology to increase the price of supply item (kit, hysteroscopic 
tubal implant for sterilization) for CPT code 58565, Hysteroscopy, 
surgical; with bilateral fallopian tube cannulation to induce occlusion 
by placement of permanent implants for this code which was created for 
CY 2005. This hysteroscopic implant kit is priced at $980 and the 
specialty is now requesting a price of $1,245, providing an invoice for 
documentation. The specialty reports that the higher price is 
attributed to a manufacturer change in design and materials, and 
submitted the manufacturer's documents supporting these changes that 
were used to secure FDA approval. Therefore, we proposed to accept the 
new price of $1,245 for the hysteroscopic implant kit due to the 
changes made in the modified model.
    Comment: We did not receive comments on this proposal.
    Response: We will finalize our proposed price of $1,245 for the 
hysteroscopic implant kit and will amend our PE database, as 
appropriate.
(x) Supply and Equipment Items Needing Specialty Input
    We have identified certain supply and equipment items for which we 
were unable to verify the pricing information (see Table 2: Supply 
Items Needing Specialty Input for Pricing and Table 3: Equipment Items 
Needing Specialty Input for Pricing). In our CY 2008 PFS proposed rule, 
we listed both supply and equipment items for which pricing 
documentation was needed from the medical specialty societies and, for 
many of these items, we received sufficient documentation containing 
specific descriptors and pricing information in the form of catalog 
listings, vendor Web pages, invoices, and manufacturer quotes. We have 
accepted the documented prices for many of these items and these prices 
are reflected in the PE RVUs in Addendum B of this final rule with 
comment period. For the items listed in Tables 2 and 3, we are 
requesting that commenters provide pricing information on items in 
these tables along with acceptable documentation, as noted in the 
footnote to each table, to support recommended prices. For supplies or 
equipment that have previously appeared on this list, and for which we 
received no or inadequate documentation, we proposed to delete these 
items unless we receive adequate information to support current pricing 
by the conclusion of the comment period for this proposed rule.
    In Tables 4 and 5, we have listed new supplies and equipment from 
the new CPT codes for CY 2008 that are discussed elsewhere in this 
final rule with comment period. These items have been added to the PE 
database and, where priced, are reflected in the PE RVUs in Addendum B.

[[Page 66240]]



                                                                   Table 2.--Supply Items Needing Specialty Input for Pricing
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                                  Unit     Primary associated     Associated  *CPT       Prior item      Commenter response   2008  item  status
               Code                 2006/7 Description           Unit            price         specialties            code(s)         status on  table     and CMS action     refer to  note(s)
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
SC088............................  Fistula needle,       Item................  .........  Dermatology.........  36522..............  Yes..............  Documentation        C
                                    dialysis, 17g.                                                                                                       received. Revised
                                                                                                                                                         description per
                                                                                                                                                         specialty's
                                                                                                                                                         comments. Price
                                                                                                                                                         accepted at $1.62.
                                   Gas, argon,           ....................  .........  Urology, Radiology,   50395..............  No...............  New Item...........  A, E
                                    cryoablation.                                          Interventional
                                                                                           Radiology.
                                   Gas, helium,          ....................  .........  Urology, Radiology,   50395..............  No...............  New Item...........  A, E
                                    cryoablation.                                          Interventional
                                                                                           Radiology.
SD140............................  Pressure bag........  item................      8.925  Cardiology..........  93501, 93508,        Yes..............  Documentation        C
                                                                                                                 93510, 93526.                           received. Price
                                                                                                                                                         accepted at $19.00.
SL119............................  Sealant spray.......  oz..................  .........  Radiation Oncology..  77333..............  Yes..............  No comments          B
                                                                                                                                                         received.
SD213............................  Tubing, sterile, non- item................       1.99  Cardiology..........  93501, 93508,        Yes..............  Documentation        C
                                    vented (fluid                                                                93510, 93526.                           received. Price
                                    administration).                                                                                                     accepted at $0.949.
                                   Stent, vascular,      Kit.................     $1,645  Radiology,            37205, 37206.......  Yes..............  Documentation        C
                                    deployment system.                                     Interventional                                                received. Price
                                                                                           Radiology.                                                    retained at $1,645.
                                   Catheter, Kumpe.....  Item................  .........  Radiology,            50385, 50386.......  No...............  New item...........  A, E
                                                                                           Interventional
                                                                                           Radiology.
                                   Disposable            ....................  .........  Oral and              21073..............  No...............  New item...........  A, E
                                    aspirating syringe.                                    Maxillofacial
                                                                                           Surgery.
                                   Guidewire, angle tip  ....................  .........  Radiology,            50385, 50386.......  No...............  New item...........  A, E
                                    (Terumo), 180 cm\1\.                                   Interventional
                                                                                           Radiology.
                                   Snare, Nitinol        Item................  .........  Radiology,            50385, 50386.......  No...............  New item...........  A, E
                                    (Amplatz).                                             Interventional
                                                                                           Radiology.
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
\*\ CPT codes and descriptions only are copyright 2008 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.
Note: Acceptable documentation includes--Detailed description (including system components), source, and current pricing information, such as copies of catalog pages, hard copy from specific
  Web pages, invoices, and quotes (letter format okay) from manufacturer, vendors or distributors. Unacceptable documentation includes--phone numbers and addresses of manufacturer, vendors or
  distributors, Web site links without pricing information, etc.
Note A: Additional documentation required. Need detailed description (including kit contents), source, and current pricing information (including pricing per specified unit of measure in
  database). Accept copies of catalog pages or hard copy from specific Web pages. Phone numbers or addresses of manufacturer, vendors or distributors are not acceptable documentation.
Note B: No/Insufficient received. Retained price in database on an interim basis. Forward acceptable documentation promptly.
Note C: Submitted price accepted.
Note D: Deleted per comment or CMS.
Note E: 2007/8 price retained on an interim basis. Forward acceptable documentation promptly.


                                  Table 3.--Equipment Items Needing Specialty Input for Pricing and Proposed Deletions
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                  Primary specialties      *CPT code(s)
      Code        2006/7 Description    2007/8      associated with      associated with     Prior status on    Commenter response    2008 Item status
                                         Price            item                 item               table           and CMS action      refer to note(s)
--------------------------------------------------------------------------------------------------------------------------------------------------------
EQ269..........  Ambulatory blood           3000  Cardiology.........  93784, 93786, 93788  Yes..............  Documentation        C
                  pressure monitor.                                                                             provided. Price
                                                                                                                accepted is $1525
                                                                                                                (Did not accept
                                                                                                                $395 warranty
                                                                                                                cost.).
                 Camera mount--floor        2300  Dermatology........  96904..............  Yes..............  Specialty to         A, E
                                                                                                                submit, asap.
                 Cross slide                 500  Dermatology........  96904..............  Yes..............  Specialty to         A, E
                  attachment.                                                                                   submit, asap.
                 Dermal imaging             4500  Dermatology........  96904..............  Yes..............  Documentation        C
                  software.                                                                                     provided. Price
                                                                                                                accepted at $4500.
                 Dermoscopy                  650  Dermatology........  96904..............  Yes..............  Documentation        C
                  attachments.                                                                                  provided. Price
                                                                                                                accepted at $650 (
                                                                                                                average of the
                                                                                                                cost of the two
                                                                                                                items provided).

[[Page 66241]]

 
EQ008..........  ECG signal                8,250  Cardiology, IM.....  93278..............  Yes..............  Documentation        A, E
                  averaging system w-                                                                           provided. Revised
                  P waves and late                                                                              description to
                  potentials                                                                                    better describe
                  software.                                                                                     system. Price
                                                                                                                accepted at 17,900.
                 Instrument,          ..........  Pathology..........  88380..............  No...............  New Item...........  A, E
                  microdissection.
                 Lens, macro, 35-     ..........  Dermatology........  96904..............  Yes..............  Deleted item as      D
                  70mm.                                                                                         price is less than
                                                                                                                $500 per
                                                                                                                documentation
                                                                                                                received.
                 Plasma pheresis          37,900  Radiology,           36481, G0341.......  Yes..............  Revised description  B
                  machine.                         Dermatology.                                                 based on comments
                                                                                                                received that
                                                                                                                light source was
                                                                                                                not part of item.
                                                                                                                Documentation
                                                                                                                requested.
ED039..........  Psychology Testing   ..........  Psychology.........  96101, 96102.......  Yes..............  Specialty to         B
                  Equipment.                                                                                    submit, asap.
ER070..........  Portal imaging          377,319  Radiation oncology.  77421..............  Yes..............  Documentation        C
                  system (w/PC work                                                                             provided. Price
                  station and                                                                                   accepted at
                  software).                                                                                    $489,940 ( average
                                                                                                                of the cost of the
                                                                                                                two items
                                                                                                                provided).
                 Strobe, 400 watts          1500  Dermatology........  96904..............  Yes..............  Documentation        B
                  (Studio) (2).                                                                                 requested.
                 Cryosurgery system   ..........  Urology, Radiology,  50593..............  No...............  New item...........  A, E
                  (for tumor                       Interventional
                  ablation)\1\.                    Radiology.
--------------------------------------------------------------------------------------------------------------------------------------------------------
* CPT codes and descriptions only are copyright 2008 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.
Note: Acceptable documentation includes--Detailed description (including system components), source, and current pricing information, such as copies of
  catalog pages, hard copy from specific Web pages, invoices, and quotes (letter format okay) from manufacturer, vendors or distributors. Unacceptable
  documentation includes--phone numbers and addresses of manufacturer, vendors or distributors, Web site links without pricing information, etc.
Note A: Additional documentation required. Need detailed description (including kit contents), source, and current pricing information (including
  pricing per specified unit of measure in database). Accept copies of catalog pages or hard copy from specific Web pages. Phone numbers or addresses of
  manufacturer, vendors or distributors are not acceptable documentation.
Note B: No/Insufficient received. Retained price in database on an interim basis. Forward acceptable documentation promptly.
Note C: Submitted price accepted.
Note D: Deleted per comment or CMS.
Note E: 2007/8 price, where specified, retained on an interim basis. Forward acceptable documentation promptly.


                          Table 4.--Practice Expense Supply Item Additions for CY 2008
----------------------------------------------------------------------------------------------------------------
                                                                          *CPT code(s)
   Equip code     Supply description         Unit        Unit price   associated with item     Supply category
----------------------------------------------------------------------------------------------------------------
NA.............  Blade, sharp pointed  item...........        0.73    88381...............  Cutters, closures.
                  surgical.
NA.............  Buffer, lysis.......  ml.............        0.46    88381...............  Lab.
NA.............  Caps, Capsure Macro   ml.............        4.54    88380...............  Lab.
                  LCM.
NA.............  Catheter, balloon,    item...........      306       68816...............  Accessory.
                  lacrimal.
NA.............  Catheter, Kumpe \1\.  item...........  ............  50385, 50386........  Accessory.
NA.............  Disposable            ...............  ............  21073...............  ....................
                  aspirating syringe
                  \1\.
NA.............  Ethanol, 95%........  ml.............        0.0033  88380, 88381........  Lab.
NA.............  Fee, image analysis.  item...........       18       99174...............  Office supply.
NA.............  Gas, argon,           ...............  ............  50593...............  Accessory.
                  cryoablation.
                 Gas, helium,          ...............  ............  50593...............  Accessory.
                  cryoablation.
NA.............  Gastrostomy. Low      item...........        5       43760...............  Accessory.
                  profile replacement
                  button (Mic-Key).
NA.............  Gastrostomy. Stoma    item...........       10       43760...............  Accessory.
                  measuring device
                  (Mic-Key).
NA.............  Glycerol, 3%........  ml.............        0.001   88380, 88381........  Lab.
NA.............  Guidewire, angle tip  item...........  ............  50385, 50386........  Accessory.
                  (Terumo), 180 cm
                  \1\.
NA.............  IV infusion set, Sof- item...........       11.50    90769, 90771........  Hypodermic, IV.
                  set (Minimed).
NA.............  Methylene blue stain  ml.............        0.178   88380...............  Lab.
NA.............  Probe, cryoablation,  item...........     1175       50593...............  Accessory.
                  renal.
NA.............  Rnase-free water....  ml.............        0.85    88381...............  Lab.
NA.............  Slide, microscope,    item...........        1       88380, 88381........  Lab.
                  sterile.
NA.............  Snare, Nitinol        item...........  ............  50385, 50386........  Accessory.
                  (Amplatz) \1\.
NA.............  Swab, patient prep,   item...........        1.04    36592...............  Pharmacy, NonRx.
                  1.5 ml (chloraprep).

[[Page 66242]]

 
NA.............  Tube, jejunsostomy..  item...........      195       49441, 49446, 49451   Accessory.
                                                                       and 49452.
----------------------------------------------------------------------------------------------------------------
* CPT codes and descriptions only are copyright 2008 American Medical Association. All Rights Reserved.
  Applicable FARS/DFARS apply.
\1\ Price verification needed. Item(s) added to table of supplies requiring specialty input.


                         Table 5.--Practice Expense Equipment Item Additions for CY 2008
----------------------------------------------------------------------------------------------------------------
                                                                         *CPT code(s)
    Equip code     Equipment description      Life      Unit price   associated with item   Equipment  category
----------------------------------------------------------------------------------------------------------------
NA...............  Cryosurgery system              10  ...........  50593................  Other Equipment.
                    (for tumor ablation)
                    \1\.
NA...............  Cardiac coil, 1.5T 8-            5        35400  7557, 7558 and 75559.  Imaging Equipment.
                    channel (MR).
                   Instrument,                      7  ...........  88381................  Laboratory.
                    Microdissection.
NA...............  Pressure sensor,                 5        25000  93982................  Documentation.
                    wireless (for
                    implanted AAA sac
                    sensor).
NA...............  Camera, ocular                   5         7000  99174................  Documentation.
                    photoscreening, w-
                    laptop and software.
----------------------------------------------------------------------------------------------------------------
* CPT codes and descriptions only are copyright 2008 American Medical Association. All Rights Reserved.
  Applicable FARS/DFARS apply.
 \1\ Price verification needed. Item(s) added to table of equipment requiring specialty input.

(xi) Additional PE Issues Raised By Commenters
    Comment: One commenter recommends that the direct inputs associated 
with all fee schedule services be made available to the public.
    Response: Since the inception of resource based PEs, all direct 
input data has been made available to the public on the CMS Web page. 
The direct inputs associated with this final rule with comment period 
are also available to the public at the following Web site under CMS-
1385-IFC: http://www.cms.hhs.gov/PhysicianFeeSched/PFSFRN/list.asp#TopOfPage.
    Comment: Several commenters recommend that we reprice supply items 
over $200 in the PE direct input database annually. Additionally, 
commenters also requested that we establish individual J codes for 
these high cost supplies. Alternatively, several other commenters 
expressed concerns over this recommendation stating that utilization 
guidelines must be set up that would trigger repricing or an undue 
burden would be placed upon those specialties using these high cost 
supplies.
    Response: Using an individual HCPCS code for each of these supplies 
would be difficult as there are multiple manufacturers, with multiple 
prices, associated with the majority of these codes. Having multiple 
manufacturers, and thus multiple prices, also makes it difficult to 
reprice these supplies within the PE methodology, which is why we 
continue to work with the AMA RUC to establish direct cost input data. 
Additionally, all direct inputs need to be budget neutralized within 
the PE methodology. Removing these high cost supplies from the standard 
PE methodology would unfairly advantage procedures that contain these 
supplies as they would not be subject to the same budget neutrality 
adjustments as would other supplies. Finally, we agree with those 
commenters that state that any annual repricing of these supplies would 
place undue burden on specific physician groups. For these reasons, we 
will continue to price these high cost supplies within the standard PE 
methodology.
    Comment: A few comments were received that recommended that desktop 
computers be included as a direct PE cost.
    Response: The direct PE database includes desktop computers with 
monitor when this computer is identified as being dedicated to a 
specific procedure. The costs associated with computers that are used 
for non-clinical purposes assigned to a specific procedure, for 
example, used for administrative procedures, are more appropriately 
captured in the indirect cost category.
    Comment: One commenter representing home care physicians requested 
that travel time and other inherent costs related to mobile medical 
services such as vehicle operation and mobile communication should be 
accounted for in the PE calculation.
    Response: To the extent that travel time is necessary to furnish 
physician services outside of the office setting, these expenses are 
not considered direct costs under the PE methodology. Although the 
mobile communication devices are not specifically included as direct PE 
inputs, 12 minutes of clinical labor time is assigned for each of the 
home visit E/M services, 6 minutes in the pre-time period and 6 minutes 
in the post time period. Phone calls are standardized at 3 minutes each 
for purposes of the direct PE inputs and would be included as part of 
this clinical labor time.
    Comment: One commenter stated that adjustments need to be made to 
the PE database for certain dialysis codes and requested that for G0393 
and G0392 an angioplasty balloon be added to the PE database and that 
for CPT code 36870 the PE database should be revised to include an 
angiographic room and a power table.
    Response: The balloon catheters are reflected in the PE database, 
as supply number SD152, and the angiographic room and an exam table are 
included in the equipment for CPT code 36870.
    Comment: Commenters expressed concern about the level of 
reimbursement for intrathecal pump management services for chronic pain 
patients and believe that the refill kit is not accounted for in the 
PE. In addition, commenters expressed concern that reimbursement did 
not cover the leasing costs for the equipment.
    Response: We reviewed the PE database and have verified that a 
refill kit, priced at $28, is included as a supply in CPT codes 95990 
and 95991. In our PE database, equipment costs are assigned based on 
the purchase price for each piece of equipment, regardless of whether 
the equipment is owned, rented or leased.
    Comment: A manufacturer expressed concern that the PE RVUs for 
intranasal administration of vaccines (CPT codes 90467/8 and 90473/4) 
are inappropriately low and should be equalized to the injectable 
immunization administration PE RVUs.

[[Page 66243]]

The commenter stated that when the codes were reevaluated in 2004 there 
was not enough experience in the office to fully understand the time 
associated with providing an intranasal vaccine. The commenter stated 
that specialty organizations have indicated that this issue is worth 
reexamining and indicated that they had been encouraged to communicate 
with the RUC in support of equalizing payment for the codes.
    Response: We appreciate the commenter's concerns about the 
disparity in the PE RVUs for the intranasal and injectable immunization 
administration procedures. To the extent that these concerns relate to 
the direct PE inputs, we would encourage the commenter to work with the 
specialty organizations to determine if it is appropriate to bring 
these codes forward for further RUC review.
    Comment: One commenter requested that we publish the RUC approved 
RVUs for all noncovered and carrier priced services, particularly for 
the positron emission tomography (PET) and PET/CT procedures.
    Response: We have made it our policy to publish work and PE RVUs 
for services in instances where the information has been forwarded to 
us, with a few exceptions. One exception to this policy is for carrier 
priced codes. Our rationale for this policy is simply that any 
published values for carrier-priced codes would be in direct 
contradiction of our intentions with respect to this designation. As we 
state in Addendum A, a ``C'' status indicator means that carriers price 
this code establishing RVUs and payment amounts without direct guidance 
from CMS. Because the commenter did not provide us with information 
about specific noncovered services that do not have published RVUs, we 
are not able to address this particular aspect of the comment.
    Comment: Commenters representing radiation oncologists expressed 
concern about the significant PE reductions in CPT code 77336 for 
continuing medical physics consults. The commenters noted this code was 
last reviewed by the PEAC in 2002 and the practice standard has changed 
significantly. Commenters recommended that the direct PE inputs for 
this code be reviewed and refined so that accurate PE data is reflected 
for this code.
    Response: While we appreciate that the commenters expressed their 
concerns to us regarding a change in the practice standards for the 
services of CPT code 77336 which they believe results in the need to 
change the direct PE inputs, we believe that the appropriate course of 
action for the commenters is to work together with the RUC affiliated 
specialty society in order to determine if these concerns can be 
appropriately addressed by the RUC.
    Comment: We received comments from individuals and associations 
with concerns about the new bottom-up PE methodology and the resulting 
effect of decreases in the PE RVUs for various services including, but 
not limited to the following: chemotherapy administration, endovenous 
ablation procedures, brachytherapy treatments, 3-D imaging services, 
and procedures for photopheresis and plasma pheresis.
    Response: As we noted earlier in this section, we are aware that 
the PE RVUs for some services were negatively impacted by the change in 
our PE methodology. However, we will reiterate here that it is our 
policy to make certain, to the maximum extent possible, that the direct 
PE inputs used in the PE RVU calculation actually reflect the typical 
resources used to provide each service. To the extent that the current 
PE RVUs are lower than those determined under our previous methodology, 
the difference is likely attributable to a previous PE RVU that was 
based on charges that overvalued the service. Because the current 
methodology uses the direct PE inputs that are inherent and typical to 
each procedure, the resulting PE RVUs more accurately reflect the 
resources that are used to provide the service.
    Comment: One commenter explained that, in the CY 2004 PFS final 
rule, we decided to set the values for the monthly ESRD-related 
services for home dialysis patients (for example, G0323) at the same 
rate as the monthly ESRD related services with 2 or 3 visits per month 
(for example, HCPCS code G0318) to provide an incentive for the 
increase use of home dialysis (as authorized under 1881(b)(3)(B) of the 
Act). The commenter notes that the current payment rate for ESRD 
related services, with 2 or 3 face-to-face visits per month is higher 
than ESRD related services for home dialysis patients, (due to a 
difference in PE). As such, the commenter is concerned that the 
differential in payment rates mitigates the incentives that we 
previously attempted to establish. The commenter suggested that 
incentives for using home dialysis should be strengthened by using a 
consistent PE value for MCP codes G0323 and G0318. However, the 
commenter prefers that we establish a new payment rate for the monthly 
management of home dialysis patients based on the weighted average of 
the MCP for patients who dialyze in a dialysis center or other 
outpatient facility.
    Response: We appreciate the suggestions regarding our payment 
policy for the monthly management of home dialysis patients. We intend 
to consider the commenters suggestions as we continue to evaluate 
payment rates for the monthly management of patients on home dialysis.

    Note: We received comments regarding certain items and services 
that are not germane to the PE RVUs or other components of the PFS. 
These issues include comments regarding: revisions to the definition 
of pre-service work and time for certain global services; inadequate 
pricing of HCPCS code A4562 for pessaries, requests for payment 
adjustments for certain services under PFS to approximate payment 
amounts for these services established under OPPS and ASCs, 
inadequate payment for pharmacy costs and nursing services for drug 
administration codes, and concerns about the reduction of PE RVUs in 
the nonfacility setting due to the changes in the PE methodology 
along with requests to freeze payment amounts at the level of the CY 
2006 transitional PE RVUs. Because these comments are outside the 
scope of the issues raised in the CY 2008 PFS proposed rule, we will 
not respond to these issues in this final rule with comment period.

B. Geographic Practice Cost Indices (GPCIs)

    We are required by section 1848(e)(1)(A) and (C) of the Act to 
develop separate Geographic Practice Cost Indices (GPCIs) to measure 
resource cost differences among localities; and to review and, if 
necessary, adjust the GPCIs at least every 3 years. In the CY 2008 PFS 
proposed rule, we published the proposed GPCIs for CY 2008 in Addendum 
E, noting that the proposed GPCIs do not reflect the 1.000 floor that 
was in place during CY 2006 and CY 2007. This floor expires as of 
January 1, 2008 in accordance with section 102 of the MIEA-TRHCA.
    In developing a GPCI, section 1848(e)(1)(A)(i) and (ii) of the Act 
require that the PE and malpractice (MP) GPCIs reflect the full 
relative cost difference while section 1848(e)(1)(A)(iii) of the Act 
requires that the physician work GPCIs reflect only one quarter of the 
relative cost differences. Section 1848(e)(1)(C) of the Act also 
specifies that if more than 1 year has elapsed since the last GPCI 
revision, we must phase in the adjustment over 2 years, applying only 
one half of any adjustment in each year. All GPCIs are developed 
through a comparison to a national average for each component, and the 
RVUs for different services uniformly weight each component.

[[Page 66244]]

1. GPCI Update
    A detailed description of the methodology used to develop and 
update the GPCIs can be found in the CY 2004 PFS proposed rule (68 FR 
49039, August 15, 2003). There are three components of the GPCIs 
(physician work, PE, and MP) and each relies on its own data source.
a. Physician Work
    The physician work GPCI is developed using the median hourly 
earnings from the 2000 Census of workers in six professional specialty 
occupation categories which we use as a proxy for physician wages and 
calculate to reflect one quarter of the relative cost differences. 
Physician wages are not included in the occupation categories because 
Medicare payments are a key determinant of physicians' earnings; 
therefore, including physician wages in the physician work GPCI would, 
in effect, make the index dependent upon Medicare payments. The 
physician work GPCI was updated in 2001, 2003, and 2005 using data from 
the 2000 Census; the proposed CY 2008 physician work GPCI is also based 
on the 2000 Census data. Because all updates since 2001 have relied on 
the 2000 Census data, the changes observed in the physician work GPCI 
in the update years are due to minor changes in utilization and budget 
neutrality factors; for CY 2008, Addendum E shows that there have been 
small changes in the physician work GPCI. Section 102 of the MIEA-TRHCA 
required application of a 1.000 floor on the work GPCI in payment 
localities where the work GPCI was less than 1.000. This provision 
expires on December 31, 2007. The CY 2008 proposed physician work GPCI 
reflects the removal of this floor.
b. Practice Expense
    The PE GPCI is developed from three data sources:
    (i) Employee Wages: We use 2000 Census median hourly earnings of 
four occupation categories. The physician work GPCI was updated in 
2001, 2003, and 2005 using data from the 2000 Census.
    (ii) Office Rents: We use residential apartment rental data 
produced annually by the Department of Housing and Urban Development 
(HUD) as a proxy for physician office rents. In 2001, 2003, and 2005, 
we used rents in the HUD 40th percentile. For CY 2008, we have 
calculated the GPCI using rents in the 50th percentile for the 
physician office rent proxy. We proposed to use the 50th percentile 
because although HUD generally allows payment for subsidized housing up 
to the 40th percentile, in some areas it allows payment up to the 50th 
percentile. We made this change to reflect the trend toward higher 
rents across the country.
    Fair Market Rents (FMRs) are gross rent estimates including rent 
and utilities. HUD calculates the FMRs annually using: (1) Decennial 
Census data; (2) American Housing Surveys conducted by the Census 
Bureau for HUD to enable HUD to develop revisions between Census years; 
and (3) random digit dial surveys to enable HUD to develop gross rent 
change factors. The American Housing Surveys cover 11 areas annually, 
rotating among the 44 largest metropolitan areas. The random digit dial 
component surveys 60 FMR areas annually.
    The FMR is set as a percentile point in the distribution of rents 
for standard housing occupied by people who moved within the previous 
15 months. The current FMR definition is the 40th percentile rent (the 
amount below which 40 percent of units are rented). Each year, the 50th 
percentile rent is also calculated by HUD and available through the 
HUDUSER Web site.
    In 2000, HUD changed its FMR policy to increase access to housing 
for families receiving Section 8 rent subsidy vouchers (65 FR 58870). 
To do so, HUD increased FMRs from the 40th percentile to the 50th 
percentile in areas where subsidized families were highly concentrated 
in certain census tracts, given evidence that affordable housing was 
not well distributed. Only metropolitan areas with more than 100 census 
tracts are considered for possible increase to the 50th percentile 
rent. FMRs can be moved from 40th to 50th percentile or back from 50th 
to 40th percentile.
    In the case of the office rent index for the PE GPCI, FMRs have 
been used to capture geographic differences in rental costs, in the 
absence of a consistent commercial rent index that covers all 
metropolitan and nonmetropolitan areas in the U.S. It has been used as 
a measure of the ``average rent'' in a market. However, since 2000, the 
FMRs have been a mixture of the 40th percentile and 50th percentile 
rents. FMR areas move between the two cutoffs. For example, in 
California, 9 counties had FMRs set at the 50th percentile in 2004. In 
2007, only 2 of these 9 counties were still at the 50th percentile 
level for the FMR, out of 4 total counties at the 50th percentile 
level.
    As described above in this section (and as detailed in 65 FR 
58870), the criteria for setting the FMR at the 40th or 50th percentile 
are based on concentrations of subsidized households. There is no 
reason to assume that commercial rents would follow the same patterns.
    Therefore, we believe the 50th percentile, or median, rents 
calculated by HUD will be a more consistent, fair measure of geographic 
differences for the purpose of proxying for commercial rents.
    Rent data produce the most significant changes because they are 
based on annual changes in HUD rents, and therefore, are more volatile 
than the wage (Census) data. While it has been suggested that we 
explore sources of commercial rental data for use in the GPCI, we do 
not believe there is a national data source better than the HUD data.
    (iii) Equipment and Supplies: We assume that items such as medical 
equipment and supplies have a national market and that input prices do 
not vary among geographic areas. As mentioned in previous updates, some 
price differences may exist, but we believe these differences are more 
likely to be based on volume discounts rather than on geographic market 
differences. Equipment and supplies are factored into the GPCIs with a 
component index of 1.000.
c. Malpractice
    The MP GPCI is calculated based on insurer rate filings of premium 
data for a $1 million to $3 million mature ``claims made'' policy along 
with premium or surcharge data for mandatory patient compensation funds 
(PCFs). The MP GPCI is the most volatile of the GPCIs. This GPCI was 
updated in 2001 and 2003 as scheduled with the physician work and PE 
GPCIs; but, there was an unscheduled update of the MP GPCI in 2004 (68 
FR 49043) to reflect increases in MP premiums nationwide. The proposed 
CY 2008 MP update reflects the most recent premium data available. The 
physician work and PE GPCIs are being updated at the same time.
    We received the following comments about our proposed GPCIs:
    Comment: We received several comments expressing the concern that 
San Benito County in California was placed in the wrong payment 
locality.
    Response: In 2003, the U.S. Census Bureau moved San Benito County 
from the Rest of State Census category and placed it in the San Jose 
MSA. Our data and methodology do not accommodate mid-decennial changes 
in Census data, and therefore, our 2008 update reflects that San Benito 
County remains in the Rest of California payment locality.

[[Page 66245]]

    Comment: We received several comments about the PE GPCI for Santa 
Clara County, California. In the proposed rule, the PE GPCI was lower 
for Santa Clara than it has been in previous years and commenters were 
concerned about why this happened.
    Response: We recognize that there was a decrease in the proposed 
Santa Clara County PE GPCI. We have studied this issue including 
examining both the source data and the methodology for obtaining the PE 
GPCI in case there was a mistake in the proposed values. However, a 
close examination of the data showed that the GPCI is accurate and 
reflects a decrease in the value of HUD rentals in Santa Clara County.
    Comment: One commenter suggested that a GPCI adjustment should not 
be applied to physician work, or that the physician work GPCI should be 
1.000 for all localities.
    Response: We are required to apply a GPCI adjustment to physician 
work in accordance with section 1848(e) of the Act. Therefore, we will 
continue to apply the physician work GPCI.
    Comment: We received several comments suggesting that the PE GPCI 
is inaccurate due to our continued use of HUD rental data as a proxy 
for medical office space.
    Response: Because Medicare is a national program, we believe it is 
important to use the best data that is available on a nationwide basis. 
We believe the HUD rental data is the most comprehensive and valid 
indicator of the national real estate rental market that is available. 
Additionally, as we stated most recently in the CY 2007 PFS final rule 
with comment period (71 FR 69656), we believe the HUD rental data 
remains the best data source to fulfill our requirements that the data 
be available for all areas, be updated annually, and retain consistency 
area-to-area and year-to-year. In the past, we have had both the GAO 
and the Research Triangle Institute examine available data sources for 
use in the PE GPCI, and both have found that available commercial data 
sets either have insufficient coverage nationally or are developed by 
suspect methodology. Therefore, we continue to believe the HUD rental 
data is the best nationally available data source to use as a proxy for 
physician office rents.
    Comment: We received several comments suggesting that the GPCIs of 
Hawaii/Guam and Alaska need to be adjusted to accommodate the higher 
costs of transportation of supplies and equipment to these localities.
    Response: The GPCIs are a proxy for costs associated with providing 
services to beneficiaries, not costs associated with living in a 
particular place. However, we will consider these comments as we 
evaluate possible changes to our methodology.
    Comment: We received comments from the Medicare Payment Advisory 
Commission (MedPAC) suggesting an alternative method for calculating 
the PE GPCI. This alternative PE GPCI method excludes cost measures for 
equipment and supplies.
    Response: We appreciate MedPAC suggesting an alternative method. We 
intend to evaluate the suggested change to the PE GPCI methodology and 
will propose any changes in future rulemaking.
    We will finalize the GPCIs shown in Addendum E. The GPCI values 
shown represent the first year of the two-year GPCI update transition 
and have been budget neutralized to ensure that nationwide total RVUs 
are not impacted by changes in locality GPCIs. Specifically, this is 
done by applying a weight that is derived from the difference between 
payments using the ``old'' GPCIs and the ``new'' GPCIs to the proposed 
GPCIs that insures that total payments would not be different. As we 
indicated above in this section, there is no 1.000 floor on the 
physician work GPCI in 2008. The GAFs are shown in Addendum D.
2. Payment Localities
a. Background
    The Medicare statute requires that PFS payments be adjusted for 
certain differences in the relative costs among areas. The statute 
requires an adjustment which reflects differences among areas for the 
relative costs of the mix of goods and services comprising PEs (other 
than Malpractice expenses) compared to the national average. The 
statute also requires adjustment for the relative costs of MP expenses 
among areas compared to the national average. Finally, the statute 
requires adjustment for one quarter of the difference between the 
relative value of physicians' work effort among areas and the national 
average of such work effort.
    The physician work component represents 52.466 percent of the 
national average fee schedule payment amount. Thus, the statutory 
requirement for geographic adjustment of only one-quarter of the 
differences in the physician work component means that, on average, 
only 13.117 percentage points of physician work are geographically-
adjusted, and, on average 39.349 percentage points of the physician 
work component are not adjusted and represent a national fee schedule 
amount.
    In addition, the PE component represents 43.669 percent of the 
national average fee schedule payment amount. PEs are comprised of 
nonphysician employee compensation, office expenses (including rent), 
medical equipment, drugs and supplies, and other expenses. As explained 
above in this section, we do not make a geographic adjustment relating 
to medical equipment, drugs, and supplies because there is a national 
market for these items. Thus, only the categories of nonphysician 
employee compensation and rents are geographically adjusted. These 
categories represent, on average, 30.862 percentage points of the total 
PE, and 12.807 percentage points of PEs are not geographically-
adjusted.
    In total, more than half (52.156 percent) of the average PFS amount 
is a national payment that is the same in all areas of the country; 
that is, 52.156 percent of the average fee is not geographically-
adjusted.
    There are two additional points about the geographic indices that 
are important to note. First, as described above in this section, the 
data used to measure cost differences among localities are proxies for 
physician work, employee compensation and office rents. That is, wage 
data for various categories of employees are used to proxy the actual 
wages of physician employees. Second, the data used for such proxies 
are based on actual Census data only for a limited number of counties. 
The geographic adjustment factors (GAFs) for more than 90 percent of 
counties are developed using proxies based on larger geographic areas 
(for example, data for all rural areas in a State are combined and used 
to proxy the values for each rural county in a State). This aggregation 
is necessary for areas where country level data are not available. 
Thus, the underlying data are proxies for actual costs, and the 
resulting GPCIs do not measure perfectly the cost differences among 
localities.
    Currently, there are 89 Medicare physician payment localities to 
which GPCIs are applied. The payment locality structure under the PFS 
was established in 1996 and took effect January 1, 1997. The 
development of this structure is described in detail in both the CY 
1997 PFS proposed (61 FR 34615) and final rules (61 FR 59494).
b. Revision of Payment Localities
    Over time, changing demographics and local economic conditions may 
lead to increased variations in practice costs within payment locality 
boundaries. We are concerned about the potential impact of these 
variations and have

[[Page 66246]]

been studying this issue and potential alternatives for a number of 
years. However, because changes to the GPCIs must be applied in a 
budget neutral manner (and under the current locality system, budget 
neutrality results in aggregate payments within each State remaining 
the same), there are significant redistributive effects to any change. 
Therefore, we are also concerned about the potential impact of locality 
revisions.
    For the past several years, we have been involved in discussions 
with California physicians and their representatives about recent 
shifts in relative demographics and economic conditions among a number 
of counties within the current California payment locality structure.
    The California Medical Association (CMA) suggested that we use our 
demonstration authority to adopt an alternative locality configuration 
and avoid certain redistributive effects, but such an approach was not 
feasible (as discussed in the CY 2005 PFS final rule with comment 
period (70 FR 70151)). In the CY 2006 PFS proposed rule (70 FR 45784), 
we proposed to remove two counties from the ``Rest of California'' 
payment locality and create a new payment locality for each county. 
These two counties were the ones with the largest difference between 
the county and locality GAFs. However, there was much more opposition 
than support for this proposal, in large part because of its negative 
effect on payments for the counties that would have remained in the 
``Rest of California'' locality. For example, the CMA commented on this 
proposal stating, ``a nationwide legislative solution that would 
provide additional funding * * * is the only solution we are supporting 
at this time.'' We did not finalize the proposal and described our 
reasons in the CY 2006 PFS final rule with comment period (70 FR 
70151).
    As indicated previously, we recognize that changing demographics 
and local economic conditions may lead to increased variations in 
practice costs within payment locality boundaries. We are concerned 
about the potential impact of these variations.
    In considering potential changes in payment localities, we believe 
it is important to evaluate both the potential impact of intralocality 
practice cost variations and the redistributive impacts that would 
result from any revisions to the localities. We also indicated that we 
are concerned about the considerable administrative issues in making 
locality changes, particularly if such changes involve a transition, 
and if they occur when new GPCI data are being phased-in. As we noted 
in the response to the June 2007 General Accountability Office report 
on localities (GAO-07-466), changing localities requires reprogramming 
systems and extensive provider education, both of which are expensive 
and burdensome administrative activities that can last for a 
significant period of time. We receive claims for payment that cross 
calendar years and carriers must maintain payment files for the 2 
different years.
    In the proposed rule we solicited comments on three possible 
locality reconfigurations. We indicated that because of the importance 
of striking an appropriate balance between intralocality variations and 
redistributive impacts with any such locality revisions, we wanted to 
be cautious and evaluate the impacts in California before considering 
applying the policy more broadly in the future.
    The three options from the proposed rule are described as follows:
    Option 1: Using the existing locality structure, apply a rule 
whereby if a county GAF is more than 5 percent greater than the GAF for 
the locality in which the county resides it would be removed from the 
current locality. A separate locality would be established for each 
county that is removed. Based on the new fully phased-in GPCI data 
(that is, for CY 2009), application of this approach in California 
would remove three counties (Santa Cruz, Monterey, and Sonoma) from the 
Rest of California payment locality and Marin county from the Marin/
Napa/Solano payment locality and create separate payment localities for 
each of these four counties.
    This approach focuses on counties for which there is the biggest 
difference between the county GAF and the locality GAF.
    This proposal is similar to the policy we previously proposed in 
the CY 2006 PFS proposed rule (70 FR 45784) but did not adopt to 
address the counties with GAFs that are most different from their 
current locality designation. Implementation of this option would lead 
to an increase in payment of 7.6 percent for Santa Cruz County (and 
average increase of 5 percent for the other counties involved) and a 
decrease in payment of 4.3 percent for Napa and Solano Counties.
    Option 2: This approach is similar to option 1, but the new 
localities would be structured differently. We would use the same 5 
percent threshold methodology but instead of creating four new 
localities in which each county becomes its own new locality, the three 
counties that are removed from the Rest of California locality would 
become one new locality. Marin County would still be removed from the 
Marin/Napa/Solano locality to become its own locality. Application of 
this approach would remove three counties (Santa Cruz, Sonoma, and 
Monterey) from the Rest of California payment locality, and Marin 
County from the existing Marin/Napa/Solano payment locality. This 
approach groups together counties from the Rest of California locality 
that have the greatest difference between the county and locality GAF. 
(This option would lead to an increase of 6 percent for the new 3-
county payment locality.) These counties have similar cost structures 
and grouping them together into one new locality is consistent with our 
goal of homogeneous resource costs within a locality.
    Option 3: Apply a methodology similar to that used in the 1997 
locality revisions (61 FR 59495), but applied at the county level 
rather than the ``existing locality'' level. That is, we sorted the 
counties by descending GAFs and compared the highest county to the 
second highest. If the difference is less than 5 percent, the counties 
were included in the same locality. The third highest is then compared 
to the highest county GAF. This process continues until a county has a 
GAF difference that is more than 5 percent. When this occurs, that 
county becomes the highest county in a new payment locality and the 
process is repeated for all counties in the State. This approach would 
group counties within a State into localities based on similarity of 
GAFs even if the counties were not geographically contiguous.
    This organizes payment localities based on costs, which would 
reduce the number of payment localities in California from 9 to 6 
localities. This option alleviates the greatest variations in cost 
between counties in California. This proposal is unique in that the new 
localities are not contiguous. Currently, all localities encompass 
adjacent geographic areas.
    The impacts associated with this option are significant. Depending 
on the tier, changes could reflect increases of as much as 7.6 percent 
or decreases of as much as 7.3 percent.
    We received numerous comments on these options as discussed below:
    We received similar comments from a number of individuals, State 
and local medical societies, and organizations, including the 
California Medical Association, on several significant issues and are 
addressing these together:
    Comment: Santa Cruz County should be removed from the Rest of 
California payment locality due to its higher costs.
    Response: We recognize that Santa Cruz County has higher costs than 
other

[[Page 66247]]

counties within the Rest of California locality, and the methodologies 
we presented in each of the options would result in Santa Cruz County 
being removed from the Rest of California payment locality.
    Comment: Many commenters were concerned about the description of 
the methodology used for Options 1 and 2. Specifically, these comments 
directed us to adopt a methodology suggested by the California Medical 
Association. The methodology compares the highest GAF county to the 
weighted average (GAF) of the remaining counties of the locality.
    Response: To clarify, the methodology we used identified counties 
where the county GAF was at least 5 percent higher than the GAF of the 
locality and then we either left that county as a payment locality 
itself or joined it with other counties into a payment locality. In 
Option 1, each of these counties became a separate locality; in Option 
2, we combined several of these counties into a single payment 
locality. This approach is not the ``iterative methodology'' that some 
commenters suggested we should follow. We recognize that there are 
alternative methodologies that can be used to consider reconfigurations 
to locality structures. We will consider the suggestions of the 
commenters in the future.
    Comment: There were concerns that combining several counties into a 
single payment locality in Option 2 was arbitrary and led to lower 
payments for these counties.
    Response: As we stated in the proposed rule, there are trade-offs 
involved in making any changes to localities, and we recognize the 
importance of trying to achieve a reasonable balance among competing 
priorities. One of our goals was to keep the number of payment 
localities manageable. Although we recognize that there are effects on 
each of the individual counties, combining counties with very similar 
costs was a reasonable way to meet this goal.
    Comment: Numerous commenters from California recommended that we 
implement Option 3 but suggested that we erred in describing the 
methodology used in the development of Table 9 of the proposed rule and 
recommended that if we implement it, we should use their suggested 
methodology. Commenters suggested that we really meant to insert a 
hierarchical approach and discussed how these are both acceptable ways 
to accomplish the restructuring of the counties. Other State societies 
expressed interest in this option as long as we use the alternative 
methodology suggested by the California commenters.
    Response: In Option 3 in the proposed rule, we ranked the counties 
by GAF from highest to lowest. We then combined into a new payment 
locality the county with the highest GAF and the other counties that 
have a GAF within 5 percent of the highest GAF county. Then, we found 
the county with the highest GAF among the remaining counties. We 
combined that county and all the counties that have a GAF within 5 
percent of the new highest GAF county into a payment locality. We 
continued this method until all counties were included in a locality. 
As previously mentioned, there are multiple approaches to reconfiguring 
the localities that result in similar outcomes. We will further study 
the suggestions provided by the commenters.
    Comment: We received a number of comments requesting that we 
provide a wide variety of data, at the county level, from numerous 
sources covering the years 1999 through 2006.
    Response: We believe we provided commenters sufficient information 
to fairly evaluate our proposals. We note that many of these requests 
involved county level data. There is very little county level data 
available nationwide. Most of our data sources are collected at the MSA 
or Consolidated MSA, or Non-Metropolitan Area level, and our 
methodology was designed to be used to develop GPCIs within a payment 
locality analysis, not a county level analysis. We do our best to 
provide requestors with sources for publicly available data and to 
provide any other data that is requested of CMS. However, we often 
simply do not have data available at other than the locality level.
    Comment: Several commenters are concerned that the data used to 
develop the latest GPCI update are out of date or inaccurate.
    Response: We used the most up-to-date data available for the GPCIs 
used in the calculation of the proposed options. Descriptions of the 
data sources we use can be found in previous regulations (69 FR 66261) 
but we will reiterate them here. For the physician work GPCI, we use 
data files from the latest decennial census (currently 2000) supplied 
to CMS by the Census Bureau. These data are available to any individual 
or group interested in obtaining them from the Census Bureau. Data for 
the rental portion of the PE GPCI update come from HUD rental files, 
and these data are available online to anyone wishing to obtain them. 
Wage data for the PE GPCI come from the 2000 Census files which are 
available from the Census Bureau. Data for the malpractice GPCI come 
from premium data that are filed by companies writing Professional 
Liability Insurance in each state. These filings are provided, upon 
request by our contractor, to CMS by each State Department of 
Insurance. Our latest update covers premium data for 2004, 2005 and 
2006.
    Comment: We received comments from certain physicians in Ohio 
requesting that we examine Ohio for a possible change in the current 
Statewide payment locality.
    Response: We are currently examining alternatives to the current 
locality structure. As a part of our study we will revisit Statewide 
localities to determine if revisions are appropriate.
    Comment: We received a number of comments from ambulance suppliers 
throughout the mid-West requesting that we make no changes that would 
have a negative impact on the GPCIs in rural areas. Other commenters 
expressed similar concerns about the impact of locality changes on 
rural physicians and beneficiaries.
    Response: The vulnerability of rural areas to decreases in relative 
payments as a result of locality revisions is an issue that is of 
considerable concern to us and something we take very seriously. 
However, as previously noted we must find an acceptable balance between 
the multiple competing concerns when making changes in localities in 
order to best meet the needs of the entire program and this generally 
cannot be done without having any impact on rural areas.
    Comment: MedPAC provided comments outlining two possible mechanisms 
for developing changes in the payment localities of the States. These 
methods are similar but differ in that one method begins at the 
locality level and the other starts with MSA level data. MedPAC also 
suggests that we determine whether those States that are currently 
single payment localities wish to remain single payment localities.
    Response: As always, we value the input of MedPAC and we intend to 
analyze their suggested methods carefully as we discuss possible 
national policy changes.
    Comment: Comments regarding changes in the payment localities in 
California were universally accompanied with a belief that we should 
implement these changes, without decreasing payments to any counties.
    Response: We understand the desire to avoid the negative impact 
implementing any of these options might have on certain areas. However,

[[Page 66248]]

the statute requires that geographic adjustments be established based 
upon an index of costs that is tied to national averages. As a result, 
when the average increases in one locality because of the addition of a 
higher cost county, the average in the locality that previously 
contained the higher cost county will necessarily decrease. Any changes 
in localities will necessarily produce changes in the underlying GPCIs, 
and we have no authority to assign or retain GPCIs that do not 
represent the actual values for a locality.
    Comment: Many commenters suggested that we consider a national 
solution to payment locality structure problems, not focus on a single 
state.
    Response: Our proposals attempted to address locality issues in an 
area of the country where the incongruity of certain GAFs within 
localities is particularly evident. In addition, these issues have been 
brought to our attention regularly over the past several years, and the 
California Medical Association has demonstrated its desire and 
willingness to work with us to develop ideas for resolving them. We 
viewed these proposals relating only to California as a starting point 
and, as we indicated in the proposed rule, we would consider applying 
any changes to additional States in the future.
    Decision: We appreciate the thoughtful comments we received in 
response to the three options we included in the proposed rule. As 
mentioned above, we recognize that changing the locality structure is a 
complex undertaking and there are competing concerns, including budget 
neutrality that results in payments in certain areas decreasing 
whenever payments in other areas are increased, that must be carefully 
balanced to achieve the most appropriate results. Historically, to help 
us find the best balance in a particular state, we have looked to State 
medical societies to work with us to provide leadership and support on 
preferred approaches to locality reconfiguration in that particular 
State.
    The comments we received from California physicians, including the 
California Medical Association's indication that it does not support 
any of the options, and interested parties from other States have 
convinced us that this issue requires further study and analysis. 
Therefore, we will not be finalizing any of the three proposed options 
in this rule. Commenters have suggested some other methodologies that 
we find worthy of further exploration, including the use of 
Metropolitan Statistical Areas (MSAs). We do not necessarily believe 
that the county is the appropriate geographic unit on which we should 
be focusing for locality revisions. Commenters also made strong 
arguments for why any locality reconfiguration should be done on a 
nationwide basis and not just one State at a time. Therefore, we intend 
to conduct a thorough analysis of approaches to reconfiguring 
localities and will address this issue again in future rulemaking.

C. Malpractice RVUs (TC/PC Issue)

    In the CY 2008 PFS proposed rule (72 FR 38142), we included a 
discussion about the radiology codes for which the technical component 
malpractice RVUs are higher than the professional component malpractice 
RVUs. In the past, several organizations have requested that we examine 
these codes and make changes to this assignment of malpractice RVUs. We 
asked for information about how we could address this issue and obtain 
data on malpractice costs associated with these radiology codes.
    We received the following comments on this issue.
    Comment: The Professional Liability Insurance (PLI) workgroup of 
the AMA/Specialty Society RVU update committee (RUC) supported by 
several other organizations recommended that we reduce the PLI 
technical component for these codes to zero. They suggest that there 
are no identifiable separate costs for professional liability for 
technical components. They also recommend that the PLI RVUs be 
redistributed across all physicians' services. The RUC is concerned 
that the Deficit Reduction Act of 2005 (Pub. L. 109-171) (DRA) cap on 
the TC payment for imaging services will remove an estimated $200 
million from the Part B pool (as a result of the exemption of the 
reduced expenditures from the budget neutrality requirement at section 
1848(c)(2)(B)(v)). The RUC believes that making the recommended changes 
will keep money that would be lost due to the DRA cap in the Part B 
pool. The RUC wants CMS to implement this change immediately and 
consider other changes to the PLI RVU assignment later.
    Response: In the CY 2008 PFS proposed rule, we explained that these 
codes had not been reviewed due to a lack of suitable data on the cost 
of PLI for technical staff or imaging centers. The RUC believes that no 
such data are available because there are no identifiable separate 
costs. At this point in time, we are not able to evaluate whether 
sufficient data exists or to make a judgment on the RUC's assertion 
that such data are not available because there are no identifiable 
costs. We will continue to explore possible sources of information 
about these costs. We made no proposal regarding malpractice RVU 
assignment and we are still considering possible changes. If we 
identify in the future what we believe is a more appropriate way to pay 
for these services, we will propose changes through notice and comment 
rulemaking.
    Comment: Some commenters stated that the malpractice RVUs in the 
technical component should not be zero. These commenters suggested that 
we either ``flip'' the malpractice RVU assignment between the 
professional and technical components or make them equal.
    Response: As we stated in the CY 2008 PFS proposed rule, we do not 
believe it would be appropriate to ``flip'' the PC and TC RVU values 
because the professional part of the MP RVUs has undergone a resource 
based review, is derived from actual data, and is consistent with the 
resource based methodology for PFS payments. Further, we will not 
simply equalize the PC and TC RVU values because at this time we have 
no data to demonstrate that the malpractice costs for the technical 
portion of these services are the same as the professional portion. We 
will continue to study this issue and will propose any changes in 
future rulemaking.
    Comment: We received several comments recommending that we make the 
PLI RVUs resource based for all codes and that we should continue to 
collect and analyze appropriate malpractice premium data before making 
changes to the RVU assignment.
    Response: We will continue to solicit, collect, and analyze 
appropriate data on this subject. Once we have sufficient information, 
we will be better able to make a determination as to what, if any, 
changes should be made, and we will propose any changes in future 
rulemaking.

D. Medicare Telehealth Services

1. Requests for Adding Services to the List of Medicare Telehealth 
Services
    As discussed in the CY 2008 PFS proposed rule (72 FR 38143), 
section 1834(m)(4)(F) of the Act defines telehealth services as 
professional consultations, office visits, and office psychiatry 
services, and any additional service specified by the Secretary. In 
addition, the statute required us to establish a process for adding 
services to or deleting services from the list of telehealth services 
on an annual basis.

[[Page 66249]]

    In the CY 2003 PFS final rule with comment period (67 FR 79988), we 
established a process for adding services to or deleting services from 
the list of Medicare telehealth services. This process provides the 
public an ongoing opportunity to submit requests for adding services. 
We assign any request to make additions to the list of Medicare 
telehealth services to one of the following categories:
    <bullet> Category <greek-i>1: Services that are similar to office 
and other outpatient visits, consultation, and office psychiatry 
services. In reviewing these requests, we look for similarities between 
the proposed and existing telehealth services for the roles of, and 
interactions among, the beneficiary, the physician (or other 
practitioner) at the distant site and, if necessary, the telepresenter. 
We also look for similarities in the telecommunications system used to 
deliver the proposed service, for example, the use of interactive audio 
and video equipment.
    <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 following to the 
list of Medicare telehealth services: psychiatric diagnostic interview 
examination; ESRD services furnished under the monthly capitation 
payment (MCP) with two to three visits per month and four or more 
visits per month (although we require at least one visit a month, in 
person ``hands on'', by a physician, Certified Nurse Specialist, NP, or 
PA to examine the vascular access site); and individual medical 
nutrition therapy.
    Requests to add services to the list of Medicare telehealth 
services must be submitted and received no later than December 31 of 
each calendar year to be considered for the next rulemaking cycle. For 
example, requests submitted before the end of CY 2006 are considered 
for the CY 2008 proposed rule. For more information on submitting a 
request for an addition to the list of Medicare telehealth services, 
visit our Web site at www.cms.hhs.gov/telehealth/.
    We received the following requests for additional approved services 
in CY 2006: (1) Subsequent hospital care (as represented by HCPCS codes 
99231 through 99233); (2) neurobehavioral status exam (HCPCS code 
96116); and (3) neuropsychological testing (HCPCS codes 96118 through 
96120).
    After reviewing the public requests, we proposed to add 
neurobehavioral status exam as described by HCPCS code 96116 to the 
list of Medicare telehealth services in the CY 2008 PFS proposed rule. 
We also proposed to revise Sec.  410.78 and Sec.  414.65 to include 
neurobehavioral status exam as a Medicare telehealth service. We did 
not propose to add subsequent hospital care or neuropsychological 
testing but requested comments as to how we could determine when 
subsequent hospital care is actually a follow-up inpatient consultation 
and specific information on neuropsychological testing. For further 
information on our proposals, see the CY 2008 PFS proposed rule (72 FR 
38143).

Subsequent Hospital Care

    The following is a summary of the comments we received regarding 
subsequent hospital care.
    Comment: We received two comments regarding the conditions (or 
requirements) we could apply to subsequent hospital care so that 
subsequent hospital care reflects a follow-up inpatient consultation. 
One commenter suggested that follow-up inpatient consultation should be 
approved as a telehealth service only if the initial inpatient 
consultation was performed via telehealth. The commenter does not 
believe we should approve a follow-up inpatient consultation for 
telehealth if the initial inpatient consultation was furnished in-
person (because it might lead to a reduction in follow-up consultations 
furnished face-to-face). The commenter also agreed with our proposal 
not to approve subsequent hospital care for telehealth. Another 
commenter noted that follow-up inpatient consultation was previously on 
the list of Medicare telehealth services and asserts that the AMA's 
deletion of follow-up inpatient consultation (as described by CPT codes 
99261 through 99263) created the need to approve the addition of 
subsequent hospital care to the list of Medicare telehealth services 
when used for follow-up inpatient consultation care. The commenter 
suggested that we create a special modifier to report follow-up 
inpatient consultation via telehealth.
    Response: We appreciate the comments on the conditions (or 
requirements) we could apply to subsequent hospital care so that 
subsequent hospital care reflects a follow-up inpatient consultation. 
We intend to consider the suggestions raised by the commenters as we 
continue to evaluate whether subsequent hospital care should be 
approved for telehealth when it is used to furnish a follow-up 
inpatient consultation. With regard to the commenter who suggested the 
creation of a special modifier, we will assess whether it would be 
appropriate to use a modifier(s) to identify when a subsequent hospital 
care service is actually a follow-up inpatient consultation.
    Comment: One commenter who supports approving subsequent hospital 
care for telehealth explained that recruiting specialists to North and 
South Dakota is difficult and that telehealth has helped hospital 
inpatients in these States to obtain access to various types of 
specialty care including pulmonology, endocrinology, pediatric 
gastroenterology, pediatric cardiology, and infectious disease 
specialties. The commenter also mentioned that inpatient consultations 
are frequently provided by infectious disease specialists for patients 
in the intensive care unit (ICU) and explained that once the patient 
has made progress and is moved from the ICU, the infectious disease 
specialist at the distant site continues to ``follow'' the patient 
until the patient is discharged from the hospital. The commenter 
recognized that access to on-going specialty care for outpatients is 
important but believes that obtaining access to specialty subsequent 
inpatient ``follow-up'' care is even more critical. Commenters 
submitted a comparative study between subsequent hospital care 
furnished as a telehealth service and furnished in-person.
    Response: As discussed in the CY 2008 PFS proposed rule, given the 
potential acuity level of the patient in the hospital setting, we 
believe that many services furnished within the scope of the subsequent 
hospital service codes are not similar to the current telehealth 
services. As such, we indicated that subsequent hospital care is a 
category 2 service (which requires sufficient comparative analyses 
before approving it for telehealth). The commenters did submit one 
comparative analysis between subsequent hospital care furnished as a 
telehealth service and subsequent hospital care furnished in-person. 
However, the study submitted involved only continuing specialist care 
(for one specialty), not continuing inpatient care by the primary 
attending physician. In

[[Page 66250]]

addition, the sample size was extremely small. Thus, the study findings 
are not generalizable.
    As such, we continue to have concerns about using a 
telecommunications system as a substitute for the on-going, day-to-day 
(in-person) evaluation and management of a hospital inpatient and 
believe further study is necessary. In the absence of sufficient, well-
designed comparison studies showing that the use of a 
telecommunications system is an adequate substitute for the in-person 
delivery of subsequent hospital care, we are not adding subsequent 
hospital care to the list of Medicare telehealth services. As discussed 
above in this response, we will work with the industry organizations 
and groups to learn more about hospital care as a telehealth service 
when it is used for follow-up inpatient consultations.
    Comment: One commenter (who submitted the request to approve 
subsequent hospital care for telehealth) stated that the original 
request to add subsequent hospital care to the list of Medicare 
telehealth services was a request to ``re-establish'' subsequent 
inpatient visits (as a Medicare telehealth service). The commenter 
described two scenarios in which subsequent hospital care could be 
furnished as a telehealth service. The first scenario would involve a 
specialty physician who furnishes an inpatient consultation as a 
telehealth service (as requested by the attending physician). The 
second scenario involves an attending or admitting physician who 
furnishes initial hospital care in-person (not as telehealth) and 
provides subsequent hospital care as a telehealth service. The 
commenter believes that access to telehealth care is better than not 
having access to any care and that studies have shown that telehealth 
care provides better clinical outcomes than no care at all. 
Additionally, the commenter asserts that tertiary care trauma surgeons, 
neurologists (for initial and follow-up stroke evaluation), 
psychiatrists (for initial assessment and prescriptive safety orders), 
infectious disease physicians, and cardiologists can be made available 
through telehealth when these specialties are not available on-site. 
The commenter believes that not approving subsequent hospital care for 
telehealth will severely hinder access to specialty care in the 
inpatient hospital setting and will lead to grave consequences for 
patients when no specialists are available on-site (at the hospital).
    Response: We agree that telehealth services may help provide 
greater access to specialty care, and therefore, better clinical 
outcomes where a shortage of medical professionals exist (or in 
situations when no care is available). As discussed in the CY 2008 PFS 
proposed rule, we are considering approving subsequent hospital care 
for telehealth when it is used for follow-up inpatient consultation. We 
believe that permitting follow-up inpatient consultations via 
telehealth will help provide greater access to specialty care in the 
inpatient hospital setting.
    Additionally, we note that, contrary to the commenter's assertion, 
subsequent inpatient hospital visits were not previously on the list of 
Medicare telehealth services. As mentioned by a previous commenter, the 
AMA deleted the codes for follow-up inpatient consultation (as 
described by CPT codes 99261 through 99263). Effective January 1, 2006, 
these CPT codes no longer exist and were removed from the PFS, and a 
conforming change was made to the list of Medicare telehealth services. 
Prior to January 1, 2006, the physician (or practitioner) at the 
distant site could have used these CPT codes to bill for follow-up 
inpatient consultations as a telehealth service. However, subsequent 
inpatient hospital visits were not on the list of Medicare telehealth 
services.
    Comment: One commenter cited the concerns we raised in the proposed 
rule regarding the acuity level of a hospital inpatient and the use of 
a telecommunications system to furnish on going evaluation and 
management services in the inpatient hospital setting. The commenter 
believes that patients in the emergency department typically have a 
higher acuity level, are in a more precarious physical state (as 
compared to a hospital inpatient) and may not have a diagnosis. The 
commenter explains that hospitalized patients have already been seen 
and admitted by a physician on site and have at least a preliminary 
diagnosis. Despite the higher acuity level of a patient in the 
emergency department, the commenter asserts that we reimburse for 
telehealth care in the emergency department (but not for inpatients).
    Additionally, the commenter discussed various scenarios involving 
the examination of acute stroke patients via telehealth in the 
emergency room and ICU. For example, the commenter provided a summary 
of a study that tested whether the use of an audio and video multimedia 
telecommunications system is a feasible and reliable means for 
delivering emergency stroke care (using the National Institute of 
Health Stroke Scale). This study concluded that ``remote examination of 
acute stroke patients with a computer based telesupport system is 
feasible and reliable when applied in the emergency room''. The 
commenter also explained how telehealth is being used to provide 24 
hour access to acute stroke care expertise for a number of hospitals in 
Massachusetts and that similar programs are being established 
throughout the United States, Canada, the United Kingdom, Scandinavia, 
and other parts of the world. The commenter also provided a discussion 
of a study that examined the fiscal impact of providing telehealth 
consultation (for acutely ill and injured children in the ICU) on rural 
hospitals. The study found that as a result of greater access to 
pediatric consultations, savings are realized from a reduction in 
patient transfers (to larger hospitals) and increased revenue for rural 
hospitals.
    Response: We appreciate the information the commenter has submitted 
on the remote evaluation of stroke patients and pediatric telehealth 
consultations in the emergency department or ICU. We intend to consider 
this information as we evaluate whether to approve subsequent hospital 
care for telehealth when it is used for follow up inpatient 
consultation. We would also mention that the nature of the comment 
indicates a misconception that we pay for emergency department services 
as a telehealth service. We note that only outpatient consultations 
(not visits) are approved as a Medicare telehealth service for a 
patient in the emergency department. If guidance or advice is needed in 
the emergency department (for example, for acute stroke care), an 
outpatient consultation may be requested from an appropriate source and 
may be furnished as a telehealth service. However, emergency department 
services (as described by CPT codes 99281 through 99285) are not on the 
list of Medicare telehealth services.
    Comment: One commenter mentioned that we previously approved the 
psychiatric diagnostic interview examination and subsequent ESRD 
related visits furnished under the monthly capitation payment (MCP) for 
telehealth without comparative analyses and data showing patient 
satisfaction (which implies that subsequent hospital care could be 
approved for telehealth on the same basis). The commenter also cited 
the proposed regulatory impact analysis for telehealth stating that 
previous additions to the list of Medicare telehealth services have not 
resulted in a significant increase in Medicare program expenditures.
    Response: In approving the psychiatric diagnostic interview 
examination for telehealth, we considered this service to be comparable

[[Page 66251]]

to an initial office visit, or consultation service, which are 
currently Medicare telehealth services. Likewise, we considered the 
outpatient dialysis visits furnished under the MCP (except for one 
visit to examine the vascular access site) to be comparable to office 
and other outpatient visits currently on the list of Medicare 
telehealth services. Therefore, we considered these services to be 
category 1, and therefore, we were able to review and approve them for 
telehealth without reviewing additional research studies to support 
their approval. However, as discussed above in this section, because of 
the potential acuity of a hospital inpatient, we were not able to 
conclude that the entire scope of services described by the subsequent 
hospital care codes is similar to the existing list of telehealth 
services (for example, an office visit, office psychology service, or 
consultation). Therefore, we considered subsequent hospital care to be 
a category 2 service (which requires sufficient comparative analyses 
before approving for telehealth).
    For more information on the addition of the psychiatric diagnostic 
interview examination see the CY 2003 PFS proposed rule (67 FR 43863). 
For more information on the addition of ESRD-related visits furnished 
under the MCP, see the CY 2005 PFS proposed rule (69 FR 47511).

Neurobehavioral Status Exam

    Comment: Several commenters expressed support for our proposal to 
add the neurobehavioral status exam to the list of Medicare telehealth 
services. Commenters agreed that because the neurobehavioral status 
exam is primarily a clinical interview (similar to the psychiatric 
diagnostic interview which is currently a Medicare telehealth service), 
it is logical and consistent to approve this service for telehealth.
    Response: We agree with the commenters. As discussed in the 
proposed rule, the neurobehavioral status exam is furnished by a 
physician or psychologist and includes an initial assessment and 
evaluation of mental status for a psychiatric patient. In this regard, 
we believe the neurobehavioral status exam is similar to psychiatric 
diagnostic interview examination (which is currently approved as a 
Medicare telehealth service).
    Comment: One commenter who supported our proposal to approve the 
neurobehavioral status exam for telehealth, stated that HCPCS code 
96116 is a new code that replaced HCPCS code 96115 (the predecessor to 
HCPCS code 96116) in the 2006 CPT compendia. The commenter believes 
that neurobehavioral status exam (as described by HCPCS code 96115) was 
previously on the list of Medicare telehealth services and considers 
our proposal to add neurobehavioral status exam (as described by CPT 
code 96116) to be a restoration of the neurobehavioral status exam as a 
telehealth service.
    Response: The commenter's assertion that our proposal to add the 
neurobehavioral status exam to the list of Medicare telehealth services 
is a restoration of the neurobehavioral status exam as a telehealth 
service is not correct. The neurobehavioral status exam (as previously 
described by CPT code 96115) was not on the list of Medicare telehealth 
services. The proposed addition of neurobehavioral status exam is a new 
proposal.
    Comment: One commenter stated that the neurobehavioral status exam 
appears to require that the service be provided face to face (in 
person). Therefore, the commenter requested us to clarify that face to 
face services may qualify as telehealth services.
    Response: As discussed in the CY 2005 PFS final rule with comment 
period, only services that traditionally require a face-to-face (in-
person) physician or practitioner encounter are candidates for the list 
of Medicare telehealth services. Services not requiring a face-to-face 
encounter with the patient that may be furnished through the use of a 
telecommunications system are already covered under Medicare. For more 
information see the CY 2005 PFS final rule (69 FR 66278).

Neuropsychological Testing

    Comment: We received conflicting comments regarding 
neuropsychological testing. For example, one commenter agreed with the 
requestor that neuropsychological testing furnished via telehealth is 
not significantly different from being furnished in-person (especially 
when administered by a computer). Additionally, the commenter stated 
that existing telehealth services for psychiatric patients include 
office visits, consultation, and office psychiatry. The commenter 
believes that the patient-provider dynamics of these services would not 
appear to be so significantly different from those for 
neuropsychological testing as to justify not approving the services for 
telehealth. The commenter also believes that testing dynamics, such as 
the patient being blindfolded or having numbers assigned to his or her 
fingers, could be easily reproduced with the help of someone at the 
originating site.
    The same commenter also provided a discussion of the importance of 
early detection of dementia through neuropsychological testing. The 
commenter included a letter from the Armed Forces Epidemiological Board 
about brain injury in military service members with recommendations on 
handling these injuries. The commenter stated that although the 
Epidemiological Board addressed military patients, the principles of 
its findings apply to civilian assessment and treatment of brain 
injuries; that is, appropriate testing at earlier stages of brain 
injury or disease is likely to elicit a more accurate patient profile, 
leading to more targeted interventions and better patient outcomes.
    In addition, the commenter stated that the administration of 
neuropsycho- logical testing may be more difficult for some patients 
than others; however, this is true in both the in-person and telehealth 
setting. The commenter believes that if the patient requires immediate 
in-person assistance, a telepresenter could be used to facilitate the 
testing and that the determination of patient suitability for testing 
should be up to the physician or practitioner at the distant site. Two 
commenters agreed that a telepresenter could assist the physician or 
psychologist at the distant site with the testing and that the 
physician or psychologist should determine which patients (and tests) 
are appropriate for telehealth.
    Another commenter who provides neuropsychological testing via 
telehealth explained that many standardized neuropsychological tests 
are available (literally hundreds) to the physician or psychologist (or 
technician) and that tests vary widely in terms of administrative 
procedure and the level of interaction between the patient and 
practitioner responsible for administering the test. The commenter 
believes that many tests could be effectively administered via 
telehealth and that it is not appropriate for us to issue a ``global 
denial'' of neuropsychological testing. For example, the commenter 
believes that neuropsychological testing administered via a computer 
should be approved for telehealth and that testing administered by a 
physician, psychologist, or qualified technician should be re-
evaluated. The commenter also explained that an RN is often used as a 
telepresenter to assist the neuropsychologist or technician with 
testing. When testing cannot be administered in a ``standardized 
fashion'' via telehealth, a qualified technician could be present on-
site with the patient to assist a psychologist who

[[Page 66252]]

furnishes the test at the distant site. However, the commenter believes 
that some testing measures may not be appropriate for telehealth. The 
commenter estimated that ``fewer than 35 percent of the hundreds of 
available measures do not lend themselves to standardized 
administration via telehealth''. The commenter also cited the American 
Psychological Association's Ethical Principles of Psychologists and 
Code of Conduct and stated these guidelines would prohibit 
administration of certain individual tests via telehealth.
    Other commenters believe that further study is necessary. The 
commenters urged us to seek additional information concerning the 
provision of neuropsychological testing before making a determination 
about these services for telehealth. One commenter believes that 
neuropsychological testing should be considered for telehealth approval 
stating, ``however it is unclear whether the technology has advanced 
far enough to allow all neuropsychological testing to be provided via 
telehealth without compromising the quality of care''. Additionally, 
the commenter stated that more time is needed to assess how 
neuropsychological testing could be provided via telehealth and listed 
the following issues that need further consideration:
    <bullet> The variety of disorders and diagnoses appropriate via 
telehealth;
    <bullet> The physical assistance that patients may need to complete 
tests; and
    <bullet> The impact of face-to-face interactions with a 
psychologist or trained psychological technician during testing on the 
interpretation of test results.
    Response: We appreciate the comments regarding the use of an 
interactive audio and video telecommunications system in furnishing 
neuropsychological testing services. Based on the comments received, we 
believe that further study is necessary before making a determination 
about neuropsychological testing for telehealth. As discussed above in 
this section, we received conflicting comments as to whether the 
administration of a neuropsychological test could be furnished 
adequately when the practitioner who is responsible for administering 
the test is not physically present with the patient.
    For example, some commenters believe that neuropsychological 
testing furnished via telehealth is not significantly different than 
when furnished in-person and that a telepresenter could be used to 
assist the physician or psychologist at the distant site if necessary. 
Other commenters believed that further study is necessary before 
approving neuropsychological testing for telehealth. One commenter 
believed that it is unclear whether the use of a telecommunications 
system for administering neuropsychological testing would compromise 
quality of care and listed specific issues that need greater 
exploration. Even a commenter who supports approving neuropsychological 
testing for telehealth indicated that many neuropsychological testing 
measures would not be appropriate for telehealth. As such, we continue 
to have concerns about using an interactive audio and video 
telecommunications system as a substitute for the face-to-face (in-
person) requirements of neuropsychological testing.
    Comment: Two commenters believe that sufficient empirical evidence 
exists to support the approval of neuropsychological testing for 
telehealth. The commenters submitted summaries of two comparative 
analyses between neuropsychological testing furnished via an 
interactive audio and video telecommunications system and 
neuropsychological testing furnished in-person.
    Response: As discussed above in this section, we believe that 
further study is necessary before approving neuropsychological testing 
for telehealth. Although the commenters did submit comparative 
analyses, in one of the studies cited, the same psychologist furnished 
neuropsychological testing in both conditions (face-to-face and via 
telehealth). In another study cited, study participants without 
neuropsychological or psychiatric disturbance were tested. 
Additionally, the studies cited had extremely small samples. As such, 
we believe it would be difficult to generalize any findings to a 
broader population.
    Comment: One commenter questioned whether the regulatory impact 
analysis for telehealth was intended to provide a rationale to make 
reductions in Medicare payment for telehealth services in the future. 
The commenter urged us to continue to fund a wide variety of telehealth 
services.
    Response: The regulatory impact analysis was not intended to be 
used as a rationale for making reductions in Medicare payment for 
telehealth services. The intent of the regulatory impact analysis on 
telehealth was to illustrate that the proposed addition of 
neurobehavioral status exam to the list of Medicare telehealth services 
should not have a significant budgetary impact on the Medicare program. 
For more information on our regulatory impact analysis for the proposed 
addition of neurobehavioral status exam to the list of Medicare 
telehealth services, see the CY 2008 PFS proposed rule (72 FR 38216).
    Comment: One commenter stated that neuropsychological testing is 
ancillary to a neurobehavioral status exam and that neuropsychological 
testing would have little additional budgetary impact (beyond the 
impact of adding neurobehavioral status exam). To support this 
assertion, the commenter cited our proposed regulatory impact analysis 
on the addition of neurobehavioral status exam (as described by CPT 
code 96116).
    Response: As discussed above in this section, we believe that 
further study is necessary before approving neuropsychological testing 
for telehealth.
    Comment: A few commenters requested that we approve additional 
services for telehealth (for example, standardized performance testing 
as described by CPT code 96125).
    Response: Requests for additions (including any supporting data 
analyses) should be submitted through our process for adding services 
and must be received by December 31 of each calendar year to be 
considered for the next proposed rule. For more information on how to 
submit a request for addition, please visit our Web site at http://www.cms.hhs.gov/telehealth.

Results of Evaluation of Comments

    We are adding the neurobehavioral status exam as represented by 
HCPCS code 96116 to the list of Medicare telehealth services. 
Additionally, we are revising Sec.  410.78 and Sec.  414.65 to include 
neurobehavioral status exam as a Medicare telehealth service.
    As discussed above, only services that traditionally require a 
face-to-face (in person) physician or practitioner encounter are 
candidates for the list of Medicare telehealth services. Services not 
requiring a face-to-face encounter with the patient that may be 
furnished through the use of a telecommunications system are already 
covered under Medicare. As discussed in chapter 15, section 30 of the 
Medicare Benefit Policy Manual, payment may be made for physicians' 
services delivered via a telecommunications system for services that do 
not require a face-to-face patient encounter. The interpretation of an 
x-ray, electrocardiogram, electroencephalogram and tissue samples are 
listed as examples of these services.

[[Page 66253]]

    After further review of the requested services for addition, 
neuropsychological testing administered by a computer (as described by 
HCPCS code 96120) is not a candidate for the list of Medicare 
telehealth services. Neuropsychological testing administered by a 
computer (HCPCS code 96120) does not require a face-to-face (in person) 
encounter between the patient and the physician or psychologist (or 
qualified technician) responsible for the administration and 
interpretation of the test results (for example, the patient is 
interfacing with the computer, not a physician or psychologist). As 
such, a telecommunications system may be used to facilitate 
neuropsychological testing administered by a computer (as described by 
HCPCS code 96120); for example, Web-based computer neuropsychological 
testing, and/or transmission of neuropsychological test results to an 
interpreting physician or psychologist via telecommunications system.

E. Specific Coding Issues Related to the PFS

1. Reduction in the Technical Component (TC) for Imaging Services Under 
the PFS to the Outpatient Department (OPD)
    Effective January 1, 2007, section 5102(b)(1) of the Deficit 
Reduction Act of 2005 (Pub. L. 109-171) (DRA) amended section 1848 of 
the Act to require that, for imaging services, if-- ``(i) The technical 
component (including the technical component portion of a global fee) 
of the service established for a year under the fee schedule* * * 
without application of the geographic adjustment factor * * *, exceeds 
(ii) The Medicare OPD fee schedule amount established under the 
prospective payment system for hospital outpatient department services* 
* * for such service for such year, determined without regard to 
geographic adjustment * * *, the Secretary shall substitute the amount 
described in clause (ii), adjusted by the geographic adjustment factor 
[under the PFS], for the fee schedule amount for such technical 
component for such year.''
    As required by the statute, for imaging services (described in this 
section) furnished on or after January 1, 2007, we cap the TC of the 
PFS payment amount for the year (prior to geographic adjustment) by the 
Outpatient Prospective Payment System (OPPS) payment amount for the 
service (prior to geographic adjustment). We then apply the PFS 
geographic adjustment to the capped payment amount.
    Section 5102(b)(1) of the DRA defines imaging services as ``imaging 
and computer-assisted imaging services, including X-ray, ultrasound 
(including echocardiography), nuclear medicine (including PET), 
magnetic resonance imaging (MRI),computed tomography (CT), and 
fluoroscopy, but excluding diagnostic and screening mammography.''
    To apply section 5102(b) of the DRA, we needed to determine the CPT 
and alpha-numeric HCPCS codes that fall within the scope of ``imaging 
services'' defined by the DRA provision. In the CY 2008 PFS proposed 
rule, we explain in detail the process we used for establishing the 
list of codes that fall within the scope of this DRA provision. We also 
stated that upon further review, we have determined that certain 
ophthalmologic procedures meet the DRA definition of imaging 
procedures, but were not included in the original list of imaging 
services subject to the OPPS cap. Therefore, we proposed to add the 
following procedures to the list of procedures subject to the OPPS cap, 
effective January 1, 2008:
    <bullet> 92135, Scanning computerized ophthalmic diagnostic imaging 
(e.g., scanning laser) with interpretation and report.
    <bullet> 92235, Fluorscein angioscopy (includes multiframe imaging) 
with interpretation and report.
    <bullet> 92240, Indocyanine-green angiography (includes multiframe 
imaging) with interpretation and report.
    <bullet> 92250, Fundus photography with interpretation and report.
    <bullet> 92285, External ocular photography with interpretation and 
report for documentation of medical progress (e.g., close-up 
photography, slit lamp photography, goniophotography, stereo-
photography).
    <bullet> 92286, Special anterior segment photography with 
interpretation and report; with specular endothelial microscopy and 
cell count.
    A complete list of CPT codes that identify imaging services as 
defined by the DRA OPPS cap provision, amended to include these 
ophthalmologic procedures, was also published in Addendum F of the CY 
2008 PFS proposed rule (72 FR 38369 through 38372). Payment for an 
individual service on this list will only be capped if the PFS TC 
payment amount exceeds the OPPS payment amount.
    Comment: Several commenters indicated that none of the six 
ophthalmologic CPT codes proposed for addition to the list of 
procedures subject to the OPPS cap meet the statutory definition of 
imaging under the DRA, that is, none of the procedures codes fall under 
the categories of x-rays, ultrasound, MRI, PET, CT or fluoroscopy. 
Specifically, they noted that CPT code 92250 utilizes a wide angle 
camera used primarily for detecting retinopathy in diabetics. Likewise, 
CPT codes 92235, 92240, and 92285 are all photos, using photographic 
equipment, or an angioscope. The commenters concluded that the Congress 
did not intend for any service that uses a camera or microscope, takes 
photographs, and produces negatives to be included in the DRA 
definition of imaging services.
    Another commenter indicated that CPT codes 92250 and 92285 do not 
meet our criterion for including a procedure under the DRA provision, 
that is, services that provide visual information regarding areas of 
the body that are not normally visible, thereby assisting in the 
diagnosis or treatment of injury. The commenter noted that the subject 
procedures take traditional pictures of parts of the eye that are 
normally visualized with the naked eye. One commenter noted that the 
six CPT codes have not experienced dramatic increases in utilization, 
but rather, utilization has remained stable or decreased.
    Response: The DRA provision describes imaging services broadly as 
``imaging and computer-assisted imaging services,'' and does not 
provide for the type of distinctions the commenters suggested. While it 
specifically includes certain imaging modalities (x-ray, ultrasound, 
MRI, PET, CT, and fluoroscopy), it does not exclude other imaging 
modalities. In fact, the DRA provision excludes only one imaging 
service, that is, diagnostic and screening mammography. Concerning CPT 
codes 92250 and 92285, we believe the images generated by these 
services may include information that requires the use of photographic 
or imaging equipment and is not normally visible by the unaided human 
eye. Finally, the description of imaging services to which the DRA 
provision applies is not limited to procedures that have experienced 
dramatic increases in utilization. We believe the six procedures meet 
the DRA definition of imagining services and are similar to other 
procedures already subject to the DRA provision. Therefore, we will 
include these CPT codes on the list of procedures subject to the OPPS 
cap. (Note: This list of procedures is published in Addendum F of this 
final rule with comment period.)
    Comment: Many comments requested clarification of the application 
of the OPPS cap when there is no OPPS payment for comparison; where the 
code is bundled under OPPS; or where

[[Page 66254]]

the OPPS payment includes items (for example, contrast agents or 
radiopharmaceuticals) that are paid separately under the PFS.
    Response: Where there is no OPPS payment for a procedure or where 
the OPPS for a procedure is bundled, there is no OPPS amount for the 
comparison with the PFS payment. Therefore, it is infeasible to apply 
an OPPS cap. The codes will remain on the list of codes subject to the 
OPPS cap, but will not be affected by the cap. Where the OPPS payment 
includes packaged services or items that are paid separately under the 
PFS, we can and do apply an OPPS cap. The physician can continue to 
bill separately for such services or items when furnished in a place of 
service, for example, a physician's office, where the item is paid 
separately.
2. Application of Multiple Procedure Reduction for Mohs Micrographic 
Surgery (CPT Codes 17311 Through 17315)
    Under the multiple procedure payment reduction policy, 
reimbursement for subsequent surgical procedures performed during the 
same operative session by the same physician is reduced by 50 percent. 
The Mohs surgery codes have been exempt from the multiple procedure 
payment reduction rules since the inception of the PFS (56 FR 59602, 
November 25, 1991).
    The CPT Editorial Panel reviewed all of the codes on the list of 
codes exempt from the multiple procedure payment reduction (the ``-51 
modifier exempt list'') to identify which codes should be exempt from 
the multiple procedure payment reduction rules. Based on the revisions 
to the code descriptors and a clearer understanding regarding the 
technical elements of the procedure, in CY 2007, the CPT Editorial 
Panel removed the Mohs procedure from the -51 modifier exempt list. The 
codes for Mohs surgery were revised to take into account the different 
level of physician work intensity involved based on anatomic site. The 
RVUs associated with the codes for each anatomic location were 
recommended by the RUC, as they are for other procedures, after a 
thorough discussion by the RUC of all aspects of the service. Work RVUs 
were developed for each Mohs surgery base code based on an assumption 
that each code is performed separately. Because the work RVUs for these 
services do not take into account the efficiencies that occur when 
multiple procedures are performed in one session, we do not believe 
that these codes should continue to be exempt from the multiple 
procedure payment reduction. Therefore, we proposed to eliminate the 
modifier 51 exemption and apply the multiple procedure payment 
reduction rules to these codes.
    Comment: We received comments supporting our proposal and 
expressing the belief that our proposal is fair and consistent with our 
multiple procedure payment policies already affecting a wide range of 
procedures with codes in the Surgery/Integumentary System of CPT. Many 
commenters opposed our proposal to eliminate the modifier -51 exemption 
and apply the multiple procedure payment reduction to these codes. 
These commenters believed that eliminating these codes from the 
modifier -51 exempt list would negatively impact Medicare 
beneficiaries'' access to timely and quality care, and could lead to 
increases in pathology charges and increase the amount spent on 
multiple facility fees, thereby raising the overall cost of treating an 
individual with skin cancer. In addition to these concerns, many of the 
commenters do not believe we have sufficient justification to make the 
change, and suggest that this is an arbitrary decision. Further, the 
commenters asserted that the AMA-RUC and CPT decisions were in error 
and should not be followed.
    Response: We verified with the CPT Editorial Panel that the 
application of the modifier -51 exempt status indicator, and 
subsequently, the inclusion of this series of codes (CPT codes 17311 
through 17315) in Appendix E, Summary of CPT Codes Exempt from Modifier 
-51, of the 2008 CPT codebook would not be carried forward with the new 
series of codes created in 2007. The CPT panel confirmed with us that 
the exclusion of these codes from Appendix E was not an error. The AMA 
RUC reviewed and valued the new and existing codes for Mohs surgery. 
Upon completion of a thorough review and discussion of the Mohs codes, 
the RUC valued these codes with the full understanding these codes were 
removed from the modifier -51 exempt list and would be subject to the 
multiple procedure payment reduction as well.
    We believe the CPT Editorial Panel and the Mohs workgroup on the 
CPT Editorial Panel gave considerable time, effort and discussion in 
the creation of the new and existing codes for Mohs surgery. We also 
believe the AMA-RUC carefully reviewed the rationale and deliberations 
which lead to the creation of new Mohs surgery codes. In addition, we 
believe the specialty society had ample time and opportunity to express 
its point of view to both the CPT Panel and the AMA-RUC. As a result of 
the revisions to these codes and their respective valuation, we do not 
believe they should continue to be treated differently from other codes 
in the Surgery/Integumentary System section of the CPT book and see no 
reason not to accept the recommendations provided by the CPT Panel and 
AMA-RUC. Therefore, we are finalizing our proposal to eliminate the 
modifier -51 exemption and apply the multiple surgery procedure payment 
reduction rules to these codes.
3. Payment for Intravenous Immune Globulin (IVIG) Add-On Code for 
Preadmission Related Services
    Intravenous immune globulin (IVIG) is a unique product derived from 
blood plasma. This drug is paid for under the ASP methodology and the 
administration of this drug is reported using the first hour and second 
hour infusion codes for therapeutic, prophylactic and diagnostic 
services under CPT.
    We recognize the importance of IVIG to patients who require it and 
are concerned about reports of problems with IVIG access and 
availability. We have initiated several actions in response to concerns 
about the supply of IVIG.
    In July 2007, we implemented new codes for reporting IVIG for 
liquid non-lyophilized IVIG.
    In CY 2006 and 2007, we established payment, through the creation 
of a special G-code, G0332, for preadministration services furnished in 
connection with the procurement of IVIG in the physician's office. This 
code is designed to compensate physicians for the extra resources 
required to be expended due to market conditions to locate and obtain 
the appropriate IVIG products and to schedule patient infusions.
    Comment: We received several comments regarding our proposal to 
continue in CY 2008 the preadministration payment under the PFS for 
patients treated with IVIG in a physician's office.
    The majority commenters supported our proposal and recommended that 
it be finalized, and recommended that this policy be made permanent. 
Commenters stated that if this code and payment are not made permanent, 
we would need to present a convincing evidence to terminate this 
payment. Commenters indicated that without continuation of the add on 
payment, access problems for Medicare beneficiaries in need of IVIG 
would be more severe.
    Many commenters indicated problems with the ASP payment methodology 
for IVIG stating that IVIG is a unique

[[Page 66255]]

product for which market conditions are unlike all other drugs paid 
under ASP. Other commenters remarked that the addition of the four new 
billing codes for liquid IVIG adopted in July 2007 should improve 
market conditions and beneficiary access to IVIG. Some commenters asked 
that we consider making the liquid IVIG codes permanent J-codes. A few 
commenters asked that CMS consider establishing an add on payment for 
IVIG similar to the add on payment for clotting factor.
    Two commenters indicated that Addendum B did not include the G-code 
for preadministration services and recommended that the code be 
included in Addendum B for the final rule.
    Response: Comments regarding the ASP pricing methodology for IVIG, 
the adoption of new drug codes for liquid IVIG in CY 2007, and the 
consideration of an add-on payment for IVIG similar to the add-on 
payment for blood clotting factor are beyond the scope of our proposal 
which focuses on payment for a service under the PFS. We will consider 
these comments in context of any proposed policies for drug payments 
made as part of the CY 2009 PFS proposed rule.
    In terms of the preadministration service for IVIG, we will 
continue the CY 2007 payment policy for code G0332 through CY 2008. We 
will carefully consider all relevant information including the 
conditions of the IVIG drug market during CY 2008 when we address 
whether it would be appropriate to continue the payment policy as part 
of the CY 2009 PFS.
    We appreciate the commenters alerting us that G0332 was omitted 
from Addendum B in the proposed rule and we will ensure that this code 
is listed in Addendum B of this final rule with comment period.
    Therefore, we are finalizing the proposal to continue to recognize 
payment for preadministration services for IVIG furnished to patients 
in a physician's office in CY 2008. Payment for this service will be 
made based on the PE RVUs previously established for this service in CY 
2007. Payment for preadminstration services for IVIG furnished to 
hospital outpatients is paid under the outpatient PPS (OPPS) and is 
addressed as part of that final rule.
4. Reporting of Cardiac Rehabilitation Services
    For CY 2008, we proposed to assign a status indicator of ``I'' 
(invalid for Medicare purposes, Medicare recognizes another code for 
the billing of this service) to the current CPT codes for cardiac 
rehabilitation services, CPT codes 93797, Physician services for 
outpatient cardiac rehabilitation; without continuous ECG monitoring 
(per session), and 93798, Physician services for outpatient cardiac 
rehabilitation; with continuous ECG monitoring (per session) and 
proposed to establish two new Level II HCPCS codes that we believe are 
more appropriate for specifically reporting cardiac rehabilitation 
services under the PFS. The proposed HCPCS codes are: GXXX1, Physician 
services for outpatient cardiac rehabilitation; without continuous ECG 
monitoring (per hour), and GXXX2, Physician services for outpatient 
cardiac rehabilitation; with continuous ECG monitoring (per hour). We 
also proposed to crosswalk the current RVUs associated with CPT codes 
93797 and 93798 to HCPCS Codes Gxxx1 and Gxxx1.
    Comment: Many commenters, including physicians and providers of 
cardiac rehabilitation services, were generally supportive of the 
proposal for the specific G-codes. Commenters believed that this 
proposed coding change would allow for more appropriate coding and 
payment for cardiac rehabilitation services in those cases where 
intensive programs provide multiple sessions each day. In addition, 
commenters requested that we explicitly state that multiple sessions of 
cardiac rehabilitation can be paid for the same date of service when 
modifier 59 is reported. They also requested that we crosswalk the 
payments for both of the proposed G-codes to the higher cost CPT code 
93798 to ensure that the full range of modalities provided in certain 
intensive cardiac rehabilitation programs are available.
    Several of these commenters also requested that we provide 
additional guidance related to reporting of the cardiac rehabilitation 
G-codes, such as: (1) Explaining that it is likely to be reasonable and 
necessary to cover 72 cardiac rehab sessions when multiple sessions are 
provided in one day; (2) encouraging contractors to factor the ``proven 
results'' of a program into coverage decisions and that 72 sessions 
should be ``presumptively covered'' when they are furnished by a 
certain intensive cardiac rehabilitation program; and (3) providing 
further clarification and expansion of nutritional counseling by 
registered dieticians, indicating that they could independently bill 
for nutritional counseling within cardiac rehabilitation programs using 
the medical nutrition therapy codes because the NCD does not 
specifically mention these services.
    Alternatively, a few commenters, including physician specialty 
groups, questioned the need for the proposed G-codes, indicating that 
no new data would be gained by a coding shift that changes a unit from 
a session to an hour. Commenters also suggested that we work with the 
AMA to address the issue of whether it would be appropriate to modify 
the CPT definition for this code from a per session to per hour basis.
    Many commenters also expressed concern that the use of the term 
``physician services'' and ``MD services'' in the G-code descriptors 
could be misinterpreted by Medicare contractors as requiring a 
physician to directly deliver the care or be in attendance during each 
service episode and requested that the code descriptor be revised.
    Response: We are aware of several intensive cardiac rehabilitation 
programs that provide multiple sessions in a day, lasting several hours 
total. The NCD for cardiac rehabilitation currently states that cardiac 
rehabilitation programs are covered for certain categories of patients 
and that the programs must be comprehensive. To be comprehensive the 
programs must include a medical evaluation, a program to modify cardiac 
risk factors (for example, nutritional counseling), prescribed 
exercise, education, and counseling. The NCD does not distinguish 
between different approaches to the delivery of cardiac rehabilitation 
services, whether the more common practice of two sessions per week or 
the more intensive programs of several sessions per day. In order to 
allow for flexibility and tailoring of cardiac rehabilitation programs 
based on patient needs, we have not been prescriptive regarding the 
precise amount of time that must be spent on each component of the 
program. Regarding intensity, we expect the intensity of cardiac 
rehabilitation programs to vary by patient and by program.
    We believe it is important that our payment policy provides 
appropriate payment for cardiac rehabilitation services. In order to 
minimize the administrative burden to physicians and providers, but 
permit accurate reporting and payment for cardiac rehabilitation 
programs that provide more than one session per day, we believe that 
continuing the use of CPT codes 93797 and 93798 and allowing physicians 
and providers to bill more than one session per day under some 
circumstances would be the most appropriate course. Therefore, based 
upon the comments received and upon further review of this issue, for 
CY 2008, we will allow physicians and providers to report more than one 
unit for a date of service if

[[Page 66256]]

more than one cardiac rehabilitation session lasting at least 1 hour 
each is provided on the same day.
    With respect to commenters' concerns about the use of the term 
``physician services'' in the proposed G-code descriptors, we note that 
the descriptors for these codes were proposed to be parallel to the 
descriptors of the CPT codes for cardiac rehabilitation sessions which 
contain the term ``physician services'' in their descriptors. We are 
not aware that physicians and providers have problems with Medicare 
contractors'' interpretation of the CPT code descriptors.
    After consideration of all public comments received, we are not 
finalizing our proposal to establish two new G-codes for reporting 
cardiac rehabilitation services. Instead, we will continue to use the 
CPT codes 93797 and 93798 to report cardiac rehabilitation services 
under the CY 2008 PFS.
    We will provide further guidance on coding and payment instructions 
for the cardiac rehabilitation services codes through program 
instructions.
    We will not provide the additional coverage-related guidance 
requested by some commenters, such as the presumptive coverage and 
independent billing for registered dieticians. These recommendations 
effectively request changes to the NCD, and therefore, are outside of 
the scope of this final rule with comment period.

F. Part B Drug Payment

1. Average Sales Price (ASP) Issues
    Medicare Part B covers a limited number of prescription drugs and 
biologicals. For the purposes of this proposed rule, the term ``drugs'' 
will hereafter refer to both drugs and biologicals, unless otherwise 
specified. Medicare Part B covered drugs not paid on a cost or 
prospective payment basis generally fall into the following three 
categories:
    <bullet> Drugs furnished incident to a physician's service.
    <bullet> DME drugs.
    <bullet> Drugs specifically covered by statute (certain 
immunosuppressive drugs, for example).
    Beginning in CY 2005, the vast majority of Medicare Part B drugs 
not paid on a cost or prospective payment basis are paid under the ASP 
methodology. The ASP methodology is based on data submitted to us 
quarterly by manufacturers. In addition to the payment for the drug, 
Medicare currently pays a furnishing fee for blood clotting factors, a 
dispensing fee for inhalation drugs, and a supplying fee to pharmacies 
for certain Part B drugs.
    In January 2006, the drug coverage available to Medicare 
beneficiaries expanded with the implementation of Medicare Part D. The 
Medicare Part D program does not change Medicare Part B drug coverage.
    In this section, we discuss changes and issues related to the 
determination of the payment amounts for covered Part B drugs and 
furnishing blood clotting factor. This section also discusses changes 
to how manufacturers calculate and report ASP data to us.
a. ASP Payment
    Section 303(c) of the Medicare Prescription Drug, Improvement, and 
Modernization Act of 2003 (Pub. L. 108-173) (MMA) amended Title XVIII 
of the Act by adding section 1847A. This section revised the payment 
methodology for the vast majority of drugs and biologicals not paid on 
a cost or prospective payment basis furnished on or after January 1, 
2005. The ASP reporting requirements are set forth in section 1927(b) 
of the Act. Manufacturers must submit ASP data by 11-digit National 
Drug Code (NDC) to us quarterly. The manufacturers' submissions are due 
to us not later than 30 days after the last day of each calendar 
quarter. The methodology for developing Medicare drug payment 
allowances based on the manufacturers' submitted ASP data is specified 
in 42 CFR, part 414, subpart K. We update the Part B drug payment 
amounts quarterly based on the data we receive. In this section of the 
preamble, we discuss certain aspects of the calculation of 
manufacturers' ASP data, issues related to bundled price concessions, 
and other Part B drug payment issues.
    Further information on manufacturers' submission of ASP data for 
Medicare Part B drugs and biologicals is contained in prior rulemaking 
documents and other guidance accessible on the CMS Web page at (http://www.cms.hhs.gov/McrPartBDrugAvgSalesPrice/). Specifically refer to the 
April 6, 2004 ASP interim final rule with comment period (IFC) (69 FR 
17935) and the CY 2007 PFS final rule with comment period (71 FR 
69624), which finalized the ASP calculation and reporting requirements 
of the April 6, 2004 IFC, and the Frequently Asked Questions available 
on the CMS Web page.
b. Bundled Price Concessions
    In the CY 2007 PFS proposed rule and final rule with comment 
period, we solicited and responded to comments regarding the issue of 
how to allocate price concessions across drugs that are sold under 
bundling arrangements for purposes of calculating the ASP. We did not 
establish a specific methodology that manufacturers must use for the 
treatment of bundled price concessions for purposes of the ASP 
calculation in the CY 2007 PFS final rule with comment period. In the 
absence of specific guidance, we maintained existing guidance that 
manufacturers may make reasonable assumptions in their calculation of 
ASP, consistent with the general requirements and the intent of the 
Act, Federal regulations, and their customary business practices. We 
also indicated that we would be closely monitoring this issue and may 
provide more specific guidance in the future if we determine it is 
warranted.
    As stated in the CY 2008 PFS proposed rule (72 FR 38150), in its 
January 2007 Report to Congress, ``Impact of Changes in Medicare 
Payments for Part B Drugs,'' the MedPAC discussed the issue of 
allocation of bundled price concessions for purposes of calculating the 
ASP, noting that ``some manufacturers offer provider discounts for one 
of their products contingent on purchases of one or more other 
products.'' This report discusses two approaches for allocating bundled 
price concessions.
    According to MedPAC, one option would be to require manufacturers 
to allocate bundled discounts in proportion to the sales of each drug 
sold under the bundled arrangement. For example, Drug A and Drug B are 
sold under a bundled arrangement and have a combined bundled discount 
equal to $200,000 on total sales of $1 million. If Drug A has sales of 
$600,000, the manufacturer would allocate 60 percent of the bundled 
discount to that drug when calculating ASP. Forty percent of the 
bundled discount would be allocated to Drug B. MedPAC states that this 
approach would parallel bundling requirements under Medicaid and would 
be simpler to administer. However, MedPAC notes that this method might 
not capture contingent discounts.
    The other approach discussed by MedPAC would be to require 
manufacturers to allocate bundled discounts to reflect the 
contingencies in the contract. That is, manufacturers would allocate 
any additional (or increased) discount to the sales of the drug (or 
drugs) that the discount is meant to increase. This approach would 
result in an ASP that more accurately reflects the transaction price of 
drugs when a discount for one drug or drugs is contingent in whole or 
in part on the purchase of another drug. For example, if a greater 
discount on the purchase price of Drug A is contingent on the

[[Page 66257]]

purchase (or purchases) of Drug B, this additional discount would be 
allocated to sales of Drug B in the calculation of ASP.
    In its discussion of bundling, MedPAC states that the goal should 
be to ensure that ASP reflects the average transaction price for drugs. 
To that end, MedPAC recommends that the Secretary clarify the ASP 
reporting requirements for bundled products to ensure that ASP 
calculations allocate discounts to reflect the transaction price for 
each drug. Further, MedPAC states that we should ensure that the 
reporting requirements for allocating discounts are clear and that they 
can be implemented by manufacturers in a timely fashion.
    In the CY 2008 PFS proposed rule (71 FR 77176), we also discussed 
the Medicaid Program: Prescription Drugs proposed rule published in the 
December 22, 2006 Federal Register (hereinafter referred to as the 
December 22, 2006 proposed rule) concerning the calculation of 
manufacturers' average manufacturer price (AMP). In the December 22, 
2006 proposed rule, we proposed that discounts associated with a 
bundled sale would be allocated proportionately according to the dollar 
value of the units of each drug sold under the bundled arrangement. For 
bundled sales where multiple drugs are discounted, the aggregate value 
of all the discounts would be proportionately allocated across all of 
the drugs in the bundle. For AMP purposes, a bundled sale would mean an 
arrangement regardless of physical packaging under which the rebate, 
discount, or other price concession is conditioned upon the purchase of 
the same drug or drugs of different types (that is, at the nine-digit 
NDC level) or some other performance requirement (for example, the 
achievement of market share, inclusion or tier placement on a 
formulary), or where the resulting discounts or other price concessions 
are greater than those which would have been available had the bundled 
drugs been purchased separately or outside of the bundled arrangement. 
In the December 22, 2006 proposed rule, we further proposed that the 
AMP should be adjusted for bundled sales by determining the total value 
of all the discounts on all drugs in the bundle and allocating those 
discounts proportionately to the respective AMP calculations. The 
aggregate discount is allocated proportionately to the dollar value of 
the units of each drug sold under the bundled arrangement. Where 
discounts are offered on multiple products in a bundle, the aggregated 
value of all of the discounts should be proportionately allocated 
across all of the drugs in the bundle. We received many comments on the 
many aspects of the December 22, 2006 proposed rule. However, the 
review of those comments and development of the final AMP calculation 
policies and rule were not complete at the time the CY 2008 PFS 
proposed rule was developed.
    In light of MedPAC's recommendation that we clarify the ASP 
reporting requirements for bundled products and our discussion of 
bundled price concessions in the CY 2007 PFS rulemaking, we stated in 
the CY 2008 PFS proposed rule that we believe specific guidance in the 
ASP context is warranted to provide for greater consistency in ASP 
reporting across manufacturers and to enhance the accuracy of the ASP 
payment system. We stated that we found MedPAC's suggestion not to 
defer further guidance in this area compelling with respect to the 
potential that manufacturers may make differing assumptions in the 
absence of specific guidance on how to allocate bundled price 
concessions in the context of ASP. In addition, we stated that we 
believe it is appropriate at this time to establish a specified method 
for treating bundled price concessions in the calculation of ASP that 
is consistent with the treatment of such discounts for purposes of the 
AMP calculation, and that appropriate consistencies across the 
calculations of ASP and AMP will result in a lower potential for error 
and more accurate calculations of both prices.
    As we noted in the CY 2008 PFS proposed rule, although ASP and AMP 
serve similar, but not identical, purposes, differences between these 
calculations provide a rationale for, and in some instances may 
require, minor differences between the final policies adopted in 
Medicaid and Medicare regulations. We believe any differences would be 
necessary to clarify certain aspects of a consistent approach for 
treatment of bundling, and would not result in significant policy 
differences on how bundling is addressed in the context of AMP and in 
the context of ASP.
    Therefore, for purposes of calculating the ASP (beginning with the 
reporting period for the first calendar quarter of 2008 and 
thereafter), we proposed that the manufacturer must allocate the total 
value of all price concessions proportionately according to the dollar 
value of the units of each drug sold under a bundled arrangement to 
ensure that the ASP is adjusted for bundled arrangements as defined at 
proposed Sec.  414.802. For a bundled arrangement, where multiple drugs 
are discounted, the aggregate value of all the discounts would be 
proportionately allocated across all of the drugs sold under the 
bundled arrangement. We proposed that a bundled arrangement, for ASP 
purposes, would mean an arrangement, regardless of physical packaging 
under which the rebate, discount, or other price concession is 
conditioned upon the purchase of the same drug or biological or other 
drugs or biologicals or some other performance requirement (for 
example, the achievement of market share, inclusion or tier placement 
on a formulary, purchasing patterns, prior purchases), or where the 
resulting discounts or other price concessions are greater than those 
that would have been available had the drugs or biologicals sold under 
the bundled arrangement been purchased separately or outside of the 
bundled arrangement. We proposed to specify at proposed Sec.  
414.804(a)(2)(iii) that all price concessions on drugs sold under a 
bundled arrangement must be allocated proportionately to the dollar 
value of the units of each drug sold under the bundled arrangement.
    In the CY 2008 PFS proposed rule, we also stated our intention to 
remain consistent, as appropriate, with the final policy adopted in the 
Medicaid Program: Prescription Drugs final rule with comment period 
published in the July 17, 2007 Federal Register (72 FR 39142) 
(hereinafter referred to as the July 17, 2007 final rule with comment 
period), which was still under development at that time. We stated that 
the Medicaid policies on bundled sales may ultimately differ from our 
discussion of the topic in the CY 2008 PFS proposed rule as a result of 
the final policy adopted in the July 17, 2007 final rule with comment 
period and that our policies for ASP in this final rule with comment 
period may reflect the final Medicaid policy on bundled sales, but only 
to the extent that it is appropriate for ASP and the public has had the 
opportunity to comment on how the final Medicaid policy for bundled 
sales, if appropriately adopted for ASP purposes, would effect the 
calculation of ASP. The final Medicaid policy on bundled sales adopted 
in the July 17, 2007 final rule with comment period was consistent with 
the discussion of this issue in the December 22, 2006 proposed rule 
with certain clarifications.
    Comment: We received many comments on this issue. Most of these 
commenters noted that our proposal for the treatment of bundled price 
concessions in the ASP context was similar to the language finalized in 
the July 17, 2007 final rule with comment period. In general, most of 
the

[[Page 66258]]

commenters supported an appropriately consistent approach for the 
treatment of bundled price concessions within both the AMP and ASP 
calculations. However, several commenters indicated that they were 
still reviewing the July 17, 2007 final rule with comment period and 
believe additional time may be needed to better understand how the 
proposed Medicare bundled arrangement definition is to be applied. 
Several commenters had questions about how the proposed bundling 
policies may apply to certain contracting arrangements, and because of 
these questions, recommended that we cease or delay implementation of 
our proposed method for treatment of bundled price concessions for 
purposes of ASP.
    Response: Based on comments recommending a delay and to better 
understand the concerns stated by the commenters, we are not finalizing 
the regulatory language changes we proposed in the CY 2008 PFS proposed 
rule at this time. Although we are not establishing a specific 
methodology that manufacturers must use for the treatment of bundled 
price concessions for purposes of calculating ASP at this time, we are 
clarifying that, in the absence of specific guidance, manufacturers may 
make reasonable assumptions in their calculation of ASP, consistent 
with the general requirements and the intent of the Act, Federal 
regulations, and their customary business practices. In making 
reasonable assumptions for purposes of calculating ASP, one method 
manufacturers could use is to reallocate price concessions that are 
conditioned upon other purchases or a performance requirement (for 
example, the achievement of market share, inclusion or tier placement 
on a formulary) so that the total value of all such price concessions 
are allocated proportionately according to the dollar value of the 
units of each drug sold. However, manufacturers may have other methods 
they could use to report bundled price concessions, so long as 
manufacturers apply reasonable assumptions consistent with the general 
requirements and the intent of the Act, Federal regulations, and their 
customary business practices. Manufacturers' reasonable assumptions 
consistent with our requirements, guidance and manufacturer's customary 
business practices remain an important aspect of ASP reporting. These 
assumptions should be submitted along with the ASP data and the signed 
certification form.
    Recognizing that the treatment of bundled price concessions in the 
ASP calculation has implications for the integrity of the ASP payment 
methodology, we will continue to monitor this issue, will consider the 
comments on this issue, and may provide more specific guidance in the 
future through rulemaking or through program instruction or other 
guidance (consistent with our authority under section 1847A(c)(5)(C) of 
the Act) if we determine it is warranted. As we continue to review 
these issues, we want to be sure we are aware of concerns from all 
stakeholders, and thus we encourage the public to provide additional 
information or concerns to us on this issue as they may arise.
c. Clotting Factor Furnishing Fee
    Section 303(e)(1) of the MMA added section 1842(o)(5) of the Act 
which requires the Secretary, beginning in CY 2005, to pay a furnishing 
fee in an amount the Secretary determines to be appropriate to 
hemophilia treatment centers and homecare companies for the items and 
services associated with the furnishing of blood clotting factor. 
Section 1842(o)(5)(C) of the Act specifies that the furnishing fee for 
clotting factor for CY 2006 and subsequent years will be equal to the 
fee for the previous year increased by the percentage increase in the 
consumer price index (CPI) for medical care for the 12 month period 
ending with June of the previous year.
    The furnishing fee for CY 2007 is $0.152 per unit clotting factor. 
The percent increase in the CPI for medical care for the 12-month 
period ending in June 2007 is 4.0 percent. Consequently, the furnishing 
fee will be $0.158 per unit of clotting factor for CY 2008. While the 
furnishing fee payment rate is calculated at 3 digits, the actual 
amount paid to providers and suppliers is rounded to 2 digits.
    In the CY 2008 PFS proposed rule, we proposed to announce the 
annual update of the blood clotting factor furnishing fee, as specified 
in section 1842(o)(5)(C) of the Act, by issuing program instructions 
and postings on the CMS Web site in lieu of including a discussion of 
this issue in PFS rulemaking for CY 2009, and thereafter, until such 
time as the update methodology may be modified. We made our proposal 
because the update is statutorily determined, is based on an index not 
affected by administrative discretion or public comment, is based on 
the percentage increase in the CPI for medical care for the 12-month 
period ending with June of the previous year, and is not released by 
the Bureau of Labor Statistics until after our proposed rule is 
published.
    As stated in the CY 2008 proposed rule, we believe that including a 
discussion of the furnishing fee update in annual rulemaking does not 
provide an advantage over other means of announcing this information, 
so long as the current statutory update methodology continues in 
effect. We believe that the public's need for information and adequate 
notice regarding the updated furnishing fee can be better met by 
issuing program instructions which will eliminate the discussion of the 
furnishing fee update annually in rulemaking. In addition, by 
communicating the updated furnishing fee in program instruction, the 
actual figure for the percent change in the applicable CPI and the 
updated furnishing fee calculated based on that figure can be announced 
more timely than when included as part of the PFS final rulemaking 
process.
    Comment: We received comments in support of our proposal to 
announce the update furnishing fee via program instructions beginning 
in CY 2009, and to continue updating the furnishing fee according to 
the consumer price index for medical care. Comments supported the 
continued use of our proposed approach until such time as the 
methodology is changed.
    Response: After consideration of the public comments, beginning for 
CY 2009, we will announce the updated blood clotting factor furnishing 
fee via program instructions and via a Web posting. In addition, we may 
include the updated blood clotting factor furnishing fee in the annual 
PFS final rules to promote broader dissemination of the announcement.
d. Widely Available Market Prices (WAMP) and AMP Threshold
    Section 1847A(d)(1) of the Act states that ``the Inspector General 
of HHS shall conduct studies, which may include surveys to determine 
the widely available market prices (WAMP) of drugs and biologicals to 
which this section applies, as the Inspector General, in consultation 
with the Secretary, determines to be appropriate.'' Section 1847A(d)(2) 
of the Act states that, ``Based upon such studies and other data for 
drugs and biologicals, the Inspector General shall compare the ASP 
under this section for drugs and biologicals with--
    <bullet> The widely available market price (WAMP) for these drugs 
and biologicals (if any); and
    <bullet> The AMP (as determined under section 1927(k)(1) of the Act 
for such drugs and biologicals.''
    Section 1847A(d)(3)(A) of the Act states that, ``The Secretary may 
disregard the ASP for a drug or biological that exceeds the WAMP or

[[Page 66259]]

the AMP for such drug or biological by the applicable threshold 
percentage (as defined in subparagraph (B)).'' The applicable threshold 
is specified in the statute as 5 percent for CY 2005. For CY 2006 and 
subsequent years, section 1847A(d)(3)(B) of the Act establishes that 
the applicable threshold is ``the percentage applied under this 
subparagraph subject to such adjustment as the Secretary may specify 
for the WAMP or the AMP, or both.'' In CY 2006 and CY 2007, we 
specified an applicable threshold percentage of 5 percent for both the 
WAMP and AMP. We based this decision on the limited data available to 
support a change in the current threshold percentage.
    For CY 2008, we proposed to specify an applicable threshold 
percentage of 5 percent for the WAMP and the AMP. At present, the OIG 
is continuing its comparison of both the WAMP and the AMP. Furthermore, 
information on how recent changes to the calculation of the AMP may 
affect the comparison of AMP to ASP is not available at this time. 
Since we do not have data that suggest another level is more 
appropriate at this time, we believe that continuing the 5 percent 
applicable threshold percentage for both the WAMP and AMP is 
appropriate for CY 2008.
    As we noted in the CY 2007 PFS final rule with comment period (71 
FR 69680), we understand that there are complicated operational issues 
associated with potential payment substitutions and will continue to 
proceed cautiously in this area and provide stakeholders, particularly 
manufacturers of drugs impacted by potential price substitutions, with 
adequate notice of our intentions regarding such, including the 
opportunity to provide input with regard to the processes for 
substituting the WAMP or the AMP for the ASP. As part of our approach, 
we intend to develop a better understanding of the issues that may be 
related to certain drugs for which the WAMP and AMP may be lower than 
the ASP over time.
    Comment: We received several comments regarding our proposal to 
maintain the threshold at 5 percent. Most commenters supported 
maintaining this threshold. One commenter suggested increasing the 
threshold but did not specify a percentage to which it should be 
increased. Another commenter suggested increasing the threshold for AMP 
to 10 percent while maintaining the 5 percent threshold for WAMP.
    Response: We recognize the public's concern regarding the 
establishment of an appropriate threshold for making price 
substitutions. We disagree with the commenter who recommended different 
thresholds for WAMP comparisons and for AMP comparisons because of 
current operational difficulties associated with maintaining and 
communicating different thresholds. At the current time, we also 
believe that maintaining two thresholds lessens stakeholders' ability 
to accurately predict the potential risk for price adjustments. After 
considering public comments on this issue, and as required by statute, 
we are finalizing our proposal to establish the WAMP/AMP threshold at 5 
percent for CY 2008.
    Comment: We received many comments suggesting that caution be 
exercised in the determination of price substitutions and that we 
develop a formal process and criteria to be used to determine when 
substitutions are necessary. Commenters also recommended that we assure 
adequate notice is provided prior to making a price substitution. 
Several commenters indicated recent policy changes made to the Medicaid 
AMP calculation could impact the accuracy of the comparisons between 
AMP and ASP and stated that these changes should be carefully studied 
and considered before implementing any pricing changes.
    Additionally, several commenters opposed any price substitutions 
for certain classes of providers or for certain specific drugs. The 
commenters noted that certain classes of providers may be subject to 
different cost structures making wholesale substitution of prices 
impractical. Some commenters asserted that certain drugs experience 
unique market forces that may be adversely affected by pricing 
substitutions.
    Response: We understand that complex operational issues, both 
within CMS and externally could impact potential payment rate 
substitutions. We acknowledge the recent changes to the AMP regulations 
and are studying such changes carefully. Furthermore, we recognize the 
variety of providers and the marketplace forces that impact drug 
pricing decisions under ASP. Therefore, we will proceed cautiously and 
provide stakeholders, particularly manufacturers of drugs impacted by 
potential price substitutions, with adequate notice of our intentions 
regarding such, including the opportunity to provide input with regard 
to the processes for substitution.
e. Other Issues
    Comment: A few commenters noted that we did not discuss the payment 
for separately billable ESRD drugs in the CY 2008 PFS proposed rule. 
These commenters supported continuation of the current policy of basing 
the payment on the ASP+6 percent.
    Response: We did not propose any policy changes to the approach 
that we currently use to pay for separately billed ESRD drugs. 
Therefore, for CY 2008 payment for separately billable drugs furnished 
by ESRD facilities will continue at ASP+6 percent in accordance with 
section 1847A of the Act.
    Comment: Several commenters noted that the billing and payment 
codes recently established for liquid IVIG to implement separate 
payment under section 1847A(b)(4) of the Act should improve beneficiary 
access to these products.
    Response: We thank the commenters for communicating their support.
    Comment: We received a few comments expressing concern that, 
because ASP based payment limit updates lag time by at least 2 calendar 
quarters, increases in market prices may not be reflected in a drug's 
payment limit for at least 6 months after a pricing adjustment. One 
commenter suggested that current technology should enable CMS to 
decrease the lag time from 6 months to 2 to 3 months.
    Response: By statute, the ASP based payment allowances are 
determined on a quarterly basis and are based on ASPs reported by 
manufacturers quarterly. Manufacturers must report to us no later than 
30 days after the close of the calendar quarter. 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. We implement these new payment 
limits through program instructions or otherwise at the first 
opportunity after we received the data, which is the calendar quarter 
after receipt.
    Comment: One commenter suggested that we modify the formula we use 
to calculate the payment amounts based on manufacturers' ASP data so 
that the formula is volume weighted as suggested by the OIG.
    Response: We discussed our formula for determining the payment 
amounts based on manufacturers' ASP data in the CY 2006 PFS final rule 
(70 FR 70217). As we stated in the CY 2006 PFS final rule, in 
establishing the formula used to calculate the payment amounts based on 
manufacturers' ASP data, we considered various approaches, including 
the alternative suggested by this commenter. If appropriate, we may 
consider revising the methodology in the future. We did not propose to 
change our current formula, and are not

[[Page 66260]]

implementing changes to our formula at this time.
    Comment: We received a few requests to increase the pharmacy 
supplying fee for immunosuppressive, oral anticancer, and oral anti-
emetic drugs for CY 2008 to reflect actual supplying costs. We also 
received comments expressing concerns that primarily because of the 
labor intensive Medicare Part B claims processing services provided by 
specialty transplant pharmacies, the current supplying fee payment for 
immunosuppressive drugs is substantially lower than reported actual 
supplying costs. One commenter requested that we eliminate the two-
tiered pharmacy supplying fee for prescriptions filled within a 30-day 
period.
    Response: We are committed to assuring that our claims systems 
process claims as timely and accurately as possible and that their 
payment methodologies result in the determination of accurate payment 
amounts. We recognize the operational complexities under which certain 
providers operate and strive to develop systems and processes to 
minimize such complexities. We appreciate the comments that were 
provided and may consider the issue in future rulemaking if 
appropriate. Since we did not propose a change to these rates for CY 
2008, they will continue to be in effect in CY 2008. We received 
several other comments on the use and potential impacts of the ASP 
payment methodology and other issues related to Part B drugs that are 
also outside the scope of this rulemaking and will not be addressed in 
this final rule with comment. These topics include the following:
    <bullet> Requests for billing codes for specific products;
    <bullet> Whether alternative payment methodologies or exceptions to 
the ASP based payment should be considered;
    <bullet> Variation in local coverage and payment policies, 
including use of least costly alternative policies and invoice pricing 
for compounded drugs;
    <bullet> Excluding prompt pay discounts from the calculation of 
ASP; and
    <bullet> Whether coverage under Part B should be expanded to 
include certain vaccines.

2. Competitive Acquisition Program (CAP) Issues

    Section 303(d) of the MMA required the implementation of a CAP for 
certain Medicare Part B drugs and biologicals not paid on a cost or PPS 
basis. The provisions for acquiring and billing drugs under the CAP 
were described in the Competitive Acquisition of Outpatient Drugs and 
Biologicals Under Part B proposed rule (published in the March 4, 2005 
Federal Register; hereinafter referred to as the March 4, 2005 proposed 
rule) and interim final rule with comment period (published in the July 
6, 2005 Federal Register; hereinafter referred to as the July 6, 2005 
IFC) (70 FR 10746 and 70 FR 39022, respectively). Certain provisions 
were finalized in the CY 2006 PFS final rule with comment period (70 FR 
70116). We specified a single CAP drug category to include a defined 
list of drugs furnished incident to a physician's service.
    In this final rule with comment period, we discuss the impact of 
provisions in section 108 of the MIEA-TRHCA on administrative and 
operational aspects of the CAP. Topics include the implementation of a 
post-payment review process and the corresponding changes to claims 
processing procedures, and changes to other operational aspects of the 
CAP. This final rule with comment period implements conforming changes 
to the CAP regulations to reflect these provisions that made changes to 
the payment process of the CAP for Part B Drugs.
    When the CAP program began on July 1, 2006, physicians were given a 
choice between obtaining these drugs from vendors selected through a 
competitive bidding process and approved by CMS, or directly purchasing 
these drugs and being paid under the ASP system. In this final rule 
with comment period, we discuss areas related to transporting CAP drugs 
and the administrative burden of the CAP submitted in response to the 
July 6, 2005 IFC. In addition, we are finalizing portions of the July 
6, 2005 IFC that were not finalized in the CY 2006 PFS final rule with 
comment period and responding to the other timely comments we received 
on the July 6, 2005 IFC that we have not responded to previously.
a. MMA Operational Provisions
    Prior to the enactment of the MIEA-TRHCA, section 1847B(a)(3)(A) of 
the Act set forth specific requirements that have a direct impact on 
the administrative and operational parameters for instituting a CAP. 
This section of the statute required the following:
    (1) Approved CAP vendors bill the Medicare program for the drug or 
biological supplied, and collect any applicable deductibles and 
coinsurance from the Medicare beneficiary. (For purposes of the 
preamble, the term ``approved CAP vendor'' means the term 
``contractor'' as referred to in the statute.)
    (2) Any applicable deductible and coinsurance may not be collected 
unless the drug was administered to the beneficiary. (For purposes of 
the preamble, the term ``drug'' refers to drugs and biologicals 
furnished under the CAP, unless the context specifies otherwise.)
    (3) Medicare can make payments only to the approved CAP vendor, and 
these payments are conditioned upon the administration of the drug.
    Section 108 of the MIEA-TRHCA amended this third element.
b. MIEA-TRHCA
    Section 108 of the MIEA-TRHCA made changes to the CAP payment 
methodology. Section 108(a)(1) of the MIEA-TRHCA amended section 
1847B(a)(3)(A)(iii) of the Act by adding new language that requires 
that payment for drugs and biologicals be made upon receipt of a claim 
for a drug or biological supplied for administration to a beneficiary. 
This statutory change took effect on April 1, 2007.
    Section 108(a)(2) of the MIEA-TRHCA requires the Secretary to 
establish (by program instruction or otherwise) a post-payment review 
process (which may include the use of statistical sampling) to assure 
that payment is made for a drug or biological only if the drug or 
biological has been administered to a beneficiary. The Secretary shall 
recoup, offset, or collect any overpayments determined by the Secretary 
under this process.
    Section 108(b) of the MIEA-TRHCA states that nothing in this 
section shall be construed as requiring the conduct of any additional 
competition under section 1847B(b)(1) of the Act; or requiring an 
additional physician election process.
    Section 108(c) of the MIEA-TRHCA states that the amendments of this 
section apply to payments for drugs and biologicals supplied: (1) On or 
after April 1, 2007; and (2) on or after July 1, 2006 and before April 
1, 2007, for claims that are unpaid as of April 1, 2007.
    Comment: Some commenters suggested that any changes to the CAP be 
made only after the expiration of the current vendor contract. The 
commenters stated that implementation of changes before the next vendor 
contract would be unfair to bidders who chose not to participate in the 
CAP because of previously issued guidance. The commenters cited the CAP 
statutory reference about waiving the FAR in order to promote 
competition. The commenters believe that such changes would 
inappropriately favor the single

[[Page 66261]]

existing vendor, and therefore, hurt competition.
    Response: We do not have the authority to delay implementing the 
claims processing changes required by the MIEA-TRHCA, which were 
effective April 1, 2007. Although some of our changes were not 
expressly required by the statute, we believe these conforming changes 
are necessary to allow the program to function in a manner that is 
consistent with, and required by, the statutory changes. Further, 
because the CAP is a new payment program, change that is consistent 
with operational experience and improves efficiency for participants is 
to be expected. Finally, we disagree that the FAR affects our ability 
to make changes in the program while the current contract is in force. 
Because these changes do not modify an approved CAP vendor's 
responsibilities under its contract with us, we do not believe the FAR 
is implicated.
    Further, as we have discussed in prior rulemaking, the CAP statute 
authorizes the waiver of provisions of the FAR (other than provisions 
relating to confidentiality of information and such other provisions as 
the Secretary determines appropriate) as necessary for the efficient 
implementation of Section 1847B of the Act, in order to promote 
competition.
    We have discussed our approach to conforming to the confidentiality 
provisions in the July 6, 2005 IFC (70 FR 39077), and we intend to 
comply with this approach during future vendor bidding periods. In 
implementing the CAP, we have waived all of the FAR except for the 
confidentiality and the conflict of interest provisions to promote 
competition and the efficient implementation of the program. We made 
the decision to waive the FAR (other than the provisions on 
confidentiality and conflict of interest) in order to increase the pool 
of qualified vendors available to participate in the program. It is our 
understanding that compliance with the FAR is not normally required of 
the companies that make up the pool of potential CAP vendors. It is 
also not required of other Medicare suppliers. We waived these 
provisions in order to structure CAP bidding in a manner consistent 
with established vendor bidding practices.
    The FAR's confidentiality provisions, as well as the conflict of 
interest standards and requirements found in FAR subsection 9.5, apply 
to approved CAP vendors and applicants. All other provisions of the FAR 
have been waived for purposes of the CAP. However, we have used certain 
provisions of the FAR for guidance in implementing the CAP, and we may 
from time to time used other FAR provisions as a guide, even though 
they have been waived. For example, as we discussed in the July 6, 2005 
IFC (70 FR 39063), we look to the provisions of the FAR to guide our 
assessment of bidder's financial solvency.
    However, even if the FAR were implicated, we believe these changes 
promote competition because they make the program a more attractive 
option for physicians, which will provide physicians who compete among 
one another a more meaningful choice between the CAP and the ASP 
methodology. We further believe the changes we are implementing here 
are designed to improve the flexibility and administrative ease of the 
CAP. Therefore, we will proceed with implementing the provisions we are 
finalizing as indicated in this final rule with comment period.
c. CAP Claims Processing
    In the July 6, 2005 IFC (70 FR 39042), we initially implemented a 
claims processing system that enables selected approved CAP vendors to 
bill the Medicare program directly, and to bill the Medicare 
beneficiary and his or her third party payer after verification that 
the physician has administered the drug. When a participating CAP 
physician elects to join the program, he or she must agree to obtain 
all drugs on the CAP drug list from the approved CAP vendor, with only 
a few exceptions. For example in furnish as written (FAW) situations 
(that is, where a beneficiary needs a particular formulation of a drug 
not available from the approved CAP vendor) the participating CAP 
physician would be allowed to obtain that drug outside of the CAP. In 
the case of Medicare Secondary Payer (MSP) (that is, where a Medicare 
beneficiary may have another payer primary to Medicare), the 
participating CAP physicians must obtain physician administered drugs 
from entities approved by the primary plan and bill the primary payer. 
Detailed MSP instructions have been issued by CMS that allow the 
physician to bill under the ASP methodology for the portion of the drug 
not covered by the primary payer in this situation.
    Prior to the MIEA-TRHCA, the claims processing procedures for the 
approved CAP vendor and the participating CAP physician were as 
follows:
    <bullet> Once a shipment is received from the approved CAP vendor, 
the participating CAP physician stores the drug until the date of drug 
administration.
    <bullet> When the drug is administered to the beneficiary, the 
participating CAP physician places the prescription order number for 
each drug administered on the claim form submitted to his or her 
regular Part B carrier.
    Similarly, when the approved CAP vendor bills Medicare for the drug 
it shipped to the participating CAP physician, it places the relevant 
prescription order number on the claim form submitted to the designated 
carrier. The use of the prescription order number on both the 
participating CAP physician's claim and the approved CAP vendor's claim 
is intended to indicate drug administration to the beneficiary. The 
participating CAP physician's claim and the approved CAP vendor's claim 
are matched in the Medicare claims processing system so that drug 
administration can be verified and payment to the approved CAP vendor 
can be made.
d. Required Changes to CAP Claims Processing
    As originally implemented, the claims matching process described 
above in this section was completed before payment was made. However, 
as of April 1, 2007, section 108 of the MIEA-TRHCA requires payment to 
be made to the CAP vendor for claims upon receipt. The statute also 
requires us to establish a post-payment review process to assure that 
payment is made for a drug only if the drug has been administered to a 
beneficiary. We are authorized under the statute to recoup, offset, or 
collect any overpayments by the Secretary. We are also authorized to 
conduct post-payment review using statistical sampling and to implement 
the post-payment review process by program instruction or otherwise. We 
implemented the necessary changes to our claims processing system and 
initiated the post-payment review process on April 1, 2007 via 
instructions to the CAP-designated claims processing contractor and 
Questions and Answers posted on the CMS competitive bidding Web site at 
http://www.cms.hhs.gov/CompetitiveAcquisforBios/15_Approved_Vendor.asp#TopOfPage.
    Under the post-payment review process, the CAP-designated carrier 
will use the CMS claims processing system to look for a match between 
the CAP prescription order number on the participating CAP physician's 
claim and the same prescription order number on the approved CAP 
vendor's claim to track drug administration on a dose by dose basis. If 
the CAP-designated carrier is able to find a match between the two 
claims, the carrier makes a determination that the beneficiary did 
receive the drug being billed for by the CAP physician. The 
participating CAP

[[Page 66262]]

physician claim may also contain information on any determination of 
medical necessity and coverage made by the local carrier.
    We will also use statistical sampling under the post-payment review 
process to determine whether drugs were medically necessary. All 
Medicare claims are subject to medical necessity determinations; 
however, under the changes required by the MIEA-TRHCA, CAP claims may 
not all have a chance to be reviewed for medical necessity before they 
are paid. Therefore, the post-payment review includes both verification 
of drug administration and a medical necessity review of a 
statistically valid sample of CAP claims. In conducting the post-
payment review, we will continue to monitor for fraud, waste, and 
abuse. All CAP claims will remain eligible for review for medical 
necessity and verification of drug administration. We anticipate that 
the post-payment review process will provide us with additional 
opportunities to monitor for the appropriate payment of drugs furnished 
under this program.
    To conduct post-payment review of claims, we may also ask for 
documentation of administration from the approved CAP vendor and for 
medical records from the participating CAP physician for any claim that 
is identified for review. While it is standard practice for CMS to 
require Medicare providers to submit medical records as part of claims 
review, we reserve the right to also specifically request any other 
records that verify the administration of a CAP drug. Furthermore, we 
want to make it very clear to the participating CAP physician that when 
electing to join the program that the physician may be asked to supply 
medical records for post-payment review. Therefore, in the CY 2008 PFS 
proposed rule (72 FR 38153), we proposed to revise Sec.  
414.908(a)(3)(xi) and the physician election agreement form to clarify 
that medical records and certain other information may be requested 
from the CAP physician during the post-payment review process.
    The procedures used to verify valid claims and ensure proper 
payment for drugs supplied under the CAP are based on established post-
payment review processes used in other parts of the Medicare program. 
The request for medical records as part of the claims payment process 
during CAP post-payment review is intended to work in conjunction with 
Item 12 on the Health Insurance Claim Form CMS-1500 which, when signed 
by a beneficiary, authorizes the release of ``any medical information 
necessary to process a claim.''
    When a claim is selected for review we notify the approved CAP 
vendor and request its records to verify administration. We also notify 
the approved CAP vendor that we will be requesting medical records from 
the participating CAP physician. If the medical record is not received 
within 30 days, the claim is denied because we will not have sufficient 
information to verify drug administration and medical necessity.
    This review process is similar to those used elsewhere in the 
Medicare program such as clinical laboratory payment review or payment 
of radiology services.
    As we specified in the July 6, 2005 IFC (70 FR 39038), the local 
carrier's medical review policies and coverage determinations will 
continue to apply in the CAP. Under our previous claims processing 
methodology, the local carrier made the coverage determination on the 
drug ordered by the participating CAP physician and furnished by the 
approved CAP vendor as part of the claim matching process prior to 
payment of the approved CAP vendor's claim. Under the new methodology, 
the drug claim will be paid upon receipt unless the local carrier has 
already made a coverage or medical necessity determination on the drug, 
and the match has already occurred showing that the drug claim should 
be denied.
    As part of the post-payment review process, the CAP-designated 
carrier checks the CMS central claims processing system to determine 
whether the local carrier has made a coverage or medical necessity 
determination on the CAP drug indicated on the participating CAP 
physician's drug administration claim. If a coverage determination has 
been made, the CAP-designated carrier reflects the local carrier's 
decision in its post-payment review of the claim. If the local carrier 
has not reviewed the drug administration portion of the participating 
CAP physician's claim as of the date that the designated carrier 
processes the approved CAP vendor's drug claim, the CAP-designated 
carrier uses the local carrier's coverage determination policies when 
conducting medical review of the claim.
    Comment: One commenter stated that we had exceeded the scope of the 
statute because we were planning to conduct a medical necessity review 
on CAP drug claims that were selected for review as part of the 
statistical sample.
    Another commenter recommended that we make detailed description of 
the claims sampling process available for public comment and asked that 
we design the process consistent with the Medicare Program Integrity 
Manual. The commenter also asked for more detail on the information 
necessary to include in the medical record to ensure that the 
participating CAP physician has appropriately documented the medical 
necessity of the drug administered.
    One commenter questioned whether we needed to obtain additional 
information from the CAP participating physician on claims selected for 
post pay review based on the statistical sample and stated that the 
information contained on the claim form should be sufficient to verify 
administration.
    Another commenter questioned why we were changing the CAP claims 
processing methodology to pay most claims upon receipt and to verify 
administration on a post pay basis. The commenter asked whether we 
would allow for extenuating circumstances if the medical record was not 
supplied by the participating CAP physician within the 30-day time 
period for situations such as bankruptcy, litigation, or closure of the 
practice.
    Response: As stated in the CY 2008 PFS proposed rule (72 FR 38153), 
we were required to make changes to the CAP claims processing 
methodology because section 108 of the MIEA-TRHCA amended section 
1847B(a)(3)(A)(iii) of the Act by adding new language that requires the 
payment for drugs and biologicals upon receipt of a claim for a drug or 
biological supplied for administration to a beneficiary. This change in 
the law was effective on April 1, 2007. Section 108(a)(2) of the MIEA-
TRHCA requires the Secretary to establish (by program instruction or 
otherwise) a post-payment review process (which may include the use of 
statistical sampling) to assure that payment is made for a drug or 
biological only if the drug or biological has been administered to a 
beneficiary. The Secretary is required to recoup, offset, or collect 
any overpayment determined by the Secretary under this process. We 
implemented the necessary changes to our claims processing system and 
initiated the post-payment review process on April 1, 2007, via 
instructions to the CAP-designated claims processing contractor and 
Questions and Answers posted the CMS competitive bidding Web site at 
http://www.cmsm.hhs.gov/CompetitiveAcquisforBios/15_Approved_Vendor.asp#TopOfPage. In the CY 2008 PFS proposed rule, we described 
the changes we had made to our claims processing system and proposed 
conforming changes to our regulations for additional items not covered 
by the MIEA-TRHCA. Because the MIEA-TRHCA gave us authority to

[[Page 66263]]

implement its provisions by program instructions or otherwise by April 
1, 2007, the necessary changes have already been made to our claims 
processing system and the post-pay review process had been implemented. 
The post-payment review process includes verification of drug 
administration and a medical necessity review of a statistically-valid 
sample of CAP claims. This process was designed in conformance with the 
Medicare Program Integrity Manual and in consultation with CMS 
statistical sampling experts, consistent with our authority to 
establish these procedures by program instruction or otherwise. For 
additional information on the requirements of the Program Integrity 
Manual see http://www.cms.hhs.gov/manuals/downloads/pim83co2pdf.
    All Medicare claims are subject to medical necessity 
determinations; however, under the changes required by the MIEA-TRHCA, 
there may not be sufficient time for all CAP claims to be reviewed for 
medical necessity before they are paid. Prior to paying the approved 
CAP vendor's claim, the designated carrier will check the claims 
processing system to determine whether the participating CAP physician 
has submitted the claim for the administration of the drug. If the 
physician has submitted the claim and the local carrier has made a 
determination that the drug is not payable because of a coverage or 
medical necessity denial, the drug claim will be denied by the 
designated carrier. However, if no determination has been made on the 
physician's claim, the designated carrier will pay the approved CAP 
vendor's claims for the drug under the MIEA-TRHCA, and the claim will 
be subject to statistical sampling on a post-pay basis. If the claim is 
selected for review, verification of drug administration and a medical 
necessity review will be conducted. As part of this process, the 
designated carrier will check the system to see whether the local 
carrier had denied the claim as not medically necessary. If a denial 
has been made, the designated carrier will deny the approved CAP 
vendor's claim on medical necessity grounds. The designated carrier 
will use the local carrier's policies when conducting the review.
    Medical necessity review is always conducted based on medical 
records obtained from the physician and will be conducted in an effort 
to look behind the information on the claim form. As specified in 
chapter 3 of the Medicare Program Integrity Manual, standard data 
elements for post-pay medical review include signature requirements, 
diagnosis requirements, and documentation of orders for testing. The 
carrier may also specify additional information it will review to 
document that coverage and medical necessity requirements have been 
met. Under the current CAP post-pay review process, the designated 
carrier requests that all records be supplied by the physician within 
30 days but allows for a limited amount of time beyond that period 
before the service will be considered not to have been administered. 
Participating CAP physicians are encouraged to send any information 
they can provide to the designated carrier within the timeframes 
provided. If the physician is unable to provide all of the requested 
information in a timely manner to the carrier, he or she may contact 
the carrier to determine if the contractor will grant an extension. 
There is also a provision in the Medicare Program Integrity Manual that 
allows contractors to grant additional time in the event of a natural 
disaster. As we indicated in the CY 2008 PFS proposed rule, it is 
standard practice for Medicare providers to be required to submit 
medical records to assist in claims review. Therefore, we are 
finalizing our proposal to revise Sec.  414.908(a)(3)(xi) and the 
physician election agreement to make it very clear to the CAP 
participating physician that they may be asked to provide medical 
records for post-payment review in the CAP.
e. Provisions for Collection of Beneficiary Coinsurance
    In the CY 2006 PFS final rule with comment period, we specified at 
Sec.  414.914(h)(1) that subsequent to receipt of final payment by 
Medicare, or the verification of drug administration by the 
participating CAP physician, the approved CAP vendor must bill any 
applicable supplemental insurance policies. If a balance remains after 
the supplemental insurer pays its share of the bill, or if there is no 
supplemental insurance, the approved CAP vendor may bill the 
beneficiary for the balance. In prior practice, a match in the claims 
system between the participating CAP physician's drug administration 
claim and the approved CAP vendor's drug claim and the subsequent 
payment by Medicare was used to indicate that the beneficiary received 
the drug. We also allowed voluntary information exchanges between the 
approved CAP vendor and the participating CAP physician's office to 
verify CAP drug administration. Additionally, we note that under the 
CAP regulations, the participating CAP physician has a responsibility 
to notify the approved CAP vendor when a drug is not administered or a 
smaller amount was administered than was originally ordered.
    Because section 108 of the MIEA-TRHCA requires the payment of CAP 
claims upon receipt, payment of a claim by Medicare may occur before 
administration of the drug has been verified. However, section 
1847B(a)(3)(A)(ii) of the Act, which states that deductible and 
coinsurance shall not be collected unless the drug or biological is 
administered, remains unchanged. Thus, because we have interpreted this 
provision as requiring verification of administration prior to the 
collection of applicable cost sharing amounts, the requirement for 
verification of administration similarly remains unchanged. However, 
because of the statutory change of section 108(a)(1) of the MIEA-TRHCA 
and its resulting impact on our claims processing methodology, the 
claims processing system no longer provides a way for CMS to verify 
administration on the approved CAP vendor's behalf before the approved 
CAP vendor collects coinsurance from the beneficiary or the 
supplemental insurer. Verification of CAP drug administration is also 
conducted in the post-payment review process. The approved CAP vendor 
is expected to make information available to verify administration for 
post-payment review as necessary.
    We believe that an approved CAP vendor can verify whether a CAP 
drug was administered in a variety of ways. For example, an approved 
CAP vendor may enter into a voluntary agreement with a participating 
CAP physician to exchange such information as described in the CY 2006 
PFS final rule with comment period (70 FR 70251). However, if a 
participating CAP physician is unwilling to enter into a voluntary 
agreement to verify administration, the approved CAP vendor may verify 
that the drug was administered by contacting the participating CAP 
physician's office to request verbal confirmation. In such an instance, 
the approved CAP vendor is expected to document the verbal confirmation 
of CAP drug administration, the identities of individuals who exchanged 
the information, and the date and time that the information was 
obtained. In addition to verifying administration through contact with 
the physician's office, we also suggest that the approved CAP vendor 
place a statement on beneficiaries' bills informing the individual of 
the statutory requirement and suggesting that the beneficiary contact 
the participating CAP physician to verify that he or she received the 
dose

[[Page 66264]]

of the drug for which he or she are being billed prior to paying any 
cost sharing amount.
    For the reasons described above in this section, we believe that 
the verification of CAP drug administration remains a required element 
of the CAP; therefore, in the CY 2008 PFS proposed rule (72 FR 38155), 
we proposed to add Sec.  414.906(a)(6) by specifying that all of the 
following elements are required to document the verification of CAP 
drug administration:
    <bullet> Beneficiary's name.
    <bullet> Health insurance number.
    <bullet> Expected date of administration.
    <bullet> Actual date of administration.
    <bullet> Identity of the participating CAP physician.
    <bullet> Prescription order number.
    <bullet> Identity of the individuals who supply and receive the 
information.
    <bullet> Dosage supplied.
    <bullet> Dosage administered.
    In the CY 2008 PFS proposed rule, these data elements were actually 
proposed in Sec.  414.914 (72 FR 38226). We believe that the drug 
administration verification requirements best fit in Sec.  414.914 
since CAP vendors must collect this information as part of their terms 
of contract. Therefore, we are finalizing Sec.  414.914 to include 
these provisions.
    Also, as a result of changes mandated by section 108(a)(1) of the 
MIEA-TRHCA, we proposed to revise new Sec.  414.914(i)(1) to remove the 
reference to ``final payment by Medicare'' and revise this language to 
state, ``payment by Medicare.'' The original language was written to 
indicate that an approved CAP vendor could not bill a beneficiary's 
supplemental insurer for applicable amounts of cost sharing until the 
CAP drug claim had matched the corresponding physician's drug 
administration claim. Under the post-payment review process, the final 
payment would not occur until a statistical review of the claims was 
complete, a process that may take several months. Removing the word 
final from this section of the regulation will clarify that the 
approved CAP vendor may bill the supplemental insurer immediately after 
the designated CAP carrier makes the initial payment on a CAP drug 
claim. Under our current regulations, the approved CAP vendor may also 
bill the beneficiary if drug administration is verified by the 
participating CAP physician. This provision remains unchanged.
    Under the revised CAP claims payment process, the approved CAP 
vendor will bill Medicare for the CAP drug that has been provided. In 
most cases Medicare will pay the claim upon receipt. If the beneficiary 
has a supplemental insurance policy, and the supplemental insurer has a 
crossover agreement with Medicare, the claim automatically will cross 
over to the supplemental insurer for payment. The supplemental insurer 
will pay its share. Upon receipt of payment from the supplemental 
insurer, the approved CAP vendor may bill the beneficiary for any 
residual amount. For beneficiaries who do not have a supplemental 
insurance policy, the approved CAP vendor may bill the beneficiary 
after payment by Medicare.
    However, in either case, the approved CAP vendor may not collect 
any coinsurance owed from the beneficiary or his or her supplemental 
insurer unless it has verified that the drug was administered. If the 
approved CAP vendor believes that the drug was administered but later 
learns that it was not, the approved CAP vendor must refund any 
coinsurance collected to the beneficiary and his or her supplemental 
insurer, as applicable. In addition, in Sec.  414.914(i)(2), we 
proposed that the approved CAP vendor must promptly refund any payment 
made by CMS if the vendor has been paid for drugs that were not 
administered. We also proposed to interpret the word ``promptly'' to 
mean 2 weeks. Thus, the approved CAP vendor would have 2 weeks from the 
date it was notified that it had been paid for a drug that had not been 
administered to refund to the designated carrier any payment for the 
claim and refund any cost sharing collected to the beneficiary or his 
or her supplemental insurer.
    Comment: We received few comments on our proposal for provisions 
for collection of beneficiary coinsurance. One commenter was concerned 
about the administrative burden placed on the participating CAP 
physician if the approved CAP vendor calls the physician's office to 
verify that a drug was administered. Another commenter agreed with our 
proposal to require that the approved CAP vendor refund any cost 
sharing collected in error promptly to the beneficiary and or his or 
her supplemental insurance provider. The commenter also suggested that 
we require the approved CAP vendor to pay a penalty above the amount 
owed if it does not refund the cost sharing amount within the 2 week 
time frame.
    Response: Physicians and their staff are the best source of 
information for drug verification since they have direct contact with 
the beneficiary. We have structured the process for verification of CAP 
drug administration in the least burdensome way possible for the 
participating CAP physician that would still provide us with 
information to comply with the statutory mandate to assure that payment 
is made for a CAP drug only if it has been administered to a 
beneficiary.
    Physicians have flexibility in how verification for drug 
administration occurs. The physician is free to enter into a voluntary 
agreement with the approved CAP vendor to verify drug administration 
and to specify the manner in which he or she would like the 
verification to occur. Alternatively, if the physician chooses not to 
enter into such an agreement and does not notify the vendor that a dose 
of a CAP drug has been administered, the approved CAP vendor will 
contact the physician to verify administration before collecting 
coinsurance from the beneficiary.
    We believe that the degree of flexibility built into this procedure 
for drug administration verification minimizes the burden for 
participating CAP physicians within the confines of our statutory 
obligation to assure that payment is made for a CAP drug only if it has 
been administered to a beneficiary. Therefore, we are finalizing our 
proposal to add new Sec.  414.914(h)(1) as described above in this 
section.
    We are also finalizing our proposal to revise new Sec.  
414.914(i)(1) to remove the reference to ``final payment by Medicare'' 
and revise this language to state, ``payment by Medicare.'' Under the 
post-payment review process, the final payment will not occur until a 
statistical review of the claims was complete, a process that may take 
several months. Removing the word final from this section of the 
regulation will clarify that the approved CAP vendor may bill the 
supplemental insurer immediately after the designated CAP carrier makes 
the initial payment on a CAP drug claim. Under our current regulations, 
the approved CAP vendor may also bill the beneficiary if drug 
administration is verified by the participating CAP physician. This 
provision remains unchanged.
    Under the revised CAP claims payment process, the approved CAP 
vendor will bill Medicare for the CAP drug that has been provided. In 
most cases Medicare will pay the claim upon receipt. If the beneficiary 
has a supplemental insurance policy, and the supplemental insurer has a 
crossover agreement with Medicare, the claim automatically will cross 
over to the supplemental insurer for payment. The supplemental insurer 
will pay its share. Upon receipt of payment from the supplemental 
insurer the approved CAP vendor may bill the beneficiary for any 
residual amount. For beneficiaries who

[[Page 66265]]

do not have a supplemental insurance policy, the approved CAP vendor 
may bill the beneficiary after payment by Medicare.
    However, in either case, the approved CAP vendor may not collect 
any coinsurance owed from the beneficiary or his or her supplemental 
insurer unless it has verified that the drug was administered. If the 
approved CAP vendor believes that the drug was administered but later 
learns that it was not, the approved CAP vendor must refund any 
coinsurance collected to the beneficiary and his or her supplemental 
insurer, as applicable.
    In addition, we are finalizing Sec.  414.914(i)(2), so that the 
approved CAP vendor must promptly refund any payment made my CMS if the 
vendor has been paid for drugs that were not administered. We are 
implementing our proposal to interpret the term ``promptly'' to mean 2 
weeks so that the approved CAP vendor would have 2 weeks from the date 
that they were notified that they had been paid for a drug that had not 
been administered to the beneficiary to refund any payment for the 
claim made to the designated carrier and refund any cost sharing 
collected to the beneficiary and his or her supplemental insurer. We 
are not implementing a penalty if the refund of any cost sharing 
collected in error exceeds the two week time frame because section 
1847B of the Act does not provide for such a remedy.
f. Approved CAP Vendor Appeals for Denied Drug Claims
    In the March 4, 2005 proposed rule (70 FR 10757 through 10758) and 
the July 6, 2005 IFC (70 FR 39054 through 39057), we discussed the 
development of the CAP dispute resolution process and the limited 
applicability of the traditional Medicare fee for service appeals 
process to an approved CAP vendor's dispute of CAP drugs claims that 
are denied by the CAP-designated carrier. We stated that the approved 
CAP vendor could file appeals as a Medicare supplier consistent with 
the rules at 42 CFR part 405, subpart I. For the purposes of the 
appeals regulations at Part 405, Subpart I, we indicated that a local 
carrier's initial determination of the participating CAP physician's 
drug administration claim was an initial determination regarding 
payment of the approved CAP vendor's drug claim. Thus, the approved CAP 
vendor was to be considered a party to any redetermination of the drug 
administration claim by the local carrier. In addition, the approved 
CAP vendor would be considered a party to an initial determination on 
the claim for payment for the drug product that the approved CAP vendor 
filed with the CAP-designated carrier.
    We also specified that appeals of either initial determination 
would be filed with the local carrier. We stated that the local 
carrier, rather than the designated carrier, possessed all information 
necessary to adjudicate an appeal in this situation. Such information 
included local coverage decisions, medical necessity determinations, 
and information regarding payment of drug administration claims. A 
dispute resolution process was set forth in Sec.  414.916.
    Under our initial implementation of the provision that authorized 
CAP, this alternative approach provided party status to the approved 
CAP vendor on the participating CAP physician's drug administration 
claim. This was necessary because an approved CAP vendor was not 
permitted to receive payment for a CAP drug until the corresponding 
drug administration claim was submitted by a participating CAP 
physician. Payment for the approved CAP vendor's claim was authorized 
when the participating CAP physician's claim and the approved CAP 
vendor's claim were matched in the system.
    However, changes to the claims processing requirements and the 
addition of a post-payment review process required by section 108(a)(2) 
of the MIEA-TRHCA (discussed above in this section) eliminate the 
approved CAP vendor's dependency on a participating CAP physician's 
filing of a drug administration claim in order to receive payment for a 
CAP drug. Accordingly, the approved CAP vendor no longer needs party 
status on the drug administration claim submitted by the participating 
CAP physician. Instead, under the MIEA-TRHCA, the approved CAP vendor's 
drug claim may be paid by the CAP-designated carrier once it is 
received. This determination made on the claim constitutes an initial 
determination as defined in Sec.  405.924. The approved CAP vendor is 
considered a party to this initial determination and may request a 
redetermination and subsequent appeals consistent with the process 
established under 42 CFR part 405, subpart I.
    The changes to CAP claims processing in this final rule with 
comment period that conform to the MIEA-TRHCA result in two scenarios 
that create appeals rights for the approved CAP vendor with respect to 
their drug product claim: (1) Prepayment denials of the approved CAP 
vendor's claim made by the CAP-designated carrier (based on information 
from the local carrier that the payment for the drug should be denied 
as excluded or non-covered); and (2) post-payment denials by the CAP-
designated carrier based on the post-payment review process established 
under the MIEA-TRHCA.
    Therefore, as proposed in the CY 2008 PFS proposed rule (72 FR 
38156), we are making the following clarifications regarding the CAP 
appeals process for an approved CAP vendor's denied drug claims:
    <bullet> For prepayment denials, the approved CAP vendor, as a 
supplier, has a direct right to appeal the initial determination made 
by the designated carrier on its drug product claim. The local carrier 
will conduct the redetermination on prepayment denials. It is the most 
appropriate entity to review prepayment denials since it is most 
familiar with the relevant coverage policies for that jurisdiction. We 
acknowledge that this process differs from a traditional fee-for-
service appeal since the redetermination will not be conducted by the 
contractor that issued the initial determination.
    <bullet> For the post-payment review process, an initial 
determination will be considered re-opened if the CAP-designated 
carrier selects the drug claim for review. If the CAP-designated 
carrier cannot verify administration or cannot determine that the drug 
is covered or medically reasonable and necessary, the CAP-designated 
carrier will issue a revised determination to deny coverage of the drug 
product claim. The CAP-designated carrier will then determine whether 
an overpayment exists, and if so, will recover the overpayment. As a 
supplier, the approved CAP vendor would then have the right to request 
a redetermination of the revised coverage determination, and the 
overpayment assessment. The CAP-designated carrier will process the 
redetermination.
    We received no comments on this topic; therefore, we are finalizing 
the proposed conforming changes to the CAP appeals process as described 
herein.
g. Definition of Exigent Circumstances
    Sections 1847B(a)(1)(A)(ii) and 1847B(a)(5)(A)(ii) of the Act 
require that each physician be given the opportunity annually to elect 
to obtain drugs and biologicals through the CAP and to select an 
approved CAP vendor. Section 1847B(a)(5)(A)(i) of the Act allows for 
selection of another approved CAP vendor more frequently than annually 
in exigent circumstances as defined by CMS.
    In the CY 2005 PFS final rule with comment period (70 FR 70258), we

[[Page 66266]]

stated that participating CAP physicians would have the option of 
changing approved CAP vendors or opting out of the CAP program on an 
annual basis. We also provided the circumstances, as specified in 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 (if multiple CAP competitive areas are developed) or, 
(4) for other exigent circumstances defined by CMS.
    We also identified a separate exigent circumstance relating to 
instances in which an approved CAP vendor declines to ship CAP drugs 
(when the conditions of new Sec.  414.914(i) are met) in Sec.  
414.908(a)(5). We noted that in these cases, a physician may opt-out of 
his or her drug category, and because there is currently only one drug 
category for the CAP, then the participating CAP physician would be 
allowed to opt-out of the CAP altogether (70 FR 39081).
    The CAP became operational on July 1, 2006. At that time, we 
believed that most issues raised by participating CAP physicians would 
relate to quality and service, which could be resolved through the 
approved CAP vendor's grievance process and the dispute resolution 
process conducted by the designated carrier. However, since then, we 
have been contacted by a few participating CAP physicians who have 
requested termination of their election agreement because they 
misunderstood the CAP program or determined that it was not a viable 
option for their practice.
    These instances demonstrate that a practice might wish to leave the 
program for other business reasons that are unrelated to the approved 
CAP vendor's performance. However, we continue to believe that 
opportunities for leaving the CAP outside the annual election process 
should be limited because the CAP was designed as a program in which 
physicians would make an annual decision to participate, as consistent 
with sections 1847B(a)(1)(A)(ii) and 1847B(a)(5)(A) of the Act.
    Therefore, in the CY 2008 PFS proposed rule (72 FR 38156), we 
proposed to define an additional exigent circumstance for opting out of 
the CAP. We proposed that within 30 days of the effective date of the 
election agreement, the participating CAP physician may submit a 
written request to terminate his or her participation in the CAP. The 
request would be sent to the designated carrier under the dispute 
resolution process, and the designated carrier would determine within 1 
business day whether the request was related to the service provided by 
the approved CAP vendor. If so, the designated carrier would refer the 
participating CAP physician to his or her approved CAP vendor's 
grievance process to further determine whether any appropriate and 
reasonable steps could be taken to resolve the identified issue.
    We proposed that the approved CAP vendor would have 2 business days 
to respond to the participating CAP physician's concern, consistent 
with Sec.  414.914(f)(5). If the approved CAP vendor is unable to 
identify a solution for resolving the issue that is consistent with the 
CAP statute, regulations, contracts and guidance, and that is 
acceptable to the physician, then the participating CAP physician would 
be referred back to the designated carrier for assistance under the 
dispute resolution process. We also proposed that the participating CAP 
physician's request would be handled under the dispute resolution 
process because protocols and defined time frames have already been 
developed for handling participating CAP physician and approved CAP 
vendor complaints in this set of procedures.
    We proposed that if the designated carrier does not believe that 
the participating CAP physician's request is related to an issue that 
could be resolved by the approved CAP vendor, then the designated 
carrier would conduct an investigation and attempt to resolve any 
issues identified in the physician's request to terminate his or her 
CAP election agreement. If the designated carrier is unable to resolve 
the situation to the physician's satisfaction within 2 business days, 
then it can either make a recommendation to CMS that the physician be 
permitted to terminate his or her CAP election agreement, or request a 
2-day extension to continue examining the issue. We stated that we 
believed that 4 business days would be sufficient to conclude this 
process because it would give the designated carrier time to gather 
information from other affected parties, such as the participating CAP 
physician's local carrier, but still prepare a speedy summary of the 
issues involved in the physician's request.
    Under our proposal, after the 2-day or 4-day period, as applicable, 
the designated carrier would forward its recommendation and the 
physician's request to CMS. We would then review the recommendation and 
make a final decision within 2 business days from the date that we 
received the request.
    We proposed that if the participating CAP physician demonstrated 
that remaining in the CAP was a significant burden, then we would allow 
that physician to terminate his or her participation in the program. We 
would inform the designated carrier of our decision, which the 
designated carrier would then communicate to the participating CAP 
physician in writing. As part of this process, the physician's 
termination date for his or her CAP election agreement would be 
determined and communicated to all parties involved, including the 
physician's local carrier.
    Conversely, if we did not believe that the physician demonstrated 
that CAP participation constituted a significant burden, then we would 
not allow the physician to terminate his or her CAP contract. 
Subsequently, we would inform the physician of our decision in writing 
via the designated carrier. We would also include a recommendation for 
corrective action.
    In the CY 2008 PFS proposed rule, we also proposed that, even if we 
agreed to terminate the participating CAP physician's CAP election 
agreement, the physician would still be required to continue to 
cooperate in any post-payment review and appeal of claims for drugs 
that the approved CAP vendor had already provided and been paid for. 
The physician would also have to make arrangements with the approved 
CAP vendor for the return of any unused drugs that had not been 
administered to the beneficiary prior to the effective date of the 
physician's termination from the CAP. If the approved CAP vendor had 
billed CMS for drugs that had not yet been administered to a 
beneficiary, then the vendor would be required to correct the claim and 
return any overpayment.
    Comment: We received several comments that supported defining an 
additional exigent circumstance for leaving the CAP because of a burden 
on the practice. Several commenters addressed the timeframe for leaving 
the CAP. Of these comments, all supported a 30-day timeframe, though 
several encouraged a longer window. Commenters who encouraged a longer 
time period believe that 30 days was insufficient time to determine the 
suitability of the CAP for their practice.
    While most commenters agreed that a demonstration of burden should 
be required, one commenter stated that allowing physicians to opt-out 
for any reason would be desirable. One commenter suggested that 
physicians should be allowed to opt-out of the CAP

[[Page 66267]]

at any time for any reason. Several commenters asked that the opt-out 
process be simplified. Another commenter requested that the process for 
determining whether to grant a physician's request to leave the CAP be 
outlined.
    Response: Based on the comments, we are revising our proposal to 
make it more flexible. While we recognize the concerns raised by 
commenters who recommended that we allow physicians to leave the CAP 
for any reason at any time, we continue to believe that there should be 
limits on a participating CAP physician's ability to leave the CAP. The 
CAP statute contemplates an annual election process. Our proposal to 
allow a 30-day period for opting out because of a burden is based on 
our authority to specify ``exigent circumstances,'' and we do not 
believe it would be appropriate to allow physicians to opt-out under 
this process without some exigency that makes termination of CAP 
participation necessary. However, in recognition of these comments, and 
because we agree that participating CAP physicians should have a 
sufficient opportunity to assess the suitability of the CAP for their 
practice, we are making the following changes to the opt-out process.
    First, we note that we intend to take a broad view of what would 
constitute a burden to the practice resulting in an ``exigent 
circumstance.'' We believe that a broad view is appropriate because 
there may be many reasons why a participating CAP physician may find 
CAP participation more burdensome than he or she expected, and we do 
not wish at this time to place a limit on what those reasons may be. As 
we gain experience with this process, we may in a future rulemaking 
specify a list of ``exigent circumstances'' or prescribe more specific 
standards for what constitutes an ``exigent circumstance'' for purposes 
of the opt-out process; however, for now we will assess requests on a 
case-by-case basis under the process described in this preamble and set 
forth in the regulations at Sec.  414.908.
    In response to comments seeking greater flexibility in the process 
and a longer window in which to assess the CAP's suitability for the 
physician's practice, we are implementing a two-tiered process that 
would both expand the initial time frame for requesting to opt-out of 
the CAP and would allow for requests to opt-out at any time based on a 
change in circumstances that was not previously known to the 
participating CAP physician. We believe that such a process, which we 
outline below, strikes a balance between providing participating CAP 
physicians with flexibility to opt-out of the CAP when participation is 
burdensome, while still placing appropriate limits on a physician's 
ability to leave the CAP outside the annual election process.
    Thus, under the two-tiered process we are finalizing in this rule, 
we are changing to 60 days the initial period during which a physician 
can request termination of his or her CAP participation agreement as a 
result of exigent circumstances. We agree with commenters that allowing 
physicians more time to determine whether the CAP is suitable for their 
practices is advisable. We believe that an initial 60-day period will 
allow the participating CAP physician time to make a more complete 
assessment of the CAP's suitability. Although certain burdens will be 
likely to be apparent immediately, the first 30 days may be a period 
with a steep learning curve for the practice as it adapts to the CAP 
drug ordering process, and the first 30 days may involve working out 
any ``start up'' issues within the practice or with the approved CAP 
vendor. For this reason, the first 30 days may not be a fully 
representative time period during which to assess ongoing CAP 
participation. We believe an additional 30 days of CAP participation 
would be sufficient to identify, in the vast majority of cases, whether 
participation will constitute a burden to the practice.
    Under this process, therefore, if a participating CAP physician's 
election agreement was effective on January 1, 2008, then he or she 
would have until March 1, 2008, to request to terminate participation 
in the program if CAP participation results in a burden to the 
practice. In addition, based on the concerns raised by commenters, we 
will allow physicians to leave the CAP at any time after the first 60 
days if they can show that a change in circumstances that was not known 
to the practice previously results in a burden to the practice. As 
noted above, we believe that in the vast majority of cases 
participating CAP physicians will be able to identify a burden, if any, 
within the first 60 days. However, we also recognize that issues may 
arise during the course of the year that would result in an ``exigent 
circumstance,'' but that were not known to the participating CAP 
physician during the first 60 days of CAP participation. In such 
instances, we agree with commenters that physicians should have a 
longer window to request an opt-out.
    For purposes of the two-tiered process, then, examples of burdens 
that we would expect a practice could identify within the first 60 days 
may include difficulties with CAP billing or drug ordering 
requirements, or documentation that the practice's initial 
understanding of these requirements was based on inaccurate information 
provided by a third party. Examples of burdens that might arise after 
the initial 60 days could include a change in practice personnel, 
patient population, computer systems, or vendor behavior that makes it 
harder to participate in the program. Where an opt-out request is 
submitted after the initial 60 days, we will require the participating 
CAP physician to demonstrate the request is based on information that 
he or she did not have within the first 60 days.
    All requests to terminate participation, whether within the first 
60 days or thereafter, would be submitted to the CAP-designated carrier 
and processed under the dispute resolution process. The request would 
need to document the physician's burden. Upon completion of the process 
outlined in proposed Sec.  414.917, we would make the decision about 
whether the participating CAP physician's participation in the CAP will 
be terminated.
    If the physician has not demonstrated that CAP participation 
represents a burden for his or her practice--either during the first 60 
days or, if thereafter, as a result of a change in circumstances that 
was not known to the practice previously, then we would not allow the 
physician to terminate his or her participation in CAP because, as 
noted above, we continue to believe that a participating CAP 
physician's ability to opt-out of the CAP under this process should be 
limited to ``exigent circumstances,'' as contemplated by the statute 
and our regulations.
    We would inform the physician of our decision in writing via the 
designated carrier. We would also include a recommendation for 
corrective action, if appropriate. For example, if the reason that the 
CAP participating physician wanted to leave the program was that the 
approved CAP vendor was not delivering drugs timely, the designated 
carrier would investigate the situation. If it found that the approved 
CAP vendor was complying with our regulations on drug delivery at Sec.  
414.914(f) and Sec.  414.902 but that the participating CAP physician 
was not ordering drugs consistent with the vendor's procedures, then 
the CAP-designated carrier could educate the physician about the proper 
drug ordering procedures and facilitate a discussion between the 
approved CAP vendor and the participating CAP physician about how the 
physician could order drugs in a way that met the

[[Page 66268]]

needs of his or her practice and the drug ordering requirements of the 
CAP vendor. The CAP-designated carrier would document the result of 
that discussion in writing. The participating CAP physician would have 
the right to request a reconsideration of our decision as specified in 
Sec.  414.916(c). We are revising Sec.  414.916(c) to clarify that the 
physician reconsideration process would apply to reconsiderations of 
our decision on whether the participating CAP physician may opt-out of 
the CAP.
    Based on our experience with the program, we continue to believe 
that handling all requests to terminate CAP election under the dispute 
resolution process is reasonable and straightforward. We further 
believe the use of our pre-existing process will not create unnecessary 
delays in processing opt-out requests, particularly in light of the 
short time frames we have specified for responding to opt-out requests. 
Moreover, we believe the dispute resolution process is sufficiently 
detailed that it provides an ample description of how a physician's 
request to terminate CAP participation will be assessed.
    Physicians will still be required to return unused CAP drugs and to 
complete any required CAP claims processing activities as described in 
proposed Sec.  414.917. The notification to a physician will also 
include the end date of CAP participation in order to facilitate an 
orderly and efficient changeover between the CAP and ASP payment 
systems.
    Therefore, we are finalizing Sec.  414.908 and Sec.  414.917 as 
proposed, subject to the changes described in this section. (We are 
making an additional technical change to Sec.  414.908 to consolidate 
the ``additional opt-out'' provision, currently set forth at Sec.  
414.908(a)(5), with the other opt-out provisions at Sec.  
414.908(a)(2). We believe this nonsubstantive change will improve the 
clarity of the regulations.) Finally, we also are finalizing Sec.  
414.916(c) as amended as described in this section.
h. Transporting CAP Drugs
    Although section 1847B((b)(4)(E) of the Act provides for the 
shipment of CAP drugs to settings other than a participating CAP 
physician's office under certain conditions, we did not propose to 
implement the CAP in alternative settings. In the July 6, 2005 IFC (70 
FR 39047), we described both comments that supported the idea of 
allowing participating CAP physicians to transport drugs to multiple 
office locations, and comments that raised concerns about the risk of 
damaging a drug that has not been kept under appropriate conditions 
while being transported.
    As stated in Sec.  414.906(a)(4), we implemented the CAP with a 
restriction that CAP drugs be shipped directly to the location where 
they will be administered. However, we were aware that physicians may 
desire to administer drugs in alternative settings, especially in a 
home. We sought comment on how this could be accommodated under the CAP 
in a way that addresses the concerns about product integrity and damage 
to the approved CAP vendors' property expressed by the potential 
vendors.
    Several comments submitted in response to the July 6, 2005 IFC 
suggested either narrowing or removing the restriction on transporting 
drugs to other locations. Commenters believed that physicians, 
particularly those who specialize in oncology, and their staff are 
knowledgeable about drug stability and handling, and therefore, were 
capable of assuming this responsibility. Other commenters indicated 
that transporting the drug to another office location may allow for 
flexibility in scheduling patient visits. It would allow practices with 
satellite operations that are not open every business day to receive 
shipments of CAP drugs at another practice location and then to 
administer the drugs in the satellite office.
    We also received several comments discussing the impact of CAP-
delivery times on rural clinics and offices with satellite locations. 
Many of these responses discussed how easing the restriction on 
transporting CAP drugs between locations would be welcome in rural 
areas and for satellite offices with limited hours.
    These comments and our experience with the CAP thus far have caused 
us to consider revising our policy. Therefore, in the CY 2008 PFS 
proposed rule (72 FR 38157), we requested comments on the potential 
feasibility of narrowing the restriction on transporting CAP drugs 
where this is permitted by State law and other applicable laws and 
regulations. We asked commenters to consider how such a policy could be 
constructed so that the approved CAP vendor could retain control over 
how the drugs that it owns are handled. We also requested comments on 
other issues that we should take into account concerning transportation 
of CAP drugs between practice locations listed on a physician's CAP 
election agreement form. Additionally, we also solicited comments on 
the following areas that we could use in the development of future 
proposals:
    <bullet> How to structure requirements so that drugs are not 
subjected to conditions that will jeopardize their integrity, stability 
or sterility while being transported and steps to keep transportation 
activities consistent with all applicable laws and regulations;
    <bullet> Whether any agreement allowing participating CAP 
physicians to transport CAP drugs to alternate practice locations 
should be voluntary. This means that approved CAP vendors would not be 
required to offer such an agreement and physicians who participate in 
the CAP would not be required to accept such an offer; and
    <bullet> Whether the agreement should be documented in writing, and 
whether it is necessary to create any restrictions on which CAP drugs 
could be transported.
    We stated that we were not making a specific proposal at this time 
but that we would use any information received to structure a future 
proposal in the event we made one.
    Comment: Several commenters supported the concept of easing the 
restriction on transporting CAP drugs if this could be done safely, and 
if changes were consistent with applicable rules, regulations, and 
within the limitations of product stability and integrity. The 
restriction on transporting CAP drugs was perceived as a barrier to 
physician participation in the program. One commenter stated that 
elimination of the restriction would result in the same flexibility as 
the ASP (buy and bill) method of acquiring drugs. Another commenter 
expressed a strong desire to implement these changes promptly.
    A few commenters also cautioned us to be certain that appropriate 
safeguards would be in place if we chose to ease the transportation 
restriction. One commenter asked that the safeguards be available for 
public scrutiny before they are implemented. Conversely, other 
commenters stated that a physician's certification or discretion were 
satisfactory.
    Response: We are sympathetic to the concerns expressed by the 
commenters and expect to issue a proposal in the CY 2009 PFS proposed 
rule that would allow the transportation of CAP drugs from one 
physician practice location in certain circumstances. We further expect 
that our proposal would propose to permit transport of CAP subject to 
voluntary agreements between the approved CAP vendor and the 
participating CAP physician that complied with all applicable State and 
Federal laws and regulations and product liability requirements. We 
welcome comments on how to structure such a proposal.

[[Page 66269]]

i. Alternatives to the CAP Prescription Order Number
    In the July 6, 2005 IFC (70 FR 39043 and 39049), we responded to 
several comments regarding the administrative burden that the CAP 
ordering and claims payment process imposes upon participating CAP 
physicians; specifically, activities associated with using and tracking 
the prescription order number were mentioned. We received additional 
comments on this issue in response to the IFC as well.
    After the close of the comment period, we also received an inquiry 
from the current approved CAP vendor about the potential length of the 
CAP prescription order number and whether it could present a burden to 
participating CAP physicians. A 30-byte field is currently available on 
the electronic claim form for prescription numbers; however, it is not 
necessary for the prescription order number to be 30 bytes long. 
Typically, 15 or fewer total characters have been used by the approved 
CAP vendor.
    The requirements for developing the CAP prescription order number 
are as follows: The first 9 characters are the approved CAP vendor's ID 
and the HCPCS code of the drug that is being billed; the approved CAP 
vendor sets the remaining characters. The assigned CAP prescription 
order number is captured in Loop 2410, REF02 (REF01=XZ) of the ANSI 
4010A1 electronic claims transaction. This segment of the electronic 
claims transaction is part of a specific data format that Medicare 
claims must adhere to in order to meet national electronic standards 
for the automated transfer of certain health care data as mandated by 
the Health Insurance Portability and Accountability Act of 1996 (Pub. 
L. 104-191) (HIPAA).
    Each prescription order number is unique to a dose of a CAP drug 
that is being shipped for administration to a particular beneficiary. 
The prescription order number is generated by the approved CAP vendor 
and, as stated in the July 6, 2005 IFC (70 FR 39042), each dose of a 
CAP drug is required to have a separate prescription order number. 
After the drug is administered, the participating CAP physician's drug 
administration claim is submitted with a no-pay line containing the 
prescription order number. The approved CAP vendor's claim for the CAP 
drug also contains the prescription order number.
    When the CAP was implemented, the prescription order number was 
used in the claims matching process to facilitate accurate payment of 
the approved CAP vendor. Prior to payment, this system paired an 
approved CAP vendor's drug claim to a participating CAP physician's 
drug administration claim using the prescription order number. A 
matching prescription order number between these two claims indicated 
that the drug had been administered.
    Since the CAP began, the claims process has changed because of 
statutory changes. Section 108(a)(2) of the MIEA-TRHCA requires us to 
make payment upon receipt of an approved CAP vendor's drug claim and 
then to conduct a post-payment review of claims. As stated in the MIEA-
TRHCA, the post-payment review process is intended to ``assure that 
payment is made only for a drug or biological * * * if the drug or 
biological has been administered to a beneficiary.''
    Under this new process, the prescription order number still plays a 
pivotal role. Prior to the payment of the approved CAP vendor's drug 
claim, the CAP-designated carrier uses the prescription order number to 
check the claims processing system to ascertain whether the local 
carrier has adjudicated the drug administration claim. If the local 
carrier has done so, then the CAP-designated carrier will look to see 
whether the local carrier has determined that the CAP drug administered 
by the participating CAP physician is covered and is medically 
necessary. The local carrier's decision determines whether the CAP-
designated carrier will pay the approved CAP vendor's drug claim. If 
the participating CAP physician's local carrier has not made a 
determination on the physician's claim and the CAP drug claim, then the 
designated carrier will pay the approved CAP vendor's claim upon 
receipt and use the CAP prescription order number to help verify drug 
administration on a post-payment basis.
    The prescription order number is also still used in other CAP 
processes. Each dose of a CAP drug that is shipped by the approved CAP 
vendor is tracked using the prescription order number. Moreover, the 
prescription order number is particularly useful in certain situations 
such as those that involve recurring cyclic drug treatment regimens. In 
these cases, the prescription order number minimizes the possibility of 
confusion by serving as a unique differentiating factor between highly 
similar drug claims. Also, the prescription order number is valuable 
during instances in which the anticipated day of service submitted by 
the participating CAP physician differs from the actual date of drug 
administration. In these situations, the prescription order number 
would clarify confusion stemming from discrepancies in dates. Overall, 
we believe that the prescription order number remains an appropriate 
and necessary tool to track the administration of a specific dose of a 
drug and for the accurate execution of the post-payment review process.
    Although we believe that the use of the prescription order number 
is necessary to facilitate accurate review of CAP claims, we are aware 
that it may be considered an inconvenience by some potential 
participating CAP physicians and approved CAP vendors. Therefore, in 
the CY 2008 PFS proposed rule (72 FR 38158), we requested comments on 
alternative methods to accurately track the administration of specific 
doses of drugs in order to meet the requirements stated in section 
108(a)(2) of the MIEA-TRHCA. These comments could then be used in the 
development of a proposal for future rulemaking.
    Comment: We received a few comments on this issue. One commenter 
suggested that the CAP-designated carrier should simply match vendor 
and physician claims but did not provide any details about how that 
could be accomplished without the prescription order number. Another 
commenter stated that the CAP prescription order number was no longer 
needed to verify drug administration and should be eliminated. Instead 
they recommended that we should rely on the approved e-CAP vendor's 
verification of drug administration and the physician's records of drug 
administrations.
    Response: While the records of participating CAP physicians and the 
CAP vendor are currently used in the post pay review process, the CAP 
prescription order number plays an important role in that it enables 
the designated carrier to identify the exact doses of a drug that was 
administered and provides a link between the approved CAP vendor's 
claim and the participating CAP physician's claim that is not available 
otherwise.
    We do not believe the suggestions that we have received thus far 
would allow us to discontinue the use of the prescription order number. 
The prescription order number allows us to better ``assure that payment 
is made only for a drug or biological * * * if the drug or biological 
has been administered to a beneficiary'' since it tracks the 
administration of a specific dose of a drug, which allows CMS to match 
the vendor and the physician claim in the post pay review process. 
However, we would appreciate receiving other suggestions that would 
allow drug administration verification on a dose specific basis. Since 
we did not make a specific proposal about this

[[Page 66270]]

issue, we will not make any changes at this time to the requirement 
that the CAP prescription order number be supplied by the approved CAP 
vendor and included on claims from both the participating CAP physician 
and the approved CAP vendor.
j. Prefilled Syringes
    In the July 6, 2005 IFC (70 FR 39061), we described public comments 
which stated that participating CAP physicians could not vouch for the 
quality of products that were opened by an approved CAP vendor for 
repackaging, for mixing the drug with other drugs or injectable fluids 
(admixture), or for removing a part of the contents to supply the exact 
dose for a beneficiary. Several commenters recommended that approved 
CAP vendors deliver their products in the same form in which they are 
received from the manufacturer, without opening packaging or 
containers, mixing or reconstituting vials, or repackaging. 
Specifically, the commenters were concerned about the capabilities of 
individuals who mix the drug, as well as shipping conditions, storage, 
and stability.
    We responded by stating that the CAP is not intended to require 
approved CAP vendors to perform pharmacy admixture services (for 
example, to furnish reconstituted or otherwise mixed drugs repackaged 
in IV bags, syringes, or other containers that are ready to be 
administered to a patient) when furnishing CAP drugs. Admixture 
services for injectable drugs require specialized staff, training, and 
equipment, and these services are subject to standards such as United 
States Pharmacopoeia Chapter 797, Pharmaceutical Compounding--Sterile 
Preparations. These requirements have significant impact on drug 
shipping, storage, and stability requirements, as well as system cost 
and complexity. As stated in Sec.  414.906(a)(4), the approved CAP 
vendor must deliver ``CAP drugs directly to the participating CAP 
physician in unopened vials or other original containers as supplied by 
the manufacturer or from a distributor that has acquired the products 
directly from the manufacturer.''
    Since issuing the July 6, 2005 IFC, we have become aware that 
bevacizumab (Avastin[supreg]) is being used for the treatment of 
exudative age-related macular degeneration (wet AMD) in very small 
doses. Although this is an off label use, it is gaining acceptance 
among ophthalmologists who treat wet AMD, and this use has been the 
subject of several carriers' local coverage determinations. Bevacizumab 
is considerably less expensive than certain other drugs used in the 
treatment of wet AMD.
    The smallest commercially-available package of bevacizumab is a 
100mg single use vial, while a dose used to treat wet AMD is 
approximately 1mg. Some local carriers who have issued coverage 
instructions for the use of bevacizumab in the treatment of wet AMD 
allow physicians to obtain these small doses of drug from a pharmacy 
that is capable of preparing sterile products. We expect to issue 
instructions that will allow participating CAP physicians to use the 
furnish as written option, as appropriate, and to obtain small doses of 
bevacizumab outside of the CAP in prefilled syringes if their local 
carrier's coverage determinations allow such a practice and if it is 
consistent with applicable laws and regulations. We believe that this 
approach will minimize the waste associated with using a 100mg single 
use vial for the treatment of wet AMD and will increase the flexibility 
for participating CAP physicians by making an alternative quantity of 
this drug available to participating CAP physicians whose carriers have 
applicable policies.
    However, this option is not available in all areas. Therefore, we 
stated that we are considering reassessing our policy on the use of 
prefilled syringes to determine whether it would be feasible to make 
the option of using prefilled syringes supplied by an approved CAP 
vendor available to all physicians who participate in the CAP, rather 
than requiring physicians to go outside the CAP in order to obtain CAP 
drugs in prefilled syringes. In the CY 2008 PFS proposed rule (72 FR 
38159), we requested comments on whether allowing approved CAP vendors 
to repackage CAP drugs in certain situations may be beneficial to 
beneficiaries, the program, and to the physicians who participate in 
it.
    In considering whether to propose a change to our regulations in 
the future, we also solicited comments on:
    <bullet> Whether approved CAP vendors are likely to be pharmacies 
or have access to pharmacy services with trained personnel and 
facilities for the small scale preparation of sterile drug products in 
response to a specific prescription order for a specific patient;
    <bullet> Whether an approved CAP vendor should be given an 
opportunity to supply bevacizumab under the CAP if it is repackaged in 
a patient-specific dose consistent with applicable state laws and 
regulations upon request from a participating CAP physician;
    <bullet> Whether this sort of activity should be restricted to 
bevacizumab, or possibly phased-in for other CAP drugs. If we were to 
apply this sort of policy to other CAP drugs, we would also have to 
determine how phasing-in might occur, which drugs it should apply to 
and whether the preparation of admixtures (including the preparation of 
sterile syringes, minibags, and mixing of drugs and solutions intended 
for intravenous administration) should be allowed as well;
    <bullet> How this sort of service could be limited to participating 
CAP physicians who voluntarily agree to use it, and whether such an 
agreement should be made in writing between the approved CAP vendor and 
the participating CAP physician;
    <bullet> How such a program could be structured so that the service 
and staff engaged in providing the service would be required to meet 
all applicable laws (including Stark, Anti-kickback, and State pharmacy 
laws), as well as regulations for the preparation of sterile products, 
(including standards for product integrity and sterility);
    <bullet> Whether the cost of preparing such product would be 
included in the CAP vendor's bid price; and
    <bullet> Whether any other important elements should be evaluated 
if we consider changing CAP policy on prefilled syringes in the future.
    Comment: We received several comments on these issues. Overall, 
responses were generally equally divided among those who supported 
prefilled syringes, those who advocated a cautious approach, and those 
who opposed the practice.
    Those who opposed making prefilled syringes available through the 
CAP cited stability and sterility concerns. Those commenters also 
raised concerns about whether the CAP vendor's preparation of a 
particular drug product for an off-label use by participating CAP 
physicians would violate existing drug law because of the potential 
scale of an approved CAP vendor's activities and because the drug was 
being prepared for use in a manner other than as described in its FDA-
approved labeling. Several commenters urged that caution be used in 
developing changes to the aspects of the CAP that are discussed above 
in this section, but many of these commenters were not completely 
opposed to the preparation of prefilled syringes by approved CAP 
vendors.
    Several commenters were quite supportive of using prefilled 
syringes. One commenter stated that pharmacy preparation of prefilled 
syringes was regarded as a ``convenient and safe practice'' and would 
avoid both waste

[[Page 66271]]

and some of the risk associated with transferring sterile products. 
Another commenter also recommended that a mechanism to pay for the 
preparation and waste associated with the process be established.
    There was a general point of agreement between commenters who urged 
a cautious approach and those who agreed with the concept of prefilled 
syringes. These commenters agreed that that additional flexibility or 
enhancements to the CAP would be welcome provided that they did not 
affect beneficiary safety and were consistent with applicable laws, 
regulations, product stability, and product integrity requirements.
    Response: We appreciate the comments on prefilled syringes and we 
will consider whether to develop a proposal that is consistent with 
applicable laws, regulations, product stability, and product integrity 
concerns in future rulemaking. Because we did not propose a change to 
our current regulations on the use of prefilled syringes in the CAP, 
they remain unchanged for the present time. We may make a proposal in 
the future.
k. Contractual Provisions
    Section 1847B of the Act is generally silent on the subject of 
disputes surrounding the delivery of drugs and the denial of drug 
claims. However, section 1847B(b)(2)(A)(ii)(II) of the Act states that 
a grievance process is a quality and service requirement expected of 
approved CAP vendors. In the July 6, 2005 IFC (70 FR 39055 through 
39058), we described the process for the resolution of approved CAP 
vendors' claims denials and the resolution of participating CAP 
physicians' drug quality and service complaints. We encouraged 
participating CAP physicians, beneficiaries, approved CAP vendors, and 
the designated carrier to use informal communication as a first step to 
resolve service-related administration issues. However, we recognized 
that certain disputes would require a more structured approach, and 
therefore, we established processes under Sec.  414.916 and Sec.  
414.917.
    Suspension and termination from the CAP were the only remedies 
described under the CAP dispute resolution processes. Having gained 
some experience with the CAP, we believe that having an intermediate 
level of remedy for less serious but persistent problems is desirable 
in order to bridge the gap between taking no action and suspension or 
termination of an approved CAP vendor.
    We believe that additional contractual obligations, such as 
additional reporting requirements, could be useful, particularly if 
they provide an opportunity for the approved CAP vendor to come into 
compliance using objective goals and a set timeline. Therefore, in the 
CY 2008 PFS proposed rule (72 FR 38160), we requested comments on what 
types of potential contractual provisions could be used to encourage 
approved CAP vendors to comply with CAP requirements for less serious 
violations, such as missing reporting deadlines, or participation in 
inappropriate promotional strategies. We also requested comments on the 
following:
    <bullet> The type of contractual provisions that would be suitable. 
For example, requests for specific or targeted reporting and monitoring 
activities in response to specific violations.
    <bullet> Whether an approved CAP vendor's code of conduct could be 
used to address these types of less serious situations and how that 
could be accomplished; and
    <bullet> Whether the CAP physician election agreement should be 
revised to include provisions to address participating CAP physicians' 
noncompliance with CAP rules or the CAP election agreement.
    Comment: One commenter agreed with the use of contractual 
provisions, including additional reporting requirements, as an 
intermediate form of remedy in response to a CAP vendor's noncompliance 
with CAP requirements. The commenter also noted that a vendor code of 
conduct would be useful.
    Response: We plan to develop a proposal for additional provisions 
that could be added to the CAP contract. These provisions would be used 
to encourage approved CAP vendors to comply with CAP requirements. We 
will propose such provisions in a future rulemaking period.
l. Finalizing Remaining Provisions of the July 6, 2005 Interim Final 
Rule with Comment Period
    In this PFS final rule with comment, we are finalizing the portions 
of the July 6, 2005 IFC that were not finalized in previous rulemaking. 
We are also responding to other timely comments we received on the July 
6, 2005 IFC that we have not responded to previously.
    Comments that we will be addressing in this rule include the 
following:
    <bullet> The use of e-prescribing in CAP.
    <bullet> Updating CAP prices and data reporting.
    <bullet> The application of Comprehensive Error Rate Testing (CERT) 
to CAP claims.
    <bullet> The 14-day participating CAP physician billing 
requirement.
    <bullet> The impact of CAP participation on clinical research.
    <bullet> Licensure requirements for CAP pharmacies and 
distributors.
    <bullet> Community mental health centers and participation in the 
CAP.
    <bullet> Administrative and financial burden of CAP participation 
for physicians.
    We have addressed drug transportation previously in this section of 
this final rule with comment period.

Basis and Scope (Sec.  414.900)

    These provisions provide that the regulations in this subpart 
implement sections 1847A and 1847B of the Act. We received no comments 
on these provisions and we are finalizing the corresponding regulatory 
text at Sec.  414.900 in its entirety.

Definitions (Sec.  414.902)

    Section 414.902 lists the definitions used in 42 CFR Subpart K. We 
did not receive any comments about the revisions to this section that 
we made in the July 6, 2005 IFC (70 FR 39093). At this time, we are 
finalizing the regulatory text at Sec.  414.902 as it currently reads.

Competitive Acquisition Program as the Basis for Payment (Sec.  
414.906)

    Section 414.906 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.
i. 2005 Comments
    In the July 6, 2005 IFC (70 FR 39074), we discussed the methodology 
used to update CAP drug prices during the bidding process. We responded 
to comments that suggested that single price updates for CAP drugs 
should be tied to changes in ASP prices. We stated that we did not 
believe that there had been enough experience with the ASP payment 
methodology to update the bids based on growth in the ASP. We also 
solicited comments on this method of updating single drug prices to the 
payment year in order to develop and refine the CAP in the future.
(a) Updating CAP Prices and Data Submission
    Comment: We received comments about updating CAP drug prices more 
frequently than annually. One commenter suggested that we should 
consider quarterly data submissions and

[[Page 66272]]

pricing updates even during the phase in period in order to produce 
greater savings in instances where vendors' overall costs for CAP drugs 
were declining, while providing greater protection for vendors in 
instances where vendors were experiencing cost increases. Another 
commenter encouraged us to compare CAP prices to ASP prices using the 
most recent data available and to account for manufacturer price 
adjustments in a timely manner.
    Response: In the July 6, 2005 IFC (70 FR 39076), we stated, ``when 
the administrative mechanisms of the CAP are operational and vendors 
have more experience under the program, we will consider whether more 
frequent reporting (of reasonable net acquisition costs) would be 
appropriate.'' Section 414.914 requires that the CAP contract must 
provide for the disclosure of the approved CAP vendor's reasonable, net 
acquisition costs for a specified period of time, not to exceed 
quarterly and provide for appropriate adjustments as described in Sec.  
414.906(c)(1). This section describes the computation of an annual 
update to the payment amount and allows updates more often than 
annually but no more often than quarterly in any of the following 
cases: introduction of new drugs; expiration of a drug patent or 
availability of a generic drug; material shortages that result in a 
significant price increase for the drug; and withdrawal of a drug from 
the market. Also, the CAP payment amount is limited by the weighted 
payment amount established under section 1847A of the Act across all 
drugs for which a composite bid is required in the category, and 
limited by the payment amount established under section 1847A of the 
Act for each other drug for which the approved CAP vendor submits a 
bid. It is not clear how the commenter is proposing that we account for 
changes in manufacturer's price adjustments in a more timely manner. 
Because the CAP has been operational for 15 months, we are still 
gaining experience with the reporting and update mechanisms already in 
place. At present, we believe these processes are sufficient to address 
the needs of the CAP; however, as the program grows, we may consider 
other options, including more frequent price updates.
(b) Impact of CAP on Clinical Research
    Comment: Some commenters stated that they were concerned that CAP 
participation would conflict with the Medicare National Coverage 
Decision (NCD) on Clinical Trials. Since the NCD enables Medicare to 
reimburse physicians for the current standard of care drugs that are 
administered to beneficiaries in the control group of clinical trial 
protocols, commenters were concerned that physicians would not be able 
to enroll Medicare beneficiaries in clinical trials if drugs required 
in the protocol were not on the CAP drug list. In addition, some 
commenters expressed their concern that there was a lack of built in 
oversight in CAP to ensure that vendors would buy drugs directly from a 
manufacturer or wholesaler. The commenters were concerned that this 
could result in the acquisition of counterfeit product, and that as a 
result, such products could infiltrate clinical trials and compromise 
the results of cancer clinical research that a CAP physician might be 
participating in.
    Response: As a result of an executive memorandum issued by the 
President of the United States in June 2000, we instituted the NCD in 
September 2000 as explained in our ``September 2000 Program 
Memorandum'' on clinical trials available at http://www.cms.hhs.gov/ClinicalTrialPolicies/. The NCD stipulates that Medicare will provide 
payment for routine costs associated with qualifying clinical trials 
and for items or services needed to treat complications arising from 
participation in such trials. The NCD was revised in July 2007 as 
outlined in CAG-00071R, the ``Decision Memorandum for the Clinical 
Trial Policy,'' which may be found at https://www.cms.hhs.gov/mcd. More 
information about the National Coverage Decision on Clinical Trials can 
be found on the CMS Web site at http://www.cms.hhs.gov/ClinicalTrialPolicies/ and through a Medicare Learning Network article 
at http://www.cms.hhs.gov/MLNMattersArticles/.
    We are very aware of the importance of clinical trial research in 
the treatment of cancer, and we do not believe that CAP participation 
has imposed any undue hardships on participating CAP physicians or 
their Medicare patients who engage in such activities. Participating 
CAP physicians do not have to buy and bill for the medications they 
receive from the approved CAP vendor. The vendor is responsible for 
billing the designated carrier and the beneficiary. Thus, if the 
standard of care drug needed for the control group of a research 
protocol is on the CAP drug list, the participating CAP physician may 
order the medication from the approved CAP vendor. This should not 
affect the participating CAP physician's ability to enroll Medicare 
patients in clinical trials. Moreover, participating CAP physicians may 
still purchase and bill for medications that are not on the CAP drug 
list through the ASP system, which would allow them to obtain the non-
CAP drugs required in a research protocol. If a particular NDC for a 
drug is not on the CAP drug list but is part of the research protocol, 
a participating CAP physician may buy the medication on their own and 
bill for it via the ``furnish as written'' provision, which allows the 
physician to bill for the drug under the ASP methodology in that 
instance, even though it is on the CAP drug list.
    Though we have had no reports that CAP physicians have been 
prevented from engaging in clinical trial research because of their CAP 
participation, we are mindful that this could be an issue because of 
the way some studies are structured. In the event that we receive 
comments that demonstrate that this has become a problem in the future, 
we will address the issues accordingly and possibly propose mechanisms 
to facilitate participation in clinical trial research and the CAP.
    We would also like to reemphasize that CAP is a voluntary program. 
If physicians do not believe that the ``furnish as written'' option and 
the CAP drug list are sufficient to meet their clinical research needs, 
then they may decline to join the CAP and continue to purchase and bill 
for medication under the ASP system.
    We also are cognizant of the importance of preserving drug quality 
and integrity in the CAP and have structured the program accordingly. 
The importance of drug quality and oversight are recognized in both the 
vendor bidding process and in the CAP dispute resolution process 
administered by the designated carrier. We have discussed our concern 
for maintaining CAP drug quality in the program as a whole on several 
occasions, most recently in the CY 2006 PFS final rule with comment 
period (70 FR 70244). Section 1847B of the Act and Sec.  414.908(b) 
delineate several requirements that vendors must meet in order to be 
selected to participate in the CAP, including an ability to ensure 
product integrity, at least 3 years experience in furnishing Part B 
Injectable drugs, and acquisition of all CAP drugs directly from the 
manufacturer or from the distributor that has acquired the products 
directly from the manufacturers. After an entity has been awarded a 
contract, we work closely with the CAP-designated carrier and the 
approved CAP vendor to monitor and respond to any concerns that are 
raised by participating CAP physicians under the dispute resolution 
process.

[[Page 66273]]

    We have not received any complaints regarding CAP drug quality and 
integrity. If such an event were to occur, it would be investigated and 
resolved promptly so that patient health and safety would not be 
jeopardized. In light of all of these requirements and protections, we 
do not believe that research and CAP participation are incompatible.
    At this time, we are finalizing the remaining provisions of this 
section.

Competitive Acquisition Program (Sec.  414.908)

    This section specifies the process for a physician to select an 
approved CAP vendor. It also details the responsibilities of a 
participating CAP physician, such as including the specific information 
required on the prescription order, notifying the CAP vendor about 
changes in drug administration, and adhering to the timeframe for 
submission of claims.
    Moreover, Sec.  414.908 delineates the process for selecting 
approved CAP vendors. It also outlines additional factors that are 
considered both during and after the vendor selection process such as 
exclusion of entities from participation in Medicare or other Federal 
health care programs under section 1128 of the Act.
i. 2005 Comments
(a) Physician Administrative and Financial Burden
    Comment: We received several comments from individual physicians 
and physician groups expressing their concern that CAP could place a 
significant burden on physicians. Some commenters stated that the 
requirement to maintain a separate inventory of CAP drugs will increase 
physicians' administrative burden and costs. Others indicated that 
physicians would have no incentive to participate in the CAP unless 
these extra administrative costs could be reimbursed. One commenter 
indicated that the program was impractical and economically unfeasible.
    Response: In the July 6, 2005 IFC (70 FR 39049), we discussed the 
issue of administrative burden. Although we agree that a physician may 
have to make some adjustments in his or her practice in order to comply 
with the requirements of the CAP, we believe that the relief from the 
financial burden of purchasing drugs and billing Medicare for them will 
be a substantial benefit for many physicians. We do not believe that 
the clerical and inventory resources associated with participation in 
the CAP exceed the clerical and inventory resources associated with 
buying and billing drugs under the ASP system. A physician is free to 
design his or her practice in a way that minimizes the extent of 
changes necessary to comply with the CAP requirements. For example, an 
electronic inventory of CAP drugs is required, but separate drug 
storage is not; it is a suggested option if such a procedure makes it 
easier on the physician's practice to track the CAP drugs. We recognize 
that although a physician's staff or their software vendor may need to 
make system changes to bill using the CAP format and to accommodate the 
CAP modifiers and prescription numbers, these initial changes would be 
a one-time occurrence.
    In the ASP system, the payment for clerical and inventory resources 
associated with buying and billing for drugs is bundled into the drug 
administration payment under the physician fee schedule. We have 
adopted this same logic in the CAP and believe that the drug 
administration payment is sufficient to cover any associated expenses 
of participating in the CAP.
    If a physician perceives that CAP participation would be more 
burdensome than the ASP system, then he or she is under no obligation 
to join the CAP because it is a voluntary program. Additionally, as 
described in other parts of this rule, participating CAP physicians may 
also petition to terminate their CAP election due to exigent 
circumstances through the dispute resolution process in the event that 
they find the participation in the program becomes a burden.
    Comment: One commenter expressed disappointment that community 
mental health centers (CMHCs) cannot elect to participate in the CAP.
    Response: As noted in the July 6, 2005 IFC (70 FR 39030), CMHCs can 
not elect to participate in the CAP for provision of Part B drugs. The 
CAP statute is clear that only physicians may elect to have section 
1847B of the Act apply in lieu of the ASP payment methodology.
    (b) E-Prescribing
    Comment: One commenter recommended that CAP vendors should be 
capable of accepting and submitting e-prescribing transactions in 
accordance with the final e-prescribing standards issued for Medicare 
Part D. The commenter reasoned that vendor compliance would not be an 
undue hardship because vendors already will have a fairly rigorous 
technical infrastructure in place.
    Response: Section 101 of the MMA amended title XVIII of the Act to 
establish a voluntary prescription drug benefit program. The MMA 
electronic prescription program provisions found in section 1860D-4(e) 
of the Act apply to the electronic transmission of prescription and 
certain prescription-related information for Medicare Part D drugs for 
Part D eligible individuals. The Part D e-prescribing requirements do 
not apply to the electronic transmission of prescriptions and 
prescription related information for Part B drugs unless those 
prescriptions are written for Part D eligible persons and the 
prescribed drug is a Part D drug. Prescription Drug Plan (PDP) sponsors 
Medicare Advantage (MA) organizations offering Medicare Advantage-
Prescription Drug Plans (MA-PD) are required to establish electronic 
prescription drug programs to provide for electronic transmittal of 
certain information to the prescribing provider and dispensing pharmacy 
and pharmacist. Prescribers and dispensers of Part D drugs are not 
required to write prescriptions electronically, but those that do so 
would be required to comply with any applicable final e-prescribing 
standards that are in effect when they conduct electronic prescription 
transactions, or seek or transmit prescription information or certain 
other related information electronically.
    We responded to a comment on whether participating physicians would 
be required to incorporate e-prescribing technologies into the CAP in 
the July 6, 2005 IFC (70 FR 39039). At that time, we stated that we 
would monitor the development of the program to see if some aspects of 
it could be adapted to the CAP. Since publication of the IFC, we have 
adopted three foundation standards (70 FR 67568), recognized six 
initial standards in a Request for Applications (RFA) (Available 
through http://www.grants.nih.gov/grants/guide/rfa-files/FRA-HS-06-001.htm), and conducted a pilot program in 2006 to test the six initial 
standards and their ability to interoperate with the foundation 
standards. More information about the MMA e-prescribing program and the 
outcome of the pilots can be found on the CMS Web site at http://www.cms.hhs.gov/EPrescribing/. The MMA requires the adoption of 
additional standards by the Secretary by April 1, 2008. We will 
continue to track the development of the e-prescribing program to see 
whether it would be appropriate to incorporate some of the program's 
elements into the CAP at a later date.

[[Page 66274]]

(c) The Comprehensive Error Rate Testing (CERT) Program and CAP Claims
    The purpose of the CERT program is to monitor and report the 
accuracy of Medicare fee for service payments. In the July 6, 2005 IFC 
(70 FR 39038), we discussed CERT and how it would apply to CAP claims. 
While we anticipated that CERT would apply to CAP, the process had not 
been determined at that point. We received no additional comments on 
this issue and have implemented CERT review of CAP claims since 
publication of the July 6, 2005 IFC. CAP claims paid by the designated 
carrier may be selected for review in a manner consistent with other 
claims the carrier processes.
(d) 14-Day Billing Requirement
    In the July 6, 2006 IFC (70 FR 39050), we summarized and responded 
to comments about the 14-day requirement for physicians to file claims 
for CAP drug administration. Although a number of commenters considered 
the time period to be too brief and were opposed to it, we decided to 
implement the 14-day requirement at Sec.  414.908(a)(3)(x) because the 
approved CAP vendor's payment for drugs furnished under the CAP 
depended on a match between the vendor's drug claim and the physician's 
drug administration claim. Implementation of the post-payment review as 
mandated by section 108 of the MIEA-TRHCA has superseded our original 
implementation of CAP claims processing procedures, which had required 
a pre-payment claims matching process for CAP drug claims, and the 14-
day billing requirement was not finalized in previous rules (70 FR 
70260).
    Comment: In 2006 several commenters asked us to allow at least 30 
days or more for physicians to submit CAP drug administration claims. 
During this comment period, we also received several comments stating 
that the 14-day requirement be withdrawn because changes to the claims 
processing system made it unnecessary and such an action would 
encourage physician participation in the CAP.
    Response: Our 14-day standard was based on a review of Medicare 
claims that showed approximately 75 percent of part B drug and drug 
administration claims were submitted within 14 days of the date of 
service. It was initially implemented as a means of facilitating the 
CAP claims matching process that was in effect prior to the 
implementation of the post-payment review process as mandated by 
section 108 of the MIEA TRHCA. As the commenters indicated, a 14-day 
requirement is less than is allowed under claim submission requirements 
used in other parts of the program.
    We agree that the claims processing changes required by Section 108 
of MIEA-TRHCA have altered the role of the claims submission standard. 
However, we do not believe that it has eliminated the need for a 
claims-matching process under the CAP. Under the new payment process 
that resulted from the MIEA-TRHCA, the CAP-designated carrier also 
conducts a pre-payment review in which it checks for any local carrier 
decisions about medical necessity prior to paying for drug claims 
submitted by the approved CAP vendor. Retaining a claims submission 
requirement for participating CAP physician drug administration claims 
may prevent the agency from paying for drugs that have been denied on a 
medical necessity basis by the local carrier because when the local 
carrier reviews the physician's claim it makes a determination on 
whether the CAP drug that was administered was medically necessary. We 
are not eliminating the requirement for prompt billing altogether, as 
requested by commenters, because it will continue to facilitate a 
quicker determination that the drug can be administered.
    However, we acknowledge that a somewhat longer claims submission 
standard would not adversely affect the post-payment review process 
because it still would allow for a relatively quick match between the 
claim for a particular dose of a CAP drug and the claim for its 
administration. Also, separate analyses of previous claims submission 
data and CAP drug claims lead us to conclude that the overwhelming 
majority of participating CAP drug administration claims are submitted 
within 30 days of the date of service. We further believe that, in 
light of the comments, increasing the 14-day claims submission 
requirement would make the CAP more appealing to physicians and provide 
them with greater claims submission flexibility.
    Therefore, we are increasing the requirement for timely CAP drug 
administration claim submission from 14 days to 30 days. We are 
finalizing the requirements at Sec.  414.908 to include this revision.
ii. Regulatory Text
    At this time, we are finalizing Sec.  414.908 as amended to reflect 
the changes discussed in this final rule with comment period.

The Bidding Process (Sec.  414.910)

    This section outlines the specific criteria for the submission of a 
bidding price for a CAP drug, and specifies what costs should be 
included in the bid price. We received no comments on this provision 
and are now finalizing the regulatory text for Sec.  414.910.

Conflicts of Interest (Sec.  414.912)

    Section 414.912 states conflict of interest requirements and 
standards that vendor applicants and approved CAP vendors must meet in 
order to participate in CAP. We received no comments on this provision, 
and therefore, are finalizing Sec.  414.912.

Terms of Contract (Sec.  414.914)

    Section 414.914 outlines the contract provisions between CMS and 
the approved CAP vendor such as contract length and termination, and 
specific requirements that the approved CAP vendor must comply with.
i. 2005 Comments
(a) Licensure Requirements for Cap Pharmacies and Distributors
    Comment: Some commenters requested clarification on the types of 
licenses that are required of CAP vendors. A few commenters also asked 
us to specify whether a CAP vendor will be operating as a pharmacy or 
as a wholesale distributor since licensing requirements and regulatory 
laws for these two types of entities can vary by state, and since 
pharmacies and distributors are two different models.
    Response: As specified in Sec.  414.914, approved CAP vendors and 
their subcontractors must meet applicable licensure requirements in 
each State in which it supplies drugs under the CAP. This includes 
appropriate licensure in States that the CAP vendor ships drug to even 
though the vendor does not maintain a physical establishment in these 
States. In the July 6, 2005 IFC (70 FR 39066), we stated that a vendor, 
its subcontractor, or both must be licensed appropriately by each State 
to conduct its operations under the CAP. Therefore, a vendor under the 
CAP would be required to be licensed as a pharmacy, as well as a 
distributor if a State requires it. It is the CAP vendor's 
responsibility to determine which State and national requirements it 
must adhere to. Based on our experience with the CAP, we are not 
persuaded by the comments that any changes to this policy are necessary 
at this time.
ii. Regulatory Text
    We finalized portions of Sec.  414.914 in the CY 2006 PFS final 
rule with

[[Page 66275]]

comment period (70 FR 70333) and are now finalizing the remainder of 
the regulatory text.

Dispute Resolution for Vendors and Beneficiaries (Sec.  414.916)

    This section discusses the steps, timeframes, and requirements of 
the dispute resolution process that are available to an approved CAP 
vendor and beneficiaries to address the issue of denied CAP drug 
claims. It also describes the protocol that physicians would utilize to 
appeal the suspension of their CAP contract.
    We did not receive any comment on this comments on this provision 
in response to the CY 2006 PFS proposed rule. However, a revision to 
this section will be made in light of the exigent circumstance 
discussion in section (g) of this section of the preamble. We are 
revising Sec.  414.916(c) to clarify that the physician reconsideration 
process would apply to reconsiderations of our decision on whether the 
participating CAP physician may opt out of the CAP. We are finalizing 
Sec.  414.916 at this time.

Dispute Resolution and Process for Suspension or Termination of 
Approved CAP Contract (Sec.  414.917)

    This section discusses the steps and timeframes of the process 
available to participating CAP physicians for the resolution of quality 
or service issues concerning an approved CAP vendor.
    We did not receive any comments on this section during the comment 
period for the July 6, 2005 IFC. Comments that we received on this 
section during the comment period for the CY 2008 PFS proposed rule are 
discussed above in this section. We are now finalizing the regulatory 
text for this section as described in this final rule with comment 
period.

Assignment (Sec.  414.918)

    Section 414.918 specifies that payment for a competitively biddable 
drug may be made only on an assignment related basis. We received no 
comments on this provision and are now finalizing Sec.  414.918.

Judicial Review (Sec.  414.920)

    Section 414.920 outlines the areas under the CAP that are not 
subject to administrative or judicial review. We received no comments 
on this provision and are now finalizing this section.
m. Brief Summary of Comments We Are Not Addressing
    In response to the FY 2007 IPPS final rule with comment period (71 
FR 47870), we received a comment related to the payment rate for 
intravenous immunoglobulin (IVIG) therapy in Medicare. We will not be 
addressing this comment since it is outside the scope of both the CY 
2008 PFS proposed rule and the FY 2007 IPPS final rule with comment 
period. In addition, in response to the CY 2007 PFS proposed rule, one 
commenter recommended that we implement continuous open enrollment in 
the CAP and eliminate the requirement for annual physician election, 
and specify who are the appropriate people to sign the CAP election 
form. We are not addressing these comments because it is outside the 
scope of the proposed rule.

G. Issues Related to the Clinical Laboratory Fee Schedule

1. Date of Service for the Technical Component of Physician Pathology 
Services (Sec.  414.510)
    In the CY 2007 PFS final rule with comment period (72 FR 69787), we 
added Sec.  414.510 for the date of service of a clinical diagnostic 
laboratory test that uses a stored specimen.
    When we added Sec.  414.510, we indicated the provision applies to 
clinical diagnostic laboratory tests. For outpatients, clinical 
diagnostic laboratory tests are paid under the Medicare Part B clinical 
laboratory fee schedule. Upon further review, we believe the provision 
should also apply to the technical component (TC) of physician 
pathology services. In practice, the collection date for both clinical 
laboratory services and the TC of physician pathology services is 
similar. Therefore, we believe Sec.  414.510 should apply to both types 
of services. This will improve claims processing and adjudication in 
relation to the clarity of dates of service, accuracy of payment, and 
detection of duplicate services. For outpatients, the TC of physician 
pathology services can be paid under the Physician Fee Schedule (PFS) 
or the hospital Outpatient prospective payment system (OPPS). As a 
result, for Sec.  414.510, in the CY 2008 PFS proposed rule (72 FR 
38160), we proposed to revise the section heading and introductory 
sentence to specify that the provision applies to both clinical 
laboratory and pathology specimens. We also proposed revising Sec.  
415.130(d) to include a reference to Sec.  414.510.
    Comment: Some commenters supported our proposal to revise the 
section heading and introductory sentence for Sec.  414.510 to specify 
that the provision applies to both clinical laboratory and pathology 
specimens. (We also proposed revising Sec.  415.130(d) to include a 
reference to Sec.  414.510.) One commenter asked that we clarify 
whether the provision applies to pathology tests where the technical 
component and the professional component (PC) are performed by the same 
lab and billed globally.
    Response: Concerning one line global billing, we would like to 
point out that the TC and the PC of a laboratory test should be on 
separate line items on the same claim when two different dates of 
service are involved, even when both services are performed by the same 
independent laboratory. One line global billing is not appropriate in 
this instance. Program instructions on this issue will be forthcoming.
    Comment: One commenter requested revisions to our regulations to 
specify that if the clinical laboratory test specimen is collected 
outside the hospital by nonhospital personnel, the beneficiary 
qualifies as a nonhospital patient.
    Response: We do recognize that the determination of whether the 
beneficiary qualifies as an inpatient, outpatient, or nonpatient is 
important for payment purposes. However, we do not agree that the 
laboratory date of service regulation should be amended to address the 
employment arrangements of the personnel performing the specimen 
collection. Furthermore, this comment is outside the scope of our 
proposal to broaden the clinical laboratory date of service rules we 
adopted last year.
    We continue to believe the date of service should relate to clear 
calendar dates for the specimen collection and day of discharge from 
the hospital if the specimen was collected while the patient was 
undergoing a hospital procedure.
    We are implementing our proposed regulation at Sec.  414.510 on the 
date of service of the TC of the physician pathology service.
2. New Clinical Diagnostic Laboratory Test (Sec.  414.508)
a. Background
    In the CY 2007 PFS final rule with comment period (71 FR 69701), we 
adopted a new subpart G under part 414 that implemented section 942(b) 
of the MMA requiring that we establish procedures for determining the 
basis for, and amount of payment for any clinical diagnostic laboratory 
test for which a new or substantially revised HCPCS code is assigned on 
or after January 1, 2005 (``new tests'').
    Under Sec.  414.508, we use one of two bases for payment to 
establish a payment amount for a new test. Under Sec.  414.508(a), the 
first basis, called

[[Page 66276]]

``crosswalking,'' is used if a new test is determined to be comparable 
to an existing test, multiple existing test codes, or a portion of an 
existing test code. If we use crosswalking, we assign to the new test 
code the local fee schedule amount and national limitation amount (NLA) 
of the existing test code or codes. If we crosswalk to multiple 
existing test codes, we determine the local fee schedule amount and NLA 
based on a blend of payment amounts for the existing test codes. The 
second basis for payment is ``gapfilling.'' Under Sec.  414.508(b), we 
use gapfilling when no comparable existing test is available. We 
instruct each Medicare carrier or MAC to determine a carrier-specific 
amount for use in the 1st year that the new code is effective. The 
sources of information that these carriers or MACs examine in 
determining carrier-specific amounts include:
    <bullet> Charges for the test and routine discounts to charges;
    <bullet> Resources required to perform the test;
    <bullet> Payment amounts determined by other payers; and
    <bullet> Charges, payment amounts, and resources required for other 
tests that may be comparable (although not similar enough to justify 
crosswalking) or otherwise relevant.
    After the first year, the carrier-specific amounts are used to 
calculate the NLA for subsequent years. Under Sec.  414.508(b)(2), the 
test code is paid at the NLA, rather than the lesser of the NLA and the 
carrier-specific amounts.
    We instruct our carriers or MACs to use the gapfill method through 
program instruction, which lists the specific new test code and the 
timeframes to establish carrier-specific amounts. During the first year 
a new test code is paid using the gapfill method, contractors are 
required to establish carrier-specific amounts on or before March 31. 
Contractors may revise their payment amounts, if necessary, on or 
before September 1. In this manner, a carrier or MAC may revise its 
carrier-specific amount based on additional information during the 1st 
year.
    In the CY 2007 PFS final rule with comment period (71 FR 69702), we 
also described the timeframes for determining the amount of and basis 
for payment for new tests. The codes to be included in the upcoming 
year's fee schedule (effective January 1) are available as early as 
May. We then list the new clinical laboratory test codes on our Web 
site, usually in June, along with registration information for the 
public meeting.
    The public meeting is held no sooner than 30 days after we announce 
the meeting in the Federal Register. The public meeting is typically 
held in July. In September, we post our proposed determination of the 
basis for payment for each new code and seek public comment on these 
proposed determinations of the basis for payment. The updated clinical 
laboratory fee schedule is prepared in October for release to our 
contractors during the first week in November so that the updated 
clinical laboratory fee schedule is ready to pay claims effective 
January 1 of the following calendar year.
    We received comments in response to the CY 2007 PFS proposed rule 
concerning information to be presented during the public meeting 
process. In responding to these comments in the CY 2007 PFS final rule, 
we stated that we did not believe that opportunities for information 
gathering on new tests have been fully utilized within the public 
meeting process. Payment recommendations from the public have sometimes 
lacked charge, cost, and clinically-detailed information for the new 
clinical laboratory tests. We also stated that when soliciting public 
input for the meeting we would recommend that all participants in the 
public meeting consultation process strive for transparency and try to 
provide as much supporting information as possible to assist us in 
evaluating their recommendations.
    In addition, in the CY 2007 PFS final rule with comment period, in 
response to comments suggesting that the method used by contractors to 
determine their price for gapfilled tests should be more specific, we 
indicated that we would engage in discussions with our carrier 
contractors and laboratory industry representatives to explore their 
experiences with the gapfill process. We also agreed to host a forum to 
listen to suggestions from the public and said that we expected to 
solicit comments on a potential reconsideration process in a future 
rulemaking.
    As explained in the CY 2008 PFS proposed rule, we discussed these 
issues with our contractors. We also solicited comments on the gapfill 
process in the July 16, 2007 clinical laboratory public meeting.
    Discussions with our contractors and other interested parties 
revealed that the length of time we allow for a contractor to establish 
a carrier-specific amount may sometimes be insufficient for obtaining 
additional sources and data on a new test. However, our contractors and 
other interested parties were also concerned that if procedures and 
determinations were permitted to extend over too long a time frame, the 
uncertainty of the final payment amount would be detrimental for 
laboratories, practitioners, and patients for incorporating new 
technology tests and improving patient care. In the CY 2008 PFS 
proposed rule, we also encouraged the public to submit written comments 
on gapfilling and said that we would respond to them to the extent they 
related to a proposal in the rule.
    In the CY 2008 PFS proposed rule, we proposed a reconsideration 
process for determining the basis for and amount of payment for any new 
test for which a new or substantially revised HCPCS code is assigned on 
or after January 1, 2008. This proposed change attempted to balance 
additional opportunities for public input against the necessity for 
establishing final fees for new clinical laboratory test codes.
    Section 1833(h)(8)(A) of the Act provides broad authority to 
develop through regulation procedures for the method for determining 
the basis for and amount of payment for new tests. We believe that we 
have authority under section 1833(h)(8)(A) of the Act to establish 
procedures under which we may reconsider the basis for and amount of 
payment for a new test. Furthermore, under section 1833(h)(8)(D) of the 
Act, the Secretary may convene such other public meetings to receive 
public comments on payment amounts for new tests as the Secretary deems 
appropriate.
    We note that, under both section 1833(h)(8)(B)(v) of the Act and 
Sec.  414.506(d)(2), the Secretary must make available to the public a 
list of ``final determinations.'' We do not believe that these 
provisions preclude us from reconsidering our final determinations. It 
is not unusual for us to provide for discretionary reopening or 
reconsideration of final agency action. It is not unusual for us to 
provide for discretionary reopening or reconsideration of final agency 
action. For example, under Sec.  405.1885, we may reopen a final agency 
determination regarding payment to a provider of services.
    Comment: Commenters were supportive of our proposal to add Sec.  
414.509 concerning a reconsideration process for new lab test payment 
determinations. Generally, commenters believed that in contrast to 
several other payment systems, which have been significantly revised in 
the last several years, the procedures for operating the clinical 
laboratory fee schedule have remained relatively static. They further 
commented that the implementation of a reconsideration process would be 
a significant step in helping assure reasonable pricing decisions for 
new

[[Page 66277]]

tests, and they commended us for our actions in this regard.
    Response: We appreciate the support for our proposal for a 
reconsideration process for new lab test payment determinations. We 
believe this additional opportunity to revisit payment determinations 
for clinical laboratory test codes will foster accurate payment levels 
for new tests. We will discuss specific suggestions for revisions to 
Sec.  414.509 below in this section.
b. Basis for Payment
    Under our existing procedures for determining the basis for payment 
of a new test, either to crosswalk or gapfill, we receive comments on 
the appropriate basis for payment for a new test both at the public 
meeting in July and after we announce our proposed determinations in 
September. In November, we post our determination on the basis for 
payment for the new test on the CMS Web site. This determination of the 
basis for payment is final, except in the case of a gapfilled test for 
which we later determine that gapfilling is not appropriate under Sec.  
414.508(b)(3).
    In the CY 2008 PFS proposed rule, we proposed to create a 
reconsideration process for determinations of the basis, either 
crosswalking or gapfilling, for payment of a new clinical diagnostic 
laboratory test. Consistent with our existing process, we would make a 
determination using the information gathered from the public meeting 
process and post a determination of the basis for payment, either to 
crosswalk or gapfill, on the CMS Web site, likely in September. We 
would accept written comments asking for a reconsideration on this 
basis determination for 30 days after we posted the determination on 
the CMS Web site. If a commenter recommended that we switch from 
gapfilling to crosswalking for a new code, the commenter would also 
have the opportunity to recommend the code or codes to which to 
crosswalk the new test code. Under Sec.  414.508, claims would be paid 
using this basis to calculate fees beginning January 1.
    After considering the comments received and the information from 
the public meeting, we would post our decision on our Web site as to 
whether we elect to reconsider our determination of the basis for 
payment. If we elect to reconsider the basis for payment (that is, 
whether to crosswalk or gapfill a test), we would post our 
determination as to whether we would change the basis for payment on 
the CMS Web site. Our decision regarding the basis for payment would be 
final and not subject to further reconsideration.
    If we change our prior determination of the basis for payment, the 
new determination would be effective on January 1. We would not reopen 
or otherwise reprocess claims with dates of service prior to the 
effective date of the revised determination.
    We note that, under our proposed reconsideration processes (for 
both the basis for payment and amount of payment) we would make two 
separate decisions. First, we would decide whether to reconsider our 
prior determination. If we elect to reconsider our prior determination, 
we would then determine whether we should change our prior 
determination.
    Comment: One commenter suggested that the agenda for the public 
meeting should announce a list of requests received by CMS to 
reconsider the basis for and amount of payment for a new clinical 
laboratory test, and the agenda should invite comment, either written 
or orally, on the requests. The commenter stated that in this way, we 
will receive views on the validity of the requests for reconsideration. 
Another commenter indicated that more than one public meeting per year 
should be hosted by CMS to discuss comments under the reconsideration 
process, as well as the payment determination process.
    Response: We are receptive to suggestions on providing information 
about the public meeting agenda. We do not believe a revision to the 
regulatory text at subpart of Sec.  414.509(a) is required in order to 
disseminate information on our meetings. We publish a public meeting 
notice in the Federal Register to announce the meeting. The notice 
includes many details about the purpose and registration process for 
the meeting and also refers to additional Web site information for the 
meeting. If we receive a request to reconsider the basis of payment for 
a new test within the 60-day window after we post our basis of payment 
on the CMS Web site, the requestor could also request to present his or 
her comment orally at the next clinical laboratory public meeting. We 
can include this information in the meeting agenda that will be posted 
on the CMS Web site. Members of the public who are interested in 
addressing a particular reconsideration request at the laboratory 
public meeting can let us know of their interest in doing so after they 
review the reconsideration requests that will be addressed at the 
laboratory public meeting. In addition, we will accept written comments 
on the reconsideration request after the public meeting. We will accept 
written comments during the same time period we set for accepting other 
comments after the clinical laboratory public meeting--usually 2 weeks. 
We note that, if the party that submitted the reconsideration request 
does not choose to present at the public meeting, members of the public 
may not comment on the reconsideration request and we will not accept 
written comments.
    However, hosting more than one public meeting per year is a timing 
issue which is limited by the constraints of the process. Currently, 
there is a limited amount of time between the receipt of the new test 
codes for the upcoming year and the deadline to issue them via CMS 
instruction; therefore, we cannot accommodate two public meetings in a 
year. As a result, we are finalizing Sec.  414.509(a) with revisions to 
specify that other commenters may speak about reconsideration requests 
on the laboratory public meeting agenda and that we will accept written 
comments on reconsideration requests addressed at the public meeting.
c. Amount of Payment
i. Crosswalking
    Under our existing procedures, commenters recommend the code or 
codes to which to crosswalk a new clinical laboratory test both at the 
public meeting in July and during the comment period after we issue our 
proposed determination in September. We consider the appropriate basis 
for payment and the amount of payment at the same time. Therefore, 
commenters that recommend crosswalking as the basis for payment for a 
new test also make recommendations concerning the code or codes to 
which to crosswalk the new test. In November, we post the code or codes 
to which we will crosswalk the test and the payment amount for the test 
on the CMS Web site. This determination is final.
    In the CY 2008 PFS proposed rule (72 FR 38162), we proposed to 
create a reconsideration process under which we may reevaluate the code 
or codes and their corresponding fees to which we crosswalk a new 
test's fees. We would accept reconsideration requests and written 
comments on the crosswalked code or codes and the resulting amount of 
payment for the new code for 60 days after we posted the determination 
on the CMS Web site, sometime in November. In addition, we proposed 
that a commenter who had submitted a written comment within the 60-day 
comment period would also be given the opportunity to present its 
comment at the public meeting. After considering the comments received 
and the

[[Page 66278]]

information of the public meeting, we would post our decision as to 
whether we had elected to reconsider our determination of the 
crosswalked code or codes and the resulting amount of payment on the 
CMS Web site. If we elect to reconsider the amount of payment and had 
determined that we should revise the amount of payment, we would post a 
new determination of the code or codes to which we would crosswalk the 
test on the CMS Web site. We proposed that, after we posted our 
determination of the code or codes to which the test would be 
crosswalked on the CMS Web site, we would pay claims on the basis of 
this determination beginning January 1. Our decision regarding the 
amount of payment would be final and not subject to further 
reconsideration.
    If we change our prior determination of the amount of payment, the 
new determination would be effective January 1. We would not reopen or 
otherwise reprocess claims with dates of service prior to the effective 
date of the revised determination.
    As discussed in section II.G.2.b., we may also change the basis for 
payment for a new test as the result of reconsideration. If we change 
the basis for payment from gapfilling to crosswalking, we would also 
determine the code or codes to which we would crosswalk the test. 
Because we believe it is important to establish final payment amounts 
within a reasonable amount of time, we also proposed that these 
determinations of crosswalked payment amounts would not be subject to 
reconsideration.
    Comment: Some commenters indicated that Sec.  414.509(b)(1) should 
establish payment amounts at the national limitation amount (NLA) of 
the tests to which the new tests are crosswalked. The NLA should 
replace carrier-specific amounts below the NLA for new tests. The 
commenters believe that if the amount of payment is lower than the NLA 
in a carrier's geographic area, patient access to a new test will be 
limited in the geographic area.
    Response: In the CY 2008 PFS proposed rule, we did not make policy 
proposals regarding the level of payment for crosswalked tests. Rather, 
our policy proposals were limited to the reconsideration process. 
Accordingly, we believe that this comment is outside of the scope of 
this rulemaking
    Comment: One commenter suggested that a similar reconsideration 
process should also be available for existing laboratory tests. The 
commenter pointed out that the payment amounts determined for certain 
laboratory tests by one or another Medicare carrier or MAC now differ 
from the payment amounts determined for these same tests by other 
Medicare contractors and from the corresponding NLA.
    Response: Section 1833(h)(1) of the Act sets forth the calculation 
of the payment amounts for test codes included on the clinical 
laboratory fee schedule to be the lower of the charge submitted, the 
carrier-specific amount, or the NLA. We believe changes to payment 
amounts for tests that are not ``new tests'' under section 
1833(h)(8)(A) of the Act would require a statutory change.
    Comment: One commenter recommended that CMS clarify how fee 
schedule amounts below the NLA will be adjusted as carriers are phased 
out and their functions are moved to MACs.
    Response: This comment is outside the scope of our proposal. If 
necessary we may address this comment in a future program memorandum.
    We are finalizing Sec.  414.509(b)(1). Consistent with the 
revisions we made to Sec.  414.509(a), we are revising Sec.  
414.509(b)(1) to provide that other commenters may speak about 
reconsideration requests on the lab public meeting agenda and that we 
will accept written comments on reconsideration requests addressed at 
the public meeting.
ii. Gapfilling
    As discussed in this preamble and in accordance with Sec.  
414.508(b), after we determine that gapfilling will be the basis for 
payment for a new clinical diagnostic laboratory test, we instruct our 
carriers or MACs to determine carrier-specific gapfill amounts by April 
1 and finalize carrier-specific amounts by September 30. We include the 
determinations of carrier-specific amounts and the NLA for the new test 
code in the clinical laboratory fee schedule the following November 
when we post our payment determinations on the CMS Web site. Except in 
the case of a gapfilled test for which we determine that gapfilling was 
not appropriate under Sec.  414.508(b)(3), these determinations are 
final.
    We proposed to provide for a reconsideration process for gapfilled 
payment amounts. Under this process, by April 30, we would post the 
carrier-specific amounts on the CMS Web site at http://www.cms.hhs.gov/ClinicalLabFeeSched/02_clinlab.asp.
    Interested parties would submit written comments to CMS (which we 
would provide to the carriers for their consideration) on the carrier-
specific amounts within 60 days from the date of posting the carrier-
specific amounts.
    In the CY 2008 PFS proposed rule, we stated that carriers or MACs 
would finalize carrier-specific amounts by September 30 and that we 
would set the NLA at the median of the carrier-specific amounts, and we 
would post the carrier-specific amounts and the NLA on our Web site. In 
addition, we stated that the public would have 60 days to submit a 
reconsideration request.
    We also proposed that if we elect to act on the reconsideration 
request to reconsider the carrier-specific amounts and decide to revise 
our prior determination, we would adjust the NLA based on comments 
received. We would post the revised NLA on the CMS Web site and payment 
for the test would be made at the NLA beginning January 1. This 
determination would be final and not subject to further 
reconsideration.
    In addition we proposed that, if we change the basis of payment 
from crosswalking to gapfilling as the result of a reconsideration, the 
new gapfilled payment amount would be subject to reconsideration under 
proposed Sec.  414.509(b)(2). Unlike a crosswalked test, the payment 
amount for a gapfilled test is not established when we determine the 
basis for payment because it takes approximately 9 months for our 
contractors to establish carrier-specific amounts. Thus providing for 
reconsideration of gapfilled payment amounts would not lengthen the 
period of time it would take to determine a final payment amount.
    We proposed to amend Sec.  414.508(b)(3) to provide that Sec.  
414.508(b)(3) applies to new tests for which a new or substantially 
revised HCPCS code assigned on or before December 31, 2007. We proposed 
that the more comprehensive reconsideration procedures would apply to 
new or substantially revised HCPCS codes assigned after December 31, 
2007.
    Comment: One commenter suggested that we should accept comments 
after the carrier-specific amounts become final, which is currently on 
September 30.
    Response: We appreciate this commenter's input. We have decided to 
revise the reconsideration process that we proposed. Under the final 
policy we are adopting in this final rule with comment period, we will 
post interim determinations of carrier-specific amounts on the CMS Web 
site in April and, for 60 days, we will accept written comments that we 
will share with our carriers and MACs. However, we will not accept 
reconsideration requests on the interim carrier-specific amounts. In 
September, we will post final carrier-

[[Page 66279]]

specific amounts on the CMS Web site. Interested parties may request 
reconsideration of the final carrier-specific amounts within 30 days of 
when we post the final carrier-specific amounts on the CMS Web site. 
Based on the written reconsideration requests received, we would 
evaluate whether we should reconsider the carrier-specific amounts and 
NLA.
    If we elect to reconsider the carrier-specific amounts and the NLA, 
we will process the request for reconsideration between the end of the 
30-day comment period and the deadline for dissemination of the 
information to the Medicare carriers or MACs via CMS instruction so 
that we can finalize our determinations prior to January 1. A request 
for reconsideration can be denied or reconsidered for a different 
payment amount.
    If we elect not to reconsider the carrier-specific amounts and the 
NLA, we will post the carrier-specific amounts and NLA on the CMS Web 
site on or before January 1. These amounts would be based on the 
carrier-specific amounts and NLA we had posted in September. Payment 
for the test would be made at the NLA on January 1. This determination 
would be final and not subject to further reconsideration.
    In addition, after the final test codes and payment amounts are 
effective on January 1, there is no reconsideration process that occurs 
after that date.
    Comment: One commenter suggested that CMS provide a rationale for 
either accepting or declining a reconsideration after it is received 
and for deciding whether to change a prior determination.
    Response: We do not plan to post a rationale for our decision to 
accept or decline a reconsideration request. This is consistent with 
our policy in other areas of the Medicare program when we make a 
decision about whether to reopen a previous decision.
    Comment: One commenter suggested that we should convene an expert 
advisory committee, broadly representative of the laboratory industry, 
to advise CMS on pricing along with standardizing the sources and 
quality of charge and cost data.
    Response: The purpose of the Clinical Laboratory public meeting is 
to convene industry experts and entertain comments, both orally and in 
writing, as well as any charge and cost data that is available from the 
industry. In fact, we specifically asked, via public notice, those in 
the clinical laboratory industry to provide charge and cost data 
related to the agenda items at the annual public meeting. We welcome 
any related information that industry representatives would like to 
provide via the public meeting forum and during the associated comment 
period.
    Comment: There were specific concerns raised by commenters 
regarding varying payment amounts set by carriers when the gapfilling 
basis is utilized to determine payment amounts for a new test code. 
These commenters recommended that we establish formal procedures for 
carriers or MACs to apply when establishing payment amounts, including 
a formal appeals process. The commenters stated the payment amounts 
should be calculated using information on the following factors, 
resources needed to perform the test, staff expertise, time needed to 
perform the test and the test's potential value. In addition, the 
commenters suggested we should publish the gapfill payment amounts 
determined by carriers or MACs and an explanation of the payment 
amounts.
    Response: Although we appreciate the comments on the establishment 
of payment amounts for new clinical laboratory test codes using the 
gapfill basis and the suggested improvements to the way we set rates, 
these comments are outside the scope of this rulemaking. In the CY 2008 
PFS proposed rule, we proposed policies and requested comment regarding 
our proposed reconsideration process. We made no policy proposals with 
respect to the methodology our contractors use to establish gapfilled 
payment amounts. However, in the interest of transparency we will 
instruct carriers or MACs to provide a rationale for their final 
carrier-specific amounts, which we will post on our Web site.
    Comment: One commenter suggested that we should establish a 
temporary NLA based on the carrier-specific amounts posted on April 30 
within the first year of the gapfill process.
    Response: We appreciate the commenter's suggestion; however, we are 
concerned that establishing a temporary NLA within a 3 month time 
period is not possible due to our substantial program requirements each 
year. Currently, clinical laboratory fee schedule payment rates are 
established on a calendar year basis. During the year preceding each 
January 1, an extensive multi-step process is in place in order to 
bring those payment rates to fruition. Currently, that process does not 
allow for additional ratesetting procedures.
d. Jurisdiction for Reconsideration Decisions
    In the CY 2008 PFS proposed rule (72 FR 38163), we proposed that 
jurisdiction for reconsideration would rest exclusively with the 
Secretary. A decision whether to reconsider a determination would be 
committed to the discretion of the Secretary. Accordingly, a refusal to 
reconsider an initial determination would not be subject to 
administrative or judicial review. We recognize that parties 
dissatisfied with an initial determination as to the amount of payment 
for a particular claim for laboratory services may appeal the initial 
determination under part 405, subpart I of our regulations. Under our 
proposal, a party could challenge under part 405, subpart I a 
determination regarding the amount of payment for a new test--
regardless of whether the amount of payment was established as the 
result of a reconsideration--but a party could not challenge a decision 
not to reconsider.
    Comment: One commenter stated that comments should be allowed on 
the final payment determination amounts.
    Response: This comment appears to request an extension of the 
reconsideration process or a change in the jurisdiction as proposed in 
Sec.  414.509. The commenter did not provide additional information on 
the circumstances that would warrant an extension of the 
reconsideration process. Also, the comment did not specify the length 
of time for an extension or procedures for an extension or change of 
jurisdiction. We believe Sec.  414.506 through Sec.  414.509 permit 
adequate opportunities for public participation in the process of 
establishing a payment amount and requesting a reconsideration. More 
than 2 years can elapse if all steps of these reconsideration 
procedures are necessary for the establishment of the basis and payment 
for a new test code. We do not agree that revisions to Sec.  414.509(d) 
are warranted.
3. Technical Revisions
    We also proposed technical revisions to Sec.  414.502, Sec.  
414.506, and Sec.  414.508. Under section 1833(h)(8)(A) of the Act, the 
term ``new tests'' is defined as any clinical diagnostic laboratory 
test for which a new or substantially revised HCPCS code is assigned on 
or after January 1, 2005. However, our regulations do not define the 
term ``new test.'' Therefore, we proposed to define the term ``new 
test'' under Sec.  414.502 using the statutory definition. In addition, 
under Sec.  414.506 and Sec.  414.508, we proposed to replace 
references to ``new clinical diagnostic laboratory test that is 
assigned a new or substantially revised code on or after January 1, 
2005'' with references to ``new test.''
    Response: We received one supportive comment on this subpart,

[[Page 66280]]

and we appreciate the positive input received on our technical 
revisions. Therefore, we are finalizing the technical revisions as 
proposed.

H. Revisions Related to Payment for Renal Dialysis Services Furnished 
by End-Stage Renal Disease (ESRD) Facilities

    In the CY 2008 PFS proposed rule (72 FR 38163), we outlined the 
proposed updates to the case mix adjusted composite rate payment system 
established under section 1881(b)(12) of the Act, added by section 623 
of the MMA. These included updates to the drug add-on component of the 
composite rate system, as well as the wage index values used to adjust 
the labor component of the composite rate.
    Specifically, we proposed the following provisions which are 
described in more detail below in this section.
    <bullet> A growth update to the drug add-on adjustment to the 
composite rates for 2008 required by section 1881(b)(12)(F) of the Act.
    <bullet> An update to the wage index adjustments to reflect the 
latest hospital wage data, including a reduction to the wage index 
floor and a revised budget neutrality adjustment to the wage index for 
2008.
    We received approximately 7 comments on these proposed changes 
which are discussed in detail below in this section.
1. Growth Update to the Drug Add-On Adjustment to the Composite Rates
    Section 623(d) of the MMA added section 1881(b)(12)(B)(ii) of the 
Act which required the establishment of an add-on to the composite rate 
to account for changes in the drug payment methodology stemming from 
enactment of the MMA. Section 1881(b)(12)(C) of the Act provides that 
the drug add-on must reflect the difference in aggregate payments 
between the revised drug payment methodology for separately billable 
ESRD drugs and the AWP payment methodology. In 2005, we generally paid 
for ESRD drugs based on average acquisition costs. Thus the difference 
from AWP pricing was calculated using acquisition costs. However, in 
2006 when we moved to ASP pricing for ESRD drugs, we recalculated the 
difference from AWP pricing using ASP prices.
    Comment: Two commenters supported our continued use of ASP+6 
percent to pay for separately billable ESRD drugs.
    Response: Although these comments are outside the scope of the 
proposed rule, we appreciate the support of our previous decision to 
pay for separately billable ESRD drugs at ASP+6 percent.
    In addition, section 1881(b)(12)(F) of the Act requires that 
beginning in CY 2006, we establish an annual update to the drug add-on 
to reflect the estimated growth in expenditures for separately billable 
drugs and biologicals furnished by ESRD facilities. This growth update 
applies only to the drug add-on portion of the case-mix adjusted 
payment system.
    The CY 2007 drug add-on adjustment to the composite rate is 14.9 
percent. The drug add-on adjustment for 2007 incorporates an inflation 
adjustment of 0.5 percent. This computation is explained in detail in 
the CY 2007 PFS final rule with comment period (71 FR 69682 through 
69684). We note that the drug add-on adjustment of 15.1 percent that 
was published in the CY 2007 PFS final rule with comment period did not 
account for the 1.6 percent update to the composite rate portion of the 
basic case-mix adjustment payment system that was subsequently enacted 
by the MIEA-TRHCA, effective April 1, 2007. Since we compute the drug 
add-on adjustment as a percentage of the weighted average base 
composite rate, the drug add-on percentage was decreased to account for 
the higher composite payment rate resulting in a 14.9 percent add-on 
adjustment beginning April 1, 2007. This adjustment was necessary to 
ensure that the total drug add-on dollars remain constant.
(a) Estimating Growth in Expenditures for Drugs and Biologicals for CY 
2008
    In the CY 2007 PFS final rule with comment period (71 FR 69682), we 
established a methodology for annually estimating the growth in ESRD 
drugs and biological expenditures that uses the Producer Price Index 
(PPI) for pharmaceuticals as a proxy for pricing growth in conjunction 
with 2 years of ESRD drug data to estimate per patient utilization 
growth.
    For CY 2008, we proposed to continue using this methodology to 
update the drug add-on adjustment, using expenditure data from CY 2005 
and CY 2006 to estimate the growth in per patient utilization of drugs. 
However, we also proposed using only drug expenditure data from 
independent ESRD facilities because we were unable to determine 
utilization change in hospital-based dialysis facilities due to the 
changes in payment methodology for these types of dialysis facilities 
from CY 2005 to CY 2006. In 2005, payments to hospital-based facilities 
were based on cost (or a percentage of charges), whereas payments to 
those facilities in 2006 were based on ASP pricing. Because of the cost 
payment methodology, the ``drug unit'' fields on the 2005 hospital-
based ESRD facility bills were not used for payment purposes, and 
therefore, the data may not have been accurately reported on those 
bills. As such, we were unable to accurately isolate the per unit 
payment differential for hospital-based ESRD facility drug expenditures 
between 2005 (cost payments) and 2006 (ASP payments) for purposes of 
estimating the residual utilization change between years. We proposed 
imputing the same utilization growth for hospital-based ESRD facilities 
as estimated for independent ESRD facilities.
    Comment: One comment urged us to reevaluate the data and 
methodology used to estimate utilization changes. The comment was 
specifically concerned about the timeliness of the data and that the 
exclusion of hospital-based drug data may significantly skew the 
accuracy of the utilization growth calculation. However, the comment 
did not suggest an alternative methodology.
    Response: The data from CY 2005 and CY 2006 represent the most up 
to date and latest full years of data available. Contrary to the 
commenter's suggestion, as we indicated in the CY 2008 PFS proposed 
rule, including hospital-based data in the computation would have 
resulted in a negative utilization growth. Therefore, we opted to 
exclude those data to avoid penalizing ESRD facilities because of the 
problems with the hospital-based ESRD facility drug data. We believe 
our approach provides the most reasonable result given the available 
data.
    Comment: One comment suggested that we adopt an index that would 
account for both price and utilization such as the National Health 
Expenditures (NHE) index. This would avoid the data issues associated 
with estimating utilization growth.
    Response: We do not believe that the NHE projections would be the 
best proxy for growth in ESRD drug expenditures. The NHE projections 
are based on the economic, demographic and Medicare spending 
projections contained in the Medicare Trustees Report as opposed to an 
independent forecast of economic assumptions, such as the Global 
Insights projections of the PPI for prescription drugs that are used in 
our Medicare market basket forecasts to update many of our payment 
systems. The NHE projection modeling approach is at an aggregate level 
and does not capture the nuances of both labor and economic markets as 
accurately as does the specific PPI forecast. We believe that, despite 
some of the limitations in the data, estimating utilization growth

[[Page 66281]]

from reported ESRD claims data provides the most accurate measure of 
actual ESRD facility drug utilization.
    Comment: One comment suggested that the PPI may not result in an 
accurate assessment of prices for ESRD drugs and that there are other 
available indices that would provide more accurate data on ESRD drugs. 
In addition, they stated that should we choose to move forward with the 
PPI, the most up to date PPI forecast should be used.
    Response: We do not know of any better price index than the PPI for 
measuring price growth for ESRD drugs. However, we welcome any 
suggestion the industry may have on an alternative price index suitable 
for measuring price growth of ESRD drugs. Global Insight, Inc. is a 
nationally recognized economic and financial forecasting firm that 
contracts with CMS to forecast the components of our market baskets. 
The current projection of the PPI for prescription drugs is based on 
the 2007 second quarter forecast using historical data through the 
first quarter of 2007, the most current data available at this time.
    Comment: One comment recommended that a mechanism be established to 
provide for a forecasting error adjustment of prior estimates.
    Response: While we appreciate the concern related to the accuracy 
of an update based on proxy measures for price and the proposed 
utilization computations, the very nature of estimating future 
expenditures under a prospective payment system requires that those 
estimates are based on the best historical data available. As such, we 
believe we have met our obligation under the statute in estimating 
growth in ESRD drug expenditures for CY 2008. Moreover, forecast error 
adjustments are rarely made in our prospective payment systems.
(b) Estimating Growth in Per Patient Drug Utilization
    To isolate and project the growth in per patient utilization of 
ESRD drugs for CY 2008, we removed the enrollment and price growth 
components from the historical data and considered the residual to be 
utilization growth. As discussed previously, we proposed to use 
independent ESRD facility drug expenditure data from CY 2005 and CY 
2006 to estimate per patient utilization growth for CY 2008.
    We first estimated total drug expenditures. For the CY 2008 PFS 
proposed rule (72 FR 38165), we used the final CY 2005 ESRD facility 
claims data and the latest available CY 2006 ESRD facility claims data, 
updated through December 31, 2006. That is, for CY 2006 we used claims 
that were received, processed, paid, and passed to the National Claims 
History File as of December 31, 2006. For this final rule with comment 
period, we are using more updated CY 2006 claims with dates of service 
for the same time period. This updated CY 2006 data file includes all 
claims that were received, processed, paid, and passed to the National 
Claims History File as of June 30, 2007 for CY 2006.
    For the CY 2008 PFS proposed rule, we adjusted the December 2006 
file to reflect our estimate of what total drug expenditures would be 
using the final June 30, 2007 bill file for CY 2006. The net adjustment 
we applied to the CY 2006 claims data was an increase of 12 percent to 
the December 2006 claims file. For this final rule with comment period, 
we are using the CY 2006 claims file as of June 30, 2007, which 
represents the final claims file for that year. To calculate the 
proposed per patient utilization growth, we removed the enrollment 
component by using the growth in enrollment data between 2005 and 2006. 
This was approximately 3 percent. To remove the price effect, we 
calculated the weighted difference between 2005 average acquisition 
price (AAP) and 2006 ASP pricing for the original top ten drugs for 
which we had average acquisition prices. We weighted the differences by 
the 2006 independent ESRD facility drug expenditure data. This process 
led to an overall 3 percent reduction in price between 2005 and 2006 
(72 FR 38165 through 38166).
    After removing the enrollment and price effects from the 
expenditure data, the residual growth would reflect the per patient 
utilization growth. To do this, we divided the product of the 
enrollment growth of 3 percent (1.03) and the price reduction of 3 
percent (1.00 - 0.03 = 0.97) into the total drug expenditure change 
between 2005 and 2006 of -0.2 percent (1.00 -0.00 = 1.00). The result 
is a proposed utilization growth factor equal to 1.00 (1.00/1.03 * 
0.97) = 1.00.
    Since we observed no growth in per patient utilization of drugs 
between 2005 and 2006, we proposed no projected growth in per patient 
utilization for all ESRD facilities for CY 2008.
c. Applying the Proposed Growth Update to the Drug Add-On Adjustment
    In the CY 2007 PFS final rule with comment period (71 FR 69684), we 
revised our update methodology by applying the growth update to the per 
treatment drug add-on amount. That is, for CY 2007, we applied the 
growth update factor of 4.03 percent to the $18.88 per treatment drug 
add-on amount for an updated amount of $19.64 per treatment.
    For CY 2008, we proposed to update the per treatment drug add-on 
amount of $19.64 established in CY 2007 by converting the update into 
an adjustment factor as specified in section 1881(b)(12)(F) of the Act.
(i) Update to the Drug Add-On Adjustment
    In the CY 2008 PFS proposed rule (72 FR 38166), we estimated no 
growth in per patient utilization of ESRD drugs for CY 2008. Using the 
projected growth of the CY 2008 PPI for prescription drugs of 3.66 
percent, we projected that the combined growth in per patient 
utilization and pricing for CY 2008 would result in an update equal to 
the PPI growth, or 3.66 percent (1.0 * 1.0366 = 1.0366). This proposed 
update factor was applied to the CY 2007 per treatment drug add-on 
amount of $19.64 (reflecting a 14.9 percent adjustment in CY 2007), 
resulting in a proposed weighted average increase to the composite rate 
of $0.72 for CY 2008 or a 0.5 percent increase in the drug add-on 
percentage. Thus, the total proposed drug add-on adjustment to the 
composite rate for CY 2008, including the growth update was 15.5 
percent (1.149 * 1.005 = 1.155).
    In addition, we proposed to continue to use this method to estimate 
the growth update to the drug add-on component of the case mix adjusted 
payment system until we have at least 3 years worth of ASP-based 
historical drug expenditure data that could be used to conduct a trend 
analysis to estimate the growth in drug expenditures. Given the time 
lag in the availability of ASP drug expenditure data, we expect that 
the earliest we could consider using trend analysis to update the drug 
add-on adjustment would be 2010. We intend to reevaluate our 
methodology for estimating the growth update at that time.
    Comment: One comment suggested that we should work with the kidney 
care community as we consider a CY 2010 transition to trend analysis 
using ASP-based historical data. The comment expressed concern that 
using actual historical ESRD drug expenditure data reflecting ASP 
pricing could adversely affect ESRD facilities due to changes in ASP 
pricing for EPO and Procrit.
    Response: Once we begin using trend analysis to update the drug 
add-on adjustment, we will provide details of that methodology in 
future rulemaking.

[[Page 66282]]

(ii) Final Growth Update to the Drug Add-On Adjustment for 2008
    Similar to the proposed rule, we estimated no growth in per patient 
utilization of ESRD drugs for CY 2008. To remove the price effect, we 
used 2006 weights for each of the top ten ESRD drugs billed by 
independent ESRD facilities. These weights are shown in Table 6.

        Table 6.--CY 2006 Drug Weights for Independent Facilities
------------------------------------------------------------------------
                                                                 2006
                     Independent drugs                         weights
                                                              (percent)
------------------------------------------------------------------------
EPO........................................................         75.2
Paricalcitol...............................................         11.6
Sodium--ferric--glut.......................................          2.9
Iron--sucrose..............................................          5.7
Levocarnitine..............................................          0.3
Doxercalciferol............................................          3.1
Calcitriol.................................................          0.1
Iron--dextran..............................................          0.0
Vancomycin.................................................          0.1
Alteplase..................................................          0.9
------------------------------------------------------------------------

    We removed the enrollment and price effects from the independent 
ESRD facility expenditure data to determine the per patient utilization 
growth. To do this we divided the product of the enrollment growth of 3 
percent (1.03) and the price reduction of 3 percent (1.00-0.03 = 0.97) 
into the total drug expenditure change between 2005 and 2006 of -0.1 
percent (1.00-0.00 = 1.00). The result is a utilization growth factor 
equal to 1.00 (1.00/1.03 * 0.97) = 1.00.
    Using the latest projected growth of the CY 2008 PPI for 
prescription drugs of 3.5 percent, we project that the combined growth 
in per patient utilization and pricing of ESRD drugs for CY 2008 would 
result in an update equal to the PPI growth or 3.5 percent (1.00 * 
1.035 = 1.035). This update factor was applied to the CY 2007 average 
per treatment drug add-on amount of $19.64 (reflecting a 14.9 percent 
adjustment for CY 2007), resulting in a weighted average increase to 
the composite rate of $0.69 for CY 2008 or a 0.5 percent increase in 
the drug add-on percentage for CY 2008. Thus, the total drug add-on 
adjustment to the composite rate for CY 2008, including the growth 
update is 15.5 percent (1.149 * 1.005 = 1.155).
2. Update to the Geographic Adjustment to the Composite Rates
    Section 1881(b)(12)(D) of the Act, as added by section 623(d) of 
the MMA, gives the Secretary the authority to revise the wage indexes 
previously applied to the ESRD composite rates. The wage index values 
are calculated for each urban and rural area. The purpose of the wage 
index is to adjust the composite rates for differing wage levels 
covering the areas in which ESRD facilities are located.
(a) Updates to Core-Based Statistical Area (CBSA) Definitions
    In the CY 2008 PFS proposed rule (72 FR 38166), we clarified that 
this and all subsequent ESRD rules and notices are considered to 
incorporate the CBSA changes published in the most recent OMB bulletin 
that applies to the hospital wage data used to determine the current 
ESRD wage index. The OMB bulletins may be accessed online at http://www.whitehouse.gov/omb/bulletins/index.html.
(b) Updated Wage Index Values
    In the CY 2006 PFS final rule with comment period (70 FR 70167), we 
described that methodology for calculating the CY 2006 wage index 
values and stated that we intend to update the ESRD wage index values 
annually. Current wage index values for CY 2007 were developed from FY 
2003 wage and employment data obtained from the Medicare hospital cost 
reports. The ESRD wage index values are calculated without regard to 
geographic reclassifications authorized under sections 1886(d)(8) and 
(d)(10) of the Act and utilize pre-floor hospital data that is 
unadjusted for occupational mix.
    We proposed to use the same methodology for CY 2008 (72 FR 38167), 
with the exception that FY 2004 hospital data will be used to develop 
the CY 2008 ESRD wage index values. For a detailed description of the 
development of the CY 2008 wage index values based on FY 2004 hospital 
data, see the FY 2008 IPPS final rule entitled ``Changes to the 
Hospital Inpatient Prospective Payment Systems and Fiscal Year 2008 
Rates'' (72 FR 47320). Section G of the preamble to that final rule 
describes the cost report schedules, line items, data elements, 
adjustments, and wage index computations. The wage index data affecting 
ESRD composite rates for each urban and rural locale may also be 
accessed on the CMS Web site at http://www.cms.hhs.gov/AcuteInpatientPPS/WIFN/list.asp. The wage data are located in the 
section entitled ``FY 2008 Final Rule Occupational Mix Adjusted and 
Unadjusted Average Hourly Wage and Pre-Reclassified Wage Index by 
CBSA.''
    Comment: One commenter expressed concern in regard to our use of 
acute care hospital wage data in the calculation of the wage index 
stating that the cost for hospital based facilities and ambulatory 
centers varies greatly. The commenter urged us to locate an alternative 
data source that reflects information directly tied to ESRD facilities.
    Response: At the present time, data that is specific to independent 
dialysis facilities is not available upon which to base the wage index. 
As described in the CY 2007 PFS final rule with comment period (71 FR 
69685), given the similarity of the labor market for professional, 
technical, and nursing staff between hospitals and ESRD facilities, we 
believe our use of hospital wage and employment data obtained from the 
Medicare cost reports to develop the ESRD wage index is appropriate. In 
addition, several of our major prospective payment systems (PPS) 
utilize the same wage index (for example, Skilled Nursing Home PPS, 
Inpatient Psychiatric Facility PPS, Inpatient Rehabilitation Facility 
PPS, Home Health PPS, and Hospice PPS.)
(i) Third Year of the Transition
    In the CY 2006 PFS final rule with comment period (70 FR 70169), we 
indicated that we would apply a 4-year transition period to mitigate 
the impact on composite rates resulting from our adoption of CBSA-based 
geographic designations. Beginning January 1, 2006, during each year of 
the transition, an ESRD facility's wage-adjusted composite rate (that 
is, without regard to any case-mix adjustments) will be a blend of its 
old MSA-based wage-adjusted payment rate and its new CBSA-based wage-
adjusted payment rate for the transition year involved. In addition, 
beginning in CY 2006 we provided a gradual reduction in the wage index 
floor. We indicated that we would reassess the need for a wage index 
floor for CY 2008. In the CY 2008 PFS proposed rule (72 FR 38167), we 
proposed a further reduction in the wage index floor. For each 
transition year, the share of the blended wage-adjusted base payment 
rate that is derived from the MSA-based and CBSA-based wage index 
values and the applicable wage index floor is as follows:
    <bullet> In CY 2006, the first year of the transition, we 
implemented a 75/25 blend. The wage index floor was reduced from 0.9000 
to 0.8500.
    <bullet> In CY 2007, the second year of the transition, we 
implemented a 50/50 blend. The wage index floor was reduced from 0.8500 
to 0.8000.
    <bullet> For CY 2008, consistent with the transition blends 
announced in the CY 2006 PFS final rule with comment period (70 FR 
70170), we are implementing a 25/75 blend between an ESRD facility's 
MSA based composite

[[Page 66283]]

rate, and its CY 2008 CBSA-based rate reflecting its revised wage index 
values. In addition, we proposed to continue the wage index floor, but 
to further reduce it from 0.8000 to 0.7500.
    An example of how the wage-adjusted composite rates would be 
blended during CY 2008 and the additional subsequent transition year 
follows.
    Example: An ESRD facility has a wage-adjusted composite rate 
(without regard to any case-mix adjustments) of $135.00 per treatment 
in CY 2007. Using CBSA-based geographic area designations, the 
facility's CY 2008 wage-adjusted composite rate, reflecting its wage 
index value would be $145.00. During the remaining 2 years of the 4-
year transition period to the new CBSA-based wage index values, this 
facility's blended rate through 2009 would be calculated as follows:

CY 2008 = 0.25 x $135.00 + 0.75 x $145.00 = $142.50
CY 2009 = 0 x $135.00 + 1.0 x $145.00 = $145.00

    We note that this hypothetical example assumes that the calculated 
wage-adjusted composite rate of $145.00 for CY 2008 does not change in 
CY 2009. In actuality, the wage-adjusted composite rate for CY 2009 
would change because of annual revisions to the wage index. However, 
the example serves only to demonstrate the effect on the composite rate 
of the CBSA-based wage index values which will be phased in during the 
remaining 2 years of the transition period. As noted above in this 
section, the 4-year transition period will expire and in CY 2009 and 
forward, we will be using CBSA-based wage index values.
    Comment: Several commenters expressed concern in regard to our 
proposal to decrease the wage index floor from 0.80 to 0.75. In 
addition, one commenter indicated that a defunct licensing board in 
Puerto Rico has inhibited licensing of dialysis technicians for a long 
period of time. As a result, registered nurses are the only group of 
licensed professional qualified to furnish dialysis within this area.
    In addition, a commenter believes that decreasing the floor will 
make it difficult to recruit and retain qualified personnel in areas 
affected by the removal of the floor. The commenter also identified the 
recent transition to the ASP drug pricing methodology and increases in 
operating expense as factors that have compounded the impact of any 
further drop in the wage index floor.
    Response: As described in the CY 2007 PFS final rule with comment 
period (71 FR 69686 through 69687), the proposed wage index floor was 
substantially higher than the actual wage index values for urban 
locales in Puerto Rico, without application of any floor and prior to 
the application of the BN adjustment. Specifically, the proposed wage 
index floor was 0.80 whereas the actual wage index values ranged from 
0.3241 to 0.4893. Similarly, the proposed wage index floor for CY 2008 
is 0.75 whereas the actual wage index values for urban locales in 
Puerto Rico range from 0.3064 to 0.4729. Therefore, we believe that the 
CY 2008 wage index floor of 0.75 compared to actual wage levels is an 
appropriate level and the new floor would not impede the ability of 
ESRD facilities to recruit and retain staff.
(ii) Wage Index Values for Areas With No Hospital Data
    In CY 2006, while adopting the CBSA designations, we identified a 
small number of ESRD facilities in both urban and rural geographic 
areas where there is no hospital wage data from which to calculate ESRD 
wage index values. The affected areas were rural Massachusetts, rural 
Puerto Rico and the urban area of Hinesville, GA (CBSA 25980). For both 
CY 2006 and CY 2007, we calculated the ESRD wage index values for those 
areas as follows:
    <bullet> For rural Massachusetts, because we had not determined a 
reasonable proxy for rural data in Massachusetts, we used the FY 2005 
wage index value for rural Massachusetts.
    <bullet> For rural Puerto Rico, the situation is similar to rural 
Massachusetts. However, since all geographic areas in Puerto Rico were 
subject to the wage index floor in CY 2006 and CY 2007, we applied the 
ESRD wage index floor to rural Puerto Rico as well.
    <bullet> For the urban area of Hinesville, GA, we calculated the CY 
2006 and CY 2007 wage index value for Hinesville, GA (CBSA 25980) based 
on the average wage index value for all urban areas within the State of 
Georgia.
    In the CY 2008 PFS proposed rule (72 FR 38168), we proposed an 
alternative methodology for establishing a wage index value for rural 
Massachusetts. Since we have used the same wage index value for two 
years with no updates, we believed it was appropriate to establish a 
methodology that uses reasonable proxy data for rural areas (including 
rural Massachusetts) and also permits annual updates to the wage index 
value based on that proxy data. Therefore, in cases where there is a 
rural area without hospital wage data, we proposed to use the average 
wage index values from all contiguous CBSAs to represent a reasonable 
proxy for that rural area.
    In determining the imputed rural wage index, we interpret the term 
``contiguous'' to mean sharing a border. In the case of Massachusetts, 
the entire rural area consists of Dukes and Nantucket Counties. We 
determined that the borders of Dukes and Nantucket counties are 
``contiguous'' with Barnstable and Bristol counties. Under the proposed 
methodology, the wage index values for the counties of Barnstable (CBSA 
12700, Barnstable Town, MA--(1.2539)) and Bristol (CBSA 39300, 
Providence-New Bedford-Fall River, RI-MA--(1.0783)) are averaged, 
resulting in a proposed imputed wage index value of 1.1665 for rural 
Massachusetts for CY 2008.
    For rural Puerto Rico, we proposed to continue to apply the wage 
index floor in CY 2008. Since all areas in Puerto Rico that have a wage 
index are eligible for the proposed CY 2008 ESRD wage index floor of 
0.7500, we proposed to also apply the floor to ESRD facilities located 
in rural Puerto Rico.
    For Hinesville, GA (CBSA 25980) which is an urban area without 
specific hospital wage data, we proposed to continue using the same 
methodology used to impute a wage index value for that area as we used 
in CY 2006 and CY 2007. Specifically, we used the average wage index 
value for all urban areas within the State of Georgia for purposes of 
calculating the wage index value for Hinesville. Therefore, for CY 2008 
we proposed that the wage index value for urban CBSA (25980) 
Hinesville-Fort Stewart, GA is calculated as the average of the wage 
index values of all urban areas in Georgia.
    We solicited comments on these proposed approaches to calculate the 
wage index values for areas without hospital wage data for CY 2008 and 
subsequent years. We indicated that we would continue to evaluate 
existing hospital wage data and, possibly, wage data from other 
sources, such as the Bureau of Labor Statistics, to determine if other 
methodologies of imputing a wage index value for these areas may be 
feasible. We received one comment on this issue.
    Comment: One commenter was supportive of our methodology used in 
calculating wage index values for areas with no hospital wage data 
including rural Massachusetts, Puerto Rico, and an urban area in 
Georgia. However, the commenter requested that we carefully evaluate 
the extent to which these methodologies would be appropriate in other 
situations nationwide.
    Response: We agree with the commenter. As additional areas are

[[Page 66284]]

identified for which hospital wage data does not exist, we will 
reevaluate the extent to which the methodologies used for 
Massachusetts, Puerto Rico, and Georgia would be appropriate and 
consider alternative methodologies on an as needed basis.
    We are finalizing the ESRD wage index and associated policies as 
proposed for CY 2008. In addition, we note that we plan to evaluate any 
policies adopted in the FY 2008 IPPS final rule (72 FR 47130, 47337 
through 47338) that affect the wage index, including how we treat 
certain New England hospitals under section 601(g) of the Social 
Security Amendments of 1983 (Pub. L. 98-21).
(iii) Budget Neutrality (BN) Adjustment
    Section 1881(b)(12)(E)(i) of the Act, as added by section 623(d) of 
the MMA, requires that any revisions to the ESRD composite rate payment 
system as a result of the MMA provision (including the geographic 
adjustment) be made in a budget neutral manner. This means that 
aggregate payments to ESRD facilities in CY 2007 should be the same as 
aggregate payments that would have been made if we had not made any 
changes to the geographic adjusters. We note that this BN adjustment 
only addresses the impact of changes in the geographic adjustments. A 
separate BN adjustment was developed for the case-mix adjustments, 
currently in effect. Since we are not proposing any changes to the 
case-mix measures for CY 2008, the current case-mix budget neutrality 
will remain in effect for CY 2008. For CY 2008, we again proposed to 
apply the BN adjustment directly to the ESRD wage index values, as we 
did in CY 2007. As we explained in the CY 2007 PFS final rule with 
comment period (71 FR 69687 through 69688), we believe this is the 
simplest approach because it allows us to maintain our base composite 
rates during the transition from the current wage adjustments to the 
revised wage adjustments described previously in this section. Because 
the ESRD wage index is only applied to the labor related portion of the 
composite rate, we computed the BN adjustment based on that proportion 
(53.711 percent).
    To compute the proposed CY 2008 wage index BN adjustment, we used 
the proposed wage index values, 2006 outpatient claims (paid and 
processed as of December 31, 2006), and geographic location information 
for each facility.
    Using the treatment counts from the 2006 claims and facility-
specific CY 2007 composite rates, we computed the estimated total 
dollar amount each ESRD provider would have received in CY 2007 (the 
2nd year of the 4-year transition). The total of these payments became 
the target amount of expenditures for all ESRD facilities for CY 2008. 
Next, we computed the estimated dollar amount that would have been paid 
to the same ESRD facilities using the proposed ESRD wage index for CY 
2008 (the 3rd year of the 4-year transition). The total of these 
payments became the third year amount of wage-adjusted composite rate 
expenditures for all ESRD facilities.
    After comparing these two dollar amounts (target amount divided by 
3rd year new amount), we calculated an adjustment factor that, when 
multiplied by the applicable CY 2008 ESRD proposed wage index value 
would result in payments to each facility that remain within the target 
amount of composite rate expenditures when totaled for all ESRD 
facilities. The proposed BN adjustment for the CY 2008 wage index was 
1.054955.
    We also must apply the BN adjustment to the proposed wage index 
floor of 0.7500 which resulted in a proposed adjusted wage index floor 
of 0.7912 (0.7500 x 1.054955) for CY 2008.
    Comment: One commenter expressed concern in regard to the 
calculation of the BN adjustment for the geographic wage index stating 
that the methodology included in the proposed rule lacked transparency. 
The commenter urged us to provide the data and methodology used in 
calculating the BN adjustment.
    Response: The commenter did not identify where transparency was 
lacking or any missing elements that would enable the community to 
assess the impact of the proposed changes. However, we received a 
similar request for clarification during last year's rulemaking process 
and provided an extensive description of the manner in which budget 
neutrality is applied to the wage index in the CY 2007 PFS final rule 
with comment period (71 FR 69687 through 69688). While claims data have 
been updated since publication of that final rule with comment period, 
the methodology has not changed.
    During the CY 2008 PFS proposed rule comment period, we made 
available an ESRD Composite Rate Payment System File. This file 
contained select claims level data from the 2006 ESRD facility 
outpatient claims, updated through December 31, 2006. For more 
information on this file, see the following page on the CMS Web site at 
http://www.cms.hhs.gov/LimitedDataSets/06.asp#TopOfPage.
    After publication of this final rule with comment period, we intend 
to provide the updated version of the CY 2006 outpatient claims (paid 
and processed as of June 30, 2007) that were used to compute the BN 
adjustment.
    To compute the final CY 2008 ESRD wage index BN adjustment, we used 
FY 2004 pre-floor, pre-reclassified, non-occupational mix-adjusted 
hospital wage data to compute the wage index values, 2006 outpatient 
claims (paid and processed as of June 30, 2007), and geographic 
location information for each ESRD facility which may be found through 
Dialysis Facility Compare. The FY 2004 hospital wage index data for 
each urban and rural locale by CBSA may also be accessed on the CMS Web 
site at: http://www.cms.hhs.gov/AcuteInpatientPPS/WIFN/list.asp. The 
wage index data are located in the section entitled ``FY 2008 Final 
Rule Occupational Mix Adjusted and Unadjusted Average Hourly Wage and 
Pre-Reclassified Wage Index by CBSA.''
    Dialysis Facility Compare Information can be found on the CMS Web 
site at http://www.cms.hhs.gov/DialysisFacilityCompare/.
    Using treatment data from the latest 2006 claims file and facility-
specific CY 2007 composite rates, we computed the estimated total 
dollar amount each ESRD provider would have received in CY 2007 (the 
2nd year of the 4-year transition). The total of these payments became 
the target amount of expenditures for all ESRD facilities for CY 2008. 
Next, we computed the estimated dollar amount that would have been paid 
to the same ESRD facilities using the ESRD wage index for CY 2008 (the 
3rd year of the 4-year transition). The total of these payments became 
the 3rd year new amount of wage adjusted composite rate expenditures 
for all ESRD facilities.
    After comparing these dollar amounts (target amount divided by 3rd 
year new amount), we calculated an adjustment factor that when 
multiplied by the applicable CY 2008 wage index value, will result in 
aggregate payments to ESRD facilities that will remain within the 
target amount of composite rate expenditures. When making this 
calculation, the ESRD wage index floor value of 0.7500 is used whenever 
appropriate.
    The final BN adjustment for the CY 2008 wage index is 1.055473.
    To ensure budget neutrality, we also must apply the BN adjustment 
to all index values, including the wage index floor of 0.7500, which 
results in an adjusted wage index floor of 0.7916 for CY 2008.
(iv) ESRD Wage Index Tables
    The final CY 2008 wage index tables applicable to ESRD facilities 
are located

[[Page 66285]]

in Addenda G and H of this final rule with comment period.

I. Independent Diagnostic Testing Facility (IDTF) Issues

    In the CY 2008 PFS proposed rule (72 FR 38169 through 38171), we 
clarified our interpretation of several of the existing performance 
standards at Sec.  410.33(b), and Sec.  410.33(g), proposed a new IDTF 
performance standard at Sec.  410.33(g)(15), and a new proposed IDTF 
provision at Sec.  410.33(i).
    We received numerous comments concerning the revisions to existing 
performance standards and new provisions affecting IDTFs and have 
revised our proposed changes, where applicable, to reflect the issues 
brought forth by the commenters. We are adopting the provisions 
contained in the proposed rule as final with the following changes.
1. Revisions of Existing IDTF Performance Standards
a. Sec.  410.33(g)(6)
    In Sec.  410.33(g)(6), we had proposed to revise this existing 
performance standard to include the requirement that an IDTF must list 
our designated contractor as a Certificate Holder on the comprehensive 
liability insurance policy by revising Sec.  410.33(g)(6) to state, 
``Has a comprehensive liability insurance policy in the amount of at 
least $300,000 per location that covers both the supplier's place of 
business and all customers and employees of the supplier and ensures 
that this insurance policy must remain in force at all times. The 
policy must be carried by a nonrelative owned company. Failure to 
maintain required insurance at all times will result in revocation of 
the IDTF's billing privileges retroactive to the date the insurance 
lapsed. IDTF suppliers are responsible for providing the contact 
information for the issuing insurance agent and the underwriter. In 
addition, we proposed that the IDTF must: ensure that the insurance 
policy must remain in force at all times and provide coverage of at 
least $300,000 per incident; notify the CMS-designated contractor in 
writing of any policy changes or cancellations; and list the CMS-
designated contractor as a Certificate Holder on the policy.''
    Comment: One commenter suggested that we amend the Sec.  
410.33(g)(6) provision on the comprehensive liability insurance policy 
to state that IDTFs should have a comprehensive liability insurance 
policy of at least $100,000 per incident, $300,000 aggregate and that 
CMS should require the IDTF to list Medicare contractors as certificate 
holders for notification purposes only.
    Response: After receiving numerous comments supporting the proposed 
figures, we are adopting the proposed figure of $300,000 per incident.
    Comment: Several commenters recommended that we revise the proposed 
performance standard found at Sec.  410.33(g)(6) to remove the 
requirement that our designated contractor be listed as a Certificate 
Holder on the liability insurance policy. One commenter supported the 
proposed changes to the performance standard at Sec.  410.33(g)(6), but 
expressed concerned about whether underwriters were willing to list the 
government as a certificate holder on an insurance policy.
    Another commenter questioned whether insurance underwriters will be 
open to the idea of adding the government as a certificate holder on an 
insurance policy and suggested that CMS survey several insurance 
carriers which provide this type of coverage to determine if this 
performance standard is achievable. One commenter stated that the 
comprehensive liability insurance policy provision (Sec.  410.33(g)(6)) 
which requires the IDTF to list the Medicare contractor as the 
certificate holder on the policy is too burdensome and obtrusive on 
small business entities. They recommended using a comparable approach 
to the one required by DMEPOS supplier, and have the IDTF provide a 
copy of the annual renewal of the insurance coverage for the IDTF to 
the Medicare contractor (the renewal package would include information 
on the coverage levels, as well as the premiums paid).
    One commenter suggested removing the contractor as the certificate 
holder for the comprehensive liability insurance policy, but if they 
are named as a certificate holder for the comprehensive liability 
insurance policy that it be only for notification purposes.
    Response: Given the concerns raised about the increased 
administrative burden, we agree that our designated contractor should 
not be included as a Certificate Holder on the IDTF's comprehensive 
liability insurance policy. We have revised the performance standard 
found at Sec.  410.33(g)(6) to remove the requirement that our 
designated contractor be listed as a Certificate Holder on the IDTF's 
comprehensive liability insurance policy. However, we believe that it 
is essential that a Medicare fee for service (FFS) contractor be 
allowed to verify information contained in the comprehensive liability 
insurance policy. We believe that a Medicare contractor (that is, 
carrier or Part A/Part B Medicare Administrator Contractor) should be 
able to verify the issuance of a comprehensive liability insurance 
policy with an insurance agent or, as necessary, an underwriter. This 
approach will allow a Medicare FFS contractor to review and verify that 
a comprehensive liability insurance policy has been issued and is in 
effect at the time of enrollment and throughout the enrollment period. 
We have revised Sec.  410.33(g)(6) to read, ``Has a comprehensive 
liability insurance policy in the amount of at least $300,000 per 
location that covers both the supplier's place of business and all 
customers and employees of the IDTF. The policy must be carried by a 
nonrelative-owned company. Failure to maintain required insurance at 
all times will result in revocation of the IDTF's billing privileges 
retroactive to the date the insurance lapsed. IDTF suppliers are 
responsible for providing the contact information for the issuing 
insurance agent and the underwriter. In addition, the IDTF must--
    <bullet> Ensure that the insurance policy must remain in force at 
all times and provide coverage of at least $300,000 per incident; and
    <bullet> Notify the CMS designated contractor in writing of any 
policy changes or cancellations.''
b. Sec.  410.33(g)(2)
    In Sec.  410.33(g)(2), we proposed to establish a 30-day reporting 
period for certain reportable events and a 90-day reporting period for 
all other reportable events.
    Comment: One commenter asked that we define the term ``nonrelative 
owned'' while another commenter asked that we remove this term 
altogether because we are not precluding self insurance.
    Response: While we do not believe that it is necessary to define 
the term ``nonrelative owned'' in this rulemaking effort, a non-
relative owned company applies to insurance policies obtained through a 
familial relationship, not a related organization or business partner. 
Therefore, we are not removing this term from the performance standard.
    Comment: Several commenters supported our proposal to revise the 
reporting requirements found in the performance standard found at Sec.  
410.33(g)(2). One commenter supported the CMS proposal to revise the 
reporting requirements found in performance standard at Sec.  
410.33(g)(2) to establish separate reporting periods for different 
reportable events. The proposed changes will provide the information 
desired by CMS in a timely

[[Page 66286]]

manner while minimizing the administrative burdens on both IDTFs and 
the Medicare contractors caused by the current notification standard.
    Response: We appreciate these comments and agree that revising this 
standard will reduce the administrative burden on both IDTFs and our 
contractors.
    Comment: One commenter recommended that we revise the CMS-855B to 
list the specific changes that must be reported within 30 calendar days 
of the change. However, one commenter stated that requiring the 
reporting of changes depending on the type change in 30 or 90 days puts 
an unfair burden on IDTFs.
    Response: We agree that the CMS-855B should be revised and should 
list the specific changes that must be reported within 30 calendar days 
of the change. Currently, IDTFs are required to report all changes in 
30 days. Our proposal would limit the number of reportable events that 
would need to be reported within 30 days of the change. We intend to 
revise the CMS-855B to clarify which reportable events must be reported 
within 30 and 90 days. We will use the Paperwork Reduction Act process 
to seek specific comments in seeking revisions to the CMS-855B.
    Comment: One commenter recommended that we allow IDTFs to make 
changes online.
    Response: We are developing the Provider Enrollment, Chain, and 
Ownership System (PECOS) Web, which will allow all providers and 
suppliers, including IDTFs, to enroll or report enrollment changes via 
the Internet. We are hoping to implement PECOS Web in most parts of the 
country by March 2008.
    Comment: One commenter suggested that all changes should be 
reported to CMS within 90 days or in the alternative. This commenter 
also recommended that IDTFs report any changes that have occurred in 
the preceding quarter on a quarterly basis.
    Another commenter suggested that we should allow at least 90 days 
for reporting changes in contact information with the contractor. This 
commenter also suggested that we further define what the policy and 
coverage requirements for self insurance and the term ``independent 
underwriter.''
    Response: Section 410.33(g)(2) requires IDTFs to report all changes 
in 30 days. By adopting our proposal, we limit the number of reportable 
events that would need to be reported within 30 days of the change. As 
stated above, we intend to revise the CMS-855B to clarify what items 
must be reported within 30 and 90 days. Since many IDTFs operate on 
different schedules, it would not be practical to implement a quarterly 
reporting requirement.
    As a result of the issues raised by the commenters, we are revising 
Sec.  410.33(g)(2) to read, ``Provides complete and accurate 
information on its enrollment application. Changes in ownership, 
changes of location, changes in general supervision, and adverse legal 
actions must be reported to the Medicare FFS contractor on the Medicare 
enrollment application within 30 calendar days of the change. All other 
changes to the enrollment application must be reported within 90 
days.''
c. Sec.  410.33(g)(8)
    We received the following comments in response to our proposal at 
Sec.  410.33(g)(8).
    Comment: Several commenters recommended that we consider limiting 
the types of beneficiary complaints that are subject to the performance 
standard found in Sec.  410.33(g)(8). Another commenter recommended 
that the standard found in Sec.  410.33(g)(8) apply only when a 
beneficiary formalizes their complaint in writing. Other commenters 
stated that the proposed change in Sec.  410.33(g)(8) is unnecessary, 
not to mention ambiguous and labor intensive to implement.
    One commenter recommended that we model the IDTF documentation 
requirement after standards established by the Food and Drug 
Administration. Specifically, this commenter recommends that IDTFs 
maintain a record for each serious complaint received by the facility 
for at least 3 years from the date the complaint was received.
    Another commenter recommended that we clarify that IDTFs are 
required to monitor only those beneficiary complaints that relate to 
the quality of care the patient receives.
    One commenter stated that the standard at Sec.  410.33(g)(8) be 
clarified to eliminate the documentation of routine billing questions 
so there is no unnecessary burden on small business entities.
    One commenter suggested that instead of adopting Sec.  410.33(g)(8) 
as written for documenting a beneficiary's questions or complaints, 
IDTFs should be required to develop and adhere to a complaint policy 
that includes documentation of material medical or billing complaints, 
and that if CMS adopts the current provision, the word questions should 
be changed to complaints. The commenter also maintains that IDTFs 
should be allowed to keep documents that are older than 30 days at a 
site other than the IDTF's physical location and CMS should clarify how 
long the IDTFs are required to keep each complaint and whether an IDTF 
will be required to record the insurance claim number for each 
complaint.
    Other commenters recommended that we clarify Sec.  410.33(g)(8) to 
specifically state that this standard relates to complaints regarding 
the provision of service, because as written, it will impose a sweeping 
new recordkeeping requirement that drastically affects small business 
entities.
    Response: Based upon the comments received, we have revised this 
provision to clarify and limit the amount of documentation that is 
necessary when a clinical complaint is received in writing. We also are 
clarifying and limiting the amount of documentation that is necessary 
when a clinical complaint is received in writing. We believe that 
complaints should be readily available for examination and we will 
establish a time frame for maintaining this documentation. Therefore, 
we have revised Sec.  410.33(g)(8) accordingly.
    Comment: One commenter recommended that we develop a standardized 
complaint form and an electronic Web-based platform for submitting 
complaints regarding an IDTF.
    Response: We believe that an IDTF can document any formal 
complaints it receives in the most convenient way possible for that 
IDTF.
    After reviewing public comments regarding our proposed change to 
Sec.  410.33(g)(8), we are adopting this proposed change with 
modifications. By revising this language, we believe that we are 
reducing the paperwork burden on IDTFs to maintain and respond to 
written clinical complaints, rather than all questions and complaints 
it receives from beneficiaries. Section 410.33(g)(8) is revised to 
read, ``Answer, document, and maintain documentation of a beneficiary's 
written clinical complaint at the physical site of the IDTF (for mobile 
IDTFs, this documentation would be stored at their home office.) This 
includes, but is not limited to, the following:
    <bullet> The name, address, telephone number, and health insurance 
claim number of the beneficiary.
    <bullet> The date the complaint was received; the name of the 
person receiving the complaint; and a summary of actions taken to 
resolve the complaint.
    <bullet> If an investigation was not conducted, the name of the 
person

[[Page 66287]]

making the decision and the reason for the decision.''
    By making this change, we believe that we are reducing the 
paperwork burden on IDTFs by asking them to maintain and respond to 
written clinical complaints, rather than address all questions and 
complaints it receives from beneficiaries.
d. Sec.  410.33(b)(1)
    We received the following comments in response to our proposal at 
Sec.  410.33(b)(1).
    Comment: Several commenters agreed with our proposal to delete the 
requirement that the supervising physician is responsible for the 
overall operation and administration of an IDTF.
    Response: We appreciate these comments and are adopting this change 
in the final regulation.
    Comment: One commenter recommended that we delay the implementation 
of our clarification that a physician providing general supervision can 
oversee a maximum of three IDTF sites by noting that term, ``sites'' 
includes fixed, as well as mobile sites.
    Response: We believe that a physician providing general supervision 
can oversee a maximum of three IDTF sites which includes fixed as well 
as mobile sites.
    Comment: One commenter recommended that we clarify that the three 
site limitation only relates to the provision of general supervision. 
In addition, one commenter recommended that we clarify that while a 
physician may only provide general supervision to three IDTF sites, 
this provision does not apply to the number of interpreting physicians 
at an IDTF site.
    Response: We agree with this comment and will clarify that the 
supervision limitation only applies to general supervision.
    Comment: One commenter stated that our proposal to consider each 
mobile IDTF unit as one IDTF site was unreasonable.
    Response: We disagree and we believe that a physician providing 
general supervision can oversee a maximum of three IDTF sites. We 
maintain that fixed and mobile IDTFs essentially are furnishing the 
same services. We note that the term, ``sites'' includes fixed as well 
as mobile sites because there are three concurrent locations where 
testing may occur at a given time.
    Comment: One commenter stated individual locations should be 
counted only if they have separate Medicare PINs.
    Response: With Medicare's implementation of the National Provider 
Identifier (NPI) on or before May 23, 2008, Medicare contractors will 
no longer issue billing numbers to the public. Providers and suppliers 
will use their assigned NPI to submit claims to Medicare. As such, 
organizations may obtain one or many NPIs. Accordingly, we are not able 
to adopt this suggestion.
    Comment: One commenter suggested that it would be inappropriate to 
require that a mobile IDTF have a different supervising physician for 
every three office locations that it visits, therefore this provision 
should apply only to those IDTFs in a fixed location.
    Response: We believe that a physician providing general supervision 
can oversee a maximum of three IDTF sites and note that the term, 
``sites'' includes fixed, as well as mobile sites, because there are 
three concurrent locations where testing may occur at a given time. A 
mobile IDTF may visit multiple locations and it would still be 
considered one mobile unit. The number of places a mobile IDTF visits 
does not change the fact that this is a single unit and up to three 
fixed base or mobile units may be under the general supervision of one 
physician.
    Comment: One commenter stated that the mobile unit described at 
Sec.  410.33(b)(1) should be consistent with the language used on the 
CMS-855B enrollment application.
    Response: We will consider revising the CMS-855B to incorporate 
this recommendation.
    Comment: One commenter recommended treating fixed base sites and 
portable units on a comparable basis in that a supervising physician 
not be limited to supervising three portable units, but also could 
supervise three sites from which portable units are dispatched.
    Response: A mobile IDTF may visit multiple locations, and it would 
still be considered one mobile unit. The number of places a mobile IDTF 
visits does not change the fact that this is a single unit and up to 
three fixed base or mobile units may be under the general supervision 
of one physician. Under the commenter's scenario, any number of mobile 
units could be in use and a physician would not be able to provide 
general supervision to an infinite number of mobile units.
    Comment: One commenter recommended that we revise Sec.  410.33(b) 
to move to a diagnostic equipment threshold limit instead of an IDTF 
site limit since, as proposed, the provision allowing fixed based IDTFs 
to run limitless testing procedures at the IDTF is equated with a 
mobile unit running one test at a time. Therefore the number of 
supervising physicians should be determined through testing volume and 
not location.
    Another commenter recommended that a maximum threshold of 15 units 
per supervising physician would be advisable and that is should be made 
clear that this section applies to general supervision and not direct 
or personal supervision.
    Response: Due to the varied and ever changing equipment used by 
IDTFs, it would be impractical to establish such limits.
    Comment: One commenter recommended that we conduct additional 
audits, monitoring, and enforcement actions, where warranted, to 
address existing compliance problems.
    Response: We agree with the commenters that audits, monitoring, and 
enforcement efforts are effective ways to identify individual 
compliance issues. We already require that Medicare contractors conduct 
an onsite visit to verify the performance standards found in this 
section prior to initial enrollment. We will consider adding and/or 
redirecting existing resources to ensure that an IDTF remains in 
compliance with these standards.
    Comment: One commenter requested clarification to differentiate 
between fixed and mobile IDTFs business models and the differences by 
which IDTFs using these models provide services.
    Response: A fixed base IDTF performs all of its diagnostic testing 
at the practice location found on the Medicare enrollment application 
(CMS-855), whereas a mobile IDTF travels and performs its diagnostic 
tests at locations other than a single practice location.
    Comment: One commenter requested that we clarify the definition of 
``site'' versus ``testing locations'' distinction.
    Response: We consider sites and testing locations to be a practice 
location for both fixed base and mobile IDTFs.
    Comment: One commenter suggested that the language at Sec.  
410.33(i)(3) is in error and was meant to be a definition, because it 
explains the first two parts of the effective date provision. The 
commenter stated that they believe that the date which a signed 
enrollment application is submitted should be considered the date of 
filing and that any time lag in contractor decisions should be excluded 
when determining the date of filing.
    Response: We agree with the commenter and are revising Sec.  
410.33(b)(1) accordingly.
    After reviewing the public comments, we are amending the provision 
to

[[Page 66288]]

remove the following sentence from Sec.  410.33(b)(1), ``The IDTF 
supervising physician is responsible for the overall operation and 
administration of the IDTFs, including the employment of personnel who 
are competent to perform test procedures, record and report test 
results promptly, accurately and proficiently, and for assuring 
compliance with the applicable regulations''.
    We are adopting the provision at Sec.  410.33(b)(1) which clarifies 
the meaning of what constitutes three IDTF sites to include both fixed 
sites and mobile units. This includes moving portable diagnostic 
equipment to another location and used it to provide IDTF services. 
Accordingly, we believe that a physician providing general supervision 
as defined in Sec.  410.32(b)(3)(i) can oversee a maximum of three 
sites (that is, fixed or mobile) where concurrent operations can be 
performed. In addition, we are clarifying that that this provision 
applies only to general supervision within an IDTF setting. Section 
410.33(b)(1) is revised to read, ``Each supervising physician must be 
limited to providing general supervision to no more than three IDTF 
sites. This provision applies to both fixed sites and mobile units 
where three concurrent operations are capable of performing tests.''
2. New IDTF Standards
a. Sec.  410.33(i)
    In Sec.  410.33(i), we proposed to establish an initial enrollment 
date for IDTFs and to limit the retrospective period for which an IDTF 
can obtain payment for services after enrolling into the Medicare 
program.
    Comment: One commenter recommended that we adopt an accelerated 
rollout plan of the PECOS Web to facilitate the enrollment process for 
IDTFs.
    Response: We expect to implement PECOS Web in most parts of the 
country by March 2008.
    Comment: One commenter recommended that we ensure that Medicare 
contractors process enrollment applications in a timely manner so that 
beneficiaries will have access to quality and convenient healthcare 
delivery at an IDTF.
    Response: We will continue to work with all Medicare contractors to 
ensure that applications are processed in a timely and accurate manner. 
With the implementation of PECOS Web, we believe that many of the 
processing delays that have occurred within the last year will be 
corrected. Specifically, PECOS Web will facilitate the submission of a 
complete application and allow applicants to make any necessary changes 
to their enrollment application in a timely manner.
    Comment: Several commenters recommended that we revise our 
proposals to allow an IDTF to begin billing Medicare for claims with 
dates of service on or after the day on which the IDTF submits a 
``substantially correct'' or ``substantially complete'' enrollment 
application or the date the IDTF first furnishes services at its 
location, whichever is later.
    Response: We disagree with the recommendation to permit an IDTF to 
submit claims with dates of service on or after the day which the IDTF 
submits a ``substantially correct'' enrollment application or the date 
the IDTF first furnishes services at its location, whichever is later. 
We believe that it is essential that all providers and suppliers, 
including IDTFs, submit a complete application at the time of filing or 
perfect the submission of their enrollment application in response to a 
contractor's request for information. Accordingly, an applicant who 
submits a complete application or responds in a timely manner to a 
request for additional information is not disadvantaged by this 
proposal. However, it is important to note that if an application is 
rejected in accordance with the provisions found at Sec.  424.525, the 
applicant will need to submit a new application to enroll in the 
Medicare program. In this case, the applicant only will be able to seek 
payments for those services furnished on or after the date of filing or 
when the Medicare contractor has approved the second application 
request.
    Comment: One commenter recommended that retroactive billing (once 
approval has been determined) be allowed back to the time of the 
initial application (even if the first submission is rejected).
    Response: As stated above in this section, we disagree with this 
recommendation. We believe that an IDTF should be allowed to bill for 
services furnished on or after the date of filing or the date the 
practice location became operational. However, we do not believe that 
it is appropriate to allow an IDTF to bill for services back to the 
filing date of the initial application if the initial application was 
rejected due to the nonsubmission of information or denied because the 
applicant did not meet the program requirements to enroll as an IDTF.
    Comment: One commenter recommended that a 60-day period be allowed 
for retroactive billing before an IDTF is enrolled.
    Response: While we believe that an IDTF should be allowed to bill 
for services furnished on or after the date of filing or the date the 
practice location became operational, we do not believe that it is 
appropriate to allow an IDTF to bill for services prior to the filing 
date associated with when the application was submitted.
    Comment: One commenter recommended that Medicare contractors follow 
a protocol that outlines the items that will require a contractor to 
reject or deny an enrollment application.
    Response: Medicare contractors are bound by applicable enrollment 
regulations and CMS manual instructions. Specifically, all Medicare 
contractors are required to follow regulations found at Sec.  424.525 
and manual instructions found in publication 100-8, Chapter 10 of the 
Program Integrity Manual (PIM) when rejecting an enrollment application 
for insufficient information. In addition, Medicare contractors are 
required to follow regulations found at Sec.  424.530 and manual 
instructions found in publication 100-8, Chapter 10 of the PIM when 
denying an enrollment application.
    Comment: One commenter recommended that we not implement our 
proposal to preclude an IDTF from being allowed to bill Medicare 
retroactively for services that are rendered prior to the provider 
being formally approved by the applicable Medicare contractor to 
participate in the Medicare program.
    Response: Since our proposal specifically allows an IDTF to receive 
reimbursement for services furnished on or after the filing or the date 
the IDTF opened a new practice location, whichever was later, we 
believe that we are allowing IDTFs a limited amount for retroactive 
billing. As stated in the preamble to the proposed rule, the purpose of 
this rulemaking effort is to establish a date of enrollment for IDTFs 
where we believe that the enrolling IDTF meets all of the program 
requirements to participate in the Medicare program.
    Comment: One commenter recommended that we clarify that our 
proposed change in billing be applied only to new or initial enrollment 
applications and would not affect existing operations when changes or 
additions are made to an enrollment application, such as the addition 
of a new physician or piece of equipment.
    Response: In general, we agree with this commenter in that the 
proposed change only will apply to new or initial enrollment 
applications. Since the provision is designed to limit

[[Page 66289]]

retrospective billing prior to enrollment in the Medicare program, we 
do not believe this change will impact existing IDTFs who are making a 
change to an existing enrollment record for a fixed or mobile practice 
location. However, it is important to note that the limitations on 
retroactive billing will apply to existing IDTFs who are adding a new 
fixed or mobile practice location to their existing enrollment record. 
Moreover, a limitation on retroactive billing may apply when there is 
change of ownership.
    Comment: One commenter stated that they had no issues with the 
effective date of the billing privileges provision. However, this 
commenter suggested that this provision be tied to a requirement that 
the CMS designated contractor process the application in a timely 
fashion.
    Response: We are also concerned about delays associated with the 
enrollment process. However, we recognize that many of the delays are 
the result of IDTF suppliers not submitting a complete application at 
the time of filing or failing to submit complete and timely responses 
to a contractor's request for information.
    In addition, we believe that it is appropriate to expect meaningful 
Medicare contractor processing timeliness standards. As necessary, the 
agency can update or revise processing standards through the manual 
instructions and through contracts with Medicare Administrative 
Contractors. We fully expect that most enrollment applications will be 
processed in accordance with CMS processing requirements found in 
Publication 100-8, Chapter 10 of the PIM. The PIM establishes 
processing standards for initial applications, changes of information, 
and reassignments that all Medicare contractors must adhere to. 
Specifically, we currently require Medicare contractors to process 80 
percent of initial applications within 60 days, 90 percent of initial 
applications within 120 days, and 99 percent of initial applications 
within 180 days. We also require Medicare contractors to process 80 
percent of changes of information and reassignments within 45 days, 90 
percent of changes of information and reassignments within 60 days, and 
99 percent within 90 days.
    With the implementation of PECOS Web, an internet version of the 
Medicare enrollment process, in FY 2008, we expect to establish more 
stringent contractor processing timeliness standards for applications 
submitted via PECOS Web.
    Comment: One commenter stated that the effective date of the 
billing privileges provision may economically affect small and medium 
sized business in that the IDTF must list the credentialed employees on 
the application itself in order for the application to be processed, 
and that these businesses cannot use or bill for their services during 
the time periods that they are not enrolled. Further, the commenter 
states that it would be impractical to hire these technicians if they 
cannot use them to perform the tests for the time it takes to get 
approved.
    Response: We disagree with the commenter because all IDTFs should 
have proper staffing, including credentialed technicians, at the time 
the IDTF practice location is applying to participate in the Medicare 
program or when the IDTF is operational.
    Comment: One commenter suggested that an IDTF that is enrolled and 
in good standing in the Medicare program at one location be able to 
enroll new sites retroactively to the first date of service at the new 
location.
    Response: We disagree with this recommendation because the approval 
of one practice location does not necessarily mean that a second 
practice location meets the requirements for approval.
    Comment: One commenter recommended that we require that applicants 
be notified of their enrollment status within 60 days of submitting 
their applications.
    Response: We believe that this comment is outside the scope of this 
final rule. However, given certain resource limitations, contractors 
are unable to respond to such status inquiries. With the implementation 
of PECOS Web, providers and suppliers, except DMEPOS suppliers, will be 
able to check the status of their applications via the Internet.
    After reviewing the public comments we are finalizing the provision 
at Sec.  410.33(i) to state that we will establish an initial 
enrollment date for an IDTF that would be the later of: (1) the date of 
filing of a Medicare enrollment application that was subsequently 
approved by Medicare FFS contractor; or (2) the date an IDTF first 
started furnishing services at its new practice location. We also 
adopted the ``date of filing'' as the date that the Medicare FFS 
contractor receives a signed provider enrollment application that the 
Medicare FFS contractor is able to process for approval. If the 
Medicare FFS contractor rejects or denies an enrollment application 
that is not later overturned during the appeals process, the new date 
of filing would be established when an IDTF submits a new enrollment 
application that the contractor is able to process to approval.
    With the implementation of an Internet enrollment process referred 
to as the PECOS Web in 2008, the date of filing for applications 
submitted through PECOS Web will be the date the Medicare contractor 
receives all of the following: (1) A signed Certification Statement; 
(2) an electronic version of the enrollment application; and (3) a 
signature page that the Medicare contractor processes to approval.
    While this change limits the retrospective payments that an IDTF 
may obtain from the Medicare program, we believe that this approach 
will ensure that a Medicare contractor is able to verify that an IDTF 
meets all program requirements at the time of filing, including the 
performance standards outlined in Sec.  410.33(g) before payment for 
service occurs.
b. Sec.  410.33(g)(3)
    We received the following comments regarding our proposal at Sec.  
410.33(g)(3) to expressly preclude hotels and motels from being 
considered an appropriate site for an IDTF setting.
    Comment: One commenter stated that many IDTFs have contracts 
directly with a hotel or motel where they rent space for studies and 
that they disagreed with the rules' provision to ban such a situation.
    Response: We disagree with this comment because we believe that 
space located within a hotel or motel can easily be transferred to 
other uses other than providing sleep studies.
    Comment: Several commenters stated that a hotel or motel room is 
not appropriate places for diagnostic testing to take place.
    Response: We agree with these comments and have revised Sec.  
410.33(g)(3) accordingly.
    Comment: One commenter suggested that the provision at Sec.  
410.33(g)(3) be changed to state that the requirements for hand washing 
and patient privacy only apply to IDTFs that see patients and to 
clarify that being able to access records electronically fulfills the 
requirement of storing business and medical records.
    Response: We have amended Sec.  410.33(g)(3) to state that the 
requirements for hand washing and patient privacy only apply to IDTFs 
that see patients and to clarify that being able to access records 
electronically fulfills the requirement of storing business and medical 
records.
    We are adopting a revision to Sec.  410.33(g)(3) to expressly 
preclude hotels and motels from being considered an appropriate site 
for an IDTF setting.

[[Page 66290]]

Based on public comments, we believe that a hotel or motel is not an 
appropriate place for diagnostic testing to take occur. Accordingly, we 
have revised Sec.  410.33(g)(3) to read, ``Maintain a physical facility 
on an appropriate site. For the purposes of this standard, a post 
office box, commercial mailbox, motel, or hotel are not considered an 
appropriate site. The physical facility, including mobile units, must 
contain space for equipment appropriate to the services designated on 
the enrollment application, facilities for hand washing, adequate 
patient privacy accommodations, and the storage of both business 
records and current medical records within the office setting of the 
IDTF, or IDTF home office, not within the actual mobile unit.''
    Additionally, we have added an exception at Sec.  410.33(g)(3)(ii), 
where IDTFs that do not see beneficiaries at their locations are exempt 
from providing hand washing and patient privacy accommodations.
c. Sec.  410.33(g)(15)
    At Sec.  410.33(g)(15), we proposed a new performance standard 
which stated, ``Does not share space, equipment, or staff or sublease 
its operations to another individual or organization.''
    Comment: One commenter stated that they were concerned about the 
emergence of arrangements in which a physician practice leases a block 
of time from an imaging provider (such as an IDTF) or agrees to pay the 
provider a per service fee to use its facility. The group practice then 
refers its patients to the imaging provider for imaging tests and bills 
the insurer for the services, usually profiting from the difference 
between the insurer's payment rates and the fees the practice pays to 
the imaging provider.
    Response: We agree with the commenter and reiterate that our 
proposals are designed to prohibit such practices.
    Comment: Several commenters supported our proposal to prohibit 
IDTFs from sharing space, equipment, or staff, or subleasing their 
operations to another individual or organization.
    Response: We appreciate these comments and agree that there has 
been a proliferation of share use agreements between IDTFs and 
physicians and/or other organizations that have allowed the sharing of 
space and equipment.
    Comment: One commenter stated that they applauded our efforts to 
address an alarming proliferation of referring physicians entering into 
``lease'' or similar purchased test arrangements with imaging centers 
for the primary purpose of enabling physicians to profit from their own 
referrals.
    Response: We appreciate these comments as our proposals are 
designed to prohibit such practices.
    Comment: Several commenters recommended that CMS not finalize Sec.  
410.33(g)(15) because it severely restricts the use of an IDTF's 
property and places unnecessary limitations on the entity.
    Response: We disagree with this comment. With the revisions we are 
making to Sec.  410.33(g)(15), we believe that an IDTF's property is 
fully available for use solely by the IDTF. The adopted provision at 
Sec.  410.33(g)(15) will allow an IDTF to conduct all of its approved 
diagnostic testing procedures.
    Comment: One commenter stated that the proposed rule would prohibit 
an IDTF from participating in any type of leasing arrangement.
    Response: In this final rule with comment period, we are 
prohibiting the leasing or subleasing of an IDTF practice location, as 
well as diagnostic equipment that are used in taking the initial 
diagnostic test. In addition, we are prohibiting leasing and subleasing 
to a third party.
    Comment: One commenter requested that we clarify whether the 
proposed performance standard found at Sec.  433.10(g)(15) would permit 
a multi-specialty clinic and an IDTF to be enrolled as a clinic and an 
IDTF, and for portions of space and staff to be used for both clinic 
and IDTF activities.
    Response: While we understand the commenter's concern, we do not 
believe that it is appropriate to co-locate a multi-specialty clinic in 
the same practice location as an IDTF. Specifically, while we are not 
prohibiting the sharing common of hallways, parking, or common areas, 
we believe that a multi-specialty clinic cannot occupy or be co-located 
within the same practice location. For example, a multi-specialty 
clinic and an IDTF could not enroll or remain enrolled using the same 
suite number within the same office building.
    Comment: Some commenters recommended that we define the term, 
``individual or organization'' to exclude hospitals and nonreferring 
radiologists, because hospitals and nonreferring radiologists are not 
in a position to self-refer.
    Response: We disagree that the terms ``individual and 
organization'' needs to be defined. For the purposes of this rule, an 
individual is a person, and an organization is any entity other than an 
individual.
    Comment: One commenter recommended that we permit an adjoining 
physician practice or a radiology group that is the owner of an IDTF to 
share space, equipment, and staff.
    Response: While we agree that it is common for IDTFs to share 
common areas (that is, waiting rooms) with the adjoining physician 
practice or radiology group that is an owner of the IDTF, we do not 
believe that it is appropriate for IDTFs to share common practice 
locations or diagnostic testing equipment.
    Comment: Several commenters recommended that we not extend the 
prohibition of sharing space, equipment, and staff to the mobile IDTF 
setting.
    Another commenter recommended that the proposed restriction on 
sharing space, equipment, and staff should not apply to mobile IDTFs, 
as this would add both physical and financial burdens that mobile units 
simply could not meet.
    Response: We agree with these commenters that requiring mobile 
IDTFs to adhere to limitations regarding space, equipment, and staffing 
may limit beneficiary access to necessary mobile services and increase 
the costs of providing necessary diagnostic care. Accordingly, we are 
excluding mobile IDTFs from the provisions found at Sec.  
410.33(g)(15).
    Comment: One commenter recommended that we revise our proposals to 
account for certain practical implications concerning the imaging 
industry, including common and legitimate sharing practices between 
multiple IDTFs, between IDTFs and hospitals, and between IDTFs and 
radiologist.
    Response: While we agree that it reasonable for IDTFs located 
within a hospital to share practice locations and diagnostic testing 
equipment, we continue to have significant concerns regarding the 
sharing of space by IDTFs in a nonhospital setting.
    Comment: One commenter recommended that we revise the performance 
standard found at Sec.  410.33(g)(15) to state, ``Does not share space, 
equipment or staff or sublease its operations to another individual, 
organization, employee or contractor of such organizations, that refers 
Medicare patients to the IDTF for designated health services.''
    Response: We have considered this comment in revising the 
performance standard at Sec.  410.33(g)(15).
    Comment: One commenter believed that the performance standard found 
in Sec.  410.33(g)(15) applies to hospitals.
    Response: Upon review of the comments, we have revised Sec.  
410.33(g)(15) to exclude hospitals.

[[Page 66291]]

    Comment: Several commenters recommended that we clarify that the 
proposed performance standard found in Sec.  410.33(g)(15) would apply 
only to newly enrolling IDTFs and not IDTFs already enrolled in the 
Medicare program. Specifically, these commenters requested that we 
clarify that this new standard would allow an IDTF to continue to lease 
personnel and equipment from third parties provided that the IDTF uses 
the personnel, space, and equipment exclusively throughout the lease 
term.
    Response: We maintain that the provision found in Sec.  
410.33(g)(15) applies to both newly enrolling IDTFs, as well as those 
IDTFs currently enrolled in the Medicare program. This provision does 
not prohibit an IDTF from leasing space or equipment that is used 
solely by that IDTF-party, such as a building management company or an 
equipment manufacturer. This does not preclude an IDTF from leasing any 
part of its practice location or equipment used in conducting the 
initial diagnostic procedure to another Medicare-enrolled individual or 
group to conduct diagnostic testing activities.
    Comment: One commenter recommended that we clarify that employees 
of affiliated employers under the Fair Labor Standards Act are not 
considered ``shared staff'' under this new standard. In addition, 
several commenters recommended that the prohibition on sharing 
``staff'' be limited to sharing nonphysician personnel.
    Response: The new sharing provision has been modified to exclude 
the prohibition on the sharing of staff.
    Comment: One commenter recommended that if we adopt the proposed 
performance standard found in Sec.  410.33(g)(15) that the 
implementation date be delayed for at least 12 months to provide IDTFs 
and physician practices with sufficient time to find new office space, 
recruit additional staff, notify their patients and generally 
restructure their existing relationships. Another commenter recommended 
that we clarify our proposed performance standard found in Sec.  
410.33(g)(15).
    Response: We agree with commenters and we are adopting a 1-year 
delay in implementation (effective January 1, 2009) of the space-
sharing provision for IDTFs that are currently occupying a practice 
location with another Medicare-enrolled individual or organization that 
is found at Sec.  410.33(g)(15)(i).
    Comment: One commenter recommended that we clarify whether the 
proposed prohibition on sharing space, equipment, and staff is intended 
to apply when the IDTF leases or subleases space from a hospital on a 
full-time, exclusive basis. Other commenters recommended that we 
exclude mobile IDTFs from the prohibition to share space because it is 
impractical in complying with this provision. One commenter stated that 
the sharing of staff standard is impractical to comply with and should 
not be extended to mobile IDTFs, because accredited and trained 
contracted personnel are sometimes necessary to contract with on a 
temporary basis.
    Another commenter suggested that we not apply this provision to 
mobile IDTFs and instead, permit an IDTF to share space, equipment and 
staff with an entity that is related to the IDTF, such as through 
common control or ownership. Also, this commenter recommended that we 
should clarify in what situation an IDTF could not share staff, such 
as; supervising physician and nonphysician personnel.
    Response: This provision is not intended to restrict an IDTF from 
entering into a rental agreement for space or equipment, excluding 
hospitals, as long as that IDTF, or the owner of the IDTF are 
exclusively using that space or equipment. We are excluding mobile 
IDTFs from the prohibition on sharing space and staff.
    Comment: One commenter stated that the sharing of space provision 
should not apply to a Medicare-certified IDTF that leases or subleases 
space and/or qualified technical staff from a hospital on a full time, 
exclusive basis (they are not ``shared'' with the hospital).
    Response: We agree with the comment and the standard has been 
revised to reflect this concern.
    Comment: One commenter wanted clarification on whether we will 
permit an IDTF to utilize a common area in a building where an IDTF 
enters into a lease or sublease with a hospital for the full-time, 
exclusive use of the operation of the IDTF.
    Response: We will permit an IDTF to utilize a common area in a 
building where an IDTF enters into a lease or sublease with a hospital 
for the full-time exclusive use of the operation of the IDTF. However, 
the IDTF must have its own practice location that is only used by that 
IDTF.
    Comment: One commenter requested clarification on whether we intend 
to prohibit only new space, equipment, or staff sharing arrangements 
from the effective date of the rule or if it will apply to existing 
arrangements. If it applies to existing arrangements, then the 
commenter requests that the implementation be delayed by 1 year.
    Response: While we intend to prohibit the sharing of space at a 
practice location from the effective date of the rule for newly-
enrolling IDTFs (including those with applications that are still 
pending as of January 1, 2008), we are adopting a 1-year delay in 
implementation (effective January 1, 2009) of the space-sharing 
provision for IDTFs that are currently occupying a practice location 
with another Medicare-enrolled individual or organization that is found 
at Sec.  410.33(g)(15)(i).
    Comment: One commenter requested clarification as to whether we 
will permit an IDTF that leases or subleases space and/or staff from a 
hospital to purchase back-office services from the hospital. (These 
types of service may include, but are not limited to, transcription, 
billing, collection, recordkeeping, and computer access services, based 
upon a flat fee or at cost plus to the hospital).
    Response: We will permit an IDTF to lease or sublease space from a 
hospital and to purchase services from the hospital which may include, 
but are not limited to, transcription, billing, collection, 
recordkeeping, and computer access services, based upon a flat fee or 
at cost plus to the hospital.
    Comment: One commenter recommended that there should be an 
exception made at Sec.  410.33(g)(15) for companies operating both an 
IDTF and portable x ray supplier, since both are surveyed and subject 
to multiple standards under the Medicare program.
    Response: While we understand this concern, we believe that an IDTF 
must have a practice location where only one Medicare-enrolled IDTF is 
furnishing services. If another Medicare-enrolled entity is using the 
same practice location space as an IDTF, especially for shortened 
periods of time, our designated contractor is not able to determine 
which entity is responsible for meeting performance standards at a 
given time.
    Comment: One commenter urged us to address the sharing of space, 
staff, and equipment provision by specifically excluding radiologists 
and radiology groups, who are not self-referring, from the sharing 
arrangements in IDTFs due to the increased costs and possible detriment 
to the beneficiary (numerous visits to different locations and 
increased stress) that may occur in this situation.
    Response: We believe that the practice location and equipment that 
an IDTF uses for its initial diagnostic testing cannot be used by 
another Medicare provider or supplier, and therefore, we

[[Page 66292]]

are not excluding radiologists and radiology groups.
    Comment: One commenter agreed that it would be inappropriate to 
commingle the clinical staff listed on the CMS-855 enrollment 
application during the times that the IDTF is open; however, the 
commenter maintains that non-clinical space and staff (such as waiting 
rooms, receptionists, and schedulers) should be shared with other 
entities.
    Response: We agree with this comment and have amended the provision 
to reflect these concerns.
    Comment: One commenter recommends that the sharing of nonclinical 
space, equipment and personnel be allowed between an IDTF and an 
adjacent facility, because it does not offer the same potential for 
abuse as situations where the clinical operations of the IDTF would be 
commingled.
    Response: We have amended the provision found at Sec.  
410.33(g)(15) to address these concerns.
    Comment: One commenter recommends that the sharing of space between 
a group or a physician practice and its own IDTF should not be 
prohibited. Another commenter recommends changing the proposed Sec.  
410.33(g)(15) because they believe it would prohibit wholly-owned 
corporate subsidiaries and affiliated under common control from sharing 
space, equipment, and staff in a cost efficient manner.
    Response: We disagree with this recommendation since it is not 
feasible to distinguish between two different practices that are co-
located at the same practice location. Also, this provision would not 
prohibit wholly-owned corporate subsidiaries and affiliated entities 
under common control from sharing equipment, as long as the change in 
equipment location is timely reported. In addition, the IDTF's practice 
location must be separately distinguishable and not commingled with 
another Medicare provider or supplier.
    Comment: One commenter recommends changing the proposed Sec.  
410.33(g)(15) to read as follows: ``Does not share space, equipment, or 
staff or sublease it operations to another individual or organization, 
except for a subsidiary or affiliated IDTF that is wholly owned by, and 
under the complete control of, the IDTF.''
    Response: We understand the commenter's recommendation and we have 
amended Sec.  410.33(g)(15) to address the commenter's concern.
    Comment: One commenter recommends that CMS specifically exempt 
IDTFs that have common ownership and common control from the definition 
of ``individual or organization,'' if CMS implements Sec.  
410.33(g)(15) as written.
    Response: We disagree with the commenter's recommendation. While 
IDTFs may have common ownership, each practice location is enrolled 
separately.
    Comment: One commenter offered support for our provision to 
prohibit fixed site IDTFs from sharing space, equipment, and staff or 
subleasing their operations to another individual or organization.
    Response: We appreciate the commenters support on the proposed 
provisions.
    Comment: One commenter suggested excluding radiologist and 
radiology groups from the definition of individual or organization in 
the regulatory language at Sec.  410.33(g)(15) so that imaging IDTFs 
can share space, equipment, and staff with radiologists and radiology 
groups.
    Response: We disagree with this recommendation because IDTFs enroll 
each practice location separately.
    Comment: One commenter suggested that we clarify in the preamble 
that the prohibition does not preclude affiliated companies (which do 
not have any referring nonradiologist physicians as owners) that 
provide services integrally related to the operations of an imaging 
IDTF (such as interoperable information system, centralized 
credentialing, staff and billing) from sharing space, equipment and 
staff.
    Response: We modified Sec.  410.33(g)(15) to reflect concerns about 
the sharing of space and equipment. Since Medicare enrolls each IDTF at 
a separate location, we believe that it is not necessary to address how 
affiliated companies interact with an IDTF as long as each IDTF is in 
compliance with the provisions of this final rule with comment period.
    Comment: One commenter suggested that CMS clarify that an ownership 
or investment interest held by radiologists and radiology groups in an 
imaging IDTF does not constitute sharing under Sec.  410.33(g)(15).
    Response: We agree that an ownership or investment interest held by 
radiologists and radiology groups in an imaging IDTF does not 
constitute sharing under Sec.  410.33(g)(15).
    Comment: One commenter suggested that we revise this provision to 
specify that an IDTF cannot share its space, equipment or staff with 
another individual or organization that has Medicare billing 
privileges, and that it is okay for another non-Medicare enrolled 
entity to use the IDTF's space, equipment, and staff.
    Response: We agree with the commenter. The IDTF may not share 
clinical space or the diagnostic equipment involved in the original 
diagnostic test with a Medicare-enrolled provider or supplier.
    Based on public comments, we have removed the sharing of staff 
aspect of this provision, and we are revising Sec.  410.33(g)(15) to 
read, ``With the exception of hospital-based and mobile IDTFs, a fixed-
base IDTF does not--
    <bullet> Share a practice location with another Medicare-enrolled 
individual or organization;
    <bullet> Lease or sublease its operations or its practice location 
to another Medicare-enrolled individual or organization; or
    <bullet> Share diagnostic testing equipment used in the initial 
diagnostic test with another Medicare-enrolled individual or 
organization.''
    We believe that it is inappropriate for a fixed-base (physical 
site) IDTF to commingle its practice location or the equipment used in 
conducting the initial diagnostic test with another individual or 
organization enrolled in the Medicare program. By sharing space and/or 
equipment, Medicare contractors are not able to determine if an IDTF 
meets all of enrollment requirements at Sec.  424.500 through Sec.  
424.555 or whether each IDTF meets and maintains all performance 
standards and other requirements under Sec.  410.33 and other 
applicable requirements.
    After examining public comments, we believe that it is appropriate 
to establish two exceptions to the prohibition associated with sharing 
space and clinical equipment. These exceptions apply to mobile IDTFs or 
IDTFs that are co-located within a hospital.
    A mobile IDTF, by its very nature, may share space with other 
Medicare-enrolled entities. As such, we believe that it would be 
detrimental to the IDTF industry to apply this new performance standard 
to mobile IDTFs, because this may limit beneficiary access to necessary 
mobile IDTF services and increase the costs of providing necessary 
diagnostic care. In addition, we believe that hospital-based IDTFs are 
inherently located within a larger facility type and based on the need 
of the hospital, may appropriately share space or clinical equipment to 
gain operating efficiencies with little additional risk to the Medicare 
program or its beneficiaries.
    Finally, while all IDTF provisions are effective on the 
implementation date of this final rule with comment period, we believe 
that additional time may be needed for some IDTFs to change their 
business model if they are sharing a

[[Page 66293]]

practice location with another Medicare-enrolled individual or 
organization. Accordingly, we are adopting a 1-year transition period 
for IDTFs that are currently enrolled and are sharing a practice 
location with another Medicare individual or organization. While this 
1-year transition period applies to the provision found at Sec.  
410.33(g)(15)(i) related to the sharing of space, it does not apply to 
the provisions found at Sec.  410.33(g)(15)(ii) or Sec.  
410.33(g)(15)(iii). Accordingly, IDTFs are prohibited from maintaining 
or establishing leasing or subleasing agreements or the sharing of 
diagnostic testing equipment used in taking the initial diagnostic 
test, after the effective date of this rule.
    3. Additional Comments and Responses
    Comment: One commenter recommended that our proposal to prohibit 
the sharing of space, equipment, and staff be applied consistently in 
all imaging centers, whether enrolled as an IDTF or as a physician-
directed clinic.
    Another commenter recommended that any policy initiative intended 
to eliminate certain suspect leasing or space sharing arrangements 
should be applied to all imaging providers, not just IDTF providers.
    One commenter supported the proposed prohibition on shared 
equipment but urged us to apply this prohibition to all entities 
(including physician practices, mobile units, and hospitals) that 
provide imaging services.
    Some commenters believe an exception should be made to include 
cardiologists that are certified for the interpretation of nuclear 
cardiology studies in an IDTF as well as allow interpretation of 
nuclear cardiology studies for an IDTF.
    One commenter stated that since self-insurance is permitted, the 
requirement that the insurance be purchased from a ``non-relative owned 
company'' should be removed, or replaced with a provision that permits 
an alternate method of meeting the requirement by maintaining insurance 
through a relative-owned company that has been approved by a state 
department of insurance or comparable state agency or that can be 
validated by a placing broker.
    Another commenter recommended that CMS should end payments to 
independent contractor physicians who are not board-certified in Sleep 
Disorders Medicine.
    One commenter recommended that CMS require interpreting physicians 
to have board certification in Sleep Medicine in metropolitan areas.
    One commenter recommended that we edit the location of service 
language at Sec.  410.33(e)(2) to redefine the location from which a 
service is billed.
    Another commenter recommended requiring a hospital licensed entity 
and actual radiology group to be the owners of entities that do not 
have to register as IDTFs and allow related entities of the hospital 
and radiology group to also own the imaging center.
    Response: We appreciate these comments and we will consider these 
recommendations in a future rulemaking effort.

J. Expiration of MMA Section 413 Provisions for Physician Scarcity Area 
(PSA)

    Section 413(a) of the MMA added a new section 1833(u) to the Act. 
That section provided a 5 percent incentive payment to physicians 
furnishing services in physician scarcity areas (PSAs) for physicians' 
services furnished on or after January 1, 2005, and before January 1, 
2008. Specifically, section 1833(u) of the Act provided for payment of 
an additional 5 percent of the payment amount for services furnished by 
primary care physicians in a primary care scarcity area and by non-
primary care physicians in a specialist care scarcity area.
    Because the provisions of section 1833(u) of the Act do not apply 
to services furnished after December 31, 2007, in the CY 2008 PFS 
proposed rule, we provided notification that these 5 percent incentive 
payments will no longer be made for services furnished on or after 
January 1, 2008.
    The list of zip codes for both primary care and specialty PSAs can 
be found on the CMS Web site at http://www.cms.hhs.gov/hpsapsaphysicianbonuses/01_overview.asp.
    Comment: We received comments expressing concern over the 
expiration of this provision. Commenters stated that the expiration of 
this provision may exacerbate the problems beneficiaries in rural areas 
experience in accessing medical services.
    Response: We acknowledge the commenters' concerns regarding access 
to care, especially in rural areas. We provided notification of the 
pending expiration of this provision in the CY 2008 PFS proposed rule. 
We note that the Congress specifically established the PSA incentive 
program to apply only to claims for services furnished between January 
1, 2005, and January 1, 2008. We do not have authority under the 
current statute to extend PSA bonus payments beyond this time frame.

K. Comprehensive Outpatient Rehabilitation Facility (CORF) Issues

    In the CY 2008 PFS proposed rule (72 FR 38171), we discussed 
Medicare payment for comprehensive outpatient rehabilitation facility 
(CORF) services, including nursing services delivered within a CORF, 
which are defined by HCPCS code (G0128) for such services. We also 
explained that we use the payment amount established by an existing fee 
schedule other than the PFS when the PFS does not establish a payment 
amount for the CORF service. Specifically, we use the existing fee 
schedules for prosthetic and orthotic devices, DME and supplies, and 
drugs and biologicals for prosthetics and orthotics devices, durable 
medical equipment (DME) and supplies, and drugs and biologicals, 
respectively, provided by CORFs that are considered CORF services. 
Covered DME, orthotic and prosthetic devices, and supplies provided by 
a CORF are paid under the DMEPOS fee schedule.
    Drugs and biologicals that are not considered to be self-
administered are specified as CORF services at section 1861(cc)(1)(F) 
of the Act. However, as discussed in the proposed rule, we believe that 
drugs and biologicals provided to CORF patients are not appropriately 
provided as part of a rehabilitation plan of treatment and, as such, we 
proposed to remove drugs and biologicals from the scope of CORF 
services as defined at Sec.  410.100. After reviewing comments, we have 
decided to retain within the definition of CORF services drugs and 
biologicals that are not self-administered, as discussed below in 
section II.K.7. However, as we are not aware of any non-self-
administered drugs and biologicals that appropriately may be included 
as part of a rehabilitation plan of treatment, we intend to closely 
track the provision of drugs and biologicals in the CORF setting and do 
not expect CORFs to bill for such drugs and biologicals. In addition, 
because we believe it is appropriate for pneumococcal, influenza, and 
hepatitis B vaccines to be administered to CORF patients in the CORF 
setting, even though such vaccines fall outside the scope of CORF 
services, we also proposed to revise the conditions of participation at 
Sec.  485.51(a) to permit CORFs to provide to their patients 
pneumococcal, influenza, and hepatitis B vaccines in addition to CORF 
services.
    Because the regulations under 42 CFR parts 410 and 413 were never 
updated to reflect the change in CORF payment methodology from a 
``reasonable cost'' basis to 80 percent of the lesser of a

[[Page 66294]]

payment amount under an existing fee schedule or the CORF's actual 
charge, we proposed to add a new subpart M to 42 CFR part 414 to 
reflect the change in CORF payment methodology.
    In addition, we proposed revisions to the definitions of certain 
CORF services under Sec.  410.100, in order to limit the scope of such 
services and items to those appropriately provided by qualified CORF 
personnel and related to the rehabilitation goals of the plan of 
treatment established under Sec.  410.105(c). Specifically, we proposed 
to clarify the definition of physician services; respiratory therapy 
services; psychological and social services; nursing services; drugs 
and biologicals; supplies, appliances, and equipment; and the home 
environment evaluation. We also proposed to add clarifying language to 
Sec.  410.105(b)(3) to make clear that physical therapy, occupational 
therapy, and speech-language pathology services can be provided offsite 
in the patient's home. In Sec.  410.105(c), we proposed to clarify that 
CORF services, that are not skilled rehabilitation services, must 
directly relate to the physical therapy or other rehabilitation plan of 
treatment and its associated goals.
1. Requirements for Coverage of CORF Services Plan of Treatment (Sec.  
410.105(c))
    In accordance with section 1861(cc)(1) of the Act, requiring that 
CORF services be furnished ``under a plan (for furnishing such items 
and services to such individual) established and periodically reviewed 
by a physician,'' Sec.  410.105(c) provides that CORF services as 
defined under Sec.  410.100 are covered only if furnished under a 
written plan of treatment. Specifically, the plan of treatment must: 
(1) Be established and signed by a physician prior to the commencement 
of treatment in the CORF setting; and (2) indicate the diagnosis and 
anticipated rehabilitation goals, and prescribe the type, amount, 
frequency, and duration of the services to be furnished. We interpret 
these provisions as requiring that the services furnished under the 
rehabilitation plan of treatment must relate directly to the 
rehabilitation of injured, disabled, or sick patients. Services 
provided in the CORF setting that do not relate directly to such 
rehabilitation goals and treatment plan are not covered as CORF 
services.
    Therefore, we proposed to revise Sec.  410.105(c) to clarify our 
policy that CORF services are covered only if they relate directly to 
the rehabilitation of injured, disabled, or sick patients. We believe 
our policy is consistent with the statutory requirements under section 
1861(cc) of the Act. Section 1861(cc)(1) of the Act specifies that CORF 
services must be furnished under a plan of treatment. Section 
1861(cc)(1)(H) of the Act further states that ``other items and 
services'' are considered CORF services only if ``medically necessary 
for the rehabilitation of the patient.'' We believe the implication of 
this limitation for ``other items of services'' is that all other CORF 
services (that is, those listed under sections 1861(cc)(1)(A) through 
(G) of the Act) also must be necessary for the rehabilitation of the 
patient. In addition, we noted that section 1861(cc)(2)(A) of the Act 
specifies that a CORF facility is a facility ``primarily engaged in 
providing * * * diagnostic, therapeutic, and restorative services to 
outpatients for the rehabilitation of injured, disabled, or sick 
persons'' (emphasis added). We believe this requirement further signals 
the Congress's intent that the services provided in a CORF setting be 
covered as CORF services only if such services relate directly to the 
rehabilitation of the patient.
    Comment: One commenter supported the proposal to clarify that all 
services provided in a CORF must be directly related to the 
rehabilitation treatment plan. The commenter noted that this proposal 
is directly aligned with the goals and purpose of physical therapy.
    Response: We appreciate the commenter's support of this 
clarification. Because the CORF is defined as a facility that is 
primarily engaged in providing diagnostic, therapeutic and restorative 
services to outpatients for the rehabilitation of injured, disabled or 
sick persons, we believe the intent of the statute is that all services 
rendered in a CORF must relate to the patient's rehabilitation needs 
which are stated in the patient's plan of treatment established by the 
physician. Section 1861(cc)(1) of the Act and Sec.  410.100 clarify 
that physician services, and services of other qualified professionals, 
can be provided in a CORF; but, a physician must first certify that the 
patient requires skilled rehabilitation services, including physical 
therapy, occupational therapy, speech-language pathology, and 
respiratory therapy, and then establish the CORF patient's 
rehabilitation plan of treatment.
    Therefore, we are finalizing Sec.  410.105(c) as proposed with the 
exception that we have added language to clarify our policy that the 
rehabilitation plan of treatment, along with its goals, is specific to 
the skilled rehabilitation services for physical therapy, occupational 
therapy, speech-language pathology, or respiratory therapy and that 
these services are distinct from all other CORF services which, when 
provided, must directly relate to the goals of the rehabilitation 
treatment plan.
2. Included Services (Sec.  410.100)
    Section 410.100 establishes the services that are covered under the 
CORF services benefit, consistent with section 1861(cc)(1) of the Act. 
Because of the change in payment methodology from that based on cost to 
payment under the PFS and other existing fee schedules beginning in CY 
1999, this section does not reflect our current payment policies. 
Therefore, we proposed to clarify our payment policy in the 
introductory paragraph of this section by including a cross reference 
to proposed Sec.  414.1101, which sets forth the payment methodology 
for CORF services, including identifying the applicable fee schedule 
for each CORF service. In addition, we proposed to revise:
    <bullet> The definition of physician services to reflect the change 
in payment methodology for CORF services;
    <bullet> The definitions of physician services, respiratory therapy 
services, social and psychological services, and nursing services to 
ensure that these definitions include only those services appropriately 
provided by qualified nonphysician and physician personnel and related 
to the rehabilitation plan of treatment established under Sec.  
410.105(c); and
    <bullet> The definition of supplies, equipment, and appliances to 
conform to the statutory provision at section 1861(cc)(1)(G) of the 
Act.
    We also proposed to remove the provision for drugs and biologicals. 
Although vaccines are not included in the definition of CORF services 
at section 1861(cc)(1) and Sec.  410.100, we proposed to make revisions 
to the CORF conditions of participation at Sec.  485.51 to reflect 
current coverage and payment policy for vaccines provided in the CORF 
setting.
3. Physician Services (Sec.  410.100(a))
    Section 410.100(a) defines the physician services included within 
the scope of CORF services. Specifically, those services of a CORF 
physician described as administrative in nature are considered CORF 
services, to the exclusion of diagnostic and therapeutic services, 
which are physician services under section 1861(q) of the Act and 
separately billable as physician services under 42 CFR part 414, 
subpart B. Section 1861(cc)(1) of the Act excludes from the definition 
of CORF services

[[Page 66295]]

any item or service that, if furnished to an inpatient of a hospital, 
would be excluded under section 1861(b) of the Act. Section 1861(b)(4) 
of the Act excludes from the definition of ``inpatient hospital 
services'' the ``medical or surgical services provided by a 
physician,'' which would include the diagnostic and therapeutic 
services of a physician. Consequently, diagnostic and therapeutic 
services provided in the CORF setting by a physician are not considered 
CORF services. In contrast, because those services of a CORF physician 
that are of an administrative nature are not ``medical'' services, such 
services are included in the definition of CORF services.
    In accordance with section 1861(cc)(2)(B)(i) of the Act and Sec.  
485.70(a)(1), the CORF physician must be either a medical doctor (MD) 
or a Doctor of Osteopathy (DO). The conditions of participation at 
Sec.  485.70(a)(2) and (3) further require that the physician have 
training or experience in the medical management of patients requiring 
rehabilitation services. The conditions of participation at Sec.  
485.58(a)(1)(i) also require the CORF facility physician to provide, in 
accordance with accepted principles of medical practice, medical 
direction, medical supervision, medical care services and consultation. 
In the CY 2008 PFS proposed rule, we proposed to revise Sec.  
410.100(a) to clarify that only those physician services required and 
provided by the CORF facility physician that are administrative in 
nature are considered CORF services, whereas diagnostic and therapeutic 
services provided by a physician to CORF patients are considered 
physician services under section 1861(q) of that Act. Specifically, we 
proposed to define CORF physician services as those services provided 
by a CORF facility physician that are administrative in nature, such as 
consultation with and medical supervision of nonphysician staff, 
patient case review conferences, utilization review, and the review of 
the therapy plan of treatment, as appropriate.
    Services provided to a CORF patient by the CORF facility physician 
or other physician that are not administrative in nature but that are 
diagnostic or therapeutic services are considered physician services 
under section 1861(q) of the Act. Where these services are covered, 
they are separately payable to the physician as physician services 
under the PFS at the nonfacility payment amount.
    In addition, Sec.  410.100(a) currently provides that physician 
services included within the definition of CORF services are reimbursed 
on a reasonable cost basis under part 413, and that physician services 
to CORF patients not included within the definition of CORF services 
but billed as physician services are paid by the carrier on a 
reasonable charge basis subject to the provisions of subpart E of part 
405 of this chapter. This description of the payment methodology for 
physician services provided in the CORF setting under Sec.  410.100(a) 
is inconsistent with the payment methodology set forth under section 
1834(k)(1) of the Act for CORF services and section 1848 of the Act for 
physician services, as well as the preamble discussion in the CY 1999 
PFS final rule (63 FR 58860). In the CY 1999 PFS final rule, we stated 
that we would base payment for diagnostic and therapeutic physician 
services provided to individuals in the CORF setting on the PFS amount 
for the services. Therefore, we proposed to revise Sec.  410.100(a) to 
remove the reference to reasonable cost based payments for CORF 
physician services and the reference to reasonable charge based 
payments for non CORF physician services. In place of these references, 
we proposed to revise Sec.  410.100(a) to add a reference to 42 CFR 
part 414, subpart B, setting forth the payment methodology for non CORF 
physician services.
    Comment: One commenter stated that the nonfacility fee schedule 
amounts for CORF services fail to fairly compensate the CORF for 
services provided by a CORF physician that are administrative in 
nature. The commenter stated that the PFS nonfacility amounts, 
containing higher PE RVUs (than those for the facility setting) for 
CORFs, are inappropriately low to cover these costs for the CORF 
setting. The commenter believes that the required level of physician 
activity in a CORF is greater than that in a physician office. Since 
there is no separate facility payment to the CORF, the commenter 
requests that we develop a new set of codes with associated fees to pay 
for the required CORF administrative physician services in a manner 
similar to that we employed to establish G0128 in the CY 1999 PFS final 
rule to pay for CORF nursing services.
    Response: The 1997 BBA required CMS to establish prospectively 
determined payments for all outpatient physical therapy, occupational 
therapy and speech-language pathology services regardless of the site-
of-service and additionally required that all other CORF services also 
be based on existing fee schedules. When we implemented these BBA 
requirements during the CY 1999 rulemaking process, we specifically 
addressed the issue of a site-of-service differential payment to 
institutional providers of outpatient therapy services, including 
CORFs. In the CY 1999 PFS final rule, we reasoned that a site-of-
service differential payment to a facility provider would create 
payment incentives that favor one setting over another. In addition, we 
believe that the law intended the creation of a ``level playing field'' 
for these services and that we accomplished this with the selection of 
the PFS nonfacility rate to pay for all rehabilitation and CORF 
services. Therefore, we will continue to make payment at the PFS 
nonfacility rate for CORF services and will not change this policy to 
allow a separate site-of-service differential payment to the CORF. 
Accordingly, we are finalizing Sec.  410.100(a) as proposed.
4. Clarifications of CORF Respiratory Therapy Services
    Section 1861(cc)(1)(B) of the Act states that CORF services include 
respiratory therapy services along with physical therapy, occupational 
therapy, and speech-language pathology services. Because respiratory 
therapists (RTs) are not recognized as independent practitioners in the 
Act or regulations, and respiratory therapy services are not 
specifically identified in a statutory benefit category except as 
specified in the CORF services benefit at section 1861(cc)(1)(B) of the 
Act, separate payment, except that made to the CORF provider, is not 
made for services provided by RTs.
    The description of CORF respiratory therapy services currently 
includes some services that we believe are more appropriately provided 
by a physician rather than a RT. As discussed above in section II.K.3., 
diagnostic and other medical services provided in the CORF setting by a 
physician are not considered CORF services, and therefore may not be 
included in a respiratory therapy plan of treatment. In addition, the 
description of respiratory therapy services under Sec.  410.100(e) 
currently includes services that in accordance with Sec.  410.105(c) 
must be performed by a physician, and not a RT. For example, only the 
physician may indicate the clinical diagnosis and rehabilitation goals, 
and prescribe the type, amount, frequency, and duration of the services 
to be furnished under the rehabilitation plan of treatment.
    Therefore, we proposed to amend Sec.  410.100(e) to revise the 
definition of respiratory therapy services to include only those 
services that can be appropriately provided to CORF patients by RTs 
under a physician-established respiratory therapy plan of

[[Page 66296]]

treatment in accordance with current medical and clinical standards and 
the requirements of Sec.  410.105(c). Specifically, we proposed to 
remove from the definition of CORF respiratory therapy services at 
Sec.  410.100(e)(1) the terms ``diagnostic evaluation'', 
``management'', and ``assessment'' because these services are performed 
by the physician to establish the medical and therapy-related diagnosis 
and the respiratory therapy plan of treatment. These services, referred 
to in the proposed rule as ``evaluation and management (E/M)'' 
services, may be provided by either the CORF facility physician, as 
CORF physician services or as non-CORF physician services, or by the 
patient's referring physician, as appropriate. We also proposed to 
remove diagnostic tests and periodic assessment at Sec.  
410.100(e)(2)(v) and (vi), respectively, from the description of CORF 
respiratory therapy services. As discussed above, we believe that under 
current medical standards, diagnostic tests that are or become 
necessary for patients receiving rehabilitation services should be 
provided by physicians. In addition, we believe that under current 
medical standards, periodic assessment of chronically ill patients in 
order to determine their need for respiratory services should be within 
the purview of the physician. We note that these services are covered 
under the physician services benefit category at section 1861(s)(2)(C) 
of the Act when provided by the physician to a CORF patient, and 
therefore, may be separately billable by the physician under the PFS.
    In addition to RTs, we noted that the conditions of participation 
also recognize respiratory therapy technicians as CORF personnel; 
however, during the CY 1999 PFS rulemaking to recognize the 1997 BBA 
payment requirements, we did not include services performed by 
respiratory therapy technicians because we believed that current 
medical standards for skilled respiratory therapy services provided to 
patients in the CORF setting required the educational requirements 
possessed by RTs. This determination to only recognize the services of 
RTs, and not those provided by respiratory therapy technicians in 
carrying out the therapy plan of treatment was further supported in the 
CY 2002 and CY 2003 rulemaking (66 FR 55311 and 67 FR 79999), when we 
developed and discussed G codes for certain CORF respiratory therapy 
services and specifically recognized the RT as the appropriate level of 
personnel to provide these CORF services. The three HCPCS codes G0237, 
G0238, and G0239 are specific to services provided under the 
respiratory therapy treatment plan and, as such, are not designated as 
subject to the therapy caps. Therefore, in the CY 2008 PFS proposed 
rule, we proposed to revise the description of respiratory therapy 
services to include only those services that are appropriately provided 
under a respiratory therapy treatment plan. In so doing, we sought to 
clarify those services that we believe the physician should provide, 
such as E/M services, diagnostic tests, and establishing the 
rehabilitation plan of treatment. In addition, we stated that a 
condition of coverage for the respiratory therapy service is that it be 
provided by an individual meeting the educational and training level of 
the RT, rather than the RT technician. For these reasons, we indicated 
we would accept comments on the service description at Sec.  
410.100(e), and the personnel qualifications at Sec.  485.70(j) and (k) 
for a respiratory therapist and a respiratory therapy technician, 
respectively.
    Comment: One commenter opposed the proposed revisions to the 
definition of CORF respiratory therapy services which removes 
diagnostic E/M services from the list of services at Sec.  
410.100(e)(1) and diagnostic tests from Sec.  410.100(e)(2)(v). The 
commenter suggested that respiratory therapists, by virtue of their 
training and competency testing, can and do provide such services as 
part of their scope of work and asks us to add at Sec.  410.100(e)(2) 
certain tests, specifically ``pulmonary function tests, spirometry and 
blood gas analyses'', as well as services for ``assessment, evaluation 
and monitoring of the patient's responses to the respiratory treatment 
plan.'' The commenter also requested that we reinsert the term 
``assessment'' in the definition of respiratory therapy services at 
Sec.  410.100(e)(1) in order to bring consistency to the definitions of 
all other CORF therapy services, such as physical therapy, occupational 
therapy, and speech-language pathology. Lastly, the commenter objected 
to the CORF requirement that the respiratory therapy treatment plan be 
entirely established by the physician.
    Response: Section 1861(cc)(1) of the Act states that respiratory 
therapy can be provided in a CORF, by qualified professional personnel, 
only under a treatment plan established and reviewed by a physician. In 
order to determine the need for and to construct an appropriate CORF 
respiratory therapy plan of treatment, a physician provides E/M 
services and often uses diagnostic tests, such as pulmonary function 
and spirometry tests, in order to establish the patient's medical and 
therapy related diagnoses. These findings are then detailed in the 
patient's rehabilitation treatment plan which, in the CORF, the 
physician must wholly establish.
    The plan of treatment is described at Sec.  410.105(c) and must 
include services furnished under a written plan of treatment that: (1) 
Is established and signed by a physician before the treatment is begun; 
(2) prescribes the type, amount, frequency, and duration of the 
services to be furnished, and indicates the diagnosis and anticipated 
rehabilitation goals. The respiratory treatment plan must be reviewed 
at least every 60 days by the physician who must certify that the 
patient is making reasonable progress in attaining the treatment goals 
and that the treatment is having no harmful effects. Therefore, we 
believe that the E/M services and diagnostic services associated with 
establishing, periodically reviewing, and overseeing the respiratory 
therapy treatment plan are appropriately furnished by the physician. As 
discussed above, physician services, including E/M services and 
diagnostic services performed by the physician, are separate Medicare 
benefits, defined at sections 1861(q) and 1861(s)(3) of the Act, 
respectively. These therapeutic and diagnostic services are covered and 
separately paid to the physician, not the CORF, when they are furnished 
to a CORF patient in the CORF setting by the physician, as discussed 
previously in this section at II.K.3.
    We agree with the commenter's request to reinsert the word 
``assessment'' in the definition of respiratory therapy services at 
Sec.  410.100(e)(1). Because assessments are conducted as an integral 
part of any service, we agree that revising the definition more 
accurately describes the services provided by RTs, as well as other 
qualified and recognized CORF personnel. As illustrated below, 
assessments can be made by the RT using the physiologic data gathered 
from the monitoring services that are inherent to CORF respiratory 
therapy services.
    Also, we would like to clarify the term ``monitoring'' as used in 
Sec.  410.100(e)(1) specifically as it relates to the provision of CORF 
respiratory therapy services. As we stated in the CY 2003 PFS final 
rule with comment period (when we created 3 G-codes--G0237, G0238, and 
G0239--to better describe CORF respiratory therapy activities), we 
incorporated the term ``monitoring'' in to each of the 3 G-code 
descriptors. We further described this ``monitoring'' to include 
physiologic or

[[Page 66297]]

other data about the patient during the period before, during, and 
after the activities. It can represent, for example, pulse oximetry 
readings, electrocardiography data, pulmonary testing measurements of 
strength or endurance performed to assess the status of the patient 
before, during and after the activities. In order to further illustrate 
and clarify our intention, we provided an example in which pursed lip 
breathing, used to create positive pressure in the upper respiratory 
tract and to improve respiratory muscle action and described as G0237, 
was identified as an included service in the patient's respiratory 
therapy treatment plan.
    Before providing this service, the RT assesses the patient to 
determine the appropriateness of providing this pursed lip breathing 
activity and may check the patient's oxygen saturation level (via pulse 
oximetry). If appropriate, the RT then provides the initial training 
and necessary retraining in order to ensure that the patient can 
accurately perform this activity. After this session, the RT may again 
check the patient's oxygen saturation level, or perform peak 
respiratory flow, or other respiratory parameters. These services are 
considered ``monitoring'' and are bundled into the payment for G0237 
(as well as HCPCS codes G0238 and G0239).
    Another example of monitoring includes the provision of a 6-minute 
walk test that is typically conducted before the start of the patient's 
respiratory therapy activities. When this ``test'' is conducted, the RT 
uses this information to form an assessment of the patient's condition 
and uses it to guide and monitor the activities that are furnished as 
specified in the treatment plan. This assessment, determined by data 
from monitoring activities is included as part of the activities 
inherent to G0237. The time spent by the RT, face-to-face and one-on-
one, with the patient to conduct these respiratory measures is counted 
as part of each of the respiratory therapy 15-minute G-codes. When 
provided as part of a CORF respiratory therapy treatment plan, payment 
for these monitoring activities is bundled into the payment for other 
services provided by the RT, including the three respiratory therapy 
specific G-codes. The bundling of these monitoring activities into each 
CORF respiratory therapy service is to acknowledge that these 
activities are inherent to the services we envisioned RTs would provide 
in the CORF setting. Similarly, assessment, including the use of 
monitoring data, is included as part of services provided by other 
rehabilitation therapists. The G-codes were specifically created to 
better describe the services provided as part of a respiratory therapy 
plan of care under the CORF benefit.
    Comment: One commenter indicated that the personnel qualifications 
in the regulations for RTs and RT technicians are out of date and that 
for over a decade the term respiratory therapist has been used to 
describe both respiratory therapy care professional categories 
currently defined in the CORF regulations. Rather, the commenter states 
that the certified respiratory therapist (CRT) and the registered 
respiratory therapist (RRT) have replaced the older terms, RT techs and 
RTs, respectively. The commenter explained that the CRT designation is 
awarded after successfully passing the entry-level examination, while 
qualifications to sit for the RRT examination include graduation from 
advanced levels of respiratory therapy educational programs and 
obtaining the CRT credential. Based on the newer terminology for 
respiratory therapists, along with information provided regarding the 
CRT and RRT credentialing processes, the commenter requested that we 
change the CORF conditions of participation to reflect the newer 
qualifications. In addition, the commenter requested that we change the 
coverage provisions to recognize both the CRT and RRT as qualified 
personnel to provide CORF respiratory therapy services.
    Response: Based on the information provided by the commenter, we 
will work within CMS to develop and update the personnel qualifications 
for RTs and RT technicians at Sec.  485.70(j) and (k), respectively. 
This request involves changes to longstanding provisions for CORF 
personnel qualifications, and we believe that other organizations, 
individuals, and medical specialties should have the opportunity to 
comment on such changes. We will propose updated qualifications for the 
CRT and RRT in future rulemaking to seek and review comments from other 
interested parties, before finalizing any changes to these personnel 
qualifications. In that rulemaking, we will revisit the issue of the 
respiratory therapy professional(s) best qualified to provide services 
under the CORF respiratory therapy plan of treatment. Until such time, 
we expect that the RT, and not the RT technician, will provide the 
services of the respiratory therapy treatment plan as previously 
discussed in CY 2002 and CY 2003 rulemaking and, again, reinforced in 
this final rule.
    We are finalizing our proposal to revise Sec.  410.100(e)(1), with 
the exception that we will not remove the term ``assessment'' for the 
reasons discussed above. We will also adopt the revisions to Sec.  
410.100(e)(2), as proposed.
5. Social and Psychological Services
    In accordance with section 1861(cc)(1)(D) of the Act, social and 
psychological services are included within the definition of CORF 
services under Sec.  410.100(h) and (i), respectively. In addition, 
Sec.  485.58 specifies that the CORF must provide a coordinated 
rehabilitation program that includes, at a minimum, social or 
psychological services, along with physical therapy services and 
physician services, and that these services must be consistent with the 
therapy plan of treatment.
    As discussed in the CY 2008 PFS proposed rule, the current 
description of social work services considered CORF services under 
Sec.  410.100(h) includes: (1) Assessment of the social and emotional 
factors related to the individual's illness, need for care, response to 
treatment, and adjustment to care furnished by the facility; (2) 
casework services to assist in resolving social and emotional problems 
that may have an adverse effect on the beneficiary's ability to respond 
to treatment; and (3) assessment of the relationship of the 
individual's medical and nursing requirements to his or her home 
situation, financial resources, and the community resources available 
upon discharge from facility care. The current description of CORF 
psychological services under Sec.  410.100(h) includes:
    (1) Assessment diagnosis and treatment of an individual's mental 
and emotional functioning as it relates to the individual's 
rehabilitation; (2) psychological evaluations of the individual's 
response to and rate of progression under the treatment plan; and (3) 
assessment of those aspects of an individual's family and home 
situation that affect the individual's rehabilitation treatment. We 
believe these current definitions of CORF social and psychological 
services are too broad. As discussed above in this section, we proposed 
to revise Sec.  410.105 to clarify our policy that CORF services are 
covered only if they are provided under the rehabilitation plan of 
treatment and relate directly to the rehabilitation of the patient. As 
such, we are concerned that the current descriptions of CORF social and 
psychological services may be misconstrued to include social and 
psychological services for the treatment of mental illness, which we 
believe is outside the scope of coverage for CORF social and 
psychological services because these services do not relate directly to 
a rehabilitation plan of

[[Page 66298]]

treatment and the associated rehabilitation goals.
    In addition, we believe it unnecessary to distinguish between CORF 
social services and CORF psychological services given their 
similarities, and therefore, we proposed to merge the two definitions 
into a single definition of CORF social and psychological services. As 
noted at section 1861(cc)(2)(B) of the Act, we believe that CORFs are 
required to provide either social services or psychological services, 
and not both types of services. We believe that merging the Sec.  
410.100(h) and (i) into a single definition of CORF social and 
psychological services is warranted to clarify the similarities between 
them.
    Therefore, we proposed to clarify the description of social and 
psychological services at Sec.  410.100(h) to include only those 
services that address the patient's response and adjustment to the 
treatment plan; rate of improvement and progress towards the 
rehabilitation goals, or other services as they directly relate to the 
physical therapy, occupational therapy, speech-language pathology, or 
respiratory therapy plan of treatment. In addition, we proposed to 
change the heading at Sec.  410.100(h) from ``social services'' to 
``social and psychological services,'' and to eliminate the separate 
definition for psychological services under Sec.  410.100(i).
    Because we proposed to revise the description of social and 
psychological services in Sec.  410.100(h), we also solicited comments 
concerning the CORF personnel qualifications in the conditions of 
participation at Sec.  485.70(g) and (l) for psychologists and social 
workers, respectively, and comments relating to the appropriate CPT 
codes to represent these CORF services.
    Due to the specificity of the purpose of CORF social and 
psychological services requiring that these covered services directly 
relate to the patient's rehabilitation treatment plan, we also invited 
comments on which CPT codes would be appropriate for CORF social and 
psychological services. We believe that the procedure codes for health 
and behavior assessment and treatment, represented by CPT codes 96150 
through 96154, specific to the patient's physical health problems, best 
describe the social and psychological services required in the CORF 
setting.
    Comment: A commenter suggested that the proposed definition of 
social and psychological services is too restrictive. The commenter 
recommends including social work, biopsychosocial functioning, and 
discharge plans in the new proposed definition of social and 
psychological services.
    One commenter is concerned that clarifying that CORFs are not 
intended to be used to treat mental illness may result in denial of the 
CORF benefit to persons who need CORF services, but who also suffer 
from a mental illness (for example, patient with schizophrenia suffers 
a stroke). A CORF patient's mental illness may need to be accounted for 
in developing a rehabilitation plan of treatment. The commenter urges 
us to avoid causing a ``chilling effect'' on those individuals 
providing social and psychological services in CORFs at the expense of 
allowing a patient to recover as fully as possible.
    A CORF provider cautioned that by not treating social and 
psychological services as a stand-alone CORF service (like physical 
therapy or occupational therapy) may have an adverse effect on the 
patient's ability to make progress toward rehabilitation goals. They 
also state that social and psychological services may be needed even 
beyond the conclusion of other CORF services.
    Response: We believe that our proposal to combine the descriptions 
of social services and psychological services into one definition best 
describes the services that CORFs are required to provide to their 
patients, as an adjunct to the rehabilitation plan of treatment. A 
broader definition of these services could be interpreted to include 
treatment of mental illness which the CORF statute and regulations do 
not permit, thereby causing Medicare to pay for services that fall 
outside the clearly defined scope of the CORF benefit.
    We proposed to combine the definitions of social services and 
psychological services to clarify and simplify the associated 
regulatory provisions. We believe that our proposal does not result in 
any actual change to either the social or psychological services, or 
the rehabilitation services, provided to CORF patients that relate 
directly to their rehabilitation plan of treatment and the associated 
rehabilitation goals.
    Therefore, we will finalize our proposal to combine the 
descriptions of social services at Sec.  410.100(h) and psychological 
services at Sec.  410.100(i) into one definition for social and 
psychological services at new Sec.  410.100(h) to make clear that these 
CORF services are the same, regardless of whether provided by a 
qualified social worker or a psychologist.
    Comment: One commenter stated that because there are several levels 
of social work education and licensure for social workers, a 
recommendation as to the qualifications for CORF social workers depends 
on whether we change our proposal to include the treatment of mental 
illness. As proposed, the commenter supports the Bachelor of Social 
Work (BSW) as the appropriate qualification educational level. However, 
if the scope of services is expanded to include the treatment of mental 
illnesses, then the commenter believes that the educational level of 
the Masters of Social Work (MSW) would be the appropriate 
qualification.
    A CORF provider stated that the personnel qualifications to perform 
CORF social and psychological services should be either a licensed 
psychologist at a Masters or PhD level, or a licensed social worker.
    A medical society representing psychiatrists suggested we use an 
existing set of qualifications for CORF psychologists and social 
workers, such as those established by the Office of Personnel 
Management.
    Response: We believe that the appropriate qualification for 
individuals providing social and psychological services in the CORF 
setting is a BSW for social workers and a Masters-level degree for 
psychologists. In response to the comment, the combination of social 
and psychological services into one definition was made for 
clarification and simplification, and does not result in any change to 
the scope of social and psychological services provided to CORF 
patients. Therefore, we believe it is appropriate to maintain the 
existing personnel qualifications for individuals providing these 
unique services in the CORF setting.
    Comment: In terms of what CPT codes might best describe the 
proposed CORF social and psychological services, one commenter 
suggested that CPT code 96155 should be added to the suggested list of 
CPT codes 96150 through 96154 in order to allow CORFs to bill for 
social and psychological services provided to a patient's family 
without the patient presence.
    Another commenter suggested that limiting the services to those 
described by CPT codes 96150 through 96154 is potentially too 
restrictive because it may not describe all of the services provided by 
CORFs. The commenter believes that this restriction would not permit 
CORFs to code the social or psychological services provided to the 
highest specificity, although no specific CPT codes were offered for 
consideration.
    In addition, one commenter believes that using a full range of CPT 
codes to describe CORF social and psychological services is 
inappropriate because these codes were not intended to be used for 
providing non-clinical CORF services. This commenter specifically 
objects to the use of CPT codes 96150 through

[[Page 66299]]

96154 because these services are specifically used by PhD level 
psychologists to provide clinical services. The commenter notes that 
other CPT codes are inappropriate to CORF use, including the CPT code 
range 90801 through 90899 that is used to treat mental illnesses, and 
the E/M CPT code series (CPT codes 99XXX), because all of these CPT 
codes represent clinical services. Rather, they believe that the social 
and psychological services provided in CORFs have ``strong case 
management and patient assessment components'' as they relate to the 
rehabilitation treatment plan. Instead of using existing CPT code(s), 
the commenter suggested we develop HCPCS code(s) specifically for CORF 
social and psychological services in order to keep case management 
services clearly distinguished from patient treatment.
    Response: In an effort to address the coding issues, at this time 
we believe that only CPT code 96152, Health and behavior intervention, 
each 15 minutes, face to-face; individual, best describes these unique 
CORF social and psychological services and should be used to bill for 
all social and psychological services provided in CORFs.
    We are sensitive to the concerns expressed by the commenter that 
CPT codes 96150 through 96154 do not accurately represent the 
descriptions of CORF social and psychological services, and that there 
may be a need to develop a HCPCS code designed specifically for use in 
the CORF setting. However, in this final rule, we do not believe it is 
appropriate to create a HCPCS code to reflect the nonclinical nature of 
the CORF social and psychological services when we did not propose 
doing so in the proposed rule. However, we will consider the 
commenter's views in making the determination regarding the necessity 
to create a new HCPCS code to describe CORF social and psychological 
services in the future.
6. Nursing Care Services
    Because the PFS does not contain a CPT code for nursing services, 
we established in the CY 1999 PFS final rule a new HCPCS code (G0128) 
for direct face to face skilled nursing services delivered to a CORF 
patient by an RN as part of a rehabilitation therapy plan of treatment. 
In the CORF conditions of participation at Sec.  485.70(b) and (h), 
qualified personnel for nursing services include an LPN or vocational 
nurse and an RN, respectively. However, when the HCPCS code G0128 was 
created for CORF nursing services we determined that a condition for 
coverage is that the nursing service be provided by an individual 
meeting the qualifications of an RN, rather than the LPN, for CORF 
clinical nursing services as they relate, or are part of, the therapy 
plan of treatment. Because we established coverage for CORF nursing 
services only when provided by an RN, in the CY 2008 PFS proposed rule, 
we proposed to revise new Sec.  410.100(i) (that is, the current Sec.  
410.100(j) is redesignated as Sec.  410.100(i)) to specifically reflect 
this coverage decision. We also requested comments on the 
appropriateness of the personnel qualification standards at Sec.  
485.79(b) and (h) for the LPN and for the RN, respectively.
    Comment: We received a comment that opposed the proposed revisions 
that would allow skilled nursing services to be performed only by 
registered nurses. The commenter suggested that the CORF nursing 
services provided by either a registered nurse or the licensed practice 
nurse should be determined by the legal scope of practice as outlined 
in State law by a State board of nursing.
    Response: During the CY 1999 final rule, we defined HCPCS code 
G0128 as a face-to-face nursing service delivered to a CORF patient 
that is directly related to a rehabilitation plan of treatment. We 
believe that the level of skill needed to render clinical nursing 
services as they relate to, or are supportive of the rehabilitation 
plan of treatment is more appropriately performed by registered nurses.
    Comment: One commenter asked us to provide an example of nursing 
services that would be appropriately furnished and separately payable 
as such in a CORF that also meets the criteria of directly relating to 
the rehabilitation treatment plan. This commenter also requests 
clarification as to whether an RN can provide services as part of the 
respiratory therapy treatment plan and if one of the HCPCS G-codes for 
respiratory therapy services, G0237, G0238, and G0239 can be used to 
bill for these services.
    Response: In the CY 1999 PFS final rule, we established coverage 
for CORF nursing services only when provided by an RN. HCPCS code G0128 
is used to bill for services that are not included in the work or PEs 
of other therapy or physician services. Because of the advances in 
medical science since the inception of the CORF benefit in 1982, the 
need for nursing services necessary to be provided as an adjunct to the 
rehabilitation treatment plan has decreased significantly. In the CY 
1999 PFS final rule, we used the example of a RN who instructs a 
patient in the proper procedure of ``in and out'' urethral 
catheterization to illustrate one such nursing service directly related 
to the rehabilitation treatment plan. At that time, nursing services 
might have been provided to patients receiving respiratory therapy 
services relating to tracheostomy tube suctioning. Another nursing 
service might be related to the cleaning instructions for ileostomy or 
colostomy bags for a patient receiving physical therapy services where 
the care is imminent to the start or completion of a therapy session.
    Comment: Another commenter noted that CORFs are required to provide 
the 3 core services, including physician services, physical therapy 
services, and social or psychological services, and asked that we 
clarify the amount that these other non-core services--specifically 
nursing services and respiratory therapy services--can comprise of the 
total CORF services. The commenter cites examples of CORFs where non-
core services comprise the majority of services, sometimes as much as 
90 percent or more, including wound care services where RNs are used to 
provide the majority of these services and other CORFs specializing 
predominantly in respiratory therapy services. Specifically, the 
commenter requested that we unambiguously address our intent as it 
relates to the provision of non-core services.
    Response: The CORF statutory provision at section 1861(cc)(2)(B) of 
the Act and Sec.  485.58 require that the CORF, as a minimum condition 
of participation, provide three core services-- physician services, 
physical therapy services, and social or psychological services. When a 
CORF provides only the three required core services, we expect that 
physical therapy services would comprise a clear majority of the total 
CORF services, since social and psychological services are provided 
only as an adjunct to the rehabilitation services and CORF physician 
services are administrative in nature and not easily identified. 
However, when a CORF provides physical therapy services and other 
skilled rehabilitation services, we expect that physical therapy 
services will be the predominant rehabilitation service provided. The 
case noted by the commenter where CORFs specialize in providing a 
preponderance of respiratory therapy services is counter to our 
expectations.
    The example cited by the commenter where the CORF is using RNs to 
provide wound care services, which together with other non-core 
services constitute the majority of services provided to a

[[Page 66300]]

patient, exemplifies a situation in which the CORF is providing nursing 
services that are not in support of a rehabilitation plan of treatment. 
In this situation, the services provided by the RNs do not conform to 
the requirement that nursing services must directly relate to or 
further a rehabilitation treatment plan and its goals, and therefore, 
are noncovered. As we discussed previously in section II.K.6 of this 
final rule with comment period, we specifically define and require CORF 
nursing services to relate to the rehabilitation plan of treatment, 
with such nursing services necessary for the attainment of the 
rehabilitation goals of the physical therapy, occupational therapy, 
speech language pathology, or respiratory therapy plan of treatment. We 
believe only professional therapists/pathologists, such as PTs, OTs, 
SLPs, and RTs, may appropriately provide these rehabilitation services 
and that it is inappropriate for an RN to provide these services. 
Nursing services may not substitute for or supplant the services of 
these therapists/pathologists, but instead should lend support to or 
further the services provided by professional therapists/pathologists 
under the rehabilitation plan of treatment. Therefore, CORF nursing 
services are covered as CORF services only when provided by a RN and 
only to the extent that they support or are an adjunct to the 
rehabilitation services provided by professional therapists/
pathologists under the rehabilitation plan of treatment.
    In addition to above clarification regarding the coverage and 
provision of the listed CORF services, we would also like to clarify 
that CORFs cannot provide services that are not included in the 
definition of CORF services at Sec.  410.100 (other than vaccines) and 
that those services included in the definition of CORF services are 
covered only to the extent that they support or further the 
rehabilitation plan of treatment. For example, we believe that CORF 
services do not include the provision of hyperbaric oxygen services, 
infusion therapy services, or diagnostic sleep studies because they do 
not meet the definition of CORF services at Sec.  410.100 or they do 
not relate to the rehabilitation plan of treatment. We believe that 
these services and other services not specifically listed as CORF 
services may be covered under other categories of Medicare benefits, 
such as physician services and diagnostic services.
    Comment: One commenter asked us to clarify if a RN could perform 
respiratory therapy services in a CORF.
    Response: As we have discussed, we believe only professional 
therapists/pathologists, such as PTs, OTs, SLPs, and RTs, may 
appropriately provide rehabilitation services, such as respiratory 
therapy services, and that it is inappropriate for an RN to provide 
these services. Therefore, respiratory therapy services provided by an 
RN are not considered CORF services under Sec.  410.100. Services 
performed by an RN may not substitute for or supplant the services of 
these therapists, but instead are covered as CORF services only to the 
extent that they support or are an adjunct to the rehabilitation 
services provided by professional therapists/pathologists under the 
rehabilitation plan of treatment.
    We would like to clarify that any CORF nursing service must be 
provided by a RN and coded as G0128 indicating that CORF ``nursing 
services'' were provided. Services provided by an RN may only be billed 
as CORF nursing services, provided they meet the definition of CORF 
nursing services at Sec.  410.100(i). We are aware that some CORFs have 
billed RN services inappropriately as E/M services, such as CPT code 
99211. In addition, we believe some physicians have inappropriately 
billed the services of CORF RNs as incident to physician services. 
Because CORF services are a distinct benefit category, and because any 
therapeutic and diagnostic services (as opposed to administrative and 
supervisory services) furnished by physicians are not CORF services, 
any service furnished by CORF personnel, including RNs, PTs, OTs, SLPs, 
and RTs, are not considered to be furnished incident to physicians'' 
services, and thus cannot be billed as services incident to physician 
services. Therefore, the CORF nursing services of RNs may only be 
billed using G0128, provided that such services meet the definition of 
CORF nursing services at Sec.  410.100(i).
    Therefore, we are finalizing Sec.  410.100(i) as proposed.
7. Drugs and Biologicals
    Section 410.100(k) currently provides that drugs and biologicals 
included within the definition of CORF services includes drugs and 
biologicals that are prescribed by a physician and administered by a 
physician or a CORF RN and not otherwise excluded from Medicare Part B 
payment under Sec.  410.29 (relating to self-administered drugs). In 
addition, in accordance with Sec.  410.105(c), drugs and biologicals 
administered to a CORF patient will be covered as CORF services only if 
included as part of the rehabilitation plan of treatment. However, we 
are unable to identify any physician prescribed drugs or biologicals 
that are not self administered that would be appropriately provided 
under a patient's rehabilitation plan of treatment. We also expressed 
our concerns about the potential for duplicative billing for drugs and 
biologicals provided in the CORF setting because they could be billed 
by the CORF or the physician furnishing such drugs and biologicals.
    Therefore, we proposed to remove Sec.  410.100(k) and invited 
comments on this proposed revision, particularly on the appropriateness 
of including drugs and biologicals under a CORF patient's 
rehabilitation plan of treatment.
    Comment: One commenter objected to the proposed removal of the 
provision for drugs and biologicals from the CORF benefit and believes 
there is an inherent risk that neither the CORF nor the physician would 
be paid for drugs and biologicals provided to CORF patients when they 
are purchased by the CORF. The commenter explained that, under our 
proposal, the CORF would no longer be permitted to submit claims for 
the drugs and biologicals they purchase, and further stated that, under 
this scenario, the physician also could not be compensated because the 
drug or biological provided in this manner would not satisfy the CMS 
incident to rules. The commenter questioned our concerns about the 
possibility of duplicative billing permitted under the current payment 
methodologies although they believe that we might be justified in our 
proposal should we have proof that both the CORF and physician are 
being paid for the same drug and biological. Until such time, the 
commenter requested we continue to permit both the CORF and the 
physician to submit claims for the drugs and biologicals provided to 
CORF patients.
    Another commenter also disagreed with our proposal to remove drugs 
and biologicals as a CORF service claiming that when the Congress 
created the CORF benefit, it ``intended to create a new type of 
facility that could provide all of the services required by a patient 
in a coordinated fashion.'' They also challenged our authority to 
remove this provision and believe that duplicative billing 
possibilities by the CORF and the physician administering the drug or 
biological is not cause for us to rewrite the statute.
    Response: The purpose of our proposal was not intended to deny 
patients access to or to avoid making payment for medically necessary 
drugs and biologicals. Because we proposed to make payment directly to 
physicians for the drugs and biologicals provided in the CORF setting, 
CORFs opting to continue purchasing these drugs and biologicals would 
not also be paid.

[[Page 66301]]

Nevertheless, we are persuaded by the commenter challenging our legal 
authority to remove drugs and biologicals from our regulatory 
definition of CORF services Sec.  410.100 in light of their inclusion 
in the statutory definition of CORF services under section 1861(cc)(1) 
of the Act. As explained in the legislative history of the CORF 
statute, the intent of this benefit was to simplify coordination of, 
and access to, ``a broad array of rehabilitation services'' (H.R. Rep. 
No. 96-1167, 96th Cong., 2nd Sess., at 375 (1980). Although as 
discussed in the proposed rule, we have been unable to identify among 
currently available drugs or biologicals that are not self-administered 
any such drugs or biologicals that appropriately may be included in as 
part of a rehabilitation plan of treatment, we cannot rule out the 
possibility that others will alert us to such drugs or biologicals or 
that future non self-administered drugs or biologicals appropriately 
may be included under a rehabilitation plan of treatment. Therefore, in 
order to ensure that, should we learn of any non self-administered 
drugs or biologicals that appropriately may be included in a 
rehabilitation plan of treatment, we may give effect to Congressional 
intent that CORFs be able to provide any such drugs or biologicals in 
coordination with other CORF rehabilitation services, we will not 
remove the reference to drugs and biologicals from the definition of 
CORF services under Sec.  410.100 as proposed.
    Instead, we will retain the existing definition of CORF-covered 
drugs and biologicals provided at new Sec.  410.100(j) (that is, the 
current Sec.  410.100(k) is redesignated as Sec.  410.100(j)) with the 
exception of adding the word ``by'' to the new Sec.  410.100(j)(1) to 
clarify our policy that, in accordance with existing professional 
standards, the administration of the drug can by provided by a RN but 
not by others under the supervision of an RN. As we are not aware of 
any non-self-administered drugs and biologicals that appropriately may 
be included in a rehabilitation plan of treatment, we intend to closely 
track the provision of drugs in the CORF setting. If in the future we 
learn that the administration of drugs or biologicals in the CORF 
setting is an appropriate service to include in the rehabilitation 
treatment plan, the regulatory framework will allow for coverage of 
such drugs or biologicals. In the mean time, we do not expect to see 
CORFs submitting claims for drugs and biologicals for the reasons noted 
above.
8. Supplies and DME
    Payment for supplies and DME as part of CORF services is specified 
at Sec.  410.100(l) as ``[s]upplies, appliances and equipment'' and 
includes nonreusable supplies, medical equipment and appliances, and 
DME as defined in Sec.  410.38 (except for renal dialysis systems). 
These are CORF covered services when provided for the patient's use 
outside the CORF whether purchased or rented, and is paid under the 
DMEPOS fee schedule. We believe that the provision at Sec.  410.100(l) 
is too broad, out of date, and inconsistent with current terminology 
used for covered services or items. The CORF provision at section 
1861(cc)(1)(G) of the Act applies only to supplies and DME, yet the 
regulatory provision also encompasses medical equipment and appliances. 
Because we believe the requirements of Sec.  410.100(l) are 
inconsistent with those of section 1861(cc)(1)(G) of the Act, we 
proposed to revise both the title and description at new Sec.  
410.100(k) (that is, the current Sec.  410.100(l) is redesignated as 
Sec.  410.100(k)) by deleting reference to medical equipment and 
appliances to reflect the CORF statutory provision by including only 
the items specified under section 1861(cc)(1)(G) of the Act. [Note: The 
preamble discussion incorrectly noted this new section as Sec.  
410.100(k) instead of Sec.  410.100(j). Section 410.100(k) is correct 
in this final rule with comment period.] We also noted that DME, as 
well as prosthetics, orthotics, and supplies, provided in the CORF 
setting requires the CORF's participation in the competitive bidding 
process, where applicable, in accordance with 42 CFR part 414 subpart 
F. In this final rule with comment period, we have added language at 
Sec.  414.1105(c)(2) to clarify that payment for DME, prosthetics, 
orthotics, and supplies determined under the DMEPOS competitive bidding 
program is a single payment amount, rather than an amount determined 
under a fee schedule. While a payment amount determined under a 
competitive bidding program is not generally thought of as a ``fee 
schedule'' for purposes of section 1834(k)(3) of the Act we believe the 
term refers to a single payment amount determined through an existing 
prospective payment system. The Congress amended the Act to replace 
reasonable cost-based payment for CORF services with prospective 
payments. Therefore, we believe the reference to ``fee schedule'' at 
section 1834(k)(3) of the Act is meant to broadly refer to existing 
prospective payment systems for the CORF-covered services or items, 
including amounts determined prospectively under a competitive bidding 
program, and should not be referring only to ``fee schedules'' in the 
narrow sense. We did not receive comments, in support of or in 
opposition to, our proposal to specify the new Sec.  410.100(k) to 
include only supplies and durable medical equipment as specified at 
section 1861(cc)(G) of the Act in the CORF benefit provision.
    Therefore, we are finalizing Sec.  410.100(k) as proposed with the 
exception that we will add the revision, discussed above, regarding the 
single payment amount determined under the DMEPOS competitive bidding 
program.
9. Clarifications and Payment Updates for Other CORF Services
    Section 4078 in the Omnibus Budget Reconciliation Act of 1987 (Pub. 
L. 100-203) (OBRA) amended section 1861(cc)(1) of the Act to provide 
that there is no requirement that any item or service furnished by a 
CORF in connection with physical therapy, occupational therapy, and 
speech pathology services under the plan of treatment be furnished at a 
single fixed location; however, such items and services are covered as 
CORF services only if payment is not otherwise made under Medicare. In 
the CY 2008 PFS proposed rule, we noted that such items and services 
may be covered under the Medicare home health benefit established under 
sections 1861(g), (m), and (p) of the Act. Accordingly, physical 
therapy, occupational therapy, and speech-language pathology services 
provided in the home are not covered as CORF services if such services 
and related items are covered under the Medicare home health benefit. 
Because the CORF regulations were not revised to reflect these changes 
in coverage and payment methodology, we proposed to clarify the 
regulations at new Sec.  410.100(l) (that is, the current Sec.  
410.100(m) which is redesignated as Sec.  410.100(l)) and Sec.  
410.105(b)(3) to reflect these requirements.
    In Sec.  410.105(b)(3), we proposed to clarify that physical 
therapy, occupational therapy, and speech-language pathology services 
can be furnished in the patient's home when payment for these therapy 
services is not otherwise made under the Medicare home health benefit.
    In addition, we proposed to revise Sec.  410.100(l) to clarify that 
the patient must be present during the home environment evaluation that 
is performed by the PT, OT or SLP, as appropriate, because we believe 
that the patient's presence is necessary to fully

[[Page 66302]]

evaluate the potential impact of the home situation on the patient's 
rehabilitation goals.
    Comment: Some commenters supported our proposal to clarify the CORF 
therapy services that can be provided in the home and who can provide 
these services. One of these commenters expressed concern about the 
requirement that the patient be present for the home environment 
evaluation and requested that we further clarify this proposal.
    Response: Section 1861(cc)(1)(H) of the Act states that there is no 
requirement for physical therapy, occupational therapy, or speech-
language pathology services to be provided at a fixed location such as 
at the CORF's physical location. This provision was further clarified 
in section 4078 of OBRA 1987 to clearly permit that, so long as the 
physical therapy, occupational therapy, or speech language pathology 
services are not otherwise covered under the Medicare home health 
benefit, these therapy services can be provided in the patient's home. 
Section 410.105(b)(3) also provides that only physical therapy, 
occupational therapy, or speech-language pathology services can be 
provided offsite, in the patient's home, and that all other CORF 
services must be provided in the CORF facility. We also proposed to 
clarify the provision at the new Sec.  410.100(l) (that is, the current 
Sec.  410.100(m) is redesignated as Sec.  410.100(l)) regarding the 
provision of a single home environment evaluation, to include the 
presence of the patient, which can be performed by a PT, OT, or SLP, as 
appropriate. [Note: The preamble discussion incorrectly noted this new 
section as Sec.  410.100(l) instead of section Sec.  410.100(k). 
Section 410.100(l) is correct in this final rule with comment period.]
    Therefore, we are finalizing the new Sec.  410.100(l) (that is, the 
current Sec.  410.100(m) is redesignated as Sec.  410.100(l)), as 
proposed.
10. Cost Based Payment (Sec.  413.1)
    Section 413.1(a)(2)(iv) currently provides for cost-based payment 
for CORF services, which reflects the payment methodology provided for 
under section 1833(a) of the Act, requiring payment on the basis of the 
lesser of the provider's reasonable costs or customary charges. As 
discussed above, this payment methodology is inconsistent with section 
1834(k) of the Act, requiring that the payment basis for outpatient 
physical therapy services (including outpatient speech-language 
pathology services), outpatient occupational therapy services, and all 
other CORF services provided on or after January 1, 1999 be 80 percent 
of the lesser of: (1) The actual charge for the services; or (2) the 
applicable fee schedule amount. Therefore, we proposed to remove Sec.  
413.1(a)(2)(iv) to clarify that cost based payment is not applicable to 
CORF services. We also proposed to remove Sec.  413.1(a)(2)(vi) for 
OPTs or rehabilitation agencies as referenced at section 1861(p) of the 
Act, because these providers were also affected by the same payment 
changes required by the 1997 BBA for physical therapy, occupational 
therapy, and speech-language pathology services effective for CY 1999.
    We did not receive comments to these technical corrections 
regarding the change in payment methodology for CORFs and OPTs that was 
effective CY 1999. Therefore, we are finalizing the technical 
corrections to remove references to cost-based payment for CORFs and 
OPTs at Sec.  413.1(a)(2)(iv) and (vi).
11. Payment for Comprehensive Outpatient Rehabilitation Facility (CORF) 
Services
    In the CY 2008 PFS proposed rule, we proposed to establish a new 
regulatory subpart M at 42 CFR part 414 to specify the payment 
methodology for comprehensive outpatient rehabilitation services 
covered under Part B of Title XVIII of the Act that are described at 
section 1861(cc)(1) of the Act. Specifically, this proposed subpart 
would identify and describe how payment is determined for services 
included as CORF services under Sec.  410.100.
    Proposed Sec.  414.1100 sets forth the basis and scope for payment 
for CORF services. Proposed Sec.  414.1105 sets forth the payment 
methodology for CORF services, including identifying the applicable fee 
schedule for each type of CORF service identified in Sec.  410.100.
    Section 1834(k)(1)(B) of the Act provides that the payment basis 
for CORF services is 80 percent of the lesser of: (1) the actual charge 
for the services; or (2) the applicable fee schedule amount. The term 
``applicable fee schedule amount'' is defined under section 1834(k)(3) 
of the Act to mean, for services furnished in a year, the payment 
amount determined under the PFS established under section 1848 of the 
Act for such services for the year ``or, if there is no such fee 
schedule established for such services, the amount determined under the 
fee schedule established for such comparable services as the Secretary 
specifies.'' Accordingly, we proposed at new Sec.  414.1105(a) to base 
payment for a CORF service on 80 percent of the lesser of the actual 
charge or the PFS amount for the service when the PFS establishes a 
payment amount for such service. Payment for CORF services under the 
PFS is made for physical therapy, occupational therapy, speech-language 
pathology, and respiratory therapy services, as well as the related 
nursing and social and psychological services. In the CY 1999 PFS final 
rule (63 FR 58860), we explained that we interpret section 1834(k)(3) 
of the Act, defining the term ``applicable fee schedule amount,'' as 
requiring us to use the payment amount established by an existing fee 
schedule other than the PFS when the PFS does not establish a payment 
amount for the CORF service. Therefore, in the CY 2008 PFS proposed 
rule we proposed at new Sec.  414.1105(c) that payment for covered DME, 
orthotic and prosthetic devices and supplies provided by a CORF be 
based on the lesser of 80 percent of actual charges or the payment 
amount established under the DMEPOS fee schedule under sections 1834 
and 1847 of the Act and in 42 CFR part 414, subparts D and F. Finally, 
we proposed at new Sec.  414.1105(d) that if there is no fee schedule 
amount established for a CORF service, payment shall be based on the 
lesser of 80 percent of actual charges or the amount determined under 
the fee schedule established for a comparable service, as specified by 
the Secretary.
    As discussed in section II.K.3., physician services included within 
the definition of CORF services under Sec.  410.100(a) are limited to 
those services of a CORF physician described as administrative in 
nature, to the exclusion of diagnostic and therapeutic services which 
are considered separately billable physician services. Medicare 
generally does not permit providers to separately bill for their 
administrative costs; rather, such costs typically are subsumed in the 
payment amounts for covered medical services and items furnished to 
Medicare beneficiaries. Under the PFS these costs are included in the 
payment amount as part of the indirect PEs that are reflected in the PE 
RVUs for each service and also captured as part of the post-visit work 
RVU component. Similarly, we believe payment to CORFs for the 
administrative duties of a CORF physician, required as a condition of 
participation at Sec.  485.58(a), such as participating in patient case 
review conferences is subsumed within PFS payments to CORFs for 
physical therapy, occupational therapy, speech-language pathology, and 
respiratory

[[Page 66303]]

therapy services, and the related nursing, and social and psychological 
services. Generally, administrative costs associated with the provision 
of such services is incorporated into payment amounts established under 
the PFS through the PE RVUs representing the resources necessary to 
perform each service in the physician office or nonfacility setting. 
Therefore, we believe it unnecessary to separately compensate CORFs for 
CORF physician services given that such services are administrative in 
nature, and proposed at Sec.  414.1105(b) not to separately pay CORFs 
for CORF physician services.
    To ensure that CORFs are not paid twice for CORF services, we 
proposed at new Sec.  414.1105 to base payment for a CORF service on 
the applicable fee schedule amount only to the extent that payment for 
such service is not included in the payment amount for other CORF 
services. Accordingly, under proposed Sec.  414.1105(c) a CORF could 
not bill separately for supplies included in the PE RVU component of 
the payment amount established for a service under the PFS. However, we 
noted that CORFs could bill separately for certain splint and cast 
supplies for the application of casts and strapping because these 
supplies have been removed from the payment amounts established under 
the PFS. We also noted that Medicare makes separate payment for 
surgical dressings, which are also referenced at section 1861(s)(5) of 
the Act, only when used by the beneficiary in his or her home. No 
separate payment is made when these surgical dressings are used in the 
CORF setting; rather the dressings' costs are bundled into the payment 
amount established under the PFS for the provided services.
    For CORF services based on the payment amount determined under the 
PFS, we proposed at new Sec.  414.1105(a)(2) to use the PFS amount 
applicable to services furnished in a nonfacility setting, with no 
separate payment made for facility costs. We proposed to use the PFS 
nonfacility amount for CORF services in order to offset any costs of 
providing such services in the CORF setting. [Note: in the proposed 
rule we incorrectly referenced the codification of the regulation text 
under proposed subpart M as Sec.  414.1001 or Sec.  414.1101 rather 
than Sec.  414.1105. However, the proposed regulation text was 
presented accurately as Sec.  414.1105 in the ``List of Subjects'' 
under the proposed subpart.]
    Other than the objection discussed above in section II.K.7 
regarding the proposed removal of the CORF provision for drugs and 
biologicals, we did not receive other comments about our proposal to 
create a regulatory provision to specify the payment methodologies for 
the CORF services identified at section 1861(cc)(1) of the Act. 
Therefore, we are finalizing our proposal to add a new regulatory 
provision defining the payment methodologies used to pay for CORF 
services except that we also include a section for payment of drugs and 
biologicals included within the definition of CORF services under the 
new Sec.  410.100(j), as explained in section II.K.7. We will implement 
this proposal, including the addition of the payment provision for 
drugs and biologicals included within the definition of CORF services 
under the new Sec.  410.100(j), and revise, by adding a new subpart M 
to part 414. The basis and scope for payment for CORF services is set 
forth at Sec.  414.1100 and Sec.  414.1105 sets forth the payment 
methodology for CORF services, including identifying the applicable fee 
schedule for each type of CORF service identified in Sec.  410.100.
12. Vaccines
    Section 485.51(a) defines a CORF as a nonresidential facility that 
``is established and operated exclusively for the purpose of 
providing'' rehabilitation services by or under the supervision of a 
physician. Because vaccines administered in the CORF setting are not 
rehabilitation services furnished under a plan of treatment relating 
directly to the rehabilitation of the patient (or, presumably, even 
medically necessary for the rehabilitation of the patient), in 
accordance with Sec.  485.51(a), a CORF may not administer vaccines to 
its patients. However, in the CY 2008 PFS proposed rule we noted that 
nothing in the Medicare statute would prohibit a CORF from providing 
pneumococcal, influenza, and hepatitis B vaccines to its patients 
provided the facility is ``primarily engaged in providing * * * 
diagnostic, therapeutic, and restorative services to outpatients for 
the rehabilitation of injured, disabled, or sick persons'' (section 
1861(cc)(2)(A) of the Act). Accordingly, under the statute, such 
vaccines may be covered separately from the CORF services benefit under 
section 1861(s)(10) of the Act--defining the term ``medical and other 
health services'' to include the pneumococcal, influenza, and hepatitis 
B vaccines--provided the applicable conditions of coverage under Sec.  
410.58 and Sec.  410.63 are met. In order to include coverage and 
payment for these vaccines when provided to CORF patients in the CORF 
setting, we proposed to amend the CORF conditions of participation at 
Sec.  485.51 to permit CORFs to provide vaccines to their patients in 
addition to rehabilitation services. Such vaccines would be covered in 
the CORF setting provided the conditions of coverage under Sec.  410.58 
and Sec.  410.63 are met. In accordance with sections 1833(a)(1) and 
1842(o)(1) of the Act, payment for covered pneumococcal, influenza, and 
hepatitis B vaccines provided in the CORF setting is based on 95 
percent of the average wholesale price (AWP).
    Comment: We received a few comments strongly supporting the 
proposal to permit vaccines to be provided in the CORF setting in 
addition to the CORF services. These commenters also strongly supported 
our proposal to clarify our policy regarding the administration of 
vaccines to CORF patients by revising the CORF conditions of 
participation to permit the provision of vaccines, in addition to CORF 
services. These commenters believe that increasing the number and types 
of providers where vaccinations can be furnished will not only help to 
ensure increased access to these vaccinations but will result in 
improved health outcomes and lower costs.
    Response: We agree with the commenters and will implement our 
proposal to revise the CORF conditions of participation, accordingly.

L. Compendia for Determination of Medically-Accepted Indications for 
Off-Label Uses of Drugs and Biologicals in an Anti-Cancer 
Chemotherapeutic Regimen (Sec.  414.930)

1. Background
a. Statutory Requirements
    Section 1861(t)(2)(B)(ii)(I) of the Act lists three drug compendia 
that may be used in determining the medically-accepted indications of 
drugs and biologicals used in an anti-cancer chemotherapeutic regimen. 
The three drug compendia listed are:

<bullet> American Hospital Formulary Service-Drug Information (AHFS- 
DI)
<bullet> American Medical Association Drug Evaluations (AMA-DE)
<bullet> United States Pharmacopoeia Drug Information (USP-DI)

    Section 1861(t)(2) of the Act provides the Secretary the authority 
to revise the list of compendia for determining medically-accepted 
indications for drugs. Due to changes in the pharmaceutical reference 
industry, fewer of the statutorily named compendia are available for 
our reference. (That is, AMA-DE is no longer in publication; USP-DI has 
been purchased by Thomson Micromedex and it is our understanding that 
the

[[Page 66304]]

name ``USP-DI'' may not be used after 2007.)
    Section 6001(f)(1) of the Deficit Reduction Act of 2005 (Pub. L. 
109-171) (DRA) amends both ``sections 1927(g)(1)(B)(i)(II) and 
1861(t)(2)(B)(ii)(I) of the Act by inserting ``(or its successor 
publications)'' after `United States Pharmacopeia Drug Information'.'' 
We interpret this DRA provision as explicitly authorizing the Secretary 
to continue recognition of the compendium currently known as USP-DI 
after its name change if the Secretary determines that it is in fact a 
successor publication rather than a substitute publication.
b. Requests To Amend the Compendia Listings
    We received requests from the stakeholder community for recognition 
of additional compendia under the following authorities:
    <bullet> Section 1861(t)(2)(B) of the Act which allows the 
Secretary to identify additional authoritative compendia; and
    <bullet> Section 1873 of the Act which allows the Secretary to 
recognize a successor publication if one of the statutorily-named 
compendia changes its name.
    In contrast, others suggested that the Secretary consider 
elimination of certain listed compendia. However, as we stated in the 
CY 2008 PFS proposed rule (72 FR 38177), there was no established 
regulatory process by which we could accept and act definitively on 
such requests. In addition, we saw the need to increase transparency of 
decision making criteria.
c. Technology Assessment of Drug Compendia Used To Determine Medically-
Accepted Uses of Drugs and Biologicals in an Anti-Cancer 
Chemotherapeutic Regimen
    We commissioned a technology assessment (TA) from the Agency for 
Healthcare Research and Quality (AHRQ) on the currently listed 
compendia (AHFS and USP-DI), as well as other compendia (that is, 
National Comprehensive Cancer Network (NCCN), ClinPharm, DrugDex, Facts 
& Comparisons (F&C)) which might provide comparable information. AHRQ 
contracted the TA to the New England Medical Center (NEMC) and Duke 
Evidence-based Practice Centers (EPCs) and found little agreement in 
the evidence cited among drug compendia. In addition, the TA found 
little agreement between the EPCs' independent identification of 
evidence on 14 example off-label indications and evidence cited in the 
drug compendia. The TA can be found at http://www.cms.hhs.gov/ mcd/
viewtechassess.asp? where=index&tid=46.
d. Medicare Evidence Development and Coverage Advisory Committee 
(MedCAC)
    On March 30, 2006, the MedCAC (formerly the Medicare Coverage 
Advisory Committee (MCAC)) met in public session to advise CMS on the 
evidence about the desirable characteristics of compendia to determine 
medically-accepted indications of drugs and biologicals in anti-cancer 
therapy and the degree to which the currently listed and other 
available compendia display those characteristics. All information on 
this MedCAC meeting can be found on the CMS Web site at http://www.cms.hhs.gov/mcd/viewmcac.asp?where=index&mid=33. The agenda 
included a presentation of the TA performed for AHRQ by staff of the 
NEMC and Duke EPCs, scheduled stakeholder presentations, as well as an 
opportunity to hear testimony from members of the audience. As is 
customary, the MedCAC panelists elicited additional information from 
the presenters and discussed the evidence in preparation for a formal 
vote.
    The MedCAC identified the following desirable characteristics:
    <bullet> Extensive breadth of listings.
    <bullet> Quick processing from application for inclusion to 
listing.
    <bullet> Detailed description of the evidence reviewed for every 
individual listing.
    <bullet> Use of pre specified published criteria for weighing 
evidence.
    <bullet> Use of prescribed published process for making 
recommendations.
    <bullet> Publicly transparent process for evaluating therapies.
    <bullet> Explicit ``Not recommended'' listing when validated 
evidence is appropriate.
    <bullet> Explicit listing and recommendations regarding therapies, 
including sequential use or combination in relation to other therapies.
    <bullet> Explicit ``Equivocal'' listing when validated evidence is 
equivocal.
    <bullet> Process for public identification and notification of 
potential conflicts of interest of the compendia's parent and sibling 
organizations, reviewers, and committee members, with an established 
procedure to manage recognized conflicts.
    The MedCAC concluded that none of the compendia fully display the 
desirable characteristics. The voting results can be viewed at the same 
Web site provided previously for the MedCAC meeting. In addition the 
MedCAC noted significant variability among the compendia. There was no 
agreement among the panel members that any particular predetermined 
number of compendia was desirable.
    Participants in the meeting also discussed the clinical usefulness 
of drug compendia in the treatment of cancer. It was reported that 
oncologists do not rely on compendia when making treatment decisions, 
relying instead on published treatment guidelines, clinical trial 
protocols, or consultation with peers.
    Prior to the CY 2008 PFS proposed rule, we received, and reviewed, 
unsolicited comments from professional societies regarding additions 
and deletions to the listing of compendia for purposes of section 
1861(t) of the Act. We received 46 public comments regarding these 
provisions on the CY 2008 PFS proposed rule.
2. Process for Determining Changes to the Compendia List
    A compendium for the purpose of this section is defined as a 
comprehensive listing of FDA-approved drugs and biologicals or a 
comprehensive listing of a specific subset of drugs and biologicals in 
a specialty compendium, for example, a compendium of anti-cancer 
treatment. A compendium: (1) Includes a summary of the pharmacologic 
characteristics of each drug or biological and may include information 
on dosage, as well as recommended or endorsed uses in specific 
diseases; (2) is indexed by drug or biological; (3) differs from a 
disease treatment guideline, which is indexed by disease. We believe 
that the use of compendia to determine medically-accepted indications 
of drugs and biologicals in the manner specified in section 
1861(t)(2)(B)(ii)(I) of the Act is more efficiently accomplished if the 
information contained is organized by the drug or biological and if the 
listings are comprehensive.
    We proposed an annual process, incorporating public notice and 
comment, to receive and make determinations regarding requests for 
changes to the list of compendia used to determine medically-accepted 
indications for drugs and biologicals used in anti-cancer treatment as 
described in section 1861(t)(2)(B)(ii)(I) of the Act. The specific 
details of the proposed process were outlined in PFS CY 2008 proposed 
rule (72 FR 38118). We received the following comments on our proposed 
process.
    Comment: Several commenters remarked that we should correlate Part 
B and Part D compendia for consistency within the Medicare program.
    Response: The Social Security Act separately determines the 
Agency's use

[[Page 66305]]

of authoritative compendia for specific programs. The use of any 
compendium for Part D or for Medicaid is beyond the scope of this 
regulation.
    Comment: Many commenters voiced concerns about the time line 
proposed by CMS to address requests for changes to the list of 
compendia.
    Response: We are striving to achieve a more expedient and 
predictable time line that will better serve the needs of those who 
care for Medicare beneficiaries. We have carefully considered the 
comments and made the following revisions:
    (1) In order to shorten the proposed timeline, CMS will not publish 
an annual notice for formal requests.
    (2) We expect to receive requests annually during a 30-day window 
starting January 15th.
    (3) We expect to post these complete requests received by March 
15th for public notice and comment on the CMS Web site.
    (4) We will accept public comments for a 30 day period beginning on 
the day that the request is posted by CMS on the Web site.
    Comment: Some commenters suggested alternative review cycles 
including changing the annual review to: a rolling review process; an 
every 3-year review process; or an every 5-year review process.
    Response: We appreciate the commenters' suggestions regarding 
alternative review cycles; however, at this time, we believe that an 
annual review cycle is the best balance of these suggestions to promote 
a publicly responsive review process. Due to the general stability of 
the compendium publishing market, an annual review process is 
sufficient. However, if we determine that the public interest would be 
served by an immediate compendia review, we reserve the right to 
internally generate a request at any time.
    Comment: Several commenters suggested specific additions to the 
list of compendia.
    Response: The addition or deletion of specific compendia is beyond 
the scope of this regulation. Formal requests for additions and 
deletions may be submitted during the annual open request period 
established in this final rule with comment period.
    Comment: The comments received from several associations and 
manufacturers stated that the language used for the individual 
desirable characteristics was not clear and that we did not give the 
appropriate consideration to quality concerns and the potential 
conflicts of interest.
    Response: We appreciate the commenters' concerns and strive to 
provide clarity on the MedCAC desirable characteristics that we will 
utilize in the compendia review process. The characteristics presented 
here represent an evidence-based consensus from the MedCAC panel on the 
desirability and priority of those characteristics. We recognize that 
different compendia might attempt to achieve these characteristics in 
individualized ways. CMS plans to use the desirable characteristics as 
framework and guidance in the review process. However, we believe that 
the public interest is best served by CMS attention to the quality and 
the integrity of each compendium's evidence evaluation process.
    Comment: A few commenters made the general suggestion for CMS to 
prioritize the desirable characteristics identified at the MedCAC 
meeting, March 2006.
    Response: We wish to clarify that the desirable characteristics 
recommended by the MedCAC will serve as guidance and a framework which 
will aid in the CMS review process. As stated in the CY 2008 PFS 
proposed rule, we ``may consider additional reasonable factors in 
making a determination'' as deemed appropriate. While we have decided 
not to rank the MedCAC desirable characteristics, we do consider the 
characteristics referencing transparency and conflict of interest to be 
of high priority to preserve the integrity and minimize bias during the 
review process.
    Comment: Some commenters stated that a deletion from the list of 
compendia could cause a beneficiary to lose coverage of an off-label 
treatment regimen already begun.
    Response: We understand the concern expressed by the commenters on 
a beneficiary's loss of coverage during the continuance of off-label 
treatment in the absence of compendium support; however local 
contractors have additional authority to make determinations regarding 
medically accepted indications. While we require local contractors to 
use the compendia as a reference in the determination of ``medically-
accepted'' off-label treatment regimens, the compendia are not the sole 
reference for these determinations. Section 1861(t)(2)(B)(ii)(II) of 
the Act provides that local contractors use ``supportive clinical 
evidence in peer-reviewed medical literature'' to aid in making 
determinations of ``medically-accepted'' off-label treatment regimens 
when appropriate.
    Comment: Commenters asked that we recognize compendia indexed by 
disease.
    Response: In order to meet our criteria, a compendium should: (1) 
Include a summary of the pharmacologic characteristics of each drug or 
biological and may include information on dosage, as well as 
recommended or endorsed uses in specific diseases; (2) be indexed by 
drug or biological; (3) differ from a disease treatment guideline, 
which is indexed by disease. We believe that the use of compendia to 
determine medically-accepted indications of drugs and biologicals in 
the manner specified in section 1861(t)(2)(B)(ii)(I) of the Act is more 
efficiently accomplished if the information contained is organized by 
the drug or biological and if the listings are comprehensive.
    Comment: Several commenters suggested that we should regulate a 
time frame for compendia to update their recommendations.
    Response: We believe that the public interest is served if 
compendia generally update their recommendations in a timely manner 
when new evidence regarding the use of drugs warrants an update. We 
also believe that this is consistent with spirit of the MedCAC's 
recommendations. However, medical evidence on a particular use of a 
specific drug may at times be complex and inconsistent, and thus, merit 
a prolonged rather than an expedited analysis. We do not believe that 
we should establish in regulation a specific broad time line 
requirement at this time. However, we will consider public input 
regarding a compendium's timely updating of its recommendations as an 
additional criterion in our compendium review process.
    Comment: We received comments suggesting that a compendium's use of 
grades of evidence may add a confusing factor in determining whether a 
compendium citation supports a particular drug use. Commenters stated 
that it is desirable for a compendium to clarify in a summary 
recommendation whether it regards each drug use as medically-accepted.
    Response: We recognize and support the desirability of an explicit 
summary recommendation for each drug or biological cited in each 
compendium. This will facilitate the consistent interpretation of off-
label recommendations by Medicare contractors.
    Comment: One commenter suggested that a recognized compendium 
should include and identify a well designed clinical trial that is 
pending FDA approval.
    Response: We do not believe that we can specify how a compendium

[[Page 66306]]

references materials regarding clinical trials for a drug not yet FDA-
approved.
    Comment: Two commenters claimed that section 1861(t)(2) of the Act 
mandates separate processes for adding and removing compendia.
    Response: While we appreciate the thoughtful interpretation of the 
language, we do not agree separate processes are required by the 
statute.
    Comment: One commenter suggested that the identity of the members 
of the compendium's advisory board and scientific review committee 
should become public record. The commenter also requested that we to 
establish a formal process to facilitate stakeholder/compendia 
communication.
    Response: Public identification of members of the compendium's 
advisory board and the scientific review committees and establishing a 
formal process for stakeholders/compendia communication is beyond our 
authority and scope of this regulation.
    Based on the public comments received, we have made revisions to 
the proposed compendia review process. We appreciate the need for a 
more expedient process to provide a useful compendia list for Medicare 
providers and have made the necessary changes.
    Requests may be submitted in two ways (no duplicates please). 
Electronic submissions are encouraged to facilitate administrative 
efficiency. We will identify the electronic address to be used for 
submissions. Hard copy requests can be sent to the Centers for Medicare 
& Medicaid Services, Coverage and Analysis Group, Mailstop C1-09-06, 
7500 Security Boulevard, Baltimore, MD, 21244. Please allow sufficient 
time for hard copies to be received prior to the close of the receipt 
period.
    We may consider additional reasonable factors in making a 
determination. (For example, we may consider factors that are likely to 
impact the compendium's suitability for this use, such as but not 
restricted to a change in ownership or affiliation, suspension of 
publication, the standards applicable to the evidence considered by the 
compendium, and any relevant conflicts of interest. We may consider 
that broad accessibility by the general public to the information 
contained in the compendium may assist beneficiaries, their treating 
physicians, or both, in choosing among treatment options.)
    <bullet> We will also consider a compendium's grading of evidence 
used in making recommendations regarding off-label uses and the process 
by which the compendium grades the evidence.
    <bullet> We may, at our discretion, combine and consider multiple 
requests that refer to the same compendium, even if those requests are 
for different actions. This facilitates administrative efficiency in 
our review of requests.
    <bullet> We will notify the public of additions or deletions to the 
list of compendia on the CMS Web site.
    <bullet> In keeping with our desire to shorten the compendia review 
time line, we will publish our decision no later than 90 days following 
the close of the public comment period.

M. Physician Self-Referral Issues

1. General
    In the CY 2008 PFS proposed rule (72 FR 38122), we proposed several 
revisions to the physician self-referral regulations. We also solicited 
comments regarding potential changes to or limitations on the use of 
the in-office ancillary services exception in Sec.  411.355(b). We 
received approximately 1100 pieces of timely correspondence in response 
to these proposals.
    We received the following comments regarding finalizing our 
proposals:
    Comment: Many commenters were concerned about the perceived 
complexity and breadth of the physician self-referral proposals. 
Several commenters questioned our ability to analyze sufficiently, and 
give adequate consideration to, the public comments due to the brief 
time period between issuance of the CY 2008 PFS proposed rule (72 FR 
38122) and the statutory deadline for publication of this final rule 
with comment period. Some commenters suggested that we not finalize any 
of the proposals at this time. Many of those commenters asserted that 
we should further contemplate the issues and propose revised regulatory 
provisions in the CY 2009 PFS proposed rule if we continue to believe 
that such revisions are necessary.
    Response: We are not inclined to follow the commenters' suggestion 
regarding reproposal of the physician self-referral provisions in the 
CY 2009 PFS proposed rule. However, given the number of physician self-
referral proposals, the significance of the provisions both 
individually and in concert with each other, and the volume of public 
comments, we do not believe it is prudent to finalize any of the 
proposals in this rule (except for the proposal for anti-markup 
provisions for diagnostic tests, as discussed below in this section). 
Although we are not finalizing the proposed revisions to the other 
physician self-referral regulations in this final rule with comment 
period, we are confident that we have sufficient information, both from 
the commenters and our independent research, to finalize revisions to 
the physician self-referral regulations without the need for new 
proposals and additional public comment. We intend to publish a final 
rule that addresses the following proposals:
    <bullet> Burden of proof;
    <bullet> Obstetrical malpractice insurance subsidies;
    <bullet> Unit-of-service (per-click) payments in lease 
arrangements;
    <bullet> The period of disallowance for noncompliant financial 
relationships;
    <bullet> Ownership or investment interests in retirement plans;
    <bullet> ``Set in advance'' and percentage-based compensation 
arrangements;
    <bullet> ``Stand in the shoes'' provisions;
    <bullet> Alternative criteria for satisfying certain exceptions; 
and
    <bullet> Services furnished ``under arrangements.'' Because we did 
not make a specific proposal regarding the in-office ancillary services 
exception, but rather merely solicited comments regarding its scope and 
application, any revisions to the exception in Sec.  411.355(b) will be 
accomplished through a future notice of proposed rulemaking with 
provisions for public comment.
    A measured, thoughtful approach to the final physician self-
referral rules is critical. We believe that the future rulemaking will 
address the public comments and present a coordinated, comprehensive 
approach to accomplishing the goals described in the proposed rule, 
namely, minimizing the threat of program and patient abuse while 
providing sufficient flexibility to enable those who are parties to 
financial arrangements to satisfy the requirements of, and remain in 
compliance with, the physician self-referral law and the exceptions 
thereto.
2. Changes to Reassignment and Physician Self-Referral Rules Relating 
to Diagnostic Tests (Anti-Markup Provisions)
    Medicare regulations currently prohibit the markup of the technical 
component (TC) of certain diagnostic tests that are performed by 
outside suppliers and billed to Medicare by a different individual or 
entity (Sec.  414.50). In addition, Medicare program instructions 
restrict who may bill for the professional component (PC) (the 
interpretation) of diagnostic tests (Section 30.2.9.1 of the CMS 
Internet-Only Manual, Publication 100-04, Medicare Claims Processing 
Manual, Chapter 1, general billing requirements, as amended or replaced 
from time to time).

[[Page 66307]]

    In the CY 2007 PFS proposed rule (71 FR 48982), we stated that 
recent changes to our rules on reassignment concerning the right to 
receive Medicare payment may have led to some confusion as to whether 
the anti-markup and purchased interpretation requirements apply in 
certain situations where a reassignment has occurred pursuant to a 
contractual arrangement. In addition, we expressed concern about the 
existence of certain arrangements that we believe are not within the 
intended purpose of the physician self-referral exception for in-office 
ancillary services, which permits physician group practices to bill for 
certain services referred by group physicians and furnished by a 
contractor physician in a ``centralized building.'' We also expressed 
concern that allowing physician group practices or other suppliers to 
purchase or otherwise contract for the provision of diagnostic testing 
services and to then realize a profit when billing Medicare may: (1) 
Lead to program and patient abuse in the form of overutilization of 
services; and (2) result in higher costs to the Medicare program (71 FR 
49054). In the CY 2007 PFS proposed rule, we proposed to amend Sec.  
424.80 to provide that, if the TC of a diagnostic test (other than a 
clinical diagnostic laboratory test paid under section 1833(a)(2)(D) of 
the Act, which is subject to the special rules set forth in section 
1833(h)(5)(A) of the Act) is billed by a physician or medical group 
(the ``billing entity'') under a reassignment involving a contractual 
arrangement with a physician or other supplier who performs the 
service, the amount billed to Medicare by the billing entity would be 
limited. We also proposed that, to bill for the TC, the billing entity 
would be required to perform the interpretation. In addition, we 
considered imposing certain conditions on when a physician or medical 
group can bill for the reassigned PC of a diagnostic test. For our 
physician self-referral rules, we proposed to modify the definition of 
``centralized building'' at Sec.  411.351. Finally, we solicited 
comments on the specific application of our proposals. (See the CY 2007 
and CY 2008 PFS proposed rules for more information on these proposals 
(71 FR 49054 through 49057 and 72 FR 38179 through 38180, 
respectively).)
    We received numerous comments on the proposals in the CY 2007 PFS 
proposed rule. Because we decided to study the issues further, we did 
not finalize our proposals in the CY 2007 PFS final rule with comment 
period. Rather, based on the comments received and other information 
that we considered, in the CY 2008 PFS proposed rule, we proposed to 
impose an anti-markup limitation on the TC and PC of diagnostic tests. 
We stated that we would apply the anti-markup provision irrespective of 
whether: (1) The billing entity outright purchases the TC or the PC; or 
(2) the physician or other supplier performing the TC or PC reassigns 
his or her right to bill the Medicare program to the billing entity 
(unless the performing supplier is a full-time employee of the billing 
entity). That is, we proposed to limit the payment to the billing 
entity to the lowest of: (1) The performing physician's or other 
supplier's net charge to the billing entity; (2) the billing entity's 
actual charge; or (3) the fee schedule amount for the service that 
would be allowed if the physician or other supplier performing the 
service billed directly. To prevent gaming, whereby the performing 
physician's or other supplier's net charge to the billing entity is 
inflated to cover the cost of equipment or space that is leased by the 
billing entity to the performing physician or other supplier, we stated 
that we would define ``net charge'' as exclusive of any amount that 
takes into consideration such charges.
    We also stated that we were concerned that overutilization of 
diagnostic tests could continue despite our proposal to apply an anti-
markup provision to TCs that are reassigned to, or outright purchased 
by, group practices. That is, we intended to address the situation in 
which the TC is performed by a part-time or leased employee of the 
group practice in a ``centralized building,'' and the group neither 
receives a reassignment from the employee technician (if the technician 
is not able to bill for the TC in his or her own right), nor purchases 
the TC outright from the technician. Therefore, we proposed to apply an 
anti-markup provision to TCs that are performed in a centralized 
building, and sought comments on whether we should have such a 
provision and, if so, how we should effect such a provision (for 
example, by amending the definition of ``centralized building'' or 
through some other means). We stated that we would except from the 
anti-markup provision PCs performed by a physician pursuant to an 
arrangement with an independent laboratory as we do not believe that 
such PCs ordered by an independent laboratory pose a significant risk 
of program abuse because the independent laboratory does not order the 
diagnostic test. We proposed revisions to Sec.  424.80 (reassignments) 
and Sec.  414.50 (purchased diagnostic tests). (We did not propose 
regulatory text revisions for our proposals to apply an anti-markup 
provision to TCs that are performed in a centralized building, and not 
apply the anti-markup provision to PCs billed by independent 
laboratories whose personnel do not order the diagnostic test.)
    Many commenters supported our proposals to prohibit the markup of 
the TC and PC of diagnostic tests in order to prevent physicians, 
physician group practices, and medical groups from profiting through 
the ordering of such tests. Commenters that supported our proposals 
often cited a concern about overutilization. Many commenters were 
opposed to our proposals. These commenters stated that the Medicare 
program and its beneficiaries are better served by physicians who refer 
tests to specialists (such as pathologists who contract directly with 
group practices), instead of physicians who use large reference 
laboratories. These commenters asserted that, because physicians 
develop a working relationship with particular pathologists, and 
because the pathologists ``specialize'' in a particular type of biopsy 
(for example, prostate biopsies), results are obtained more quickly and 
quality is enhanced. Finally, most commenters who responded to our 
proposal to apply an anti-markup to reassignments from part-time 
employees, irrespective of whether they were in support generally of 
our proposals, opposed this specific proposal.
    After careful consideration of all of the comments, we are adopting 
our proposals, with modification. We are imposing an anti-markup 
provision on TCs of diagnostic tests that are ordered by the billing 
physician or other supplier (or ordered by a party related by common 
ownership or control to such billing supplier), if the TC is outright 
purchased or if the TC is performed at a site other than the office of 
the billing physician or other supplier.\1\ (For purposes of the anti-
markup provisions, the ``office of the billing physician or other 
supplier'' has its common meaning. The term is defined at revised Sec.  
414.50(a)(2)(iii) as space where the physician or other supplier 
regularly furnishes patient care. With respect to a billing physician 
or other supplier that is a physician

[[Page 66308]]

organization (as defined at Sec.  411.351 of this chapter), the 
``office of the billing physician or other supplier'' is space in which 
the physician organization provides substantially the full range of 
patient care services that the physician organization provides 
generally.) We are also imposing an anti-markup provision on PCs of 
diagnostic tests that are ordered by the billing physician or other 
supplier (or ordered by a party related by common ownership or control 
to such billing supplier), if the PC is outright purchased or if the PC 
is not performed in the office of the billing physician or other 
supplier. Also, part-time employees are treated no differently than 
full-time employees or contractors who reassign benefits.
---------------------------------------------------------------------------

    \1\ We note that, in our proposals, we used the term ``billing 
entity'' to refer to a billing physician or medical group. In this 
final rule with comment period, the anti-markup provisions 
potentially apply to TCs and PCs billed by any supplier; therefore, 
we use the terms ``billing physician or other supplier'' and 
``billing supplier.'' These terms are used interchangeably.
---------------------------------------------------------------------------

    We are primarily revising Sec.  414.50, although we have also 
revised Sec.  424.80 by adding (d)(3) to alert the reader that, in the 
case of the reassignment of the TC or PC of a diagnostic test, the 
reader should consult Sec.  414.50 to investigate whether the anti-
markup provisions apply to the TC or PC. We are also revising our 
definition of ``entity'' at Sec.  411.351, which is relevant to our 
rules on physician self-referral. Currently, the definition of 
``entity'' provides an exception for a physician's practice when it 
bills Medicare for a diagnostic test in accordance with Sec.  414.50. 
We are revising the definition of ``entity'' at Sec.  411.351 to 
exclude a physician's practice when it bills Medicare for the TC or PC 
of a diagnostic test in accordance with Sec.  414.50.
    Examples of the application of the final provisions to particular 
facts appear immediately below, followed by a discussion of the 
specific comments we received on our proposals. We note that the 
following examples are intended only to illustrate the application of 
the anti-markup provisions of this final rule with comment period; they 
are not intended to address whether the physician self-referral rules 
would prohibit payment due to financial relationships that may exist 
between the billing supplier and any physician ordering a test or 
performing the TC or PC of a test.

    Example 1. A urology group practice contracts with a leasing 
company that supplies a technician and a pathologist to perform 
testing on prostate samples. The technician performs the tissue 
sampling and the pathologist reads the slides. All work is done 
outside of the office of the billing group practice, and instead is 
performed in space that is rented exclusively ``24/7'' by the group 
practice (thus meeting the definition of a ``centralized building'' 
at Sec.  411.351) for the sole purpose of providing pathology 
services for the group's patients. Because the centralized building 
does not qualify as ``the office of the billing physician or other 
supplier,'' the anti-markup provisions apply to both the TC and the 
PC, and the group may bill Medicare the lowest of the following: (1) 
The leasing company's net charge to the group; (2) the group's 
actual charge; or (3) the fee schedule amounts for the TC and 
interpretation that would be allowed if the leasing company were 
enrolled in and billed Medicare directly.
    Example 2. Same as Example 1, except that the TC and PC are 
performed by the group practice's employee technician and a 
pathologist who is an independent contractor of the group practice, 
respectively. Here, the anti-markup provisions again apply to both 
the TC and the PC because the work was not done in the ``office of 
the billing physician or other supplier'' (that is, the office of 
the group practice). It does not matter that the technician is an 
employee and the pathologist is an independent contractor because 
the work was not performed in the office of the billing group 
practice.
    Example 3. A physician in a group practice orders a diagnostic 
test and a technician who is a part-time employee of the group 
performs the test in the group's office. A physician who is an 
independent contractor of the group performs the PC in the group's 
office and reassigns his or her right to payment to the group. The 
anti-markup provisions do not apply to the group's billing of the TC 
or the PC.
    Example 4. Same as Example 3, except that the independent 
contractor physician performs the PC in his or her home and 
reassigns his or her right to payment to the group. The group's 
billing of the TC is not subject to the anti-markup provision, but 
the group's billing of the PC is subject to the anti-markup 
provision because the work was not performed in the office of the 
billing supplier.
    Example 5. A group practice purchases both a diagnostic test and 
its interpretation from a laboratory and bills the TC and PC to 
Medicare. The anti-markup provisions apply to both the TC and the 
PC. Because the TC and the PC were purchased, the location(s) at 
which the TC and the PC were performed does not matter.
    Example 6. A group practice orders a diagnostic test from an 
independent laboratory. The laboratory performs the test and 
contracts with a physician to perform the PC. The laboratory bills 
Medicare for both the TC and the PC. The laboratory is not subject 
to the anti-markup provision for the PC, because the laboratory did 
not order the test.
    Example 7. Same as Example 6, except that a physician orders a 
diagnostic test from an independent diagnostic testing facility 
(IDTF). The IDTF bills Medicare for both the TC and the PC of the 
test. The anti-markup provisions do not apply because the IDTF did 
not order the test.
a. Authority
    Comment: Several commenters questioned whether we have the 
authority pursuant to section 1842(n) of the Act to impose an anti-
markup provision as described in the CY 2008 PFS proposed rule. The 
commenters specifically noted that, in section 1842(n) of the Act, the 
Congress directed the Secretary to impose an anti-markup on the TC of 
diagnostic tests, yet our proposal applied to the TC and the PC of 
diagnostic tests. Commenters stated that the interpretation of a 
diagnostic test is a physician service, and that section 1848 of the 
Act mandates that physician services be paid the lesser of the billing 
physician's actual charge or the fee schedule amount, and therefore, we 
have no authority to extend the anti-markup rule to physician services.
    Response: We believe that several provisions of the Medicare 
statute provide us with the requisite authority to impose anti-markup 
provisions on the TC and PC of certain diagnostic tests. Section 
1842(n)(1)(A) of the Act, which was enacted as part of the Omnibus 
Budget Reconciliation Act of 1987, provides that, if the diagnostic 
test was not performed or supervised by the billing physician and also 
was not performed or supervised by a physician with whom the billing 
physician shares a practice, the Medicare payment is the lower of the 
costs (net of any discount) charged by the performing supplier to the 
billing physician, or the performing supplier's reasonable charge (or 
other applicable limit). This is commonly known as the anti-markup 
provision. Although, to date, this statutory provision has been 
implemented through the regulation in Sec.  414.50 that imposes an 
anti-markup provision on the TC only of a diagnostic test, nothing in 
this section limits our authority to apply this section to the PC of a 
diagnostic test.
    Moreover, we believe that we can interpret the language ``shares a 
practice'' as giving us the authority to impose an anti-markup 
provision on the TC of tests that are outright purchased by a billing 
physician or group, as well as on the TC of tests for which payment is 
reassigned to the billing physician or group. Although we previously 
implemented this statutory provision through regulation in Sec.  414.50 
by enacting an anti-markup provision on the TC of ``purchased'' 
diagnostic tests from an outside supplier, the statutory provision does 
not speak in terms of ``purchased'' tests. In the intervening time 
since CMS promulgated the regulation in Sec.  414.50, other changes to 
the Medicare program, in particular, the changes made by section 952 of 
the MMA to the reassignment exceptions authority, have created 
incentives for conduct that we believe increases the risk of 
overutilization and abuse of the Medicare program. We believe that the 
language ``shares a practice'' in section 1842(n)(1) of the Act can 
cover not just

[[Page 66309]]

tests that are outright purchased, but also tests for which payment is 
reassigned to the billing supplier. We are amending Sec.  414.50 in 
this final rule to provide that TCs and PCs that are not performed in 
the office of the billing physician or other supplier are subject to 
the anti-markup provision. We believe that, if the TC or PC is not 
purchased and is performed in the office of the billing supplier by an 
employee (whether full-time or part-time) or an independent contractor 
who reassigns benefits, a sufficient nexus with the practice of the 
billing supplier (that is, the billing physician or group) is 
established such that the employee or independent contractor may be 
viewed as ``sharing a practice'' with the billing supplier for purposes 
of section 1842(n)(1) of the Act. In addition, we believe that we have 
authority under sections 1102(a) and 1871(a) of the Act (our general 
rulemaking authority) to impose anti-markup provisions on the TC and PC 
of diagnostic tests in order to fully effectuate the Congress' intent 
in enacting section 1842(n)(1) of the Act.
    We find additional authority in section 1842(b)(6) of the Act. This 
section generally prohibits Medicare payment to anyone other than the 
Medicare beneficiary or the physician or other person who furnished the 
item or service to the beneficiary. We allow a physician or other 
supplier to bill for tests and test interpretations that are purchased 
from an outside supplier because we have deemed the test or 
interpretation to be performed by the billing supplier; however, we are 
not required to deem the test or interpretation as having been 
performed by the billing supplier, nor are we required to do so without 
placing limits on the amount the purchasing supplier may bill. 
Likewise, whereas section 1842(b)(6) of the Act also provides 
exceptions (known as the reassignment exceptions) to the general rule 
that payment may be made only to the beneficiary or the physician or 
other person who furnished the item or service, such exceptions allow 
us (``payment may be made''), but do not require us, to make payment to 
an individual or an entity other than the beneficiary or the physician 
or other person who furnished the item or service to the beneficiary. 
(We note that the Congress specifically provided for CMS to implement 
safeguards in the context of reassignments pursuant to a contractual 
arrangement. Section 952 of the MMA permitted Medicare to pay a 
physician or entity billing for an item or service as a result of a 
reassignment created pursuant to a contractual arrangement, regardless 
of the site of service. However, in section 952 of the MMA, the 
Congress specifically authorized the Secretary to subject such 
arrangements to ``such program integrity and other safeguards as the 
Secretary may determine to be appropriate.'') Therefore, we believe 
that we have ample authority under section 1842(b)(6) of the Act to 
place restrictions on the billing of tests and interpretations when the 
tests or interpretations were performed by someone other than the 
billing supplier, particularly with respect to situations in which 
there is the potential for overutilization.
    We do not view the application of the anti-markup provision to the 
PC of diagnostic tests as representing a conflict with section 1848 of 
the Act as stated by the commenters. Although section 1848 of the Act 
does outline how physician services will be paid in the typical 
situation, section 1848 of the Act does not preclude us from setting 
conditions on physician payment or from deviating from the payment 
methodology outlined in section 1848 of the Act where a physician or 
other supplier is seeking to take advantage of a special situation made 
available to physicians or other suppliers by CMS. Payment pursuant to 
the terms of section 1848 of the Act is available for all the 
diagnostic tests in question. Physicians and other suppliers are free 
not to take advantage of the purchased test option or the reassignment 
option, and bill and receive payment only for tests they have 
personally performed. Where physicians and other suppliers choose to 
take advantage of these options, for purposes of convenience or for 
other reasons, we have the authority under our general rulemaking 
authority in sections 1102(a) and 1871(a) of the Act, as well as under 
our authority to set conditions for the payment of purchased and 
reassigned tests in section 1842(b)(6) of the Act, to promulgate rules 
to ensure that these options do not increase the likelihood of Medicare 
program abuse.

b. Scope of Application of the Anti-Markup Provisions

    Comment: One commenter offered alternatives to our proposals. The 
commenter stated that, at least initially, the anti-markup provisions 
should apply exclusively to gastroenterology, dermatology, and urology 
physician group practices because those specialties order a significant 
number of pathology tests. The commenter suggested that we could 
subsequently broaden application of the anti-markup provisions to the 
extent that ``new abusive'' arrangements develop. Alternatively, 
according to the commenter, CMS could define the specialties to which 
the anti-markup provisions would apply on the basis of objective 
criteria. For example, the anti-markup provisions could apply to group 
practices billing for pathology services where at least 75 percent of 
the members are from a single nonpathology specialty and where at least 
75 percent of the pathology services billed by the group practice were 
ordered by members of the group. The commenter asserted that such a 
definition should cover most of the abusive arrangements that have 
developed in recent years. The commenter urged us to impose a broad 
prohibition on profiting from pathology tests, which would apply 
without regard to whether the histotechnologists are full-time 
employees or independent contractors of the group practice. According 
to the commenter, a prohibition on profiting could be accomplished by 
prohibiting any markup over the direct costs incurred by the group 
practice in providing such services, and direct costs should be limited 
to the compensation paid to the persons providing the services and the 
cost of the equipment and supplies utilized in performing the services. 
Finally, the commenter suggested the alternative of amending the 
requirements for ``group practices'' in Sec.  411.352 to prohibit 
gastroenterology, dermatology and urology group practices from 
profiting from Medicare payments for pathology services performed 
within the group practice.
    Response: We decline to adopt any of the approaches suggested by 
the commenter. The anti-markup provisions in this final rule with 
comment period apply to group practices (as well as all other 
suppliers) regardless of specialty. We believe that making the rule 
applicable to all suppliers ensures fair and equitable treatment among 
types of suppliers and also ensures that the potential for 
overutilization is addressed regardless of the particular type of 
supplier involved. As we discuss in greater detail below, we agree with 
the commenter that it should not matter whether the person performing 
the TC is a full-time employee, part-time employee or independent 
contractor. If the TC (or PC) is purchased, or if it is performed in a 
place other than the office of the billing supplier, the anti-markup 
provision will apply, irrespective of the employment status of the 
person performing the TC (or PC). We are not revising the requirements 
for ``group practices'' at Sec.  411.352 at this time. We did not 
propose to amend

[[Page 66310]]

these provisions and believe that such a change would be outside the 
scope of the proposed rulemaking.
    Comment: A commenter suggested that we consider an anti-markup 
provision that would apply to any group practice where at least 90 
percent of the practice is comprised of a single specialty other than 
pathology that orders the pathology tests billed by the group. The 
anti-markup rule should prohibit the markup of the direct costs 
incurred by the group (such as compensation paid to the 
histotechnologists and pathologists, and equipment and supplies 
utilized).
    Response: We believe that the commenter's suggestion would be 
cumbersome and difficult to administer, and therefore, we are not 
persuaded to adopt it. We believe that the anti-markup rules that we 
have finalized are much more practical and will be an effective 
deterrent to the ordering of medically unnecessary tests.
    Comment: One commenter stated that the anti-markup provisions 
should apply equally to all physicians, including pathologists. The 
commenter noted that, in some cases, a pathologist performing the PC 
purchases the TC from a hospital or another pathology laboratory and 
bills globally. In addition, the commenter asserted that it is a myth 
to say that pathologists do not order tests and, therefore, should be 
exempt from the proposed anti-markup provision applicable to the PC of 
a diagnostic test. Another commenter stated that there is no more 
likelihood of abuse in specialty physician-owned pathology laboratories 
than with pathology groups ordering expensive and unneeded special 
tests and stains on specimens that they then interpret in the pathology 
group-owned histology laboratory.
    Response: The revisions to Sec.  414.50 and Sec.  424.80 concerning 
the anti-markup requirements apply equally to all physicians, including 
pathologists. We recognize that, in some situations, a pathologist may 
order additional tests to be performed by an outside pathologist. Where 
a pathologist orders and bills for a test that he or she did not 
personally perform, the anti-markup provisions may apply to the TC or 
PC, or both (depending on whether the TC or PC was purchased or, if 
not, whether the TC or PC was performed in the pathologist's office). 
If the pathologist did not order the test, the anti-markup rules do not 
apply.
    Comment: One commenter requested clarification that Sec.  414.50 
applies only to physicians and medical groups, and not to suppliers, 
such as medical foundations, that, under State laws governing the 
corporate practice of medicine, are required to enroll in Part B as a 
clinic or group practice. The commenter asserted that, in States 
prohibiting the corporate practice of medicine, many suppliers enrolled 
as a clinic or group practice are unable to directly employ the 
radiologist or other physician who performs a test interpretation.
    Response: In this final rule with comment period, we are revising 
Sec.  414.50 to apply to all suppliers. However, the anti-markup 
provisions do not apply to TCs and PCs that are not purchased and that 
are performed in the office of the billing physician or other supplier. 
Therefore, in the commenter's example, if clinic personnel order, for 
example, the TC and PC, and the TC and PC are performed in the clinic's 
office, neither the TC nor the PC will be subject to the anti-markup 
provisions.
    Comment: Two commenters asserted that IDTFs operate similarly to 
independent laboratories in that the tests are ordered by a financially 
independent physician. The commenters also said that the physician 
performing the interpretation sees the patient. Therefore, the 
commenters recommended that we provide an exception to the proposed 
anti-markup rules for purchased interpretations for imaging suppliers, 
such as IDTFs, if the current purchased interpretation rules are met.
    Response: We are not persuaded to provide an exception to the final 
anti-markup provisions for purchased interpretations for imaging 
suppliers if the current purchased interpretation rules are met. We 
note that, if the interpreting physician sees the patient, the 
purchased interpretation rules are not fully met. Therefore, the 
imaging supplier is not satisfying all of the purchased interpretation 
rules, and the imaging supplier should only bill for the TC portion of 
the test.
    Comment: One commenter requested clarification that the anti-markup 
proposals do not apply to radiologists who have contractual 
arrangements with IDTFs. The commenter asserted that radiologists and 
IDTFs are not in a position to refer to each other or to themselves 
because both are dependent upon referrals from other physicians in the 
community. Another commenter asked us to clarify that the anti-markup 
for the PC will not apply to an IDTF that purchases the PC from the 
interpreting physician, particularly in States in which the corporate 
practice of medicine doctrine applies. Another commenter stated that 
the anti-markup provision for the PC should not be applied to 
physicians or group practices that bill for the professional services 
performed by an independent contractor or part-time employee if those 
services were performed pursuant to the order of another practitioner 
who is independent of the group, and thus would not profit from his or 
her referral.
    Response: As finalized, the anti-markup provisions are applicable 
to all types of suppliers. However, in the situation in which an IDTF, 
radiology practice, or other supplier does not order the diagnostic 
test, the anti markup provisions do not apply.
    Comment: A few commenters questioned whether the proposed anti-
markup provision, for the PC of diagnostic tests, would apply to IDTFs 
that purchase the PC from an interpreting physician, particularly in 
States where the corporate practice of medicine prohibits an IDTF from 
hiring the physician as an employee.
    Response: The anti-markup rules will not apply to entities that are 
enrolled as an IDTF where the IDTF does not order the test. If the IDTF 
orders the test, the anti markup provisions will apply to the same 
extent that they apply to other suppliers.
    Comment: A few commenters urged us to clarify in Sec.  424.80 that 
the anti-markup provisions apply to reassignments under both the 
contractual arrangement exception as well as the employee reassignment 
exception. The commenters also suggested that Sec.  424.80 and Sec.  
414.50 should state that the anti-markup provisions are limited to 
claims submitted by physicians and medical groups and do not apply to 
claims submitted by independent laboratories. The commenters were 
concerned that the preamble language on the applicability of the anti-
markup provisions to independent laboratories was not carried over and 
included in the regulatory text in Sec.  424.80 and Sec.  414.50.
    Response: We have determined to revise Sec.  414.50, with a cross 
reference in new Sec.  424.80(d)(3). As finalized, the anti-markup 
provisions apply to reassignments under both the employee exception and 
the contractual arrangements exception, to the extent that the services 
for which payment is reassigned are not performed in the office of the 
billing physician or other supplier. The anti-markup provisions apply 
to a billing supplier only if the billing supplier orders the TC. 
Therefore, if an independent laboratory does not order the TC, the 
anti-markup provisions will not apply to the laboratory billing of the 
TC or the PC.
    Comment: Two commenters urged us to create an exception for 
entities that are located off-campus from a hospital

[[Page 66311]]

which are jointly owned by radiologists and the hospital and which have 
an exclusive contract for the provision of professional interpretations 
to the hospital. According to the commenters, it is important to allow 
such joint ventures to exist, because the profits generated by the 
ventures give financial stability to community hospitals that otherwise 
would be financially impaired as outpatient imaging continues to 
migrate away from the hospital. In States in which the corporate 
practice of medicine doctrine exists, the joint ventures do not 
directly employ the physicians, but rather typically contract with the 
professional radiology practice to provide the PC. The commenter stated 
that the radiologists providing the professional reads are neither 
full-time employees nor exclusively employed by the joint venture 
imaging center to which they reassign their right to Medicare payment.
    Response: We do not believe that it is necessary to create such an 
exception. The comment is unclear as to which entity, the joint venture 
imaging center or the hospital, is billing for the service; however, if 
the imaging center is billing for the PC, the anti-markup provision 
will not apply if the physician performs the PC in the imaging center's 
office. If the imaging center, or an entity related to it by common 
ownership or control, orders the TC, and the physician does not perform 
the PC in the imaging center's office, the anti-markup provision will 
apply.
    Comment: Some commenters believed that the anti markup provisions 
should not apply to imaging suppliers that meet the purchased test 
rules in CMS manuals.
    Response: In the CY 2007 PFS proposed rule, we stated that we were 
considering placing restrictions on the ordering of PCs that would be 
similar to the purchased interpretation rules in our manuals. After 
giving the matter considerable thought, we believe that an anti-markup 
billing provision is necessary to guard against potential 
overutilization and that it would not be sufficient simply to require 
that billing entities meet the purchased interpretation rules in our 
manuals.
    Comment: In the proposed rule, we proposed to add new Sec.  
424.80(d)(3) to require that, in order to bill for the TC, the billing 
entity must directly perform the PC of the service. Two commenters 
asked that we clarify what we meant by ``directly perform.'' Other 
commenters recommended that we clarify in Sec.  424.80 the requirement 
to bill for the TC of a diagnostic test, and clarify in Sec.  414.50 
the requirement that a billing entity must directly perform the PC of 
the service.
    Response: We are not finalizing the proposed change to Sec.  
424.80(d)(3). We note that the requirement continues to appear in our 
manuals at CMS Internet-Only Manual, Pub. 100-04, Chapter 1, section 
30.2.9. Currently, we are considering whether to retain this 
requirement in the manuals or to withdraw it.
    Comment: One commenter supported generally the establishment of an 
anti-markup provision on purchased interpretations, but voiced concerns 
that our proposal to incorporate the billing rules for purchased 
diagnostic testing services to all reassigned services (unless 
performed by a full-time employee of the group) could adversely affect 
the billing practices of pathologists and pathology groups who often 
depend upon the reassignment rules to bill for services performed by 
independent contractor and part-time pathologists. Therefore, the 
commenter requested an exception from our proposed rules for 
independent laboratories and single-specialty pathology physician 
groups.
    The commenter also asserted that reassignment arrangements between 
pathology groups do not raise the same threat of abuse because the vast 
majority of pathology services are initiated by a request for a 
consultation from a referring physician of another specialty, and the 
pathologist is not in a position to influence the referrals from 
ordering physicians. The commenter further stated that a broader 
exception for single-specialty pathology physician groups and 
independent laboratories that covers both the TC and PC of a pathology 
service is supported by the existing physician self-referral law and 
regulations. The commenter stated that, the ``Congress recognized that 
certain physicians, specifically pathologists, diagnostic radiologists 
and radiation oncologists, who order certain services pursuant to a 
consultation with another physician do not have the same risk of abuse 
and, consequently, will not be treated as having made a restricted 
referral to an entity with which they have a financial interest.'' The 
commenter urged us, for this same policy reason, to recognize an 
exception for single-specialty pathology physician groups and 
independent laboratories that bill for pathology services performed or 
supervised by another pathologist, whether an independent contractor or 
full-time or part-time employee.
    Response: In order to be fair and to avoid the appearance of giving 
preferential treatment to one physician specialty group over another, 
the anti-markup provisions on the TC and PC of diagnostic tests are 
potentially applicable to all physician specialty groups that order 
tests and wish to bill for the TC or PC, or both, performed by another 
person or group and billed as a purchased test or billed through a 
reassignment. (Whether the anti-markup provision for the TC or the 
anti-markup provision for the PC will, in fact, apply depends on 
whether the TC or the PC was purchased, or, if not purchased, whether 
the TC or the PC was performed in the office of the billing physician 
or other supplier.) Therefore, we are not recognizing an exception for 
single-specialty pathology physician groups that bill for pathology 
services performed or supervised by another pathologist, unless the 
single-specialty pathology physician group does not order the test. If 
a pathologist in the single-specialty pathology physician group orders 
and bills for the test performed by another supplier, the anti-markup 
rules apply. If the pathologist does not order the test and wishes to 
bill for the test, which is performed by another supplier, the anti-
markup rules will not apply. Finally, we note that clinical diagnostic 
laboratory tests performed by independent laboratories and paid under 
section 1833(a)(2)(D) of the Act are not subject to the anti-markup 
provisions pertaining to diagnostic tests.
c. Overutilization
    Comment: Many commenters in favor of the proposed rulemaking cited 
overutilization as a concern in the existing billing and payment 
environment. Commenters opposed to our proposals denied that 
contractual arrangements for pathology services lead to 
overutilization.
    In support of their contention that current arrangements facilitate 
overutilization, some commenters cited various studies for the 
proposition that physician self-referral leads to increased 
utilization. For example, one commenter cited 1989 studies from the OIG 
and GAO that found that physicians who had an ownership or investment 
interest in a laboratory ordered more tests than those physicians who 
did not have such an interest. This commenter also noted that an 
analysis by the Florida Cost Containment Board in 1998 found that 
physician-owned clinical laboratories, diagnostic imaging centers, 
physical therapy centers, and rehabilitation centers performed more 
procedures on a per-patient basis than those facilities that were not 
physician-owned. The commenter also cited the 2007 study by

[[Page 66312]]

the McKinsey Global Institute that found that the United States spends 
more of its wealth on health care than any other developed country, and 
that one reason for the difference in spending is due to profit 
incentives in physician ownership of medical facilities. Other 
commenters mentioned the 2007 OIG studies of three urology practices, 
which the commenters described as finding that all three practices 
substantially increased the number of biopsies ordered per patient 
after entering into an arrangement for contracted pathology services, 
and that, after entering into such an arrangement, all three practices 
billed significantly more biopsies than what their respective carriers 
paid on average to other suppliers. One commenter cited a study by the 
Center for Health Policy Studies that examined the effects of State 
``direct billing'' laws. Under such laws, the pathologist or entity 
performing the ordered pathology services is required to bill for the 
services. This study found that laboratory charges per enrollee under 
private health insurance programs were 41 percent higher in non-direct 
billing States than in direct billing States. Another commenter stated 
that a study in the American Journal of Roentgenology in 2002 confirmed 
that physician self-referral may be contributing to the uncontrolled 
growth in imaging services. According to the commenter, that study 
reported that, when a managed care organization prohibited certain non-
radiologist specialties from billing for imaging services, total 
billings for imaging declined 20 to 25 percent from the amount of 
billings that were expected based on the previous trend in imaging 
growth.
    One commenter stated that it is unaware of any evidence of 
overutilization by gastroenterologists who have entered into 
contractual arrangements for pathology services. Another commenter 
stated that its managed ``pod labs'' are vital to the accurate 
detection and treatment of prostate cancer and do not expose Medicare 
to an undue risk of program abuse. The commenter asserted that no data 
supports the accusation that its managed laboratories facilitate the 
generation of medically unnecessary biopsies, and in any event, 
clinical indications for prostate biopsy are not subject to 
manipulation.
    Another commenter stated that urological pathology volume is based 
upon objectively demonstrated medical necessity, and is not affected by 
profit margin or who is billing for services. This commenter suggested 
that specific requirements could be placed on contractual arrangements 
to address overutilization concerns, while preserving the benefits of 
these types of arrangements. The commenter stated that the best way to 
ensure that contractual arrangements are maximizing their potential for 
improving care and outcomes, while discouraging overutilization, is to 
prohibit arrangements that are merely passive investments of the 
treating physicians. The commenter asserted that physicians who own 
off-site pathology laboratories should be actively involved in their 
direction and supervision, and responsible for the services provided by 
the laboratory. The commenter offered several specific recommendations, 
including: (1) If a group practice intends to bill for the TC, it must 
also perform the PC; (2) consistent with CLIA regulations, a 
pathologist may not be the medical director of more than five 
laboratories; and (3) refined credentialing criteria for pathologists. 
In its comments to the CY 2008 PFS proposed rule, MedPAC stated that it 
agrees that allowing physicians to purchase or contract for the 
provision of diagnostic tests and to realize a profit when billing 
Medicare could lead to overuse of services and higher program costs.
    One commenter discussed available types of diagnostic tests for 
prostate cancer and stated that there does not appear to be any added 
benefit to the patient from receiving a 12-part biopsy series instead 
of a smaller number. According to the commenter, this method of biopsy 
results only in increased diagnosis of minimal prostate disease or 
atypical small acinar proliferations, which leads only to further 
biopsies and increased medical costs. The commenter stated that the 
argument of urologists, that 12 biopsies is the standard of care, is 
shown to be fallacious by the fact that, when members of a particular 
urology group perform prostate biopsies in local hospitals, they are 
doing only two-part biopsies. However, another commenter stated that he 
knows of more than one urologist who routinely submitted two core 
biopsies for review, but after employing a pathologist, switched to 12 
core biopsies. Another commenter stated that patient care improves with 
contractual arrangements because the test results are timelier and are 
of higher quality. Faster results, together with the opportunity to 
collaborate with pathologists, permit urologists to better manage their 
patients' care. According to the commenter, the number of cores taken 
for each prostate biopsy is a direct result of the evolving 
understanding of the nature of prostate cancer, rather than, as some 
state, the formation of urology specialty laboratory arrangements 
between urologists and pathologists. One commenter stated that, whereas 
it understood our concern of overutilization, the current malpractice 
system creates far more incentive to perform unnecessary tests.
    Two commenters stated that the incessant complaints of profits 
being made at the expense of the Medicare program do not serve any 
purpose. The commenters claimed that, unless a profit can be achieved, 
no one will perform services needed by Medicare or any other program. 
The commenters suggested that, regardless of who collects the fees for 
pathology and laboratory services and makes a profit, whether an 
individual pathologist, a commercial laboratory, or a physician 
specialty practice, this should not be a focus of CMS. Rather, CMS 
should review the standards of care and hold suppliers to those 
standards. The commenters pointed out that the National Comprehensive 
Cancer Network developed standards for a patient with early prostate 
cancer. At first, the standard was only two cores. In the mid 1990s, 
the standard was increased to six cores, then, with additional 
research, the standard was increased to ten cores, and, recently, the 
recommendation was further increased to 12 cores. The research has 
shown a dramatic increase in prostate cancer detection with increased 
core sampling. The commenters stated that it is hypocritical that 
pathologists are claiming overutilization of services by physician 
specialty groups, when these same pathologists accepted 12 core 
biopsies without a whisper of discontent. These commenters asserted 
that overutilization would cease to be an issue if CMS actively pursued 
those practitioners, including pathologists, who do not follow the 
accepted and published standards of care.
    Response: It is difficult to determine whether and the extent to 
which overutilization is due to, or facilitated by, arrangements that 
allow the referring physician or group practice to bill for the TC and 
the PC of diagnostic tests. Our proposals were not predicated upon a 
belief that there was a correlation between the size of the group 
practice and the volume of diagnostic tests and the risk of program 
abuse. We appreciate that, for a particular practice specialty, an 
increase in biopsies ordered may be due to a change in business 
arrangements that produces profits for the referring physician or group 
practice, or it may be due to a change in the standard protocols (or in

[[Page 66313]]

the referring physician's or group's perception of the appropriate 
standard of care). Nevertheless, studies have shown that, in the 
aggregate, utilization of diagnostic tests increases in the case of 
physician self-referral. We believe it is appropriate to guard against 
the potential for overutilization through an anti-markup provision on 
the TC and PC of diagnostic tests. We decline to use a specific number 
of prostate biopsies as a trigger point for application of the anti-
markup provisions, as we believe the appropriate number of biopsies is 
largely patient-specific.
    Comment: Several commenters stated that contractual arrangements 
for anatomic pathology testing pose no risk of overutilization because 
Medicare patients would not be subjected to unnecessary testing due to 
the invasive nature of test procedures such as colon or prostate 
biopsies.
    Response: We are skeptical that the risk of overutilization for 
biopsies is appreciably less than that of other types of diagnostic 
tests. In any event, in enacting the anti-markup provision in section 
1842(n)(1) of the Act, the Congress made no exception for biopsies or 
other minimally invasive tests, and in order to effectuate 
Congressional intent we are not providing for such an exception.

d. Quality and Patient Access

    Comment: Many commenters, both in favor of and against the proposed 
rulemaking, focused on the issue of the quality of the diagnostic 
testing, particularly pathology services.
    Two commenters stated that the financial incentive inherent in some 
arrangements can result in physicians selecting laboratories not on the 
basis of quality but on the potential for profit from these 
arrangements. One commenter believes that ``by reducing pathologists to 
the status of indentured servants of clinicians who `own' the patients 
and their biopsies, the autonomy and quality of the pathology services 
provided is fatally eroded.'' According to one commenter, aspects of 
pathology practice, such as the adequacy of the biopsy, the sampling 
procedure, the need for deeper or additional sections, the severity of 
a process, the adequacy of margins, the need for re-excision, the 
appropriateness of special studies, and the need for outside expert 
consultation despite increased expense, ultimately are decided based on 
what provides the maximum economic benefit to the ordering and billing 
physician. The other commenter stated that a gastroenterology group 
practice that had been sending its pathology work to his pathology 
practice ended the relationship because it entered into an arrangement 
with another pathology group under which the gastroenterology group 
practice could bill for the TC. The commenter stated that the 
gastroenterology group said that there was no dissatisfaction with 
quality or the service of the commenter's work, but rather it was 
purely a business decision that enabled the gastroenterology group 
practice to capture additional revenue in an environment of shrinking 
reimbursement. Another commenter stated that he received a biopsy for 
review that was performed on a urologist who routinely sent his (the 
urologist's) patients' biopsies to his (the urologist's) employed 
pathologist. The commenter stated that what was good enough for the 
urologist's patients was not good enough for the urologist.
    One commenter stated that captive pathology arrangements are 
detrimental to patient care. The commenter stated that a local 
gastroenterology group was able to locate a pathologist who was 
desperate for work and who reads the biopsies only once a week. The 
commenter called the turn-around time of once per week ``atrocious.'' 
The commenter claimed that pathologists who are not willing to work for 
less than fair market value are being put out of work by physicians who 
are ignorant of the value of quality pathology services and who hire 
anyone willing to read slides for any price under any condition. 
Another commenter asserted that, although gastroenterologists claim 
they get better service from pathologists who allow the 
gastroenterologists to bill for the pathology services, the ``better 
service'' is, in reality, more money for the gastroenterologists.
    One commenter stated that surgeons and surgical pathologists need 
to work in close contact with each other, and that the pathologist in a 
``pod lab'' has little or no interaction with surgeons and other 
clinicians. Hospital-based pathologists meet on a regular basis with 
surgeons and other clinicians to share insights and perspectives on 
cases, sometimes with immeasurable patient benefit. The ``pod lab'' 
arrangement impacts negatively upon the ``pod'' pathologist's 
professional growth. Another commenter suggested that we should be 
aware that the ``current campaign'' against so-called ``pod labs'' is 
led by a few self-interested private pathologists, some in leadership 
positions in their national organizations, who wish to monopolize the 
outpatient biopsy market. The commenter stated that these pathologists 
are using scare tactics to paint with the same brush any nontraditional 
pathology arrangement, without regard to any real demonstration of 
quality problems. The commenter suggested that, instead of focusing on 
the ``straw man'' of ``pod labs,'' we should require all suppliers of 
pathology services to demonstrate quality of service and 
appropriateness of utilization in order to end the ongoing abusive 
pathology practices that are occurring in traditional pathology groups, 
independent laboratories and academic medical centers.
    One commenter asserted that the use of contractual arrangements 
allows specialization by pathologists that otherwise would be seen only 
in the largest medical centers or reference laboratories. Moreover, the 
commenter stated that pathologists who work together in contractual 
arrangements with various groups have the unique opportunity to consult 
with each other on a regular basis. An entity that manages ``pod labs'' 
stated that internal data generated by group practices that refer to 
their own managed laboratories show a higher positive incidence of 
prostate cancer now than before they contracted with the commenter. One 
commenter contended that most gastroenterologists who enter into 
contractual arrangements with pathology laboratories do so in order to 
achieve a higher quality of patient care through timely diagnoses and 
the use of pathology personnel who are experts in gastrointestinal and 
liver pathology. The commenter expressed certainty that our proposal 
would have an adverse effect on practice efficiency and the quality of 
patient care.
    A commenter stated that large corporate laboratories do not always 
provide the highest level of care available. According to the 
commenter, large laboratories have an incentive to hire the cheapest 
physician labor in order to ``churn out'' a high volume of services. 
The commenter argued that the interaction between the urologists in a 
group practice and a dedicated pathologist in that practice will lead 
to better outcomes. Another commenter stated that some gastrointestinal 
group practices have opened their own pathology laboratories because 
they believed that the pathology reports they received from general 
laboratory companies were in some ways lacking. A commenter echoed that 
sentiment, and added that the fact that the pathologist was practicing 
in its office meant that the group can easily discuss the pathologist's 
findings with him and even review slides together.
    One commenter contended that, based on her experience gained from 
working for large, national laboratories, sections are poorly processed 
there and, often,

[[Page 66314]]

much of the tissue is lost. According to the commenter, extra ribbons 
are not collected at these laboratories and immunostains often do not 
contain the area suspicious for carcinoma. There is no communication 
with the physician's office and usually no clinical information is 
exchanged. She further asserted that group practices that send tissue 
samples to large laboratories run the risk that an inexperienced 
pathologist could be performing the work. The commenter related a 
personal experience in which biopsies were read at a large national 
laboratory as showing HGPIN, a precursor to adenocarcinoma. The 
commenter stated that the slides she reviewed on re-biopsy showed no 
HGPIN, and, not only was the patient made to worry unnecessarily, but 
the mistaken biopsy review led to the expense of a re-biopsy and 
another reading. Another commenter stated that its clients say that it 
provides better quality services and in a timelier manner than do the 
national commercial laboratories. According to the commenter, this is 
because physician practices that send anatomic pathology specimens to 
large commercial laboratories do not choose the pathologists who 
interpret the slides and thus do not know the qualifications of the 
pathologist.
    Response: We believe that, everything else being equal, there can 
be some advantages to a physician or group practice referring to the 
same pathologist, if the referring physician or group practice chooses 
the pathologist on the basis of his or her qualifications and 
experience, and the service that he or she provides. However, we also 
believe that, where there is a financial reward for choosing a 
pathologist or other diagnostic specialist based on financial self-
interest, there is the potential to disregard, or at least subordinate, 
quality considerations. This final rule with comment period eliminates 
the profit incentive in choosing a pathologist or other specialist 
while preserving the referring physician or group practice's right to 
continue to use the pathologist or other specialist of its choosing. 
That is, if a billing group practice currently has a contractual 
arrangement with a particular histotechnologist and particular 
pathologist because it believes that the histotechnologist and the 
pathologist provide superior quality and service, it may continue to 
refer to them; it only will be prevented from marking up the TC and PC 
(unless the TC and PC are not purchased and are provided in the office 
of the group practice).
    Comment: Many commenters asserted that there would be no adverse 
effect on patient access if the proposal was adopted. Other commenters 
stated that patient care would be significantly disrupted if the 
proposal was adopted. Specifically, commenters stated that the proposed 
changes would limit access to multiple urologic services in a local 
area, namely, radiation therapy, lithotripsy, and many in-office 
procedures such as thermal ablative procedures for prostate 
obstruction. These commenters contended that many in-office procedures 
are never performed in hospitals, and that, if the proposed changes to 
the reassignment and purchased diagnostic test rules become effective, 
it would be difficult, if not impossible, to provide these services to 
Medicare beneficiaries.
    Response: We are skeptical that our proposal would cause any 
patient access problem. There appear to be adequate choices throughout 
the country for physicians and group practices to obtain timely access 
to diagnostic testing. No evidence was brought to our attention that a 
patient access problem previously existed and was somehow alleviated 
when physicians and group practices began entering into contractual 
arrangements for the provision of pathology and other diagnostic 
services. In any event, as noted above, our proposal as finalized does 
not prohibit physicians and group practices from continuing to use the 
same diagnostic services that they have been using to date.
e. Purchased Tests as They Relate to Reassigned Tests
    Comment: We received comments stating that physician contractual 
arrangements with pathologists constitute an attempt to evade the 
restrictions of the physician self-referral law. Several commenters 
stated that there is no practical distinction between a purchased 
service and a reassigned service. One commenter stated that the 
proposal effectively eliminates the reassignment rules. The commenter 
argued that, although CMS states that, under section 952 of the Act, it 
is required to recognize contractual reassignments only to the extent 
they meet program integrity and other standards determined by the 
Secretary, the commenter asserts that the Congress surely did not mean 
that this statutory provision could be administratively repealed by 
merging it into the already existing purchased diagnostic test rules. 
Another commenter stated that our proposal appears to be mixing the 
purchased diagnostic test policies with contractual reassignments, 
which could result in confusion for the imaging industry.
    Response: We are concerned that some current arrangements are not 
in accord with the spirit or the letter of the anti-markup provision in 
section 1842(n)(1) of the Act. Section 1842(n)(1)(A) of the Act, which 
was enacted as part of the Omnibus Budget Reconciliation Act of 1987 
(Pub. L. 100-203), provides that, if a diagnostic test described in 
section 1861(s)(3) of the Act (other than a clinical diagnostic 
laboratory test) was not performed or supervised by the billing 
physician and also was not performed or supervised by a physician with 
whom the billing physician ``shares a practice,'' Medicare payment is 
the lower of the costs (net of any discount) charged by the performing 
supplier to the billing physician, or the performing supplier's 
reasonable charge (or other applicable limit). We implemented the anti-
markup provision of section 1842(n)(1) of the Act by promulgating 
current Sec.  414.50, ``Physician billing for purchased diagnostic 
tests.'' The current version of Sec.  414.50 applies to TCs performed 
by an ``outside supplier,'' but that term is undefined. We acknowledge 
that some have understood Sec.  414.50 as applying only to TCs that are 
outright purchased, instead of reassigned, but as we indicated in the 
CY 2007 PFS proposed rule (71 FR 49056), and as some commenters have 
noted, reassigned tests are functionally the equivalent of purchased 
tests. When section 1842(n)(1) of the Act was enacted, there was 
perhaps more of a difference between purchased tests and reassigned 
tests, but subsequent events have blurred the distinction between tests 
that are outright purchased and tests for which payment is reassigned.
    At the time section 1842(n)(1) of the Act was enacted, 
reassignments under the contractual arrangement reassignment exception 
in section 1842(b)(6)(A)(ii) of the Act were permitted only to the 
extent the work was performed on the premises of the billing supplier. 
Therefore, at that time, a physician reassigning benefits to another 
physician was either an employee of the billing supplier or a 
contractor who was furnishing the services on the premises of the 
billing supplier. However, in our January 4, 2001 (Phase I) final rule 
with comment period, we provided that, for purposes of our rules on 
physician self-referral, an independent contractor physician is a 
``physician in the group practice,'' as defined at Sec.  411.351, 
during the time the physician is providing care to the group practice's 
patients ``in the group practice's facilities'' (66 FR 885 through

[[Page 66315]]

886, 955). Further, in that same rulemaking, we provided that a group 
practice's facilities (again, for purposes of our rules on physician 
self-referral) can include a ``centralized building'' (66 FR 888 
through 889). As defined at Sec.  411.351, space qualifies as a group 
practice's ``centralized building'' if it is leased ``24/7'' by the 
group practice, irrespective of the amount of square footage of the 
space and irrespective of the proximity (or lack thereof) to the 
group's facilities. Following that rulemaking, a group practice could, 
in compliance with our rules on physician self-referral, refer patients 
for designated health services (DHS) (such as diagnostic testing) to an 
independent contractor physician, and such physician could perform or 
supervise the performance of diagnostic tests in a centralized 
building, provided that all requirements of an exception were 
satisfied. Further, the independent contractor physician arguably 
satisfied the ``on the premises'' requirement of section 
1842(b)(6)(A)(ii) of the Act and, thus, was permitted to reassign 
benefits to the group practice for the work performed in the 
centralized building, because we considered a centralized building to 
be the group practice's facilities. In any event, in section 952 of the 
MMA of 2003, the Congress amended section 1842(b)(6)(A)(ii) of the Act 
to remove the requirement that the services must be performed on the 
premises of the billing supplier in order to utilize the contractual 
arrangement exception. Therefore, following the MMA amendment, it is 
clear that independent contractor physicians who perform or supervise 
the performance of diagnostic tests in a centralized building may 
reassign payment for such tests to the group practice that owns or 
leases the centralized building.
    Being mindful of the Congress' intent to impose an anti-markup on 
the TC of diagnostic tests that are not performed or supervised by a 
physician who ``shares a practice'' with the billing physician, we are 
amending Sec.  414.50 in this final rule with comment period to provide 
that TCs that are not performed in the office of the billing physician 
or other supplier are subject to the anti-markup provision. With 
respect to a physician organization (such as a group practice), we 
consider the ``office of the billing physician or other supplier'' to 
be medical office space in which the physician organization provides 
substantially the full range of patient care services that the 
physician organization provides generally. Therefore, with respect to 
group practices, we do not consider space to be the ``office of the 
physician or other supplier'' if that space does not meet the 
requirement regarding patient care services in revised Sec.  
414.50(a)(2)(iii) (for example, space that is utilized as a 
``centralized building'' for purposes of the exceptions for physician 
services and in-office ancillary services in Sec.  411.355(a) and (b), 
respectively, but in which the group practice provides diagnostic 
testing services only).
    We believe that, if the TC is performed by an employee (full-time 
or part-time), or by an independent contractor who reassigns benefits, 
in the office of the billing physician or other supplier, a sufficient 
nexus with the practice of the billing supplier is established. (In 
this regard, we note that, if the TC is performed by someone other than 
an employee or a contractor who reassigns benefits, that is, someone 
who sells the test to the billing physician or other supplier, the 
anti-markup provision will apply regardless of where the service is 
performed.) Further, we see no reason to distinguish between the TC and 
the PC of diagnostic tests for purposes of the anti-markup provisions. 
Although the Congress did not establish an anti-markup provision in 
section 1842(n)(1) of the Act or elsewhere for the PC of diagnostic 
tests, the omission may have been inadvertent. That is, it is not 
immediately clear why the Congress, if it wished to prevent 
overutilization of diagnostic testing, would not have desired an anti-
markup on the PC, because without such a provision, the incentive to 
order unnecessary tests (and profit on the PC) remains. We believe 
that, in order to fully effectuate the Congress' intent to prevent or 
limit the ordering of unnecessary diagnostic tests, it is necessary to 
impose an anti-markup provision on the PC of diagnostic tests. 
Accordingly, our revisions to Sec.  414.50 apply to PCs to the same 
extent as they apply to TCs.
    We see no reason to distinguish between physicians and physician 
group practices on the one hand, and other types of suppliers on the 
other hand, that bill for diagnostic tests. In the proposed rule, we 
used the terminology ``physician or medical group,'' which we borrowed 
from the existing manual provisions on purchased tests and purchased 
test interpretations. However, the term ``medical group'' is not 
defined and is not commonly used elsewhere. We are amending Sec.  
414.50 so that it applies to a billing ``physician or other supplier.'' 
Any enrolled supplier that bills for a diagnostic test or its 
interpretation is potentially subject to the anti-markup provisions in 
Sec.  414.50.
f. Definition of ``Entity''
    Comment: One commenter stated that, although we proposed to expand 
the purchased diagnostic test rule in Sec.  414.50 to apply also to the 
purchased PC of a diagnostic test, it was not entirely clear whether we 
proposed to expand the scope of the exception in the definition of 
``entity'' at Sec.  411.351 for purposes of our rules on physician 
self-referral. The commenter noted that the definition of ``entity'' at 
Sec.  411.351 provides that a physician's practice is not acting as an 
``entity'' when it bills Medicare for ``a diagnostic test in accordance 
with Sec.  414.50.'' The commenter contended that the phrase 
``diagnostic test'' is currently interpreted to mean only the TC, in 
part because Sec.  414.50 currently applies only to the TC. The 
commenter also stated that if the scope of Sec.  414.50 is expanded to 
cover both the TC and the PC, one could interpret the phrase in Sec.  
411.351, ``diagnostic test in accordance with Sec.  414.50,'' to mean 
that a physician practice is not an entity when it bills Medicare for 
either the TC or the PC in accordance with Sec.  414.50. The commenter 
suggested that, if we finalize our proposal to apply an anti-markup 
provision to purchased TCs and PCs, we should revise the definition of 
``entity'' at Sec.  411.351 to clarify that the exception for purchased 
diagnostic tests applies to both the TC and the PC. Another commenter 
also supported changing the definition of ``entity'' at Sec.  411.351 
to except from that definition a supplier that is billing for the PC in 
accordance with the anti-markup provisions of Sec.  414.50.
    Response: Under our physician self-referral rules in part 411, 
subpart J of this chapter, a physician may not refer a patient for 
certain designated health services (DHS) to an entity with which the 
physician (or an immediate family member) has a financial relationship, 
and the entity may not bill Medicare for such DHS, unless an exception 
applies. The definition of ``entity'' at Sec.  411.351 ``does not 
include a physician's practice when it bills Medicare for a diagnostic 
test in accordance with Sec.  414.50.'' The rationale for excluding 
from the definition of ``entity,'' and hence from the application of 
our physician self-referral rules, a physician practice that is billing 
for a TC that is subject to the anti-markup provision, is that there is 
no risk of overutilization arising from a financial relationship 
between the referring physician and the physician's practice billing 
for the service. We believe the same rationale should apply to PCs made 
subject to an anti-markup provision under this final rule with

[[Page 66316]]

comment period. We are amending slightly the definition of ``entity'' 
at Sec.  411.351 to make clear that the exclusion applies to both TCs 
and PCs. As amended, the pertinent language reads ``does not include a 
physician's practice when it bills Medicare for the TC or the PC of a 
diagnostic test for which the anti-markup provision is applicable in 
accordance with Sec.  414.50.''
    We note that, under our physician self-referral rules, an 
independent contractor physician is a ``physician in the group'' for 
purposes of the physician services exception in Sec.  411.355(a) and 
the in-office ancillary services exception in Sec.  411.355(b), only 
with respect to services performed on the group's premises (including a 
``centralized building'' as defined at Sec.  411.351). Therefore, one 
practical effect of the change in the definition of ``entity'' is that 
a group practice that currently may not bill for a PC performed by an 
independent contractor physician, because the independent contractor 
physician is not performing the PC on the group's premises, will be 
able to do so without running afoul of the physician self-referral 
rules if the PC is billed in accordance with the anti-markup provisions 
of this final rule with comment period.
g. Employment Status
    Comment: A commenter that supported our proposed changes to the 
reassignment rules pertaining to diagnostic tests stated that it was 
appropriate for CMS to focus on the billing of diagnostic tests 
performed by someone other than a full-time employee. The vast majority 
of commenters that addressed the employment status issue, however, 
opposed applying the anti-markup provisions to part-time employees and 
independent contractors based simply on their employment status. Three 
commenters asserted that the proposed changes are unnecessary and would 
negatively impact the way physicians provide care to patients, possibly 
resulting in the termination of part-time physicians or a prohibition 
on part-time physicians furnishing diagnostic tests. Many commenters 
claimed that, if the proposed changes to the purchased diagnostic test 
rules are implemented, physicians and group practices would not be able 
to provide certain routine medical procedures if limited to using full-
time employees. One commenter requested that we exempt part-time 
employees and independent contractors from the anti-markup rules 
provided that the billing supplier satisfies a physician self-referral 
exception and the services are furnished in the billing supplier's 
office. A few commenters proposed that CMS not apply the anti-markup 
requirements to technicians who work on-site at the medical group and 
who work at least half-time for that specific group.
    One commenter stated that limiting reimbursement for the PC of 
diagnostic tests performed by outside suppliers would create an 
incentive to hire full-time staff and then overutilize pathology 
services in an attempt to recoup the costs of such personnel. The 
commenter urged us not to penalize physician groups by having the anti-
markup rules apply when using part-time employees or independent 
contractors who furnish services on less than a full-time basis. Two 
commenters considered our proposal to be premised on the unsupported 
belief that group practices that perform a lower volume of diagnostic 
tests and, therefore, need only employ pathologists on a part-time 
basis, present more risk of program abuse. Another commenter stated 
that forcing suppliers and their staff into full-time relationships 
will impose needless costs and will require forgoing efficiencies that 
are available through more flexible supplier-staff relationships. 
Several commenters believed that applying an anti-markup provision 
based upon the employment status of the technician or physician would 
unfairly disadvantage individuals who want to work only part-time (for 
example, mothers of young children). One of these commenters stated 
that we essentially placed a hurdle in front of group practices that 
wish to accommodate the professional and personal needs of its 
employees, and that, given the shortage of qualified health 
professionals in many areas, we should be making it easier, and not 
more difficult, for professionals to provide care.
    Response: We agree that it is not necessary or advisable to premise 
the application of the anti-markup provisions on the employment status 
of the person performing the TC or PC. We are revising the language in 
Sec.  414.50 to clarify that an outside supplier is someone who is not 
an employee of the billing physician or other supplier and who does not 
furnish the test or interpretation to the billing supplier under a 
reassignment that meets the requirements of Sec.  424.80. Therefore, 
diagnostic testing services furnished by part-time employees and 
independent contractors in the office of the billing supplier will not 
be subject to the anti-markup rules, unless the services of the 
independent contractor are billed as a purchased diagnostic test.
    Comment: One commenter stated that the anti-markup provisions 
should apply only when the diagnostic service is provided in a 
centralized building outside of the physician's primary office site 
where he or she provides his or her professional services, and should 
not apply based on the employment status of the individual performing 
the TC.
    Response: We agree generally and have revised Sec.  414.50 and 
Sec.  424.80 to specify that the anti-markup rules apply to purchased 
tests and interpretations (regardless of site of service) and to TCs 
and PCs performed at a site other than the office of the billing 
supplier. With respect to physician group practices, the group's 
``office'' is the medical office space in which the physician 
organization provides substantially the full range of patient care 
services that the physician organization provides generally. The 
group's office does not include space utilized by the group as a 
``centralized building'' (or other space) where only (or primarily) 
diagnostic testing is performed by radiologists or pathologists.
    Comment: One commenter found the proposed definition of an outside 
supplier as someone other than a full-time employee of the billing 
physician or medical group to be confusing and inconsistent with the 
definitions at Sec.  411.351. Thus, the commenter recommended replacing 
the term ``full-time employee of the billing physician or medical 
group'' with the defined term ``member of the group or member of a 
group practice.''
    Response: In the CY 2007 PFS proposed rule (71 FR 49054), we 
proposed that TCs and PCs that are reassigned under the contractual 
arrangements exception in section 1842(b)(6)(A)(ii) of the Act would be 
subject to an anti-markup provision. We received comments expressing 
concern that our proposals would be ineffective to the extent that 
contractors who performed TCs and PCs for multiple group practices 
would now become part-time employees of the same group practices. In 
response, in the CY 2008 PFS proposed rule, we proposed that the anti-
markup provisions would apply to reassigned TCs and PCs that are not 
performed by full-time employees. However, we believe we can guard 
adequately against potential overutilization by imposing an anti-markup 
provision on purchased PCs and TCs, and, with respect to non-purchased 
TCs and PCs, imposing an anti-markup provision on the TCs and PCs that 
are performed outside of the office of the billing physician or other 
supplier, without regard to the employment status of the person

[[Page 66317]]

performing the TC or PC, thus leaving intact the part-time employment 
arrangements that have traditionally existed. Therefore, we believe it 
is unnecessary and inadvisable to adopt the commenter's suggestion.
    Comment: Several commenters requested that we clarify what is meant 
by a ``full-time employee.'' They urged us to use the Department of 
Labor's Bureau of Labor Statistics standard, which is 35 hours per 
week.
    Response: For the reasons stated above, we do not believe it is 
necessary to define ``full-time employee.''
    Comment: Several commenters suggested that we exempt TCs and PCs 
furnished by part-time employees of the billing supplier from the anti-
markup provisions, provided that the employees are working exclusively 
for one billing supplier, such as a single health care organization. 
Other commenters suggested that, instead of providing that the anti-
markup provisions would apply to the TCs and PCs performed by part-time 
employees, we apply an anti-markup provision to work performed by 
employees who work for more than a certain number of physician 
practices.
    Response: We considered creating an exception from the anti-markup 
provisions for services provided by part-time employees who work 
exclusively for one billing supplier. We also considered restricting 
the application of the anti-markup provision to work performed by 
employees who work for more than a certain number of physicians' 
practices. We rejected both approaches as unnecessary given our 
decision to base the application of the anti-markup primarily on the 
site of service, as well as because we believe that each approach would 
add undue complexity to the rule and would be difficult for both 
billing suppliers and for us to administer. We will monitor the 
effectiveness of our site-of-service approach in addressing our 
concerns regarding potential overutilization. If arrangements that 
currently are taking place at a site other than the office of the 
billing physician or other supplier simply migrate to the ``office of 
the billing physician or other supplier'' in order to escape the 
application of the anti-markup provisions, we may revisit the idea of 
imposing an anti-markup provision for services performed by a 
technician or physician who works for more than a certain number of 
physician practices.
h. Deductibles and Coinsurance
    Comment: Several commenters observed that there appeared to be a 
drafting error regarding the application of deductibles and coinsurance 
to the anti-markup limits in proposed Sec.  414.50 and Sec.  424.80. In 
both sections, the maximum payment is set as an amount that is net of 
deductibles and coinsurance, that is, ``less the applicable deductibles 
and coinsurance.'' The commenters noted that the price limitation 
should represent the Medicare allowable amount, which should include 
any coinsurance or deductibles to be paid by the Medicare beneficiary. 
One of the commenters stated that the current language could be 
interpreted such that the combined Medicare and beneficiary payment to 
the physician could exceed the amount that a physician paid an outside 
supplier of a TC or PC by 20 percent, the applicable coinsurance for 
PFS services. The commenter recommended that the language be revised to 
read ``the payment to the billing physician or medical group, including 
applicable deductibles and coinsurance, may not exceed the lowest of 
the following amounts.''
    Response: Proposed Sec.  414.50 and proposed Sec.  424.80 stated 
that, payment to the billing supplier, ``less the applicable 
deductibles and coinsurance'' may not exceed the lowest of the 
following amounts: (1) The supplier's net charge to the physician; (2) 
the physician's actual charge; or (3) the fee schedule amount for the 
test that would be allowed if the supplier billed directly. The quoted 
language referenced above is identical to that in current Sec.  414.50 
and is virtually identical to that in section 1842(n)(1) of the Act. We 
read the statute and regulations as saying that the contractor's 
payment to the billing supplier, in the situation in which the anti-
markup provision applies, is the lowest of the performing supplier's 
net charge, or the billing supplier's actual charge, or the applicable 
fee schedule amount, less any applicable deductible and coinsurance 
amounts.
    We agree with the commenters that the total payment (that is, by 
the contractor and the beneficiary or third party payor on behalf of 
the beneficiary) is limited to the lowest of the three amounts 
specified above. This interpretation represents historical Medicare 
policy, and we believe that this policy has been implemented correctly 
by the carriers. However, we are refining the language of the 
regulation as suggested by the commenter for greater clarity. We do not 
consider this a substantive change. We are revising Sec.  414.50 to 
read ``the payment to the billing physician or other supplier 
(including applicable deductibles and coinsurance paid by the 
beneficiary or on behalf of the beneficiary) for the technical or 
professional component of the test may not exceed the lowest of the 
following amounts * * *''
i. Net Charge
    Comment: Several commenters addressed the question of how to 
determine the net charge for purposes of applying the anti-markup 
provisions. Commenters asserted that most physicians are paid an 
aggregate monthly or annual amount for their services and therefore 
there is no ``charge'' to report on a claim. One commenter stated that 
independent contractors are frequently paid based on time spent 
furnishing the services, as opposed to a per-interpretation price. 
Alternatively, payment may be made at a fixed rate per month or year. 
Yet another model is a per-service price reflecting a blended rate of 
different payor pricing, not just the Medicare allowable amount. 
Employees, including part-time employees, are often salaried. 
Consequently, according to the commenter, there is no cost or charge 
per professional interpretation, and it would be impossible for a group 
practice to determine the unit price for purposes of the anti-markup 
provision. The commenter contended that all of the various types of 
employment relationships would have to be restructured, at great cost 
and administrative burden, to practices.
    One commenter stated that it would not be administratively feasible 
to determine the net charge per test in order to apply the anti-markup 
provisions to part-time employees or independent contractors who are 
paid on an hourly basis or a per-diem rate. Other commenters complained 
that the proposed rules do not address how the billing entity is 
supposed to determine the net charge per service on the claim. 
According to these commenters, it causes confusion as well as the risk 
of false claims liability to require physician practices to include a 
charge for all diagnostic test services. Another commenter pointed to 
what it saw as difficulties in allocating charges between the TC and 
the PC when a billing supplier purchases both the TC and the PC.
    A few commenters urged us to provide guidance on how to determine 
the ``net charge'' for a service. One commenter requested that we 
clearly state that the billing entity must calculate its net unit 
price, which may reflect payments divided by the number of slides 
referred; for example, if the billing entity pays a supplier a set 
amount per month or per year to prepare and read all the slides that 
were

[[Page 66318]]

referred. One commenter stated that it agreed with the proposed 
approach of not allowing the net charge to reflect the cost incurred by 
the performing supplier of leasing equipment or space from the billing 
supplier. The commenter expressed concern, however, that participants 
in some joint venture laboratories may inappropriately attempt to 
inflate the acquisition cost of the service, and suggested that we not 
permit other related costs, such as separately purchased or leased 
equipment, supplies, insurance, etc., to be included when determining 
the amount charged by the person performing the TC or PC. If these 
costs were included, it would have the effect of raising the net 
charge, and permit the billing suppliers to charge Medicare a higher 
price.
    Response: We are leaving the responsibility for determining the net 
charge for a test with the billing supplier. The anti-markup provision 
imposed on the PC through this final rule with comment period is 
similar to the longstanding provision for prohibiting a markup on the 
TC. Thus, we do not believe most suppliers will experience significant 
difficulty in calculating the net charge, despite the fact that some 
physicians are paid an aggregate monthly or annual amount for their 
services. Suppliers that incur difficulty in calculating the net charge 
may structure arrangements so that the anti-markup provisions do not 
apply (for example, by ensuring that tests and interpretations are not 
purchased and are performed in the office of the billing physician or 
other supplier), may allow the performing supplier to bill for the TC 
or PC, or may use a payment method (such as per-procedure) that yields 
an easily ascertainable net charge. Suppliers must calculate the net 
charge in a reasonable manner. This final rule with comment period does 
not prevent suppliers from using any particular method that yields an 
accurate net charge. For example, in some situations, it may be 
appropriate to divide a technician's weekly compensation by the number 
of procedures performed to arrive at the net charge for each procedure 
performed during that week. Because suppliers would have the burden of 
establishing that the charge billed was the net charge, suppliers 
should retain contemporaneous documentation of the methodology and 
information used to calculate the net charge.
    We are not adopting at this time the commenter's suggestion that, 
to guard against parties artificially inflating the cost of the TC or 
PC, we specifically prohibit the performing supplier to take into 
account, when calculating its net charge, the costs of equipment or 
services (such as insurance), obtained from the billing supplier. 
However, we note that, to the extent that a billing supplier would sell 
goods or services at an inflated price so as to game the application of 
the anti-markup provisions, such excess compensation may constitute a 
violation of our rules on physician self-referral and may also be a 
violation of the anti-kickback statute (section 1128B(b) of the Act). 
We will monitor financial relationships between billing and performing 
suppliers and, if it appears that parties are attempting to evade 
application of the anti-markup provisions through the sale of goods and 
services, we may modify the provisions.
    Comment: One commenter expressed concern about expanding the anti-
markup provision to cover the PC, noting that, because a per-
interpretation price is not the most efficient method of compensation 
for purchased PCs, practices would likely develop a system of 
compensation that would pay the reading physician differently depending 
on the patient's payor. For example, practices might pay the reading 
physician on a salary basis for reads for patients of private and non-
Medicare payors and on a per-read basis for Medicare patients. 
According to the commenter, this could result in lower costs associated 
with non-Medicare patients than with Medicare patients, depending on 
the way in which the physician and the practice negotiate payment for 
the different groups of patients. The commenter questioned whether it 
is appropriate to charge Medicare more on a per-procedure basis than 
other payors.
    Response: Nothing in this final rule with comment period requires 
practices to pay for professional services for Medicare patients on a 
per-procedure basis or using any particular payment method. What is 
important is that the practice calculates an accurate net charge for 
purposes of these regulations. In reviewing the accuracy of the net 
charges of a practice that pays differently for professional services 
based on the payor status of the patients, we would look to see whether 
the use of different payment structures results in inappropriate 
shifting of costs to Medicare (that is, by paying physicians more for 
Medicare reads than non-Medicare reads, the practice is able to collect 
more reimbursement under the anti-markup provisions). Moreover, we note 
that section 1128(b)(6)(A) of the Act provides for the permissive 
exclusion of providers or suppliers that submit bills or requests for 
payment based on charges or costs to Medicare that are substantially in 
excess of the party's usual charges or costs, absent a finding of good 
cause for the differential. Responsibility for that statute is 
delegated to the OIG.
    Comment: One commenter questioned whether the anti-markup 
provisions would apply to diagnostic tests performed through block 
lease arrangements. This commenter (and another commenter) also stated 
that it would be difficult to calculate the per-test charge on tests 
performed in block lease arrangements.
    Response: The anti-markup rules do apply to diagnostic tests 
performed through block lease arrangements, and the burden is on the 
billing entity to determine how to calculate its net charge per test.
    Comment: Several commenters urged us to ensure that the calculation 
of the payment level under the anti-markup rules will not impose new 
administrative burdens on the billing supplier. A few commenters stated 
that the billing supplier should be able to mark up the PC between 7 
and 10 percent to cover the costs of billing. A few commenters asserted 
that the proposed anti-markup provisions will adversely affect group 
practices that wish to bill globally for interpretations performed by 
teleradiologists located outside of the billing group practice's 
office. The commenters were concerned that billing physicians or other 
suppliers would not be able to include administrative expenses in the 
price paid for the interpretation. One commenter stated that, by 
limiting reimbursement to a practice's actual acquisition cost, we are 
ignoring the role of the RBRVS system to appropriately establish a 
proper payment amount for services.
    Response: Where the anti-markup provisions are applicable, the 
billing supplier will be responsible for calculating the net charge. 
Suppliers that do not wish to contend with calculating the net charge 
will have to structure arrangements so that the anti-markup provisions 
do not apply (for example, by requiring the suppliers performing the TC 
and PC to bill for them, or by ensuring that the TC and PC are 
performed in the office of the billing physician or other supplier), or 
utilize a per-procedure method of payment or other method that yields 
an easily ascertainable net charge. Similarly, suppliers that do not 
wish to incur the cost of billing without being able to mark up the TC 
or PC, should structure arrangements so that the anti-markup provisions 
do not apply.

[[Page 66319]]

    Comment: One commenter contended that, in a medical foundation 
context, there is no way to determine the net charge to the foundation 
for the services of the interpreting physician. The commenter stated 
that the anti-markup proposal would result in the need to generate 
artificial invoices, greatly complicating and needlessly burdening 
medical foundations.
    Response: A medical foundation, or any other medical group 
practice, billing for the TC or PC of a diagnostic test that it did not 
perform will need to calculate its own net charge per test. We perceive 
no need to generate artificial invoices. The purpose of this 
requirement is to address potential program abuse where physicians and 
other suppliers order tests and bill for tests that they did not 
perform at a markup from the price paid for the test.
    Comment: Several commenters inquired how we would be able to verify 
the true cost of purchasing a TC or PC of a diagnostic test. The 
commenters questioned our rationale for this proposal and asserted that 
the proposal would be detrimental because it would have the effect of 
precluding suppliers from recouping overhead costs. The commenters 
voiced concerns that we are trying to eliminate purchased diagnostic 
tests entirely.
    Response: We can verify the true cost of a purchased TC or PC by 
requesting supporting documentation from the provider or supplier. The 
burden of proof in substantiating the validity of a claim rests with 
the billing provider or supplier. The anti-markup provisions finalized 
in this rule are not designed to prevent the billing supplier from 
recovering overhead expenses or to eliminate purchased diagnostic tests 
entirely, but rather to minimize program and patient abuse. Where the 
TC or PC is performed in the office of the billing physician or other 
supplier, the billing supplier will be able to recoup some or all of 
the overhead it incurs in the performance of the TC or PC by billing at 
the fee schedule amount (or at the Medicare limiting charge amount). 
If, however, the billing supplier has incurred overhead expenses for a 
TC or PC that was performed at a site other than the office of the 
billing supplier (such as in space leased by a billing group practice 
and utilized by the group practice as a ``centralized building'' that 
does not meet the definition of ``office of the billing physician or 
other supplier'' at Sec.  414.50(a)(2)(iii)), the billing supplier will 
not be able to recoup the overhead, but rather will be limited to the 
lowest of the performing supplier's net charge, the billing supplier's 
actual charge, or the applicable fee schedule amount. (In the unlikely 
event that the lowest of the three amounts is either the billing 
supplier's actual charge or the applicable fee schedule amount, the 
billing supplier may be able to recoup its overhead but nevertheless 
would be receiving less payment than the performing supplier's net 
charge.) We believe that this result is appropriate. If billing 
suppliers were able to recoup overhead incurred for TCs and PCs that 
are performed at sites other than their offices, the effectiveness of 
the anti-markup provisions would be undermined, because there would be 
an incentive to overutilize to recover the overhead incurred for 
purchasing or leasing space.
    Comment: One commenter recommended that we require, as a condition 
for reassignment of a purchased interpretation, that the parties to the 
arrangement calculate a net charge for the service. The commenter 
stated that, if this condition applied, per-diem or other time-based 
arrangements, which are more susceptible to markups, would not be 
permitted.
    Response: We realize that, in most circumstances, a group practice 
would not want to pay an independent contractor more for a service than 
the payment it receives from an insurer for furnishing the service. 
However, we are under the impression that some physician group 
practices that have exclusive contracts with hospitals under which the 
group practice furnishes all PCs of inpatient and outpatient radiology 
services often hire independent contractors to provide PCs that are 
needed at night or on weekends. We have been informed that, in some of 
these cases, the group practice willingly pays its independent 
contractors more for their services than the group practice receives in 
reimbursement so that the group practice physicians do not have to 
provide services late at night. There may also be other reasons (for 
example, as an improper inducement for referrals) why parties could 
agree to an amount that does not accurately reflect the true net 
charge.
    As explained above, we believe that a group practice may pay an 
independent contractor on a per-diem or hourly basis, and also arrive 
at an appropriate amount to bill Medicare for each service based on the 
number and differing work intensities of the services provided.
    Comment: One commenter recommended that we prohibit any mark-up 
over the direct costs incurred by the group practice in providing 
diagnostic testing services. Direct costs would be defined as limited 
to the compensation paid to the persons providing the services and the 
cost of equipment and supplies utilized in performing the services. One 
commenter asserted that the proposed restrictions would not allow a 
billing practice to be paid for its legitimate overhead costs. Two 
commenters requested that we permit employers to include in the 
calculation of a supplier's net charge the lower of the following: (1) 
A reasonable practice expense (PE) derived from its own relative value 
cost; or (2) the actual overhead costs attributable to the supplier. 
The commenters suggested that this would permit a group to utilize 
part-time diagnostic physicians without financially penalizing the 
employer, and at the same time safeguard against artificially inflated 
overhead costs.
    Response: In effect, the commenters requested that we adopt a ``net 
charge plus'' approach. In order for the anti-markup provisions to have 
real effect, it is necessary that payment by Medicare be limited to the 
lowest of: (1) The physician's or other supplier's net charge to the 
billing supplier; (2) the billing supplier's actual charge; or (3) the 
fee schedule amount for the service that would be allowed if the 
physician or other supplier billed directly. If we were to allow 
billing suppliers to include costs in addition to the performing 
supplier's net charge, we would defeat the purpose of the anti-markup 
provisions.
    Comment: A few commenters requested that we ensure consistency in 
the language in Sec.  414.50 and Sec.  424.80. For example, proposed 
Sec.  414.50(a)(3)(i) states that net charge does not include ``any 
charge that is intended to reflect the cost of equipment or space 
leased to the outside supplier,'' whereas Sec.  424.80 states that it 
does not include ``any charge that is intended to cover or address the 
cost of this equipment.''
    Response: As noted above, we have effectuated the anti-markup 
provisions by revising Sec.  414.50, and by placing a cross reference 
to that section in new Sec.  424.80(d)(3). The language of proposed 
Sec.  414.50(a)(3)(i), ``reflect the cost of equipment or space 
leased'' survives.
    Comment: One commenter recommended that we include in the net 
charge the costs incurred by the purchasing supplier to facilitate test 
interpretations, specifically, the cost of teleradiography to transmit 
images to the interpreting physician and the cost of producing a 
written report of the interpretation.
    Response: To the extent that costs such as those noted by the 
commenter are incurred by the billing supplier, as opposed to the 
performing supplier, we are not persuaded to permit the inflation

[[Page 66320]]

of the net charge to include such costs. As discussed above with 
respect to the recoupment of overhead costs, we believe that allowing 
billing suppliers to recoup the costs suggested by the commenter would 
defeat the purpose of the anti-markup provisions.
i. Miscellaneous
    Comment: One commenter suggested that, as an alternative to an 
anti-markup provision, we prescribe a fixed dollar amount (for example, 
based on a percentage of what Medicare would pay for the PC if billed 
directly), as a ceiling for Medicare payment. The ceiling would be 
adjusted for certain PEs such as bona fide collection costs and bad 
debt.
    Response: We believe that setting a fixed dollar amount for 
diagnostic tests and interpretations performed under particular 
circumstances is problematic. There would be difficulties in 
determining what the fixed dollar amount should be, and what, if any, 
PEs should be taken into consideration to augment the fixed dollar 
amount. In addition, we did not propose such an approach, and believe 
it may be outside the logical outgrowth test for issuing final rules to 
adopt the commenter's approach in this final rule with comment period. 
Moreover, even if we were able to adopt such an approach without first 
specifically proposing one, it would take us considerable time to study 
the feasibility of prescribing a payment ceiling for TCs and PCs under 
particular circumstances, and we believe that it is important to issue 
a final rulemaking on this subject without further delay in order to 
address our current concerns with potential overutilization.
    Comment: Two commenters stated that, in addition to restrictions 
contained in the proposed rule, we should also require that: (1) A 
pathologist not be allowed to work for more than one physician group 
practice; (2) a pathologist not be allowed to work for, or have any 
arrangement with, independent reference laboratories; and (3) medical 
liability insurance for the pathologist should be paid by the physician 
group practice billing for the pathologist's services. (The commenters 
explained that the purpose of the second proposed requirement is to 
eliminate the possibility that a reference laboratory could provide a 
pathologist to a physician group practice in return for receiving the 
right to bill for the TC.) One of the commenters was also concerned 
that, if a single pathologist is performing work for the billing 
physician practice, appropriate or optimal quality assurance will not 
take place. The commenter stated that, in her pathology group practice, 
all malignancies are reviewed by at least two pathologists.
    Response: With respect to the commenters'' first suggested 
requirement, we proposed that an anti-markup provision would apply to 
PCs that are reassigned by someone who is not a full-time employee of 
the supplier billing for the PC, because we were concerned with the 
potential for overutilization where a single physician performs 
interpretations for more than one group practice in contiguous 
centralized buildings (such as in ``pod'' or ``condo'' laboratories). 
Specifically, we were concerned that a physician who formerly 
reassigned benefits under the contractual arrangements reassignment 
exception could simply be made a part-time employee of a number of 
group practices. As noted above, in response to public comments, we are 
not imposing an anti-markup on the PC of a diagnostic test simply 
because the PC was performed by someone other than a full-time employee 
of the billing supplier. Rather, we are addressing our concerns 
regarding potential overutilization by imposing an anti-markup on the 
PC of a diagnostic test if it is purchased or if it is not performed in 
the office of the billing physician or other supplier. We believe our 
decision to impose an anti-markup provision on PCs that are ordered by 
the billing supplier and performed at a site other than the office of 
the billing supplier (for example, in space that the billing supplier 
utilizes as a ``centralized building'' but that does not meet the 
definition of ``office of the billing physician or other supplier'' in 
revised Sec.  414.50(a)(2)(iii)), regardless of the employment status 
of the physician, will adequately address our concerns with 
overutilization. As for the other two proposed requirements and the 
second commenter's implied proposed requirement, we do not believe it 
is within the scope of this rule to attempt to restrict a pathologist 
from working for more than one supplier, or to require a group practice 
to pay for a pathologist's malpractice premiums, or to impose quality 
standards for pathologist performed PCs.
    Comment: A commenter recommended that we revise the definition of 
``centralized building'' at Sec.  411.351 to include the following 
language: ``In the case of a space used for the performance of the [TC] 
of a diagnostic test, which is billed by a group practice, such space 
can qualify as a centralized building only if the group complies with 
the requirements of Sec.  414.50 or Sec.  424.80(d)(3) when billing for 
the [TC].'' The commenter also suggested that, by changing the 
definition of ``centralized building,'' a physician or medical group 
would be prohibited from marking up what it paid for the TC of a test 
that was performed in a centralized building, unless it was performed 
by a full-time employee.
    Response: We are not revising the definition of ``centralized 
building'' in this rule. Because the anti-markup provisions will apply 
to all TCs and PCs that are both: (1) Ordered by a group practice (or 
an entity related to the group practice by common ownership or control; 
see Sec.  413.17 regarding ``common ownership or control''); and (2) 
performed at a site other than the office of the physician or other 
supplier, it is not necessary at this time to narrow the definition of 
a ``centralized building'' in order to guard against potential 
overutilization.
    Comment: One commenter expressed concern regarding physicians who 
have invested heavily in in-office equipment and have followed CMS 
guidelines established for the in-office ancillary services exception 
in Sec.  411.355(b) for purposes of the physician self-referral rules. 
The commenter recommended that we regulate the usage of ancillary 
services through medical necessity guidelines and by requiring that the 
services be provided at fair market value, rather than by the proposed 
changes to the reassignment and purchased test rules.
    Response: As finalized, the anti-markup provisions do not apply to 
non-purchased TCs and PCs performed in the office of the billing 
physician or other supplier. We note that in the CY 2008 PFS proposed 
rule, we sought comments as to whether we should narrow the in-office 
ancillary services exception, including whether we should exclude 
certain types of services from the protection of the exception. We 
received many comments on this issue, and if we are inclined to make 
any changes to the in-office ancillary services exception we will first 
propose such changes in a notice of proposed rulemaking.
    Comment: One commenter urged us to require that imaging technology 
be provided only by physicians trained in modality-specific 
interpretation of imaging procedures who follow the guidelines of 
specialty organizations such as the American College of Cardiology and 
the American Society of Echocardiography. In addition, the commenter 
supported the accreditation of facilities that provide such imaging 
services, provided that we allow adequate time for practices to become 
accredited by relevant organizations that

[[Page 66321]]

are dedicated to improving the quality of imaging services.
    Response: The comment is outside the scope of the proposed rule. 
Moreover, currently we do not have the statutory authority to restrict 
payment for these procedures to physicians who possess the training and 
accreditation recommended by the commenter.
    Comment: One commenter urged us to enforce the anti-markup 
requirements on purchased diagnostic tests by auditing pathology 
practices and laboratories. The commenter contended that there is 
widespread ordering of unnecessary tests by pathologists with no 
regulatory oversight by CMS. The commenter suggested that effective 
enforcement and application of current anti-markup rules to the 
pathology community would obviate the need to add new regulations that 
would limit physician practices from providing quality pathology 
services to their Medicare patients. The commenter also suggested that 
we adopt reasonable protocols and standards for the review of Pap 
smears, among other tests, which, according to the commenter, would 
significantly reduce unnecessary testing by pathologists and result in 
tremendous cost savings to the Medicare program.
    Response: Our contractors perform pre-pay and post-pay reviews of 
services, including reviews to determine if the services were 
reasonable and necessary. However, the extremely large number of claims 
that contractors must handle each year, as well as the difficulty in 
sometimes knowing whether services were reasonable and necessary, 
underscores the need to adopt rules to address the potential for 
overutilization in other ways, rather than relying solely on reviews 
for medical necessity. The proposed anti-markup provisions would apply 
equally to all physicians, including pathologists. However, section 
1842(n)(1) of the Act does not authorize the anti-markup on diagnostic 
tests to apply to clinical laboratory tests, and we did not propose to 
extend the anti-markup provisions to such tests. We are concerned with 
preventing the billing supplier from ordering unnecessary tests for 
profit. Laboratories typically do not order tests, and therefore, there 
has not been a concern about abuse by laboratories in purchasing 
diagnostic tests. The comment that we should adopt protocols or 
standards for the review of Pap smears and other tests is outside the 
scope of the proposed rule.
    Comment: One commenter urged us to prohibit any markup of the TC of 
surgical pathology specimens and let each physician decide where the TC 
is performed in addition to where the PC is performed.
    Response: Section 414.50 and section 30.2.9 of Pub. 100-04, Chapter 
1, CMS Internet-Only Manual, currently prohibit markups of the TC of a 
diagnostic test if the TC is performed by an outside supplier. As 
finalized, our revisions to Sec.  414.50 will prohibit the markup of a 
TC if the TC is ordered by the billing supplier and is either purchased 
or performed somewhere other than the office of the billing supplier. 
Physicians are permitted to determine where the TC and PC are 
performed, provided that the arrangement is in compliance with the 
purchased test rules and physician self-referral rules.
    Comment: One commenter stated that the proposed anti-markup 
provisions are unfair and would interfere with existing business 
relationships. The commenter asserted that medical practices should 
have the freedom to hire in-house professionals or contract with other 
practices to perform services without fear of financial penalty.
    Response: We are not persuaded that our anti-markup proposals, as 
finalized in this final rule with comment, are unfair. The proposals as 
finalized are designed to reduce overutilization of diagnostic tests, 
so that tests are ordered because they are medically necessary and are 
not ordered because a profit can be made on each test. Practices can 
maintain relationships with other professionals on a part-time or 
contractual basis. If the services are furnished in the office of the 
billing supplier, the anti-markup rules will not apply, unless the 
services of an independent contractor are billed as a purchased test.

N. Beneficiary Signature for Ambulance Transport Services

    Section 424.36 requires that a beneficiary's signature must appear 
on all claims submitted for Medicare services, unless the beneficiary 
has died, or another exception applies. However, ambulance suppliers 
and providers have stated that, in emergency situations, it is often 
impossible or impractical for ambulance providers or suppliers to 
obtain a beneficiary's or other authorized person's signature on a 
claim to properly bill Medicare for ambulance transport services 
because: (1) Many beneficiaries are incapable of signing claims due to 
their medical condition at the time of transport; (2) another person 
authorized to sign the claim under Sec.  424.36(b) is not available, or 
is unwilling to sign the claim at the time of transport; and (3) if an 
individual listed in Sec.  424.36(b) is not available or is unwilling 
to sign a claim on behalf of the beneficiary at the time of transport, 
it is impractical later to locate the beneficiary (or the beneficiary's 
authorized representative) to obtain a signature on the claim form 
before submitting it to Medicare for payment.
    As stated in the CY 2008 PFS proposed rule (72 FR 38187), we are 
sympathetic to the concerns of ambulance providers and suppliers 
insofar as emergency transport services are involved. Therefore, we 
proposed to revise Sec.  424.36 to provide that, for emergency 
ambulance transport services, where the ambulance provider or supplier 
documents that the beneficiary was physically or mentally incapable of 
signing a claim form at the time the service was provided and that none 
of the individuals listed in Sec.  424.36(b)(1) through (b)(5) \2\ was 
available or willing to sign a claim on behalf of the beneficiary, the 
ambulance provider or supplier could submit the claim without a 
beneficiary signature. Under our proposal, such claim submission would 
be permitted only if: (1) The beneficiary was physically or mentally 
incapable of signing the claim form at the time the service was 
provided; (2) none of the individuals listed in Sec.  424.36(b)(1) 
through (b)(4) was available or willing to sign the claim form on 
behalf of the beneficiary at the time the service was provided; and (3) 
the ambulance provider or supplier maintains in its files for a period 
of at least 4 years from the date of service certain documentation. 
Required documentation would include: (1) A signed contemporaneous 
statement, made by an ambulance employee present during the trip to the 
receiving facility, that the beneficiary was physically or mentally 
incapable of signing a claim form and that none of the individuals 
listed in Sec.  424.36(b)(1) through (b)(4) was available or willing to 
sign the claim form on behalf of the beneficiary at the time the 
service was provided; (2) the date and time the beneficiary was 
transported, and the name and location of the facility where the 
beneficiary was received; and (3) a signed contemporaneous statement 
from a representative of the facility that received the beneficiary, 
which documents the name of the beneficiary and the time and date that 
the beneficiary was received by that facility.
---------------------------------------------------------------------------

    \2\ We are making a technical change in the final rule. The 
references in the proposed rule to Sec.  424.36(b)(5) were in error, 
as individuals are specified only in Sec.  424.36(b)(1) through 
(b)(4).
---------------------------------------------------------------------------

    For non-emergency ambulance transport services, the ambulance

[[Page 66322]]

provider or supplier would continue to be required to obtain a 
beneficiary's signature on a claim form (or the signature of someone 
who is authorized to sign on behalf of the beneficiary under Sec.  
424.36(b)(1) through (b)(4)) prior to submitting claims to Medicare.
    We received comments from two national associations that represent 
providers and suppliers of ambulance services and hospitals. The 
remainder of the comments came from ambulance owners and employees. The 
commenters generally agreed that we should eliminate the beneficiary 
signature requirement entirely when a beneficiary is mentally or 
physically incapable of signing a claim and no other person authorized 
to sign a claim on behalf of the beneficiary is available or willing to 
sign at the time of transport. In addition, the commenters argued that 
the proposed documentation requirements would be costly and burdensome 
to ambulance providers and suppliers.
    We are adopting our proposal, with modification. Specifically, we 
are allowing a secondary form of verification to be used in lieu of the 
proposed signed contemporaneous statement from a representative of the 
facility that received the beneficiary (which remains an alternative). 
We are also amending Sec.  424.32(a) to clarify that the beneficiary 
signature requirement is satisfied if one of the exceptions in Sec.  
424.36 is satisfied. Finally, we are making a technical change to our 
proposal. In the proposed rule, we stated that ambulance providers and 
suppliers could utilize proposed Sec.  424.36(b)(6) if none of the 
individuals listed in Sec.  424.36(b)(1) through (b)(5) were available 
or willing to sign the claim on behalf of the beneficiary at the time 
the service was provided. The references to Sec.  424.36(b)(5) were in 
error, as individuals are specified only in Sec.  424.36(b)(1) through 
(b)(4).
    Comment: The majority of the commenters opposed our proposed 
changes to the beneficiary signature requirements in Sec.  424.36. The 
commenters stated that the proposed changes would have the unintended 
effect of increasing the administrative and compliance burden on 
providers and suppliers of ambulance services and on the hospitals.
    Response: The proposal would not have imposed any additional 
burdens on providers and suppliers of ambulance services. Rather, the 
proposal, which we are adopting with some modification, set forth an 
alternate method of satisfying the beneficiary signature requirement 
for claims submitted for emergency ambulance services. Those ambulance 
providers and suppliers that believe that it is burdensome to comply 
with new Sec.  424.36(b)(6), may avail themselves of the other means 
specified in Sec.  424.36 for satisfying the beneficiary signature 
requirement.
    Comment: Commenters asserted that when a beneficiary is physically 
or mentally incapable of signing a claim, the ambulance industry has 
already been signing claims on behalf of such beneficiaries in 
accordance with the requirements listed in the CMS Internet-Only Manual 
(IOM), Pub. 100-02, Medicare Benefit Policy Manual, Chapter 10, Section 
20.1.2 and IOM, Pub. 100-04, Medicare Claims Processing Manual, Chapter 
1, Section 50.1.6(A)(3)(c), without any objections from CMS 
contractors. The commenters stated that the ambulance industry has also 
been relying on Sec.  424.36(b)(5) as further authority to sign claims 
on behalf of beneficiaries when beneficiaries are incapable of signing 
and the requirements of Sec.  424.36(b)(1) through (b)(4) have not been 
met.
    Response: Section 424.36(b)(5) applies only if the beneficiary is 
physically or mentally incapable of signing the claim and none of the 
persons listed in Sec.  424.36(b)(1) through (b)(4) is available to 
sign the claim. Note that we interpret Sec.  424.36(b), including Sec.  
424.36(b)(5), as meaning that neither the beneficiary nor any of the 
persons listed in Sec.  424.36(b)(1) through (b)(4) is available at 
all, not just that none of them is available at the time the service is 
performed. Thus, even assuming that Sec.  424.36(b)(5) applies to 
ambulance providers (and we believe that this subparagraph was intended 
to apply only to institutional providers such as a hospital), an 
ambulance provider would not be allowed to rely on Sec.  424.36(b)(5) 
to sign a claim for ambulance services simply because the beneficiary 
was incapable of signing the claim at the time of delivery to the 
hospital or ESRD facility and none of the persons listed in Sec.  
424.36(b)(1) through (b)(4) was available and willing to sign the claim 
for ambulance services at the time of delivery. Instead, the provider 
would be required, in advance of submitting the claim, to make 
reasonable efforts to locate and obtain a signature from the 
beneficiary or, if the beneficiary is not capable of signing, one of 
the alternative individuals specified in Sec.  424.36(b)(1) through 
(b)(4). It would make little sense to specify different categories of 
individuals in Sec.  424.36(b)(1) through (b)(4) who could sign a claim 
on behalf of a beneficiary who is unable to sign, if a provider was 
allowed to file a claim without making an effort to obtain a signature 
from one of the other authorized individuals. To the extent that 
ambulance suppliers have been relying on Sec.  424.36(b)(5) under any 
circumstances, such suppliers have been failing to follow the 
regulations, as this subparagraph does not pertain to suppliers. We are 
clarifying Sec.  424.36(b)(5) to provide that, before a provider may 
avail itself of the exception in Sec.  424.36(b)(5), it must make 
reasonable efforts (including over a reasonable period of time) to have 
either the beneficiary or one of the individuals specified in Sec.  
424.36(b)(1) through (b)(4) to sign the claim. Similarly, the sections 
of the CMS IOM cited by the commenters, Pub. 100-02, Chapter 10, 
section 20.1.2 and Pub. 100-04, Chapter 1, section 50.1.6(A)(3)(c) 
imply that reasonable efforts must be made to locate other individuals 
prior to submitting the claim. We plan to issue clarifying instructions 
in the near future, to ensure that our regulations and manual 
instructions on the beneficiary signature requirement are fully 
consistent with each other.
    In contrast, the proposal, as adopted with modification, allows 
ambulance providers and suppliers, in the case of emergency transport, 
to sign the claim, if certain documentation requirements are met, where 
the beneficiary is not capable of signing the claim at the time of 
transport.
    Comment: Most of the commenters agreed that some of our proposed 
documentation requirements are already being followed by ambulance 
providers and suppliers. However, they strongly objected to proposed 
Sec.  424.36(b)(6)(ii)(C), which would have required a signed 
contemporaneous statement from a representative of the facility that 
received the beneficiary, documenting the name of the beneficiary, and 
the date and time the beneficiary was received by that facility. The 
commenters asserted that it is not practical or feasible to obtain a 
signed contemporaneous statement from a representative of the receiving 
facility documenting the name of the beneficiary and the date and time 
the beneficiary was received by that facility. The commenters stated 
that hospital personnel in emergency departments often are either too 
busy or refuse to sign any forms when receiving a patient. In addition, 
the commenters contended that attempting to obtain a signature from a 
representative of the hospital would decrease the amount of time 
available for ambulances to serve their respective communities. 
Therefore, the commenters recommended that CMS modify the proposed 
beneficiary

[[Page 66323]]

signature requirements for ambulance services in Sec.  424.36(b)(6) to 
include only proposed subsection Sec.  424.36(b)(6)(i). One commenter 
stated that a signature from hospital staff does not add any more 
credibility to the ambulance provider or supplier's claim that the 
patient was unable to sign the claim than what is already present from 
the EMT's attestation that the patient was unable to sign.
    Response: We are not persuaded to modify the proposed alternative 
to the beneficiary signature requirement in Sec.  424.36(b)(6) to 
include only Sec.  424.36(b)(6)(i). The purpose of the proposed 
requirement to secure a signed contemporaneous statement from a 
representative of the facility that received the beneficiary, as a 
means of satisfying the alternative, was to ensure that someone other 
than an ambulance employee verifies the transport and receipt of the 
beneficiary; the purpose was not to obtain verification that the 
beneficiary was unable to sign the claim. We continue to believe that 
in many, if not most, cases the ambulance transport personnel will have 
no difficulty in securing a signature from personnel at the hospital or 
other facility that acknowledges receipt of the patient. Indeed, it is 
our understanding that, as protection from liability or for other 
purposes, some ambulance providers and suppliers routinely secure a 
signature from the receiving facility in order to document that the 
patient was transported. We note that our proposal would not have 
required the hospital or other receiving facility to do anything more 
than acknowledge receipt through a signature. That is, the ambulance 
provider or supplier could add a signature block and an attestation 
clause, acknowledging receipt, to its trip ticket or other form that 
would already contain the necessary patient information (that is, the 
beneficiary's name and the date and time of delivery). However, after 
further consideration, we are revising Sec.  424.36(b)(6)(ii)(C) to 
provide an alternative to the requirement under Sec.  424.36(b)(6) that 
ambulance providers or suppliers must obtain a signed contemporaneous 
statement from a representative of the facility that received the 
beneficiary, which documents the name of the beneficiary and the date 
and time the beneficiary was received by that facility. The final rule 
allows the ambulance provider or supplier to meet the condition 
specified in Sec.  424.36(b)(6) by obtaining a secondary form of 
verification, prior to submitting the claim for payment. Secondary 
methods of verification may include the patient care or trip report, 
the patient medical record, the hospital registration/admissions sheet, 
the hospital log, or other internal hospital or facility records. 
Regardless of its specific form, the documentation must be from the 
receiving facility must indicate that the beneficiary in question was 
transported to the facility by the ambulance provider or supplier that 
is submitting the claim, and must be signed by a representative of the 
facility.
    Comment: One commenter stated that the proposal was fair and 
correct, would not create a heavy burden on the service provider and 
can be accomplished in a timely manner. A signed contemporaneous 
statement used on a limited basis and tightly controlled so that it 
will not become a routine event should help compliance in this area. A 
clear and standardized format for the contemporaneous statement should 
be issued to allow for proper compliance with the new rule.
    Response: We understand the commenter as supporting our proposal 
and as saying that ambulance providers and suppliers should not be 
entitled to routinely rely on proposed Sec.  424.36(b)(6), but rather 
should be able to rely on this exception only when the beneficiary is, 
in fact, unable to sign the claim, and only when the proposed 
documentation requirements have been satisfied. We agree that in most 
cases an ambulance provider or supplier should not have difficulty in 
obtaining a signature from the hospital or other facility that 
acknowledges receipt of the beneficiary; however, we are modifying the 
proposal to provide for an alternate method of documenting that the 
beneficiary was transported to the facility. We do not believe that it 
is necessary to prescribe a specific form for ambulance providers and 
suppliers to use as a contemporaneous statement to document the 
transport of the beneficiary, but instead are allowing ambulance 
providers and suppliers to use existing forms of their own, or, where 
necessary, to modify their forms to comply with the requirements of the 
new Sec.  424.36(b)(6)(ii). We again emphasize that ambulance providers 
and suppliers that do not wish to take advantage of the new exception 
in Sec.  424.36(b)(6) to the beneficiary signature requirement, may 
instead obtain the beneficiary's signature prior to submitting the 
claim, satisfy one of the exceptions in Sec.  424.36(b)(1) through 
(b)(5), or, where appropriate, bill the beneficiary.
    Comment: Several commenters recommended that we eliminate the 
beneficiary signature requirement entirely. They believe that the 
requirement is not necessary because, for every transport of a Medicare 
beneficiary, the ambulance crew completes a trip report that described 
the condition of the beneficiary, treatment, origin/destination, etc. 
Also, the origin and destination facilities complete their own records, 
which document that the beneficiary was sent or received. Commenters 
stated that if it becomes necessary to audit claims, CMS can obtain 
information from the transporting and receiving facilities in order to 
establish that the beneficiary was, in fact, transported as claimed by 
the ambulance provider or supplier.
    Response: We proposed an alternative, optional method of fulfilling 
the beneficiary signature requirement for claims for emergency 
transport services. We did not propose to eliminate the signature 
requirement and are not prepared to do so at this time. The beneficiary 
signature requirements help ensure that services were in fact rendered 
and were rendered as billed. Although we agree that documentation 
obtained from the transporting and (particularly) from the receiving 
facility may help to alleviate any concern whether services were 
furnished or were furnished as claimed, we do not believe that it is 
our responsibility to attempt to locate such documentation should 
claims be called into question (and it is also uncertain whether we 
would have the right to compel the transporting or receiving facility 
to provide us with such documentation). Therefore, to the extent that 
an ambulance provider or supplier wishes to use third-party 
documentation to demonstrate that a beneficiary was transported as 
claimed, instead of having the beneficiary sign the claim or meeting 
one of the exceptions in Sec.  424.36(b)(1) through (b)(4), it must 
follow the procedures in new Sec.  424.36(b)(6).
    Comment: Most of the commenters questioned the need for the 
beneficiary signature, because they asserted that the beneficiary 
signature is no longer necessary given that it is not required for the 
assignment of benefits or the authorization of records release to CMS 
or its contractors. In addition, the commenters stated that almost 
every covered ambulance transport is to or from a facility (that is, a 
hospital or skilled nursing facility) where a valid signature is 
already on file. These facilities typically obtain the beneficiary's 
signature at the time of admission, authorizing the release of medical 
records for their services, or any related services. The commenters 
believe that ambulance transport to a facility, for purposes of 
receiving treatment at that facility, constitutes a

[[Page 66324]]

``related service,'' because the ambulance transports the patient to or 
from that facility for treatment or admission. Commenters also noted 
that, with respect to beneficiaries who are eligible both for Medicare 
and Medicaid, a signature is already on file with the State Medicaid 
office. Therefore, they argued that duplicating the requirement for a 
signature is costly and burdensome on ambulance service providers.
    Response: The purpose of the assignment of benefits signature is 
different than the purpose of the beneficiary signature to file a 
claim. As stated above, the purpose of the beneficiary signature to 
file a claim is to ensure that services were furnished and were 
furnished as billed. Although the assignment of benefits signature is 
not required for services billed on mandatory assignment, the 
beneficiary signature is still required for submitting a claim to 
Medicare.
    A beneficiary's signature on file at a hospital or a skilled 
nursing facility does not indicate that an ambulance provider or 
supplier was authorized to submit a claim for transport services on 
behalf of the beneficiary or that transport services in fact were 
furnished. Rather, the signature on file at a facility is used for 
claims filed by that facility for treatment the facility furnished to 
the beneficiary. Similarly, the fact that a beneficiary's signature may 
be on file with a State Medicaid office (or elsewhere) does not in any 
way speak to the issue of whether the ambulance provider or supplier 
was authorized to submit a claim for transport services on behalf of 
the beneficiary or that transport services in fact were furnished.
    Comment: A commenter stated that when submitting claims 
electronically, a provider or supplier must answer ``Y'' or ``N'' for 
the question of whether the provider or supplier has obtained a 
beneficiary signature. The commenter suggested that we should add 
language to the regulations to indicate that the beneficiary signature 
requirement will be met if one of the exceptions to the requirement is 
met.
    Response: We agree that it is proper and accurate to answer ``Y'' 
(for yes) to the question in the case where the beneficiary has not 
signed the claim but one of the alternatives in Sec.  424.36(b) through 
Sec.  424.36(e) has been satisfied. We are clarifying Sec.  
424.32(a)(3) (basic requirements of all claims) accordingly.
    Comment: Many commenters stated that the proposal would encourage 
ambulance providers and suppliers to seek signatures from patients who 
are in need of medical care and under mental duress. They stated that 
beneficiaries under duress should not be required to sign anything.
    Response: We agree that beneficiaries under duress should not be 
required to sign claims; in fact, we consider a beneficiary signature 
obtained under duress to be invalid. We do not agree, however, that our 
proposal encouraged ambulance providers and suppliers to obtain 
beneficiary signatures under duress. As stated above, the proposal was 
intended to provide ambulance providers and suppliers with another 
alternative to obtaining the beneficiary's signature. It was not, and 
the final rule is not, a narrowing of the available alternatives to 
ambulance providers and suppliers. Moreover, the commenters appear to 
assume that if ambulance providers and suppliers are to obtain a 
beneficiary's signature, they must do so at the time of transport. 
However, ambulance providers and suppliers have always been able to 
obtain the beneficiary's signature (or the signature of one of the 
persons specified in Sec.  424.36(b)(1) through (b)(4)) at any time 
prior to submitting the claim. In fact, as noted above, before 
providers may avail themselves of the exception in Sec.  424.36(b)(5), 
they are required to make reasonable efforts to have the beneficiary or 
one of the persons specified in Sec.  424.36(b)(1) through (b)(4) sign 
the claim. With this final rule, ambulance providers and suppliers, in 
the case of emergency transport services, may submit the claim without 
making such reasonable efforts if they satisfy the documentation 
requirements of new Sec.  424.36(b)(6).

O. Update to Fee Schedules for Class III Durable Medical Equipment 
(DME) for CYs 2007 and 2008

1. Background
a. Durable Medical Equipment, Prosthetics, Orthotics, and Supplies 
(DMEPOS) Classifications
    Under Sec.  414.210, for Medicare payment purposes, fee schedules 
are determined for the following classes of equipment and devices:
    <bullet> Inexpensive or routinely purchased items as specified in 
Sec.  414.220.
    <bullet> Items requiring frequent and substantial servicing, as 
specified in Sec.  414.222.
    <bullet> Certain customized items, as specified in Sec.  414.224.
    <bullet> Oxygen and oxygen equipment, as specified in Sec.  
414.226.
    <bullet> Prosthetic and orthotic devices, as specified in Sec.  
414.228.
    <bullet> Other DME (capped rental items), as specified in Sec.  
414.229.
    <bullet> Transcutaneous electric nerve stimulators (TENS), as 
specified in Sec.  414.232.
    We designate the items in each class of equipment or device through 
our program instructions.
    Under section 513 of the Federal Food, Drug, and Cosmetic Act (21 
U.S.C. 360c), the Food and Drug Administration (FDA) must classify 
devices into one of three regulatory classes: Class I, class II, or 
class III. FDA classification of a device is determined by the amount 
of regulation necessary to provide a reasonable assurance of safety and 
effectiveness; class III devices typically posing the greatest risk. 
See the CY 2008 PFS proposed rule (72 FR 38188) for a specific 
explanation of the three regulatory classifications of devices.
b. DMEPOS Payment
    Section 302(b)(1) of the MMA amended section 1847 of the Act to 
require the Secretary to establish and implement competitive 
acquisition programs for the furnishing under Medicare Part B of 
certain types of DMEPOS. Section 1847(a)(2)(A) of the Act provides that 
devices determined by the FDA to be class III devices under the Federal 
Food, Drug, and Cosmetic Act (21 U.S.C. 301 et seq.) cannot be included 
in the competitive acquisition programs. As part of the transition to 
competitive acquisition, the Congress mandated in sections 
1834(a)(14)(G) through (I) of the Act that the fee schedule amounts for 
DME, other than class III devices, be frozen at 2003 levels through 
2008.
    For class III devices, section 1834(a)(14)(G)(i) of the Act 
mandates that an annual update factor based on the percentage change in 
the consumer price index for urban customers (CPI-U) be applied to the 
fee schedule amounts for CYs 2004 through 2006. Section 
1834(a)(14)(H)(i) of the Act, as added by section 302 of the MMA, gives 
the Secretary discretion in determining the appropriate fee schedule 
update percentage for CY 2007 for DME which are class III medical 
devices described in section 513(a)(1)(C) of the Federal Food, Drug, 
and Cosmetic Act (21 U.S.C. 360c(a)(1)(C)).\3\ Specifically, for 2007, 
the 2006 fee schedule amounts for class III devices are to be updated 
by the percentage change determined to be appropriate by the Secretary, 
taking into account recommendations contained in

[[Page 66325]]

a report of the Comptroller General of the United States under section 
302(c)(1)(B) of the MMA. Also mandated by section 1834(a)(14)(I)(i) of 
the Act, for 2008, the 2007 fee schedule amounts for class III devices 
are to be increased by an annual factor based on the percentage change 
in the CPI-U, as applied to the 2007 payment amount determined after 
application of the percentage change under section 1834(a)(14)(H)(i) of 
the Act.
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    \3\ Section 513(a)(1)(C) of the Federal Food, Drug, and Cosmetic 
Act has been codified as 21 U.S.C. 360c(a)(1)(C). Accordingly, we 
believe that the references to 21 U.S.C. 360(c)(1)(C) in sections 
1834(a)(14)(G)(i), (H)(i), and (I)(i) of the Act are scrivener's 
errors.
---------------------------------------------------------------------------

    As stated above in this section of this final rule with comment 
period, section 1834(a)(14)(H)(i) of the Act mandated that the 
Secretary take into account recommendations by the Comptroller General 
of the United States, who is the head of the Government Accountability 
Office (GAO), when determining the appropriate update percentage for 
class III devices for 2007. On March 1, 2006, the GAO published a 
report, ``Class III Devices do not Warrant a Distinct Annual Payment 
Update'' (GAO-06-62). The GAO concluded in that report, ``because the 
initial payment rates for all classes of devices on the Medicare DME 
fee schedule are based on retail prices or an equivalent measure, they 
account for the costs of class III and similar class II devices in a 
consistent manner. Distinct updates for two different classes of 
devices are unwarranted.'' The GAO recommended that the Secretary 
establish a uniform payment update to the DME fee schedule for 2007 for 
class II and class III devices.
    In the May 1, 2006 Federal Register, we published the Competitive 
Acquisition for Certain Durable Medical Equipment, Prosthetics, 
Orthotics, and Supplies (DMEPOS) and Other Issues proposed rule (71 FR 
25660). We solicited comments on how to determine the appropriate fee 
schedule percentage change for class III devices for 2007 and 2008. We 
stated that we would consider the comments received in conjunction with 
the recommendations in the GAO report in determining the appropriate 
update percentage for these devices for 2007 and 2008.
    A majority of the submitted public comments indicated that the GAO 
report was flawed since it did not recommend a specific update factor 
or take into account changes over time in the costs of producing, 
supplying and servicing class III devices. Several commenters 
recommended that we continue to use the CPI-U to adjust fee schedule 
amounts for class III devices, but offered no substantive information 
that would otherwise support a distinct update factor for class III 
devices. Another commenter recommended that the class III proposal be 
included in a separate rulemaking procedure because it is not related 
to competitive acquisition.
2. Update to Fee Schedule
    We believe that the GAO has done a thorough job in reviewing 
Medicare payment rules and methods and issues associated with the costs 
of furnishing class III devices. Accordingly, we agree with the finding 
in the report that the costs of furnishing class II and class III DME 
devices have been factored into the fee schedule amounts calculated for 
these devices. We also agree with the GAO recommendation that a uniform 
payment update be established to the DME fee schedule for 2007 for 
class II and class III devices. For class II devices, the MMA provided 
for a zero percent payment update from 2004 through 2008. Accordingly, 
for 2007, in the CY 2008 PFS proposed rule we proposed a zero percent 
update for class III devices (72 FR 38188 through 38189). Also, in 
accordance with the MMA, we proposed to use the percent change in the 
CPI-U to update the class III device 2007 fee schedule amounts for 
2008.
    Comment: One commenter supported an update based on the CPI-U but 
did not provide any additional information. A second commenter 
indicated that class III devices are innovative, beneficial, cost-
effective devices and supported a reasonable payment update but did not 
recommend a specific update and also did not provide any information 
explaining why class III devices should receive a different update for 
2007 than other DME.
    Response: We do not believe that the information submitted by the 
commenters provides any information that would indicate that class III 
devices warrant a different update than other DME. Accordingly, for 
2007, we are adopting the proposed update methodology of applying a 
zero percent update for class III devices. Also, in accordance with the 
MMA, we are adopting the proposed methodology of applying the percent 
change in the CPI-U to update the class III device 2007 fee schedule 
amounts for 2008. The change in the CPI-U for the 12-month period 
ending with June 2007 was 2.7 percent. Therefore, a 2.7 percent 
increase will be applied to the 2007 fee schedule amounts for class III 
DME to determine the 2008 fee schedule amounts for these items.

P. Discussion of Chiropractic Services Demonstration

    In the CY 2006 PFS final rule with comment period (70 FR 70266) and 
the CY 2007 PFS final rule with comment period (71 FR 69707), we 
included a discussion of the 2-year chiropractic services demonstration 
that ended on March 31, 2007. This demonstration was authorized by 
section 651 of the MMA to evaluate the feasibility and advisability of 
covering chiropractic services under Medicare. These services extended 
beyond the current coverage for manipulation to care for 
neuromusculoskeletal conditions typical among eligible beneficiaries, 
and covered diagnostic and other services that a chiropractor was 
legally authorized to perform by the State or jurisdiction in which the 
treatment was provided. The demonstration was conducted in four sites, 
two rural and two urban. The demonstration was required to be budget 
neutral as the statute requires the Secretary to ensure that the 
aggregate payment made under the Medicare program does not exceed the 
amount which would be paid in the absence of the demonstration.
    Ensuring budget neutrality requires that the Secretary develop a 
strategy for recouping funds should the demonstration result in costs 
higher than those that would occur in the absence of the demonstration. 
As we stated in the CY 2006 and CY 2007 PFS final rules with comment 
period, we would make adjustments to the chiropractor fees under the 
Medicare PFS to recover aggregate payments under the demonstration in 
excess of the amount estimated to yield budget neutrality. We will 
assess budget neutrality by determining the change in costs based on a 
pre- and post-comparison of aggregate payments and the rate of change 
for specific diagnoses that were treated by chiropractors and 
physicians in the demonstration sites and control sites. Because the 
aggregate payments under the expanded chiropractor services may have an 
impact on other Medicare expenditures, we will not limit our analysis 
to reviewing only chiropractor claims.
    Any needed reduction to chiropractor fees under the PFS would be 
made in the CY 2010 and CY 2011 physician fee schedules as it will take 
approximately 2 years after the demonstration ends to complete the 
claims analysis. If we determine that the adjustment for BN is greater 
than 2 percent of spending for the chiropractor fee schedule codes 
(comprised of the 3 currently covered CPT codes 98940, 98941, and 
98942), we would implement the adjustment over a 2-year period. 
However, if the adjustment is less than 2 percent of spending under the 
chiropractor fee schedule codes, we would implement the adjustment over 
a 1-year period. We will include the detailed analysis of budget 
neutrality and the proposed

[[Page 66326]]

offset during the CY 2009 PFS rulemaking process.
    Comment: We received a number of comments on the methodology for 
determining budget neutrality. One commenter indicated that it 
continues to oppose our methodology for assuring budget neutrality 
under the demonstration. Instead of the application of an adjustment to 
the national chiropractor fee schedule, the commenter recommends that 
CMS make an adjustment to the totality of services payable under the 
Part B Trust Fund. This would be consistent with the requirements in 
section 651(f)(1)(A) of the Medicare Prescription Drug, Improvement, 
and Modernization Act of 2003 (MMA).
    Another commenter stated that CMS should apply budget neutrality 
only to the chiropractic codes used in the demonstration project. 
Because the demonstration did not require a physician referral, 
physicians should not be penalized for any utilization of chiropractic 
services. The commenter further noted that if budget neutrality is not 
limited to the chiropractic codes, CMS should incorporate estimates of 
the impact on other services into its SGR ``law and regulation'' factor 
estimates.
    Response: Section 651(f)(1)(B) of the MMA 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 demonstration 
projects under this section were not implemented.'' The statute does 
not specify a specific methodology for ensuring budget neutrality. Our 
methodology meets the statutory requirement for budget neutrality and 
appropriately impacts the chiropractic profession that is directly 
affected by the demonstration. The budget neutrality adjustment under 
the PFS will be limited to adjusting chiropractor fee schedule codes 
(comprised of the 3 currently covered CPT codes 98940, 98941, and 
98942). No other codes would be affected.
    Comment: One commenter noted that there are numerous dimensions to 
the analysis of effectiveness of treatment. By restricting our analysis 
only to Medicare expenditure, CMS would miss the important dimension of 
the effect of care on the beneficiary. Combining claims data with a 
measurement of functional status would permit a more useful examination 
of the impact of expanding chiropractor services. The commenter 
recommends that if CMS undertakes any further examination of the 
effectiveness of any intervention for neuromuscular conditions, 
functional status be considered.
    Response: The budget neutrality analysis is only one part of a 
broader evaluation of the chiropractic services demonstration. A survey 
was conducted of beneficiaries who received chiropractic services under 
the demonstration to determine the benefits of treatment and 
satisfaction with the chiropractic care provided under the 
demonstration. These results will be included in a Report to Congress 
on the demonstration.

Q. Technical Corrections

1. Particular Services Excluded From Coverage (Sec.  411.15)
    Sections 612 and 613 of the MMA added coverage under Part B for 
cardiovascular disease screening tests and diabetes screening tests, 
effective for services furnished on or after January 1, 2005, subject 
to certain eligibility and other limitations. These provisions were 
implemented in the CY 2005 PFS final rule with comment period (69 FR 
66236) and were codified in Sec.  410.17 and Sec.  410.18, 
respectively. However, at the time we neglected to make additional 
conforming changes to Sec.  411.15, which discusses particular services 
excluded from coverage, to reflect this expansion in coverage.
    To conform the regulations to the MMA provisions, we proposed a 
technical correction to the provisions in Sec.  411.15 by specifying 
additional exceptions to provide payment for cardiovascular disease 
screening tests and diabetes screening tests that meet the eligibility 
limitation and the conditions for coverage that we specified under 
Sec.  410.17, Cardiovascular Disease Screening Tests, and Sec.  410.18, 
Diabetes Screening Tests.
    Comment: One commenter suggested that the psychiatric screening 
examination should be included in the list of preventive health 
screenings and examinations exceptions from services that are excluded 
from Medicare coverage under proposed Sec.  411.15. The commenter 
suggested the advantage for having Medicare cover psychiatric screening 
examination is that better patient outcomes and decreased use of 
services often occur as a result of early identification of psychiatric 
disorders.
    Response: The purpose of the proposed technical correction in Sec.  
411.15 was to conform that provision to the cardiovascular disease 
screening test and the diabetes screening test benefits that were 
established in Sec.  410.17 and Sec.  410.18, respectively. These two 
part B screening benefits were specifically authorized by sections 612 
and 613 of the MMA. The proposed rule did not address the possibility 
of coverage of a psychiatric screening examination under Medicare Part 
B. There is no statutory provision that authorizes a benefit for 
psychiatric screening. Therefore, the commenter's suggestion in this 
regard falls outside the scope of this final rule.
2. Medical Nutrition Therapy (Sec.  410.132(a))
    In the CY 2006 PFS final rule with comment period (70 FR 70160), we 
added individual medical nutrition therapy, as represented by HCPCS/CPT 
codes G0270, G0271, 97802, 97803, and 97804 to the list of telehealth 
services. In the CY 2008 PFS proposed rule, we proposed a technical 
correction to Sec.  410.132(a) to conform the regulations to include an 
exception for services provided at Sec.  410.78. This revised paragraph 
reads as follows: ``(a) Conditions for coverage of MNT services. 
Medicare Part B pays for MNT services provided by a registered 
dietitian or nutrition professional as defined in Sec.  410.134 when 
the beneficiary is referred for the service by the treating physician. 
Except as provided at Sec.  410.78, services covered consist of face to 
face nutritional assessments and interventions in accordance with 
nationally accepted dietary or nutritional protocols.''
    Comment: We received one comment concurring with the proposed 
technical correction.
    Response: We are finalizing the technical correction to Sec.  
410.132(a) as proposed.
3. Payment Exception: Pediatric Patient Mix (Sec.  413.184)
    In the CY 2006 PFS final rule with comment period (70 FR 70214), we 
revised Sec.  413.180 through Sec.  413.192 regarding criteria and the 
application procedures for requesting an exception to the ESRD 
composite rate payment. As part of the revisions we intended to amend 
the section heading of Sec.  413.184 to reflect that, as specified in 
the statute, this exception only pertains to a pediatric ESRD facility. 
However, this change was not made. Therefore, we proposed to revise the 
section heading of Sec.  413.184 to read as follows: ``Payment 
exception: Pediatric patient mix.''
    We did not receive any comments regarding this proposal. Therefore, 
we are finalizing this provision as proposed.

[[Page 66327]]

4. Diagnostic X-Ray Tests, Diagnostic Laboratory Tests, and Other 
Diagnostic Tests: Conditions (Sec.  410.32(a)(1))
    Section 1861(r)(5) of the Act was amended by section 4513(a) of the 
BBA to allow Medicare payment for a chiropractor's manual manipulation 
of the spine to correct subluxation, without requiring the subluxation 
to be demonstrated by an x-ray. The BBA provision was effective for 
services furnished on or after January 1, 2000. Prior to this statutory 
change, the subluxation was required to be demonstrated by an x-ray. 
Because chiropractors are limited by statute in the services they can 
provide under Medicare, it was necessary to create an exception to the 
requirement that diagnostic services (including x-rays) must be ordered 
by the treating physician as provided in Sec.  410.32(a). This 
exception, which permits a physician who is not a treating physician to 
order and receive payment for an x-ray that is used by a chiropractor, 
is specified in Sec.  410.32(a)(1).
    Because of the BBA change, which removed the requirement that 
subluxation must be demonstrated by an x-ray, the so-called 
``chiropractic exception'' at Sec.  410.32(a)(1) is no longer 
warranted. We do not believe it is necessary or appropriate to continue 
to permit payment for an x-ray ordered by a nontreating physician when 
a chiropractor, not the ordering physician, will use that x-ray. 
Therefore, we proposed to revise Sec.  410.32 by removing paragraph 
(a)(1) and redesignating paragraphs (a)(2) and (a)(3) as (a)(1) and 
(a)(2), respectively.
    Comment: We received several comments on this proposal. Some 
commenters noted that x-rays are not necessary to identify spinal 
subluxations, but stated that the ability to obtain an x-ray for 
Medicare beneficiaries is critical to providing responsible, safe, and 
medically prudent care. They stated that without this ability they fear 
beneficiaries and the chiropractic profession as a whole will be at a 
higher risk for receiving and providing the wrong type of care. The 
majority of commenters expressed concern that without the chiropractic 
exception at Sec.  410.32(a)(1), the beneficiary may incur greater out 
of pocket expenses to obtain a noncovered x-ray when needed by the 
chiropractor. Other commenters believed that the overall costs for 
medical services may increase because a beneficiary wanting to seek 
chiropractic care directly may elect to first seek care for their 
condition from a medical doctor (MD) or doctor of osteopathy (DO) to 
obtain an order for a covered chiropractic x-ray, resulting in added 
costs for physician E/M services. Finally, many chiropractors commented 
that they are qualified to provide x-rays and other services that 
Medicare does not cover when furnished by a chiropractor and they 
believe that x-rays can be essential to rule out ``red flags'' and 
contraindications that may indicate the need for further diagnostic 
imaging or a referral to another health care professional.
    Response: We believe that retaining the chiropractic exception 
would be inconsistent with the statutory provision at section 
1861(r)(5) of the Act which defines a chiropractor as a physician only 
for the purposes of sections 1861(s)(1) and 1861(s)(2)(A) of the Act 
and only with respect to treatment by means of manual manipulation of 
the spine (that is, to correct a subluxation). This statutory provision 
does not include diagnostic services at section 1861(s)(3) of the Act, 
which is the benefit category under which x-rays are covered under 
Medicare. In addition, commenters noted that x-rays are not required to 
identify subluxations; rather, commenters stated that they use the x-
rays to rule out other conditions where manual manipulation of the 
spine would be contraindicated or for which further imaging studies are 
indicated. While the use of x-rays for this purpose is outside the 
scope of covered chiropractic services, it is also not addressed by the 
chiropractic exception at Sec.  410.32(a)(1). The chiropractic 
exception only permits a non treating physician to order an x-ray to 
identify a subluxation. Therefore, we are finalizing our proposal to 
revise Sec.  410.32 by removing paragraph (a)(1) and redesignating 
paragraphs (a)(2) and (a)(3) as (a)(1) and (a)(2), respectively, so 
that it is consistent and conforms to the statutory revisions mandated 
by the BBA.

R. Other Issues

1. Recalls and Replacement Devices
    In the CY 2008 PFS proposed rule (72 FR 38191), we included a 
discussion about recent recalls of implantable cardioverter-
defibrillator (ICDs) and cardiac resynchronization therapy 
defibrillators (CRT-Ds). These recalls, as well as previous recalls of 
ICDs and pacemakers in CY 2004 and CY 2005, raise issues both with 
regard to the additional costs of replacement devices and with regard 
to the additional physicians' services and diagnostic tests that 
beneficiaries who have these devices often need.
    The impact of the costs of replacement devices for Medicare payment 
of inpatient and outpatient hospital services is addressed in separate 
rulemaking for the respective inpatient and outpatient hospital payment 
systems. However, in the CY 2008 PFS proposed rule, we also 
acknowledged there are costs associated with physician monitoring of 
patients treated with recalled devices. This could involve extra visits 
to physicians' offices or hospital outpatient departments, as well as 
additional diagnostic tests which might be needed to care for the 
beneficiaries who have the recalled devices. Based on our concern of 
the potential costs to both Medicare and the beneficiary for these 
unforeseen extra services, we solicited comments on how to identify and 
address additional health care costs and Medicare expenditures 
associated with device recall actions.
    Comment: We received several comments acknowledging the potential 
for additional costs that may result from recalled devices, 
particularly in light of the increases in technology. Commenters stated 
that such costs should be the responsibility of device manufacturers 
and not the Medicare program, private payers, or the general public. 
Some commenters expressed concern that we would impose a financial 
penalty on physicians who deal with the consequences of product 
recalls. Several of the commenters suggested alternatives that could be 
used to address this issue, such as development of a modifier or a 
specific ``recall code'' that could be used to track the additional 
time and work associated with these recalls, and urged us to ensure 
that these additional costs are accounted for in the SGR target. 
Commenters also stressed that any proposal should be ``vetted'' through 
the appropriate stakeholders.
    Response: We appreciate the suggestions that the commenters 
provided. It is not our intention to ``penalize'' physicians who care 
for patients affected by implantable device recalls. Rather, it is our 
intention to ensure that costs of the additional physicians' services 
and diagnostic tests associated with recalled devices are recognized 
and appropriately addressed. We will consider the concerns and 
suggestions provided by the commenters as we develop a plan to address 
this issue.

[[Page 66328]]

2. Therapy Standards and Requirements
a. Revisions to Personnel Qualification Standards for Therapy Services
    In the CY 2005 PFS final rule with comment period (69 FR 66354), we 
amended Sec.  410.59, Sec.  410.60, and Sec.  410.62 to refer to the 
qualifications for physical therapists (PTs), occupational therapists 
(OTs) and speech-language pathologists (SLPs) at Sec.  484.4, which 
sets the personnel qualifications required under the HHA Conditions of 
Participation.
    Section 484.4 contains requirements for persons furnishing services 
in HHAs that include physical therapists (PTs), physical therapist 
assistants (PTAs), occupational therapists (OTs), occupational therapy 
assistants (OTAs) and SLPs. The CY 2005 PFS final rule with comment 
period clarified that the personnel qualifications in Sec.  484.4 are 
applicable to all outpatient PT, OT, and SLP services ``in order to 
create consistent requirements for therapists and therapy assistants'' 
(69 FR 66345).
    In the CY 2008 PFS proposed rule (72 FR 38191), we proposed to 
update the personnel qualifications in Sec.  484.4 for PTs, PTAs, OTs, 
and OTAs. We also proposed to revise the qualifications for SLPs to 
remove a reference to audiologists in the definition for speech-
language pathologists because a speech-language pathologist would not 
have a Certificate of Clinical Competence in audiology, as implied by 
the regulation, unless that person was dually qualified as an 
audiologist.
    We proposed these changes for the following reasons.
    <bullet> The current regulations at Sec.  484.4 contain outdated 
terminology relating to several of the relevant professional 
organizations.
    <bullet> The standards that now exist in the fields of physical 
therapy and occupational therapy have changed since a substantial 
portion of these qualification requirements were developed.
    <bullet> Some of the current qualification requirements do not 
address individuals who have been trained outside of the United States, 
or refer to outdated requirements.
    <bullet> These revisions would have the benefit of establishing 
consistent standards across provider/supplier lines.
    Although all States license PTs, some States have no licensing 
provisions for PTAs, OTs, OTAs, and SLPs. We proposed to revise our 
requirements to recognize as qualified PTs, OTs, PTAs, or OTAs who meet 
their respective State qualifications (or have received State 
recognition as PTs, OTs, PTAs or OTAs) before January 1, 2008.
    We did not propose to allow those who, before January 1, 2008, meet 
only the State qualifications to practice physical therapy, and not the 
education requirements, to provide services under the Home Health PPS 
or the Hospice PPS. As we indicated in the CY 2008 PFS proposed rule, 
we did not expect that there are therapists furnishing services in a 
HHA or hospice that do not meet either the current or proposed revised 
qualifications.

Grandfathering Provision for Home Health

    Comment: Commenters were concerned about the inconsistency in 
standards between settings, stating that there is no justification for 
the absence of a grandfathering provision for therapists and assistants 
practicing in Home Health settings. Many also indicated a concern that 
currently licensed or regulated professionals would not be allowed to 
continue to practice in a HHA or hospice, and recommended that 
sufficient time be allowed before implementation of the new standards 
for new professionals to meet their training.
    Response: The commenters make a compelling case for the 
grandfathering provisions to be applied uniformly across payment 
systems. We agree that it is important to apply consistent standards 
and we will apply the grandfathering provision in all settings as 
specified in part 484 of our regulations. Since all of part 484 
describes personnel qualifications, we refer to part 484 in this rule 
rather than specifically to Sec.  484.4. The cross-reference has also 
been changed in the regulation text from Sec.  484.4 to part 484 in all 
applicable sections. Although we proposed that these grandfathering 
provisions would be included in revisions to Sec.  409.17, Sec.  
409.23, Sec.  410.43, Sec.  410.59, Sec.  410.60, Sec.  482.56, Sec.  
485.70, Sec.  485.705, Sec.  491.9, the application of the 
grandfathering provisions to home health in part 484 makes some 
sections of proposed regulation text unnecessary and necessitates 
changes in the language of others. The changes proposed to sections 
Sec.  485.705 and Sec.  491.9 have been omitted, as they are no longer 
necessary.

Delay in Implementation of New Personnel Qualifications

    Comment: Some commenters requested that we delay implementation of 
consistent therapy standards and qualifications until we can apply them 
consistently to SNF services, and provide education to providers and 
suppliers.
    Response: We believe a 2-year delay in implementation of personnel 
qualifications will provide sufficient time for new personnel to come 
into compliance with the new standards. Therapists and assistants who 
met the qualifications of their State's practice act (in other words, 
who are licensed, certified or otherwise regulated by the State as a 
practitioner in the particular discipline) prior to December 31, 2009, 
will not be required to upgrade their qualifications. However, in 
States that have no regulations for practitioners in a particular 
discipline and for services furnished incident to the services of 
physicians where licensure does not apply, therapists and assistants 
must be qualified by education and examination as described in this 
final rule with comment period. Those who currently qualify to provide 
services without licensure by meeting the Medicare education or 
examination standards in effect at the time of the CY 2008 proposed 
rule will continue to qualify under those policies. On January 1, 2010, 
any individual who has not met the earlier requirements must meet the 
new requirements.

Consistent Policy Standards

    Comment: Many commenters indicated we have not provided a 
justification for applying the personnel and policy standards that we 
have articulated for Part B services consistently to Part A services. 
Most of these comments came from commenters who also support the right 
of States to create Medicare standards, who represent interest groups 
other than Medicare beneficiary/therapy users, and who believe we favor 
professional organizations in setting policies.
    Response: Under both Medicare Part A and B, we must ensure that all 
services are described within a statutory benefit category. In order to 
do so, we frequently establish qualifications for health care 
professionals who furnish, or are involved in furnishing, Medicare 
services. In many Part A settings, we have historically relied on 
Medicare contractors to review facility records, State laws and local 
policies to determine that services have been furnished by qualified 
therapists. As a result of information provided by new contractors, 
which has been confirmed by numerous comments to the proposed rule, we 
have concluded that therapy is not always being furnished by 
individuals trained as therapists--even in some Part A settings. 
Therefore, we believe it is critical that we establish in regulations 
consistent standards for

[[Page 66329]]

qualified therapists in the Medicare program.
    Comment: Some commenters objected to the use of the terms therapy 
and rehabilitation to mean physical therapy (PT), occupational therapy 
(OT), and speech-language pathology (SLP) services. The commenters 
recommended allowing any State licensed or authorized health 
professional to provide rehabilitation services if the provider's 
medical staff and State law would permit them to do so. The commenters 
recommended convening a work group to discuss the creation of rational 
personnel qualifications and scope of services.
    Response: The terms ``therapy'' and ``rehabilitation'', as used in 
this section of this final rule with comment period, apply only to the 
Medicare benefit for PT, OT, and SLP services and to the qualified 
professionals who provide them. The qualifications have been 
established to assure that all of the personnel who provide these 
services are suitably trained in the discipline they practice. We see 
no reason to believe the skills and training required to furnish 
therapy and rehabilitation in Part A settings are less than those 
required in Part B settings, and therefore, qualifications for 
personnel in the inpatient setting should not be less stringent than in 
the outpatient setting. Therefore, we will adopt the proposed 
qualifications (with minor modifications), and these qualifications 
will be made applicable in Part A and Part B settings.

Grandfathering Provision

    Comment: Many commenters believe that a grandfathering provision is 
not necessary for physical therapists and speech-language pathologists 
since the changes to their qualifications are not substantial.
    Response: We agree and have removed reference to physical 
therapists and speech-language pathologists from the relevant 
grandfather clauses in the final rule with comment period.
    Comment: Several commenters believe that our proposal to require 
those who were grandfathered to continue to practice at least part time 
without an interruption of more than 2 years is not necessary, and that 
the language is confusing.
    Response: We agree and have removed the requirement for continued 
practice from this final rule with comment period.
    Comment: We received many comments concerning application of a 
requirement for State licensure, registration, certification or other 
regulation to physical therapist assistants. The commenters indicate 
large numbers of PTAs in California and other States are licensed but 
do not meet the proposed education and examination requirements. The 
commenters report implementation of the proposed qualifications would 
cause severe access problems for beneficiaries and operational 
disruption for facilities. All commenters supported the adoption of a 
grandfather clause to allow currently practicing PTAs to continue 
furnishing services to Medicare patients, and many requested the 
grandfathering be implemented when the rule is finalized in November, 
rather than January 1, 2008.
    Response: We will recognize as qualified to provide Medicare 
services those therapists and assistants who are licensed or otherwise 
regulated by their States before December 31, 2009. Individuals who are 
not licensed or otherwise regulated as PTs, OTs, PTAs, and OTAs in 
their States may furnish services incident to a physician's service if 
they meet the education and examination requirements in this final rule 
with comment period. These changes will be effective on the date this 
final rule with comment period is effective.

Personnel Qualifications--General

    For therapists and assistants trained outside the United States or 
trained by the United States military, we proposed standards we 
considered comparable to those applied to therapists and assistants 
trained in the United States. However, we noted we would not recognize 
as qualified therapists or therapy assistants individuals trained in 
other disciplines for purposes of furnishing PT, OT, or SLP services to 
Medicare beneficiaries.
    Comment: APTA recommends the use of the term ``substantially 
equivalent'' to replace ``comparable'' to avoid confusion in the 
language concerning those trained outside the United States.
    Response: We have modified the language to substitute in 
regulations the term ``substantially equivalent'' for ``comparable''.
    Comment: Several commenters believe that the qualifications for 
military trained OTs/OTAs (when applicable) and PTs/PTAs should be the 
same as for all OTs/OTAs and PTs/PTAs.
    Response: We agree that separate qualifications for U.S. military-
trained therapy personnel are not necessary for PTs, OTs, and OTAs, 
since the training programs available in the military already meet the 
same standards as other U.S.-trained OTs and PTs and OTAs. For PTAs who 
may, in the future, be trained in the military, we will apply the 
standard of substantial equivalency consistent with those trained 
outside the United States, or the same standards as other United States 
trained PTAs, as appropriate.
    Comment: Some commenters recommended that licensure be the only 
qualification for PTs and OTs. The commenters recommended we defer to 
individual States or to the medical staff of a hospital to determine 
the qualifications for physical therapists and occupational therapists.
    Commenters agreed generally that we should rely on State licensure 
in those States where it exists and for those settings where licensure 
is applicable. The commenters note that there have been attempts to 
deregulate health professions in the name of regulatory reform and they 
recommend inclusion (for OT) and continuation (for PT) of education and 
exam requirements to assure there will be standards in place when 
licensure does not apply.
    Response: We believe it is appropriate, as we proposed, to require 
qualifications related to education and examination to address those 
situations where licensure does not apply. We added language in 
regulations to indicate that when licensure or other regulation is not 
applicable for therapists and assistants, the education and examination 
requirements apply.
    Comment: Several commenters support applying the proposed 
qualifications and therapy standards for staff providing services 
incident to the services of physicians. Some continue to object to the 
implementation of section 1862(a)(20) of the Act.
    Response: Section 1862(a)(20) of the Act excludes from payment 
under Medicare Parts A and B any expenses for outpatient PT or OT 
services furnished incident to the services of a physician that do not 
meet the standards and conditions that apply to therapists, except 
``any licensing requirement specified by the Secretary.'' Therefore, as 
we described in the proposed rule, we will not apply the requirement 
that therapists and assistants be licensed or otherwise regulated by a 
State in the case of services furnished incident to the services of 
physicians. We will apply education and examination requirements.
    In the proposed rule, we explained that when we referred to persons 
who are licensed, certified, and otherwise regulated by a State, we 
interpreted ``otherwise regulated'' to mean that, while a State may not 
regulate a profession by granting a license or certifying educational 
or training

[[Page 66330]]

credentials, it may nevertheless regulate the practice of a profession 
by application of certain other requirements.
    We received no comments on the use of this term, and therefore, we 
intend to use it as proposed. Because we believe the term 
``certification'' is redundant to ``otherwise regulated'', that term 
has been omitted.

Occupational Therapy

    We proposed to require that OTs beginning their practice after 
January 1, 2010, must be licensed, certified, registered or otherwise 
regulated as an OT, and have graduated from an occupational therapist 
curriculum accredited by the Accreditation Council for Occupational 
Therapy Education (ACOTE) of the American Occupational Therapy 
Association (AOTA), and also have successfully completed the 
certification examination developed and administered by the National 
Board for Certification in Occupational Therapy (NBCOT). We established 
that ``successfully completed'' means the individual must perform 
sufficiently well on the exam to receive (or be eligible to receive) 
certification. For services incident to a physician's or nonphysician 
practitioner's service where the licensure requirement does not apply, 
we proposed the education and examination requirements continue to 
apply.

OT Comments

    Comment: AOTA recommended qualifications based on licensure or 
education and examination.
    Response: We require qualifications based both on licensure and on 
education and examination so that there are appropriate qualifications 
that apply where licensure is not applicable, for example, to therapy 
services furnished incident to the physician's service.
    Comment: The NBCOT recommended that qualified OTs be credentialed 
by their examination and be members in good standing of their 
organization. The AOTA recommended that AOTA approve any new 
credentialing body that might develop in the future.
    Response: We recognize that currently the ACOTE or the World 
Federation of Occupational Therapists (WFOT) credential education 
programs for OTs and/or OTAs and the NBCOT determines eligibility and 
furnishes examinations. We have modified the policy to approve those 
organizations and added ``or successor organizations'' to allow for 
changes in the ACOTE title. We do not agree membership in NBCOT should 
be a requirement. Since NBCOT is already approved by The American 
National Standards Institute (ANSI), the National Commission for 
Certifying Agencies and the National Organization for Competency 
Assurance, CMS does not believe it is necessary to grant AOTA's request 
to permit it to approve any future credentialing body.

International OT/OTA

    We also proposed that OTs who are educated outside the United 
States: (1) Be graduates of an occupational therapy curriculum 
accredited by the WFOT; (2) have successfully completed the NBCOT 
International Occupational Therapy Eligibility Determination (IOTED) 
review; and (3) have successfully completed the certification 
examination for Registered Occupational Therapist. We proposed to adopt 
similar standards for OTAs (but with an OTA curriculum) and requested 
comments on qualifications for internationally educated occupational 
therapy assistants.
    Comment: The AOTA and NBCOT support the proposal that the 
internationally educated OT standards should be comparable to United 
States trained OTs and that the NBCOT conduct the credentialing process 
for these OTs. The AOTA requests that there be a way to allow a 
professionally recognized credentialing body other than NBCOT to 
develop or administer the examination.
    NBCOT reports there are no internationally trained OTAs and 
recommends qualifications for such OTAs be stricken from the rules.
    Response: This final rule with comment period recognizes the ACOTE, 
NBCOT or WFOT to contribute to credentialing internationally trained 
OTs and OTAs. Although NBCOT may not now recognize internationally 
trained OTAs, such OTAs do exist. In addition, we are adopting 
regulations in anticipation of any international programs that meet the 
qualifications in the future.
    Comment: AOTA commented that the proposals for those who began 
practice between December 31, 1977, and January 1, 2008, are archaic 
and cannot be directly applied to many professionals qualified by their 
States.
    Response: We agree that the current language is not applicable and 
we have updated this language for the new qualifications in this final 
rule with comment period, adding current credentialing bodies for 
United States trained and internationally trained OTs. To assure that 
no one covered under the existing qualifications is inadvertently 
disqualified, the prior language continues to apply for those who are 
not licensed but were qualified under the previous policy.
    Comment: Commenters note that many States allow graduate OTs and 
OTAs to furnish services under a temporary license or permit while 
eligible for examination. The commenters expressed concern that the 
qualifications in the proposed rule would limit new graduates from 
entering the workforce.
    Response: We agree that it is not necessary to change the current 
requirement of eligibility for the examination for United States 
trained OTs and OTAs when they are licensed or otherwise regulated by 
their States. However, we will require foreign trained OTs and OTAs 
(when applicable) to have passed the examination, and not merely be 
eligible for it. We believe this requirement is appropriate in the case 
of foreign trained individuals in order to ensure that they have 
acquired sufficient knowledge through their education program to pass 
the examination and, thus, are adequately prepared to begin furnishing 
services to Medicare beneficiaries.

Physical Therapy

    For PTs, we proposed the therapist must be licensed as a physical 
therapist by the State in which practicing and accredited by the CAPTE 
based on APTA guidelines. When the licensure requirement is not 
applicable (that is, for services furnished incident to the services of 
physicians and NPPs), we proposed to require that PTs must be 
accredited by the CAPTE. We requested comments on qualifications for 
PTs which include satisfactory completion of a curriculum and a 
national examination each approved by the APTA.
    Comment: APTA recommended that we remove the requirement that a PT 
pass a National Examination approved by the APTA. Since all States 
require a national licensing exam, APTA does not believe it is 
necessary for APTA to approve the exam. State Boards supported State 
licensing requirements, which include examination.
    Response: In cases where the licensing standards do not apply (for 
therapy services incident to a physician's service or in the event a 
State deregulates PT practice), we believe it is important to have 
standards in place to ensure that an individual is qualified to furnish 
physical therapy services. We will not finalize the requirement for 
APTA to approve the licensing exam. Instead, we will accept a national 
licensing exam used by State boards to qualify personnel who have

[[Page 66331]]

been trained in a physical therapy curriculum.
    We proposed that licensure or certification, or other regulation by 
the State in which services are furnished would be required for PTAs 
under our regulations. We also proposed that PTAs be accredited by the 
CAPTE. We requested comments on appropriate qualifications for PTAs.
    Comment: APTA believes it is critical that we require approval by 
APTA for foreign trained PTAs. The Commission on Accreditation of 
Physical Therapist Education (CAPTE) of the APTA has been nationally 
recognized since 1977 as the only organization that approves PT and PTA 
education programs; it has no financial interest in the credentialing 
bodies for PTs or PTAs.
    Some commenters disagreed with our proposal to allow the APTA to 
approve the credentialing body that establishes qualifications for 
foreign trained PTs and/or PTAs. They suggest that the U.S. Citizenship 
and Immigration Services and the Department of Homeland Security 
approve credentialing bodies that set standards and credential 
individuals and the States decide whether to license that individual. 
The commenters note there are currently no approved foreign PTA 
programs.
    Response: While commenters tell us there are no foreign PTA 
programs that meet their credentialing standards, there may be PTA 
programs in foreign countries that meet the standards in the future. 
Therefore, this final rule with comment period addresses this future 
need. The CAPTE of the APTA is approved by the U.S. Department of 
Education (USDE) and the Council for Higher Education Accreditation 
(CHEA). We find no reason to doubt that CAPTE/APTA will make fair 
determinations on the appropriateness of educational programs in the 
United States or credentials evaluation organizations for foreign 
trained PTs and PTAs. However, in response to comments, we have 
recognized both CAPTE and a credentials evaluation organization 
identified in 8 CFR 212.15(e) (the Homeland Security Act) as it relates 
to physical therapists and assistants to determine an education program 
to be substantially equivalent to PT and PTA entry level education in 
the United States. We believe the additional requirement for passing a 
national examination will mitigate any variations in credentialing.
    Comment: Several commenters stated that adoption of the proposed 
qualifications for PTs would usurp the rights of State governments in 
licensing and determining the scope of practice for healthcare 
professionals, creating ``a monopoly for curriculum approval''.
    Response: As we indicated in the proposed rule, we believe it is 
important to establish consistent and meaningful standards and 
conditions for the provision of Medicare covered services. Professional 
standards change periodically and these are often eventually adopted by 
State licensing boards, each of which has different language in its 
statutes. We believe the standards we proposed would not usurp or 
interfere with the adoption of standards by States. Rather, in most 
cases the standards incorporate the State standards. However, we 
believe it is necessary for CMS to address circumstances where State 
licensing or other regulation are not applicable. We are not creating a 
monopoly for curriculum approval by recognizing CAPTE. While it is the 
only existing credentialing body used by the States in their licensing 
process, we assess other credentialing qualifications if they are 
developed. Therefore, we are finalizing standards that include State 
standards (licensing or other regulation), as well as education and 
examination. We will assess other credentialing qualifications if they 
are developed.
b. Application of Consistent Therapy Standards
(1) Personnel Qualifications
    We believe therapy services should be provided according to the 
same standards and policies in all settings, to the extent possible and 
consistent with statute. Therefore, we proposed to revise our 
regulations to cross-reference the personnel qualifications for 
therapists in Sec.  484.4 to the personnel requirements for PTs, OTs, 
PTAs, OTAs, and SLPs in the following sections:
    <bullet> Sec.  409.10 and Sec.  409.16 (Inpatient hospital services 
and inpatient critical access hospital services).
    <bullet> Sec.  409.23 (Posthospital SNF care).
    <bullet> Sec.  410.43 (Partial hospitalization services).
    <bullet> Sec.  410.59 (Outpatient occupational therapy services).
    <bullet> Sec.  410.60 (Outpatient physical therapy services).
    <bullet> Sec.  410.62 (Outpatient SLP services).
    <bullet> Sec.  418.92 (Hospice).
    <bullet> Sec.  482.56 (Optional hospital services, Rehabilitation 
services).
    <bullet> Sec.  485.70 (Specialized providers).
    <bullet> Sec.  485.705 (Clinics, Rehabilitation agencies, Public 
health agencies).
    <bullet> Sec.  491.9 (Rural health clinics and Federally qualified 
health centers (FQHCs)).
    We also solicited comments on whether the personnel qualifications 
at Sec.  484.4 should be made applicable in other settings.

Consistent Personnel Qualification Standards

    Comment: Many commenters supported consistent personnel 
qualifications. Commenters indicated beneficiaries deserve to be 
treated by qualified professionals in both inpatient and outpatient 
settings.
    We also heard from commenters who oppose the application of 
consistent qualifications for therapists in Part A settings. The 
commenters stated that if only qualified physical therapists provide 
physical therapy services in Part A settings, it will prevent hospitals 
from continuing to employ athletic trainers to provide physical 
medicine and rehabilitation services. The commenters suggest the 
medical staff should decide the qualifications for therapists at a 
hospital.
    Response: The policies outlined in the proposed rule apply only to 
therapy services. The State Operations Manual Appendix A Survey 
Protocol, Regulations and Interpretive Guidelines for Hospitals (Rev. 
1, 05-21-04) Sec.  482.56 Condition of Participation: Rehabilitation 
Services indicates that therapy services, if provided, must be in 
accordance with acceptable standards of practice which include 
compliance with any applicable Federal or State laws, regulations or 
guidelines, as well as standards and recommendations promoted by APTA, 
ASHA, and AOTA. In States where there are no personnel qualifications 
for therapists or assistants, hospitals should currently be following 
the personnel qualification standards set by those professional 
organizations. Most States and all of the professional organizations 
require graduation from approved education programs and a passing grade 
on a national examination. Therefore, we do not anticipate that 
adherence to the personnel qualifications in this final rule will cause 
any changes in hospital personnel.
    At the same time, we recognize that there may be athletic trainers 
(AT), lymphedema specialists, low vision specialists, nurses, 
physicians, and other staff employed in hospital settings who furnish 
other services for which they are qualified, and for which payment is 
included in the payment to the facility. Those services should be 
appropriately documented as, for example, athletic training or 
lymphedema services. Where the services of health care professionals 
who are not PTs, OTs, PTAs, OTAs, or SLPs are now being appropriately 
furnished, documented and reimbursed,

[[Page 66332]]

we anticipate the application of consistent personnel qualifications 
relating to PT, OT and SLP services will have no effect on the 
appropriate provision of these other services. In settings where 
therapy services are separately billable, there will only be an impact 
on current practice if services that are being documented as PT, OT, or 
SLP services are being furnished by personnel who do not meet the 
requirements to be considered qualified therapists. Personnel who do 
not meet the applicable professional standards to be considered 
qualified therapists cannot furnish or be paid for PT, OT, and SLP 
services.
    Comment: Several commenters indicated that therapy services are not 
covered in rural health clinics.
    Response: Rural Health Clinics (RHCs) provide a core set of primary 
health care services as defined in statute. RHC services include the 
services that would commonly be furnished in a physician's office, 
(such as PT, OT, and SLP services), but only when directly provided by 
a Medicare approved RHC provider, such as a physician, nurse 
practitioner, or physician assistant. A certified nurse midwife, 
clinical psychologist, and or clinical social worker may provide RHC 
services, but not PT, OT, or SLP services, because PT, OT, and SLP 
services are not in their scope of practice. A face-to-face encounter 
with any other practitioner including, for example, a PT, OT, or SLP, 
athletic trainer, kinesiologist, or registered nurse is not covered as 
an RHC encounter, even if the service may be medically necessary, 
because these are not Medicare approved RHC providers (as defined in 
statute). Since therapists are not approved RHC providers, we will 
remove the reference in Sec.  491.9 to personnel qualifications for 
therapists.

Consistent Policies

(2) Application of Consistent Therapy Standards
    In tandem with cross-referencing Part A and Part B therapy 
personnel requirements in the regulations, we proposed to clarify our 
policies to improve consistency in the standards and conditions for 
Part A and Part B therapy services. Many, but not all, of the policies 
described for therapy services in Part B settings are also appropriate 
to Part A settings.
    Specifically, in Sec.  409.17, we proposed to clarify that hospital 
services include physical therapy, occupational therapy, and SLP. We 
also proposed to add regulations for inpatient hospital services to 
include a plan for therapy services consistent with the plan required 
for outpatient therapy services. We invited comment on PT, OT, and SLP 
plan of treatment policies that are appropriately applied to all 
therapy services, whether provided under Medicare Part A or B.
    While the concept of consistent policies was strongly supported, 
many commenters were concerned about the application of specific Part B 
policies to Part A settings.
    Comment: Several commenters indicated concern that application of 
the Part B policies, especially plan and documentation polices, to the 
inpatient hospital setting would impact treatment and increase the 
paperwork burden to staff.
    Response: We are aware that inpatient stays are short. If 
clinically appropriate documentation is now provided, the new policies 
are unlikely to increase the burden. We have not delineated which of 
the Part B policies would apply in Part A specifically to allow some 
flexibility in the application of the general treatment guidelines as 
appropriate to the setting. We anticipate addressing these issues in 
manual instructions.
    We note that we continue to believe the general concept that 
therapy services should be provided in a similar manner by qualified 
personnel in all settings is an appropriate one.
    Comment: The AOTA requests that any change to the therapy plan of 
care be incorporated ``as soon as possible'' rather than 
``immediately.''
    Response: We recognize that the term ``immediately'' could be 
relative. Therefore, we have substituted ``as soon as possible'' to 
refer to changes in the plan in Sec.  424.24 and Sec.  482.56.
    Comment: Commenters indicated concern that the outpatient plan of 
care certification requirement would be transferred to inpatient policy 
and that an ordered service that is being provided under the care of a 
hospital physician would also require certification for every change in 
the provision of treatment.
    Response: The policy at Sec.  409.17 and Sec.  482.56 is compatible 
with the concept of the therapy plan as part of the overall plan in a 
facility. Also, we defer to hospital policies and procedures for 
changes to the plan. Guidance will be provided in manuals concerning 
modifications in the provision of care that do not constitute changes 
to the plan. Requirements concerning orders for establishment of a 
therapy plan (development and implementation) in the hospital are not 
changed by this final rule with comment period. We anticipate 
clarifying further in manual instructions documentation requirements 
that are consistent with the care of inpatients and will take into 
account comments received. We believe that, in general, good practice 
would call for documentation of significant changes to the patient's 
response to treatment in all settings, even if the Medicare program 
does not specifically require it.
    Comment: AOTA asserts that in the inpatient setting, goal setting 
and treatment planning may not fit the mold of what is typically 
required by CMS in outpatient settings, that is, functional 
restoration. They indicate concern that therapy will not be provided 
consistent with their professional guidelines or scope of practice.
    Response: We recognize that some of the services furnished by 
therapists in the acute inpatient hospital setting may not achieve 
functional changes expected in other settings. We have noted in Sec.  
482.56 that the provision of care and the personnel qualifications must 
be in accordance with national acceptable standards of practice. 
Although documentation is not relevant to billing in this setting, it 
is still critical that the services furnished be accurately documented. 
We anticipate issuing further guidance regarding documentation for 
therapy services in hospital settings in Medicare manuals.
    Comment: AOTA requests removal of the reference to review of the 
plan prior to certification in Sec.  409.17(e). APTA agrees that the 
review language is unnecessary.
    Response: We agree that it is unnecessary in the regulation to 
remind physicians or nonphysician practitioners to read the plan before 
they certify it and we have removed the paragraph from Sec.  410.61(e) 
and Sec.  409.17(e), and Sec.  482.56(e).
    Comment: Several commenters agree with the proposal that in the 
hospital setting the physician's review and approval of a therapy plan 
should be implied in the physician's review and approval of a facility 
plan that includes therapy services. The commenters believe the same 
rationale applies to services furnished in skilled nursing facilities 
and urge CMS to state that, in the SNF Part A setting, review of the 
therapy plan is implied by the physician's review of the facility plan.
    Response: We agree with the commenters regarding the implied 
physician review and approval of the therapy plan in the Part A SNF 
setting. We have recognized this issue previously in the preamble to 
the Prospective Payment System and Consolidated Billing for Skilled 
Nursing Facilities; Update Notice (69 FR 45780),

[[Page 66333]]

where we stated that `` * * *. It is not necessary for a SNF to obtain 
a separate physician signature on the therapy treatment plan itself 
prior to billing Part A for therapy services * * * .''

Delay in Implementing Policies

    Comment: Many commenters requested delays in the implementation of 
the policies for Part A therapy services, indicating they want time to 
have input into the manual guidelines and may need time to learn new 
procedures.
    Response: We will delay the implementation of the policies pending 
the issuance of manual guidance which we anticipate that we will 
develop in mid 2008.

Students

    Comment: Many commenters believe that it is imperative that we not 
inadvertently develop a policy that prevents students from receiving 
clinical training. APTA suggests we consider conforming the policies 
for students to the SNF policy for services provided by aides and 
students. The SNF policy allows services by aides and students in the 
``line of sight'' of the therapist to count toward minutes accrued on 
the Minimum Data Set.
    Response: We will consider conforming all policies for student 
supervision to the SNF policy for line of sight supervision, and will 
address this issue in manual guidance.
c. Outpatient Therapy Certification Requirements
    In 1988, in an attempt to control the expanding utilization of 
therapy services, we added a 30-day recertification requirement for 
outpatient therapy services to our regulation at Sec.  424.24. This 
requires that a physician certifies a plan of care for 30 days, 
regardless of the appropriate length of treatment. To continue 
treatment past 30 days, the physician is required to recertify the 
plan. As explained in the CY 2008 PFS proposed rule, after many years 
of experience with the current recertification requirements, we now 
believe that requiring recertification at 30-day intervals may not 
always provide sufficient flexibility to the physician to order the 
appropriate amount of therapy for the patient's needs. Therefore, we 
proposed to change the plan recertification schedule in Sec.  424.24 to 
an episode length based on the patient's needs, not to exceed 90 days.
    Comment: We received strong support for changing the 
recertification schedule to a date determined by the physician (not to 
exceed 90 days) from the therapy associations, medical societies, 
facilities, and individuals. They emphasized that physician approval of 
a clinically appropriate length of treatment at the initial 
certification will improve the patients' access to treatment, reduce 
administrative burden to physicians, therapists and office staff and 
reduce unnecessary visits for patients. Several indicated that a limit 
is not necessary since the physician should determine the episode 
length. MedPAC indicated a concern about reducing the number of 
physician reviews of the services in the context of the increasing 
utilization of therapy services
    Response: We agree that a physician is qualified to certify the 
appropriate length of care in the initial certification; and that 
recertification should be required as often as the individual's 
condition requires. However, we believe a 90-day limit is a reasonable 
modification of the policy at this time. We will continue to review the 
utilization of therapy services to assess any changes in the relative 
utilization patterns for beneficiaries or providers/suppliers that may 
suggest changes in practice related to this policy. As we proposed, 
after 2 years, if we determine that there are changes in relative 
utilization patterns that suggest inappropriate utilization of therapy 
services based on the certification timing, we will reconsider this 
policy.
    Comment: One commenter stated that a physician generally does not 
have statistical data from which to make a decision regarding the 
appropriateness of initiation or continuation of therapy, and, 
therefore, recertification of therapy by physicians seems meaningless. 
The commenter urges the use of risk-adjusted data based on gains in 
functional status relative to number of visits to inform physician 
decision making for appropriate utilization.
    Response: We agree that collection of data related to the patient's 
functional condition and relative utilization of services may be useful 
in our ongoing development of recommendations for alternatives to 
therapy caps. On September 6, 2007, we released a Request for Task 
Order Proposals to the pool of contractors under the CMS MRAD (Master 
Research And Development) contract vehicle. The goal of this request 
for proposals is to develop recommendations for alternatives to therapy 
caps for CMS covered Outpatient Therapy services.
    Comment: There was very strong support for extension of the 90 day 
recertification policy to CORF settings, consistent with the proposed 
policy for all other settings. There were no comments opposed to 
consistent recertification policy in the CORF.
    Response: We will apply this policy consistently across settings, 
including the CORF reference in Sec.  410.105(c)(ii)(2) and 424.27(b).

Review of Plan

    We proposed that review of the plan as required in Sec.  424.24 
would continue to be required at certification and recertification. 
Since the plan may be established by a nurse practitioner, a clinical 
nurse specialist, or a physician assistant (nonphysician 
practitioners), as well as a physician, we proposed to modify the 
language in Sec.  410.61 to include those professionals among those who 
may review the plan. Since the certification and recertification of the 
plan for Part B services requires a signature, we proposed to remove 
the current redundant requirement at Sec.  410.61(e) to date and sign a 
review at the same time the plan is certified. In addition, we proposed 
to revise Sec.  424.24 to remove reference to a certification 
``statement.''
    Comment: We received one comment supporting the changes to the 
review language and no dissenting comments.
    Response: We are finalizing the proposed changes to the review of 
plan language in this final rule with comment period.
3. Amendment of the Exemption for Computer-Generated Facsimile 
Transmission From the National Council for Prescription Drug Programs 
(NCPDP) SCRIPT Standard for Electronically Transmitting Prescription 
and Certain Prescription-Related Information for Part D Eligible 
Individuals
a. Legislative History
    Section 101 of the MMA amended title XVIII of the Act to establish 
a voluntary prescription drug benefit program. Prescription Drug Plan 
(PDP) sponsors and Medicare Advantage (MA) organizations offering 
Medicare Advantage--Prescription Drug Plans (MA-PD) are required to 
establish electronic prescription drug programs to provide for 
electronic transmittal of certain information to the prescribing 
provider and dispensing pharmacy and pharmacist. This would include 
information about eligibility, benefits (including drugs included in 
the applicable formulary, any tiered formulary structure and any 
requirements for prior authorization), the drug being prescribed or 
dispensed and other drugs listed in the medication history, as well as 
the availability of lower cost, therapeutically appropriate

[[Page 66334]]

alternatives (if any) for the drug prescribed. The MMA directed the 
Secretary to issue uniform standards for the electronic transmission of 
such data.
    There is no requirement that prescribers or dispensers implement e-
prescribing. However, prescribers and dispensers who electronically 
transmit prescription and certain other prescription-related 
information for covered drugs prescribed for Medicare Part D eligible 
beneficiaries, directly or through an intermediary, would be required 
to comply with any applicable final standards that are in effect.
b. Foundation Standards and Exemption for Computer Generated Facsimiles 
(Faxes)
    In the E-Prescribing and the Prescription Drug Program final rule 
(70 FR 67568, November 7, 2005), we adopted the NCPDP SCRIPT standard, 
Implementation Guide, Version 5, Release 0 (Version 5.0), May 12, 2004, 
excluding the Prescription Fill Status Notification Transaction (and 
its three business cases; Prescription Fill Status Notification 
Transaction--Filled, Prescription Fill Status Notification 
Transaction--Not Filled, and Prescription Fill Status Notification 
Transaction--Partial Fill), hereafter referred to as NCPDP SCRIPT 5.0, 
as the standard for communicating prescriptions and prescription-
related information between prescribers and dispensers. Subsequently, 
on June 23, 2006 (71 FR 36020), HHS published an interim final rule 
that maintained NCPDP SCRIPT 5.0 as the adopted standard, but allowed 
for the voluntary use of a subsequent backward compatible version of 
the standard, NCPDP SCRIPT 8.1. As use of either of these two named 
versions of the NCPDP SCRIPT standard is permitted, for ease of 
reference, we will simply refer to ``NCPDP SCRIPT'' in this rule.
    The November 7, 2005 final rule also established an exemption to 
the requirement to utilize NCPDP SCRIPT for entities that transmit 
prescriptions or prescription-related information by means of computer 
generated facsimiles (faxes generated by one computer and 
electronically transmitted to another computer or fax machine which 
prints out or displays a image of the prescription or prescription-
related information). Providers and dispensers who use this technology 
are not compliant with NCPDP SCRIPT. The exemption was intended to 
allow such providers and dispensers time to upgrade to software that 
utilizes the NCPDP SCRIPT standard, rather than forcing them to revert 
to paper prescribing.
c. Elimination of Exemption
    In the CY 2008 PFS proposed rule (72 FR 38194), we proposed to 
revise Sec.  423.160(a)(3)(i) to eliminate the computer generated fax 
exemption to the NCPDP SCRIPT Standard for the communication of 
prescription or certain prescription related information between 
prescribers and dispensers for the transactions listed at Sec.  
423.160(b)(1)(i) through (xii).
    Since computer-generated faxing retains some of the disadvantages 
of paper prescribing (for example, the administrative cost of keying 
the prescription into the pharmacy system and the related potential for 
data entry errors that may impact patient safety), we believed it was 
important to take steps to encourage prescribers and dispensers to move 
toward use of NCPDP SCRIPT.
    In our November 7, 2005 final rule discussion of computer-generated 
faxing, we distinguished between cases where the prescriber's or 
dispenser's software has the ability to generate transactions utilizing 
the NCPDP SCRIPT, but the prescriber has not activated the feature on 
their software, and other cases where software (such as a word 
processing program) is used to create a document that can be sent as a 
fax that results in print out or displays a image of a prescription or 
response at the receiving end, but does not have true e-prescribing 
(electronic data interchange using NCPDP SCRIPT) capabilities.
    We believed the elimination of the computer-generated fax exemption 
would encourage prescribers and dispensers using this computer-
generated fax technology to, where available, utilize true e-
prescribing capabilities.
    It might also encourage those without such capabilities to upgrade 
their current software products, or, where upgrades are not available, 
to switch to new products that would enable true e-prescribing.
    Because the elimination of the computer-generated facsimile 
exception would encourage those prescribers that are already using e-
prescribing software that is capable of true e-prescribing to utilize 
those capabilities, we believed that the elimination of the computer-
generated fax exemption would increase the number of NCPDP SCRIPT 
transactions fairly significantly in a relatively short time period, 
and that this could, in turn, create a ``tipping point'' that could 
create economic incentives for independent pharmacies to adopt NCPDP 
SCRIPT capable software to begin to exchange true e-prescribing 
transactions with their prescriber partners.
    We proposed to eliminate the computer generated fax exemption 
effective 1 year after the effective date of the CY 2008 PFS final 
rule, on January 1, 2009. We believed that this would provide 
sufficient notice to prescribers and dispensers who would need to 
implement or upgrade e-prescribing software to look for products and 
upgrades that are capable of generating and receiving transactions that 
utilize NCPDP SCRIPT. It would also afford current e-prescribers time 
to work with their trading partners to eventually eliminate computer-
to-fax transactions.
    We believed the elimination of the exemption for computer-generated 
faxing would encourage e-prescribers and dispensers to move as quickly 
as possible to use of the NCPDP SCRIPT standard with what we perceived 
to be minimal impact.
    We solicited comments on the impact of the proposed elimination of 
this exemption.
    Comment: Several commenters concurred with our proposal to 
eliminate the exemption for computer-generated faxes. These commenters 
indicated that lifting the exemption for computer generated faxes would 
act as an incentive to move prescribers and dispensers toward true e-
prescribing (electronic data interchange using the NCPDP SCRIPT 
standard) and that once the benefits of true e-prescribing are realized 
by a core group of prescribers and dispensers, word of mouth would help 
foster more extensive adoption.
    Less than half of all commenters disagreed with our proposal to 
eliminate the exemptions for computer-generated faxes, citing concerns 
about increased hardware/software costs, transaction fees, 
certification and other activation costs. Some commenters agreed that 
many prescribers who are already e-prescribing likely already possess 
the ability to generate NCPDP SCRIPT compliant transactions using their 
software or can comply by obtaining a version upgrade under their 
maintenance agreements. Some commenters also questioned whether lifting 
the exemption would move the industry forward toward, or raise barriers 
to, greater use of true e-prescribing. We also received comments from 
some individuals who erroneously thought that we had proposed the 
elimination of all faxes, including paper-to-paper faxes.
    Response: For new e-prescribers, the cost of implementing a product 
that can generate an NCPDP SCRIPT-compliant transaction would not 
differ from a

[[Page 66335]]

product that could not, and we expect that, over time, the market will 
move toward the exclusive use of NCPDP SCRIPT-compliant transactions. 
Moreover, the adoption of the PQRI structural measure discussed section 
II.S.1. of this final rule with comment period will provide an 
incentive to providers to implement e-prescribing. We recognize that 
pharmacies that are not now conducting transactions that utilize NCPDP 
SCRIPT will incur costs to implement this capability, and that 
pharmacies will likely experience an increase in e-prescribing 
transaction volumes and costs. However, those costs would be balanced 
by administrative savings. We refer to the November 7, 2005 final rule 
(70 FR 67568) for a further discussion of potential costs associated 
with e-prescribing.
    As more prescribers and dispensers embrace interoperable health 
information technology in general, and the use of e-prescribing 
standards in particular, they will see real value and realize costs 
savings. Dispenser data entry time and transcription errors due to data 
re-entry or illegible paper prescriptions will be reduced. Prescribers 
and dispensers will spend less time on the phone requesting and 
responding to refill requests. Improved workflow will free up staff 
time for patient counseling and other services. Patient safety will 
improve as providers are linked with medication history, allergy 
information and/or drug contraindications that will result in a 
reduction of adverse drug events.
    Comment: Many commenters agreed that the proposed compliance date 
of January 1, 2009 was a reasonable timeframe for those who needed to 
comply. Others urged us to extend the compliance date to April 1, 2009, 
to coincide with the projected effective date of the next set of e-
prescribing standards, or to January 1, 2010, to give prospective e-
prescribers more time to identify compliant products. Some commenters 
recommended that the requirement to use the adopted e-prescribing 
standards should only apply to those prescribers/dispensers who have 
software or applications that have the ability to generate transactions 
utilizing NCPDP SCRIPT. Others suggested that the use of computer-
generated faxes continue to be permitted for those prescribers and 
dispensers who already have the functionality to engage in transactions 
utilizing NCPDP SCRIPT, and allow those who adopt software that 
generates transactions utilizing NCPDP SCRIPT after the compliance date 
of January 1, 2009, an additional 1 year to comply with the NCPDP 
SCRIPT requirement.
    Response: The 2006 CMS e-prescribing pilot noted that the majority 
of e-prescribing software currently being used by prescribers is 
already able to transmit information using NCPDP SCRIPT. Moreover, 
commenters agreed that most current e-prescribers could become 
compliant by installing an NCPDP SCRIPT-enabled version upgrade. 
Therefore, we believe that the January 1, 2009 compliance date provides 
adequate time for current e-prescribers in the industry to comply with 
the NCPDP SCRIPT e-prescribing standard provisions while encouraging 
other prescribers and dispensers to move closer toward true e-
prescribing. We do not see a purpose in affording new e-prescribers an 
additional year to comply, since it should not take more time to 
implement an NCPDP SCRIPT-compliant product than a noncompliant 
product.
    Comment: Many commenters suggested that we continue to allow for 
the use of computer-generated faxes in the case of transmission failure 
and network outages.
    Response: Computer-generated faxes may be needed for prescriptions 
which fail in electronic data interchange (EDI) transmission. Allowing 
computer-generated faxes as a fall back measure would allow the 
prescription to be expedited to the pharmacy, ensuring timely 
dispensing of the medication, thus enhancing patient safety. We agree 
that there should be a viable contingency plan in the event that an 
EDI-transmitted prescription fails due to network transmission failures 
or similar, temporary communication problems that are episodic and non-
repetitive in nature. We find the use of computer-generated faxes, but 
only in instances of the aforementioned transmission failures or 
similar communication problems of a temporary/transient nature, to be 
an acceptable and viable solution. We do not, however, consider it to 
be a permanent substitute for ongoing EDI transmission problems. As we 
will continue to allow computer-generated faxes as a fallback in cases 
of temporary/transient transmission failures and communications 
problems, we will not totally eliminate but instead amend the exemption 
for computer-generated facsimile transmission from the NCPDP SCRIPT 
Standard to account for this contingency.
    Comment: Approximately one-fourth of commenters from all sectors of 
the health care industry called for the delay of the elimination of the 
exemption for computer-generated faxes until such time as the Drug 
Enforcement Agency (DEA) changes its rules to allow the e-prescribing 
of controlled substances. Commenters believe that the current DEA 
position on disallowing e-prescribing of controlled substances creates 
a barrier to adoption, and the proposed CMS compliance date of January 
2009 will only exacerbate the issue.
    Response: As we have no indication as to when the Drug Enforcement 
Agency will make a determination on the e-prescribing of controlled 
substances, it would be difficult for us to predicate eliminating the 
exemption for computer-generated faxes based upon such an unknown 
timetable. However, we concur with commenters who stated that the 
inability to prescribe these controlled substances electronically 
hampers e-prescribing adoption by providers. We continue to work with 
the DEA to help facilitate a solution that addresses both the 
enforcement requirements of the DEA with respect to prescribing of 
controlled substances, and the needs of the healthcare community for a 
solution that is scalable and commercially viable.
    Comment: One commenter suggested that we exempt controlled 
substances from this requirement.
    Response: The November 7, 2005 E-prescribing final rule (70 FR 
67568) recognizes the DEA's role in the enforcement of the prescribing 
of controlled substances. As controlled substances cannot be legally e-
prescribed, an exemption from the NCPDP SCRIPT standard for the e-
prescribing of controlled substances would have no effect.
    Comment: Some commenters were confused as to whether the computer 
generated fax exemption would affect the exemption in the long term 
care setting, and requested that we clarify that prescribers and 
dispensers in the long term care setting were exempt from the 
requirement to use NCPDP SCRIPT despite the amendment of the exemption 
of the computer generated faxes.
    Response: Our amendment of the exemption for computer generated 
faxes does not apply at this time to the long term care industry as 
defined under Medicare Part D. At the time the CY 2008 PFS proposed 
rule (72 FR 38194) was published in the Federal Register, the long term 
care industry exemption for using adopted standards in e-prescribing 
(as contained in the November 7, 2005 final rule (70 FR 67568)) was, 
and remains, in place. Based on the comments we received, we are 
finalizing an amendment of the exemption for computer-generated faxes.

[[Page 66336]]

S. Division B of the Tax Relief and Health Care Act of 2006--Medicare 
Improvements and Extension Act of 2006 (Pub. L. 109-432) (MIEA-TRHCA)

    In addition to the provisions of the MIEA-TRHCA discussed in 
sections II.B. (GPCIs) and II.F. (CAP), additional provisions of the 
MIEA-TRHCA are discussed in this section of the final rule with comment 
period.
1. Section 101(b)--Physician Quality Reporting Initiative (PQRI)
a. Background
(i) Program Background and Statutory Basis
    Section 101(b) of the MIEA-TRHCA amended section 1848 of the Act by 
adding subsection (k). Section 1848(k)(1) of the Act requires the 
Secretary to implement a system for the reporting by eligible 
professionals of data on quality measures as described in section 
1848(k)(2) of the Act. Section 1848(k)(3)(B) of the Act specifies that 
for the purpose of the quality reporting system, eligible professionals 
include physicians, other practitioners as described in section 
1842(b)(18)(C) of the Act, physical and occupational therapists, and 
qualified speech-language pathologists. Section 101(c) of the MIEA-
TRHCA authorizes ``Transitional Bonus Incentive Payments for Quality 
Reporting'' in 2007, specifically for satisfactory reporting of quality 
data, as defined by section 101(c)(2) of the MIEA-TRHCA. We have named 
this quality reporting system the ``Physician Quality Reporting 
Initiative (PQRI)'' for ease of reference.
    For 2007, section 1848(k)(2)(A)(i) of the Act, as added by the 
MIEA-TRHCA, provides that the quality measures for the PQRI shall be 
the 66 physician quality measures published as 2007 Physician Voluntary 
Reporting Program (PVRP) quality measures on the CMS web site as of the 
date of enactment of this subsection, except for any changes based on 
the results of a consensus-based process in January 2007. Based on 
actions approved at the AQA Alliance (formerly the Ambulatory Care 
Quality Alliance) meeting on January 22, 2007, 8 measures were added to 
the 66 measures from the PVRP. Thus, the final ``2007 PQRI Quality 
Measures'' comprise 74 measures, which are applicable to specific 
combinations of patient conditions and Medicare Physician Fee Schedule 
(PFS) covered professional services. The measure titles, descriptions, 
and specifications are available for download from the PQRI Measures/
Codes page of the PQRI section of the CMS Web site at http://www.cms.hhs.gov/PQRI.
    Section 1848(k)(2)(A)(ii) of the Act does not allow for any further 
additions to or deletions from the 2007 PQRI Quality Measures after 
January 2007, and does not allow modifications or refinements (such as 
code additions, corrections, or revisions) to the detailed 
specifications for the 2007 PQRI quality measures after the July 1, 
2007, beginning date of the reporting period. The final 2007 
specifications for the 2007 PQRI quality measures are available as a 
download from the Measures/Codes page of the PQRI section of the CMS 
Web site at http://www.cms.hhs.gov/pqri. Additional information on the 
2007 PQRI is also available from this section of the CMS Web site, 
including, but not limited to:
    <bullet> Tools to help professionals select measures;
    <bullet> Tools to help professionals capture data on 2007 PQRI 
quality measures;
    <bullet> Explanations of the calculation of eligibility for and 
amount of bonus payment for satisfactory reporting; and
    <bullet> A description of the methodology that we will use to 
validate whether professionals have satisfactorily reported the MIEA-
TRHCA required minimum number of applicable measures.
    Section 1848(k)(2)(B) of the Act further requires that the 
Secretary publish in the Federal Register not later than August 15, 
2007, proposed quality measures that would be appropriate for eligible 
professionals to use to submit data to the Secretary in 2008. The final 
2008 PQRI quality measures must be determined and published by November 
15, 2007, as specified in section 1848(k)(2)(B) of the Act as amended 
by the MIEA-TRHCA.
(ii) Overview of the PQRI Section in the Final Rule With Comment Period
    In the CY 2008 PFS proposed rule (72 FR 38196 through 38199), we 
provided a slightly longer summary of the MIEA-TRHCA requirements and 
the PQRI program than is provided immediately above in this section, 
and explained our interpretation of applicable statutory and 
government-wide policies relevant to defining a consensus organization 
and consensus-based measure development process, and our policy for 
determining which measures meet requirements for inclusion in PQRI. In 
satisfaction of the MIEA-TRHCA requirement to publish proposed 2008 
PQRI measures by August 15th, we published 148 proposed 2008 PQRI 
quality measures in the CY 2008 PFS proposed rule (72 FR 38199 through 
38202). We invited comments on the implications of including or not 
including any specific measure(s), and on our plans to explore 
mechanisms for submission of electronic clinical performance 
measurement information and/or summary measure results information 
extracted from electronic health records (EHRs) and/or clinical data 
registries.
    In this PQRI section of the final rule with comment period, we 
first address the general or overview public comments.
(iii) General/Program Comments and Responses
    Comment: We received a number of comments commending CMS and the 
PQRI program for being responsive to stakeholder concerns, focusing on 
health care quality and performance improvement, and consistently using 
accurate and inclusive terminology (for example, where appropriate, 
``eligible professionals'' rather than ``physicians'') while 
implementing on an aggressive timeline a functional program with an 
extensive and well-received education and outreach component. A number 
of commenters also expressed a desire to continue to work with us in a 
spirit of partnership to advance and improve the program and its 
utility to beneficiaries, professionals, and the industry at large.
    Response: We appreciate the constructive input of the wide variety 
of stakeholders who have provided insights, information, and partnered 
with us to disseminate informational materials about PQRI to the 
eligible professionals in the health care community. We plan to 
continue dialogue with stakeholder organizations and will consider 
their and PQRI participants' input (including questions and comments 
submitted via informal, as well as formal, channels of inquiry) as we 
continue working to provide 2007 PQRI participants with reporting rate 
and clinical performance results feedback reports and (for those 
participants achieving satisfactory reporting per MIEA-TRHCA 
requirements) PQRI incentive payments in mid-2008, and as we develop 
and implement strategies for individual-clinician-level and related 
quality reporting and improvement initiatives for 2008 and beyond.
    Comment: We received numerous comments identifying specific ways in 
which commenters recommended we enhance the PQRI in the future. One 
theme was that, although defined per MIEA-TRHCA as professionals 
eligible to participate in PQRI, some clinicians may be unable to 
participate due to lack of PQRI measures applicable to their practices. 
A closely related concern was that some clinicians with otherwise 
applicable PQRI measures may be

[[Page 66337]]

unable to participate due to data submission relying on the Part B PFS 
Fee-For-Service claims mechanism. These limitations include that some 
PQRI-eligible professionals (such as physical and occupational 
therapists) who cannot currently participate in PQRI because 
reimbursement for the MPFS covered professional services they furnish 
is claimed in a format (X12 837-I electronic transaction or the UB04 
form) that does not allow for attribution of each service to the 
individual professional who furnished it.
    Several commenters suggested that submission of electronic clinical 
information (ECI) from registries and/or electronic health records 
(EHRs) may potentially address the limitations of claims-based quality 
measures data submission. Other commenters simply urged us to find a 
mechanism, potentially a claims-based mechanism, to afford all eligible 
professionals the opportunity to participate prior to proceeding with 
PQRI subsequent to 2007.
    Response: We agree with the goal of offering the opportunity to 
participate in PQRI to as many eligible professionals as feasible and 
practical, consistent with the MIEA-TRHCA statutory requirements. In 
support of this goal, especially where there are gaps in available 
consensus measures for specific practitioners, we have worked to 
encourage and contract for the development of quality measures and to 
fund consensus projects. For 2008, we have supported via contract with 
Quality Insights of Pennsylvania (QIP) the development of structural 
measures and measures applicable to a broad cross-section of PQRI 
eligible professionals, including some nonphysician practitioners 
(NPPs) who had few or no measures available in 2007. We prioritized 
development of these measures based on the existing gaps in measures 
available or otherwise in development and on a need to address as broad 
a cross section of eligible professions or specialties as possible 
within the limited volume of measures for which we could support 
development in time for inclusion in the 2008 PQRI.
    We plan to continue working to fill gaps in available consensus-
endorsed or -adopted measures consistent with available time and 
resources. However, we largely depend on and encourage the development 
of measures by professional organizations and other measure developers. 
We note that MIEA-TRHCA includes a provision that requires the 
Secretary to include measures developed by specialty societies. 
Ideally, in the future CMS would not need to be closely involved in the 
development of clinician-level quality measures, but would select from 
measures that meet the MIEA-TRHCA requirements.
    In regard to the potential use of nonclaims mechanisms for 
submission of electronic clinical information, we agree with this goal; 
however it is not feasible to implement for 2008. In regard to claims-
based alternatives to enable participation by professionals for whose 
covered professional services payment is made under or based on the 
MPFS but claimed via institutional formats (X12 837-I electronic 
transaction or UB04 form), we have analyzed the possibilities and 
determined that the MIEA-TRHCA requirement that satisfactory reporting 
and amount of any incentive payment be determined at the individual-
professional level cannot be satisfied without extensive modifications 
to the claims processing systems of CMS and providers, which would 
represent a material administrative burden to us and providers, and/or 
modifications to the industry standard claims formats, which would 
require substantial time to effect via established processes and 
structures that we do not maintain or control.
    Comment: Although most commenters acknowledged that we proposed and 
will finalize 2008 measures in response to MIEA-TRHCA statutory 
mandate, numerous commenters expressed concerns that we are proceeding 
with design and implementation of PQRI 2008 before we have been able to 
evaluate the 2007 PQRI. One such commenter specifically declined to 
comment on the 2007 PQRI in advance of public availability of 2007 PQRI 
evaluation information and requested that we solicit comments on the 
2007 PQRI, and the 2007 PQRI evaluation information, in the CY 2009 PFS 
proposed rule. Specific examples of evaluation information that 
commenters requested CMS consider and publish include:
    <bullet> Rates of participation by eligible professionals;
    <bullet> Cost or administrative burden of the PQRI from the 
perspective of participating professionals and the Medicare program;
    <bullet> The apparent impact of PQRI on professionals' clinical 
performance; and
    <bullet> The impact on beneficiaries.
    Some of these commenters, and several other commenters who did not 
specifically raise concerns about program-level evaluation, requested 
that we consider delaying the start of the 2008 reporting period until 
mid-2008 to give 2007 participants a chance to assess their 2008 
results to identify process changes to improve their 2008 reporting 
rate and clinical performance results.
    Response: We are in the process of operationalizing, in a phased 
manner appropriate to data availability and analytic infrastructure 
implementation, a comprehensive ongoing program monitoring strategy 
that will provide interim indications, at the program level, of some of 
the same aspects of the program we will ultimately examine in our 
evaluation(s) of the impact of the 2007 program after the conclusion of 
the 2007 reporting period. To the extent feasible within the limits of 
available resources including, but not limited to, funding and 
sufficiently complete data, we anticipate conducting an evaluation of 
the 2007 PQRI. The aspects of PQRI impact we would expect to assess 
include participation rates by specialty/profession, associated trends 
in clinical performance and beneficiary outcomes, and other observable 
impacts on participants, the Medicare program, and beneficiaries. 
Although we have not yet finalized the operational details of our 
evaluation strategy, we do anticipate making the results of the 
evaluation, at the national level, available to the public. We may also 
make publicly available the results of such analyses aggregated at 
other meaningful levels (for example, State, specialty, or profession). 
We do not at this time plan to make results publicly available in a 
format or with content that would enable identification of individual 
professionals or specific practices' specific reporting or performance 
results. We have not made a determination as to the most appropriate 
venue(s) for making PQRI evaluation information available to the 
public.
    This section of the final rule with comment period is specific to 
the establishment of measures appropriate for use by professionals to 
submit quality-of-care data in 2008, as we are directed to do by 
section 101(b) of the MIEA-TRHCA. The incentive bonus requirements and 
reporting period for PQRI in 2008 are addressed in section 101(d) of 
the MIEA-TRHCA, Physician Assistance and Quality Improvement (PAQI), 
section (II.S.5.) of this final rule with comment period. Such details 
of the 2008 bonus-incentive program are beyond the scope of this MIEA-
TRHCA Section 101(b), PQRI section of this final rule with comment 
period.
    Comment: A number of comments requested or recommended that we make 
readily available on an ongoing basis more detailed information on the 
measure development process and measures in development. Numerous 
commenters also requested final

[[Page 66338]]

measure specifications be published as far in advance of the beginning 
of the reporting period as possible, and that more detailed information 
about measures proposed or finalized for use in PQRI be published in, 
at the same time as, or in advance of future rulemaking.
    Response: We agree that it could be useful to our stakeholder 
partners in health care quality measurement and improvement, including 
but not limited to potential measure developers, to make available in a 
prominent place (such as the CMS PQRI Web site) additional information 
on measure development in context of PQRI, potentially including 
guidance to other publicly available sources of general information on 
health care quality measurement and development of specific metrics. We 
will consider our options to accomplish this in a practical and 
sustainable way and use various appropriate communications channels to 
notify stakeholder organizations and the community at large of our 
strategy once we have developed it.
    We agree with the commenters that it is desirable to provide final 
measure specifications sufficiently in advance of the reporting period 
to allow reasonable time for professionals to analyze new or revised 
measures and implement any needed changes in their office workflows to 
accurately capture and successfully submit data on a selection of 
measures applicable to their practice on which they can act to improve 
the quality of the services they furnish. We are aware that such ``lead 
time'' should also help the eligible professionals' specialty or 
professional societies be better prepared to support the professionals' 
selection of relevant, actionable measures. Having detailed information 
on measures available in advance of the reporting period also enhances 
the ability of vendors (such as practice-management software, billing 
services, and electronic health records vendors) to support 
professionals' successful implementation of revised data-capture 
processes for the measures.
    The MIEA-TRHCA requires that we publish the final list of 2008 PQRI 
measures no later than November 15, 2007. We would expect to publish 
detailed specifications shortly after that date. Detailed measure 
specifications for measures new or revised for 2008 PQRI will be 
published on the Measures/Codes page of the CMS PQRI Web site at http:/
/www.cms.hhs.gov/pqri. These detailed specifications will include 
instructions for reporting and identify the circumstances in which each 
measure is applicable. The detailed technical specifications for 
measures in the final listing for the 2008 PQRI remain potentially 
subject to corrections until the start of the 2008 reporting period, as 
we stated in the proposed rule.
    Comment: Many commenters expressed concerns that recent legal 
rulings raise concerns about whether the individual participating 
professionals' reporting and clinical performance results may 
constitute administrative data potentially subject to disclosure 
requirements of the Freedom of Information Act (FOIA). Commenters urged 
that any clinician performance program or system should remain 
voluntary and its results confidential.
    Response: Commenting on or otherwise addressing the legal standing 
of PQRI participants' reporting and performance results in context of 
FOIA, other applicable statutes, or case law is outside the scope of 
this rule. At this time, we have no plans to publish without 
participants' voluntary consent either 2007 or 2008 PQRI participants' 
reporting or performance results in a way that would be specifically 
identified or readily identifiable at the individual-professional, 
group practice-site, or billing unit (Taxpayer Identification Number) 
levels. As mentioned in response to comments urging us to share 
information resulting from its 2007 PQRI program-evaluation analyses, 
we do plan to make available information at various meaningful levels 
of aggregation other than the individual professional, practice, or 
billing unit.
    Comment: Several commenters recommended specific enhancements to 
PQRI participant feedback reporting including displays of additional 
analyses (beyond the measure calculation as specified) for specific 
measure(s) and/or provision of interim reporting and performance 
results during the 2008 reporting period. Some commenters recommended 
we conduct additional analyses of measure data but did not specifically 
tie that recommendation to the participant feedback report content.
    Response: Detailed design of the participant feedback reports and 
specific analyses of PQRI data for purposes other than calculating 
bonus payment eligibility or amount (for example, for future measure 
development or refinement) are outside the scope of this section of 
this final rule with comment period. However, we will consider these 
recommendations as part of the ongoing dialogue with the stakeholder 
and participant community in order to collaboratively identify ways to 
enhance the measures' and/or program's value to its participants and 
the Medicare program. We are currently assessing the feasible options 
and timeframe within which we may be able to provide meaningful interim 
feedback reports to 2008 PQRI participants. As a matter of practical, 
operational reality, it is highly probable that we will not be able to 
make any 2008 interim feedback reports available until after we make 
available the 2007 final feedback reports. The 2007 PQRI was unable to 
offer during the reporting period any interim feedback reports of 
participants' reporting and performance rates to date because the 
aggressive statutory timeframe for implementing the program did not 
allow for the necessary data infrastructure (including analytic 
programming and report access mechanisms) to be implemented in time to 
provide accurate, meaningful results feedback for 2007 in an 
appropriately secure/confidential report access environment prior to 
mid 2008.
    Comment: Some commenters requested specific or general 
clarifications or additional guidance on the PQRI program, and how to 
code its measures, in the implementation support tools (for example, a 
handbook, or worksheets) provided on the CMS PQRI Web site.
    Response: Although not directly applicable to the proposed rule 
content on which we sought comment, these comments are appreciated and 
will be taken into consideration along with other input that these 
materials' users have provided via less formal avenues of 
communication.
    Comment: Many commenters expressed concern that the burden of data 
collection and submission may be an obstacle to program participation 
for some practices. Some commenters further noted that the claims-based 
submission process may be particularly burdensome for those practices 
that are simultaneously implementing electronic health records or whose 
PQRI-eligible members already participate in a medical data registry.
    Response: To implement a data submission mechanism that was 
technically feasible for CMS and providers, and that is broadly 
available to and already used by the vast majority of PQRI-eligible 
professionals, we determined that claims-based data submission is the 
only possible mechanism for 2007 and the only viable mechanism for full 
operationalization in 2008. Thus, measures appropriate for use by 
professionals to submit quality-of-care data to CMS in 2008 must be 
specified for claims-based submission and analysis. We are, however, 
committed to exploring and supporting practical, effective mechanisms 
for quality-of-care data submission that

[[Page 66339]]

promote efficiency by streamlining participants' and our data 
collection and handling. As discussed below in this section, in the 
registry- and EHR-based submission topics of this section of this final 
rule with comment period, we plan to test in 2008 registry- and EHR-
based mechanisms for data submission, in order to develop the potential 
ability to fully implement such mechanisms in the future. Those 
professionals whose practices that have implemented the referenced HIT 
will have available EHR and e-prescribing structural measures for 
reporting in 2008, which would, if reported, count toward 
professionals' eligibility for the incentive payment discussed below in 
section II.S.5. of this final rule with comment period.
    Comment: Several comments recommended or urged us to consider using 
the group practice as the unit of analysis, and to consider developing 
and implementing sampling methodologies at the group level as a means 
of reducing reporting burden in the future.
    Response: The 2007 unit of analysis is established at the 
individual-professional level by MIEA-TRHCA, and we have not proposed 
to change that for 2008. As the 2007 PQRI evaluation results become 
available and further legislative action provides additional guidance, 
such alternatives may indeed prove important to explore or develop.
b. MIEA-TRHCA Requirements for Measures Included in the 2008 PQRI
(i) MIEA-TRHCA Requirements for 2008 Quality Measures
(A) Overview and Summary
    As noted in the CY 2008 PFS proposed rule (72 FR 38196 through 
38197), section 1848(k)(2)(B)(i) of the Act requires, ``for purposes of 
reporting data on quality measures for covered professional services 
furnished during 2008, the quality measures specified under this 
paragraph for covered professional services shall be measures that have 
been adopted or endorsed by a consensus organization (such as the 
National Quality Forum or AQA), that include measures that have been 
submitted by a physician specialty, and that the Secretary identifies 
as having used a consensus-based process for developing such measures. 
Such measures shall include structural measures, such as the use of 
electronic health records and electronic prescribing technology.''
    Section 1848(k)(2)(B)(ii) of the Act requires that ``[n]ot later 
than August 15, 2007, the Secretary shall publish in the Federal 
Register a proposed set of quality measures that the Secretary 
determines are described in clause (i) and would be appropriate for 
eligible professionals to use to submit data to the Secretary in 2008. 
The Secretary shall provide for a period of public comment on such set 
of measures.''
    In the CY 2008 PFS proposed rule (72 FR 38197), we explained our 
interpretation of these statutory requirements and the policies used in 
selecting measures to propose as appropriate for professionals to use 
to submit data on the quality of covered professional services 
furnished to Medicare beneficiaries in 2008.
    In examining the statutory requirements of section 1848(k)(2)(B)(i) 
of the Act, we believe that the requirement that measures be endorsed 
or adopted by a consensus organization applies to each measure that 
would be included in the measures set for submitting quality data on 
covered professional services furnished during 2008. Likewise, the 
requirement for measures to have been developed using a consensus based 
process applies to each measure. By contrast, we do not interpret the 
provision requiring inclusion of measures submitted by a specialty to 
apply to each measure. Rather, we believe this requirement means that 
in endorsing or adopting measures, a consensus organization must 
include in its consideration process at least some measures submitted 
by a physician or an organization representing a particular specialty. 
Similarly, we interpret the requirement that 2008 measures include 
structural measures, such as the use of EHRs and electronic prescribing 
technology, to mean that the 2008 measure set must include at least 2 
structural measures.
    In examining sections 1848(k)(2)(B) of the Act, we believe that the 
Secretary is given broad discretion to determine which quality measures 
meet the statutory requirements and are appropriate for inclusion in 
the final set of measures for 2008. We do not interpret the Act to 
require that all measures that meet the basic requirements of section 
1848(k)(2)(B)(i) of the Act must be included in the 2008 set of quality 
measures. We next discuss the statutory requirements for consensus 
organizations and the use of a consensus-based process for developing 
quality measures as they relate to the requirements for the set of 
measures for 2008 in the context of other applicable Federal law and 
policy.
    The MIEA-TRHCA requires that measures used for 2008 be identified 
by the Secretary as having been endorsed or adopted by a consensus 
organization and have been developed through the use of a consensus-
based process. As stated in the proposed rule (72 FR 38197 through 
38199), we believe that these requirements should be interpreted in the 
context of the National Institute of Standards and Technology Act 
(NISTA) (15 U.S.C. 271 et seq.) as amended by the National Technology 
Transfer and Advancement Act of 1995 (Pub. L. 104-113) (NTTAA) and 
implemented by Revised OMB Circular No. A-119 (OMB A-119) dated 
February 10, 1998.
    Per the NTTAA, except when it is inconsistent with applicable law 
or otherwise impractical, all Federal agencies and departments shall 
use standards that are developed or approved by voluntary consensus 
standards bodies. OMB A-119 provides specific policy guidance to 
agencies on the appropriate interpretation of agency responsibilities 
under the NTTAA. As we discussed in the proposed rule (72 FR 38197 
through 38199), OMB A-119 establishes as government-wide policy that 
agencies ``must use voluntary consensus standards, both domestic and 
international, in its regulatory and procurement activities in lieu of 
government unique standards, unless use of such standards would be 
inconsistent with applicable law or otherwise impractical.'' OMB A-119 
further explains that in determining whether use of existing voluntary 
consensus standards in its regulatory and procurement activities is 
otherwise impractical, `` `Impractical' includes circumstances in which 
such use would fail to serve the agency's program needs; would be 
infeasible; would be inadequate, ineffectual, inefficient, or 
inconsistent with agency mission; or would impose more burdens, or be 
less useful, than the use of another standard.'' OMB A-119 also 
provides that ``voluntary consensus standards'' are standards developed 
or adopted by voluntary consensus standards bodies, and defines 
``voluntary consensus standards body'' as an organization maintaining 
the following attributes: (1) Openness; (2) Balance of interest; (3) 
Due process; (4) An appeals process; (5) Consensus; which is defined as 
general agreement, but not necessarily unanimity, and also includes a 
process for attempting to resolve objections by interested parties. The 
process requires that, as long as all comments have been fairly 
considered, each objector is advised of the disposition of his or her 
objection(s) and the reasons for the disposition, and the consensus 
body members are given an opportunity to change their votes after 
reviewing the comments. Voluntary consensus

[[Page 66340]]

standards must include provisions requiring that owners of relevant 
intellectual property have agreed to make that intellectual property 
available to all interested parties on a nondiscriminatory, royalty-
free, or reasonable royalty basis.
    Other types of standards that are distinct from voluntary consensus 
standards but that may be used by federal agencies when voluntary 
consensus standards are not available and practical to address the 
government's programmatic needs, include government-unique standards, 
industry standards, company standards, nonconsensus standards, or de 
facto standards which are developed in the private sector but not in 
the full consensus process of a voluntary consensus standards body. For 
further discussion of the NTTAA, OMB A-119, and their relevance to 
quality measures for use of professionals to submit quality-of-care 
data to the Secretary, please review the 2008 MPFS Proposed Rule PQRI 
section at 72 FR 38197-38199.
    Two consensus organizations are referenced in section 
1848(k)(2)(B): the National Quality Forum (NQF) and the AQA Alliance. 
The NQF has a formal organizational structure and established processes 
that are intentionally designed to comply with the NTTAA and OMB A-119. 
Membership is open and includes a broad cross-section of stakeholder 
perspectives. In determining whether or not to endorse a standard, the 
NQF uses a formal process that consists of five principal steps that 
follow a project's conceptualization, prioritization, and planning. The 
steps are: (1) Consensus Standard Development; (2) Widespread Review; 
(3) Member Voting and Member Council Approval; (4) Board of Directors 
Action; and (5) Evaluation that includes an appeals process. The NQF 
meets the NTTAA requirements for a voluntary consensus standards body 
within the meaning of the NTTAA and its endorsed healthcare quality 
measures constitute voluntary consensus standards within the meaning of 
NTTAA.
    The AQA is also referenced in section 1848(k)(2)(B) of the Act as a 
consensus organization for the purpose of identifying measures that 
have successfully completed review by a consensus organization, though 
it does not feature all of the structural characteristics or processes 
of a voluntary consensus standards body per NTTAA and the OMB A-119. By 
citing AQA as an example of an acceptable consensus organization, 
section 1848(k)(2)(B) of the Act establishes that AQA adoption 
satisfies the requirement of section 1848(k)(2)(B) of the Act that PQRI 
quality measures be adopted or endorsed by a consensus organization. We 
believe it follows that the Congress did not intend to require all 2008 
quality measures under section 1848(k)(2)(B) of the Act to meet the 
requirements to be considered voluntary consensus standards under the 
NTTAA. However, by giving NQF and AQA as examples of consensus 
organizations, we believe the Congress intended that consensus 
organizations should, in the context of section 1848(k)(2)(B) of the 
Act, have a breadth of stakeholder involvement and voting participation 
substantially comparable to that of the NQF or AQA.
    Given the potential for apparent overlap of NQF and AQA as 
consensus organizations under the MIEA-TRHCA, it is important to 
distinguish their roles. As currently established, the principal 
purpose of AQA for physician quality measures is to select among NQF 
endorsed measures for coordinated implementation. However, during a 
time of rapid physician quality measures development and 
implementation, it is impractical to delay implementation of physician 
quality measures until the formal processes of NQF are completed. 
Therefore, AQA has been able to enable CMS to incorporate new measures 
into the quality reporting system by providing consensus review 
acceptable under MIEA-TRHCA for implementation of a measure prior to 
actual NQF endorsement. In the event of a determination by NQF to 
decline endorsement of a particular measure after it had been adopted 
by AQA, we anticipate that AQA would withdraw its adoption of such a 
measure.
    Turning to the requirement of a consensus-based process for 
developing quality measures, we interpret this requirement in light of 
the NTTAA and the importance of broad consensus for health care quality 
measures used for regulatory purposes. In this context we have outlined 
in the proposed rule, and rather than cite the proposed rule, we will 
for readers' convenience reiterate below the process of health care 
quality measurement development and distinguish basic development steps 
from the completion of a consensus-based development process as 
required under MIEA-TRHCA.
    Many organizations are involved in the development of health care 
quality measures. These organizations include physician organizations, 
health care providers, Federal agencies, accreditation organizations, 
disease-focused not-for-profit organizations, research organizations, 
and health plans. The basic development processes of leading health 
care quality measure developers generally use standardized methods that 
include identification of a quality goal or gap, literature and 
evidence review, expert and technical evaluation, specification 
development, testing, organizational review, and that may include 
public comment.
    In the framework of the NTTAA, upon completion of the basic 
development work, healthcare quality measures do not constitute 
voluntary consensus standards, even though they may have utilized 
consensus as a mechanism of achieving agreement among the developer's 
participants or within the developer's organizational structure. 
Rather, to achieve the status as a voluntary consensus standard under 
NTTAA, the measure must go through the additional development that 
occurs through the broader consensus process of consensus endorsement. 
During this process, based on the need to achieve agreement, quality 
measures are often modified in order to achieve the necessary broad 
consensus.
    Consistent with this concept, we interpret ``consensus-based 
process for developing measures'' as used in MIEA-TRHCA to encompass 
not only the basic development work of the formal measure developer, 
but also to include the achievement of consensus among stakeholders in 
the health care system based on at least a level of openness, balance 
of interest, and consensus reflected in the structures and processes of 
the NQF or the AQA as of the date of enactment of MIEA-TRHCA.
    Based on the considerations previously discussed, we apply the 
following policies in identifying measures that meet the MIEA-TRHCA 
requirements for having used a consensus-based process for development 
and the requirement for having been endorsed or adopted by a consensus 
organization such as the NQF or AQA, and that are appropriate for 
inclusion as 2008 measures:
    (1) We interpret ``a consensus-based development process'' as 
meaning that in addition to the measure development, the measure has 
achieved adoption or endorsement by a consensus organization having at 
least the basic characteristics of the AQA as a consensus organization 
as of December 2006, when the MIEA-TRHCA incorporating reference to AQA 
was passed and signed into law. Those basic characteristics include a 
comparable level of openness, balance of interest, and consensus-based 
on voting participation. As discussed above in this section and further 
clarified in points (3) and (5) of this section, we do not

[[Page 66341]]

interpret ``consensus-based development process'' per section 
1848(k)(2)(B) of the Act to require that the consensus organization or 
process meet all of the criteria of the NTTAA and OMB A-119 definition 
of a voluntary consensus standards body.
    (2) ``Voluntary consensus standard'' is interpreted to mean a 
voluntary consensus standard that has been endorsed as such by a 
consensus organization that meets the requirements of the NTTAA, and 
the provisions of OMB A-119, for a voluntary consensus standards body.
    (3) Where there are available quality measures, and some of these 
measures meet the definition of ``voluntary consensus standards'' while 
others do not, those measures that meet the definition of ``voluntary 
consensus standards'' are preferred to other measures not meeting the 
requirements of the NTTAA.
    (4) In view of the preference for voluntary consensus standards, 
if, as of the earlier of November 15, 2007, or the date of publication 
of this final rule, a measure has been specifically considered by NQF 
for possible endorsement but NQF has declined to endorse it, we 
proposed not to include it in the final set of 2008 PQRI Quality 
Measures, even if previously adopted by AQA.
    (5) Although the AQA does not meet the requirements of the NTTAA 
for a voluntary consensus standards body, it is a consensus 
organization per section 1848(k)(2)(B) of the Act. In circumstances 
where no voluntary consensus standard (NQF-endorsed) measure is 
available, and the measure has not been specifically declined for 
endorsement by NQF, a quality measure that has been adopted by the AQA 
(or another consensus organization with comparable consensus-
organization characteristics), will meet the requirements of MIEA-TRHCA 
if we determine that it is appropriate for eligible professionals to 
use to submit data.
    (6) We are unaware of other consensus organizations that are 
comparable to the NQF in terms of meeting the formal requirements of 
the NTTAA, or of organizations other than AQA that do not strictly meet 
the requirements of the NISTA, as amended by the NTTAA, but that 
feature the breadth of stakeholder involvement in the consensus process 
necessary to meet the intent of the MIEA-TRHCA. However, the MIEA-TRHCA 
does not limit consensus organizations to the NQF or the AQA, nor 
restrict the field of potential consensus organizations. The MIEA-
TRHCA, thereby, maintains flexibility in potential sources of measure 
consensus review, which is, like having multiple sources of measure 
development, key to maintaining a robust marketplace for development 
and review of quality measures.
    (7) The basic steps for developing the physician level measures may 
be carried out by a variety of different organizations. We do not 
interpret the MIEA-TRHCA to place special restrictions on the type or 
make up of the organizations carrying out this basic development of 
physician measures, such as restricting the initial development to 
physician-controlled organizations. Any such restriction would unduly 
limit the basic development of physician quality measures and the scope 
and utility of measures that may be considered for endorsement as 
voluntary consensus standards.
    (8) The policies we proposed were based on the preference as 
articulated in NTTAA and OMB A-119 for ``voluntary consensus 
standards'' to government-unique standards. However, the MIEA-TRHCA 
does not require that quality measures meet the NTTAA or OMB A-119 
definition of ``voluntary consensus standards'' in order to be used for 
PQRI. Thus, though we prefer to use quality measures meeting the NTTAA 
and OMB A-119 criteria for voluntary consensus standards, neither this 
CMS preference nor the NTTA or OMB A-119 preclude CMS from exercising 
our discretion under the MIEA-TRHCA to select measures for PQRI meeting 
the less stringent consensus requirements of the MIEA-TRHCA, when 
necessary to meet our program needs as determined by the Secretary.
(B) Summary of Comments and CMS's Responses
    Comment: Many commenters thanked us for clarifying the requirements 
for consensus-based development, consensus endorsement or adoption, and 
the basic, high level structure of the measure-development process. As 
discussed above in context of the PQRI program/overview content and 
comments topic, multiple commenters requested additional and more 
detailed information about measure development and related processes 
and organizations. In context of the consensus requirements, several 
commenters requested further explanation of the detailed definition or 
distinction between the stages of measure development.
    Response: We are pleased that many commenters that found our 
description of the measurement development processes useful and were 
supportive of our interpretation of the statutory requirements for 
consensus endorsement and adoption and consensus-based development 
process. In terms of providing additional clarification, the status for 
PQRI implementation of measures that have been approved by AQA but 
declined for endorsement by NQF is clarified in the final language. 
Measures approved by AQA are sufficient for inclusion in 2008 PQRI in 
terms of the statutory requirements for consensus-organization adoption 
or endorsement and consensus-based development requirements of MIEA-
TRHCA. Measures, however, that have been specifically declined for 
endorsement by NQF, are not selected for use in 2008 PQRI, based on our 
preference for Voluntary Consensus Standards (72 FR 38198).
    Comment: Many commenters requested or recommended that measure 
development processes employ robust mechanisms for incorporation of 
broadly inclusive consensus and/or public comment during the initial, 
as well as final phase of development. However, some commenters 
expressed the counterbalancing concern that we should more specifically 
clarify that appropriate quality measures for PQRI should in fact be 
based on evidence interpreted in processes which include consensus 
methods and organizations, as opposed to measures that are based 
primarily on stakeholder consensus about measure need and design 
without a firm foundation in scientifically sound clinical evidence.
    Response: As described in the proposed rule (72 FR 38197 through 
38198) the basic (initial) development processes of measure developers 
typically include various standardized processes that include both an 
evaluation of the evidence base for a measure and a public comment 
opportunity. We do not believe that we should delineate these processes 
via rulemaking, nor require a particular evidence base for a measure. 
Rather, the adequacy of measures from these and many other standpoints 
is subject to evaluation during the consensus process.
    Comment: Several commenters suggested we consider establishing as 
policy that quality measures to be used by, and analyzed at the level 
of, individual PQRI-eligible professionals, must be developed by 
clinician-controlled organizations to assure relevance and promote 
uptake by the eligible professional community. Multiple commenters 
suggested explicit preference be given for measures developed or 
endorsed by physician

[[Page 66342]]

specialty societies, in context of consensus-organization review and 
CMS measure selection processes. Some commenters stated that the AMA-
PCPI should be the sole source for physician-level measures. One 
commenter specifically presented an interpretation of the MIEA-TRHCA 
requirement for the 2008 PQRI measures to include measures submitted by 
a physician specialty as meaning that the 2008 PQRI should include only 
measures developed by physician organizations, to assure physician 
control of available measures applicable to assessing the clinical 
performance of individual physicians. Other commenters expressed 
differing viewpoints, commenting on the importance of an open process 
for initial measure development, and noting that no single organization 
stands ready to lead in the quality arena. Multiple commenters pointed 
to concerns about existing measure development and consensus 
organizations particularly in terms of structure and transparency, 
opposing any single organization controlling measurement development, 
opposing requiring PQRI measurement development to come solely from 
physician controlled organizations, and supporting alternatives to 
existing organizations.
    Response: Physician involvement and leadership is standard in the 
work of both measure developers and consensus organizations. As a 
result, physicians are actively involved at all levels of measurement 
development and consensus adoption and endorsement. We are in agreement 
that physician expertise is an important ingredient in measurement 
development and in the consensus process. We further recognize the 
leadership of physician organizations, as is reflected in the large 
number of physician quality measures included in PQRI which were 
developed by the AMA-PCPI and its participating specialty societies.
    However, we do not agree that physicians should be in complete 
control of the process of measure development, as would be the case if 
measures were required to be developed solely by physician-controlled 
organizations. Any such restriction would unduly limit the basic 
development of physician quality measures and the scope and utility of 
measures that may be considered for endorsement as voluntary consensus 
standards. Rather, as we described in the proposed rule, the basic 
steps for developing the physician level measures are appropriately 
carried out by a variety of different organizations. We do not 
interpret the MIEA-TRHCA to place special restrictions on the type or 
make up of the organizations carrying out this basic development of 
physician measures, such as restricting the initial development to 
physician-controlled organizations. Similarly, we do not interpret 
MIEA-TRHCA to require that each measure included in the 2008 PQRI have 
been developed by a physician specialty.
    Finally, we do not interpret MIEA-TRHCA to limit the field of 
potential consensus organizations to those it named as examples of 
acceptable organizations, so long as the requirements for broad 
consensus we articulated as required under MIEA-TRHCA is achieved. The 
MIEA-TRHCA, thereby, maintains flexibility in potential sources of 
measure consensus review, which is, like having multiple sources of 
measure development, key to maintaining a robust marketplace for 
development and review of quality measures.
    Comment: Many commenters suggested we establish a centralized 
process or structure to prioritize measure development in specific 
ways. Some commenters recommended priority be given to meaningful, 
actionable gaps in care or specific high-impact disease conditions. 
Others recommended that the first priority be assuring measure 
availability for all PQRI-eligible professions and specialties. 
Commenters recommended a centralized establishment of national 
priorities for measure development and suggested that such 
prioritization would help to align clinician-focused quality measures 
with measures used in other governmental and private-sector initiatives 
focused on other provider types, and advance measurement and close gaps 
in care for high-prevalence and/or high-cost conditions.
    Response: Health care quality measures are currently developed by a 
variety of organizations and used by a variety of governmental, 
nongovernmental, and public-private partnership initiatives which have 
various and at times differing programmatic needs for quality measures. 
Although a cooperative and voluntarily coordinated approach to agreeing 
upon quality goals which would guide development and selection of 
measures may be of value, the Secretary retains the authority to select 
from available measures meeting applicable statutory requirements those 
most appropriate for use in this program.
    Comment: Many commenters illustrated, directly or indirectly, that 
the proposed rule language (72 FR 38198 through 38199) reads to a 
material proportion of reviewers as meaning or implying that a measure 
must be both adopted by the AQA ``and'' endorsed by the NQF to be 
included in the PQRI for 2008. Several of these comments also 
specifically requested clarification of the status of measures that 
will, as of the date CMS finalizes the list of 2008 PQRI quality 
measures, be AQA-adopted but not yet reviewed by NQF.
    Response: In general, the consensus requirement under the MIEA-
TRHCA is met if a measure is either NQF-endorsed or AQA-adopted. 
However, where an AQA-adopted measure has been specifically considered 
by NQF but declined for endorsement, we have not selected such measures 
for 2008. This derives from our stated preference for standards of a 
voluntary consensus standards organization (such as NQF) over an 
organization which does not (such as AQA). Also, as stated in the 
proposed rule (72 FR 38198), in the event of a determination by NQF to 
decline endorsement of a particular measure after it had been adopted 
by AQA, we anticipate that AQA would withdraw its adoption of that 
measure. Thus, a measure that has been AQA adopted and then reviewed by 
NQF with a decision to decline endorsement we would expect would, soon 
after the NQF decision, be neither NQF-endorsed nor AQA-adopted and 
therefore it would be undesirable to include a measure imminently 
destined to not retain approval of either consensus organization simply 
because we may have been identifying final 2008 measures during the 
brief period of lag between the NQF's decision to decline endorsement 
and the AQA's opportunity to reconsider its adoption of the measure.
    To further clarify this point, of the measures proposed for 2008 
(72 FR 38199 through 38202), the only ones that might be removed as a 
result of having been AQA adopted but then subsequently declined NQF 
endorsement are certain measures that were included in the 2007 PQRI on 
the basis of AQA adoption and that have since been declined for 
endorsement by NQF after specifically being considered.
    For newly-proposed measures (those not part of the 2007 PQRI set), 
either NQF or AQA consensus endorsement or adoption is sufficient for 
PQRI. Most of these measures will have been adopted by the AQA but not 
yet reviewed by NQF. Others may have been endorsed by the NQF, but not 
yet adopted by the AQA.
    Comment: One commenter suggested that the entirety of the PQRI 
section of the proposed rule could potentially be

[[Page 66343]]

construed to imply that there may be, based on which specific entities 
develop or own a measure, different levels of consensus-standard status 
required for measures to qualify for our consideration for inclusion in 
PQRI.
    Response: The measure developer was listed for identification 
purposes only. This was necessary for measures that when proposed were 
still under development. The remaining measures that had achieved 
consensus endorsement or adoption were sufficiently identified by 
consensus organization, without listing the developer. The statutory 
requirements for consensus-organization adoption or endorsement, 
consensus-based development and statutory and policy preferences for 
measures that have achieved the status of voluntary consensus standards 
apply equally to all potential PQRI quality measures regardless of the 
organization type or specific identity of any given measure's developer 
or owner.
    Comment: We received a large number of comments on the 
interpretation of the requirement of per Section 1848(k)(2)(B)(i) of 
the Act, that 2008 PQRI measures ``shall be measures that have been 
adopted or endorsed by a consensus organization (such as the National 
Quality Forum or AQA)''. These comments reflected a diversity of 
opinion amongst various stakeholders on key conceptual points related 
to the balance between rigor and flexibility in measure review and 
approval, as well as on the suitability of specific organizations for 
their roles as we define them in the PFS rule.
    Many commenters encouraged us to rely solely on highly structured, 
scientifically rigorous processes for measure approval to promote 
stability in measures over time. Many other comments advised against 
requiring a degree of formality or scientific rigor in the review 
process that would unduly slow the availability and implementation of 
new quality measures to fill current gaps in professionals or clinical 
foci for which applicable measures exist.
    Several commenters closely related to the recommendation of 
reliance on more rigorous review processes further suggested we 
identify a single voluntary consensus standards body to be considered 
qualified to establish measures as PQRI measures. The rationales 
provided for this suggestion include enhanced probability of a cohesive 
or coordinated universe of endorsed measures and prevention of 
endorsement of duplicate or near duplicate (``competing'' or 
``conflicting'') measures.
    The value of having multiple consensus organizations available to 
approve measures was noted by many comments that were closely related 
to, or that were elaborating upon, maintaining flexibility and 
adaptability of the universe of available measures. These commenters 
included observations that setting requirements that limit the total 
available capacity for measure review will slow the development not 
only of specific additional quality measures but likely also innovative 
advancement in the science of health care quality measurement. Some of 
these commenters urged us to remain alert for the development of 
additional organizations into potential consensus organizations on par 
with the NQF or with the AQA as of the date MIEA-TRHCA was signed into 
law, and two commenters named two specific potential candidates that 
might choose to develop to that degree in the near future.
    Response: We believe the existence of multiple consensus 
organizations promotes availability of a broad array of measures from 
which we can select those most appropriate for use in PQRI based on 
program policy goals. The availability of the AQA as a consensus 
organization meeting the requirements of MIEA-TRHCA, though it does not 
meet the full NTTAA and OMB A-119 criteria for a voluntary consensus 
standards body (VCSB), has proven important to the consensus 
development of the 2008 PQRI measures. Specifically, the AQA's more 
flexible and expeditious processes have made measures available on a 
shorter timeline than would be possible within the more rigorous 
processes of a VCSB. At present, we are able to identify only the NQF 
and the AQA as satisfying the consensus organization requirements of 
MIEA-TRHCA. Should additional organizations develop to feature 
consensus characteristics at least comparable to the level of openness, 
balance of interest, and broadly representative voting membership 
demonstrated by the AQA as of the date MIEA-TRHCA became law, we would 
consider measures endorsed by those organizations eligible for 
consideration for inclusion in PQRI.
    We concur with the commenters identifying the desirability of 
alignment or harmony of quality measures across settings to more 
effectively promote overall CMS quality goals. We strive to achieve 
synergy between measures used in various settings and quality related 
initiatives to the extent practical.
    Comment: Many commenters concurred with our interpretation that NQF 
is a VCSB per NTTAA and OMB A-119. Several commenters also commended 
NQF for the scientific rigor of its structure and review processes. 
Some commenters in favor of establishing a single consensus 
organization entity whose approval would qualify a measure for PQRI 
inclusion went on to name NQF as the leading or only named candidate 
for such an organization. Simultaneously, multiple concerns were raised 
about the uneven (project-driven) NQF funding stream and its resultant 
potentially long or uncertain review timeframes, and the potential for 
this to impede measure development. Several comments also raised 
concern that the NQF's processes for review of physician-applicable 
measures are not yet as developed and predictable as those measures 
applicable to other types of providers. A few commenters noted that the 
NQF determinations on physician-applicable measures apparently vary 
unpredictably between workgroups and that the appeals process is not 
clearly identifiable.
    Some comments recommended that CMS or another agency should provide 
steady core funding to the NQF on an ongoing basis.
    Response: The NQF is currently the only organization we identified 
that reviews health care quality measures while simultaneously meeting 
the NTTAA and OMB A-119 definition of a VCSB. NQF processes for review 
and endorsement of physician-applicable measures are expected to 
develop and stabilize as it gains more experience with such measures. 
We will continue to monitor the NQF and its processes and work with NQF 
and its members to promote the prompt achievement of that growth.
    The funding stream of the NQF is outside the scope of this 
rulemaking. The concerns raised over the current NQF funding mechanism 
and internal operational structures does, however, highlight the 
desirability of having an alternative source or multiple alternative 
sources of consensus-organization review of quality measures to assure 
that the measure has been vetted in a process that offers at least a 
reasonable degree of openness, balance of interests, and broad voting 
participation.
    Comment: Multiple comments expressed concerns about the AQA's 
structure and original intended purpose not being ideally suited to its 
current role in PQRI, and its role in the measure endorsement process 
being confusing or its role not clearly adding value to the process. 
Multiple other comments commended the AQA as currently

[[Page 66344]]

structured, including its responsiveness, openness, breadth of 
participation, and utility as a forum for building consensus among 
stakeholders in quality measurement. Several comments also noted that 
the AQA is currently re-evaluating its structure, and recommended 
either that the AQA be required to restructure itself to meet the NTTAA 
and OMB A-119 criteria for a VCSB or that we reassess the AQA after any 
restructure to assure that it retains at least the comparable level of 
consensus-organization characteristics that it featured at the time 
MIEA-TRHCA became law.
    Response: As noted above in this section, we interpret that the AQA 
currently meets the MIEA-TRHCA intended definition of a consensus 
organization for purposes of measure approval, as its mention in MIEA-
TRHCA as an example of a consensus organization confirms it did at the 
time the statute was enacted. Further, we have expressed what we 
understand its value to be for the purpose of making quality measures 
available for consideration for inclusion in the PQRI. We do not have 
direct control over the AQA; requiring the AQA to take any specific 
action or restructure in any specific way would be outside the scope of 
CMS authority. However, we are observing the AQA's re-evaluation of its 
structure and will consider altering its role in relation to approval 
of future PQRI measures based on its resultant structure.
    Comment: Several commenters requested we specifically define the 
minimum criteria to be a non-VCSB consensus organization meeting the 
requirements of MIEA-TRHCA.
    Response: We have defined the requirement as being that an 
organization must possess a level of consensus-organization 
characteristics at least comparable to those of the AQA as of the date 
MIEA-TRHCA became law. To attempt to quantify or score an 
organization's level of consensus characteristics would be difficult to 
do in a way that was not misleading or arbitrary. The key features, as 
stated in the proposed rule (at 72 FR 38198), include openness, balance 
of interest, and consensus based on voting participation.
c. The Final 2008 PQRI Quality Measures
    In the proposed rule (72 FR 38199), we solicited comments on the 
implications of including or excluding 148 specific quality measures in 
7 broad categories. We received numerous comments both general and 
measure-specific, which are summarized and addressed as follows.
    Comment: Many comments on measure inclusion were general or 
conceptual and, in fact, mirrored comments on prioritization of measure 
development or endorsement.
    Specific to measure selection, some commenters supported our 
including or excluding measures based on a targeted focus on specific 
gaps in care, while other commenters supported maximum inclusivity of 
conditions, services, and professionals. Some of the comments specific 
to measure selection stated two main perspectives: (1) We should set 
the priorities and/or prioritization process in collaboration with a 
maximally inclusive and representative cohort of stakeholders (to 
specifically include pharmaceutical, device, and information technology 
manufacturers and trade associations, as well as clinicians and 
consumers); and (2) the prioritization or selection of quality measures 
should be accomplished by a VCSB in a formal consensus process.
    Response: In selecting measures, we have sought to achieve a broad 
opportunity for eligible professionals to participate, and to promote 
the quality goals forming the basis for the measures themselves. The 
general quality goal underlying the measures as developed is a 
performance gap relating to important processes or outcomes of care. 
While we agree that prioritized themes for quality improvement can be 
useful in certain contexts, for PQRI the scope of practice of the 
various eligible professionals varies significantly. Therefore, it 
would be difficult to limit measures selected to a few specific 
prioritized quality goals without also limiting the opportunity to 
participate. With respect to the role of a VCSB under MIEA-TRHCA, it is 
to achieve consensus endorsement of particular measures, rather than to 
prioritize measures for PQRI. The responsibility for selection of 
measures for PQRI is directed to the Secretary, based on proposing 
measures, soliciting public comment, and then finalizing the measures. 
Public comment could include the views of a VCSB as to which measures 
are most appropriate for PQRI based on quality goals or other 
considerations. These could then be considered, in conjunction with the 
other public comments and the program needs as determined by the 
Secretary, in finalizing the measures.
    Comment: Several comments in context of measure selection urged us 
to select or prioritize for PQRI inclusion measures aligned or 
harmonized with those used in other governmental initiatives that focus 
other provider types in addition to or instead of individual PQRI-
eligible professionals.
    Response: We concur with comments identifying the desirability of 
alignment or harmony of quality measures across settings to more 
effectively promote overall CMS quality goals. We strive to achieve 
such synergy among settings and initiatives to the extent practical.
    Comment: We received several comments specifically commending or 
recommending inclusion of specific quality measures, including, but not 
limited to: Specific eyecare measures; vaccination and preventive 
services measures; diabetic foot and ankle measures; and perioperative 
care measures including venous thromboembolism(VTE) prophylaxis.
    Response: All of the proposed measures strongly supported by 
multiple comments are included in the final 2008 measures listed below 
in this section.
    Comment: We received many comments expressing concern that the 
following 2007 PQRI measure that has achieved NQF endorsement was not 
included in measures proposed for 2008: ``Age Related Macular 
Degeneration: Dilated Macular Examination''.
    Response: As noted in the proposed rule's correction notice (72 FR 
43581), the omission of this measure was a technical/editorial error 
that was corrected via that notice. The measure titled ``Age Related 
Macular Degeneration: Dilated Macular Examination'' is included in the 
final list in Table 7.
    Comment: Several commenters recommended changes to specific quality 
measures' titles, definitions, and detailed specifications or coding. 
Many of these recommendations were based on alternative interpretations 
of clinical evidence or concerns about the utility of the measures. 
Some requests were specifically concerned that measures be expanded or 
constrained to include or exclude specific professionals from those to 
whom the measure may be applicable.
    Response: Quality measures that have completed the consensus 
processes of NQF or AQA have a designated party (generally the 
developer/owner) who has accepted responsibility for maintaining the 
measure. In general, it is the role of the measure owner, developer or 
maintainer to make any changes to the basic elements of a measure. 
Examples of such basic elements would be the particular process of care 
covered by the measure, professional services to which the measure 
applies, or the diagnosis (or diagnoses) defining the denominator

[[Page 66345]]

population. A request to modify any basic elements of a measure should 
be addressed to the measure's maintainer. In addition, NQF has for its 
endorsed measures an established maintenance process which may be 
accessed. Measure maintenance and modification activities are conducted 
by the developers/owners and/or maintainers of measures outside the CMS 
rule-making process. In implementing the measures for PQRI, CMS may, 
when necessary, make certain technical modifications to assure that 
reporting and performance rates can be calculated. These technical 
modifications do not modify the basic elements of the measure and are 
carried out in collaboration with the measure developer/owner or 
maintainer.
    Comment: Many commenters requested the inclusion for 2008 of 
additional measures not proposed as PQRI measures in the proposed rule. 
Measures requested included additional structural measures, additional 
measures of medication use appropriateness and compliance, measures 
applicable to additional clinical topics, and the measures identified 
in the proposed rule as mandatory for erythropoietin stimulating agent 
reimbursement in 2008.
    Response: The MIEA-TRHCA requires that measures proposed for use in 
the 2008 PQRI be published in the Federal Register prior to August 15, 
2007. We are also required by other applicable statutes to provide 
opportunity for public comment on provisions of policy or regulation 
that are established via notice and comment rulemaking. Measures that 
were not included in the proposed rule for inclusion in the 2008 PQRI 
that were recommended to CMS via comments on the proposed rule have not 
been placed before the public with opportunity for the public to 
comment on them within the rulemaking process. When measures have been 
published in the Federal Register, but in other contexts and not 
specifically proposed as PQRI measures, such publication does not 
provide true opportunity for public comment on those measures' 
potential inclusion in PQRI. Thus, such additional measures recommended 
via comments on the proposed rule cannot be included in the 2008 
measures MIEA-TRHCA requires be finalized via publication in the 
Federal Register by November 15, 2007. However, we have captured these 
recommendations and will have them available for consideration in 
identifying measure sets for future years' PQRI and other initiatives 
to which those measures may be pertinent.
    The measures we identify for 2008 in this final rule with comment 
period will be final as of the effective date of this final rule, and 
no changes (no additions or deletions of measures) will be made after 
that date. However, as was done for 2007, we may make modifications or 
refinements, such as code additions, corrections, or revisions, to the 
detailed specifications for the 2008 measures until the beginning of 
the reporting period. Such specification modifications may be made 
through the last day preceding the beginning of the reporting period. 
The 2008 measures specifications will be available on the PQRI section 
of the CMS Web site at http://www.cms.hhs.gov/pqri when they are 
sufficiently developed or finalized, but in no event later than 
December 31, 2007. No further changes to the specifications will be 
made after the start of the 2008 reporting period. The measures' 
detailed specifications will include instructions for reporting and 
identify the circumstances in which each measure is applicable.
    The final 2008 PQRI Quality Measures are listed in Tables 7 through 
13, and fall into 7 broad categories. The final measures for 2008 were 
selected based upon the following:
    <bullet> The achievement of NQF endorsement or AQA adoption by the 
earlier of November 15, 2007, or the date of publication of this final 
rule with comment period;
    <bullet> Identification in the proposed rule for use in 2008 with 
opportunity for public comment via the rulemaking process;
    <bullet> Development completion in a sufficiently timely manner 
that implementation for 2008 would be practical;
    <bullet> Their importance in relation to quality goals;
    <bullet> Their meaningfulness as measures of quality;
    <bullet> Their utility in the PQRI program such as through 
augmenting the scope of services provided by eligible professionals to 
which PQRI measures apply;
    <bullet> The degree to which they meet the needs of the Medicare 
program and their functionality in terms of ability to be collected and 
calculated in the PQRI program;
    <bullet> Statutory requirement for inclusion in quality measures 
for 2008.
(i) Measures Selected From the 2007 PQRI Quality Measures
    We include in the final 2008 PQRI measures the following 2007 PQRI 
measures in Table 7, proposed as 2008 PQRI measures (72 FR 38199 
through 38200). The measures in Table 7 include measures submitted by 
specialties, in compliance with section 1848(k)(2)(B) of the Act.

                      Table 7.--2007 PQRI Measures
------------------------------------------------------------------------
 
-------------------------------------------------------------------------
Hemoglobin A1c Poor Control in Type 1 or 2 Diabetes Mellitus.
Low Density Lipoprotein Control in Type 1 or 2 Diabetes Mellitus.
High Blood Pressure Control in Type 1 or 2 Diabetes Mellitus.
Screening for Future Fall Risk.
Heart Failure: Angiotensin-Converting Enzyme (ACE) Inhibitor or
 Angiotensin Receptor Blocker (ARB) Therapy for Left Ventricular
 Systolic Dysfunction (LVSD).
Oral Antiplatelet Therapy Prescribed for Patients with Coronary Artery
 Disease.
Beta-blocker Therapy for Coronary Artery Disease Patients with Prior
 Myocardial Infarction (MI).
Heart Failure: Beta-blocker Therapy for Left Ventricular Systolic
 Dysfunction.
Antidepressant Medication During Acute Phase for Patients with New
 Episode of Major Depression.
Medication Reconciliation.
Assessment of Presence or Absence of Urinary Incontinence in Women Aged
 65 Years and Older.
Characterization of Urinary Incontinence in Women Aged 65 Years and
 Older.
Plan of Care for Urinary Incontinence in Women Aged 65 Years and Older.
Chronic Obstructive Pulmonary Disease (COPD): Spirometry Evaluation.
Chronic Obstructive Pulmonary Disease (COPD): Bronchodilator Therapy.
Asthma: Pharmacologic Therapy.
Stroke and Stroke Rehabilitation: Computed Tomography (CT) or Magnetic
 Resonance Imaging (MRI) Reports.
Stroke and Stroke Rehabilitation: Carotid Imaging Reports.
Primary Open Angle Glaucoma: Optic Nerve Evaluation.

[[Page 66346]]

 
Age-Related Macular Degeneration: Dilated Macular Examination.
Diabetic Retinopathy: Documentation of Presence or Absence of Macular
 Edema and Level of Severity of Retinopathy.
Diabetic Retinopathy: Communication with the Physician Managing Ongoing
 Diabetes Care.
Perioperative Care: Timing of Antibiotic Prophylaxis--Ordering
 Physician.
Perioperative Care: Selection of Prophylactic Antibiotic--First OR
 Second Generation Cephalosporin.
Perioperative Care: Discontinuation of Prophylactic Antibiotics (Non-
 Cardiac Procedures).
Perioperative Care: Venous Thromboembolism (VTE) Prophylaxis (when
 indicated in All patients).
Osteoporosis: Management Following Fracture.
Osteoporosis: Communication with the Physician Managing Ongoing Care
 Post-Fracture.
Aspirin at Arrival for Acute Myocardial Infarction (AMI).
Electrocardiogram Performed for Non-Traumatic Chest Pain.
Electrocardiogram Performed for Syncope.
Vital Signs for Community-Acquired Bacterial Pneumonia.
Assessment of Oxygen Saturation for Community-Acquired Bacterial
 Pneumonia.
Assessment of Mental Status for Community-Acquired Bacterial Pneumonia.
Empiric Antibiotic for Community-Acquired Bacterial Pneumonia.
Asthma Assessment.
Perioperative Care: Timing of Prophylactic Antibiotics--Administering
 Physician.
Stroke and Stroke Rehabilitation: Deep Vein Thrombosis Prophylaxis (DVT)
 for Ischemic Stroke or Intracranial Hemorrhage.
Stroke and Stroke Rehabilitation: Discharged on Antiplatelet Therapy.
Stroke and Stroke Rehabilitation: Anticoagulant Therapy Prescribed for
 Atrial Fibrillation at Discharge.
Stroke and Stroke Rehabilitation: Tissue Plasminogen Activator (t-PA)
 Considered.
Stroke and Stroke Rehabilitation: Screening for Dysphagia.
Stroke and Stroke Rehabilitation: Consideration of Rehabilitation
 Services.
Screening or Therapy for Osteoporosis for Women Aged 65 Years and Older.
Osteoporosis: Pharmacologic Therapy.
Use of Internal Mammary Artery (IMA) in Coronary Artery Bypass Graft
 (CABG) Surgery.
Preoperative Beta-blocker in Patients with Isolated Coronary Artery
 Bypass Graft (CABG) Surgery.
Perioperative Care: Discontinuation of Prophylactic Antibiotics (Cardiac
 Procedures).
Appropriate Treatment for Children with Upper Respiratory Infection
 (URI).
Appropriate Testing for Children with Pharyngitis.
Myelodysplastic Syndrome (MDS) and Acute Leukemias: Baseline Cytogenetic
 Testing Performed on Bone Marrow.
Myelodysplastic Syndrome (MDS): Documentation of Iron Stores in Patients
 Receiving Erythropoietin Therapy.
Multiple Myeloma: Treatment with Bisphosphonates.
Chronic Lymphocytic Leukemia (CLL): Baseline Flow Cytometry.
Hormonal Therapy for Stage IC-III ER/PR Positive Breast Cancer.
Chemotherapy for Stage III Colon Cancer Patients.
Plan for Chemotherapy Documented Before Chemotherapy Administered.
Radiation Therapy Recommended for Invasive Breast Cancer Patients Who
 Have Undergone Breast Conserving Surgery.
Advance Care Plan.
------------------------------------------------------------------------

    Please note that detailed specifications for some 2007 PQRI 
measures may have been updated or modified during the NQF endorsement 
process during 2007. The detailed 2008 PQRI measure specifications for 
any given measure may, therefore, be different from detailed 
specifications for the same measure used for 2007. All specifications 
for 2008 measures must be obtained from the specifications document for 
2008 measures, which will be available on the CMS PQRI Web site on or 
before December 31, 2007.
    The following measures proposed for 2008 (72 FR 38200) are not 
included in the final 2008 PQRI measures listed in Table 7 because they 
have been considered by NQF and did not achieve endorsement:
    <bullet> Dialysis Dose in End Stage Renal Disease (ESRD) Patients.
    <bullet> Hematocrit Level in ESRD Patients.
    Comment: We did not receive any comments specifically suggesting 
that any of the 2007 PQRI measures proposed for 2008 be removed from 
the 2008 PQRI measures. Some commenters suggested alternative measures 
apparently in addition to the measures we had proposed.
    Response: We have not included in final 2008 PQRI measures any 
measures that were not identified in the proposed rule as proposed 2008 
measures for the reporting system as required by Section 1848(k)(1) and 
1848(k)(2)(B) of the Act. As discussed above in this rule, we were 
obligated by MIEA-TRHCA and other applicable statutes to publish and 
provide opportunity for public comment on proposed PQRI quality 
measures. Measures recommended via comments on the proposed rule that 
were not included in the proposed rule have not been placed before the 
public with opportunity for the public to comment on their potential 
use in PQRI. Thus, such additional measures recommended via comments on 
the proposed rule cannot be included in the 2008 measures MIEA-TRHCA 
requires be finalized via publication in the Federal Register by 
November 15, 2007. However, we have captured these recommendations and 
will have them available for consideration in identifying measure sets 
for future years' PQRI and other initiatives to which those measures 
may be pertinent.
(ii) AMA--PCPI Measures
    The measures listed in Table 8, which were developed via the 
American Medical Association (AMA) Physicians Consortium for 
Performance Improvement (PCPI), are finalized as 2008 PQRI measures as 
of the date of publication of this final rule with comment period. All 
of these measures were proposed as 2008 PQRI measures (72 FR 38200 
through 38201). The measures listed in Table 8 achieved AQA adoption or 
NQF endorsement on or before October 31, 2007.
    We will publish the detailed specifications for all final PQRI 
measures on the CMS PQRI Web site at http://www.cms.hhs.gov/pqri on or 
before December 31, 2007.

[[Page 66347]]



     Table 8.--AMA/PCPI Measures Finalized for 2008 With Consensus-
                   Organization Approval by 10/31/2007
------------------------------------------------------------------------
 
-------------------------------------------------------------------------
Prevention of Ventilator-Associated Pneumonia--Head elevation.
Prevention of Catheter-Related Bloodstream Infections (CRBSI)--Central
 Venous Catheter Insertion Protocol.
ACE Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy in patients
 with CKD.
Chronic Kidney Disease (CKD): Laboratory Testing (Calcium, Phosphorus,
 Intact Parathyroid Hormone (iPTH) and Lipid Profile).
Influenza Vaccination in patients with End Stage Renal Disease (ESRD).
Vascular Access for patients undergoing Hemodialysis.
Plan of Care for ESRD patients with Anemia.
Plan of Care for Inadequate Hemodialysis in ESRD patients.
Plan of Care for Inadequate Peritoneal Dialysis.
Assessment of GERD Symptoms in Patients Receiving Chronic Medication for
 GERD.
Testing of patients with Chronic Hepatitis C (HCV) for Hepatitis C
 Viremia.
Initial Hepatitis C RNA Testing.
HCV Genotype Testing Prior to Therapy.
Consideration for Antiviral Therapy in HCV Patients.
HCV RNA Testing at Week 12 of Therapy.
Hepatitis A and B Vaccination in patients with HCV.
Counseling patients with HCV Regarding Use of Alcohol.
Counseling of patients Regarding Use of Contraception Prior to Starting
 Antiviral Therapy.
Patients who have Major Depression Disorder who meet DSM IV Criteria.
Patients who have Major Depression Disorder who are assessed for suicide
 risks.
Patients with Osteoarthritis who have an assessment of their pain and
 function.
Acute Otitis Externa (AOE): Topical Therapy.
Acute Otitis Externa (AOE): Pain Assessment.
Acute Otitis Externa (AOE): Systemic Antimicrobial Therapy--Avoidance of
 Inappropriate Use.
Otitis Media with Effusion (OME): Diagnostic Evaluation--Assessment of
 Tympanic Membrane Mobility.
Otitis Media with Effusion (OME): Hearing Testing.
Otitis Media with Effusion (OME): Antihistamines or Decongestants--
 Avoidance of Inappropriate Use.
Otitis Media with Effusion (OME): Systemic Antimicrobials--Avoidance of
 Inappropriate Use.
Otitis Media with Effusion (OME): Systemic Corticosteroids--Avoidance of
 Inappropriate Use.
Breast cancer patients who have a pT and pN category and histologic
 grade for their cancer.
Colorectal cancer patients who have a pT and pN category and histologic
 grade for their cancer.
Appropriate initial evaluation of patients with Prostate Cancer.
Inappropriate use of Bone Scan for staging Low-Risk Prostate Cancer
 patients.
Review of treatment options in patients with clinically localized
 Prostate Cancer.
Adjuvant Hormonal therapy for High-risk Prostate Cancer patients.
Three-dimensional radiotherapy for patients with Prostate Cancer.
Chronic Kidney Disease (CKD): Blood Pressure Management.
Chronic Kidney Disease (CKD): Plan of Care: Elevated Hemoglobin for
 Patients Receiving Erythropoiesis--Stimulating Agents (ESA).
------------------------------------------------------------------------

    The AMA PCPI measures that were proposed in Table 17 of the 
proposed rule (72 FR 38200 through 38201) were under development at the 
time the proposed rule was published. Several of these measures did not 
complete development or did not complete development in a sufficiently 
timely manner to permit implementation in the 2008 PQRI program. We 
have not included in the final PQRI measures listed in Table 8 the 
following proposed 2008 measures (from Table 17 of the proposed rule, 
72 FR 38200 through 38201) for which development was not completed or 
not completed in sufficient time for implementation for 2008:
<bullet> Stress Ulcer Disease (SUD) Prophylaxis in Ventilated Patients
<bullet> Perioperative Temperature Management for Surgical Procedures 
Under General Anesthesia
<bullet> Assessment of Thromboembolic Risk Factors in patients with 
Atrial Fibrillation
<bullet> Chronic Anticoagulation in patients with Atrial Fibrillation
<bullet> Monthly INR Measurements in patients with Atrial Fibrillation
<bullet> GFR Calculation in patients with Chronic Kidney Disease (CKD)
<bullet> Permanent Catheter Vascular Access for patients Receiving 
Hemodialysis
<bullet> Patients with Osteoarthritis who receive Anti inflammatory or 
Analgesia Medication
<bullet> Documentation of hydration status in Pediatric Patients with 
Acute Gastroenteritis (PAG)
<bullet> Weight measurement in patients with PAG
<bullet> Recommendation of appropriate oral rehydration solution in PAG 
patients
<bullet> Education parents of PAG patients
<bullet> Perioperative Cardiac risk assessment (history)
<bullet> Perioperative Cardiac risk assessment (current symptoms)
<bullet> Perioperative Cardiac risk assessment (physical examination)
<bullet> Perioperative Cardiac risk assessment (electrocardiogram)
<bullet> Perioperative Cardiac risk assessment (continuation of Beta 
Blockers).

    During completion of the measure development process, the measure 
developer eliminated the restriction to ventilated patients of the 
proposed (72 FR 38201) measure titled, ``Prevention of Catheter-Related 
Bloodstream Infections in Ventilated Patients--Catheter Insertion 
Protocol''. This measure is, therefore, listed in the Final 2008 PQRI 
measures in Table 8 as ``Prevention of Catheter-Related Bloodstream 
Infections (CRBSI)--Central Venous Catheter Insertion Protocol''.
    During completion of the measure development process, several of 
the measures proposed for 2008 in Table 17 of the proposed rule (72 FR 
38200 through 38201) were combined into one measure by the measure 
developer. The final, combined measures contain the substantive 
components of each of the measures. The following is reflected in the 
Final 2008 PQRI Measures listed in Table 8:
    <bullet> Proposed measures (72 FR 38201) titled ``Blood Pressure 
Measurement in patients with CKD'' and ``Plan of Care for patients with 
CKD and Elevated Blood Pressure'' were combined into the measure 
entitled ``Chronic Kidney Disease (CKD): Blood Pressure Management.''
    <bullet> Proposed measures (72 FR 38201) ``Calcium, Phosphorus and 
Intact

[[Page 66348]]

Parathyroid Hormone Measurement in patients with CKD'' and ``Lipid 
Profile in patients with CKD'' were combined into the measure in Table 
8 entitled ``Chronic Kidney Disease (CKD): Laboratory Testing (Calcium, 
Phosphorus, Intact Parathyroid Hormone (iPTH) and Lipid Profile).''
    <bullet> Proposed measures (72 FR 38201) ``Hemoglobin Monitoring in 
patients with CKD'' and ``Erythropoietin Overuse in patients with CKD 
and normal Hemoglobin'' were combined into the measure in Table 8 
entitled ``Chronic Kidney Disease (CKD): Plan of Care: Elevated 
Hemoglobin for Patients Receiving Erythropoiesis-Stimulating Agents 
(ESA).''
    During the measure development process, several measures listed in 
the proposed rule (72 FR 38201) as pertaining to the medical conditions 
Acute Otitis Externa (AOE) and Otitis Media with Effusion (OME) were 
narrowed to apply to only one or the other. The measure developer made 
these refinements as a result of more in-depth consideration of the 
evidence for the clinical relevance of each specific measure to each or 
either condition. Modifications to the measures' titles reflect these 
decisions. Otitis Media with Effusion (OME) was eliminated from the 
proposed 2008 measures below. The revised measure titles are listed in 
Table 8 for each proposed 2008 measures:
    <bullet> Measure proposed (72 FR 38201) as ``Patients with Acute 
Otitis Externa (AOE) or Otitis Media with Effusion (OME) who receive 
Topical Therapy'' is now entitled ``Acute Otitis Externa (AOE): Topical 
Therapy.''
    <bullet> Measure proposed (72 FR 38201) as ``Patients with AOE/OME 
who have a pain assessment'' is now entitled ``Acute Otitis Externa 
(AOE): Pain Assessment.''
    <bullet> Measure proposed (72 FR 38201) as ``Patients with AOE/OME 
who are inappropriately prescribed antimicrobials'' is now entitled 
``Acute Otitis Externa (AOE): Systemic Antimicrobial Therapy--Avoidance 
of Inappropriate Use''. Acute Otitis Externa (AOE) was eliminated from 
the proposed (72 FR 38201) measures below. The revised measure titles 
are listed in Table J2 for each proposed 2008 measures.
    <bullet> Measure proposed (72 FR 38201) as ``Patients with AOE/OME 
who have an assessment of tympanic membrane mobility'' is now entitled 
``Otitis Media with Effusion (OME): Diagnostic Evaluation--Assessment 
of Tympanic Membrane Mobility.''
    <bullet> Measure proposed (72 FR 38201) as ``Patients with AOE/OME 
who undergo hearing testing'' is now entitled ``Otitis Media with 
Effusion (OME): Hearing Testing.''
    <bullet> Measure proposed (72 FR 38201) as ``Patients with AOE/OME 
who inappropriately receive antihistamines/decongestants'' is now 
entitled ``Otitis Media with Effusion (OME): Antihistamines or 
Decongestants--Avoidance of Inappropriate Use.''
    <bullet> Measure proposed (72 FR 38201) as ``Patients with AOE/OME 
who inappropriately receive systemic antimicrobials'' is now entitled 
``Otitis Media with Effusion (OME): Systemic Antimicrobials--Avoidance 
of Inappropriate Use.''
    <bullet> Measure proposed (72 FR 38201) as ``Patients with AOE/OME 
who inappropriately receive systemic steroids'' is now entitled 
``Otitis Media with Effusion (OME): Systemic Corticosteroids--Avoidance 
of Inappropriate Use.''
    Comment: We received several comments from organizations involved 
in the measure development process noting that the measure titles as 
proposed in Table 17 of the proposed rule (72 FR 38200 through 38201) 
were incorrect or obsolete based on progress in measure development 
between the time the proposed rule went on display (July 2, 2007) and 
the date the commenters submitted their comment letters (various 
specific dates at the end of August, 2007).
    Response: As stated above, the measure titles in Table 8 reflect 
the correct titles as of the conclusion of the development process 
preparing these measures for consensus-organization review in the late 
summer and early fall of 2007.
    Comment: We received comments in support of certain measures listed 
in Table 8, such as the Chronic Kidney Disease measures. Other 
commenters suggested including additional measures not proposed as 2008 
PQRI measures. No commenters opposed inclusion of any of the measures 
listed on Table 8.
    Response: The measures from Table 16 of the proposed rule (72 FR 
38200 through 38201) that were sufficiently completed in time for use 
in the 2008 PQRI are included in Table 8. As discussed above, several 
of the CKD measures proposed in Table 16 of the proposed rule (72 FR 
38201) have been combined into with one another as listed in Table 8.
    As iterated above in response to comments on measures in Table 7, 
we cannot include in the 2008 PQRI measures that were not published as 
proposed 2008 PQRI measures in the Federal Register by August 15, 2007. 
We have, however, made note of the measures suggested and may consider 
them for inclusion in future quality-reporting initiatives to which 
they may be relevant.
(iii) Nonphysician Measures
    We include measures in the final 2008 PQRI quality measures listed 
in Table 9 developed by Quality Insights of Pennsylvania (under the 
Medicare Quality Improvement Organization (QIO) contract for the State 
of Pennsylvania) that were proposed as 2008 PQRI measures in Table 18 
of the proposed rule (72 FR 38201 through 38202). These measures were 
developed primarily to afford expanded reporting opportunities for NPPs 
who had few or no measures available in 2007. Some may also be 
applicable to physicians. The clinicians who could report each measure 
are identified in the measure's detailed specifications, which will be 
available on the Measures/Codes page of the CMS PQRI Web site at http:/
/www.cms.hhs.gov/pqri as far in advance of the 2008 reporting period as 
practical. We have not included in the final PQRI measures listed in 
Table 9 the following measures proposed in Table 18 of the proposed 
rule (72 FR 38201 through 38202) whose development was not completed in 
a sufficiently timely manner for implementation in the 2008 PQRI 
program:
    <bullet> Universal Hypertension Screening.
    <bullet> Universal Hypertension Screening Follow-up.
    During completion of the measure development process, several of 
the measures proposed for 2008 in Table 18 of the proposed rule (72 FR 
38201 through 38202) were combined into one measure by the measure 
developer. The final, combined measures contain the substantive 
components of each of the measures. The following is reflected in the 
Final 2008 PQRI Measures listed in Table 8:
    <bullet> Proposed (72 FR 38201) measures titled ``Universal Weight 
Screening (BMI)'' and ``Universal Weight Screening Follow-up (BMI)'' 
were combined into the measure entitled ``Universal Weight Screening 
and Follow-up.''
    <bullet> Proposed (72 FR 38201) measures ``Patient Co-development 
of Treatment Plan'' and ``Patient Co-development of Plan of Care'' were 
combined into the measure in Table 8 entitled ``Patient Co-development 
of Treatment Plan/Plan of Care.''
    Comment: We received numerous comments pertaining to the measures 
proposed in Table 18 of the proposed rule (72 FR 38201 through 38202), 
now listed in Table 9 of this final rule with

[[Page 66349]]

comment period. Most of these comments addressed the scope of 
applicability of these measures to particular non-physician 
specialties, such as speech language pathologists (SLPs) and 
occupational therapists.
    Response: The applicability of the final 2008 PQRI measures is 
dependent on whether the given practitioner can bill for the services 
identified by the procedures or services represented by the Current 
Procedural Terminology (CPT) Category I codes in the measure's 
denominator per its detailed specifications. The inclusion of specific 
procedures or services in a measure's denominator is determined during 
the measure development and consensus process, based on the clinical 
relevance of the measure to particular services/procedures. The 
determination of services/procedures to which a specific measure is 
relevant and therefore applicable is not subject to change via the 
rulemaking process. The measures in Table 9 achieved AQA consensus 
adoption on or before October 19, 2007. These measures have not yet 
been reviewed by the NQF.
    We will publish the detailed specifications for all final PQRI 
measures, including these QIP nonphysician measures, on the CMS PQRI 
Web site at http://www.cms.hhs.gov/pqri on or before December 31, 2007.

    Table 9.--Quality Insights of Pennsylvania Nonphysician Measures
------------------------------------------------------------------------
 
-------------------------------------------------------------------------
Universal Weight Screening (BMI) and Follow-up.
Universal Influenza Vaccine Screening and Counseling.
Universal Documentation and Verification of Current Medications in the
 Medical Record.
Screening for Clinical Depression.
Screening for Cognitive Impairment.
Patient Co-development of Treatment Plan/Plan of Care.
Pain Assessment Prior to Initiation of Patient Treatment.
------------------------------------------------------------------------

(iv) Structural Measures Currently Under Development
    We include structural measures in the final 2008 PQRI measures 
listed in Table 10 developed by Quality Insights of Pennsylvania (under 
the Medicare Quality Improvement Organization (QIO) contract for the 
State of Pennsylvania), that were proposed as 2008 measures in Table 19 
of the proposed rule (72 FR 38202). These measures meet the requirement 
of section 1848(k)(2)(B)(i) of the Act.
    Comment: Numerous comments expressed support of the measures listed 
in Table 10. Other commenters stated a belief that there is a lack of 
scientific evidence to support the benefits of e-prescribing.
    Response: As required by MIEA-TRHCA, the final 2008 PQRI measures 
shall include structural measures such as the use of EHRs and 
electronic prescribing technology. The determination of the sufficiency 
of the scientific basis for quality measures is part of the review and 
evaluation during the measure development and consensus processes. The 
measures are included in Table 10. These measures were adopted by the 
AQA on or before October 31, 2007.

     Table 10.--Quality Insights of Pennsylvania Structural Measures
------------------------------------------------------------------------
 
-------------------------------------------------------------------------
HIT--Adoption/Use of E-Prescribing.
HIT--Adoption/Use of Health Information Technology (Electronic Health
 Records).
------------------------------------------------------------------------

(v) Additional AQA Starter-Set Measures
    We include measures in the final 2008 PQRI measures from the AQA 
starter set that were not included in the 2007 PQRI quality measures 
but that are relevant to Medicare beneficiaries and which we proposed 
as 2008 measures in Table 20 of the proposed rule (72 FR 38202). We 
have not included in the final 2008 measures listed in Table 11 the 
following measure that was listed in Table 20 of the proposed rule (72 
FR 38202), because its adaptation to the claims-based provider-self-
reported format was not found to be feasible:
    <bullet> Beta Blocker Therapy (persistent for 6 months or more) 
Post MI.
    We received several comments in support of the measures listed in 
Table 20 of the proposed rule (72 FR 38202) and now listed in Table 11, 
as preventive care measures and measures related to smoking cessation.

             Table 11.--Additional AQA Starter-Set Measures
------------------------------------------------------------------------
 
-------------------------------------------------------------------------
Dilated eye exam in diabetic patient.
Screening Mammography.
Colorectal Cancer Screening.
Inquiry regarding Tobacco Use.
Advising Smokers to Quit.
------------------------------------------------------------------------

(vi) Other NQF-Endorsed Measures
    We include in the final 2008 PQRI measures other measures endorsed 
by the NQF that were not included in the 2007 PQRI quality measures but 
that were proposed as 2008 measures (72 FR 38202) and that are relevant 
to Medicare beneficiaries, address overuse/misuse of pharmacologic 
therapy, and/or that expand the specialty applicability and patient 
population. We have not included in the final PQRI measures listed in 
Table 12 the following proposed measure (72 FR 38202), because its 
adaptation to the PQRI format was subsequently not found to be 
feasible:
    <bullet> Annual Therapeutic monitoring for patients on the 
following persistent medications: Angiotensin Converting Enzyme 
Inhibitor (ACE)/Angiotensin Receptor Blocker (ARB), Digoxin, Diuretics, 
Anticonvulsants; and Statins.
    We received several comments in support of including the measures 
listed in Table 12. We did not receive any comments opposing the 
inclusion of any of the measures listed in Table 12.

                 Table 12.--Other NQF-Endorsed Measures
------------------------------------------------------------------------
 
-------------------------------------------------------------------------
Inappropriate antibiotic treatment for adults with acute bronchitis.
Disease Modifying Anti-rheumatic Drug Therapy in Rheumatoid Arthritis.
Angiotensin Converting Enzyme Inhibitor (ACE) or Angiotensin Receptor
 Blocker (ARB) Therapy for patients with coronary artery disease and
 diabetes and/or left ventricular systolic dysfunction (LVSD).
Urine screening for microalbumin or medical attention for nephropathy in
 diabetic patients.
Influenza vaccination for patients >= 50 years old.
Pneumonia vaccination for patients 65 years and older.
------------------------------------------------------------------------

(vii) Podiatric Measures
    We include measures in the final 2008 PQRI quality measures listed 
in Table 13 developed by the American Podiatric Medical Association 
(APMA). These two measures are finalized as 2008 PQRI measures as of 
the date of publication of this final rule with comment period. These 
measures were proposed as 2008 PQRI measures in Table 21 of the 
proposed rule (72 FR 38202), and were

[[Page 66350]]

adopted by the AQA on or before October 31, 2007.
    A third proposed measure (72 FR 38202), titled ``Diabetic Foot and 
Ankle Care, Peripheral Arterial Disease: Ankle Brachial Index (ABI) 
Measurement'' has not achieved AQA adoption or NQF endorsement in time 
to be included in this final rule with comment period, and is therefore 
not included in the final 2008 PQRI quality measures.
    Comment: A number of comments expressed support of these measures. 
We received comments requesting correction of the title of this topic 
and the substantive title/heading for the table from ``Podiatric 
Measures'' to ``Diabetic Foot and Ankle Measures'' to reflect the 
potential applicability of these measures beyond podiatrist. At the 
same time, we received comments that these measures are not applicable 
to orthopedic surgeons.
    Response: We have retained the original measure-category title to 
reflect the developer, and thus the origin of the measures, rather than 
the scope of applicability. This identification of nomenclature is 
aligned with the nomenclature used for other categories of measures, 
such as those in Table 11, which are identified as originating in the 
AQA Starter Set rather than by the type of services to which they 
pertain. MIEA-TRHCA makes no presumption as to applicability based 
solely on measure title or specifications, let alone the categorization 
that may be applied to various groups of measures for identification 
and ease of reference. Rather, measures are presumed applicable to a 
practitioner based on the scope and pattern of practice of the 
physician reporting the measure in combination with its specifications.

                      Table 13.--Podiatric Measures
------------------------------------------------------------------------
 
-------------------------------------------------------------------------
Diabetic Foot and Ankle Care, Peripheral Neuropathy: Neurological
 Evaluation.
Diabetic Foot and Ankle Care, Ulcer Prevention: Evaluation of Footwear.
------------------------------------------------------------------------

d. Addressing a Mechanism for Submission of Data on Quality Measures 
via a Medical Registry or Electronic Health Record
(i) Addressing a Mechanism for Submission of Data on Quality Measures 
via a Medical Registry--Background and Summary of Proposed Rule
    As explained in the proposed rule (72 FR 38202), section 1848(k)(4) 
of the Act, as amended by the MIEA-TRHCA, requires that ``as part of 
the publication of proposed and final quality measures for 2008 under 
clauses (i) and (iii) of paragraph (2)(B), the Secretary shall address 
a mechanism whereby an eligible professional may provide data on 
quality measures through an appropriate medical registry''.
    In the proposed rule, we discussed what constitutes a medical 
registry and the general desirability of registries serving as an 
alternative to claims based reporting. We proposed to address reporting 
from medical registries by testing one or more of five mechanisms for 
such reporting during 2008, and requested comment on five options for 
data submission by registries. These options vary as to whether 
individual beneficiary-level data is submitted by the registry, as well 
as the number and type of data elements needed from the registry. The 
five options were described in detail in the proposed rule (72 FR 38203 
through 38204).
    The 2008 registry reporting is only a test of the feasibility and 
accuracy for the two selected submission options (identified as Options 
2 and 3 in the proposed rule (72 FR 38203 through 38204)) and described 
again, in summary, below in response to comments. In order to qualify 
for the incentive bonus for PQRI data submission, practitioners will 
need to continue their quality data codes through the claims process.
(ii) Addressing a Mechanism for Submission of Data on Quality Measures 
via a Medical Registry--Summary of Comments and CMS's Responses
    Comment: The majority of the comments advocated the use of option 
2, 3, or 5. There was not significant support for option 1 or option 4; 
instead the preponderance of comments on options 1 and 4 were in 
opposition to their implementation.
    Response: We have decided to test options 2 and 3 in 2008.
    We agree that option 1 should not be tested. Under this option only 
the quality data codes for selected PQRI measures would be reported by 
the registry without submission of associated diagnosis or service 
rendered. Under this option, the denominator information would have to 
be obtained from the claims and linked to the quality data codes 
submitted via the registry. This option would create an added 
administrative burden for the CMS systems that would need to link data 
from the two sources at the beneficiary or episode/encounter/procedure 
level.
    We also agree that option 4 should not be tested. Option 4 would 
place significant burden upon practitioners, by requiring practitioners 
not only to submit claims to Medicare for the services provided, but 
also enter data obtained from the explanation of benefits into the 
registry.
    Option 5, which calls for a ``data dump'' was supported by some 
commenters as this option would potentially provide the most complete 
and robust set of data for purposes of clinical improvement. It could 
also be beneficial in evaluating a physician's practice, particularly 
since it would not necessarily need to be limited to Medicare Part B 
beneficiaries or soley PQRI measures. Thus, while we agree that data 
submission via registry-based mechanisms in models such as Option 5 has 
significant potential over time because of the comprehensiveness of the 
data, we do not believe that this option is currently practical for 
implementation even on a test basis. We intend to continue to explore 
ways to enhance our ability to capture registry data so that it may be 
suitable for future use.
    Under Option 2, the registry would provide the quality data codes 
and diagnosis codes and beneficiary identification (HIC) numbers or 
other limited beneficiary information for identification. Using the 
beneficiary information to match registry information to a submitted 
claim for a particular service, CMS would have the data needed to 
calculate a practitioner's reporting and performance rates.
    Under Option 3 the registry will calculate and submit reporting and 
performance rates for various measures to CMS, rather than have CMS 
calculate the rates. While this is compatible with the role of a 
registry in providing feedback to the physician, for future PQRI 
implementation, a validation process for the registry calculations 
would need to be in place and provided to CMS.
    Comment: Many commenters requested that registry-based mechanisms 
for 2008 be made a fully operational alternative through which 
participants could achieve satisfactory reporting and quality for a 
2008 PQRI incentive payment. Several commenters suggested we find a way 
to let participants in testing activities ``get credit'' toward PQRI 
reporting for their participation in the test.
    Response: We proposed a test of registry submission (72 FR 38203 
through 38204). It is not feasible or practical to implement registry 
submission without such testing. Any registries and any of their 
subscribers participating in any testing activities in 2008 will be 
participating in this data-submission testing on a strictly voluntary 
basis. Any registry seeking to participate in the testing should notify 
their subscribers to continue submitting

[[Page 66351]]

quality data codes on their Part B professional services claims in 
order to pursue PQRI bonus payments.
    Comment: We received several comments requesting that a specific 
organization's registry be deemed or ``certified'' to satisfy PQRI 
reporting. Additionally, it was suggested that we implement a mechanism 
to make those professionals submitting data to the registry potentially 
able to qualify for a 2008 PQRI bonus payment on the basis of 
participating in the registry. We received several related comments 
suggesting we consider deeming specialty boards' maintenance of 
certification (MOC) programs so that successful participation in a 
deemed MOC would qualify a professional for a 2008 PQRI bonus payment.
    Response: We believe that, in the long run, registries having such 
deemed status may be a very suitable and desirable way for quality data 
submission and measures calculation to be conducted for physicians and 
other practitioners. However, at the present time we do not find it 
feasible or practical to implement such a suggestion.
    Comment: Several commenters encouraged us to maintain for the 
foreseeable future multiple options for PQRI participants to submit 
data, including claims based, as well as registry or EHR-based 
submission mechanisms. Some of these comments noted that the state of 
the art for medical registries is embryonic to nascent. Commenters also 
noted that the percentage of eligible professionals who use EHRs 
capable of successful data extraction and transmission to a CMS data 
warehouse is relatively low. Related comments recommended we develop a 
long term strategy that will be sufficiently flexible to allow for 
innovative developments in the registry field as it begins to grow in 
sophistication and market penetration.
    Response: For 2008, claims-based submission will remain the only 
mechanism of PQRI quality measure data submission. We hope in future 
years to make alternative ECI-based submission mechanisms available. 
However, we recognize that for the near future, claims-based submission 
is likely to be the only mechanism that will provide an avenue for 
virtually all eligible practitioners to participate within PQRI. As a 
result, we would anticipate that claims based submission would be 
maintained.
    Comment: Several commenters expressed concern that many registries 
are proprietary and charge a fee for using the registry. Commenters 
expressed concern about using proprietary registries, specifically that 
such use raises potential antitrust (barrier to competition) issues, as 
well as barriers to participation by professionals who would have to 
subscribe to a proprietary registry. Several commenters urged that any 
CMS registry-based mechanism be in the public domain and supported by a 
public domain registry available to individual professionals.
    Response: In the proposed rule, we discussed registry-based 
reporting as an alternative, not a requirement. We agree that 
physicians should not be required to use any particular proprietary 
service. Rather, the purpose in addressing registries is to allow 
physicians who find it desirable to submit data to registries to be 
able to avoid duplicate data submission to CMS through the claims 
process.
    Comment: A few commenters expressed concern that creating new 
registries or altering existing interfaces would be burdensome and 
costly.
    Response: We are not recommending developing new registries and any 
decision to do so should be made independently of PQRI. Nevertheless, 
there are currently various registries in existence which may, 
ultimately, be capable of interfacing with the CMS data warehouse. As 
has been previously discussed, for 2008, we will only be testing 
registry-based data submission. As envisioned for the future, registry-
based submission of quality-measures data would be an alternative, not 
a requirement.
    Comment: Some comments expressed concerns about transmitting 
patient data through registries or EHRs in context of applicable 
statutes, regulations, and policies protecting patient privacy.
    Response: Preserving the confidentiality of patients' individually 
identifiable and protected health information is a high priority at 
CMS. Generally, personally identifiable data on individuals and/or 
their health are protected by the Privacy Act of 1974 and/or the Health 
Insurance Portability and Accountability Act of 1996 (Pub. L. 104-191) 
(HIPAA). HIPAA establishes protections specific to certain individually 
identifiable health information, and the Privacy Act establishes the 
protections specific to certain information that the government 
maintains which is individually identifiable. HIPAA and its extensive 
implementing regulations have established privacy and security 
standards for health care plans, health care clearinghouses, and 
providers that conduct electronic transactions covered by HIPAA. These 
entities are termed ``covered entities''. All patient registries, EHRs, 
data transmission, and data storage done by or on behalf of a covered 
entity must be HIPAA compliant. The claims-based method of reporting 
currently uses patient identifiers for submission of quality data along 
with data required to process the provider's claim for payment. The use 
of registries or EHRs would require, for purposes of validation, the 
same information as currently used by the claims-based method of 
submitting quality-measures data.
(iii) Addressing a Mechanism for Submission of Data on Quality Measures 
Via a Medical Registry--Final Plan
    For 2008, we will test Options 2 and 3 on a voluntary basis, based 
on self-nomination by the registries. Each registry participating in 
the testing of each option must maintain compliance with all applicable 
statutory and regulatory requirements and any contractual obligations 
to the professionals/providers for processing, storing, and 
transmitting the data required by the option.
    Functionally, the registry would act as a data submission vendor 
for the eligible professional. A ``data submission vendor'' is defined 
for purposes of this rule as an entity that has permission from the 
eligible professional to provide medical registry data to the Quality 
Reporting System developed per the MIEA-TRHCA. This definition 
parallels the definition of ``data submission vendor'' as used in other 
programs, such as the Hospital Compare data-submission process, where 
examples of such vendors include Joint Commission Oryx vendors.
    In the testing process, again in parallel to similar mechanisms 
already implemented for other provider types by CMS, we anticipate the 
registry, acting as a data submission vendor, will submit data to the 
CMS clinical data warehouse, using a CMS-specified record layout based 
on the quality measures' specifications as published by CMS. For 
purposes of this rule, the term ``CMS clinical data warehouse'' is 
defined as a clinical data warehouse designated by CMS for use in this 
testing. The exact warehouse infrastructure may vary between the 
testing activity in 2008 and any full implementation of registry-based 
data submission that may in the future follow from that testing.
    Options 1 and 4 as described in the proposed rule will not be 
tested in 2008, and we do not envision any future consideration. Thus, 
they are not described in this rule. Option 5, while of potential 
interest for future consideration, is also not described

[[Page 66352]]

below. As options 2 and 3 will be tested in 2008, they are described 
below.
    Option 2: Registries provide the quality codes and diagnosis codes. 
In testing this option, we will use claims data extracted from the 
National Claims History to capture the payment information at the NPI/
Tax ID level. All PQRI reporting and performance calculations will be 
performed using registry data. The registries will, therefore, be 
required to include specific data elements in their databases in order 
to include the codes needed to calculate performance measures and to 
match registry data to claims data. Although not identified in the 
proposed rule, we have upon further technical analysis concluded that 
along with data elements previously identified, patient identifiers 
will also be needed from the registry under this option. Patient 
identifier data are needed specifically in order to allow matching of 
registry data with Medicare claims. It is our understanding that for 
many, if not all, registries, inclusion of at least the patient 
identifier data elements will represent an addition to their databases.
    While developing and through the implementation of the testing 
phase we may discover additional data elements are needed to support 
reliably valid analyses. The following is a list of examples of the 
minimum data elements we believe will be needed from a registry under 
Option 2:

<bullet> Beneficiary/procedure-level data (ICD 9 and CPT codes)
<bullet> HCPCS quality-data codes (G codes and CPT category II codes 
and modifiers)
<bullet> NPI and Tax ID
<bullet> Date of service
<bullet> Beneficiary Date of Birth
<bullet> HIC number

    Option 3: Registries calculate the reporting and performance rates 
for Medicare beneficiaries only, and submit these rates to CMS (that 
is, aggregate information by NPI within a Tax ID). We assume no 
beneficiary level information will be shared. Registries will be 
required to include data elements in their databases to capture either 
quality-data codes or the clinical data needed to compute the quality-
data codes. Registries will be required to perform the necessary 
calculations to be able to submit completed numerator/denominators for 
both reporting and performance rates. Additionally, the registries must 
have a validation strategy in place.
    For any option, the registry must maintain compliance with all 
applicable statutory or regulatory requirements and any contractual 
obligations to the providers for processing, storing, and transmitting 
the data required by the option. To be considered an appropriate 
registry from which we can accept and process data for the purposes of 
calculating PQRI measures, a registry must also comply with the 
interoperability standards recognized by the Secretary, and therefore, 
applicable to HHS initiatives. Examples of standards recognized by the 
Secretary include Consolidated Health Informatics Initiative (CHI) 
standards and standards subsequently recognized by the Secretary under 
Executive Order 13410 in place of CHI standards. A description of the 
specific health informatics standards adopted by the Federal 
government, as well as the specific interoperability standards 
recognized by the Secretary, is available on the HHS Office of the 
National Coordinator for Health Information Technology (ONC) Web site 
at http://www.hhs.gov/healthit/chiinitiative.html.
    We will request that registries interested in participating in the 
testing of the registry based quality data submission project self 
nominate. A letter stating the registries interest should be received 
by CMS by 6 PM, Eastern time, on January 4, 2008. Self-nomination 
letters should be sent to: ``PQRI IT Testing Nomination'', Centers for 
Medicare and Medicaid Services Office of Clinical Standards and 
Quality, Quality Measurement and Health Assessment Group, 7500 Security 
Boulevard, Mail Stop S3-02-01, Baltimore, MD 21244-8532.
    We plan to select for testing, from the self nominees, a group of 
registries that comply with all applicable statutory and/or regulatory 
requirements, and any contractual obligations to the professionals/
providers for processing, storing, and transmitting the data required 
by the option(s) tested. Registries selected must also comply with 
applicable system interoperability standards recognized by the 
Secretary and be technically capable of interfacing with the CMS 
clinical warehouse electronic data exchange interface. The number of 
registries selected for testing may be limited to those that are 
technically capable or those that already contain key minimum data 
elements for testing purposes. Additionally, the actual level of 
complexity and effort required for testing from the CMS data 
infrastructure may also limit registry participation in the testing 
phase. (Experience with other initiatives has suggested that some data 
submission vendors and their software are more easily interfaced and 
tested with the CMS data warehouse electronic data exchange interface 
than others.)
    In addition to the requirements listed above in this section, any 
registry that self-nominates for 2008 testing must, at a minimum, have 
the following characteristics:
    (1) Be able to separate and report information for Medicare 
beneficiaries only.
    (2) Use at least 1 PQRI measure that is selected for 2008 
inclusion. We will consider other measures recommended by specialty 
registries for possible future use in quality reporting and 
performance.
    (3) Provide the data as outlined in the rule for the particular 
available option under which they are submitting data (that is, being 
able to report using option 2 and/or option 3).
    (4) Have a validation process for their data.
    (5) Have or have applied for a QualityNet Exchange account.
    We expect that information on the results of the testing in 2008 
will be posted on the CMS PQRI Web site at http://www.cms.hhs.gov/pqri.
(iv) Electronic Health Records (EHRs)
    The proposed rule noted (72 FR 38204) that we would explore the 
operational feasibility of accepting clinical quality data for a 
limited number of PQRI measures from EHRs, and solicited comments on 
this concept. The summaries of, and our responses to, the numerous 
comments we received on this topic are presented at the end of this 
PQRI-specific section.
    Having conducted further technical analyses and reviewed public 
comments received on the proposed rule, we have determined that we 
will, in 2008, partner with several self nominated EHR vendors/groups 
that we select to develop and test EHR clinical quality data 
submission. Since mechanisms for submission of electronic clinical data 
extracted from an EHR will only be for testing purposes in 2008, 
vendors should notify their clients that the practitioners will need to 
submit their quality data codes through the claims process to be 
eligible for a 2008 bonus payment.
    EHR vendors/groups who wish to participate in the development and 
testing process may self-nominate by sending a letter to CMS expressing 
their interest. Self-nomination letters should be sent to: ``PQRI IT 
Testing Nomination'', Centers for Medicare and Medicaid Services Office 
of Clinical Standards and Quality, Quality Measurement and Health 
Assessment Group, 7500 Security Boulevard, Mail Stop S3-02-01, 
Baltimore, MD 21244-8532.

[[Page 66353]]

    The letter must be received by CMS by 6 p.m., e.s.t., on January 4, 
2008. Vendors who are selected for this process must:
    (1) Be able to submit data according to the HL7 technical 
specifications for submission of data to the Outpatient Clinical 
Warehouse, as defined for the Doctor's Office Quality--Information 
Technology (DOQ-IT) Project; and
    (2) Have or have applied for a QualityNet Exchange account.
    As with registry-based mechanisms, vendors and their customers 
(eligible professionals) who choose to participate in the testing in 
2008 will be doing so on a strictly voluntary basis. We will continue 
to express this, and will urge EHR vendors to explain this to their 
customers when seeking volunteers to participate in the testing with 
them.
    For more information on required capability (1), above, please see 
the QualityNet Exchange User's Guide, and the DOQ-IT measures' 
technical specifications (as implemented in the DOQ-IT project), both 
available for download free of charge from http://qualitynet.org. 
Additionally, 5 overlapping DOQ-IT and PQRI quality measures have been 
updated for potential use in the 2008 testing. The updated detailed 
technical specifications for these five DOQ-IT/PQRI overlapping 
measures are available for download from the 2008 PQRI Information page 
of the CMS PQRI Web site at http://www.cms.hhs.gov/pqri.
    Comment: Numerous comments were received regarding accepting 
clinical quality data from EHRs for use in PQRI. While some commenters 
opposed the idea of using EHR-derived data in PQRI, the majority of 
responses were in favor of accepting clinical quality data from an EHR.
    Response: Although we will be unable to offer EHR-based data 
submission mechanism on other than a test basis, we are encouraged by 
the generally positive response to the pursuit of this option due to 
its substantial potential to enhance data quality and reduce data 
collection burden on providers.
    Comment: Numerous comments expressed concerns about data security, 
especially as it pertains to patient privacy, and patient privacy as it 
relates to CMS use of the quality data, in the context of EHR-based 
data submission mechanisms.
    Response: Preservation of patient confidentiality is imperative. It 
is the inescapable responsibility of every party that collects, stores, 
handles, or uses patients' personally identifiable health information 
for any purpose. In order to participate in the 2008 testing, all 
participating parties must be able to ensure that uses and disclosures 
of protected health information EHRs, data transmission mechanisms, and 
data receipt and storage systems will be in compliance with all 
applicable statutes and regulations and any contractual obligations to 
the professionals/providers for processing, storing, and transmitting 
the data required by each option tested. Moreover, although EHR 
submission may involve identifiable personal health information, that 
information is limited to what is minimally necessary to be able to 
audit the data accuracy and completeness in addition to the particular 
clinical information (lab values, vital sign values, documentation of a 
procedure or test ordered or performed) necessary to calculate the 
performance measure. It does not involve submitting the entire patient 
medical record, and it is possible that the information as transmitted 
can have the patient's actual identifying information (for example, 
name, and HIC number) ``masked'' by using a practice-internal chart ID 
<greek-i> or other method that still allows for accurate audit.
    Comment: Multiple comments urged us to develop and implement EHR-
based data submission mechanisms in a way that minimizes the burden 
such submission might impose.
    Response: We agree that data submission burden is an important 
factor to consider in PQRI data submission.
    Comment: We received several comments expressing concern over 
professionals losing ``control'' of patient records as a result of EHR-
based PQRI quality data submission. The comments appeared to assume 
that our plan was either to import and maintain within our data 
warehouse entire patient medical records or to implement an interface 
that would allow our warehouse to access and mine the data from 
patients' medical records.
    Response: The patient's health record is populated and maintained 
in a practitioner's office, regardless of whether its content is stored 
on paper or electronic format or media. Nothing in this rule affects 
the rights of patients or practitioners with respect to the information 
contained in a patient's health record.
    We plan to accept clinical data that is extracted from medical 
records and then submitted to us by a professional (or a data-
submission vendor acting on a professional's behalf).
    We would not attempt to upload entire medical records into the data 
warehouse, only the data elements minimally necessary to accomplish the 
purposes of PQRI. We do not plan to enable our system to directly mine 
data from the practice's medical records database; that will need to be 
accomplished by the professional or a data vendor acting on the 
professional's behalf. The data submission requires an affirmative 
action on the part of the professional to submit the data or to 
instruct his or her data submission vendor to submit the data to our 
warehouse.
2. Section 110--Reporting of Hemoglobin or Hematocrit for Part B Cancer 
Anti-Anemia Drugs (Sec.  414.707(b))
    Medicare Part B provides payment for certain drugs used to treat 
anemia. Anemia is common in cancer patients and may be caused by either 
the cancer itself or by various anti-cancer treatments, including 
chemotherapy, radiation therapy, and surgical therapy. Anemia occurs 
when the number of red blood cells is reduced by an anti-cancer 
treatment. This happens due to the effect of chemotherapy or radiation 
therapy on the bone marrow, wherein red blood cells are produced by 
dividing precursor cells. This chemotherapy effect is commonly referred 
to as ``bone marrow suppression.'' Anemia may also result from blood 
loss in association with surgical therapy for the cancer.
    Anemia adversely impacts the quality of life for beneficiaries 
being treated for cancer. Fatigue and reduced performance capacity are 
the side effects of anemia that cancer patients report as the most 
disabling and contributing to poor quality of life. The treatment of 
anemia in cancer patients commonly includes the use of drugs, 
specifically erythropoiesis stimulating agents (ESAs) such as 
recombinant erythropoietin and darbepoietin. Although other 
pharmacologic interventions are available, ESAs are the most commonly 
used drugs to treat anemia in this setting. Notably, recent research 
has prompted a Black Boxed warnings in the labels for ESAs, noting 
significant adverse effects including a higher risk of mortality and 
tumor progression in some populations.
    In 2006, we implemented a revised ESA claims monitoring policy 
based on the last hemoglobin or hematocrit value from the preceding 
month on Medicare claims for payment of ESAs administered to 
beneficiaries with anemia due to end-stage renal disease (ESRD) 
receiving dialysis treatments in facilities. For many years prior, we 
have required the reporting of these red blood cell indicators on the 
Medicare claims by ESRD facilities to ensure that the beneficiaries' 
anemia was addressed.

[[Page 66354]]

    Section 110 of the MIEA-TRHCA amends section 1842 of the Act by 
adding a new subsection (u) that reads as follows: ``Each request for 
payment, or bill submitted, for a drug furnished to an individual for 
the treatment of anemia in connection with the treatment of cancer 
shall include (in a form and manner specified by the Secretary) 
information on the hemoglobin or hematocrit levels for the 
individual.'' Section 110 of the MIEA-TRHCA requires such reporting for 
drugs furnished on or after January 1, 2008. In addition, subsection 
(b) directs the Secretary to use the rulemaking process under section 
1848 of the Act to address the implementation of this requirement.
    By requiring the reporting of anemia quality indicators for 
Medicare Part B anti-anemia drugs that are used in the context of 
cancer treatment, we will facilitate assessment of the quality of care 
for this condition. We will use the information reported to help 
determine the prevalence and severity of anemia associated with cancer 
therapy, the clinical and hematologic responses to the institution of 
anti-anemia therapy, and the outcomes associated with various doses of 
anti-anemia therapy.
    While not specifically addressing other indications, the recent 
research on the adverse effects of ESAs in patients with cancer does 
raise concerns as to whether patients receiving ESAs for other 
conditions, such as in the treatment of HIV-AIDS and for some surgical 
patients, are also at higher risk. We solicited public comment on the 
potential of expanding this regulation to include all uses of ESAs.

Comments and Responses

    In general, commenters responded favorably to requiring the 
reporting of the most recent hemoglobin or hematocrit level on claims 
seeking payment for the administration of ESAs for all uses. One 
commenter supported broadening the requirement for reporting hemoglobin 
and hematocrit levels for all ESA claims and stated that such 
requirements would provide valuable data concerning reasonable care. 
The commenter stated that any new information on the use of ESAs for 
other, non-cancer diseases gained by the data collection would be 
helpful in understanding the effects of ESA use in different diseases. 
Another commenter supported the broad goal of gathering the information 
to improve the quality of care. Thus, in light of the potential adverse 
events from ESA use and in accordance with our reading of Congressional 
intent, we believe it is appropriate to require reporting of the 
hemoglobin or hematocrit with respect to all ESA claims, and therefore, 
we have revised the regulations text to reflect this policy in this 
final rule with comment period.
    Most commenters' concerns were limited to the implementation of the 
requirement and possible subsequent undue administrative burden placed 
on providers. A few commenters addressed a recently published National 
Coverage Determination on the use of ESAs for certain patients and 
others included comments related to our ESAs claims monitoring policy 
(EMP). We are not addressing those comments in this final rule with 
comment period as the issues are outside the scope of this regulation.
    Comment: A commenter recommended that we exercise caution in 
implementing the anemia quality indicator secondary to a recent Food 
and Drug Association (FDA) Black Boxed Warning (BBW) on the use of 
ESAs. The commenter noted that anemia measures were removed from the 
Physician Consortium for Performance and Improvement ESRD measurement 
set pending further clarification by either the FDA or the National 
Kidney Foundation.
    Response: This final rule with comment period does not establish 
new or additional standards related to anemia or the administration of 
ESAs. It simply mandates the reporting of the most recent hemoglobin or 
hematocrit level on claims for payment of the administration of ESAs to 
treat anemia. Similar to claims for ESAs administered in renal dialysis 
facilities, the requirement to report a recent hemoglobin or hematocrit 
on claims for the administration of ESAs for any use is not a 
development of a clinical standard. Thus, we believe that collecting 
this information will not impact nor be impacted by any consensus 
standard organizations' development of practice standards, quality 
measures or new scientific evidence.
    Comment: A commenter asked that we clarify if the reporting 
requirement applies to all anemia treatment, which includes, but is not 
limited to, the use of ESAs.
    Response: The statutory requirement does not limit the scope to 
ESAs. We recognize that other drugs and vitamin and mineral supplements 
such as Vitamin B12, folic acid, and iron may also be used in the 
treatment of anemia. ESAs are only FDA approved for the treatment of 
anemia while the other agents are commonly used to treat a variety of 
conditions other than anemia. Vitamin and mineral supplements are 
commonly self administered and we expect that most uses of these agents 
would not result in claims for Medicare payment in the context of the 
treatment of anemia related to anti cancer therapy. However, if payment 
is requested for these anti-anemia drugs furnished to an individual for 
the treatment of anemia in connection with the treatment of cancer, we 
believe that they are within the scope of the statute.
    We believe that the reporting of hemoglobin or hematocrit levels on 
claims for ESAs is consistent with Congressional intent that quality 
indicator data be submitted for patients receiving anti-anemia drugs 
and to ensure that anemia is addressed.
    Comment: Several commenters recommended that we provide clear 
instruction on the scope and reporting of the hemoglobin or hematocrit 
levels.
    Response: We will use the change request process to issue 
implementing instructions to Medicare contractors. Instructions to 
Medicare contractors include requirements for provider education.
    Comment: Several commenters expressed concern that the requirement 
will be burdensome for providers. One commenter asked that we delay the 
implementation of this requirement until the administrative burden to 
practitioners is understood.
    Response: We do not have the authority to delay the effective date 
of the statutory requirement. In addition, we believe that reporting 
the most recent hemoglobin or hematocrit level on a claim for ESA will 
not result in undue administrative burdens on providers. Many local 
Medicare contractors already require such reporting for claims 
submitting within their jurisdictions. ESRD providers have been 
reporting hemoglobin or hematocrit levels on claims for ESAs for 
several years.
    Comment: A commenter recommended that should we broaden the 
reporting requirement to all ESA use and that we should assess minimal 
data sets for understanding how beneficiaries with various underlying 
conditions respond to a particular course of anemia management.
    Response: We appreciate the recommendation and shall review 
available data sets when assessing responses to anemia management.
    Comment: A commenter recommended that we include anemia quality 
indicators in the Physician Quality Reporting Initiative (PQRI) data 
reporting.
    Response: This comment is addressed above in the section of this 
final rule specific to 2008 PQRI measures. The identification or 
establishment of PQRI

[[Page 66355]]

measures is not within the scope of this section of this final rule 
with comment period.
    Comment: A commenter asked that retail pharmacies be exempt from 
this requirement.
    Response: The MIEA TRHCA does not provide for any exemption for 
retail pharmacies.
    Comment: One commenter asked that we clarify whether a provider may 
report a hematocrit or hemoglobin level.
    Response: A provider seeking payment for ESAs may report the 
patient's most recent hematocrit or hemoglobin level on the claim.
    Comment: Several commenters asked that we clarify the requirement 
to report ``the most recent'' hemoglobin or hematocrit level. They 
expressed concern that we may require a patient to have a hemoglobin or 
hematocrit level drawn each time an ESA is administered.
    Response: We are not determining in this regulation when a 
hematocrit or hemoglobin level should be drawn to inform a provider's 
decision to administer ESA therapy. The requirement is that ``the most 
recent'' hemoglobin or hematocrit level be reported on the claim. Thus, 
the provider should report the most recent level preceding the ESA 
administration. We recognize that in some instances the same hemoglobin 
or hematocrit value might be reported on more than one claim.
    Comment: Several commenters stated that we should permit providers 
to report hematocrit or hemoglobin levels in either box 19 or 24A of 
the CMS 1500 form. The CMS 1500 form was recently modified to allow 
reporting in box 24A; however, many providers utilize billing vendors 
that provide software and are unable to modify their product in time 
for the January 1, 2008 implementation.
    Response: We will consider this information when developing claims 
processing systems instructions.
    Comment: One commenter suggested that we employ Q codes for 
reporting the most recent hemoglobin or hematocrit levels. The 
commenter stated that permitting a provider to report the level in box 
19 would not allow an automated extraction of the data element (the 
hemoglobin or hematocrit level) for data analysis.
    Response: We are working with claims processing systems to ensure 
appropriate retrieval of data sets.
3. Section 104--Extension of Treatment of Certain Physician Pathology 
Services Under Medicare
    The technical component (TC) of physician pathology services refers 
to the preparation of the slide involving tissue or cells that a 
pathologist will interpret. (In contrast, the pathologist's 
interpretation of the slide is the professional component (PC) service. 
If this service is furnished by the hospital pathologist for a hospital 
patient, it is separately billable. If the independent laboratory's 
pathologist furnishes the PC service, it is usually billed with the TC 
service as a combined service.)
    In the CY 2000 PFS final rule with comment period (64 FR 59408 
through 59409), we stated that we would implement a policy to pay only 
the hospital for the TC of physician pathology services furnished to 
hospital patients. Before that provision, any independent laboratory 
could bill the carrier under the PFS for the TC of physician pathology 
services for hospital patients. As stated in the CY 2000 PFS final rule 
with comment period (64 FR 59408 through 59409), this policy has 
contributed to the Medicare program paying twice for the TC service, 
first through the inpatient prospective payment rate to the hospital 
where the patient is an inpatient and again to the independent 
laboratory that bills the carrier, instead of the hospital, for the TC 
service.
    Therefore, in the CY 2000 PFS final rule with comment period (64 FR 
59408 through 59409), in Sec.  415.130, we specified that for services 
furnished on or after January 1, 2001, the carriers would no longer pay 
claims to the independent laboratory under the PFS for the TC of 
physician pathology services for hospital patients.
    Ordinarily, the provisions in the PFS final rule with comment 
period are implemented in the following year. However, in this case, 
the change to Sec.  415.130 was delayed 1 year (until January 1, 2001), 
at the request of the industry, to allow independent laboratories and 
hospitals sufficient time to negotiate arrangements. Moreover, our full 
implementation of Sec.  415.130 was further delayed by section 542 of 
the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection 
Act of 2000 (Pub. L. 106-554) (BIPA) and section 732 of the MMA, which 
directed us to continue payment to independent laboratories for the TC 
of physician pathology services for hospital patients through CY 2006.
    In the CY 2007 PFS final rule with comment period (71 FR 69700), we 
announced that beginning January 1, 2007, we would no longer allow the 
carriers to pay the independent laboratory for the TC of physician 
pathology services to hospital patients. In effect, we would be: (1) 
Implementing the provisions of the CY 2000 PFS final rule with comment 
period whose implementation had been delayed by section 542 of the BIPA 
and section 732 of the MMA; and (2) ensuring that the Medicare program 
does not make duplicate payments for the same service.
    Subsequent to publication of the CY 2007 PFS final rule with 
comment period, the MIEA-TRHCA was enacted. Section 104 of the MIEA-
TRHCA provided for an additional 1 year extension to allow carriers to 
continue to pay independent laboratories under the PFS for the TC 
portion of physician pathology services furnished to patients of a 
covered hospital.
    Consistent with this legislative change, we are amending Sec.  
415.130(d) to specify that for services furnished after December 31, 
2007, an independent laboratory may not bill the carrier for the TC of 
physician pathology services furnished to a hospital inpatient or 
outpatient.
    Comment: Many commenters asked us to implement the grandfather 
provision on a permanent basis, and if this cannot be accomplished 
administratively, the commenter requested that we implement this 
provision no earlier than July 1, 2008. The commenter indicated that 
this delay would allow the grandfathered independent laboratories the 
opportunity to implement new billing requirements and inform customers 
of this change.
    Response: We will delay implementation of this provision only if 
legislation is enacted requiring a further delay. Otherwise, we will, 
as explained in the CY 2008 PFS proposed rule, implement this provision 
effective for TC services furnished on or after January 1, 2008.
    Comment: A commenter indicated a potential problem in the preamble 
language of the CY 2008 PFS proposed rule that explains the 
implementation of the TC physician pathology provision effective 
January 1, 2008. In the CY 2008 PFS proposed rule, the preamble reads, 
``Consistent with this legislative change, we are amending Sec.  
415.130(d) to reflect that for services furnished after December 31, 
2007, an independent laboratory may not bill the carrier for physician 
pathology services furnished to a hospital inpatient or outpatient'' 
(72 FR 38205). As currently written, this language would mean that the 
independent laboratory cannot bill the carrier for the PC of physician 
pathology services for hospital patients, an unintended result.
    Response: The preamble inadvertently omitted the term ``technical 
component'' and should read, ``For

[[Page 66356]]

services furnished after December 31, 2007, an independent laboratory 
may not bill the carrier for the technical component of physician 
pathology services furnished to a hospital inpatient or outpatient.'' 
We proposed this language in the regulations text of the proposed rule 
and are finalizing this language in this final rule with comment 
period.
4. Section 201--Extension of Therapy Cap Exception Process
    Section 1833(g)(1) of the Act applies an annual per beneficiary 
combined cap beginning January 1, 1999, on outpatient physical therapy 
and speech-language pathology services, and a similar separate cap on 
outpatient occupational therapy services. These caps apply to expenses 
incurred for the respective therapy services under Medicare Part B, 
with the exception of services furnished as outpatient hospital 
services. Section 1833(g)(2) of the Act provides that, for CY 1999 
through CY 2001, the caps were $1500, and for the calendar years after 
2001, the caps are equal to the preceding year's cap increased by the 
percentage increase in the Medicare Economic Index (MEI) (except that 
if an increase for a year is not a multiple of $10, it is rounded to 
the nearest multiple of $10).
    The cap for CY 2008 will be $1810 per beneficiary for PT and SLP 
services combined, and $1810 for OT services. Therapy caps apply to 
expenses incurred for therapy services in all outpatient settings 
except the outpatient hospital department. As explained below in this 
section, the statute requires that we implement the therapy caps 
without providing for an exceptions process beginning on January 1, 
2008.
    Section 5107(a) of the DRA required the Secretary to develop an 
exceptions process for the therapy caps effective for expenses incurred 
during CY 2006. Details of the CY 2006 exceptions process were 
published in a manual change on February 13, 2006 (CR4364, which 
consists of Transmittal 855, Transmittal 47, and Transmittal 140). 
Section 201 of the MIEA-TRHCA extended the exceptions process to apply 
for expenses incurred through December 31, 2007. Therapy cap exception 
policies for 2007 were specified in Change Request 5478 which consists 
of three transmittals with current numbers of--
    <bullet> Transmittal 1145CP, Pub. 100-04;
    <bullet> Transmittal 63BP, Pub. 100-02; and
    <bullet> Transmittal 181PI, Pub. 100-08.
    The transmittals are incorporated into the Internet Only Manuals 
available at http://www.cms.hhs.gov/Manuals and are also available on 
our Web site at http://www.cms.hhs.gov/Transmittals/.
    In accordance with the statute as amended by the MIEA-TRHCA, we 
will continue to implement therapy caps, but the exceptions process 
will no longer be applicable for expenses incurred for services 
furnished beginning on January 1, 2008. As noted previously in this 
section, under current law, therapy caps will continue to apply to 
expenses incurred for therapy services after December 31, 2007, with 
one exception. That is, in accordance with section 1833(g) of the Act, 
the therapy caps will remain inapplicable to expenses incurred for 
therapy services furnished in the outpatient hospital setting.
    We received several comments on this proposal.
    Comment: Most commenters understood that we have no authority to 
change therapy caps, but still commented in favor of repealing them. 
Some commenters supported the continuation of the exceptions process as 
a well-conceived method of eliminating unnecessary treatment. Some 
commenters objected to the inapplicability of the caps for therapy 
expenses incurred in the outpatient hospital setting. One commenter 
supported the repeal of therapy caps and stated it is not an effective 
cost control when a steady source of replacement patients is available.
    Another commenter opposed the policy underlying the statutory 
provision to apply a financial cap on therapy services. The commenter 
cited other means of ensuring appropriate utilization of therapy 
services including CCI edits, edits required by the Deficit Reduction 
Act, local coverage determination policies, and Transmittal 63, which 
required greater documentation. The commenter indicated that we are 
effectively achieving the objective to assure appropriate utilization 
of therapy services without the financial caps.
    Response: We do not have the authority to repeal therapy caps, to 
change the exception to applicability of the caps for services provided 
in the outpatient hospital setting, or to extend the therapy cap 
exceptions process beyond the period for which was made applicable by 
statute (CYs 2006 and 2007).
    Comment: Several commenters urged CMS to implement the 
recommendations contained in the Computer Science Corporation (CSC) 
Outpatient Therapy Service Pilot Report of 2006 to collect patient-
specific data using available measurement tools. Although they 
acknowledged that we may have concerns about the use of proprietary 
tools, the commenter urged the use of therapy-specific tools already on 
the market that were recommended by both CSC and MedPAC, including the 
National Outcomes Measurement System.
    Response: In evaluating alternative payment systems, we will 
consider all methods of obtaining the required patient-related 
information including reports of past and future contract deliverables.
    Comment: Many commenters are deeply concerned about the negative 
impact the caps would have, in the absence of the exceptions process, 
on an estimated 14.5 percent of the physical therapy (PT) users who 
would exceed the cap. The commenters commended CMS for progress made 
toward alternatives to the financial caps in recent years and urged a 
high priority in resources and funding to continuing research to 
identify alternatives that would also ensure access to medically 
necessary therapy services. The commenters support the collection of 
patient outcome data with patient assessment tools and use of risk 
adjustment to account for individual differences. They support the 
ongoing study for which CMS recently issued a Request for Task Order 
(RTOP-CMS-07-033) and look forward to participating in the study.
    Many commenters reported that they will be collecting and reporting 
outcome data before January 1, 2008. They urged CMS to use clinical 
outcome data to determine the amount of care needed by individuals and 
offered assistance in data collection.
    Response: We recently issued a request for proposals (RTOP-CMS-07-
033) to continue our study of therapy services. The study will: (1) 
Identify, collect and use therapy-related information that is tied to 
beneficiary needs and treatment effectiveness; and (2) develop payment 
method alternatives to the current cap on outpatient therapy services.
    We welcome any information concerning clinical outcome data studies 
from providers or suppliers. If the information is applicable to our 
deliberations on payment alternatives, we will consider it along with 
the results of past and future contract deliverables.
    Comment: One commenter recommended that we continue to collect 
outpatient therapy utilization information for 2006 and 2007.
    Response: We contracted with the CSC (HHSM-500-2007-00322G) to 
extract 2006 therapy utilization data and provide a high level 
analysis. To the extent possible, we intend to further

[[Page 66357]]

study the impact of therapy caps including the 2006 exceptions process.
5. Section 101(d)--Physician Assistance and Quality Initiative (PAQI) 
Fund
    Section 1848(l) of the Act, as added by section 101(d) of the MIEA-
TRHCA requires the Secretary to establish a Physician Assistance and 
Quality Initiative (PAQI) Fund (the Fund) which shall be available for 
physician payment and quality improvement initiatives, and which may 
include application of an adjustment to the update of the PFS 
conversion factor (CF). The provision makes available $1.35 billion to 
the Fund for services furnished during CY 2008. Specifically, the 
provision directs the Secretary to provide for expenditures from the 
Fund in a manner designed to provide (to the maximum extent feasible) 
for the obligation of the entire $1.35 billion for payment for 
physicians' services furnished during CY 2008. The provision also 
requires that if expenditures from the Fund are applied to, or 
otherwise affect, a CF for a year, the CF for a subsequent year shall 
be computed as if the adjustment to the CF had never occurred. We note 
that the Transitional Medical Assistance, Abstinence Education, and 
Qualifying Individual Programs Extension Act of 2007 (Pub. L. 110-90) 
recently was signed into law and it provides an additional $325 million 
to be used as a part of the PAQI Fund for payment with regard to 
services furnished in 2009 and $60 million for payment for physicians' 
services furnished on or after January 1, 2013. The legislation does 
not make any other changes to the program, and therefore, remains as 
discussed in the proposed rule.
    As the MIEA-TRHCA legislation indicates, this Fund can be used for 
physician payment and quality improvement, including application of an 
adjustment to the update of the conversion factor. In the CY 2007 PFS 
proposed rule, we proposed to use the $1.35 billion to fund bonus 
payments to be made during CY 2009 for physician reporting of measures 
during CY 2008. Specifically, we proposed that the physician quality 
initiative for CY 2008 be structured and implemented in the same manner 
as the 2007 PQRI with regard to the professionals eligible to 
participate in the program, reporting quality measures via claims 
submission, and the standards for satisfactory reporting.
    The differences between CY 2007 and CY 2008 that we currently 
anticipate are noted below in this section. As we monitor the 
implementation of the 2007 PQRI and possibly make refinements to the 
2007 program, we anticipate that such refinements would also apply 
under the 2008 program. Such refinements, should they be needed, will 
be noted with guidance linked from the CMS quality reporting Web site 
at http://www.cms.hhs.gov/PQRI.
    As with the 2007 PQRI, we proposed that eligible professionals who 
successfully report a designated set of quality measures in 2008 may 
earn a bonus payment of a percentage of total allowed charges for 
covered Medicare services, subject to a cap based on the volume of 
quality reporting. In contrast to 2007, we proposed that eligible 
professionals could report applicable measures for services furnished 
from January 1, 2008 through December 31, 2008, and allowed charges 
during such period would be the basis for calculating the bonus 
payments. We proposed that the CY 2008 measures that we finalize in 
this final rule with comment period would apply for CY 2008. We also 
proposed to estimate all of the bonus payments that would be payable to 
physicians using the same method as the one used for reporting during 
2007 and to calculate the amount of the bonus payment, after the close 
of CY 2008 reporting period. Given that we proposed to use the PAQI 
Fund for the 2008 PQRI program, we also proposed that the bonus 
payments to individual physicians be subject to an aggregate cap of 
$1.35 billion. Because we proposed to scale aggregate payments to 
physicians in a manner such that Medicare would pay $1.35 billion 
during CY 2009 for measures reported for services furnished during CY 
2008, we were unable to provide an exact percentage for the bonus 
payment. However, we anticipated that the bonus payments would be 
approximately 1.5 percent of allowed charges for participating 
professionals (and we did not expect that the ultimate percentage 
amount would exceed 2 percent).
    Comment: Comments received on the proposed rule were generally 
opposed to using the PAQI Fund for CY 2008 PQRI bonus payments. Almost 
all comments on this issue requested that we use the entire $1.35 
billion to help offset the estimated negative 9.9 percent physician 
update for CY 2008.
    Response: In the CY 2007 PFS proposed rule, we acknowledged this 
alternative approach of using the $1.35 billion in some manner to 
reduce the update to the PFS of negative 9.9 percent that is projected 
for CY 2008. However, we noted that there are fundamental operational 
problems with this approach that make it not feasible. The $1.35 
billion is a fixed dollar amount. Once the amount is reached, there is 
no authority to pay any more than that amount. Medicare is an 
entitlement program that covers medically necessary services for 
eligible beneficiaries, but such coverage is not limited to a fixed 
dollar amount for a year. While we estimate that the $1.35 billion 
would reduce the negative update by approximately 2 percentage points, 
actual spending could be above or below the estimate. To insure that we 
do not exceed the Fund amount, we would have to estimate an amount to 
reduce the update by that is low enough to ensure the $1.35 billion 
funding cap is not exceeded. While this approach might reduce the CY 
2008 negative update, it could still leave money in the Fund. We are 
concerned that there may be potential oversight or other legal 
consequences in the event that we significantly exceed the Fund or do 
not apply the entire Fund. Therefore, we believe the best use of the 
Fund is to apply it to extend PQRI into CY 2008.
    Comment: Commenters asserted that use of the PAQI Fund for anything 
other than the physician update was inconsistent with Congressional 
intent. Commenters cited TRHCA language that the Fund ``may include 
application of an adjustment to the update of the conversion factor.'' 
Commenters further noted that this use must have been Congressional 
intent, since the legislation includes explicit language of how to deal 
with the update in subsequent years when the Fund is used towards the 
update: ``[I]n the case that expenditures from the Fund are applied to, 
or otherwise affect, a conversion factor * * * the conversion factor 
under such subsection shall be computed for a subsequent year as if 
such application or effect had never occurred.''
    Many commenters cited the Congressional Budget Office's cost 
estimate for the TRHCA legislation, which anticipated CMS developing a 
plan to use approximately 90 percent of the Fund in CY 2008 and the 
remaining funds in CY 2009. These comments cited section 101(d) of the 
MIEA-TRHCA, where the Congress stated that the Fund should be used ``to 
the maximum extent feasible'' for physicians' services during CY 2008, 
interpreting Congressional intent to be that CMS do its best to 
distribute most of the money in CY 2008, and any remaining monies in CY 
2009.
    Commenters rejected the rationale that there were serious legal and 
operational barriers to applying the PAQI Fund to the physician update; 
they expressed confidence that we could find some way to use the Fund 
to offset the reduction.

[[Page 66358]]

    Further, commenters noted that it was within our discretion to 
apply the PAQI Fund to the physician update, and they were highly 
critical of our unwillingness to take administrative steps to mitigate 
the negative 9.9 percent physician update.
    Response: Section 101(d) of the MIEA-TRHCA directs the Secretary to 
establish a PAQI Fund to be available to the Secretary for physician 
payment and quality improvement initiatives, which may include 
application of an adjustment to the update of the CF under that 
subsection. The legislation clearly indicates that the Secretary has 
the discretion to use the Fund for physician payment and quality 
improvement initiatives, including application of an adjustment to the 
update of the conversion factor. However, we are not required to use 
the funds for the update.
    As noted above, there are fundamental operational problems with 
applying the PAQI Fund to the conversion factor update. We are 
concerned that there may be potential oversight or other legal 
consequences in the event the Agency significantly exceeds the Fund or 
does not apply the entire Fund. For the reasons previously discussed, 
we believe it is in the best interests of the program to apply this 
Fund to the extension of PQRI.
    Comment: Commenters rejected the notion that use of the $1.35 
billion to fund the CY 2008 PQRI is the best way to insure physicians 
get the greatest benefit from the PAQI Fund's resources. Commenters 
stated that the PQRI does not provide all physicians with an 
opportunity to participate and that many specialties treat patients 
with conditions for which PQRI measures do not apply. In contrast, 
using the Fund to offset the negative update for CY 2008 would benefit 
all physicians.
    Response: Medicare payment systems need to encourage reliable, high 
quality and efficient care, rather than making payment simply based on 
the quantity of services provided and resources consumed. Applying the 
$1.35 billion to PQRI bonuses allows CMS to further the goal of 
improving quality and efficiency by utilizing the infrastructure that 
both physicians and Medicare have invested in for the CY 2007 PQRI. We 
believe implementing this Fund through an extension of the PQRI program 
is the best way to ensure that the Fund is being used to increase 
quality and efficiency of care for Medicare beneficiaries.
    Comment: Commenters rejected the notion that using the PAQI Fund 
for bonuses would improve quality. For most physicians, the proposed 
estimated 1.5 percent bonus payment is insufficient to cover the costs 
to institute such quality reporting measures. Commenters noted that if 
CMS truly wished to encourage more providers to participate in the 
PQRI, ``new money'' must be found to fund the initiative. Commenters 
suggested bonuses between 5 and 10 percent of allowed charges would 
more reasonably cover the costs of improving their infrastructure to 
appropriately report quality measures.
    Response: Funding the PQRI is consistent with the goal of improving 
quality and efficiency in Medicare. Eligible professional can 
participate in the PQRI by reporting the appropriate quality measure 
data on claims submitted to their Medicare claims processing 
contractor. We provide educational resources on the PQRI Web site that 
allow eligible professionals to integrate PQRI reporting into their 
care delivery process without significant changes in their 
infrastructures.
    We appreciate the desire of eligible professionals to improve their 
infrastructure to better track quality of care. For many eligible 
professionals, such infrastructure is already in place for PQRI and 
will not require additional investment. However, we note that PQRI 
bonuses are financial incentives to participate in a voluntary quality 
reporting program and were not intended to cover the costs of 
significantly improving the infrastructure of eligible professionals.
    Comment: Many commenters noted that the PQRI has not been proven to 
have any positive effect on patient care or health outcomes. Rather 
than utilizing the $1.35 billion to support an unproven program, it 
would be better to directly improve physician reimbursement and better 
cover the costs of the necessary care they are currently providing to 
beneficiaries.
    Response: The PAQI Fund was made available to the Secretary for 
physician payment and quality improvement initiatives. We are actively 
engaged with the physician community in identifying ways to align 
Medicare's physician payment system with the goals of health 
professionals for high-quality care. Using the PAQI Fund to pay for the 
PQRI aligns reimbursement with quality and efficiency. We have worked 
collaboratively with the physician community to develop measures that 
capture the quality of care being provided to our Medicare 
beneficiaries. The PQRI encourages physicians to provide the type of 
care that is best suited for our beneficiaries: Care focused on 
prevention and treating complications; and care focused on the most 
effective, proven treatments available.
    We acknowledge the relative newness of the PQRI. To that end, we 
are committed to continue working with the physician community in an 
open and transparent way to insure that the PQRI supports the best 
approaches to provide high quality health care services.
    Comment: Commenters noted that Congressional intent was to provide 
some relief and stability to the physician payment system during CY 
2008. However, under the terms of the proposed rule, CMS cannot let 
physicians know the amount of the reporting bonus until well after the 
close of the CY 2008 reporting period, and physicians would not receive 
bonuses until some time in CY 2009.
    Response: Section 101(d) of the MIEA-TRHCA charges the Secretary 
with a timely obligation of all available funds for services furnished 
during CY 2008, directing the Secretary to provide for expenditures 
from the Fund in a manner designed to provide (to the maximum extent 
feasible) for the obligation of the entire $1.35 billion for 
physicians' services furnished during CY 2008. Although the legislation 
is clear that payment of the Fund is based on services furnished during 
CY 2008, the legislation does not limit the Secretary to paying from 
the PAQI Fund during CY 2008.
    Comment: One commenter stated that quality payments should not be 
geographically adjusted. The commenter suggested that PQRI payments 
should be based on RVUs, not allowed charges.
    Response: Section 101(c) of MIEA-TRHCA authorizes a financial 
incentive for eligible professionals to participate in a voluntary 
quality reporting program. Eligible professionals, who choose to 
participate and successfully report on a designated set of quality 
measures for services paid under the Medicare Physician Fee Schedule 
and provided between July 1 and December 31, 2007, may earn a bonus 
payment of 1.5 percent of their allowed charges during that period, 
subject to a cap. In the CY 2008 PFS proposed rule (72 FR 38206), we 
proposed that the physician quality initiative for CY 2008 be 
structured and implemented in the same manner as the 2007 PQRI, as 
described above. This includes calculating the amounts of the 2008 
bonus payments based upon a percentage of allowed charges, as was 
statutorily required for 2007 bonus payments. By definition, allowed 
charges include the geographical adjustments in payments, as determined 
by the geographic practice cost indices (GPCIs), which

[[Page 66359]]

reflect the variation in practice costs from area to area.

III. Revisions to the Payment Policies of Ambulance Services Under the 
Fee Schedule for Ambulance Services; Ambulatory Inflation Factor Update 
for CY 2007

    As discussed in the CY 2008 PFS proposed rule (72 FR 38207), under 
the ambulance fee schedule, the Medicare program pays for 
transportation services for Medicare beneficiaries when other means of 
transportation are contraindicated. Ambulance services are classified 
into different levels of ground (including water) and air ambulance 
services based on the medically necessary treatment provided during 
transport. These services include the following levels of service:
    For Ground--
    <bullet> Basic Life Support (BLS).
    <bullet> Advanced Life Support, Level 1 (ALS1).
    <bullet> Advanced Life Support, Level 2 (ALS2).
    <bullet> Specialty Care Transport (SCT).
    <bullet> Paramedic ALS Intercept (PI).
    For Air--
    <bullet> Fixed Wing Air Ambulance (FW).
    <bullet> Rotary Wing Air Ambulance (RW).
A. History of Medicare Ambulance Services

    1. Statutory Coverage of Ambulance Services
    Under sections 1834(l) and 1861(s)(7) of the Act, Medicare Part B 
covers and pays for ambulance services, to the extent prescribed in 
regulations, when the use of other methods of transportation would be 
contraindicated by the beneficiary's medical condition. The House Ways 
and Means Committee and Senate Finance Committee Reports that 
accompanied the 1965 Social Security Amendments suggest that the 
Congress intended that--
    <bullet> The ambulance benefit cover transportation services only 
if other means of transportation are contraindicated by the 
beneficiary's medical condition; and
    <bullet> Only ambulance service to local facilities be covered 
unless necessary services are not available locally, in which case, 
transportation to the nearest facility furnishing those services is 
covered (H.R. Rep. No. 213, 89th Cong., 1st Sess. 37 and Rep. No. 404, 
89th Cong., 1st Sess. Pt 1, 43 (1965)).
    The reports indicate that transportation may also be provided from 
one hospital to another, to the beneficiary's home, or to an extended 
care facility.
2. Medicare Regulations for Ambulance Services
    Our regulations relating to ambulance services are set forth at 42 
CFR part 410, subpart B and 42 CFR part 414, subpart H. Section 
410.10(i) lists ambulance services as one of the covered medical and 
other health services under Medicare Part B. Therefore, ambulance 
services are subject to basic conditions and limitations set forth at 
Sec.  410.12 and to specific conditions and limitations as specified in 
Sec.  410.40. Part 414, subpart H, describes how payment is made for 
ambulance services covered by Medicare.
3. Transition to National Fee Schedule
    The national fee schedule for ambulance services was phased in over 
a 5-year transitional period beginning April 1, 2002, as specified in 
Sec.  414.615. As of January 1, 2006, the total payment amount for air 
ambulance providers and suppliers is based on 100 percent of the 
national ambulance fee schedule. In accordance with section 414 of the 
MMA, we added Sec.  414.617 which specifies that for ambulance services 
furnished during the period July 1, 2004, through December 31, 2009, 
the ground ambulance base rate is subject to a floor amount, which is 
determined by establishing nine fee schedules based on each of the nine 
census divisions, and using the same methodology as was used to 
establish the national fee schedule. If the regional fee schedule 
methodology for a given census division results in an amount that is 
lower than or equal to the national ground base rate, then it is not 
used, and the national fee schedule amount applies for all providers 
and suppliers in the census division. If the regional fee schedule 
methodology for a given census division results in an amount that is 
greater than the national ground base rate, then the fee schedule 
portion of the base rate for that census division is equal to a blend 
of the national rate and the regional rate through CY 2009. Thus, as of 
January 1, 2007, the total payment amount for ground ambulance 
providers and suppliers is based on either 100 percent of the national 
ambulance fee schedule amount, or a combination of 80 percent of the 
national ambulance fee schedule and 20 percent of the regional 
ambulance fee schedule.

B. Ambulance Inflation Factor (AIF) During the Transition Period

    As we noted in the previous section, the national fee schedule for 
ambulance services was phased in over a 5 year transition period 
beginning April 1, 2002, as specified in Sec.  414.615. During the 
transition period, the ambulance inflation factor (AIF) was applied 
separately to both the fee schedule portion of the blended payment 
amount (regardless of whether a national or regional fee schedule 
applied) and to the supplier's reasonable charge or provider's 
reasonable cost portion of the blended payment amount, respectively, 
for each ambulance provider or supplier. Then, the two amounts were 
added together to determine the total payment amount for each provider 
or supplier.

C. Ambulance Inflation Factor (AIF) for CY 2008

    Section 1834(l)(3)(B) of the Act provides the basis for updating 
payment amounts for ambulance services. Section 414.610(f) specifies 
that certain components of the ambulance fee schedule are updated by 
the AIF annually, based on the consumer price index for all urban 
consumers (CPI-U) (U.S. city average) for the 12-month period ending 
with June of the previous year. In the CY 2008 PFS proposed rule, we 
stated the AIF for CY 2008 would be announced as part of this final 
rule with comment period. For CY 2008, the percentage is 2.7 percent. 
In addition, as set forth in Section III.D., we also proposed to 
announce the AIF for CY 2009 and subsequent years via CMS instruction 
and on the CMS Web site.

D. Revisions to the Publication of the Ambulance Fee Schedule (Sec.  
414.620)

    Currently, Sec.  414.620 specifies that changes in payment rates 
resulting from incorporation of the AIF will be announced by notice in 
the Federal Register without opportunity for prior comment. As 
explained in the CY 2008 PFS proposed rule, we believe it is 
unnecessary to undertake notice and comment rulemaking to update the 
AIF because the statute and regulations specify the methods of 
computation of annual inflation updates, and we have no discretion in 
that matter. Thus, the annual AIF notice does not change or establish 
policy, but merely applies the update methods specified in the statute 
and regulations.
    As discussed in the proposed rule, by mid-July of each year, we 
have the CPI-U for the 12-month period ending with June of such year. 
Therefore, we know what the AIF for the upcoming calendar year will be 
by mid-July of each year. However, Sec.  414.620 currently states that 
the AIF will be announced in the Federal Register. Each document 
published in the Federal Register requires scheduling and a thorough 
review by CMS, HHS, and OMB prior to publication. Therefore, even 
though we

[[Page 66360]]

know the AIF by mid-July of each year, the final rule announcing the 
AIF is not published until November. This publication timeframe does 
not allow Medicare contractors the optimal amount of time to update 
their systems to implement the proper payment for Medicare ambulance 
claims by January 1 of the coming year. In addition, it does not 
provide an optimal amount of time for either the Medicare contractors 
or the ambulance industry to take advantage of testing systems to make 
sure that the update is working properly as implemented. We believe 
that announcing the AIF via CMS instructions and on the CMS Web site 
would enable the AIF to be released earlier in the calendar year, 
allowing the Medicare contractors to test their data systems, and to 
timely effectuate and provide accurate payments on Medicare ambulance 
claims.
    Therefore, we proposed to revise Sec.  414.620 to state that we 
will announce the AIF via CMS instruction and on the CMS Web site and 
to remove the language that states that we will announce the AIF by 
notice in the Federal Register.
    Comment: Comments received regarding the issue of announcing the 
AIF via CMS instruction and on the CMS Web site were very supportive of 
this proposal.
    Response: As we proposed, we are revising Sec.  414.620 to state 
that CMS will announce the AIF via CMS instruction and on the CMS Web 
site, and to remove the language that states that we will announce the 
AIF by notice in the Federal Register.

IV. Refinement of RVUs for CY 2008 and Response to Public Comments on 
Interim RVUs for 2007

    [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 IV.B. and IV.C. of this final rule with comment describes 
the methodology used to review the comments received on the RVUs for 
physician work, including the additional codes from the 5-Year Review 
of work RVUs, and the process used to establish RVUs for new and 
revised CPT codes. Changes to the RVUs and billing status codes 
reflected in Addendum B are effective for services furnished beginning 
January 1, 2008.

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

    The CY 2007 PFS final rule with comment period (71 FR 69624) 
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, 2007. We considered the RVUs for the interim codes 
to be subject to public comment under the annual refinement process. In 
the CY 2008 PFS proposed rule we also proposed work RVUs for additional 
codes from the 5-Year Review of work RVUs. In this section, we address 
comments and summarize the refinements to the additional codes from the 
5-Year Review of work RVUs, the interim work RVUs published in the CY 
2007 PFS final rule with comment period, and our establishment of the 
work RVUs for new and revised codes for the CY 2008 PFS.

C. 5-Year Review of Work RVUS

1. Additional Codes From the 5-Year Review of Work RVUs
    The CY 2008 PFS proposed rule (72 FR 38146) discussed the RUC 
recommendations on work RVUs for a number of codes from the 5-Year 
Review that were deferred from the CY 2007 PFS rulemaking and listed 
the specific codes in Table 10. We proposed to accept all of the RUC 
recommendations, with the exception of CPT code 93325, Doppler 
echocardiography color flow velocity mapping (List separately in 
addition to codes for echocardiography), which we proposed to bundle. 
We also noted that CPT codes 92557, 92567, 92568, 92569, 92579, 92601, 
92602, 92603 and 92604 previously had no work RVUs assigned to them.
    Many commenters expressed support for our proposed valuations of 
many of the services. However, other commenters expressed specific 
concern or disagreement with the proposed valuation of approximately 17 
codes.
    To evaluate these comments, we used a process similar to the 
process used since 1997. (See the CY 1998 PFS final rule published in 
the October 31, 1997 Federal Register (62 FR 59084) for the discussion 
of refinement of CPT codes with interim work RVUs.) We convened a multi 
specialty 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 14: Work RVU 
Revisions for Additional 5-Year Review Codes. 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> Clinicians representing the commenting specialty(ies), 
based on our determination of those specialties which are most 
identified with the services in question. Although commenting 
specialties were welcomed to observe the entire refinement process, 
they were only involved in the discussion of those services for which 
they were invited to participate.
    <bullet> Primary care clinicians nominated by the AAFP and the 
American College of Physicians.
    <bullet> Carrier Medical Directors.
    <bullet> Clinicians who practice in related specialties and have 
knowledge of the services 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 reference services and asked the panel members to 
compare the clinical aspects of the work for the service a commenter 
believed was incorrectly valued to one or more of the reference 
services. In compiling the reference set, we attempted to include: (1) 
Services that are commonly furnished for which work RVUs are not 
controversial; (2) services that span the entire spectrum of work 
intensity from the easiest to the most difficult; and (3) at least 
three services furnished 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 for each 
service, each participant rated the work for that procedure. Ratings 
were individual and confidential; 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 that 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 general terms, we used statistical tests 
to determine whether there was enough agreement among the groups on the 
panel and, if so, whether the agreed-upon work RVUs were significantly 
different from the proposed work RVUs

[[Page 66361]]

in the CY 2008 PFS proposed rule to demonstrate that the proposed work 
RVUs should be modified. We did not modify the work 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 work 
RVUs should be, we eliminated the outlier group, and looked for 
agreement among the remaining groups as to the basis for new work RVUs. 
We used the same methodology in analyzing the ratings that we first 
used in the refinement process for the CY 1993 PFS final rule published 
in the November 25, 1992 Federal Register which described the 
statistical tests in detail (57 FR 55938). Our decision to convene a 
multi-specialty panel of physicians and to apply the statistical tests 
described above in this section 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 14 lists the additional codes for the 5-Year Review on which 
we received comments. This table includes the following information:
    <bullet> CPT/HCPCS Code. This is the CPT or alphanumeric HCPCS code 
for a service.
    <bullet> Modifier. A modifier 26 is shown if the work RVUs 
represent the professional component (PC) of the service.
    <bullet> Description. This is an abbreviated version of the 
narrative description of the code.
    <bullet> Proposed Work RVUs. This column includes the work RVUs 
proposed in the CY 2008 PFS proposed rule for each reviewed code.
    <bullet> Requested Work RVUs. This column identifies the work RVUs 
requested by the commenters. If the commenters requested different 
RVUs, the table lists the highest requested RVUs.
    <bullet> RUC Recommendation. This column identifies the work RVUs 
recommended by the RUC that appeared in the CY 2008 PFS proposed rule.
    <bullet> 2008 Work RVUs. This column contains the work RVUs for the 
CY 2008 PFS.
    <bullet> Basis for Decision. This column indicates whether the CY 
2008 work RVUs resulted from comments received or the refinement panel 
process.

                                            Table 14.--Work RVU Revisions for Additional 5-Year Review Codes
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                                   Work RVUs
   CPT/HCPCS code \1\         Mod             Descriptor         Proposed work   requested by       RUC rec      2008 work RVU     Basis for decision
                                                                      RVU         commenters
--------------------------------------------------------------------------------------------------------------------------------------------------------
92557...................  ...........  Comprehensive hearing              0.60            1.40            0.60            0.60  Refinement.
                                        test.
92579...................  ...........  Visual audiometry (vra)            0.70            1.70            0.70            0.70  Refinement.
99326...................  ...........  Domicil/r-home visit               2.27            2.85            2.27            2.63  Refinement.
                                        new pat.
99327...................  ...........  Domicil/r-home visit               3.03            3.75            3.03            3.46  Refinement.
                                        new pat.
99328...................  ...........  Domicil/r-home visit               3.78            4.26            3.78            4.09  Refinement.
                                        new pat.
99334...................  ...........  Domicil/r-home visit               0.76            1.25            0.76            1.07  Refinement.
                                        est pat.
99335...................  ...........  Domicil/r-home visit               1.26            2.00            1.26            1.72  Refinement.
                                        est pat.
99336...................  ...........  Domicil/r-home visit               2.02            2.75            2.02            2.46  Refinement.
                                        est pat.
99337...................  ...........  Domicil/r-home visit               3.03            4.05            3.03            3.58  Refinement.
                                        est pat.
99343...................  ...........  Home visit, new patient            2.27            2.65            2.27            2.53  Refinement.
99344...................  ...........  Home visit, new patient            3.03            3.60            3.03            3.38  Refinement.
99345...................  ...........  Home visit, new patient            3.78            4.26            3.78            4.09  Refinement.
99347...................  ...........  Home visit, est patient            0.76            1.10            0.76            1.00  Refinement.
99348...................  ...........  Home visit, est patient            1.26            1.70            1.26            1.56  Refinement.
99349...................  ...........  Home visit, est patient            2.02            2.50            2.02            2.33  Refinement.
99350...................  ...........  Home visit, est patient            3.03            3.45            3.03            3.28  Refinement.
93325...................  ...........  Doppler color flow add-            0.07            0.30             CPT            0.07  Comments.
                                        on.
--------------------------------------------------------------------------------------------------------------------------------------------------------
\1\ All CPT codes and descriptors copyright 2007 American Medical Association.

Discussion of Comments by Clinical Area

    For CPT code 92557, Comprehensive audiometry threshold evaluation 
and speech recognition, and CPT code 92579, Visual reinforcement 
audiometry (VRA), the RUC recommended 0.60 work RVUs for CPT 92557 and 
0.70 work RVUs for CPT code 92579, which we accepted.
    Comment: Commenters disagreed with the RUC-recommended work values 
for these services, which we had accepted. The commenters believed that 
the recommended values were not appropriate considering the time and 
intensity involved in performing these services. Based on these 
comments, we referred these codes to the multi-specialty validation 
panel for review.
    Response: As a result of the statistical analysis of the 2007 
multi-specialty validation panel ratings, we have assigned 0.60 work 
RVUs to CPT code 92557 and 0.70 work RVUs to CPT code 92579.
    For CPT code 99326, Domiciliary or rest home visit for the 
evaluation and management of a new patient, which requires these three 
key components: A detailed history; a detailed examination; and medical 
decision making of moderate complexity; CPT code 99327, Domiciliary or 
rest home visit for the evaluation and management of a new patient, 
which requires these three key components: A comprehensive history; a 
comprehensive examination; and medical decision making of moderate 
complexity; CPT code 99328, Domiciliary or rest home visit for the 
evaluation and management of a new patient, which requires these three 
key components: A comprehensive history; a comprehensive examination; 
and medical decision making of high complexity; CPT code 99334, 
Domiciliary or rest home visit for the evaluation and management of an 
established patient, which requires at least two of these three key 
components: A problem focused interval history; a problem focused 
examination; straightforward medical decision making; CPT code 99335, 
Domiciliary or rest home visit for the evaluation and management of an 
established patient, which requires at least two of these three key 
components: An expanded problem focused interval history; an expanded 
problem focused examination; medical decision making of low complexity; 
CPT code 99336, Domiciliary or rest home visit for the evaluation and 
management of an established patient, which requires at least two of 
these three key components:

[[Page 66362]]

A detailed interval history; a detailed examination; medical decision 
making of moderate complexity; CPT code 99337, Domiciliary or rest home 
visit for the evaluation and management of an established patient, 
which requires at least two of these three key components: A 
comprehensive interval history; a comprehensive examination; and 
medical decision making of moderate to high complexity; CPT code 99343, 
Home visit for the evaluation and management of a new patient, which 
requires these three key components: A detailed history; a detailed 
examination; and medical decision making of moderate complexity; CPT 
code 99344, Home visit for the evaluation and management of a new 
patient, which requires these three components: A comprehensive 
history; a comprehensive examination; and a medical decision making of 
moderate complexity; CPT code 99345, Home visit for the evaluation and 
management of a new patient, which requires these three key components: 
A comprehensive history; a comprehensive examination; and medical 
decision making of high complexity; CPT code 99347, Home visit for the 
evaluation and management of an established patient, which requires at 
least two of these three key components: A problem focused interval 
history; a problem focused examination; straightforward medical 
decision making; CPT code 99348, Home visit for the evaluation and 
management of an established patient, which requires at least two of 
these three key components: A problem focused interval history; a 
problem focused examination; straightforward medical decision making; 
CPT code 99349, Home visit for the evaluation and management of an 
established patient, which requires at least two of these three key 
components: A detailed interval history; a detailed examination; 
medical decision making of moderate complexity; and CPT code 99350, 
Home visit for the evaluation and management of an established patient, 
which requires at least tow of these three key components: A 
comprehensive interval history; a comprehensive examination; medical 
decision making of moderate to high complexity, the RUC recommended 
that the work RVUs for these codes be maintained at their current 
values: 2.27 work RVUs for CPT code 99326; 3.03 work RVUs for CPT code 
99327; 3.78 work RVUs for CPT code 99328; 0.76 work RVUs for CPT code 
99334; 1.26 work RVUs for CPT code 99335; 2.02 work RVUs for CPT code 
99336; 3.03 work RVUs for CPT code 99337; 2.27 work RVUs for CPT code 
99343; 3.03 for CPT code 99344; 3.78 work RVUs for CPT code 99345; 0.76 
work RVUs for CPT code 99347; 1.26 work RVUs for CPT code 99348; 2.02 
work RVUs for CPT code 99349; and 3.03 work RVUs for CPT code 99350, 
which we accepted.
    Comment: Commenters disagreed with the RUC-recommended work values 
for these services, which we had accepted. The commenters disagreed 
with the RUC-recommended work RVUs and believed the services were 
undervalued. The commenters also believed that the home visit work RVUs 
should remain ``relatively'' the same with respect to office visit 
codes as they did prior to the five-year review and requested that CMS 
reject the RUC recommended work RVUs and follow their survey values. 
Based on these comments, we referred these codes to the multi-specialty 
validation panel for review.
    Response: As a result of the statistical analysis of the 2007 
multi-specialty validation panel ratings, we have assigned 2.63 work 
RVUs to CPT code 99326; 3.46 work RVUs to CPT code 99327; 4.09 work 
RVUs to CPT code 99328; 1.07 work RVUs to CPT code 99334; 1.72 work 
RVUs to CPT code 99335; 2.46 work RVUs to CPT code 99336; 3.58 work 
RVUs to CPT code 99337; 2.53 work RVUs to CPT code 99343; 3.38 work 
RVUs to CPT code 99344; 4.09 work RVUs to CPT code 99345; 1.00 work 
RVUs to CPT code 99347; 1.56 work RVUs to CPT code 99348; 2.33 work 
RVUs to CPT code 99349; and 3.28 work RVUs to CPT code 99350.
    For CPT code 93325, Doppler echocardiography color flow velocity 
mapping (List separately in addition to codes for echocardiography), 
the RUC 5-Year Review workgroup recommended sending the code to the CPT 
Editorial Panel so that it could bundle CPT code 93325 into doppler 
echo code 93307. However, we believe that the technology of doppler 
imaging has evolved over the past 2 decades to enable color flow 
velocity and spectral analysis, both important components of doppler 
imaging, to be furnished concurrently or in concert to obtain more 
accurate interpretation and documentation of the anatomy and 
physiologic function of the structure(s) and organ being evaluated. 
Since the services described in 93325 have become intrinsic to the 
performance of other echocardiography services, we proposed to bundle 
93325 into CPT codes 76825, 76826, 76827, 76828, 93303, 93304, 93307, 
93308, 93312, 93314, 93315, 93317, 93320, 93321, 93350 and assign CPT 
code 93325 a status indicator of ``B'' (Bundled).
    Comment: Commenters uniformly opposed this proposal. They did not 
support the bundling of CPT codes 93325 into all of the codes we 
proposed. The commenters would prefer for CMS to adopt the new CPT code 
and not bundle CPT code 93325 with any other codes with CPT code 93325. 
The commenters believed we are circumventing the existing process to 
address bundling of these services and we should follow that process. 
Alternatively, the commenters believed that if we must bundle the 
codes, then we should increase the RVUs for the codes in which CPT code 
93325 is being bundled to recognize the work, PE, and malpractice 
components that are unique to CPT code 93325.
    Response: Based on comments received, we have decided to accept the 
RUC recommendation and allow the RUC to value the new CPT code for CY 
2009 for bundling CPT code 93325 with CPT codes 93320 and 93307. As a 
result of this decision, the work RVUs for CPT code 93325 will be 
maintained for CY 2008 at the 2007 work value of 0.07. The cardiology 
community has indicated to the RUC and CMS that the newly bundled CPT 
code represents the first of a series of coding changes they intend to 
propose over the course of the next year. These changes would result in 
the bundling of CPT code 93325 and other echocardiography codes to 
reflect the utilization of ultrasound services that are routinely 
performed together when providing care to a patient. We appreciate the 
initiative the cardiology community is taking on this issue, and we 
will reassess the echocardiography codes once this process is complete.
2. Anesthesia Coding (Part of 5-Year Review)
    Although anesthesia services are paid under the PFS, under section 
1848(b)(2)(B) of the Act, they are paid on the basis of an anesthesia 
code specific base unit and time units that vary based on the actual 
anesthesia time of the case. Since anesthesia services do not have a 
work RVU per code as do other medical and surgical services, a work 
value must be imputed for each anesthesia code. The imputed value is 
determined by multiplying the national average allowed charge for each 
anesthesia service by its anesthesia work share and dividing this 
amount by the general PFS conversion factor (CF). This places the work 
of the anesthesia service on the same relative value scale as all other 
physicians' services.
    As discussed in the CY 2008 PFS proposed rule, in the second 5-Year 
Review of anesthesia work implemented in 2002, the AMA RUC and the

[[Page 66363]]

American Society of Anesthesiologists (ASA) used a building block 
approach to estimate the value of anesthesia work and compared this 
value to the imputed work value to determine whether the work of 
anesthesia services is properly valued. Under the building block 
approach, each anesthesia code was uniformly divided into five 
components; pre anesthesia, equipment and supply preparation, 
induction, post induction anesthesia, and post anesthesia. Work is 
determined for each of the five components and summed to calculate 
total anesthesia work for the anesthesia code. The imputed value for 
the anesthesia code is compared to the building block estimate of work 
in order to assess whether, and if so, to what extent, the anesthesia 
code is not properly valued.
    The most significant component of work for the anesthesia service 
is the intensity for the post-induction anesthesia time. The ASA 
thought that the RUC significantly misvalued this component in the 
second 5-Year Review. In addition, the ASA was dissatisfied that the 
RUC did not extend the analysis from the 19 high volume anesthesia 
codes reviewed by the RUC to all anesthesia codes.
    In the CY 2007 PFS final rule with comment period, we addressed the 
issue of the work of anesthesia services under the third 5-Year Review 
of work. As explained in that rule, we made very modest adjustments to 
the work of the 19 anesthesia codes surveyed and analyzed by the RUC in 
the second 5-Year Review of work. These adjustments were made 
recognizing that the work of the pre- and post-anesthesia service 
components was linked to certain E/M services. Since we accepted the 
AMA RUC's recommendations for increased work values for certain E/M 
codes for the third 5-Year Review of work, we recalculated the work of 
the 19 anesthesia services to incorporate these higher work values. The 
adjustment in work was reflected by increasing the anesthesia CF by 
less than 1 percent.
    However, on the more significant issue of the valuation of work in 
the post induction anesthesia period, we took no action. Rather, in the 
CY 2007 PFS final rule with comment period, we asked the RUC to review 
and consider this issue as part of the third 5-Year Review of work. We 
also asked the RUC to consider how increases in the work of pre- and 
post-anesthesia services could cause adjustments to the anesthesia 
services not specifically reviewed by the ASA and the RUC.
    In January 2007, the ASA requested the AMA RUC to review the 
undervaluation of the work of the post-induction anesthesia period and 
to consider also an analytic approach, based on linear regression 
analysis, which could be used to evaluate the work of the entire 
anesthesia service. The linear regression model relates the work of the 
post-induction period time and the work of the entire anesthesia 
service to the base unit value for the anesthesia code. Under this 
model, the work of anesthesia services is undervalued by approximately 
34 percent.
    The RUC established an anesthesia workgroup to examine this 
proposal. The workgroup discussed this proposal extensively at its two 
teleconferences, prior to the April RUC meeting, and at the April RUC 
meeting itself. In May 2007, the AMA RUC, based on the analyses and 
recommendations of its workgroup, submitted a recommendation to CMS for 
a 32 percent increase in the work of anesthesia services.
    The workgroup approved the ASA's use of the linear regression model 
to value only the work of the post-induction period time. In contrast 
to the ASA proposal, the workgroup considered an analytic approach 
different from the regression model developed by the ASA. This approach 
is based on a building block approach that could be used to evaluate 
the work of all anesthesia service components other than the post 
induction period time. For example, for pre-anesthesia time, the 
methodology is as shown in Table 15.

                     Table 15.--Pre-Anesthesia Time
------------------------------------------------------------------------
 
-------------------------------------------------------------------------
All Anesthesia codes with 3 base units--linked to the work of 99201.
All Anesthesia codes with 4 base units--linked to the blend of work for
 99201 and 99202.
All Anesthesia codes with 5 to 15 base units--linked to the work of
 99202.
All Anesthesia codes with 16 to 30 base units--linked to the work of
 99252.
------------------------------------------------------------------------
Note: The source of the link for work is the pre anesthesia valuation
  from the 19 surveyed anesthesia codes whose base units varied from 3
  units to 25 units.

    Similar approaches are used for each anesthesia component: 
Preparation time, induction period time, and post-anesthesia time. 
Systematically, codes with lower anesthesia base unit values have lower 
work values for each component of the building block approach than do 
codes with higher anesthesia base unit values. For the given building 
block component, the work value of that component is the same for all 
anesthesia services that have the same base unit value.
    According to the workgroup's revised methodology which is extended 
from the 19 surveyed codes to all CPT anesthesia codes, the work of 
anesthesia services is undervalued by approximately 32 percent. Thus, 
based on the acceptance of the workgroup and the RUC's recommendation, 
an adjustment of approximately 25 percent would be applied to the 
anesthesia CF.
    Increases in the work of anesthesia services would have to be 
offset by additional adjustments to the PFS BN adjustor for work. We 
estimated that the increase in the anesthesia CF would result in an 
additional 1.0 percent increase in the BN adjuster for work.
    Other adjustments also affect the anesthesia CF. For example, an 
increase in anesthesia work may have implications for PE because 
indirect PEs are allocated based on the sum of work and direct PEs. 
When we ran the PE RVU program, there was a 1 percent decrease in the 
aggregate anesthesia PEs for CY 2008. Thus, an adjustment was made to 
the PE share of the anesthesia service of the CY 2008 anesthesia CF for 
this component.
    We proposed to accept the RUC's recommendation and increase the 
work of anesthesia services by 32 percent.
    Comment: Organizations and individual commenters supported our 
proposal and urged us to take action to implement this proposal in CY 
2008. They commented that this proposal improves the valuation of the 
work of anesthesia services and will help ensure that Medicare 
beneficiaries have access to quality anesthesia care. One commenter 
indicated that three additional anesthesia codes, 00142, 00210 and 
00562, have been identified as misvalued during the AMA RUC's 
evaluation of the work of anesthesia services. Both CMS and the AMA RUC 
agreed that the RUC would review the base units for 00142 at the 
September 2007 RUC meeting and that the other codes, as agreed by the 
ASA, would be referred to the CPT so that the codes descriptors could 
be clarified. The RUC reviewed and approved the ASA's request to 
support the current base unit value of four units for anesthesia code 
00142.
    Response: We have decided to accept the RUC's recommendation and 
increase the work of anesthesia services by 32 percent. We have also 
accepted the RUC's recommendation to maintain the value of four base 
units for anesthesia code 00142.
3. Budget Neutrality Adjustment
    Due to the proposed work RVU changes for the additional codes from 
the 5-Year Review of Work RVUs and

[[Page 66364]]

the proposed increases in the work of anesthesia services, in the CY 
2008 PFS proposed rule, we proposed to revise the work adjustor to 
maintain budget neutrality. Based upon the increases, the proposed 
revised work adjustor was estimated to be 0.8816. Further discussion of 
this work adjustor was included in the impact section of the CY 2008 
PFS proposed rule (72 FR 38211 through 38220).
    Comment: Several commenters recommended that we reconsider applying 
the BN adjustment associated with the 5-Year Review of work RVUs to the 
CF rather than the work RVUs.
    Response: We appreciate the commenters' interest in this topic. 
However, this issue was fully addressed in the CY 2007 PFS final rule 
with comment period (71 FR 69735), and we made no further proposals 
regarding this issue in the CY 2008 PFS proposed rule. We continue to 
believe that it is most appropriate to apply the BN adjustment to work 
RVUs and refer the commenters to the CY 2007 PFS final rule for an 
explanation of our decision.
    We note that as a result of the changes made in response to 
comments received and the work of the refinement panel, the separate 
work adjustor has changed from the proposed 0.8816. The separate work 
adjustor for CY 2008 will be 0.8806.

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

1. Interim 2007 Codes
    Although the RVUs in the CY 2007 PFS final rule with comment period 
were used to calculate 2007 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 comments on the following CPT codes.

Anticoagulation Management Codes

    The CPT Editorial Panel created two anticoagulation management 
codes in February 2006: CPT code 99363, Anticoagulant management for an 
outpatient taking warfarin, physician review and interpretation of 
International Normalized Ratio (INR) testing, patient instructions, 
dosage adjustment (as needed), and ordering of additional tests; 
initial 90 days of therapy (must include a minimum of 8 INR 
measurements), and CPT code 99364, Anticoagulant management for an 
outpatient taking warfarin, physician review and interpretation of 
International Normalized Ratio (INR) testing, patient instructions, 
dosage adjustment (as needed), and ordering of additional tests; each 
subsequent 90 days of therapy (must include a minimum of 3 INR 
measurements). The RUC reviewed the codes and recommended 1.65 work 
RVUs for code 99363 and 0.63 work RVUs for 99364. In the CY 2007 PFS 
final rule with comment period, we decided not to accept the RUC 
recommendation and decided that the services provided by 99363 and 
99364 are bundled into existing E/M services. Hence, there is no 
separate payment under the PFS. Currently clinicians managing 
anticoagulation therapy may bill, if appropriate, the CPT code that 
best represents the level of outpatient E/M service provided on that 
day, including CPT code 99211.
    Comment: We received comments from commenters who strongly disagree 
with our decision to continue to consider anticoagulation management 
codes to be bundled into the work of E/M codes and noted that these CPT 
codes recognize the important work of managing serious disease. The 
commenters also requested that we not finalize our decision to consider 
these services bundled but instead change their status to separately 
payable, covered services.
    Response: We generally do not pay separately for disease-specific 
management services. We believe the services represented by CPT codes 
99363 and 99364 are inherent in the services captured by the existing 
E/M codes. We will continue to recognize codes 99363 and 99364 as 
bundled services and continue to pay for E/M services as appropriate.

Medical Genetics and Genetic Counseling

    CPT code 96040, Medical genetics and genetic counseling services, 
each 30 minutes face-to-face with patient/family, was reviewed in the 
CY 2007 PFS final rule with comment period and assigned status B 
(bundled service).
    Comment: Commenters disagree with the assigned status indicator of 
B (bundled service) for this service and urge CMS to reconsider its 
decision to make this a bundled service because they believe it is a 
separate and distinct procedure.
    Response: The procedure does not contain any physician work and is 
a code that is designed to capture clinical labor time and PE. To the 
extent that this service is covered, we believe this service like other 
counseling services, is incorporated into existing E/M services, and 
therefore, will maintain the status assignment of B.
Home Ventilator Management
    For CPT code 94005, Home ventilator management care plan oversight 
of a patient (patient not present) in home, domiciliary or rest home 
(eg, assisted living) requiring review of status, review of 
laboratories and other studies and revision of orders and respiratory 
care plan (as appropriate), within a calendar month, 30 minutes or 
more, the RUC recommended 1.50 work RVUs. We assigned a status 
indicator of B (bundled service) to this service in the CY 2007 PFS 
final rule with comment period because: (1) The patient is not present 
when this service is rendered; and (2) we believe this service is 
captured in E/M services.
    Comment: Commenters believe this service should not be bundled and 
recommend that this code be separately payable.
    Response: We continue to believe this service should be assigned a 
status indicator of B (Bundled) for the reasons previously stated in 
the CY 2007 PFS final rule with comment period: (1) The patient is not 
present when the service is rendered; and (2) we believe this service 
is captured in the E/M services. (Note: The RUC-recommended RVUs for 
this code will be reflected in Addendum B.)
    In the CY 2007 PFS final rule with comment period (70 FR 66370), we 
also responded to the RUC recommendations on the PE inputs for the new 
and revised CPT codes for 2007. In addition to PE comments discussed in 
section II.A.2. of this final rule with comment period, concerning PE 
inputs:
    Comment: One commenter, representing a network of providers, 
requested that the PE inputs for CPT codes 35475 and 35476 be reviewed. 
These codes are used as the basis for the PE inputs for HCPCS codes 
G0392 and G0393 that were included in Addendum C. The commenter 
believes that the PE inputs have changed since the service was reviewed 
in 2004. The commenters also believed that items were missing from the 
PE database and included a list of these items.
    Response: We suggest that the commenter work with the specialty 
group to determine if the PE inputs for CPT codes 35475 and 35476 
should be reviewed by the RUC PE subcommittee. We have also reviewed 
the PE database regarding the missing PE items noted by the commenter 
and have verified that all PE inputs from CPT 35475 and 35476 have been 
crosswalked to G0392 and G0393, respectively.
    Comment: One commenter, representing the specialty of dermatology, 
requested that the Unna

[[Page 66365]]

boot be removed from the PE database as a supply item and be assigned a 
HCPCS Q code so that it could be billed separately.
    Response: This issue was specifically addressed in the CY 2007 PFS 
final rule with comment period (71 FR 69644 through 69645). We 
clarified that the policy we finalized relating to splint and cast 
supplies did not change the HCPCS Q-code descriptors or their pairing 
with certain CPT codes for payment purposes.
    Comment: One commenter, representing the ophthalmology association, 
disagreed with our assessment that the specific topography equipment 
priced at $44,000 is not typically used with CPT code 92025, 
Computerized corneal topography, unilateral or bilateral, with 
interpretation and report, and questioned our substitution of the 
topography equipment priced at $13,495. The commenter pointed out that 
the $44,000 topography equipment is the only equipment that will 
provide the services of this procedure.
    Response: We have reviewed the request from the commenter and agree 
that the $13,495 topography unit we assigned for CY 2007 should be 
replaced with the $44,000 equipment that is specifically designed for 
the procedure inherent to CPT code 92025.
    Comment: One commenter, representing therapeutic radiology, 
requested that for CPT code 77371, Radiation treatment delivery, 
stereotactic radiosurgery (SRS), complete course of treatment of 
cerebral lesion(s) consisting of 1 session; multi-source Cobalt 60 
based, we treat the radiation source (Cobalt 60), as a direct PE rather 
than an indirect one. Since Cobalt 60 is: (1) Purchased by the 
physician; (2) exceeds the $500 threshold (price is $15,000); and, (3) 
is clearly attributable to the procedure; it meets the established 
criteria for treatment as a direct expense. The commenter indicated 
that this radiation source must be replaced monthly, requiring a useful 
life assignment of 0.08 years.
    Response: Based on this comment, we have re-examined our assignment 
of the Cobalt 60 radiation source used in CPT code 77371 as indirect 
PE. While the radiation source may meet some of the criteria to be 
considered as a direct PE input for equipment (for example, that it is 
an expense to the physician and its price is above the $500 threshold), 
the commenter did not present information that is needed to verify the 
1-month useful life that was requested. We lack the required evidence 
needed to determine the amount of viable radiation contained in the 
$15,000 source that is consumed through the provision of the radiation 
treatments versus the amount that was not utilized but could have been 
used, during the 1-month time period. This unused amount would be 
considered a wasted resource and cannot be accounted for as a direct PE 
input. Consequently, we will not include the Cobalt-60 radiation source 
as a direct PE input as the commenter requested.

E. 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 2008 
(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 2008 
CPT Codes'')

    One aspect of establishing RVUs for 2008 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 CY 1997 PFS 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 169 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 received approximately 7 recommendations from the Health Care 
Professional Advisory Committee (HCPAC).
    Table 16: AMA RUC and HCPAC Recommendations and CMS Decisions for 
New and Revised 2008 CPT Codes lists the new or revised CPT codes, and 
their associated work RVUs, that will be interim in 2008. Table 16 
includes the following information:
    <bullet> A ``<greek-i>'' identifies a new code for CY 2008.
    <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 PC 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.
    <bullet> 2008 Work RVUs. This column establishes the interim 2008 
work RVUs for physician work.

                           Table 16.--AMA RUC and HCPAC Recommendations and CMS' Decisions for New and Revised 2008 CPT Codes
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                                             HCPAC
   CPT \1\ code           Mod                Descriptor          RUC  recommendation     recommendation       CMS  decision           2008 work RVU
--------------------------------------------------------------------------------------------------------------------------------------------------------
<greek-i> 20555...  ...............  PLACE NDL MUSC/TIS FOR RT  6.00................  ...................  Agree..............  6.00
20660.............  ...............  APPLY, REM FIXATION        4.00................  ...................  Agree..............  4.00
                                      DEVICE.
20690.............  ...............  APPLY BONE FIXATION        8.65................  ...................  Agree..............  8.65
                                      DEVICE.
20692.............  ...............  APPLY BONE FIXATION        16.00...............  ...................  Agree..............  16.00
                                      DEVICE.
<greek-i> 20985 *.  ...............  CPTR-ASST DIR MS PX......  2.50................  ...................  Agree..............  2.50

[[Page 66366]]

 
<greek-i> 20986 *.  ...............  CPTR-ASST DIR MS PX IO     Carrier Priced......  ...................  Agree..............  Carrier Priced.
                                      IMG.
<greek-i> 20987 *.  ...............  CPTR-ASST DIR MS PX PRE    Carrier Priced......  ...................  Agree..............  Carrier Priced.
                                      IMG.
<greek-i> 21073...  ...............  MNPJ OF TMJ W/ANESTH.....  3.33................  ...................  Agree..............  3.33
<greek-i> 22206...  ...............  CUT SPINE 3 COL, THOR....  37.00...............  ...................  Agree..............  37.00
<greek-i> 22207...  ...............  CUT SPINE 3 COL, LUMB....  36.50...............  ...................  Agree..............  36.50
<greek-i> 22208...  ...............  CUT SPINE 3 COL, ADDL SEG  9.66................  ...................  Agree..............  9.66
23515.............  ...............  TREAT CLAVICLE FRACTURE..  11.00...............  ...................  Disagree...........  9.53
23585.............  ...............  TREAT SCAPULA FRACTURE...  16.25...............  ...................  Disagree...........  14.07
23615.............  ...............  TREAT HUMERUS FRACTURE...  14.00...............  ...................  Disagree...........  12.12
23616.............  ...............  TREAT HUMERUS FRACTURE...  21.00...............  ...................  Disagree...........  18.19
23630.............  ...............  TREAT HUMERUS FRACTURE...  12.00...............  ...................  Disagree...........  10.39
23670.............  ...............  TREAT DISLOCATION/         14.00...............  ...................  Disagree...........  12.12
                                      FRACTURE.
23680.............  ...............  TREAT DISLOCATION/         15.00...............  ...................  Disagree...........  12.99
                                      FRACTURE.
<greek-i> 24357...  ...............  REPAIR ELBOW, PERC.......  5.32................  ...................  Agree..............  5.32
<greek-i> 24358...  ...............  REPAIR ELBOW W/DEB, OPEN.  6.54................  ...................  Agree..............  6.54
<greek-i> 24359...  ...............  REPAIR ELBOW DEB/ATTCH     8.86................  ...................  Agree..............  8.86
                                      OPEN.
24545.............  ...............  TREAT HUMERUS FRACTURE...  15.00...............  ...................  Disagree...........  12.99
24546.............  ...............  TREAT HUMERUS FRACTURE...  17.01...............  ...................  Disagree...........  14.73
24575.............  ...............  TREAT HUMERUS FRACTURE...  11.00...............  ...................  Disagree...........  9.53
24579.............  ...............  TREAT HUMERUS FRACTURE...  13.00...............  ...................  Disagree...........  11.26
24635.............  ...............  TREAT ELBOW FRACTURE.....  10.00...............  ...................  Disagree...........  8.64
24665.............  ...............  TREAT RADIUS FRACTURE....  Referred to CPT.....  ...................  CPT................  8.22
24666.............  ...............  TREAT RADIUS FRACTURE....  Referred to CPT.....  ...................  CPT................  9.74
24685.............  ...............  TREAT ULNAR FRACTURE.....  9.50................  ...................  Disagree...........  8.21
25515.............  ...............  TREAT FRACTURE OF RADIUS.  10.00...............  ...................  Disagree...........  8.64
25525.............  ...............  TREAT FRACTURE OF RADIUS.  12.00...............  ...................  Disagree...........  10.37
25526.............  ...............  TREAT FRACTURE OF RADIUS.  15.00...............  ...................  Disagree...........  12.96
25545.............  ...............  TREAT FRACTURE OF ULNA...  9.00................  ...................  Disagree...........  7.78
25574.............  ...............  TREAT FRACTURE RADIUS &    10.00...............  ...................  Disagree...........  8.64
                                      ULNA.
25575.............  ...............  TREAT FRACTURE RADIUS/     14.00...............  ...................  Disagree...........  12.10
                                      ULNA.
25628.............  ...............  TREAT WRIST BONE FRACTURE  11.00...............  ...................  Disagree...........  9.51
26615.............  ...............  TREAT METACARPAL FRACTURE  8.00................  ...................  Disagree...........  6.91
26650.............  ...............  TREAT THUMB FRACTURE.....  6.00................  ...................  Disagree...........  5.19
26665.............  ...............  TREAT THUMB FRACTURE.....  9.00................  ...................  Disagree...........  7.78
26685.............  ...............  TREAT HAND DISLOCATION...  8.00................  ...................  Disagree...........  6.91
26715.............  ...............  TREAT KNUCKLE DISLOCATION  7.95................  ...................  Disagree...........  6.87
26735.............  ...............  TREAT FINGER FRACTURE,     8.40................  ...................  Disagree...........  7.26
                                      EACH.
26746.............  ...............  TREAT FINGER FRACTURE,     11.10...............  ...................  Disagree...........  9.59
                                      EACH.
26765.............  ...............  TREAT FINGER FRACTURE,     6.60................  ...................  Disagree...........  5.70
                                      EACH.
26785.............  ...............  TREAT FINGER DISLOCATION.  7.45................  ...................  Disagree...........  6.44
27248.............  ...............  TREAT THIGH FRACTURE.....  12.83...............  ...................  Disagree...........  10.64
<greek-i> 27267...  ...............  CLTX THIGH FX............  5.38................  ...................  Agree..............  5.38
<greek-i> 27268...  ...............  CLTX THIGH FX W/MNPJ.....  7.00................  ...................  Agree..............  7.00
<greek-i> 27269...  ...............  OPTX THIGH FX............  18.75...............  ...................  Agree..............  18.75
<greek-i> 27416...  ...............  OSTEOCHONDRAL KNEE         14.00...............  ...................  Agree..............  14.00
                                      AUTOGRAFT.
27511.............  ...............  TREATMENT OF THIGH         18.05...............  ...................  Disagree...........  14.97
                                      FRACTURE.
27513.............  ...............  TREATMENT OF THIGH         23.04...............  ...................  Disagree...........  19.11
                                      FRACTURE.
27514.............  ...............  TREATMENT OF THIGH         17.43...............  ...................  Disagree...........  14.46
                                      FRACTURE.
27519.............  ...............  TREAT THIGH FX GROWTH      15.80...............  ...................  Disagree...........  13.11
                                      PLATE.
27535.............  ...............  TREAT KNEE FRACTURE......  16.00...............  ...................  Disagree...........  13.27
27540.............  ...............  TREAT KNEE FRACTURE......  13.45...............  ...................  Disagree...........  11.16
27556.............  ...............  TREAT KNEE DISLOCATION...  15.50...............  ...................  Disagree...........  12.86
27557.............  ...............  TREAT KNEE DISLOCATION...  19.00...............  ...................  Disagree...........  15.76
27558.............  ...............  TREAT KNEE DISLOCATION...  22.00...............  ...................  Disagree...........  18.25
<greek-i> 27726...  ...............  REPAIR FIBULA NONUNION...  14.20...............  ...................  Agree..............  14.20
27766.............  ...............  OPTX MEDIAL ANKLE FX.....  8.50................  ...................  Disagree...........  7.73
<greek-i> 27767...  ...............  CLTX POST ANKLE FX.......  2.50................  ...................  Agree..............  2.50
<greek-i> 27768...  ...............  CLTX POST ANKLE FX W/MNPJ  5.00................  ...................  Agree..............  5.00
<greek-i> 27769...  ...............  OPTX POST ANKLE FX.......  10.00...............  ...................  Agree..............  10.00
27784.............  ...............  TREATMENT OF FIBULA        10.45...............  ...................  Disagree...........  9.51
                                      FRACTURE.
27792.............  ...............  TREATMENT OF ANKLE         10.50...............  ...................  Disagree...........  9.55
                                      FRACTURE.
27814.............  ...............  TREATMENT OF ANKLE         11.50...............  ...................  Disagree...........  10.46
                                      FRACTURE.
27822.............  ...............  TREATMENT OF ANKLE         12.12...............  ...................  Disagree...........  11.03
                                      FRACTURE.
27823.............  ...............  TREATMENT OF ANKLE         14.26...............  ...................  Disagree...........  12.98
                                      FRACTURE.
27826.............  ...............  TREAT LOWER LEG FRACTURE.  12.00...............  ...................  Disagree...........  10.92
27827.............  ...............  TREAT LOWER LEG FRACTURE.  16.00...............  ...................  Disagree...........  14.56
27828.............  ...............  TREAT LOWER LEG FRACTURE.  20.00...............  ...................  Disagree...........  18.20
27829.............  ...............  TREAT LOWER LEG JOINT....  9.50................  ...................  Disagree...........  8.64
27832.............  ...............  TREAT LOWER LEG            11.00...............  ...................  Disagree...........  10.01
                                      DISLOCATION.

[[Page 66367]]

 
28415.............  ...............  TREAT HEEL FRACTURE......  17.54...............  ...................  Disagree...........  15.96
28420.............  ...............  TREAT/GRAFT HEEL FRACTURE  19.00...............  ...................  Disagree...........  17.29
28445.............  ...............  TREAT ANKLE FRACTURE.....  17.07...............  ...................  Disagree...........  15.53
<greek-i> 28446...  ...............  OSTEOCHONDRAL TALUS        17.50...............  ...................  Agree..............  17.50
                                      AUTOGRFT.
28465.............  ...............  TREAT MIDFOOT FRACTURE,    9.50................  ...................  Disagree...........  8.64
                                      EACH.
28485.............  ...............  TREAT METATARSAL FRACTURE  8.00................  ...................  Disagree...........  7.28
28505.............  ...............  TREAT BIG TOE FRACTURE...  8.00................  ...................  Disagree...........  7.28
28525.............  ...............  TREAT TOE FRACTURE.......  6.00................  ...................  Disagree...........  5.46
28555.............  ...............  REPAIR FOOT DISLOCATION..  10.43...............  ...................  Disagree...........  9.49
28585.............  ...............  REPAIR FOOT DISLOCATION..  12.00...............  ...................  Disagree...........  10.92
28615.............  ...............  REPAIR FOOT DISLOCATION..  11.50...............  ...................  Disagree...........  10.46
28645.............  ...............  REPAIR TOE DISLOCATION...  8.00................  ...................  Disagree...........  7.28
28675.............  ...............  REPAIR OF TOE DISLOCATION  6.00................  ...................  Disagree...........  5.46
<greek-i> 29828 *.  ...............  ARTHROSCOPY BICEPS         13.00...............  ...................  Agree..............  13.00
                                      TENODESIS.
<greek-i> 29904...  ...............  SUBTALAR ARTHRO W/FB RMVL  8.50................  ...................  Agree..............  8.50
<greek-i> 29905...  ...............  SUBTALAR ARTHRO W/EXC....  9.00................  ...................  Agree..............  9.00
<greek-i> 29906...  ...............  SUBTALAR ARTHRO W/DEB....  9.47................  ...................  Agree..............  9.47
<greek-i> 29907...  ...............  SUBTALAR ARTHRO W/FUSION.  12.00...............  ...................  Agree..............  12.00
31500.............  ...............  INSERT EMERGENCY AIRWAY..  2.33................  ...................  Agree..............  2.33
<greek-i> 33257 *.  ...............  ABLATE ATRIA, LMTD, ADD-   9.63................  ...................  Agree..............  9.63
                                      ON.
<greek-i> 33258 *.  ...............  ABLATE ATRIA, X10SV, ADD-  11.00...............  ...................  Agree..............  11.00
                                      ON.
<greek-i> 33259 *.  ...............  ABLATE ATRIA W/BYPASS ADD- 14.14...............  ...................  Agree..............  14.14
                                      ON.
<greek-i> 33864 *.  ...............  ASCENDING AORTIC GRAFT...  60.00...............  ...................  Agree..............  60.00
<greek-i> 34806 *.  ...............  ANEURYSM PRESS SENSOR ADD- 2.06................  ...................  Agree..............  2.06
                                      ON.
<greek-i> 35523...  ...............  ARTERY BYPASS GRAFT......  24.00...............  ...................  Agree..............  24.00
36620.............  ...............  INSERTION CATHETER,        1.15................  ...................  Agree..............  1.15
                                      ARTERY.
<greek-i> 41019...  ...............  PLACE NEEDLES H&N FOR RT.  8.84................  ...................  Agree..............  8.84
43760.............  ...............  CHANGE GASTROSTOMY TUBE..  0.90................  ...................  Agree..............  0.90
<greek-i> 49203...  ...............  EXC ABD TUM 5 CM OR LESS.  20.00...............  ...................  Agree..............  20.00
<greek-i> 49204...  ...............  EXC ABD TUM OVER 5 CM....  26.00...............  ...................  Agree..............  26.00
<greek-i> 49205...  ...............  EXC ABD TUM OVER 10 CM...  30.00...............  ...................  Agree..............  30.00
<greek-i> 49440...  ...............  PLACE GASTROSTOMY TUBE     4.18................  ...................  Agree..............  4.18
                                      PERC.
<greek-i> 49441...  ...............  PLACE DUOD/JEJ TUBE PERC.  4.77................  ...................  Agree..............  4.77
<greek-i> 49442...  ...............  PLACE CECOSTOMY TUBE PERC  4.00................  ...................  Agree..............  4.00
<greek-i> 49446...  ...............  CHANGE G-TUBE TO G-J PERC  3.31................  ...................  Agree..............  3.31
<greek-i> 49450...  ...............  REPLACE G/C TUBE PERC....  1.36................  ...................  Agree..............  1.36
<greek-i> 49451...  ...............  REPLACE DUOD/JEJ TUBE      1.84................  ...................  Agree..............  1.84
                                      PERC.
<greek-i> 49452...  ...............  REPLACE G-J TUBE PERC....  2.86................  ...................  Agree..............  2.86
<greek-i> 49460...  ...............  FIX G/COLON TUBE W/DEVICE  0.96................  ...................  Agree..............  0.96
<greek-i> 49465...  ...............  FLUORO EXAM OF G/COLON     0.62................  ...................  Agree..............  0.62
                                      TUBE.
<greek-i> 50385...  ...............  CHANGE STENT VIA           4.44................  ...................  Agree..............  4.44
                                      TRANSURETH.
<greek-i> 50386...  ...............  REMOVE STENT VIA           3.30................  ...................  Agree..............  3.30
                                      TRANSURETH.
<greek-i> 50593 *.  ...............  PERC CRYO ABLATE RENAL     9.08................  ...................  Agree..............  9.08
                                      TUM.
51797.............  ...............  INTRAABDOMINAL PRESSURE    0.80................  ...................  Agree..............  0.80
                                      TEST.
<greek-i> 52649...  ...............  PROSTATE LASER             17.16...............  ...................  Agree..............  17.16
                                      ENUCLEATION.
<greek-i> 55920...  ...............  PLACE NEEDLES PELVIC FOR   8.31................  ...................  Agree..............  8.31
                                      RT.
57284.............  ...............  REPAIR PARAVAG DEFECT,     14.25...............  ...................  Agree..............  14.25
                                      OPEN.
<greek-i> 57285...  ...............  REPAIR PARAVAG DEFECT,     11.52...............  ...................  Agree..............  11.52
                                      VAG.
<greek-i> 57423 *.  ...............  REPAIR PARAVAG DEFECT,     16.00...............  ...................  Agree..............  16.00
                                      LAP.
<greek-i> 58570 *.  ...............  TLH, UTERUS 250 G OR LESS  15.75...............  ...................  Agree..............  15.75
<greek-i> 58571 *.  ...............  TLH W/T/O 250 G OR LESS..  17.56...............  ...................  Agree..............  17.56
<greek-i> 58572 *.  ...............  TLH, UTERUS OVER 250 G...  19.96...............  ...................  Agree..............  19.96
<greek-i> 58573 *.  ...............  TLH W/T/O UTERUS OVER 250  22.98...............  ...................  Agree..............  22.98
                                      G.
<greek-i> 67041...  ...............  VIT FOR MACULAR PUCKER...  19.00...............  ...................  Agree..............  19.00
<greek-i> 67042...  ...............  VIT FOR MACULAR HOLE.....  22.13...............  ...................  Agree..............  22.13
<greek-i> 67043...  ...............  VIT FOR MEMBRANE DISSECT.  22.94...............  ...................  Agree..............  22.94
<greek-i> 67113...  ...............  REPAIR RETINAL DETACH,     25.00...............  ...................  Agree..............  25.00
                                      CPLX.
<greek-i> 67229...  ...............  TR RETINAL LES PRETERM     16.00...............  ...................  Agree..............  16.00
                                      INF.
<greek-i> 68816 *.  ...............  PROBE NL DUCT W/BALLOON..  3.00................  ...................  Agree..............  3.00
<greek-i> 75557 *.  26.............  CARDIAC MRI FOR MORPH....  2.35................  ...................  Agree..............  2.35
<greek-i> 75558 *.  26.............  CARDIAC MRI FLOW/VELOCITY  2.60................  ...................  Agree (c)..........  2.60
<greek-i> 75559 *.  26.............  CARDIAC MRI W/STRESS IMG.  2.95................  ...................  Agree..............  2.95
<greek-i> 75560 *.  26.............  CARDIAC MRI FLOW/VEL/      3.00................  ...................  Agree (c)..........  3.00
                                      STRESS.
<greek-i> 75561 *.  26.............  CARDIAC MRI FOR MORPH W/   2.60................  ...................  Agree..............  2.60
                                      DYE.
<greek-i> 75562 *.  26.............  CARD MRI FLOW/VEL W/DYE..  2.86................  ...................  Agree (c)..........  2.86
<greek-i> 75563 *.  26.............  CARD MRI W/STRESS IMG &    3.00................  ...................  Agree..............  3.00
                                      DYE.
<greek-i> 75564 *.  26.............  HT MRI W/FLO/VEL/STRS &    3.35................  ...................  Agree (c)..........  3.35
                                      DYE.
78811 *...........  26.............  PET IMAGE, LTD AREA......  1.54................  ...................  Agree..............  1.54
78812 *...........  26.............  PET IMAGE, SKULL-THIGH...  1.93................  ...................  Agree..............  1.93

[[Page 66368]]

 
78813 *...........  26.............  PET IMAGE, FULL BODY.....  2.00................  ...................  Agree..............  2.00
78814 *...........  26.............  PET IMAGE W/CT, LMTD.....  2.20................  ...................  Agree..............  2.20
78815 *...........  26.............  PET IMAGE W/CT, SKULL-     2.44................  ...................  Agree..............  2.44
                                      THIGH.
78816 *...........  26.............  PET IMAGE W/CT, FULL BODY  2.50................  ...................  Agree..............  2.50
86486.............  ...............  SKIN TEST, NOS ANTIGEN...  (a).................  ...................  (a)*...............  0.00
88380 *...........  ...............  MICRODISSECTION, LASER...  1.56................  ...................  Agree..............  1.56
<greek-i> 88381 *.  ...............  MICRODISSECTION, MANUAL..  1.18................  ...................  Agree..............  1.18
<greek-i> 90769 *.  ...............  SC THER INFUSION, UP TO 1  0.21................  ...................  Agree..............  0.21
                                      HR.
<greek-i> 90770 *.  ...............  SC THER INFUSION, ADDL HR  0.18................  ...................  Agree..............  0.18
93503.............  26.............  INSERT/PLACE HEART         2.91................  ...................  Agree..............  2.91
                                      CATHETER.
<greek-i> 93982 *   ...............  ANEURYSM PRESSURE SENS     0.30................  ...................  Agree..............  0.30
 **.                                  STUDY.
95004.............  ...............  PERCUT ALLERGY SKIN TESTS  0.01................  ...................  Agree..............  0.01
95024.............  ...............  ID ALLERGY TEST, DRUG/BUG  0.01................  ...................  Agree..............  0.01
95027.............  ...............  ID ALLERGY TITRATE-        0.01................  ...................  Agree..............  0.01
                                      AIRBORNE.
<greek-i> 95980 *.  ...............  IO ANAL GAST N-STIM INIT.  0.80................  ...................  Agree..............  0.80
<greek-i> 95981 *.  ...............  IO ANAL GAST N-STIM SUBSQ  0.30................  ...................  Agree..............  0.30
<greek-i> 95982 *.  ...............  IO GA N-STIM SUBSQ W/      0.65................  ...................  Agree..............  0.65
                                      REPROG.
<greek-i> 96125...  ...............  COGNITIVE TEST BY HC PRO.  ....................  1.70...............  Agree..............  1.70
<greek-i> 98966 *.  ...............  HC PRO PHONE CALL 5-10     ....................  0.25...............  Agree (c)..........  0.25
                                      MIN.
<greek-i> 98967 *.  ...............  HC PRO PHONE CALL 11-20    ....................  0.50...............  Agree (c)..........  0.50
                                      MIN.
<greek-i> 98968 *.  ...............  HC PRO PHONE CALL 21-30    ....................  0.75...............  Agree (c)..........  0.75
                                      MIN.
<greek-i> 98969...  ...............  ONLINE SERVICE BY HC PRO.  ....................  Carrier Priced.....  Agree (c)..........  Carrier Priced.
<greek-i> 99174...  ...............  OCULAR PHOTOSCREENING....  (a).................  ...................  (a)*...............  0.00
<greek-i> 99366...  ...............  TEAM CONF W/PAT BY HC PRO  ....................  0.82...............  Agree (b)..........  0.82
<greek-i> 99367...  ...............  TEAM CONF W/O PAT BY PHYS  1.10................  ...................  Agree (b)..........  1.10
<greek-i> 99368...  ...............  TEAM CONF W/O PAT BY HC    ....................  0.72...............  Agree (b)..........  0.72
                                      PRO.
<greek-i> 99406...  ...............  BEHAV CHNG SMOKING 3-10    0.24................  ...................  Agree..............  0.24
                                      MIN.
<greek-i> 99407...  ...............  BEHAV CHNG SMOKING < 10    0.50................  ...................  Agree..............  0.50
                                      MIN.
<greek-i> 99408...  ...............  AUDIT/DAST, 15-30 MIN....  0.65................  ...................  Agree (c)..........  0.65
<greek-i> 99409...  ...............  AUDIT/DAST, OVER 30 MIN..  1.30................  ...................  Agree (c)..........  1.30
<greek-i> 99441 *.  ...............  PHONE E/M BY PHYS 5-10     0.25................  ...................  Agree (c)..........  0.25
                                      MIN.
<greek-i> 99442 *.  ...............  PHONE E/M BY PHYS 11-20    0.50................  ...................  Agree (c)..........  0.50
                                      MIN.
<greek-i> 99443 *.  ...............  PHONE E/M BY PHYS 21-30    0.75................  ...................  Agree (c)..........  0.75
                                      MIN.
<greek-i> 99444...  ...............  ONLINE E/M BY PHYS.......  Carrier Priced......  ...................  Agree (c)..........  Carrier Priced.
<greek-i> 99477...  ...............  INIT DAY HOSP NEONATE      7.00................  ...................  Agree..............  7.00
                                      CARE.
--------------------------------------------------------------------------------------------------------------------------------------------------------
<greek-i> New CPT code.
\1\ All CPT codes copyright 2007 AMA.
* New Code for Re-Examination at the next 5-Year Review.
** Denotes restricted coverage of code.
(a) No RUC work RVU recommendation.
(a) * See code discussion in Section F, Discussion of Codes and RUC/HCPAC Recommendations.
(b) RUC-recommended work RVU accepted but coverage status of code is Bundled.
(c) RUC-recommended work RVU accepted but coverage status of code is Noncovered.

    Table 17: AMA RUC Anesthesia Recommendations and CMS Decisions for 
New and Revised 2008 CPT Codes lists the new or revised CPT codes for 
anesthesia and their base units that will be interim in CY 2008. Table 
17 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> 2008 Base Units. This column establishes the CY 2007 base 
units for these services.

     Table 17.--AMA RUC Anesthesia Recommendations and CMS Decisions for New and Revised/Reviewed CPT Codes
----------------------------------------------------------------------------------------------------------------
                                                                 RUC                                  2008 base
       * CPT \1\ code                 Description          recommendation        CMS decision           units
----------------------------------------------------------------------------------------------------------------
<greek-i><greek-i> 00142....  ANESTH, LENS SURGERY.......           4.00   Agree...................         4.00
<greek-i> 01935.............  ANESTH, PERC IMG DX SP PROC           5.00   Agree...................         5.00
<greek-i> 01936.............  ANESTH, PERC IMG TX SP PROC           5.00   Agree...................        5.00
----------------------------------------------------------------------------------------------------------------
\1\ All CPT codes copyright 2007 AMA.

[[Page 66369]]

 
<greek-i> New CPT code.
<greek-i><greek-i> Note: CPT code 00142 is neither a new nor revised code for 2008. However, the RUC reviewed
  the base unit values for this code for 2008 and recommended that the value be maintained.

F. Discussion of Codes and RUC/HCPAC Recommendations

    The following is a summary of our rationale for not accepting 
particular RUC work RVUs. It is arranged by type of service in CPT 
order. This summary refers only to work RVUs.
    1. Internal Fixation Codes--Shoulder/Elbow (CPT codes 23515, 23585, 
23615, 23616, 23680, 23670, 23680, 24545, 24546, 24575 and 24579), 
Elbow/Hand (CPT codes 24635, 24685, 25515, 25525, 25526, 25545, 25574, 
25575, 25628, 26615, 26650, 26665, 26685, 26715, 26735, 26746, 26765, 
26785), Hip and Knee (CPT codes 27248, 27511, 27513, 27514, 27519, 
27535, 27540, 27556, 27557 and 27558) and Foot and Ankle (CPT codes 
27766, 27784, 27792, 27814, 27822, 27823, 27826, 27827, 27828, 27829, 
27832, 28415, 28420, 28445, 28465, 28485, 28505, 28525, 28555, 28585, 
28615, 28645 and 28675)
    These codes were originally part of the 5-Year Review of work RVUs 
and were referred to the CPT Editorial Panel by the RUC for further 
clarification because it was unclear whether the previous valuation for 
these codes included the situation when internal and external fixation 
is applied to the fracture site. The CPT Editorial Panel agreed that 
these codes needed to be clarified and removed reference to external 
fixation from these codes. As a result of this editorial change, the 
RUC reexamined these families of codes and recommended increased work 
RVUs. The RUC recommended 11.00 work RVUs for CPT code 23515; 16.25 
work RVUs for CPT code 25385; 14.00 work RVUs for CPT code 23615; 21.00 
work RVUs for CPT code 23616; 12.00 work RVUs for CPT code 23680; 14.00 
work RVUs for CPT code 23670; 15.00 work RVUs for CPT code 23680; 15.00 
work RVUs for CPT code 24545; 17.01 work RVUs for CPT code 24546; 11.00 
work RVUs for CPT code 24575; 13.00 work RVUs for CPT code 24579; 10.00 
work RVUs for CPT code 24635; 9.50 work RVUs for CPT code 24685; 10.00 
work RVUs for CPT code 25515; 12.00 work RVUs for CPT code 25525; 15.00 
work RVUs for CPT code 25526; 9.00 work RVUs for CPT code 25545; 10.00 
work RVUs for CPT code 25574; 14.00 work RVUs for CPT code 25575; 11.00 
work RVUs for CPT code 25628; 8.00 work RVUs for CPT code 26615; 6.00 
work RVUs for CPT code 26650; 9.00 work RVUs for CPT code 26665; 8.00 
work RVUs for CPT code 26685; 7.95 work RVUs for CPT code 26715; 8.40 
work RVUs for CPT code 26735; 11.10 work RVUs for CPT code 26746; 6.60 
work RVUs for CPT code 26765; 7.45 work RVUs for CPT code 26785; 12.83 
work RVUs for CPT code 27248; 18.05 work RVUs for CPT code 27511; 23.04 
work RVUs for CPT code 27513; 17.43 work RVUs for CPT code 27514; 15.80 
work RVUs for CPT code 27519; 16.00 work RVUs for CPT code 27535; 13.45 
work RVUs for CPT code 27540; 15.50 work RVUs for CPT code 27556; 19.00 
work RVUs for CPT code 27557; 22.00 work RVUs for CPT code 27558; 8.50 
work RVUs for CPT code 27766; 10.45 work RVUs for CPT code 27784; 10.50 
work RVUs for CPT code 27792; 11.50 work RVUs for CPT code 27814; 12.12 
work RVUs for CPT code 27822; 14.26 work RVUs for CPT code 27823; 12.00 
work RVUs for CPT code 27826; 16.00 work RVUs for CPT code 27827; 20.00 
work RVUs for CPT code 27828; 9.50 work RVUs for CPT code 27829; 11.00 
work RVUs for CPT code 27832; 17.54 work RVUs for CPT code 28415; 19.00 
work RVUs for CPT code 28420; 17.07 work RVUs for CPT code 28445; 9.50 
work RVUs for CPT code 28465; 8.00 work RVUs for CPT code 28485; 8.00 
work RVUs for CPT code 28505; 6.00 work RVUs for CPT code 28525; 10.43 
work RVUs for CPT code 28555; 12.00 work RVUs for CPT code 28585; 11.50 
work RVUs for CPT code 28615; 8.00 work RVUs for CPT code 28645; and 
6.00 work RVUs for CPT code 28675. Although we agree with the 
relationships, the increases in work RVUs reestablish the relativity of 
the services in these families and in doing so created BN issues. In 
order to retain BN within these families of codes, the work RVUs 
associated with each code had to be adjusted. 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 each family will be the same as the 
sum of the current work RVUs (weighted by projected frequency of use) 
for each family of codes. The adjusted work RVUs are as follows: 9.53 
work RVUs for CPT code 23515; 14.07 work RVUs for CPT code 25385; 12.12 
work RVUs for CPT code 23615; 18.19 work RVUs for CPT code 23616; 10.39 
work RVUs for CPT code 23680; 12.12 work RVUs for CPT code 23670; 12.99 
work RVUs for CPT code 23680; 12.99 work RVUs for CPT code 24545; 14.73 
work RVUs for CPT code 24546; 9.53 work RVUs for CPT code 24575; 11.26 
work RVUs for CPT code 24579; 8.64 work RVUs for CPT code 24635; 8.21 
work RVUs for CPT code 24685; 8.64 work RVUs for CPT code 25515; 10.37 
work RVUs for CPT code 25525; 12.96 work RVUs for CPT code 25526; 7.78 
work RVUs for CPT code 25545; 8.64 work RVUs for CPT code 25574; 12.10 
work RVUs for CPT code 25575; 9.51 work RVUs for CPT code 25628; 6.91 
work RVUs for CPT code 26615; 5.19 work RVUs for CPT code 26650; 7.78 
work RVUs for CPT code 26665; 6.91 work RVUs for CPT code 26685; 6.87 
work RVUs for CPT code 26715; 7.26 work RVUs for CPT code 26735; 9.59 
work RVUs for CPT code 26746; 5.70 work RVUs for CPT code 26765; 6.44 
work RVUs for CPT code 26785; 10.64 work RVUs for CPT code 27248; 14.97 
work RVUs for CPT code 27511; 19.11 work RVUs for CPT code 27513; 14.46 
work RVUs for CPT code 27514; 13.11 work RVUs for CPT code 27519; 13.27 
work RVUs for CPT code 27535; 11.16 work RVUs for CPT code 27540; 12.86 
work RVUs for CPT code 27556; 15.76 work RVUs for CPT code 27557; 18.25 
work RVUs for CPT code 27558; 7.73 work RVUs for CPT code 27766; 9.51 
work RVUs for CPT code 27784; 9.55 work RVUs for CPT code 27792; 10.46 
work RVUs for CPT code 27814; 11.03 work RVUs for CPT code 27822; 12.98 
work RVUs for CPT code 27823; 10.92 work RVUs for CPT code 27826; 14.56 
work RVUs for CPT code 27827; 18.20 work RVUs for CPT code 27828; 8.64 
work RVUs for CPT code 27829; 10.01 work RVUs for CPT code 27832; 15.96 
work RVUs for CPT code 28415; 17.29 work RVUs for CPT code 28420; 15.53 
work RVUs for CPT code 28445; 8.64 work RVUs for CPT code 28465; 7.28 
work RVUs for CPT code 28485; 7.28 work RVUs for CPT code 28505; 5.46 
work RVUs for CPT code 28525; 9.49 work RVUs for CPT code 28555; 10.92 
work RVUs for CPT code 28585; 10.46 work RVUs for CPT code 28615; 7.28 
work RVUs for CPT code 28645; and 5.46 work RVUs for CPT code 28675.
2. Cardiac MRI Codes
    Cardiac MRI services have evolved over the past decade from 
providing primarily anatomic information to providing both anatomic and 
physiologic information. We have had a national noncoverage 
determination in place for Magnetic Resonance Imaging (MRI) that 
provides blood flow measurement since March 1994. This NCD provides 
that CPT code 75556,

[[Page 66370]]

Cardiac magnetic resonance imaging for velocity flow, is not covered.
    As a result of the technological changes in MRI scanning, the CPT 
Editorial Panel created eight new Cardiac MRI codes and deleted five 
existing Cardiac MRI codes. The new codes are: CPT code 75557, Cardiac 
magnetic resonance imaging for morphology and function without contrast 
material; CPT code 75558, Cardiac magnetic resonance imaging for 
morphology and function without contrast material; with flow/velocity 
quantification; CPT code 75559, Cardiac magnetic resonance imaging for 
morphology and function without contrast material; with stress imaging; 
CPT code 75560, Cardiac magnetic resonance imaging for morphology and 
function without contrast material; with flow/velocity quantification 
and stress; CPT code 75561, Cardiac magnetic resonance imaging for 
morphology and function without contrast material(s), followed by 
contrast material(s) and further sequences; CPT code 75562, Cardiac 
magnetic resonance imaging for morphology and function without contrast 
material(s), followed by contrast material(s) and further sequences; 
with flow/velocity quantification; CPT code 75563, Cardiac magnetic 
resonance imaging for morphology and function without contrast 
material(s), followed by contrast material(s) and further sequences; 
with stress imaging; and CPT code 75564, Cardiac magnetic resonance 
imaging for morphology and function without contrast material(s), 
followed by contrast material(s) and further sequences; with flow/
velocity quantification and stress. The RUC recommended 2.35 work RVUs 
for CPT code 75557; 2.60 work RVUs for CPT code 75558; 2.95 work RVUs 
for CPT code 75559; 3.00 work RVUs for CPT code 75560; 2.60 work RVUs 
for CPT code 75561; 2.86 work RVUs for CPT code 75562; 3.00 work RVUs 
for CPT code 75563; and 3.35 work RVUs for CPT code 75564.
    The deleted codes are: CPT code 75552, Cardiac magnetic resonance 
imaging for function, without contrast material; CPT code 75553, 
Cardiac magnetic resonance imaging for function, without contrast 
material with contrast material; CPT code 75554, Cardiac magnetic 
resonance imaging for function, with or without morphology; complete 
study; CPT code 75555, Cardiac magnetic resonance imaging for function, 
with or without morphology; limited study; and CPT code 75556 Cardiac 
magnetic resonance imaging for velocity flow mapping.
    Upon review of the new cardiac MRI codes, we recognize that four of 
the new codes incorporate blood flow measurement, which remains one of 
the nationally noncovered indications for MRI in the Medicare program. 
Due to a national non-coverage determination for MRI that provides 
blood flow measurement, CPT codes 75558, 75560, 75562 and 75564 will 
not be recognized by the Medicare program and have been assigned a 
status indicator of ``N'' (Noncovered) on the Medicare physician fee 
schedule. (Note: The RUC-recommended RVUs for these codes will be 
reflected in Addendum B.)
    The remaining codes in this family (CPT codes 75557, 75559, 75561 
and 75563) will be recognized as active on the Medicare PFS.
3. Skin Test, Unlisted Antigen
    For CPT code 86486, Skin test; unlisted antigen, the RUC did not 
make a work RVU recommendation. During our 2007 public meeting for new 
clinical laboratory tests held in accordance with Sec.  414.506, we 
received approximately four comments. The commenters indicated the code 
belongs in the skin test code series included in the PFS with a payment 
crosswalk to CPT code 86490 Skin test; coccidioidomycosis. We agree 
with the recommendations. We are assigning the code a status indicator 
of A (Active code). The status indicator does not mean that Medicare 
has made a national coverage determination regarding this service. 
Contractors may develop local coverage determinations. CPT also deleted 
predecessor CPT code 86586 effective January 1, 2008; thus, CPT code 
86586 will be deleted from the 2008 clinical laboratory fee schedule.
4. Wireless Pressure Sensor Implantation and Study
    For CPT code 93982, Noninvasive physiologic study of implanted 
wireless pressure sensor in aneursymal sac following endovascular 
repair, complete study including recording, analysis of pressure and 
waveform tracings, interpretation and report, the RUC recommended 0.30 
work RVUs. We have assigned a status indicator of R (Restricted) to 
this service because the sensor used in this procedure is FDA approved 
for pressure interpretation at the time of an endovascular aneurysm 
repair only and is currently not FDA approved for the follow-up 
evaluation of pressure analysis in the office or outpatient setting 
once the patient is discharged from the hospital.
5. Non-Face-to-Face Physician and Qualified Healthcare Professional 
Services
    For CPT code 98966, Telephone assessment and management service 
provided by a qualified non-physician health care professional to an 
established patient, parent, or guardian not originating from a related 
assessment and management service provided within the previous seven 
days nor leading to an assessment and management service or procedure 
within the next 24 hours or soonest available appointment; 5-10 minutes 
of medical discussion; CPT code 98967, Telephone assessment and 
management service provided by a qualified non-physician health care 
professional to an established patient, parent, or guardian not 
originating from a related assessment and management service provided 
within the previous seven days nor leading to an assessment and 
management service or procedure within the next 24 hours or soonest 
available appointment; 11-20 minutes of medical discussion; CPT code 
98968, Telephone assessment and management service provided by a 
qualified non-physician health care professional to an established 
patient, parent, or guardian not originating from a related assessment 
and management service provided within the previous seven days nor 
leading to an assessment and management service or procedure within the 
next 24 hours or soonest available appointment; 21-30 minutes of 
medical discussion; CPT code 98969, Online evaluation and management 
service provided by a qualified non-physician health care professional 
to an established patient, guardian or health care provider not 
originating from a related assessment and management service provided 
within the previous 7 days, using the Internet or similar electronic 
communications network; CPT code 99441, Telephone evaluation and 
management service provided by a physician to an established patient, 
parent, or guardian not originating from a related E/M service provided 
within the previous seven days nor leading to an E/M service or 
procedure within the next 24 hours or soonest available appointment; 5-
10 minutes of medical discussion; CPT code 99442, Telephone evaluation 
and management service provided by a physician to an established 
patient, parent, or guardian not originating from a related E/M service 
provided within the previous seven days nor leading to an E/M service 
or procedure within the next 24 hours or soonest available appointment; 
11-20 minutes of medical discussion;

[[Page 66371]]

 CPT code 99443, Telephone evaluation and management service provided 
by a physician to an established patient, parent, or guardian not 
originating from a related E/M service provided within the previous 
seven days nor leading to an E/M service or procedure within the next 
24 hours or soonest available appointment; 21-30 minutes of medical 
discussion; and CPT code 99444, Online evaluation and management 
service provided by a physician to an established patient, guardian or 
health care provider not originating from a related E/M service 
provided within the previous 7 days, using the Internet or similar 
electronic communications network, the HCPAC recommended 0.25 work RVUs 
for CPT code 98966; 0.50 work RVUs for CPT code 98967; 0.75 work RVUs 
for CPT code 98968; carrier pricing for CPT code 98969; and the RUC 
recommended 0.25 work RVUs for CPT code 99441; 0.50 work RVUs for CPT 
code 99442; 0.75 work RVUs for CPT code 99443; and carrier pricing for 
CPT code 99444. We are assigning a status indicator of ``N'' (Non-
covered service) to these services because: (1) These services are non-
face-to-face; and (2) the code descriptor includes language that 
recognizes the provision of services to parties other than the 
beneficiary and for whom Medicare does not provide coverage (for 
example, guardian). (Note: The RUC or HCPAC recommended RVUs for these 
codes will be reflected in Addendum B.)
6. Team Conference
    For CPT code 99366, Medical team conference with interdisciplinary 
team of health care professionals, face-to-face with patient and/or 
family, 30 minutes or more; participation by non-physician qualified 
health care professional; CPT code 99367, Medical team conference with 
interdisciplinary team of health care professionals, patient and/or 
family not present, 30 minutes or more; participation by physician; and 
CPT code 99368, Medical team conference with interdisciplinary team of 
health care professionals, patient and/or family not present, 30 
minutes or more; participation by non-physician qualified health care 
professional, the HCPAC recommended 0.82 work RVUs for CPT code 99366; 
the RUC recommended 1.10 work RVUs for CPT code 99367; and the HCPAC 
recommended 0.72 work RVUs for CPT code 99368. We are assigning a 
status indicator of ``B'' (Bundled) to these services because to the 
extent that these services are covered, we believe these services like 
other counseling services are incorporated into existing E/M services. 
(Note: The RUC or HCPAC recommended RVUs for these codes will be 
reflected in Addendum B.)
7. Reporting of Alcohol and/or Substance Abuse Assessment and 
Intervention Services
    For CY 2008, the CPT Editorial Panel has created two new Category I 
CPT codes for reporting alcohol and/or substance abuse screening. They 
are CPT code 99408, Alcohol and/or substance (other than tobacco) abuse 
structured screening (e.g., AUDIT, DAST), and brief intervention (SBI) 
services; 15 to 30 minutes, and CPT code 99409, Alcohol and/or 
substance (other than tobacco) abuse structured screening (e.g., AUDIT, 
DAST), and brief intervention (SBI) services; greater than 30 minutes.
    The code descriptions for these CPT codes suggest that these CPT 
codes may describe services that include screening services. In 
general, screening services under Medicare are considered to be those 
services provided to beneficiaries in the absence of signs or symptoms 
of illness or injury; therefore, to the extent that the services 
described by these two CPT codes have a screening element, the 
screening component would not meet the statutory requirements for 
coverage under section 1862(a)(1)(A) of the Act. Screening services are 
not covered by Medicare without specific statutory authority, such as 
has been provided for mammography, diabetes, and colorectal cancer 
screening. Accordingly, we will not recognize these CPT codes that 
incorporate screening for payment under the PFS.
    Instead, we have created two parallel G-codes to allow for 
appropriate Medicare reporting and payment for alcohol and substance 
abuse assessment and intervention services that are not provided as 
screening services, but that are performed in the context of the 
diagnosis or treatment of illness or injury. The codes are HCPCS code 
G0396, Alcohol and/or substance (other than tobacco) abuse structured 
assessment (e.g., AUDIT, DAST) and brief intervention, 15 to 30 minutes 
and HCPCS code G0397, Alcohol and/or substance (other than tobacco) 
abuse structured assessment (e.g., AUDIT, DAST) and intervention 
greater than 30 minutes. We will instruct Medicare contractors to pay 
for these codes only when considered reasonable and necessary. We will 
also provide coding and payment instructions for these assessment and 
intervention services in the program instructions implementing the CY 
2008 PFS.
    We are assigning a status indicator of ``N'' (Noncovered) to CPT 
codes 99408 and 99409. However, the work RVUs and PE inputs for 99408 
will be crosswalked to G0396 and the work RVUs and PE inputs for 99409 
will be crosswalked to G0397.
8. Ocular Photoscreening
    For CPT code 99174, Ocular photoscreening with interpretation and 
report, bilateral, the RUC did not provide a recommendation. We are 
assigning a status indicator of ``N'' (Noncovered) to this service 
because it is a screening service that is not covered under the 
Medicare statute.

G. Additional Coding Issues

1. Modifier -51 Exempt List
    The CPT Editorial Panel reviewed all of the codes on the modifier -
51 exempt list to identify which codes should be exempt from the 
multiple procedure payment reduction rules and which codes should be 
removed from the exemption list. We have reviewed all codes recommended 
for removal from the exemption list and agree with the CPT Editorial 
Panel's recommendations. We have updated payment modifiers where 
applicable.
2. New Codes for Re-Examination at the Next 5-Year Review
    As part of its annual recommendations, the RUC includes a list 
identifying new CPT codes for reexamination at the next 5-Year Review 
of Work RVUs. New CPT codes that have been added to this list are 
identified with an asterisk (*) on Table 16: AMA RUC and HCPAC 
Recommendations and CMS' Decisions for New and Revised 2008 CPT Codes.

H. 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 2008

    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 CY 2008 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 Table 16: 
AMA RUC and HCPAC Recommendations and CMS' Decisions for New and 
Revised

[[Page 66372]]

2008 CPT Codes except as noted below in this section.

CPT Code Series 49450 Through 49465

    In this series of nine G-, J-, and G-J Tubes CPT codes, 49440, 
49441, 49442, 49446, 49450, 49451, 49452, 49460 and 49465, we made 
revisions to the clinical labor time to conform to the RUC-established 
standard under which the time assigned to any one labor type for the 
``intra'' time, based on the physician's time to perform the procedure, 
can not exceed 100 percent of the physician time. These revisions 
affected the service period times for the angio-tech/RT for each code. 
For each CPT code, the angio-tech/RT time to assist the physician in 
performing the procedure was allocated at 67 percent of the physician 
time and the angio-tech/RT time to assist the physician with image 
acquisition during the procedure was allocated the remaining 33 percent 
of the physician time.
    We also made minor revisions to the supply list for this family of 
codes in order to match the number of requested needles with the number 
of syringes. We allocated one needle for each saline flush syringe and 
1 additional needle to administer the lidocaine. Each needle was 
assigned the supply category ``SC029, needle, 18-27g'' to encompass 
both the 18g and 25g needles requested. In addition, we added a 10-12 
ml syringe that could be used to administer the lidocaine.

CPT Code 50593

    We disagreed with the RUC recommended number of renal cryoablation 
probes typically needed to perform this procedure. Instead of 4 probes, 
we believe that an average of 2.5 probes is typical to this procedure 
based on 2005 clinical data (collected at Karmonos Cancer Institute) 
that was included as an attachment to information provided by the 
manufacturer. Therefore, we have assigned 2.5 probes for renal 
cryoablation, at $1,175 each, for CPT 50593.

V. Physician Self-Referral Prohibition: Annual Update to 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. Annual Update to the Code List

1. Background
    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 Code List also identifies 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 2007 PFS final rule with 
comment period (71 FR 69624) and in a subsequent correction notice (72 
FR 18909).
2. Response to Comments
    We received only one public comment relating to the Code List that 
became effective January 1, 2007. The commenter was supportive of our 
additions and deletions.
3. Revisions Effective for 2008
    The updated, comprehensive Code List effective January 1, 2008, 
appears as Addendum x in this final rule with comment period and is 
available on our Web site at http://www.cms.hhs.gov/PhysicianSelfReferral/11_List_of_Codes.asp#TopOfPage.
    Tables 19 and 20 identify the additions and deletions, 
respectively, to the comprehensive Code List that was published in 
Addendum J of the CY 2007 PFS final rule (71 FR 70247 through 70251) 
and revised in a subsequent correction notice (72 FR 18909). Tables 19 
and 20 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 Sec.  411.355(h) (regarding preventive screening tests, 
immunizations and vaccines).
    The additions and deletions specified in Tables 19 and 20 are 
necessary to conform the Code List to the most recent publications of 
CPT and HCPCS and to changes in Medicare payment policies.
    We will consider comments regarding the codes listed in Tables 19 
and 20. Comments will be considered if we receive them by the date 
specified in the DATES section of this final rule with comment period. 
We will not consider any comment that advocates a substantive change to 
any of the DHS defined in Sec.  411.351.

   Table 19.--Additions to the Physician Self-Referral List of CPT \1\
                               HCPCS Codes
------------------------------------------------------------------------
 
------------------------------------------------------------------------
                      CLINICAL LABORATORY SERVICES
------------------------------------------------------------------------
[no additions]
------------------------------------------------------------------------
  PHYSICAL THERAPY, OCCUPATIONAL THERAPY, AND SPEECH-LANGUAGE PATHOLOGY
                                SERVICES
------------------------------------------------------------------------
96125.................................  Cognitive test by HC pro.
------------------------------------------------------------------------
              RADIOLOGY AND CERTAIN OTHER IMAGING SERVICES
------------------------------------------------------------------------
75557.................................  Cardiac mri for morph.
75558.................................  Cardiac mri flow/velocity.
75559.................................  Cardiac mri w/stress img.
75560.................................  Cardiac mri flow/vel/stress.
75561.................................  Cardiac mri for morph w/dye.
75562.................................  Card mri flow/vel w/dye.
75563.................................  Card mri w/stress img & dye.
75564.................................  Ht mri w/flo/vel/strs & dye.
A9501.................................  Technetium TC-99m teboroxime.
A9509.................................  Iodine I-123 sod iodide mil.
A9569.................................  Technetium TC-99m auto WBC.
A9570.................................  Indium In-111 auto WBC.
A9571.................................  Indium In-111 auto platelet.

[[Page 66373]]

 
A9572.................................  Indium In-111 pentetreotide.
A9576.................................  Inj prohance multipack.
A9577.................................  Inj multihance.
A9578.................................  Inj multihance multipack.
A9579.................................  Gad-base MR contrast NOS, 1ml.
Q9965.................................  LOCM 100-199mg/ml iodine, 1ml.
Q9966.................................  LOCM 200-299mg/ml iodine, 1ml.
Q9967.................................  LOCM 300-399mg/ml iodine, 1ml.
------------------------------------------------------------------------
                 RADIATION THERAPY SERVICES AND SUPPLIES
------------------------------------------------------------------------
0182T.................................  HDR elect brachytherapy.
20555.................................  Place ndl musc/tis for rt.
41019.................................  Place needles h&n for rt.
55920.................................  Place needles pelvic for rt.
C1716.................................  Brachytx source, Gold 198.
C1717.................................  Brachytx source, HDR Ir-192.
C1719.................................  Brachytx source, Non-HDR Ir-192.
C2616.................................  Brachytx source, Yttrium-9.
C2634.................................  Brachytx source, HA, I-125.
C2635.................................  Brachytx source, HA, P-13.
C2636.................................  Brachytx linear source, P-13.
C2637.................................  Brachytx, Ytterbium-169.
C2638.................................  Brachytx, stranded, I-125.
C2639.................................  Brachytx, non-stranded, I-125.
C2640.................................  Brachytx, stranded, P-13.
C2641.................................  Brachytx, non-stranded, P-13.
C2642.................................  Brachytx, stranded, C-131.
C2643.................................  Brachytx, non-stranded, C-131.
C2698.................................  Brachytx, stranded, NOS.
C2699.................................  Brachytx, non-stranded, NOS.
------------------------------------------------------------------------
               DRUGS USED BY PATIENTS UNDERGOING DIALYSIS
------------------------------------------------------------------------
[no additions]
------------------------------------------------------------------------
         PREVENTIVE SCREENING TESTS, IMMUNIZATIONS AND VACCINES
------------------------------------------------------------------------
90669.................................  Pneumococcal vacc, ped <5.
------------------------------------------------------------------------
\1\ CPT codes and descriptions only are copyright 2007 AMA. All rights
  are reserved and applicable FARS/DFARS clauses apply.


Table 20.--Deletions to the Physician Self-Referral List of CPT\1\/HCPCS
                                  Codes
------------------------------------------------------------------------
 
------------------------------------------------------------------------
                      CLINICAL LABORATORY SERVICES
------------------------------------------------------------------------
[no deletions]
------------------------------------------------------------------------
  PHYSICAL THERAPY, OCCUPATIONAL THERAPY, AND SPEECH-LANGUAGE PATHOLOGY
                                SERVICES
------------------------------------------------------------------------
[no deletions]
------------------------------------------------------------------------
              RADIOLOGY AND CERTAIN OTHER IMAGING SERVICES
------------------------------------------------------------------------
75552...............................  Heart mri for morph w/o dye.
75553...............................  Heart mri for morph w/dye.
75554...............................  Cardiac MRI/function.
75555...............................  Cardiac MRI/limited study.
78609...............................  Brain imaging (PET).
78615...............................  Cerebral vascular flow image.
A9565...............................  In111 pentetreotide.
Q9945...............................  LOCM<=149mg/ml iodine, 1ml.
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.
Q9952...............................  Inj Gad-base MR contrast, 1ml.
------------------------------------------------------------------------
                 RADIATION THERAPY SERVICES AND SUPPLIES
------------------------------------------------------------------------
[no deletions]
------------------------------------------------------------------------
               DRUGS USED BY PATIENTS UNDERGOING DIALYSIS
------------------------------------------------------------------------
[no deletions]
------------------------------------------------------------------------
         PREVENTIVE SCREENING TESTS, IMMUNIZATIONS AND VACCINES
------------------------------------------------------------------------
[no deletions]
------------------------------------------------------------------------
\1\ CPT codes and descriptions only are copyright 2007 AMA. All rights
  are reserved and applicable FARS/DFARS clauses apply.

VI. Physician Fee Schedule Update for CY 2008

A. Physician Fee Schedule Update

    The PFS update is set under a formula specified in section 
1848(d)(4) of the Act, as amended by the MIEA-TRHCA. Section 101 of the 
MIEA-TRHCA provided a 1 year increase in the CY 2007 conversion factor 
and specified that the conversion factor for CY 2008 must be computed 
as if the 1-year increase had never applied. Consistent with this 
requirement, the update for CY 2008 is equal to the product of 1 plus 
the CY 2007 update (as published in the CY 2007 PFS final rule with 
comment period (71 FR 69751)), 1 plus the percentage increase in the 
MEI (divided by 100), and 1 plus the UAF. As stated in the CY 2007 PFS 
final rule with comment period, if section 101 of the MIEA-TRHCA had 
not subsequently been enacted, the CY 2007 update would have been -5.0 
percent (0.94953). For CY 2008, the MEI is equal to 1.8 percent 
(1.018). The UAF is -7.0 percent (0.930). The product of the published 
CY 2007 update (0.94953), MEI (1.018), and the UAF (0.930) equals the 
CY 2008 update of -10.1 percent (0.89896).
    Our calculations of these figures are explained in this section.

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

    The Medicare Economic Index (MEI) is authorized by section 
1842(b)(3) of the Act, which states that prevailing charge levels 
beginning after June 30, 1973 may not exceed the level from the 
previous year except to the extent that the Secretary finds, on the 
basis of appropriate economic index data, that the higher level is 
justified by year-to-year economic changes.
    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 CY 2000 
base year weights, is comprised of two broad categories: (1) 
Physician's own time; and (2) physician's PE.
    The physician's own time component represents the net income 
portion of business receipts and primarily reflects the input of the 
physician's own time into the production of physicians' services in 
physicians' offices. This category consists of two subcomponents: (1) 
Wages and salaries; and (2) fringe benefits.
    The physician's PE category represents nonphysician inputs used in 
the production of services in physicians' offices. This category 
consists of wages and salaries and fringe benefits for nonphysician 
staff and other nonlabor inputs. The physician's PE component also 
includes the following categories of nonlabor inputs: Office expense; 
medical materials and supplies; professional liability insurance; 
medical equipment; prescription drugs; and other expenses. The 
components are adjusted to reflect productivity growth in physicians' 
offices by the 10-year moving average of productivity in the private 
nonfarm business sector.
    In the CY 2008 PFS proposed rule (72 FR 38190), we presented a 
listing of the cost categories with the associated cost weights. We 
also explained that the Bureau of Labor Statistics (BLS) has 
discontinued production and publication of the white collar

[[Page 66374]]

occupation employment cost index (ECI) series which was used as the 
price proxy for nonphysician benefits in the MEI. There was no other 
comparable published series that was a suitable replacement for the 
white collar benefit ECI. Therefore, a nationally recognized economic 
and financial forecasting firm, Global Insight, Inc. (GII), and CMS 
jointly developed a composite series which is composed of four 
published ECI series and weighted by November 2004 National Industry 
Specific Occupational Employment and Wage Estimates for NAICS 6211, 
Office of Physicians. We proposed to replace the ECI white collar 
benefit series with this composite benefit index effective for the CY 
2008 MEI update (See the CY 2008 PFS proposed rule (72 FR 38190) for a 
more detailed explanation of the specific proposal). In addition, we 
also published a preliminary estimate of the expected MEI update.
    Table 21 presents a listing of the MEI cost categories with 
associated weights and percent changes for price proxies for the 2008 
update. For CY 2008, the increase in the MEI is 1.8 percent, which 
includes a 1.4 percent productivity offset based on the 10-year moving 
average of multifactor productivity. This is the result of a 3.7 
percent increase in physician's own time and a 2.7 percent increase in 
physician's PE. Within the physician's PE, the largest increase 
occurred in prescription drugs, which increased 4.2 percent, and 
professional and technical wages, which increased 4.0 percent.

  Table 21.--Increase in the Medicare Economic Index Update for CY 2008
                                   \1\
------------------------------------------------------------------------
                                                              CY 2008
   Cost categories and price measures         CY 2000         percent
                                            weights \2\       changes
------------------------------------------------------------------------
Medicare Economic Index Total,                       N/A             1.8
 productivity adjusted \3\..............
    Productivity: 10-year moving average             N/A             1.4
     of multifactor productivity,
     private nonfarm business sector 3 4
Medicare Economic Index Total, without           100.000             3.2
 productivity adjustment \4\............
        1. Physician's Own Time \5\.....          52.466             3.7
            a. Wages and Salaries:                42.730             4.0
             Average Hourly Earnings,
             private Nonfarm............
            b. Fringe Benefits:                    9.735             2.7
             Employment Cost Index,
             benefits, private nonfarm..
        2. Physician's Practice Expense           47.534             2.7
         \5\............................
            a. Nonphysician Employee              18.653             3.6
             Compensation...............
                (1) Wages and Salaries:           13.808             3.6
                 Employment Cost Index,
                 wages and salaries,
                 weighted by occupation.
                (2) Fringe Benefits:               4.845             3.7
                 Employment Cost Index,
                 fringe benefits,
                 weighted by occupation
                 \7\....................
            b. Office Expense: Consumer           12.209             3.5
             Price Index for Urban Areas
             (CPI-U), housing...........
            c. Drugs and Medical                   4.319             2.9
             Materials and Supplies.....
                (1) Medical Materials              2.011             1.0
                 and Supplies: Producer
                 Price Index (PPI),
                 surgical appliances and
                 supplies/CPI-U, medical
                 equipment and supplies
                 (equally weighted).....
                (2) Pharmaceuticals:               2.308             4.2
                 Producer Price Index
                 (PPI ethical
                 prescription drugs)....
            d. Professional Liability              3.865            -0.8
             Insurance: Professional
             liability insurance
             Premiums \6\...............
            e. Medical Equipment: PPI,             2.055            -0.4
             medical instruments and
             equipment..................
            f. Other Expenses...........           6.433            2.6
------------------------------------------------------------------------
\1\ The rates of historical change are estimated for the 12-month period
  ending June 30, 2007, which is the period used for computing the CY
  2008 update. The price proxy values are based upon the latest
  available Bureau of Labor Statistics data as of August 31, 2007.
\2\ The weights shown for the MEI components are the 2000 base year
  weights, which may not sum to subtotals or totals because of rounding.
  The MEI is a fixed weight, Laspeyres-type input price index whose
  category weights indicate the distribution of expenditures among the
  inputs to physicians' services for CY 2000. To determine the MEI level
  for a given year, the price proxy level for each component is
  multiplied by its 2000 weight. The sum of these products (weights
  multiplied by the price index levels) over all cost categories yields
  the composite MEI level for a given year. The annual percent change in
  the MEI levels is an estimate of price change over time for a fixed
  market basket of inputs to physicians' services.
\3\ These numbers may not sum due to rounding and the multiplicative
  nature of their relationship.
\4\ On March 23, 2006, Bureau of Labor Statistics introduced a new Multi
  Factor Productivity (MFP) series based on the 1997 NAICS
  classification system to replace its SIC based series published until
  2005 (the last historical value was for 2002). The new series differs
  historically from the old MFP series and adds two new historical
  values through 2004. Therefore, we used the most recently available
  information (thru CY 2006) to develop the productivity adjustment for
  the CY 2008 update.
\5\ The measures of productivity, average hourly earnings, Employment
  Cost Indexes, as well as the various Producer and CPIs can be found on
  the BLS Web site at http://stats.bls.gov.
\6\ Derived from data collected from several major insurers (the latest
  available historical percent change data are for the period ending
  second quarter of 2007).
\7\ In April 2007, with their March 2007 publication, Bureau of Labor
  Statistics (BLS) discontinued production and publication of the white
  collar occupation employment cost index (ECI) series. CMS replaced
  this proxy with a composite benefit series. The historical percent
  changes for the non physician employee benefits match the BLS white
  collar benefit series through 2006Q4, and from 2007Q1 forward, the
  percent changes reflect those of the composite benefit series. For
  more detail on the composite benefit series see the CY 2008 PFS
  proposed rule (72 FR 38190).

    Comment: Many commenters proposed that we should reduce the 
productivity adjustment to the MEI to 0.65 percentage points from the 
proposed productivity adjustment of 1.5 percentage points. They believe 
the MEI should be subject to the same productivity adjustment as the 
recommended productivity adjustment for hospital, hospice, and 
ambulance care providers, which they state was recommended in the 
President's Budget proposal. The commenters also note that it is not 
logical for CMS to believe that physician's productivity is increasing 
at twice the rate of other health care providers.
    Response: We disagree that the productivity adjustment to the MEI 
should be changed based on the proposals made in the FY 2008 
President's Budget.\4\ The MEI has contained a productivity adjustment 
since its inception in 1973. The rationale for, and technical 
appropriateness of the current MEI productivity adjustment has been 
well documented in the Federal Register (for example, 67 FR 80020 
through 80023). Moreover, we recently partnered with

[[Page 66375]]

the Assistant Secretary of Planning and Evaluation of the Department of 
Health and Human Services to sponsor an analysis of physician-specific 
productivity. The results of this effort were presented at a conference 
of stakeholders in October 2006. A highly respected panel of experts 
concluded that the use of the 10-year moving average for private, 
nonfarm business sector multifactor productivity was not an 
unreasonable proxy for physician-specific productivity. Papers from 
this research effort are expected to be published in the forthcoming 
Winter 2007/2008 edition of the Health Care Financing Review. We will 
continue to monitor, on an ongoing basis, the appropriateness of the 
use of this economy-wide measure of multifactor productivity for 
purposes of adjusting the MEI.
---------------------------------------------------------------------------

    \4\ http://www.whitehouse.gov/omb/budget/fy2008/hhs.html.
---------------------------------------------------------------------------

    With respect to historical productivity achievement in other health 
care sectors, there is comparatively little on this topic in the 
literature. We intend to continue to research various health-related 
productivity measures and would welcome the provision of data or 
completed studies on this topic.
    Comment: One commenter questioned why other providers receive a 
0.65 percent adjustment while physicians face an adjustment of more 
than twice that amount.
    Response: To date, there are no laws in place requiring 
productivity adjustments for other PPS-reimbursed providers such as 
hospitals, and skilled nursing facilities. However, the MEI has 
contained an explicit productivity adjustment since its inception in 
1973. The rationale and technical appropriateness of the current MEI 
productivity adjustment was addressed in the CY 2003 PFS final rule 
with comment period (67 FR 80019).
    Comment: Several commenters requested that we address the broader 
issue that the MEI only measures changes in the specific types of 
practice costs that existed in 1973. They note that inputs to the MEI 
are vastly different now than when the MEI was first developed in the 
1970s, and suggest additional inputs may be needed to ensure that the 
current MEI adequately measures the costs of practicing medicine.
    Response: We disagree with the commenters' claim that the MEI only 
measures changes in specific types of practice costs that existed in 
1973. The current MEI is based on costs reported by physicians for the 
year 2000. The 2000-based cost weights are derived from the 2003 AMA 
Physician Socioeconomic Characteristics publication (2003 Patient Care 
Physician Survey data), which measures physicians' earnings and overall 
PEs for 2000. This is the latest available data on the breakdown of 
physician expenses.
    Although cost weights in the various market baskets do not tend to 
change dramatically over short periods of time, we do recognize that 
they can change over long periods of time. We are presently researching 
alternative data sources for a forthcoming rebasing of the MEI, 
including the potential use of an AMA-sponsored Physician Practice 
Information Survey that was fielded in 2007. We have also considered 
data from the Census Bureau's Business Expenditure Survey (BES). This 
survey is the most comprehensive source of periodic national industry 
statistics on major economic inputs by type. Data are published every 5 
years for years ending in ``2'' and ``7''. Currently the most recent 
data is reported for 2002. We compared the cost weights we derived from 
the 2002 BES data for NAICS 6211, Offices of Physicians and found that 
the overall cost weights for compensation and all other costs are quite 
similar to the cost weights for the current MEI market basket as shown 
in Table 22. We are optimistic that the new data from AMA or the Census 
Bureau will be sufficiently robust for the purpose of updating the 
MEI's input cost weights.

Table 22.--A Comparison of Major Cost Category MEI Market Basket Weights
                         Using AMA and BES Data
------------------------------------------------------------------------
                                                               2002 BES
                                                  MB 2000     (excluding
                                                  weights      capital)
                                                 (percent)    (percent)
------------------------------------------------------------------------
Compensation..................................         71.2         73.5
Other.........................................         28.8         26.5
------------------------------------------------------------------------

    Comment: Several commenters believe that the MEI does not 
adequately account for the costs related to the multitude of 
regulations and requirements that physicians must comply with in their 
practices. For example, they note that the physician quality reporting 
initiative (PQRI) has reduced productivity in physician's offices. 
Similarly, a commenter had concerns that employee wages used in the MEI 
formula do not capture the wages of highly skilled professionals such 
as nurse practitioners, physician assistants, certified nurse 
specialists, nurse midwives, therapists, computer professional, and 
other types of professional occupations.
    Response: The current MEI cost weights are based on input costs 
reported by physicians for 2000, which would reflect changes in the 
distributions of the cost weights associated with new government-
imposed regulatory requirements up to that point. These cost weights 
are derived from the 2003 AMA Physician Socioeconomic Characteristics 
publication (2003 Patient Care Physician Survey data), which measures 
physicians' earnings and overall PEs for CY 2000. While we understand 
that more recent data would better measure relative input costs, we 
presently lack a viable alternative data source with which to compute 
new cost weights. The data used as the basis for the current MEI market 
basket cost weights represent the latest available data on physician 
expenses. As stated previously, we are awaiting the data from the 2007 
AMA Physician Practice Information Survey and are hopeful that this 
source will be sufficiently robust for use in rebasing the cost weights 
found in the MEI. We would expect that any relative cost changes 
related to regulatory changes would be reflected in this new data.
    Comment: One commenter suggested we should discontinue use of the 
MEI to measure physician input price pressures and switch to the same 
market basket update used by the hospital outpatient prospective 
payment system (OPPS).
    Response: We disagree with the commenter that physicians and 
outpatient hospital departments face the same input costs.
    The MEI reflects the cost structure and price changes associated 
with the inputs used in furnishing physicians' services while the 
hospital market basket reflects the cost structure and price changes 
associated with the inputs used in providing hospital services.
    Comment: One commenter noted that input expenses for recruiting and 
employing trained personnel and other PEs in the physician's office are 
identical to those in a hospital.
    Response: The expenses for trained personnel are captured in the PE 
portion of the MEI. These PE cost weights are derived from the 2003 AMA 
Physician Socioeconomic Characteristics publication (2003 Patient Care 
Physician Survey data), which measures physicians' earnings and overall 
PEs for CY 2000. As indicated above in this section, while we 
understand that more recent data would better measure relative input 
costs, we presently lack a viable alternative data source with which to 
compute new cost weights. The data used as the basis for the current 
MEI market basket cost weights represent the latest available data on 
physician expenses. We are awaiting the

[[Page 66376]]

data from the 2007 AMA Physician Practice Information Survey and are 
hopeful that this source will be sufficiently robust for use in 
rebasing the cost weights found in the MEI. We would expect that any 
relative cost changes related to PE costs would be reflected in this 
new data.
    Comment: One commenter disagreed with the price proxy used for 
office expenses in the MEI noting that the growth in office rents 
differ from apartment rents. The commenter also suggested that we get 
data from a contractor comparing the cost of building medical office 
space to that of residential living space.
    Response: We agree that the construction costs of a physician's 
office differ from the construction costs of a residential dwelling; 
however, the cost category for office expenses is not designed to 
measure the changes in initial construction costs. Instead, we attempt 
to measure the rate of price changes related to a monthly office 
expense payment. The majority of monthly office expenses are related to 
rent or mortgage for commercial space. As we are not aware of a 
publicly-available proxy that measures the price changes in rental 
costs of commercial space, we use what we believe to be the best, 
technically appropriate alternative; the consumer price index (CPI) for 
housing. Other major office expenses, such as medical equipment, are 
broken out in greater detail. Once data is available for the next 
rebasing of the MEI, we will explore the feasibility of breaking office 
expenses into more comprehensive cost categories.
    Comment: One commenter has concerns that the forecasts of the MEI 
have been and continue to be declining (from over 3 percent to below 2 
percent) for the foreseeable future. The commenter would like for CMS 
to examine in more detail the assumptions of the price proxy forecasts 
produced by Global Insight Inc. (GII).
    Response: It is important to note that the MEI update is based on 
historical data rather than on forecasted data. For example, the CY 
2008 update is based on the actual measured price inflation through the 
second quarter of 2007. Since the MEI update is based on historical 
data, not on a forecast, the concern that GII's work does not involve 
forecasting the price proxies for compensation and PEs accurately is 
not relevant. Table 23 shows the MEI updates for the past 5 years and 
the current CY 2008 update. While the MEI update for CY 2003 through CY 
2006 was closer to 3.0 percent, the MEI update for CY 2007 and CY 2008 
is closer to 2.0 percent. These lower updates are not, however, a 
function of an incorrect forecast. The recent lower overall MEI updates 
are a function of both a deceleration in input price pressures and 
relatively higher gains in multifactor productivity.

                  Table 23.--MEI Updates for the Past 5 Years and the Current CY 2008 Update *
----------------------------------------------------------------------------------------------------------------
                        MEI final updates                            Adjusted       Unadjusted     Productivity
----------------------------------------------------------------------------------------------------------------
CY 2003.........................................................             3.0             3.8             0.8
CY 2004.........................................................             2.9             3.8             0.9
CY 2005.........................................................             3.1             4.0             0.9
CY 2006.........................................................             2.8             3.8             1.0
CY 2007.........................................................             2.1             3.5             1.3
CY 2008.........................................................             1.8             3.2            1.4
----------------------------------------------------------------------------------------------------------------
* Prior to the update for CY 2003 the MEI was adjusted for Labor productivity rather than by private non-farm
  multifactor productivity.

    Comment: One commenter stated that the only solution the commenter 
would support at this time would be a nationwide legislative solution 
that would provide additional funding for fair and equitable payment to 
Medicare participating physicians in every State.
    Response: We do not have the administrative authority to make such 
a legislative change. More so, this comment is beyond the scope of the 
MEI proposals of the CY 2008 PFS proposed rule.

C. The Update Adjustment Factor (UAF)

    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.
    Section 101 of the MIEA TRHCA provided a 1 year increase in the CY 
2007 conversion factor. The provision specified that the CF for CY 2008 
must be computed as if the 1 year increase for CY 2007 had never 
applied.
1. Calculation Under Current Law
    Under section 1848(d)(4)(B) of the Act, the UAF for a year 
beginning with CY 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 (CY 2008 in this case), the 
current CY (that is, CY 2007) and the preceding CY (that is, CY 2006) 
are to be determined on the basis of the best data available as of 
September 1 of the current year. Allowed expenditures for a year are 
initially estimated and subsequently revised twice. The second revision 
occurs after the CY has ended

[[Page 66377]]

(that is, we are making the final revision to 2006 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 24 shows annual and cumulative allowed and actual 
expenditures for physicians' services from April 1, 1996 through the 
end of the current CY, including the short periods in 1999 when we 
transitioned to a CY system. Also shown is the SGR corresponding with 
each period. The calculation of the SGR is discussed in detail below in 
this section.

  Table 24.--Annual and Cumulative Allowed and Actual Expenditures for Physicians' Services From April 1, 1996 Through the End of the Current Calendar
                                                                          Year
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                                    Cumulative        Cumulative
                                              Annual allowed    Annual  actual        allowed           actual
                   Period                    expenditures  ($  expenditures  ($  expenditures  ($  expenditures  ($               FY/CY SGR
                                               in billions)      in billions)      in billions)      in billions)
--------------------------------------------------------------------------------------------------------------------------------------------------------
4/1/96-3/31/97.............................         \1\ $48.9             $48.9             $48.9             $48.9  N/A
4/1/97-3/31/98.............................              50.5              49.4              99.4              98.4  FY 1998=3.2%
4/1/98-3/31/99.............................              52.6              50.5             152.0             148.9  FY 1999=4.2%
1/1/99-3/31/99.............................              13.3              13.1             (\2\)             148.9  FY 1999=4.2%
4/1/99-12/31/99............................              42.1              39.5             (\3\)             188.4  FY 2000=6.9%
1/1/99-12/31/99............................              55.3              52.6             194.0             188.4  FY 1999/2000
1/1/00-12/31/00............................              59.3              58.1             253.4             246.5  CY 2000=7.3%
1/1/01-12/31/01............................              62.0              66.3             315.4             312.8  CY 2001=4.5%
1/1/02-12/31/02............................              67.2              70.9             382.6             383.7  CY 2002=8.3%
1/1/03-12/31/03............................              72.1              78.2             454.6             461.9  CY 2003=7.3%
1/1/04-12/31/04............................              76.8              87.1             531.5             549.0  CY 2004=6.6%
1/1/05-12/31/05............................              80.1              91.8             611.5             640.8  CY 2005=4.2%
1/1/06-12/31/06............................              81.3              93.4             692.8             734.2  CY 2006=1.5%
1/1/07-12/31/07............................              83.9              94.6             776.6             828.8  CY 2007=3.2%
1/1/08-12/31/08............................              83.8                NA             860.4                NA  CY 2008= 0.1%
--------------------------------------------------------------------------------------------------------------------------------------------------------
\1\ Allowed expenditures in the first year (April 1, 1996-March 31, 1997) are equal to actual expenditures. All subsequent figures are equal to
  quarterly allowed expenditure figures increased by the applicable SGR. Cumulative allowed expenditures are equal to the sum of annual allowed
  expenditures. We provide more detailed quarterly allowed and actual expenditure data on our Web site at the following address: http://www.cms.hhs.gov/SustainableGRatesConFact/ SustainableGRatesConFact/. We expect to update the Web site with the most current information later this month.
\2\ Allowed expenditures for the first quarter of 1999 are based on the FY 1999 SGR.
\3\ Allowed expenditures for the last three quarters of 1999 are based on the FY 2000 SGR.

    Consistent with section 1848(d)(4)(E) of the Act, Table 24 includes 
our final revision of allowed expenditures for CY 2006, a recalculation 
of allowed expenditures for CY 2007, and our initial estimate of 
allowed expenditures for CY 2008. To determine the UAF for CY 2008, the 
statute requires that we use allowed and actual expenditures from April 
1, 1996 through December 31, 2007 and the CY 2008 SGR. Consistent with 
section 1848(d)(4)(E) of the Act, we will be making revisions to the CY 
2007 and CY 2008 SGRs and CY 2007 and CY 2008 allowed expenditures. 
Because we have incomplete actual expenditure data for CY 2007, 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 24 in the following statutory 
formula:
[GRAPHIC] [TIFF OMITTED] TR27NO07.000

UAF<INF>08</INF> = Update Adjustment Factor for CY 2008 = -26.7 
percent
Target<INF>07</INF> = Allowed Expenditures for CY 2007 = $83.9 
billion
Actual<INF>07</INF> = Estimated Actual Expenditures for CY 2007 = 
$94.6 billion
Target <INF>4/96-12/07</INF> = Allowed Expenditures from 4/1/1996-
12/31/2007 = $776.6 billion
Actual <INF>4/96-12/07</INF> = Estimated Actual Expenditures from 4/
1/1996-12/31/2007 = $828.8 billion
SGR<INF>08</INF> = -0.1 percent (0.999)
[GRAPHIC] [TIFF OMITTED] TR27NO07.001

    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 -0.267 is less than -0.070, the UAF 
for CY 2008 will be -0.070.
    Section 1848(d)(4)(A)(ii) of the Act indicates that 1.0 should be 
added to the UAF determined under section 1848(d)(4)(B) of the Act. 
Thus, adding 1.0 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'

[[Page 66378]]

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 CY 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 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. (The Act also provides for adjustments to be made 
to the SGRs for FY 1998 and FY 1999. 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 CY 2008 SGR, a 
revision to the CY 2007 SGR, and our final revision to the CY 2006 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 November 
1, 2001 Federal Register (66 FR 55316). 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 PAs, certified registered nurse anesthetists, 
certified nurse midwives, clinical psychologists, clinical social 
workers, NPs, and certified nurse specialists.
    <bullet> Screening tests for prostate cancer, colorectal cancer, 
and glaucoma.
    <bullet> Screening mammography, screening pap smears, and screening 
pelvic exams.
    <bullet> Diabetes outpatient self-management training (DSMT) 
services.
    <bullet> MNT 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 physical 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 (70 FR 50940).
    Telehealth services and the power mobility device related services 
were 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) (70 FR 70305).

Summary of Comments on the Physician Update and the SGR

    We appreciate the comments we received expressing concern about the 
negative update for CY 2008 and the SGR formula. These comments and our 
responses are summarized here.
    Comment: The 2007 Medicare Trustees Report projected an approximate 
10 percent reduction in payment for physicians' services in CY 2008 and 
about a 5 percent reduction in each subsequent year through CY 2016. 
The cumulative impact of the projected reductions from CY 2008 to CY 
2016 is estimated to be about -40 percent. In contrast, the MEI 
increase over this same period is projected to be about 15 percent.
    Commenters noted that Medicare reimbursement does not reflect the 
actual costs of delivering services to Medicare beneficiaries. The 
commenters stated the reimbursement system has been unstable, and 
physicians cannot plan for the future in an unpredictable reimbursement 
environment that fails to keep pace with the costs of labor and 
supplies. Commenters also stated that practitioners unable to absorb 
the sustained losses will refuse or limit Medicare patients, resulting 
in reduced access to care. Commenters believe that beneficiaries will 
be forced to seek care in inpatient settings, which will be more costly 
for Medicare, less efficient in delivering care, and yield worse health 
outcomes for beneficiaries.
    Commenters recommended that the SGR be replaced with a more 
equitable and sustainable formula, such as an appropriate inflation 
rate linked to changes in the actual costs of medical practice. Many 
commenters suggested the MEI as an appropriate measure. Commenters 
requested that we assume the leadership in pushing the Congress to 
enact legislation preventing a negative update for CY 2008, and to 
replace the SGR with a more sustainable system.
    Response: We understand the potential implications of more than 9 
years of negative physician updates. We remain concerned regarding 
these trends, and we are closely monitoring physicians' participation 
in the Medicare program, as well as beneficiaries' access to care.
    It is a top priority at CMS to transform Medicare from a passive 
payor to an active purchaser of high quality, efficient health care 
services. We are studying and implementing value based purchasing 
initiatives for Medicare payment systems, including physicians' 
services. In addition, the FY 2008 President's Budget supports budget 
neutral physician payment reform and states that ``an important 
component of improving quality is encouraging more efficient and high-
quality physician services.'' (For further discussion of the 
President's FY 2008 Budget initiatives to improve the quality, 
efficiency and transparency of health care, see http://www.whitehouse.gov/omb/budget/fy2008/hhs.html.)

[[Page 66379]]

    Ultimately, the formula for the SGR and the physician update are 
dictated by statute. We are required to follow this methodology when 
calculating the payment rates under the PFS. We look forward to working 
with the Congress, the physician community, and other interested 
parties as we continue to analyze appropriate alternatives to the 
current system that could ensure appropriate payments while promoting 
high quality care, without increasing Medicare costs.
    Comment: Commenters noted that only physicians and other 
practitioners under the PFS face steep cuts under the SGR formula. The 
commenters also noted that other health care providers have payment 
updates that reflect the cost of inflation. Further, the commenters 
stated the approximately 10 percent cut in payment rates is in stark 
contrast to providers enrolled in Medicare Advantage (MA) plans, who 
are paid on average 112 percent above the cost of traditional Medicare.
    Response: As noted previously, the formula for the SGR and the 
physician update are dictated by statute. We are required to follow 
this methodology when calculating the payment rates under the PFS. 
Other Medicare payment systems have their own update formulas.
    Comment: Many commenters requested that we use our administrative 
authority to reduce the negative physician update for CY 2008. Many 
commenters stated that we are authorized to remove the cost of 
Medicare-covered physician-administered drugs from the SGR on a 
retrospective basis. They stated that we must also adjust the SGR 
target to reflect the impact of National and Local Coverage Decisions 
on physician spending. Commenters noted that the current formula does 
not account for costs and savings associated with new technologies. The 
commenters stated that if we make such administrative changes now, then 
the cost of legislation revising the payment methodology for 
physicians' services will drop, and the likelihood of Congressional 
action to fix the SGR permanently will increase. Commenters expressed 
frustration that these administrative adjustments have been requested 
numerous times, yet we have never implemented the changes.
    Response: We indicated in the past (most recently in the CY 2007 
PFS final rule with comment period (71 FR 69756)) that many of these 
administrative changes are statutorily difficult, and according to our 
current estimates, making such changes would not provide relief from 
the projected negative updates for the next several years. As indicated 
above in this section, we are working with the Congress and health 
professional organizations on potential reforms that would improve the 
effectiveness of the payment methodology for physicians without 
increasing overall Medicare costs.
    Comment: Commenters noted that payment updates under the SGR are 
tied to the gross domestic product (GDP), which bears little 
relationship to Medicare beneficiaries' health care needs or physician 
practice costs. Commenters noted that medical needs of individual 
patients are not related to the growth of the overall economy, and 
beneficiaries' medical needs do not decline during economic downturns. 
Commenters stated that MEI is a better reflection than GDP of the 
growth in health care costs.
    Response: As discussed in the CY 2007 PFS final rule with comment 
period (71 FR 69756), the percentage change in the MEI is one of the 
key components used to update the PFS CF. GDP is a general measure of 
economic growth. It is not intended to reflect factors specific to 
operating a medical practice because these factors are captured in the 
MEI. The statute requires that GDP be used as a component of the SGR, 
which is then used to calculate the target level of expenditures. 
Although both MEI and GDP are factors that affect the calculation of 
the CF, the MEI has a more direct and greater impact on the physician 
update than GDP.
    Comment: Commenters stated that additional funds need to be added 
to the SGR allowed expenditures for all the ancillary costs associated 
with new benefits. New benefits adjust the target, but they generate 
other services whose costs are not added to the targeted allowed 
expenditures.
    Response: As discussed in the CY 2007 PFS final rule with comment 
period (71 FR 69756 through 69757), our estimate of changes in 
expenditures arising from changes in laws and regulations includes 
induced spending impacts, when applicable and material. Our estimate of 
the additional expenditures associated with any new benefit, like all 
of the figures used to determine a particular year's SGR, is an 
estimate that will be revised based on subsequent data. A 2-year look 
back window allows adjustments to the estimates to reflect actual 
impacts. 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. (See below in this section for a discussion of all the new 
benefits that were considered in estimating the change in expenditures 
due to changes in law and regulation in 2006, 2007, and 2008.)

C. Preliminary Estimate of the SGR for 2008

    Our preliminary estimate of the CY 2008 SGR is -0.1 percent. We 
first estimated the CY 2008 SGR in March 2007, and made the estimate 
available to the MedPAC and on our Web site. Table 25 shows the March 
2007 estimate and our current estimates of the factors included in the 
CY 2008 SGR.

                                         Table 25.--2008 SGR Calculation
----------------------------------------------------------------------------------------------------------------
           Statutory factors                   March estimate                      Current estimate
----------------------------------------------------------------------------------------------------------------
Fees...................................  2.0 percent (1.020).......  1.9 percent (1.019).
Enrollment.............................  -0.2 percent (0.998)......  -0.7 percent (0.993).
Real Per Capita GDP....................  1.9 percent (1.019).......  1.7 percent (1.017).
Law and Regulation.....................  -1.5 percent (0.985)......  -2.9 percent (0.971).
                                        ------------------------------------------------------------------------
    Total..............................  2.2 percent (1.022).......  -0.1 percent (0.999).
----------------------------------------------------------------------------------------------------------------
Note: Consistent with section 1848(f)(2) of the Act, the statutory factors are multiplied, not added, to produce
  the total (that is, 1.019 x 0.993 x 1.017 x 0.971 = 0.999). A more detailed explanation of each figure is
  provided in section VII.F.1 of this preamble.


[[Page 66380]]

D. Revised Sustainable Growth Rate for 2007

    Our current estimate of the CY 2007 SGR is 3.2 percent. Table 26 
shows our preliminary estimate of the CY 2007 SGR that was published in 
the CY 2007 PFS final rule with comment period (71 FR 69757) and our 
current estimate.

                                         Table 26.--2007 SGR Calculation
----------------------------------------------------------------------------------------------------------------
        Statutory factors             Estimate from CY 2006 final rule                Current estimate
----------------------------------------------------------------------------------------------------------------
Fees.............................  2.2 percent (1.022)...................  1.9 percent (1.019).
Enrollment.......................  -0.9 percent (0.991)..................  -2.6 percent (0.974).
Real Per Capita GDP..............  2.0 percent (1.020)...................  1.9 percent (1.019).
Law and Regulation...............  -1.5 percent (0.985)..................  2.0 percent (1.020).
                                  ------------------------------------------------------------------------------
    Total........................  1.8 percent (1.018)...................  3.2 percent (1.032).
----------------------------------------------------------------------------------------------------------------

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

E. Final Sustainable Growth Rate for 2006

    The SGR for 2006 is 1.5 percent. Table 27 shows our preliminary 
estimate of the 2006 SGR from the CY 2006 PFS final rule with comment 
period (70 FR 70309), our revised estimate from the CY 2007 PFS final 
rule with comment period (71 FR 69757) and the final figures determined 
using the best available data as of September 1, 2007.

                                                             Table 27.--2006 SGR Calculation
--------------------------------------------------------------------------------------------------------------------------------------------------------
        Statutory factors             Estimate from CY 2006 final rule        Estimate from CY 2007 final rule                     Final
--------------------------------------------------------------------------------------------------------------------------------------------------------
Fees.............................  2.7 percent (1.027)...................  2.2 percent (1.022)...................  2.1 percent (1.021).
Enrollment.......................  -3.1 percent (0.969)..................  -2.2 percent (0.978)..................  -2.6 percent (0.974).
Real Per Capita GDP..............  2.2 percent (1.022)...................  2.1 percent (1.021)...................  2.1 percent (1.021).
Law and Reg......................  0.0 percent (1.000)...................  0.0 percent (1.000)...................  0.0 percent (1.000).
                                  ----------------------------------------------------------------------------------------------------------------------
    Total........................  1.7 percent (1.017)...................  2.1 percent (1.021)...................  1.5 percent (1.015).
--------------------------------------------------------------------------------------------------------------------------------------------------------

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

F. Calculation of CY 2008, CY 2007, and CY 2006 Sustainable Growth 
Rates

1. Detail on the CY 2008 SGR
    All of the figures used to determine the CY 2008 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 CY 2008
    This factor is calculated as a weighted-average of the CY 2008 
changes in fees 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 80.4 percent of total allowed charges included in the SGR 
in CY 2008 and are updated using the MEI. The MEI for CY 2008 is 1.8 
percent. Diagnostic laboratory tests are estimated to represent 
approximately 7.6 percent of Medicare allowed charges included in the 
SGR for CY 2008. 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 CY 2004 through CY 2008.
    Drugs are estimated to represent 12.0 percent of Medicare allowed 
charges included in the SGR in CY 2008. We estimated a weighted average 
change in fees for drugs included in the SGR (using the ASP + 6 percent 
pricing methodology) of 4.0 percent for CY 2008.
    Table 28 shows the weighted average of the MEI, laboratory, and 
drug price changes for CY 2008.

   Table 28.--Weighted Average of the MEI, Laboratory, and Drug Price
                           Changes for CY 2008
------------------------------------------------------------------------
                                                      Weight     Update
------------------------------------------------------------------------
Physician.........................................      0.804        1.8
Laboratory........................................      0.076        0.0
Drugs.............................................      0.120        4.0
Weighted-average..................................      1.000        1.9
------------------------------------------------------------------------

    We estimate that the weighted average increase in fees for 
physicians' services in CY 2008 under the SGR (before applying any 
legislative adjustments) will be 1.9 percent.
<bullet> Factor 2--The Percentage Change in the Average Number of Part 
B Enrollees From CY 2007 to CY 2008
    This factor is our estimate of the percent change in the average 
number of fee-for-service enrollees from CY 2007 to CY 2008. 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 0.7 percent from CY 2007 to CY 2008. Table 29 
illustrates how this figure was determined.

[[Page 66381]]



                     Table 29.--Average Number of Medicare Part B Fee-for-Service Enrollees
                    [(Excluding beneficiaries enrolled in MA plans) from CY 2007 to CY 2008]
----------------------------------------------------------------------------------------------------------------
                                                         2007                                2008
----------------------------------------------------------------------------------------------------------------
Overall................................  40.726 million.....................  41.480 million.
Medicare Advantage (MA)................  7.890 million......................  8.888 million.
Net....................................  32.836 million.....................  32.592 million.
Percent Increase.......................  ...................................  -0.7 percent.
----------------------------------------------------------------------------------------------------------------

    An important factor affecting fee-for-service enrollment is 
beneficiary enrollment in Medicare Advantage (MA) plans. Because it is 
difficult to estimate the size of the MA enrollee population before the 
start of a CY, 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 CY 2008 becomes known.
<bullet> Factor 3--Estimated Real Gross Domestic Product Per Capita 
Growth in 2008
    We estimate that the growth in real GDP per capita from CY 2007 to 
CY 2008 will be 1.7 percent (based on the 10-year average GDP over the 
10-years of 1999-2008). 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 
2008.
<bullet> Factor 4--Percentage Change in Expenditures for Physicians' 
Services Resulting From Changes in Statute or Regulations in CY 2008 
Compared With CY 2007
    The statutory and regulatory provisions that will affect 
expenditures in CY 2008 relative to CY 2007 are estimated to have an 
impact on expenditures of -2.9 percent. These provisions include the 
expiration of the MMA provisions for the work GPCI floor and HPSA 
bonuses, the DRA provision reducing payments for imaging services, and 
the MIEA-TRHCA provisions regarding the conversion factor and the 2007 
PQRI reporting bonuses payable in 2008. The details of these provisions 
are discussed elsewhere in this final rule with comment.
2. Detail on the 2007 SGR
    A more detailed discussion of our revised estimates of the four 
elements of the 2007 SGR follows.
<bullet> Factor 1--Changes in Fees for Physicians' Services (Before 
Applying Legislative Adjustments) for 2007
    This factor was calculated as a weighted-average of the 2007 
changes in fees 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 82.5 percent of total allowed charges included in the SGR 
in CY 2007. These services were updated using the CY 2007 MEI of 2.1 
percent. We estimate that diagnostic laboratory tests represent 
approximately 7.3 percent of total allowed charges included in the SGR 
in CY 2007. 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 CY 2004 through CY 
2008. We estimate that drugs represent 10.2 percent of Medicare-allowed 
charges included in the SGR in CY 2007. We estimate a weighted-average 
change in fees for drugs included in the SGR of 1.3 percent for CY 
2007.
    Table 30 shows the weighted-average of the MEI, laboratory, and 
drug price changes for CY 2007.

   Table 30.--Weighted Average of the MEI, Laboratory, and Drug Price
                           Changes for CY 2007
------------------------------------------------------------------------
                                                      Weight     Update
------------------------------------------------------------------------
Physician.........................................      0.825        2.1
Laboratory........................................      0.073        0.0
Drugs.............................................      0.102        1.3
Weighted-average..................................      1.000        1.9
------------------------------------------------------------------------

    After taking into account the elements described in Table 30, we 
estimate that the weighted-average increase in fees for physicians' 
services in 2007 under the SGR (before applying any legislative 
adjustments) will be 1.9 percent. Our estimate of this factor in the CY 
2007 PFS final rule with comment period was 2.2 percent. The decrease 
in the estimate is due to the availability of some actual data.
<bullet> Factor 2--The Percentage Change in the Average Number of Part 
B Enrollees from CY 2006 to CY 2007
    OACT estimates that the average number of Medicare Part B fee-for-
service enrollees (excluding beneficiaries enrolled in Medicare 
Advantage plans) decreased by 2.6 percent in CY 2007. Table 31 
illustrates how we determined this figure.

 Table 31.--Average Number of Medicare Part B Fee-for-Service Enrollees
[(Excluding beneficiaries enrolled in MA plans) from CY 2006 to CY 2007]
------------------------------------------------------------------------
                                         2006                2007
------------------------------------------------------------------------
Overall.........................  40.271 million....  40.726 million.
Medicare Advantage (MA).........  6.550 million.....  7.890 million.
Net.............................  33.721 million....  32.836 million.
Percent Increase................  ..................  -2.6 percent.
------------------------------------------------------------------------

    OACT's estimate of the -2.6 percentage change in the number of fee-
for-service enrollees, net of Medicare Advantage enrollment for CY 2007 
compared to CY 2006, is lower than our original estimate of -0.9 
percent in the CY 2007 PFS final rule with comment period (71 FR 
69758). While our current projection based on data from 8 months of 
2007 is lower than our original estimate of -0.9 percent when we had no 
actual data, it is still possible that

[[Page 66382]]

our final estimate of this figure will be different once we have 
complete information on CY 2007 fee-for-service enrollment.
<bullet> Factor 3--Estimated Real Gross Domestic Product Per Capita 
Growth in CY 2007
    We estimate that the growth in real GDP per capita will be 1.9 
percent for CY 2007 (based on the 10-year average GDP over the 10 years 
of CY 1998 through CY 2007). 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 CY 2007 economic performance becomes 
available to us in 2008.
<bullet> Factor 4--Percentage Change in Expenditures for Physicians' 
Services Resulting From Changes in Statute or regulations in CY 2007 
Compared With CY 2006
    The statutory and regulatory provisions that will affect 
expenditures in CY 2007 relative to CY 2006 are estimated to have an 
impact on expenditures of 2.0 percent. These provisions include the DRA 
provisions adding the AAA ultrasound test to the Welcome to Medicare 
visit as a preventive benefit and reducing payments for imaging 
services. Also included is the MIEA-TRHCA 1-year adjustment to the 
conversion factor. The details of these provisions are discussed 
elsewhere in this final rule with comment.
3. Detail on the CY 2006 SGR
    A more detailed discussion of our final revised estimates of the 
four elements of the CY 2006 SGR follows.
<bullet> Factor 1--Changes in Fees for Physicians' Services (Before 
Applying Legislative Adjustments) for 2006
    This factor was calculated as a weighted average of the CY 2006 
changes in fees 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 83.8 
percent of total Medicare-allowed charges included in the SGR for CY 
2006 and are updated using the MEI. The MEI for CY 2006 was 2.8 
percent. Diagnostic laboratory tests represented approximately 7.2 
percent of total CY 2006 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 CY 2004 through CY 2008. Drugs represented approximately 
9.1 percent of total Medicare-allowed charges included in the SGR for 
CY 2006. We estimate a weighted-average change in fees for drugs 
included in the SGR of -2.8 percent for 2006. Table 32 shows the 
weighted average of the MEI, laboratory, and drug price changes for CY 
2006.

   Table 32.--Weighted Average of the MEI, Laboratory, and Drug Price
                           Changes for CY 2006
------------------------------------------------------------------------
                                                      Weight     Update
------------------------------------------------------------------------
Physician.........................................      0.838        2.8
Laboratory........................................      0.072        0.0
Drugs.............................................      0.091       -2.8
Weighted-average..................................      1.000        2.1
------------------------------------------------------------------------

    After taking into account the elements described in Table 32, we 
estimate that the weighted-average increase in fees for physicians' 
services in CY 2006 under the SGR (before applying any legislative 
adjustments) was 2.1 percent. This figure is a final one based on 
complete data for CY 2006.
<bullet> Factor 2--The Percentage Change in the Average Number of Part 
B Enrollees from CY 2005 to CY 2006
    We estimate the decrease in the number of fee-for-service enrollees 
(excluding beneficiaries enrolled in MA plans) from CY 2005 to CY 2006 
was 2.6 percent. Our calculation of this factor is based on complete 
data from CY 2006. Table 33 illustrates the calculation of this factor.

 Table 33.--Average Number of Medicare Part B Fee-for-Service Enrollees
[(Excluding beneficiaries enrolled in MA plans) from CY 2005 to CY 2006]
------------------------------------------------------------------------
                                         2005                2006
------------------------------------------------------------------------
Overall.........................  39.698 million....  40.271 million.
Medicare Advantage (MA).........  5.084 million.....  6.550 million.
Net.............................  34.615 million....  33.721 million.
Percent Increase................  ..................  -2.6 percent.
------------------------------------------------------------------------

<bullet> Factor 3--Estimated Real Gross Domestic Product Per Capita 
Growth in 2006
    We estimate that the growth in real per capita GDP was 2.1 percent 
in 2006 (based on the 10-year average GDP over the 10 years of CY 1997 
through CY 2006). This figure is a final one based on complete data for 
CY 2006.
<bullet> Factor 4--Percentage Change in Expenditures for Physicians' 
Services Resulting From Changes in Statute or Regulations in CY 2006 
Compared With CY 2005
    Our final estimate for the net impact on expenditures from the 
statutory and regulatory provisions that affect expenditures in CY 2006 
relative to CY 2005 is less than 0.05 percent. These provisions include 
the expiration of the temporary higher payments to physicians in 
Alaska, the new power wheelchair code for physicians, and the IVIG pre-
administration fee.

VIII. Anesthesia and Physician Fee Schedule Conversion Factors for CY 
2008

    The CY 2008 PFS CF will be $34.0682. The CY 2008 national average 
anesthesia CF is $16.3176. Both CFs will be subject to a separate, 
independent BN adjustor, as described below.

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 timesplied by the update determined under 
section 1848(d)(4) of the Act, as amended by the MIEA-TRHCA. Section 
101 of the MIEA-TRHCA provided a 1-year increase in the CY 2007 CF and 
specified that the CF for CY 2008 must be computed as if the 1-year 
increase had never applied.
    The PFS update for CY 2008 is determined by timesplying the CY 2007 
conversion factor update that would have occurred in the absence of the 
MIEA-TRHCA (as published in 71 FR 69760), the estimated MEI, and the

[[Page 66383]]

estimated update adjustment factor, as shown in Table 34 (0.89896 = 
0.94953 x 1.018 x 0.930). To determine the estimated CY 2008 CF, the 
Pre-MIEA-TRHCA CY 2007 CF update is applied to the CY 2006 CF of 
$37.8975 to produce the Pre-MIEA-TRHCA CY 2007 CF of $35.9848. Then 
applying the estimated MEI for CY 2008 and the estimated UAF for CY 
2008 to the Pre-MIEA-TRHCA CY 2007 a CF produces an estimated CF for CY 
2008 of $34.0682. We illustrate the calculation for the 2008 PFS CF in 
Table 34.

         Table 34.--Calculation of the CY 2008 Conversion Factor
------------------------------------------------------------------------
 
------------------------------------------------------------------------
CY 2006 Conversion Factor........  $37.8975.
Pre-MIEA-TRHCA CY 2007 CF Update.  -5.0 percent (0.94953).
CY 2007 Pre-MIEA-TRHCA Conversion  $35.9848.
 Factor.
2008 MEI.........................  1.8 percent (1.018).
2008 Update adjustment factor....  -7.0 percent (0.930).
CY 2008 Update...................  -5.3 percent (0.94674).
CY 2008 Conversion Factor Update.  -10.1 percent (0.89896).
CY 2008 Conversion Factor........  $34.0682.
------------------------------------------------------------------------

    Section 1848(c)(2)(B)(ii)(II) of the Act requires that increases or 
decreases in RVUs for a year may not cause the amount of expenditures 
for the year to differ by more than $20 million from what expenditures 
would have been in the absence of these changes. If this threshold is 
exceeded, we must make adjustments to preserve BN.
    The 5-Year Review of work RVUs, including the refinement to the 
work RVU changes for the additional codes and the increases in the work 
of anesthesia services, would result in a change in expenditures that 
would exceed $20 million if we made no offsetting adjustments to either 
the CF or RVUs. As discussed in section IV.C.3 of this final rule with 
comment period, we are applying the following BN adjustor to the work 
RVUs in order to calculate payment for a service:
    2008 Work Adjustor: 11.94 percent (0.8806)
    Payment for services under the PFS will be calculated as follows:
    Payment = [(RVU work x BN adjustor (round product to two decimal 
places) x GPCI work) + (RVU PE x GPCI PE) + (RVU malpractice x GPCI 
malpractice)] x CF

B. Anesthesia Fee Schedule Conversion Factor

    We calculate the physician anesthesia CF similar to the general PFS 
CF in Table 34. As noted, section 101 of the TRCHA provided for a 1-
year increase in the CY 2007 conversion factor and specified the 
conversion factor for 2008 must be computed as if the 1-year increase 
had never applied. The PFS update for CY 2008 is determined by 
timesplying the CY 2007 conversion factor that would have occurred in 
the absence of TRCHA by the estimated MEI and the estimated update 
adjustment factor for 2008.
    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 PE methodology using imputed 
anesthesia RVUs that were made comparable to other PFS services. The 
2008 adjustment factor in Table 35 includes the combined effect of the 
PE adjustment, the increase in work of anesthesia services under the 
recent five year review and the BN adjustment.
    We illustrate the calculation for the 2008 anesthesia CF in Table 
35.

    Table 35.--Calculation for the 2008 Anesthesia Conversion Factor
------------------------------------------------------------------------
 
------------------------------------------------------------------------
CY 2006 Anesthesia Conversion      $17.7663.
 Factor.
Pre-TRHCA CY 2007 CF Update......  -5.0 percent (0.94953).
2007 Combined Adjustment for PE    0.9089.
 and BN.
CY 2007 Pre-TRHCA Anesthesia       $15.3328.
 Conversion Factor.
------------------------------------------------------------------------
2008 MEI.........................  1.8 percent (1.018).
2008 Update adjustment factor....  -7.0 percent (0.930).
CY 2008 Anesthesia CF after MEI    $14.5162.
 and 2008 Adjustment Factor.
2008 Combined Adjustment for PE    1.1250.
 and BN.
CY 2008 Anesthesia Conversion      $16.3307.
 Factor.
------------------------------------------------------------------------

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 2008 is 1.8 
percent.
    Therefore, for CY 2007, the payment amount for HCPCS code Q3014, 
Telehealth originating site facility fee, is 80 percent of the lesser 
of the actual charge or $23.35. The Medicare telehealth originating 
site facility fee and MEI increase by the applicable time period is 
shown in Table 36.

[[Page 66384]]



 Table 36.--The Medicare Telehealth Originating Site Facility Fee and MEI Increase by the Applicable Time Period
----------------------------------------------------------------------------------------------------------------
                                                                       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
$22.94.............................................................               2.1      01/01/2007-12/31/2007
$23.35.............................................................               1.8      01/01/2008-12/31/2008
----------------------------------------------------------------------------------------------------------------

X. Provisions of the Final Rule

    The provisions of this final rule with comment restate the 
provisions of the CY 2008 PFS proposed rule, except as noted elsewhere 
in the preamble.

XI. Waiver of Proposed Rulemaking and Delay in Effective Date

    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.
    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) require 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 in this section, 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.
    In addition, we ordinarily publish a notice of proposed rulemaking 
in the Federal Register and provide a period for public comment before 
we make final the provisions of the notice. We can waive this 
procedure, however, if we find good cause that notice-and-comment 
procedure is impracticable, unnecessary, or contrary to the public 
interest and we incorporate a statement of finding and its reasons in 
the notice issued. We find it unnecessary to undertake notice and 
comment rulemaking in this instance for the ambulance inflation factor 
because the law specifies the method of computation of annual updates, 
and we have no discretion in this matter. Further, we are merely 
applying the update method specified in statute and regulation. 
Therefore, under 5 U.S.C. 553(b)(B), for good cause, we waive notice 
and comment procedures for this ambulance inflation factor update.

XII. Collection of Information Requirements

    Under the Paperwork Reduction Act of 1995, we are required to 
provide 60-day notice in the Federal Register and solicit public 
comment before a collection of information requirement is submitted to 
the Office of Management and Budget (OMB) for review and approval. 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.
    This final rule with comment period does not contain any new 
information collection requirements. However, we are republishing the 
discussion of the information collection requirements as it appeared in 
the CY 2008 PFS

[[Page 66385]]

proposed rule (72 FR 38122). We are soliciting public comment on each 
of these issues for the following sections of this document that 
contain information collection requirements.

Independent Diagnostic Testing Facility (Sec.  410.33)

    Section 410.33(g)(2) states that an independent diagnostic testing 
facility (IDTF) should provide complete and accurate information on its 
Medicare enrollment application. In addition, an IDTF is required to 
notify its designated fee-for-service contractor within 30-days of any 
changes in ownership, changes of location, changes in general 
supervision, and any adverse legal actions. The notification must be 
made on the Medicare enrollment application. All of the changes to the 
enrollment application must be reported within 90 days.
    The aforementioned requirements are not new. The burden associated 
with completing the Medicare enrollment application is currently 
approved under OMB control number 0938-0685. The collection has an 
expiration date of April 30, 2009.
    Section 410.33(g)(6) states the comprehensive liability insurance 
requirements for IDTFs. Specifically, Sec.  410.33(g)(6)(1) states they 
must have a comprehensive insurance policy to notify the CMS designated 
contractor, in writing, of any policy changes or cancellations. The 
burden associated with this requirement is the time and effort 
necessary to draft and submit the written notification to the CMS 
designated contractor. While this requirement is subject to the PRA, we 
believe it is exempt from the PRA as stipulated under 5 CFR 
1320.3(h)(6). This information will be collected on case by case basis.
    Section 410.33(g)(8) requires an IDTF to answer, document, maintain 
documentation of beneficiaries questions and responses to beneficiary 
complaints at the physical site of the IDTF. Sections 410.33(g)(8) (i 
through iii) list the minimum amount of documentation needed to comply 
with this requirement. The burden associated with these requirements is 
the time and effort associated with responding to beneficiary questions 
and complaints, documenting the actions taken in response to the 
questions and complaints, and maintaining the documentation. While this 
requirement is subject to the PRA, we believe the associated burden is 
exempt under 5 CFR 1320.3(b)(2). The burden associated with documenting 
and maintaining the documentation of the corrective actions is a usual 
and customary business practice. The time, effort, and financial 
resources necessary to comply this information collection requirement 
would be incurred by persons in the normal course of their activities 
(for example, in compiling and maintaining business records) and is not 
subject to the PRA.

Basis of Payment (Sec.  414.707)

    Section 414.707(c) states that effective January 1, 2008, each 
request for payment for anti-anemia drugs furnished to treat anemia 
resulting from the treatment of cancer must report the beneficiary's 
most recent hemoglobin or hematocrit level. The burden associated with 
this requirement is the time and effort associated with obtaining the 
most recent hemoglobin or hematocrit levels and documenting it on the 
request for payment. The requirement and its associated burden are not 
subject to the PRA under 5 CFR 1320.3(h)(5). The interpretation of 
biological analyses of body fluids, tissues, or other specimens, or the 
identification or classification of such specimens is not subject to 
the PRA.

Term of Contract (Sec.  414.914)

    Section 414.914(h) states that the approved CAP vendor must verify 
drug administration prior to the collection of any applicable cost 
sharing amount. As part of the verification process, Sec.  
414.914(h)(1) through (2) states lists the documentation that is 
required as part of the verification process. Section 414.914(h)(3) 
states that the approved CAP vendor must provide this information to 
CMS or the beneficiary upon request.
    The burden associated with the requirements in Sec.  414.914(1) 
through (3) is the time and effort needed to verify the drug 
administration. When obtaining written verification, the CAP vendor 
must document the elements listed in Sec.  414.914(h)(1)(i) through 
(vi). When obtaining verbal verification, the CAP vendor must document 
the elements listed in Sec.  414.914(h)(2)(i) through (ii). We believe 
the requirements and their associated burden are not subject to the 
PRA; they are part of the CAP vendor's usual and customary business 
practices as stipulated under 5 CFR 1320.3(h)(5).
    In addition, Sec.  414.914(h)(3) imposes both recordkeeping and 
reporting requirements. We believe that the burden associated with the 
recordkeeping requirement imposed by Sec.  414.914(h)(3) is not subject 
to the PRA under 5 CFR 1320.3(c)(4) because it would affect less than 
10 persons.
    The reporting requirement places burden on the CAP vendor to 
provide the information listed in Sec.  414.914(h) (1-2) to a 
beneficiary upon request. We estimate that the CAP vendor will receive 
72 requests per year from beneficiaries. We believe it will take 15 
minutes per request for the vendor to provide this information to the 
beneficiary. The total annual burden associated with this requirement 
is 1080 minutes or 18 burden hours. However, we believe this 
information collection requirement and the associated burden is not 
subject to the PRA as defined in 5 CFR 1320.3(c)(4) because it would 
affect less than 10 persons.

Compendia for Determination of Medically-Accepted Indications for Off-
Label Uses of Drugs and Biologicals in an Anti-Cancer Chemotherapeutic 
Regimen (Sec.  414.930)

    Section 414.930(b) states the process for listing compendia for 
determining medically-accepted uses of drugs and biologicals in anti-
cancer treatment. We will annually provide an annual opportunity to 
request changes to the list of compendia. As stated in Sec.  
414.930(c)(1), CMS will review a complete written request that is 
submitted in writing, electronically or via hard copy. A complete 
written request must contain the following information as stated in 
Sec.  414.930(c)(1)(i) through (vi): Full name and contact information 
for the requestor; full identification of the compendium in question; a 
complete written copy of the compendium in question; the specific 
action requested of CMS; supporting documentation for the requested 
action; address a single compendium per request.
    The burden associated with the requirements contained in Sec.  
414.930(b) through (c) is the time and effort required to draft and 
submit to CMS a complete written request for changes to the list of 
compendia. While these requirements are subject to the PRA, we believe 
the burden is exempt under 5 CFR 1320.3(c)(4) because it would affect 
less than 10 persons or entities. There are only 6 compendia that could 
reasonably be expected to be the subject of a request, so 6 requests is 
a likely maximum.

Signature Requirements (Sec.  424.36)

    Section 424.36(a) requires the beneficiary's signature on a claim 
for payment of services unless the beneficiary has died or the 
provisions of Sec.  424.36(b), (c), or (d) apply. Section 424.36(b) 
states that if the beneficiary is physically or mentally incapable of 
signing the claim, the claim may be signed by one of the parties 
specified in Sec.  424.36(b)(1) through (5). Proposed

[[Page 66386]]

Sec.  424.36(b)(6) states that, for emergency ambulance transport 
services, if certain conditions and documentation requirements are met, 
an ambulance provider or supplier would be permitted to sign the claim 
on behalf of the beneficiary. Specifically, Sec.  424.36(b)(6)(ii)(A) 
through (C) lists the documentation that would be required, all of 
which would have to be maintained by the ambulance provider or supplier 
in its files for a period of at least 4 years from the date of service. 
An ambulance provider or supplier would be required to obtain a signed, 
contemporaneous statement from an ambulance employee present during 
transport of the patient that, at the time the service was provided, 
the beneficiary was physically or mentally incapable of signing the 
claim and that none of the other qualified parties listed in Sec.  
424.36(b)(1) through (5) were available or willing to sign the claim on 
behalf of the beneficiary.
    The ambulance provider or supplier would also be required to 
maintain documentation of the date and time that the beneficiary was 
transported and the name and location of the facility that received the 
beneficiary. In addition, the ambulance provider or supplier would be 
required to obtain and maintain a signed contemporaneous statement from 
a representative of the facility that received the beneficiary. The 
statement would have to contain the name of the beneficiary and the 
date and time the beneficiary was received at the facility.
    The burden associated with the recordkeeping requirements contained 
in Sec.  424.36(b)(6) is the time and effort associated with drafting, 
obtaining, and maintaining written statements from both employees of 
the ambulance provider or supplier transporting the beneficiary and 
employees of the facility receiving the beneficiary. We estimate that 
9,000 ambulance providers or suppliers will comply with these 
requirements. We estimate that it will take no more than five minutes 
for each provider or supplier to comply with the recordkeeping 
requirements. Based on the best available data at this time, we 
estimate the total annual burden associated with the requirements in 
Sec.  424.36(b)(6) to be 541,667 hours nationwide. The annual total 
number of burden hours was arrived at by multiplying five minutes by 
the total estimated number of emergency ambulance transports of 
6,500,000. We note that the total number of burden hours may be 
overstated, because not every beneficiary who receives emergency 
ambulance transport services is unable to sign the claim. However, we 
also note that the 6.5 million figure for emergency transports is the 
estimated number of ALS1-emergency and BLS-emergency ambulance claims 
processed by Part B carriers, incurred in 2006 and processed through 
April of 2007, and thus does not include the number of emergency 
ambulance transport services billed to fiscal intermediaries by 
ambulance providers (which number is not available to us). In any 
event, we believe our proposal will benefit ambulance providers and 
suppliers by allowing them an alternative procedure for submitting 
claims to Medicare. In the absence of the proposed procedure for 
signing claims on behalf of beneficiaries for emergency ambulance 
transport services, ambulance suppliers and providers would be required 
to track down beneficiaries after the emergency transport services have 
been rendered, in an attempt to have the beneficiary sign the claim. 
Moreover, such attempts may prove fruitless, thereby preventing the 
ambulance suppliers and providers from submitting the claim to 
Medicare.

Additional Information Collection Requirements

    This final rule with comment period imposes collection of 
information requirements as outlined in the regulation text and 
specified above. However, this final rule with comment period also 
makes reference to several associated information collections that are 
not discussed in the regulation text. The following is a discussion of 
these collections, which have already received OMB approval.

Part B Drug Payment

    Section II.F.1 of the preamble discusses payment for Medicare Part 
B drugs and biologicals under the ASP methodology. Drug manufacturers 
are required to submit ASP data to us on a quarterly basis. As stated 
in section II.F.1.a of the preamble, the ASP reporting requirements are 
set forth in section 1927(b) of the Act.
    The collection of ASP data imposes a reporting requirement on the 
public. The burden associated with this requirement is the time and 
effort required by manufacturers of Medicare Part B drugs and 
biologicals to calculate, record, and submit the required data to CMS. 
While the burden associated with this requirement is subject to the 
PRA, it is currently approved under OMB control number 0938-0921, with 
an expiration date of May 31, 2009.

Competitive Acquisition Program (CAP)

    In section II.F.2.d of the preamble, we propose to revise the CAP 
physician election agreement. In conjunction with post-payment review 
process, we are revising the CAP physician election agreement to 
reflect the physician's obligation to provide medical records to assist 
with claims review. The CAP physician election agreement is currently 
approved under 0938-0955 with an expiration date of August 31, 2009. 
Under a separate notice, we will make the revised instrument available 
for public comment prior to submitting the revised information 
collection request to OMB for approval.
    Section II.F.2.f of the preamble discusses details of the 
competitive acquisition program. Each year, physicians are given the 
option to elect to obtain Medicare Part B drugs and biologicals through 
the CAP. In addition, physicians are also given an opportunity to 
select an approved CAP vendor. The burden associated with these 
election requirements is the time and effort necessary for a physician 
to make an election and notify CMS. The burden associated with election 
requirements for participating in the CAP and selecting an approved CAP 
vendor is subject to the PRA. However, it is currently approved under 
OMB control numbers 0938-0955 and 0938-0987 with expiration dates of 
August 31, 2009 and April 30, 2009, respectively.
    Section II.F.2.g. of the preamble also discusses the exigent 
circumstances exception for leaving the CAP outside of the annual 
election process. A physician may request a release from the CAP within 
the first 60 days of his or her participation if he or she can show 
that CAP participation imposes a burden on the practice, or later if he 
or she can show that a change in circumstances that was not known to 
the practice previously results in a burden to the practice. 
Specifically, the physician must submit a release request to the CAP-
designated carrier.
    While this burden is subject to the PRA, we believe it is exempt 
under 5 CFR 1320.3(h)(6). Facts or opinions collected from a single 
person or entity are not subject to the PRA. The aforementioned 
information collection request will be reviewed individually on a case 
by cases basis.
    If the designated carrier receives an exigent circumstance removal 
request related to the approved CAP vendor's service, it is required to 
refer the physician to his or her approved CAP vendor within 1 business 
day of its receipt of the request. As part of the grievance process, 
the CAP vendor will try to work with the physician to address their 
concerns with respect to participation in the program. The designated 
carrier can alternatively continue to investigate, and within 2

[[Page 66387]]

business days of its receipt of the request, can request a single 2-
business day extension (after which it must submit findings and a 
recommendation to CMS), submit findings and a recommendation to CMS 
that the physician be permitted to terminate his or her CAP 
participation, or submit findings and a recommendation to CMS that the 
physician not be permitted to terminate his or her CAP participation.
    Requests from physicians will be reviewed by CAP vendors on an 
individual, case by case basis. We will continue to monitor the 
process. If we believe that we will receive 10 or more requests, we 
will submit an information collection request to OMB.

Physician Quality Reporting Initiative (PQRI)

    Section II.U.1.a of the preamble discusses the background of the 
reporting initiative and provides information about the measures 
available to eligible professionals who choose to participate in PQRI. 
Section 1848(k)(1) of the Act requires the Secretary to implement a 
system for eligible professionals to submit data pertaining to certain 
quality measures. As stated in section II.U.1.a, eligible 
professionals, for the purpose of the quality reporting system, include 
physicians, other practitioners as described in section 1842(b)(18)(c) 
of the Act, physical and occupational therapists, and qualified speech-
language pathologists. As also stated in section II.U.1.a, this is a 
voluntary initiative. Eligible professionals may choose whether to 
participate and, to the extent they satisfactorily submit data on 
quality measures for covered professional services, they can qualify to 
receive a bonus incentive payment.
    Specifically, to qualify to receive a bonus incentive payment for 
satisfactory reporting of quality data on covered professional services 
furnished in 2007, an eligible professional must submit data on 1, 2, 
or 3 measures selected from the 74 PQRI 2007 quality measures. The 
minimum number of measures each professional must report in order to 
qualify for the bonus payment is determined by how many available 
measures are applicable to the services that professional furnishes to 
Medicare beneficiaries. For a majority of the eligible professionals, 
the requirement, per 1848(k) of the Act, will be that they 
satisfactorily report on at least three measures. An eligible 
professional could meet the satisfactory reporting requirement, and 
thus be eligible for the bonus incentive payment, by reporting fewer 
than three measures only if his or her practice has fewer than three 
applicable measures. The quality measures are posted and available for 
download on the CMS Web site at http://www.cms.hhs.gov/pqri.
    The burden associated with this requirement is the time and effort 
associated with eligible professionals identifying applicable PQRI 
quality measures for which they can report the necessary information. 
In addition, they must gather the required information, select the 
appropriate quality data codes, and include the appropriate quality-
data codes on the claims they submit for payment.
    In 2007, the PQRI will collect quality-data codes exclusively as 
additional (optional) line items on the existing HIPAA transaction 837-
P and/or CMS Form 1500. There will be no new forms and no modifications 
to the existing transaction or form in support of 2007 PQRI. CMS also 
does not anticipate changes to the 837-P or CMS Form 1500 for 2008.
    Because this is a voluntary program, it is impossible to estimate 
with any degree of accuracy how many eligible professionals will opt to 
participate in the PQRI in 2008. Moreover, the time needed for an 
eligible professional to review the quality measures and other 
information, select measures applicable to his or her patients and the 
services he or she furnishes to them, and incorporate the use of 
quality data codes into the office work flows is expected to vary along 
with the number of measures that are potentially applicable to a given 
professional's practice. We estimate that the additional time required 
to put quality data codes on each claim is not a material increment to 
the time required to code the claim for payment. The total estimated 
annual burden for this requirement will also vary along with the volume 
of claims on which quality data is reported.

                         Table 37.--Estimated Annual Reporting and Recordkeeping Burden
----------------------------------------------------------------------------------------------------------------
                                                                                                   Total annual
              Regulation section(s)                 OMB control     Respondents      Responses        burden
                                                        No.                                           (hours)
----------------------------------------------------------------------------------------------------------------
Preamble section II.F.1.........................       0938-0921             120             480          17,760
Preamble section II.F.2.f.......................       0938-0955              12              12             480
Sec.   410.33...................................       0938-0685         400,000         400,000       1,000,000
Sec.   424.36...................................        0938-New           9,000       6,500,000         541,667
                                                 ---------------------------------------------------------------
    Total.......................................  ..............  ..............  ..............       1,579,907
----------------------------------------------------------------------------------------------------------------

    If you comment on these information collection and recordkeeping 
requirements, please mail copies directly to the following: Centers for 
Medicare & Medicaid Services, Office of Strategic Operations and 
Regulatory Affairs, Regulations Development Group, Attn: William N. 
Parham, III, CMS-1385-FC, Room C4-26-05, 7500 Security Boulevard, 
Baltimore, MD 21244-1850; and Office of Information and Regulatory 
Affairs, Office of Management and Budget, Room 10235, New Executive 
Office Building, Washington, DC 20503, Attn: Carolyn Lovett, CMS Desk 
Officer, [CMS-1385-P], <a href="/cdn-cgi/l/email-protection#27444655484b5e49784b485142535367484a450942485709404851"><span class="__cf_email__" data-cfemail="d3b0b2a1bcbfaabd8cbfbca5b6a7a793bcbeb1fdb6bca3fdb4bca5">[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 Mandates 
Reform Act of 1995 (Pub. L. 104-4), and Executive Order 13132.
    Executive Order 12866 (as amended by Executive Order 13258, which

[[Page 66388]]

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 in this regulatory 
impact analysis, we estimate that the PFS provisions included in this 
final rule with comment period rule will redistribute more than $100 
million in 1 year. We are considering this final rule with comment 
period rule to be economically significant because its provisions are 
estimated to result in an increase, decrease or aggregate 
redistribution of Medicare spending that will exceed $100 million. 
Therefore, this final rule with comment period is a major rule and we 
have prepared a regulatory impact analysis.
    The RFA requires agencies to analyze options for regulatory relief 
of small entities. For purposes of the RFA, small entities include 
small businesses, nonprofit organizations, and small governmental 
jurisdictions. Most hospitals and most other providers and suppliers 
are small entities, either by nonprofit status or by having revenues of 
$6.5 million to $31.5 million in any 1 year (For further information, 
see the Small Business Administration's regulation at 70 FR 72577, 
December 6, 2003.) Individuals and States are not included in the 
definition of a small entity. The RFA requires that we analyze 
regulatory options for small businesses and other entities. We prepare 
a regulatory flexibility analysis unless we certify that a rule would 
not have a significant economic impact on a substantial number of small 
entities. The analysis must include a justification concerning the 
reason action is being taken, the kinds and number of small entities 
the rule affects, and an explanation of any meaningful options that 
achieve the objectives with less significant adverse economic impact on 
the small entities.
    For purposes of the RFA, physicians, NPPs, and suppliers, including 
IDTFs, are considered small businesses if they generate revenues of 
$6.5 million or less. Approximately 95 percent of physicians are 
considered to be small entities. There are about 980,000 physicians, 
other practitioners and medical suppliers that receive Medicare payment 
under the PFS.
    The CAP provides alternatives to physicians who do not wish to 
purchase drugs directly or collect coinsurance. The impact of the CAP 
provisions on an individual physician is dependent on whether the drugs 
they furnish to Medicare beneficiaries are included in the list of CAP 
drugs, whether the physician chooses to obtain drugs administered to 
Medicare beneficiaries through the CAP. The CAP provisions in this 
final rule with comment period will also have a potential impact on 
entities that are involved in the dispensing or distribution of drugs, 
plan to become approved CAP vendors, or are approved CAP vendors.
    For purposes of the RFA, approximately 80 percent of clinical 
diagnostic laboratories are considered small businesses according to 
the Small Business Administration's size standards. Ambulance providers 
and suppliers for purposes of the RFA are also considered to be small 
entities.
    In addition, most ESRD facilities are considered small entities, 
either based on nonprofit status or by having revenues of $31.5 million 
or less in any year. We consider a substantial number of entities to be 
affected if the rule is estimated to impact more than 5 percent of the 
total number of small entities. Based on our analysis of the 915 
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 period will have a 0.9 percent increase in overall 
payments to nonprofit ESRD facilities relative to current overall 
payments. The analysis and discussion provided in this section, as well 
as elsewhere in this final rule with comment period, complies with the 
RFA requirements.
    For the e-prescribing provisions, physician practices and 
independent pharmacies are considered small entities.
    Because we acknowledge that many of the affected entities are small 
entities, the analysis discussed throughout the preamble of this final 
rule with comment period constitutes our regulatory flexibility 
analysis for the remaining provisions.
    Section 1102(b) of the Act requires us to prepare a regulatory 
impact analysis for any final rule with comment period 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 period would have minimal 
impact on small hospitals located in rural areas. Of the 202 hospital 
based ESRD facilities located in rural areas, only 40 are affiliated 
with hospitals with fewer than 100 beds.
    Section 202 of the Unfunded Mandates Reform Act of 1995 also 
requires that agencies assess anticipated costs and benefits before 
issuing any rule that may result in expenditures in any year by State, 
local, or tribal governments, in the aggregate, or by the private 
sector, of $127 million. This final rule with comment period will not 
mandate any requirements for State, local, or tribal governments. 
Medicare beneficiaries are considered to be part of the private sector 
for this purpose. A discussion concerning the impact of this rule on 
beneficiaries is found later in this section.
    We have examined this final rule with comment period in accordance 
with Executive Order 13132 and have determined that this regulation 
would not have any significant impact on the rights, roles, or 
responsibilities of State, local, or tribal governments.
    We have prepared the following analysis, which, together with the 
information provided in the rest of this preamble, meets all assessment 
requirements. The analysis explains the rationale for and purposes of 
this final rule with comment period rule; details the costs and 
benefits of the rule; analyzes alternatives; and presents the measures 
we use to minimize the burden on small entities. As indicated elsewhere 
in this final rule with comment period, 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 
period. We are unaware of any relevant Federal rules that duplicate, 
overlap or conflict with this final rule with comment period. The 
relevant sections of this final rule with comment period contain a 
description of significant alternatives if applicable.

[[Page 66389]]

A. RVU Impacts

1. Resource-Based Work and PE RVUs
    Section 1848(c)(2)(B)(ii) of the Act requires that increases or 
decreases in RVUs may not cause the amount of expenditures for the year 
to differ by more than $20 million from what expenditures would have 
been in the absence of these changes. If this threshold is exceeded, we 
make adjustments to preserve BN. In the CY 2007 PFS final rule with 
comment period, the $4 billion impact of changes in work RVUs resulting 
from the 5-Year Review required that a BN adjustment be made.
    As discussed in section IV.D.3 of the CY 2007 PFS final rule with 
comment period (71 FR 69735), we carefully reviewed the comments 
received concerning the BN adjustment needed to offset the $4 billion 
impact of changes in work RVUs resulting from the 5-Year Review. To 
meet the requirements set forth in section 1848(c)(2)(B)(ii)(II) of the 
Act, we implemented a BN adjustor of 0.8994 or 10.1 percent to be 
applied to the work RVUs.
    Subsequent to the publication of the CY 2007 PFS final rule with 
comment period and the announcement of the 0.8994 BN adjustment to the 
work RVUs, the AMA RUC supplied work RVU recommendations on additional 
CPT codes from the 5-Year Review and recommendations for an increase in 
the work of anesthesia services. As stated in the CY 2007 PFS final 
rule with comment period, these additional codes are still considered 
part of the 5-Year Review. The impact of these additional 
recommendations and increases in the work of anesthesia services on the 
BN adjustment must be accounted for by revising the current work 
adjustor of 0.8994. The work adjustor for CY 2008, based upon the final 
work RVUs for these additional CPT codes and increases in the work of 
anesthesia services, is approximately 0.8806. Table 38 shows the 
specialty-level impact of the work and PE RVU changes.
    Our estimates of changes in Medicare revenues for PFS services 
compare payment rates for CY 2007 with payment rates for CY 2008 using 
CY 2006 Medicare utilization for all years. To the extent that there 
are year to year changes in the volume and mix of services provided by 
physicians, the actual impact on total Medicare revenues will be 
different than those shown in Table 38. 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 38 shows only the payment impact on PFS services. The 
following is an explanation of the information represented in Table 38.
    <bullet> Specialty: The physician specialty or type of 
practitioner/supplier.
    <bullet> Allowed charges: Allowed charges are the Medicare Fee 
Schedule amounts for covered services and include copayments and 
deductibles (which are the financial responsibility of the 
beneficiary.) These amounts have been summed across all services 
furnished by physicians, practitioners, or suppliers within a specialty 
to arrive at the total allowed charges for the specialty.
    <bullet> Impact of Work RVU Changes for additional changes in work 
RVUs from the 5-Year Review.
    <bullet> Impact of PE RVU changes. The impact is shown for both 
2008 which is the second year of the 4-year transition using the new 
methodology and the fully implemented 2010 PE RVUs.
    <bullet> Combined impact of the finalized work RVUs and PE RVUs for 
both 2008 and the fully implemented 2010 PE RVUs.

            Table 38.--Combined Total Allowed Charge Impact for Work and Practice Expense RVU Changes
----------------------------------------------------------------------------------------------------------------
                                                              Impact of PE RVU changes    Combined impact of PE
                                                                      (percent)             and work changes*
                                      Allowed     Impact of  ---------------------------------------------------
             Specialty                charges      work RVU     2008 (PE     2010 (PE     2008 (PE     2010 (PE
                                       (mil)       changes    trans. year      full     trans. year      full
                                                  (percent)        2)      implement.)       2)      implement.)
                                                               (percent)    (percent)    (percent)    (percent)
----------------------------------------------------------------------------------------------------------------
TOTAL.............................      $76,551            0            0            0            0            0
ALLERGY/IMMUNOLOGY................          173            1            1            3            2            4
ANESTHESIOLOGY....................        1,579           15           -1           -3           14           12
CARDIAC SURGERY...................          396           -1           -1           -2           -2           -3
CARDIOLOGY........................        7,519           -1           -1           -3           -2           -4
COLON AND RECTAL SURGERY..........          122           -1            1            2            0            2
CRITICAL CARE.....................          199           -1            0            0           -1           -2
DERMATOLOGY.......................        2,248           -1            2            7            2            7
EMERGENCY MEDICINE................        2,203           -2            0           -1           -2           -2
ENDOCRINOLOGY.....................          350           -1            0            0           -1           -1
FAMILY PRACTICE...................        5,060            0            0            1            0            1
GASTROENTEROLOGY..................        1,750           -1            1            4            0            3
GENERAL PRACTICE..................          974            0            0            0            0            0
GENERAL SURGERY...................        2,309           -1            0            0           -1            0
GERIATRICS........................          147            3            0            1            3            4
HAND SURGERY......................           80           -1           -1           -3           -2           -4
HEMATOLOGY/ONCOLOGY...............        1,917           -1            0            0           -1           -1
INFECTIOUS DISEASE................          504           -1            0            1           -1            0
INTERNAL MEDICINE.................        9,981            1            0            0            0            0
INTERVENTIONAL RADIOLOGY..........          244           -1           -1           -3           -2           -4
NEPHROLOGY........................        1,664           -1           -1           -4           -3           -5
NEUROLOGY.........................        1,398           -1            0           -1           -1           -2
NEUROSURGERY......................          576           -1           -1           -2           -2           -3
NUCLEAR MEDICINE..................           78           -1            5           14            4           14

[[Page 66390]]

 
OBSTETRICS/GYNECOLOGY.............          628           -1            0           -1           -1           -1
OPHTHALMOLOGY.....................        4,664            2           -1           -3            1           -1
ORTHOPEDIC SURGERY................        3,248           -1            0           -1           -1           -2
OTOLARNGOLOGY.....................          913            2           -1           -3            1           -1
PATHOLOGY.........................          948           -1           -1           -3           -2           -4
PEDIATRICS........................           74            0            0            0            0            0
PHYSICAL MEDICINE.................          784            1           -1           -2           -1           -2
PLASTIC SURGERY...................          272           -1            0            1           -1            0
PSYCHIATRY........................        1,099           -1            1            2            0            1
PULMONARY DISEASE.................        1,691           -1            0            1           -1            0
RADIATION ONCOLOGY................        1,612           -1            1            2            0            1
RADIOLOGY.........................        5,245           -1            1            2            0            1
RHEUMATOLOGY......................          494           -1            0           -1           -1           -2
THORACIC SURGERY..................          436           -1           -1           -2           -2           -3
UROLOGY...........................        2,033           -1            0            0           -1           -1
VASCULAR SURGERY..................          641           -1            0            0           -1           -1
AUDIOLOGIST.......................           31           26          -14          -43           12          -17
CHIROPRACTOR......................          725           -1           -1           -2           -2           -3
CLINICAL PSYCHOLOGIST.............          531           -1           -2           -6           -3           -7
CLINICAL SOCIAL WORKER............          354           -1           -2           -5           -3           -6
NURSE ANESTHETIST.................          608           22            0            0           22           21
NURSE PRACTITIONER................          796            2            0            1            2            3
OPTOMETRY.........................          790            4            0           -1            4            3
ORAL/MAXILLOFACIAL SURGERY........           37           -1            1            3            1            3
PHYSICAL/OCCUPATIONAL THERAPY.....        1,391           -1            1            4            1            4
PHYSICIAN ASSISTANT...............          600            0            0            1            0            0
PODIATRY..........................        1,575            0            2            5            2            5
DIAGNOSTIC TESTING FACILITY.......        1,191            0            0            1            0            1
INDEPENDENT LABORATORY............        1,087            0            3           10            3           10
PORTABLE X-RAY SUPPLIER...........           81            0            2            7            2           7
----------------------------------------------------------------------------------------------------------------
* Components may not sum to total due to rounding.

2. Adjustments for Payments for Imaging Services
    Section 1848(c)(2)(B)(iv)(II) of the Act as added by section 5102 
of the Deficit Reduction Act of 2005 (Pub. L. 109-171) (DRA) exempts 
the estimated savings from the application of the OPPS based payment 
limitation on PFS imaging services from the PFS BN requirement. We 
estimate that the combined impact of the current BN exemptions 
instituted by such section, the addition of 6 codes to the list of 
services subject to the DRA OPPS cap (discussed in section II.E.1.), 
and the payment revisions to OPPS cap amounts would result in no 
measurable changes in the specialty specific impacts of the DRA 
provisions with the exception of vascular surgery in CY 2008.
3. Combined Impact
    Table 39 shows the specialty-level impact of the work and PE RVU 
changes, section 5102 of the DRA (including the additional 6 services 
that were added to the list of services subject to the DRA OPPS cap and 
the revision to OPPS payment amounts), and our most recent estimate (-
10.1 percent) of the CY 2008 Medicare PFS update. Additionally, the 
impacts in this final rule with comment period rule reflect the use of 
updated physician time data from the AMA-RUC.
    As indicated in Table 39, our estimates of changes in Medicare 
revenues for PFS services compare payment rates for CY 2007 with 
payment rates for CY 2008 using CY 2006 Medicare utilization 
crosswalked to 2008 services. To the extent that there are year-to-year 
changes in the volume and mix of services furnished by physicians, the 
actual impact on total Medicare revenues will be different than those 
shown in Table 39. 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 furnishes.
    Table 39 shows only the payment impact on PFS services. The 
following is an explanation of the information represented in Table 39.
    <bullet> Specialty: The physician specialty or type of 
practitioner/supplier.
    <bullet> Allowed Charges: Allowed charges are the Medicare Fee 
Schedule amounts for covered services and include copayments and 
deductibles (which are the financial responsibility of the 
beneficiary.) These amounts have been summed across all services 
furnished by physicians, practitioners, or suppliers within a specialty 
to arrive at the total allowed charges for the specialty.
    <bullet> Impact of the CY 2008 Work and PE RVU changes using the 
methodology finalized in the CY 2007 PFS final rule with comment period 
and the revised data sources discussed in this final rule with comment 
period.
    <bullet> Impact of section 5102 of the DRA: The CY 2008 percentage 
decrease in allowed charges attributed to section 5102 of the DRA with 
the addition of six codes to the OPPS cap list and revisions to the 
OPPS payment amounts.

[[Page 66391]]

    <bullet> Combined impact of the finalized work and PE RVUs, section 
5102 of the DRA and the addition of six codes to the OPPS cap list, and 
the revisions to OPPS payment amounts.
    <bullet> CY 2008 Update: The percentage decrease in allowed charges 
attributed to the estimated CY 2008 PFS conversion factor update of -
10.1 percent.
    <bullet> Combined impact with CY 2008 update: The CY 2008 
percentage decrease in allowed charges attributed to the impact of the 
work and PE RVU changes, section 5102 of the DRA (plus six additions to 
OPPS cap list), revisions to OPPS payment amounts, and the CY 2008 
update.

    Table 39.--Combined CY 2008 Total Allowed Charge Impact for the Remaining 5-Year Review of Work RVUs and
                       Practice Expense Changes, OPPS Imaging Cap, and the CY 2008 Update
----------------------------------------------------------------------------------------------------------------
                                                                             Combined                  Combined
                                      Allowed     Impact of    Impact of    impact RVU    CY 2008    impact with
             Specialty                charges    work and PE    DRA 5102     and DRA       update      CY 2008
                                       (mil)     RVU changes   (percent)     5102 **     (percent)    update **
                                                 * (percent)                (percent)                 (percent)
----------------------------------------------------------------------------------------------------------------
TOTAL.............................      $76,551            0            0            0          -10          -10
ALLERGY/IMMUNOLOGY................          173            2            0            2          -10           -8
ANESTHESIOLOGY....................        1,579           14            0           14          -10            4
CARDIAC SURGERY...................          396           -2            0           -2          -10          -12
CARDIOLOGY........................        7,519           -2            0           -2          -10          -12
COLON AND RECTAL SURGERY..........          122            0            0            0          -10          -10
CRITICAL CARE.....................          199           -1            0           -1          -10          -11
DERMATOLOGY.......................        2,248            2            0            2          -10           -8
EMERGENCY MEDICINE................        2,203           -2            0           -2          -10          -12
ENDOCRINOLOGY.....................          350           -1            0           -1          -10          -11
FAMILY PRACTICE...................        5,060            0            0            0          -10          -10
GASTROENTEROLOGY..................        1,750            0            0            0          -10          -10
GENERAL PRACTICE..................          974            0            0            0          -10          -10
GENERAL SURGERY...................        2,309           -1            0           -1          -10          -11
GERIATRICS........................          147            3            0            3          -10           -7
HAND SURGERY......................           80           -2            0           -2          -10          -12
HEMATOLOGY/ONCOLOGY...............        1,917           -1            0           -1          -10          -11
INFECTIOUS DISEASE................          504           -1            0           -1          -10          -11
INTERNAL MEDICINE.................        9,981            0            0            0          -10          -10
INTERVENTIONAL RADIOLOGY..........          244           -2            0           -2          -10          -12
NEPHROLOGY........................        1,664           -3            0           -3          -10          -13
NEUROLOGY.........................        1,398           -1            0           -1          -10          -11
NEUROSURGERY......................          576           -2            0           -2          -10          -12
NUCLEAR MEDICINE..................           78            4            0            5          -10           -5
OBSTETRICS/GYNECOLOGY.............          628           -1            0           -1          -10          -11
OPHTHALMOLOGY.....................        4,664            1            0            1          -10           -9
ORTHOPEDIC SURGERY................        3,248           -1            0           -1          -10          -11
OTOLARNGOLOGY.....................          913            1            0            1          -10           -9
PATHOLOGY.........................          948           -2            0           -2          -10          -12
PEDIATRICS........................           74            0            0            0          -10          -10
PHYSICAL MEDICINE.................          784           -1            0           -1          -10          -11
PLASTIC SURGERY...................          272           -1            0           -1          -10          -11
PSYCHIATRY........................        1,099            0            0            0          -10          -10
PULMONARY DISEASE.................        1,691           -1            0           -1          -10          -11
RADIATION ONCOLOGY................        1,612            0            0            0          -10          -10
RADIOLOGY.........................        5,245            0            0            0          -10          -10
RHEUMATOLOGY......................          494           -1            0           -1          -10          -11
THORACIC SURGERY..................          436           -2            0           -2          -10          -12
UROLOGY...........................        2,033           -1            0           -1          -10          -11
VASCULAR SURGERY..................          641           -1           -1           -1          -10          -11
AUDIOLOGIST.......................           31           12            0           12          -10            2
CHIROPRACTOR......................          725           -2            0           -2          -10          -12
CLINICAL PSYCHOLOGIST.............          531           -3            0           -3          -10          -13
CLINICAL SOCIAL WORKER............          354           -3            0           -3          -10          -13
NURSE ANESTHETIST.................          608           22            0           22          -10           12
NURSE PRACTITIONER................          796            2            0            2          -10           -8
OPTOMETRY.........................          790            4            0            4          -10           -6
ORAL/MAXILLOFACIAL SURGERY........           37            1            0            1          -10           -9
PHYSICAL/OCCUPATIONAL THERAPY.....        1,391            1            0            1          -10           -9
PHYSICIAN ASSISTANT...............          600            0            0            0          -10          -10
PODIATRY..........................        1,575            2            0            2          -10           -8
DIAGNOSTIC TESTING FACILITY.......        1,191            0            0            0          -10          -10
INDEPENDENT LABORATORY............        1,087            3            0            3          -10           -7
PORTABLE X-RAY SUPPLIER...........           81            2            0            2          -10          -8
----------------------------------------------------------------------------------------------------------------
* PE changes are CY 2008 second year transition changes. For fully implemented CY 2010 PE changes see Table 1.
** Components may not sum to total due to rounding.


[[Page 66392]]

    Table 40 shows the estimated impact on total payments for selected 
high volume procedures of all of the changes discussed previously. We 
selected these procedures because they are the most commonly furnished 
by a broad spectrum of physician specialties. There are separate 
columns that show the change in the facility rates and the nonfacility 
rates. For an explanation of facility and nonfacility PE refer to 
Addendum A of this final rule with comment period rule.

 Table 40.--Impact of Final Rule With Comment Period and Estimated Physician Update on 2008 Payment for Selected
                                                   Procedures
----------------------------------------------------------------------------------------------------------------
                                                            Facility                       Non-facility
                                               -----------------------------------------------------------------
     CPT/HCPCS        MOD       Description                            Percent                          Percent
                                                   2007       2008      change      2007       2008      change
----------------------------------------------------------------------------------------------------------------
11721.............  .......  Debride nail, 6       $28.80     $24.53        -15     $39.03     $35.43         -9
                              or more.
17000.............  .......  Destruct premalg       44.72      41.56         -7      63.29      60.30         -5
                              lesion.
27130.............  .......  Total hip           1,360.52   1,194.77        -12         na         na         na
                              arthroplasty.
27244.............  .......  Treat thigh         1,100.92     963.11        -13         na         na         na
                              fracture.
27447.............  .......  Total knee          1,464.74   1,283.35        -12         na         na         na
                              arthroplasty.
33533.............  .......  CABG, arterial,     1,908.52   1,658.44        -13         na         na         na
                              single.
35301.............  .......  Rechanneling of     1,071.74     934.49        -13         na         na         na
                              artery.
43239.............  .......  Upper GI              155.00     140.36         -9     325.16     294.01        -10
                              endoscopy,
                              biopsy.
66821.............  .......  After cataract        253.53     222.81        -12     270.97     237.80        -12
                              laser surgery.
66984.............  .......  Cataract surg w/      641.98     560.08        -13         na         na         na
                              iol, 1 stage.
67210.............  .......  Treatment of          556.34     487.86        -12     580.59     507.96        -13
                              retinal lesion.
71010.............  .......  Chest x-ray......         na         na         na      26.15      22.83        -13
71010.............       26  Chest x-ray......       8.72       7.84        -10       8.72       7.84        -10
77056.............  .......  Mammogram, both           na         na         na      97.40      93.35         -4
                              breasts.
77056.............       26  Mammogram, both        41.31      37.48         -9      41.31      37.48         -9
                              breasts.
77057.............  .......  Mammogram,                na         na         na      81.86      73.93        -10
                              screening.
77057.............       26  Mammogram,             33.35      30.32         -9      33.35      30.32         -9
                              screening.
77427.............  .......  Radiation tx          176.22     158.42        -10     176.22     158.42        -10
                              management, x5.
78465.............       26  Heart image (3d),      73.14      66.43         -9      73.14      66.43         -9
                              multiple.
88305.............       26  Tissue exam by         37.90      32.36        -15      37.90      32.36        -15
                              pathologist.
90801.............  .......  Psy dx interview.     129.99     112.08        -14     145.15     131.50         -9
90862.............  .......  Medication             44.72      39.18        -12      50.40      46.67         -7
                              management.
90935.............  .......  Hemodialysis, one      67.46      58.26        -14         na         na         na
                              evaluation.
92012.............  .......  Eye exam               34.11      38.50         13      61.77      62.69          1
                              established pat.
92014.............  .......  Eye exam &             55.71      59.28          6      91.33      90.96          0
                              treatment.
92980.............  .......  Insert                795.85     720.88         -9         na         na         na
                              intracoronary
                              stent.
93000.............  .......  Electrocardiogram      24.63      20.78        -16      24.63      20.78        -16
                              , complete.
93010.............  .......  Electrocardiogram       8.34       7.50        -10       8.34       7.50        -10
                              report.
93015.............  .......  Cardiovascular        104.22      93.01        -11     104.22      93.01        -11
                              stress test.
93307.............       26  Echo exam of           46.99      42.24        -10      46.99      42.24        -10
                              heart.
93510.............       26  Left heart            242.92     215.31        -11     242.92     215.31        -11
                              catheterization.
98941.............  .......  Chiropractic           28.80      25.55        -11      33.35      29.64        -11
                              manipulation.
99203.............  .......  Office/outpatient      67.08      58.60        -13      91.71      81.42        -11
                              visit, new.
99213.............  .......  Office/outpatient      42.07      37.48        -11      59.50      53.15        -11
                              visit, est.
99214.............  .......  Office/outpatient      66.32      58.60        -12      90.20      80.40        -11
                              visit, est.
99222.............  .......  Initial hospital      119.00     104.59        -12         na         na         na
                              care.
99223.............  .......  Initial hospital      173.57     153.65        -11         na         na         na
                              care.
99231.............  .......  Subsequent             35.62      31.68        -11         na         na         na
                              hospital care.
99232.............  .......  Subsequent             63.67      56.55        -11         na         na         na
                              hospital care.
99233.............  .......  Subsequent             90.95      81.08        -11         na         na         na
                              hospital care.
99236.............  .......  Observ/hosp same      205.40     179.20        -13         na         na         na
                              date.
99239.............  .......  Hospital               94.74      83.13        -12         na         na         na
                              discharge day.
99243.............  .......  Office                 93.23      83.13        -11     122.41     109.36        -11
                              consultation.
99244.............  .......  Office                145.91     130.14        -11     179.26     160.12        -11
                              consultation.
99253.............  .......  Inpatient             108.77      97.09        -11         na         na         na
                              consultation.
99254.............  .......  Inpatient             156.52     140.02        -11         na         na         na
                              consultation.
99283.............  .......  Emergency dept         60.64      52.81        -13         na         na         na
                              visit.
99284.............  .......  Emergency dept        110.28      97.44        -12         na         na         na
                              visit.
99291.............  .......  Critical care,        208.82     182.61        -13     256.19     224.17        -12
                              first hour.
99292.............  .......  Critical care,        104.60      91.64        -12     114.45     100.16        -12
                              addtl 30 min.
99348.............  .......  Home visit, est           na         na         na      66.32      68.14          2
                              patient.
99350.............  .......  Home visit, est           na         na         na     150.83     139.34         -8
                              patient.
G0008.............  .......  Admin influenza           na         na         na      18.95      18.40         -3
                              virus vac.
G0317.............  .......  ESRD related svs      283.09     245.29        -13     283.09     245.29        -13
                              4+mo 20+yrs.
----------------------------------------------------------------------------------------------------------------


[[Page 66393]]

B. Geographic Practice Cost Index Changes

    Section 1848(e)(1)(A) of the Act requires that payments under the 
Medicare physician fee schedule vary among payment areas only to the 
extent that area costs vary as reflected by the area GPCIs. The GPCIs 
measure area cost differences in the three components of the physician 
fee schedule: Physician work, PEs (employee wages, rent, medical 
supplies, and equipment), and malpractice insurance. Section 
1848(e)(1)(C) of the Act requires that the GPCIs be reviewed and, if 
necessary, revised at least every 3 years. The first GPCI revision 
occurred in 1993. The second revision was implemented in 1998, the next 
in 2001, and the last in 2005. We are implementing the next GPCI update 
in this rule and the 2008 updated, budget neutralized values are shown 
in Addendum E. These values reflect the removal of the 1.000 floor on 
physician work as mandated by the MIEA-TRHCA law of December 2006. As 
required by law, the GPCIs are phased in over a two year period; 
therefore the 2008 GPCI values are calculated as one-half the 
difference between the fully implemented 2007 GPCIs and the fully 
implemented 2009 (updated) GPCIs.
    An estimate of the overall effects of GPCI changes on fee schedule 
area payments can be demonstrated by a comparison of area geographic 
adjustment factors (GAFs). The GAFs are a weighted composite of each 
area's work, PE, and malpractice expense GPCIs using the national GPCI 
cost share weights. While we do not actually use the GAFs in computing 
the fee schedule payment for a specific service, they are useful in 
comparing overall area costs and payments. The actual effect on payment 
for any actual service will deviate from the GAF to the extent that the 
services proportions of work, PE, and malpractice expense RVUs differ 
from those of the GAF. The GAFs reflect the removal of the 1.000 floor 
on physician work as mandated by the MIEA-TRHCA law of December 2006.
    The most significant positive changes occur in seven payment 
localities where the GAF moves up between 5.91 percent (Rest of Maine) 
and 2.05 percent (Ventura, Calif.). Nineteen payment localities show an 
increase in GAF of between 1.99 percent (Rest of Texas) to 1.05 percent 
(New Hampshire). Twenty-two payment localities have increases of less 
than 1 percent.
    The Detroit, Michigan payment locality shows a drop in the GAF 
value of 4.32 percent, the largest, and eight other payment localities 
(including Santa Clara, California, Atlanta, Georgia, Fort Worth, 
Texas, and Chicago, Illinois) decrease between 3.8 percent and 2.16 
percent in the GAF value. Fourteen payment localities show decreases 
between 1.10 percent (Rest of Michigan) and 1.92 percent (Miami, 
Florida). Twenty-two payment localities show decreases between 0.01 
percent (Anaheim, California) and 0.90 percent (Seattle, Washington).
    Increases or decreases in GPCI values do not necessarily reflect 
increases or decreases in the actual costs associated with a specific 
locality, but rather reflect the relative costs compared to a national 
average. As an example, when rents go up in Wisconsin or Ohio, the 
index for California or New York goes down, even if actual costs for 
California or New York stay the same or even increase. Other factors 
also play a part in the overall GPCI picture. We do not have sufficient 
data to undertake a sensitivity analysis of exact elements of the 
change but we can make some generalized assumptions. For example, the 
changes in GAF values for several areas of California reflect 
significant changes in the malpractice GPCIs; and, a lowering of the PE 
GPCI in many urban settings is offset by increases in the PE GPCI of 
more rural settings.
    The 2008 GPCIs are budget neutralized so the update does not result 
in an increase in spending as a result of the changes.

C. Telehealth

    In section II.D of this rule, we are adding neurobehavioral status 
exam as represented by HCPCS code 96116 to the list of telehealth 
services. To date, Medicare expenditures for telehealth services have 
been extremely low. For instance, in CY 2006, the total Medicare 
payment amount for telehealth services (including the originating site 
facility fee) was approximately $2 million. Moreover, previous 
additions to the list of Medicare telehealth services have not resulted 
in a significant increase in Medicare program expenditures. For 
example, the psychiatric diagnostic interview examination (as described 
by CPT code 90801) was added to the list of Medicare telehealth 
services in CY 2003. The addition of CPT code 90801 resulted in an 
increase in Medicare payment amounts of approximately $100,000 in CY 
2006.
    The neurobehavioral status exam (CPT code 96116) includes an 
initial assessment and evaluation of the mental status for a 
psychiatric patient. In this regard, the neurobehavioral status exam is 
similar to the psychiatric diagnostic interview examination (CPT code 
90801). However, the utilization rate of psychiatric diagnostic 
interview examination is much greater than the neurobehavioral status 
exam. For instance, in CY 2006, the total allowed services for CPT code 
90801 was approximately 1.3 million while total allowed services for 
neurobehavioral status exam in CY 2006 was approximately 105,000. 
Because utilization of neurobehavioral status exam is substantially 
less than the psychiatric diagnostic interview examination, we believe 
the budgetary impact of adding neurobehavioral status exam to the list 
of Medicare telehealth services will be even less than the previously 
added psychiatric diagnostic interview examination.
    While we believe that addition of this service to the telehealth 
service list will enable more beneficiaries to access to these 
services, we do not anticipate that this change will have a significant 
budgetary impact on the Medicare program.

D. Payment for Covered Outpatient Drugs and Biologicals

1. ASP Issues
    The issues discussed in section II.F.1. with respect to payment for 
covered outpatient drugs and biologicals, are estimated to have no 
impact on Medicare expenditures. However, we believe the policies we 
are adopting will assist in clarifying existing policy with respect to 
ASP payment.
2. CAP issues
    This final rule describes a significant change in how CAP drug 
claims are paid due to the implementation of section 108(a)(2) of the 
MIEA-TRHCA. This rule also addresses comments and finalizes regulations 
on certain approaches to refining the CAP that seek to improve service 
by improving compliance, increasing flexibility, and increasing choices 
available to participating CAP physicians. The finalized CAP provisions 
will also have a potential impact on entities that are involved in the 
dispensing or distribution of drugs, that plan to become approved CAP 
vendors, or are approved CAP vendors. Changes associated with section 
108(a)(2) of the MIEA-TRHCA, especially the provision for payment to 
vendors upon receipt of a claim, will almost certainly be perceived as 
a positive step. Other finalized changes seek to improve service by 
improving compliance and increasing flexibility under the CAP. At this 
time, we anticipate that these changes will result in no significant 
additional cost savings or increases

[[Page 66394]]

associated with the CAP, relative to the ASP payment system.

E. Clinical Laboratory Fee Schedule Issues

    As discussed in section II.G of this final rule, we are adopting 
Sec.  414.509 for establishing payment for a new clinical diagnostic 
laboratory paid under the Medicare Part B clinical laboratory fee 
schedule. Also, we are clarifying dates in Sec.  414.502 and Sec.  
414.508. These changes will not increase or decrease payments for 
current clinical diagnostic laboratory tests. For newly developed 
tests, we will permit an opportunity for the public to request a 
reconsideration of a payment amount. Because any new laboratory tests 
to undergo a reconsideration request of a payment amount are unknown to 
us at the current time, we do not have any data to estimate the impact. 
However, we anticipate that the reconsideration process will apply to 
fewer than five new tests per year so that no significant additional 
costs to the clinical laboratory payment system will occur.

F. Provisions Related to Payment for Renal Dialysis Services Furnished 
by End State Renal Disease (ESRD) Facilities

    The ESRD-related provisions in this final rule are discussed in 
section II.H. 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 year (CY 2007 payments) to 
estimated payments under the revisions to the composite rate payment 
system as discussed in II.H. of this final rule with comment period 
(2008 payments). To estimate the impact among various classes of ESRD 
facilities, it is imperative that the estimates of current payments and 
projected payments contain similar inputs. Therefore, we simulated 
payments only for those ESRD facilities that we are able to calculate 
both current 2007 payments and projected 2008 payments.
    ESRD providers were grouped into the categories based on 
characteristics furnished 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 2007 update of CY 2006 National Claims History file as a basis for 
Medicare dialysis treatments and separately billable drugs and 
biologicals. Due to data limitations, we are unable to estimate current 
2007 payments and projected 2008 payments for 153 of the 4,813 ESRD 
facilities that billed for ESRD dialysis treatments in CY 2006.
    Table 41 shows the impact of this year's changes to CY 2008 
payments to hospital-based and independent ESRD facilities. The first 
column of Table 41 identifies the type of ESRD provider, the second 
column indicates the number of ESRD facilities for each type, and the 
third column indicates the number of dialysis treatments.
    The fourth column shows the effect of the change to the wage index 
floor as it affects the composite rate payments to ESRD facilities for 
CY 2008. The fourth column compares aggregate ESRD wage adjusted 
composite rate payments in the third year of the transition (CY 2008) 
using the CY 2008 wage index with a 0.80 floor compared to aggregate 
ESRD wage adjusted composite rate payments in the third year of the 
transition (CY 2008) using the CY 2008 wage index with a 0.75 floor. 
Note that the fourth column only includes the effect of the change to 
the wage index floor and does not include the effects of other wage 
index changes, such as, moving from the second to third year of the 
transition and updated wage index values from CY 2007 to CY 2008.
    The fifth column shows the effect of all changes to the ESRD wage 
index for CY 2008 as it affects the composite rate payments to ESRD 
facilities. It is inclusive of the changes in the fourth column. The 
fifth column compares aggregate ESRD wage adjusted composite rate 
payments in the third year of the transition (CY 2008) to aggregate 
ESRD wage adjusted composite rate payments in the second year of the 
transition (CY 2007). In the third year of the transition (CY 2008), 
ESRD facilities receive 75 percent of the CBSA wage adjusted composite 
rate and 25 percent of the MSA wage adjusted composite rate. In the 
second year of the transition, ESRD facilities receive 50 percent of 
the CBSA wage adjusted composite rate and 50 percent of the MSA wage 
adjusted composite rate. The overall effect to all ESRD providers in 
aggregate is zero because the CY 2008 ESRD wage index has been 
multiplied by a BN adjustment factor to comply with the statutory 
requirement that any wage index revisions be done in a manner that 
results in the same aggregate amount of expenditures as would have been 
made without any changes in the wage index. The decreases shown among 
census regions is primarily due to reducing the wage index floor, as 
there were areas in these areas with wage index values below the 
reduced floor.
    The sixth column shows the overall effect of the changes in 
composite rate payments to ESRD providers. The overall effect is 
measured as the difference between the projected CY 2008 payment with 
all changes in this final rule and CY 2007 payment. This payment amount 
is computed by multiplying the wage adjusted composite rate with the 
drug add-on for each provider times the number of dialysis treatments 
from the CY 2006 claims. The projected CY 2008 payment is the 
transition year 3 wage-adjusted composite rate for each provider (with 
the 15.5 percent drug add-on) times dialysis treatments from CY 2006 
claims. The CY 2007 current payment is the transition year 2 wage-
adjusted composite rate for each provider (with the current 14.9 
percent drug add-on) times dialysis treatments from CY 2006 claims.
    The overall impact to ESRD providers in aggregate is 0.5 percent. 
This increase corresponds to the 0.5 percent increase to the drug add-
on. The variation shown in column 6 is due to variation in changes in 
the wage index (column 5). All provider types receive the same 0.5 
percent increase to the drug add-on.

       Table 41.--Impact of CY 2008 Changes in Payments to Hospital Based and Independent ESRD Facilities
         [Percent change in composite rate payments to ESRD facilities (both program and beneficiaries)]
----------------------------------------------------------------------------------------------------------------
                                                               Number of
                                                                dialysis    Effect of    Effect of
                                                  Number of    treatments   changes in   changes in    Overall
                                                  facilities      (in       floor only   wage index   effect \3\
                                                               millions)       \1\          \2\
----------------------------------------------------------------------------------------------------------------
All Providers..................................        4,660         35.5          0.0          0.0          0.5
    Independent................................        4,101         31.8          0.0         -0.1          0.5
    Hospital Based.............................          559          3.7          0.0          0.5          1.0
By Facility Size
    Less than 5000 treatments..................        1,650          4.7         -0.1         -0.3          0.3

[[Page 66395]]

 
    5000 to 9999 treatments....................        1,800         13.0          0.0          0.0          0.5
    Greater than 9999 treatments...............        1,210         17.7          0.0          0.1          0.6
Type of Ownership
    Profit.....................................        3,745         28.9          0.0         -0.1          0.4
    Nonprofit..................................          915          6.5          0.0          0.3          0.9
By Geographic Location
    Rural......................................        1,261          7.3         -0.4         -0.6          0.0
    Urban......................................        3,399         28.1          0.1          0.1          0.7
By Region
    New England................................          141          1.1          0.1          1.4          2.0
    Middle Atlantic............................          553          4.5          0.1          0.5          1.0
    East North Central.........................          727          5.7          0.1         -0.6         -0.1
    West North Central.........................          358          1.9          0.1         -0.3          0.3
    South Atlantic.............................        1,063          8.1          0.0          0.0          0.6
    East South Central.........................          365          2.6         -0.5         -1.4         -0.8
    West South Central.........................          646          5.0         -0.1         -0.7         -0.2
    Mountain...................................          254          1.6          0.1          0.3          0.8
    Pacific....................................          523          4.4          0.1          1.4          2.0
    Puerto Rico................................           30          0.4         -2.1         -3.0        -2.5
----------------------------------------------------------------------------------------------------------------
\1\ This column shows the effect of the wage index floor changes on ESRD providers. Composite rate payments
  computed using the CY 2008 wage index with a 0.80 floor are compared to composite rate payments using the CY
  2008 wage index with a 0.75 floor.
\2\ This column shows the overall effect of wage index changes on ESRD providers. Composite rate payments
  computed using the current wage index are compared to composite rate payments using the CY 2008 wage index
  changes.
\3\ This column shows the percent change between CY 2008 and CY 2007 composite rate payments to ESRD facilities.
  The CY 2008 payments include the CY 2008 wage adjusted composite rate, and the 15.5% drug add-on times
  treatments The CY 2007 payments to ESRD facilities includes the CY 2007 wage adjusted composite rate and the
  14.9% drug add-on times treatments.

G. IDTF Changes

    We believe that our provisions regarding IDTFs as discussed in 
section II.I. of this final rule with comment period would have no 
budgetary impact. However, we believe that these changes are necessary 
to ensure that only legitimate IDTFs are enrolled into the program. In 
addition, we believe that the IDTF provisions contained in this final 
rule will help ensure that beneficiaries receive quality care. 
Therefore, we expect to have an impact on an unknown number of persons 
and entities who will be denied enrollment into the Medicare program.

H. CORF Issues

    The revisions to the CORF regulations discussed in section II.K. 
update the regulations for consistency with the PFS payment rules. 
These revisions will help to clarify payment for CORF services and are 
expected to have minimal impact on Medicare expenditures.

I. Compendia for Determination of Medically-Accepted Indications for 
Off-Label Use of Drugs and Biologicals in an Anti-Cancer 
Chemotherapeutic Regimen.

    We anticipate that the changes related to the compendia discussed 
in section II.L. of this final rule with comment period will have a 
negligible cost to the Medicare program. The changes will enable CMS to 
respond quickly should changes in the number and quality of the 
compendia indicate a need to amend the list.

J. Physician Self-Referral Provisions

    We anticipate that our provisions in section II.M. of this final 
rule with comment period for the reassignment and anti-markup 
provisions, and the physician self-referral provisions will result in 
savings to the program by reducing overutilization and anti-competitive 
business arrangements. We cannot gauge with any certainty the extent of 
these savings to the Medicare program.

K. Beneficiary Signature for Ambulance Transport Services

    We believe that our provision in section II.N. of this final rule 
with comment period for allowing the ambulance provider or supplier to 
sign the claim on behalf of the beneficiary with respect to emergency 
transport services, provided that certain conditions are satisfied, 
will have no budget impact.

L. Update to Fee Schedules for Class III DME for CYs 2007 and 2008

    In section II.O. of this final rule with comment period, we discuss 
the update to the fee schedules for class III DME for CYs 2007 and 
2008. Total allowed charges for class III devices in 2005 were $71 
million. Accordingly, with a zero percent increase for DME, other than 
class III devices, for 2005 and 2006 and with the establishment of an 
update for 2007 of zero percent for class III devices, rather than 4.3 
percent based on the CPI-U, this results in a savings to the Medicare 
program of approximately $2 million in FY 2007, $4 million in FY 2008, 
$4 million in FY 2009, $5 million in FY 2010, $5 million in FY 2011, 
and $5 million in FY 2012.

M. Therapy Services

    In section II.R.2., we are changing the certification requirement 
for the plan of care, for outpatient physical therapy, occupational 
therapy and speech-language pathology services from every 30 days to an 
appropriate length, based on the patient's needs, limited to 90 days. 
As we stated in the proposed rule, analysis of Medicare claims data 
shows negative or no impact for this change and this was also supported 
by commenters. In most cases, the appropriate length of treatment will 
be

[[Page 66396]]

less than 30 days. Certification of the appropriate length of treatment 
will discourage the practice of billing for re-evaluations prior to 
recertification regardless of need.
    The 30-day recertification allows treatment under a plan of care 
for 30 days after initial certification, regardless of the appropriate 
length of treatment. The initial certification cannot assure that a 
physician reviews the plan or follows the patient's progress.
    We will review the utilization of therapy services after a 2-year 
trial to assess any changes that might be related to certification of a 
plan of care for an appropriate length of treatment. At that time, if 
we determine that this change has caused an increase in inappropriate 
utilization, we will reconsider the 30-day certification requirement.

N. TRHCA 101(b) Physician Quality Reporting Initiative

    As discussed section II.S.1. of this rule, the final 2008 PQRI 
measures satisfy the requirement of section 1848(k)(2)(B)(ii) of the 
Act that the Secretary publish in the Federal Register by August 15, 
2007, measures that the Secretary proposes as appropriate for eligible 
professionals to use to submit data to the Secretary in 2008. We also 
expect to address registry- and EHR-based data submission on a test 
basis in 2008, as discussed in section II.T.1. of this rule. Although 
there may be some cost incurred for maintaining the measures and their 
associated code sets, and for enhancing an existing clinical data 
warehouse to accommodate the registry- and EHR-based data submission, 
we do not anticipate a significant cost impact on the Medicare program.

O. TRHCA 101(d) Physician Assistance and Quality Initiative Fund

    As discussed in section II.S.5. of this final rule with comment 
period, section 101(d) of the MIEA-TRHCA created the Physician 
Assistance and Quality Initiative Fund (PAQI) which provides $1.35 
billion for physician payment and quality improvement initiatives. The 
legislation directs the Secretary to provide for expenditures from the 
Fund in a manner designed to provide (to the maximum extent feasible) 
for the obligation of the entire $1.35 billion for payment for 
physicians' services furnished during 2008. As discussed in section 
II.S.5. of this final rule with comment period, we will scale aggregate 
payments to physicians in a manner such that Medicare would pay $1.35 
billion during CY 2009 for measures reported for services furnished 
during CY 2008. We are unable to provide an exact percentage for the 
bonus payment, but we anticipate that the bonus payments will be 
approximately 1.5 percent of allowed charges for participating 
professionals (and we do not expect that the ultimate percentage amount 
would exceed 2 percent). We also note that the Transitional Medical 
Assistance, Abstinence Education, and Qualifying Individual Programs 
Extension Act of 2007 (Pub. L. 110-90) provided an additional $325 
million to be used as a part of the PAQI Fund for payment with regard 
to services furnished in 2009 and $60,000,000 for payment with respect 
to physicians' services furnished on or after January 1, 2013.

P. TRHCA 110 Reporting of Anemia Quality Indicators

    As discussed in section II.S.2. of this final rule with comment 
period, there are no program cost savings or increased expenditures 
associated with this change; however, we expect that the regulation 
will have a positive impact on patient care.

Q. Amendment of the Exemption From NCPDP SCRIPT Standard for Computer-
Generated Facsimile Transmissions Under Medicare Part D

    The amendment of the exemption for computer-generated fax 
transactions under Medicare Part D is discussed in section II.R.3. of 
this rule. E-prescribing is voluntary for providers and pharmacies. 
This amendment only affects providers and pharmacies that already 
conduct e-prescribing using products that generate faxes rather than 
SCRIPT transactions.
    We believe that providers and pharmacies that are now e-prescribing 
using products that generate faxes generally already possess the 
hardware necessary to e-prescribe. Many would need to obtain software 
upgrades to send and receive the SCRIPT transaction. This software will 
generally be available to providers through automatic version upgrades 
built into annual software vendor maintenance fees. However, providers 
currently using software that cannot be upgraded to generate SCRIPT 
transactions would need to purchase and install new e-prescribing 
software or revert to sending paper fax transactions to pharmacies.
    Dispensers that currently e-prescribe but have not established the 
connectivity necessary to receive and send SCRIPT transactions would 
need to connect to a network, and may need to install software 
upgrades, which will generally be covered under annual fees. Because 
pharmacies customarily bear the cost of transaction fees for the SCRIPT 
transactions they receive and send, these costs would increase as the 
rate of e-prescribing increases.
    The amendment of this exemption will have indirect benefits in that 
it will help to encourage e-prescribing using electronic data 
interchange, which will ultimately result in improved patient safety. 
We also will continue to allow computer-generated faxes as a fallback 
in cases of temporary/transient transmission failures and 
communications problems.
    Because of the voluntary nature of e-prescribing for physicians and 
pharmacies, the relatively small number of entities currently e-
prescribing, and the minimal nature of the anticipated costs, we 
believe this provision does not constitute a major rule for purposes of 
this analysis.

R. Revisions to Payment Policies Under the Ambulance Fee Schedule and 
the Ambulance Inflation Factor Update for CY 2008

    For the purposes of the RFA, ambulance providers and suppliers are 
considered to be small entities. Removing the requirement that the AIF 
be published annually via Federal Register notice has no monetary 
impact on small entities or small businesses. It merely allows for the 
earlier dissemination of necessary information to the ambulance 
industry, the Medicare contractors, and the general public.
    We estimate that the total program expenditure for CY 2007 for 
ambulance services covered by the Medicare program is approximately 
$5.2 billion. Application of an AIF of 2.7 percent will result in an 
additional total program expenditure for CY 2008 of approximately $140 
million over CY 2007 expenditures.

S. Alternatives Considered

    This final rule with comment period contains a range of policies, 
including some provisions related to specific MMA provisions. The 
preamble provides descriptions of the statutory provisions that are 
addressed, identifies those policies when discretion has been 
exercised, presents rationale for our decisions and, where relevant, 
alternatives that were considered.

T. Impact on Beneficiaries

    There are a number of changes made in this final rule with comment 
period that would have an effect on beneficiaries. In general, we 
believe these changes, particularly the implementation of the PQRI with 
its continuing focus on measuring, submitting, and analyzing quality 
data, will have a positive impact and improve

[[Page 66397]]

the quality and value of care furnished to Medicare beneficiaries.
    We do not believe that beneficiaries will experience drug access 
issues as a result of the changes with respect to Part B drugs and CAP.
    As explained in more detail subsequently in this section, the 
regulatory provisions may affect beneficiary liability in some cases. 
Most changes in aggregate beneficiary liability from a particular 
provision would be a function of the coinsurance (20 percent if 
applicable for the particular provision after the beneficiary has met 
the deductible) and the effect of the aggregate cost (savings) of the 
provision on the calculation of the Medicare Part B premium rate 
(generally 25 percent of the provision's cost or savings). In 2008, 
total cost sharing (coinsurance and deductible) per Part B enrollee 
associated with physician fee schedule services is estimated to be 
$590. In addition, the portion of the 2008 standard monthly Part B 
premium attributable to PFS services is estimated to be $38.60.
    To illustrate this point, as shown in Table 40, the 2007 national 
payment amount in the nonfacility setting for CPT code 99203 (Office/
outpatient visit, new), is $91.71 which means that currently a 
beneficiary is responsible for 20 percent of this amount, or $18.34. 
Based on this final rule with comment period, the 2008 national payment 
amount in the nonfacility setting for CPT code 99203, as shown in Table 
40, is $81.42 which means that, in 2008, the beneficiary coinsurance 
for this service would be $16.28.
    Policies discussed in this rule that do affect overall spending, 
such as the additions to the list of codes that are subject to section 
5102 of the DRA imaging provisions, would similarly impact 
beneficiaries'' coinsurance.

U. Accounting Statement

    As required by OMB Circular A-4 (available at http://www.whitehouse.gov/omb/circulars/a004/a-4.pdf), in Table 42, we have 
prepared an accounting statement showing the classification of the 
expenditures associated with this final rule with comment period. This 
estimate includes the incurred benefit impact associated with the 
estimated CY 2008 PFS update, shown in this final rule with comment 
period, based on the 2007 Trustees Report baseline. All estimated 
impacts are classified as transfers.

      Table 42.--Accounting Statement: Classification of Estimated
                        Expenditures for CY 2008
                              [In billions]
------------------------------------------------------------------------
                 Category                             Transfers
------------------------------------------------------------------------
Annualized Monetized Transfers............  -$6.0.
From Whom To Whom?........................  Federal Government to
                                             physicians, other
                                             practitioners and suppliers
                                             who receive payment under
                                             the Medicare Physician Fee
                                             Schedule; ESRD Medicare
                                             Providers; ambulance
                                             suppliers, DME suppliers,
                                             and Medicare suppliers
                                             billing for Part B drugs.
------------------------------------------------------------------------

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

List of Subjects

42 CFR Part 409

    Health facilities, Medicare.

42 CFR Part 410

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

42 CFR Part 411

    Kidney diseases, Medicare, Physician Referral, Reporting and 
recordkeeping requirements.

42 CFR Part 413

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

42 CFR Part 414

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

42 CFR Part 415

    Health facilities, Health professions, Medicare, Reporting and 
recordkeeping requirements.

42 CFR Part 418

    Health facilities, Hospice care, Medicare, Reporting and 
recordkeeping requirements.

42 CFR Part 423

    Administrative practice and procedure, Emergency medical services, 
Health facilities, Health maintenance organizations (HMO), Health 
Professionals, Medicare, Penalties, Privacy, Reporting and 
recordkeeping requirements.

42 CFR Part 424

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

42 CFR Part 482

    Grant programs--health, Hospitals, Medicaid, Medicare, Reporting 
and recordkeeping requirements.

42 CFR Part 484

    Grant programs--health, Health facilities, Health professions, 
Health records, Medicaid, Medicare, Nursing homes, Nutrition, Reporting 
and recordkeeping requirements, Safety.

42 CFR Part 485

    Grant programs--health, Health facilities, Medicaid, Medicare, 
Reporting and recordkeeping requirements.

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 409--HOSPITAL INSURANCE BENEFITS

0
1. The authority citation for part 409 continues to read as follows:

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

Subpart B--Inpatient Hospital Services and Inpatient Critical 
Access Hospital Services

0
2. Section 409.17 is added to read as follows:


Sec.  409.17  Physical therapy, occupational therapy, and speech-
language pathology services.

    (a) General rules. (1) Except as specified in paragraph (a)(1)(ii) 
of this section, physical therapy, occupational

[[Page 66398]]

therapy or speech-language pathology services must be furnished by 
qualified physical therapists, physical therapist assistants, 
occupational therapists, occupational therapy assistants or speech-
language pathologists who meet the requirements specified part 484 of 
this chapter.
    (2) Physical therapy, occupational therapy or speech-language 
pathology services must be furnished under a plan that meets the 
requirements of paragraphs (b) through (d) of this section, or plan 
requirements specific to the payment policy under which the services 
are rendered, if applicable.
    (b) Establishment of the plan. The plan must be established before 
treatment begins by one of the following:
    (1) A physician.
    (2) A nurse practitioner, a clinical nurse specialist or a 
physician assistant.
    (3) The physical therapist furnishing the physical therapy 
services.
    (4) A speech-language pathologist furnishing the speech-language 
pathology services.
    (5) An occupational therapist furnishing the occupational therapy 
services.
    (c) Content of the plan. The plan:
    (1) Prescribes the type, amount, frequency, and duration of the 
physical therapy, occupational therapy, or speech-language pathology 
services to be furnished to the individual; and
    (2) Indicates the diagnosis and anticipated goals.
    (d) Changes in the plan. Any changes in the plan are implemented in 
accordance with hospital policies and procedures.

Subpart C--Posthospital SNF Care

0
3. Section 409.23 is amended by adding paragraph (c) to read as 
follows:


Sec.  409.23  Physical, occupational, and speech therapy.

* * * * *
    (c) Except as specified in paragraph (c)(1)(ii) of this section, 
physical therapy, occupational therapy or speech-language pathology 
services must be furnished--
    (1) By qualified physical therapists, physical therapist 
assistants, occupational therapists, occupational therapy assistants or 
speech-language pathologists as defined in part 484 of this chapter
    (2) In accordance with a plan that meets the requirements of Sec.  
409.17(b) through (d) of this part.

PART 410--SUPPLEMENTARY MEDICAL INSURANCE (SMI) BENEFITS

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

    Authority: Secs. 1102, 1834, 1871, and 1893 of the Social 
Security Act (42 U.S.C. 1302, 1395m, 1395hh, and 1395ddd).

Subpart B--Medical and Other Health Services


Sec.  410.32  [Amended]

0
5. Section 410.32 is amended by--
0
A. Removing paragraph (a)(1).
0
B. Redesignating paragraphs (a)(2) and (a)(3) as paragraphs (a)(1) and 
(a)(2).

0
6. Section 410.33 is amended by--
0
A. Revising paragraphs (b)(1), (g)(2), (g)(3), (g)(6), and (g)(8).
0
B. Adding paragraphs (g)(15) and (i).
    The revisions and addition read as follows:


Sec.  410.33  Independent diagnostic testing facility.

* * * * *
    (b) * * *
    (1) Each supervising physician must be limited to providing general 
supervision to no more than three IDTF sites. This applies to both 
fixed sites and mobile units where three concurrent operations are 
capable of performing tests.
* * * * *
    (g) * * *
    (2) Provides complete and accurate information on its enrollment 
application. Changes in ownership, changes of location, changes in 
general supervision, and adverse legal actions must be reported to the 
Medicare fee-for-service contractor on the Medicare enrollment 
application within 30 calendar days of the change. All other changes to 
the enrollment application must be reported within 90 days.
    (3) Maintain a physical facility on an appropriate site. For the 
purposes of this standard, a post office box, commercial mailbox, 
hotel, or motel is not considered an appropriate site.
    (i) The physical facility, including mobile units, must contain 
space for equipment appropriate to the services designated on the 
enrollment application, facilities for hand washing, adequate patient 
privacy accommodations, and the storage of both business records and 
current medical records within the office setting of the IDTF, or IDTF 
home office, not within the actual mobile unit.
    (ii) IDTF suppliers that provide services remotely and do not see 
beneficiaries at their practice location are exempt from providing hand 
washing and adequate patient privacy accommodations.
* * * * *
    (6) Have a comprehensive liability insurance policy of at least 
$300,000 per location that covers both the place of business and all 
customers and employees of the IDTF. The policy must be carried by a 
nonrelative-owned company. Failure to maintain required insurance at 
all times will result in revocation of the IDTF's billing privileges 
retroactive to the date the insurance lapsed. IDTF suppliers are 
responsible for providing the contact information for the issuing 
insurance agent and the underwriter. In addition, the IDTF must--
    (i) Ensure that the insurance policy must remain in force at all 
times and provide coverage of at least $300,000 per incident; and
    (ii) Notify the CMS designated contractor in writing of any policy 
changes or cancellations.
* * * * *
    (8) Answer, document, and maintain documentation of a beneficiary's 
written clinical complaint at the physical site of the IDTF (For mobile 
IDTFs, this documentation would be stored at their home office.) This 
includes, but is not limited to, the following:
    (i) The name, address, telephone number, and health insurance claim 
number of the beneficiary.
    (ii) The date the complaint was received; the name of the person 
receiving the complaint; and a summary of actions taken to resolve the 
complaint.
    (iii) If an investigation was not conducted, the name of the person 
making the decision and the reason for the decision.
* * * * *
    (15) With the exception of hospital-based and mobile IDTFs, a 
fixed-base IDTF does not include the following:
    (i) Sharing a practice location with another Medicare-enrolled 
individual or organization;
    (ii) Leasing or subleasing its operations or its practice location 
to another Medicare-enrolled individual or organization; or
    (iii) Sharing diagnostic testing equipment used in the initial 
diagnostic test with another Medicare-enrolled individual or 
organization.
* * * * *
    (i) Effective date of billing privileges. The filing date of the 
Medicare enrollment application is the date that the Medicare 
contractor receives a signed provider enrollment application that it is 
able to process to approval. The effective date of billing privileges 
for a

[[Page 66399]]

newly enrolled IDTF is the later of the following:
    (1) The filing date of the Medicare enrollment application that was 
subsequently approved by a Medicare fee-for-service contractor; or
    (2) The date the IDTF first started furnishing services at its new 
practice location.

0
7. Section 410.43 is amended by revising paragraph (a)(3)(ii) to read 
as follows:


Sec.  410.43  Partial hospitalization services: Conditions and 
exclusions.

    (a) * * *
    (3) * * *
    (ii) Occupational therapy requiring the skills of a qualified 
occupational therapist, provided by an occupational therapist, or under 
appropriate supervision of a qualified occupational therapist by an 
occupational therapy assistant as specified in part 484 of this 
chapter.

0
8. Section 410.59 is amended by revising the introductory text to 
paragraph (a) to read as follows:


Sec.  410.59  Outpatient occupational therapy services: Conditions.

    (a) Basic rule. Except as specified in paragraph (a)(3)(iii) of 
this section, Medicare Part B pays for outpatient occupational therapy 
services only if they are furnished by an individual meeting the 
qualifications in part 484 of this chapter for an occupational 
therapist or an appropriately supervised occupational therapy assistant 
but only under the following conditions:
* * * * *

0
9. Section 410.60 is amended by revising the introductory text of 
paragraph (a) to read as follows:


Sec.  410.60  Outpatient physical therapy services: Conditions.

* * * * *
    (a) Basic rule. Except as specified in paragraph (a)(3)(iii) of 
this section, Medicare Part B pays for outpatient physical therapy 
services only if they are furnished by an individual meeting the 
qualifications in part 484 of this chapter for a physical therapist or 
an appropriately supervised physical therapist assistant but only under 
the following conditions:
* * * * *


Sec.  410.61  [Amended]

0
10. Section 410.61 is amended by removing paragraph (e).

0
11. Section 410.78 is amended by revising the introductory text of 
paragraph (b) to 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), individual medical nutrition therapy, and 
neurobehavioral status exam furnished by an interactive 
telecommunications system if the following conditions are met:
* * * * *

Subpart D--Comprehensive Outpatient Rehabilitation Facility (CORF) 
Services

0
12. Section 410.100 is amended by--
0
A. Revising the introductory text and paragraphs (a), (e), and (h).
0
B. Removing paragraph (i).
0
C. Redesignating paragraphs (j), (k), (l), and (m) to (i), (j), (k), 
and (l) respectively.
0
D. Revising new paragraphs (i), (j), (k), and (l).
    The revisions read as follows:


Sec.  410.100  Included services.

    Subject to the conditions and limitations set forth in Sec.  
410.102 and Sec.  410.105, CORF services means the following services 
furnished to an outpatient of the CORF by personnel that meet the 
qualifications set forth in Sec.  485.70 of this chapter. Payment for 
CORF services are made in accordance with Sec.  414.1105.
    (a) Physician's services. CORF facility physician services are 
administrative in nature and include consultation with and medical 
supervision of nonphysician staff, participation in plan of treatment 
reviews and patient care review conferences, and other medical and 
facility administration activities. Diagnostic and therapeutic services 
furnished to an individual CORF patient by a physician in a CORF 
facility are not CORF physician services. These services, if covered, 
are physician services under Sec.  410.20 with payment for these 
services made to the physician in accordance with part 414 subpart B.
* * * * *
    (e) Respiratory therapy services. (1) Respiratory therapy services 
are for the assessment, treatment, and monitoring of patients with 
deficiencies or abnormalities of cardiopulmonary function.
    (2) Respiratory therapy services include the following:
    (i) Application of techniques for support of oxygenation and 
ventilation of the patient.
    (ii) Therapeutic use and monitoring of gases, mists, and aerosols 
and related equipment.
    (iii) Bronchial hygiene therapy.
    (iv) Pulmonary rehabilitation techniques to develop strength and 
endurance of respiratory muscles and other techniques to increase 
respiratory function, such as graded activity services; these services 
include physiologic monitoring and patient education.
* * * * *
    (h) Social and psychological services. Social and psychological 
services include the assessment and treatment of an individual's mental 
and emotional functioning and the response to and rate of progress as 
it relates to the individual's rehabilitation plan of treatment, 
including physical therapy services, occupational therapy services, 
speech-language pathology services and respiratory therapy services.
    (i) Nursing care services. Nursing care services include nursing 
services provided by a registered nurse that are prescribed by a 
physician and are specified in or directly related to the 
rehabilitation treatment plan and necessary for the attainment of the 
rehabilitation goals of the physical therapy, occupational therapy, 
speech-language pathology, or respiratory therapy plan of treatment.
    (j) Drugs and biologicals. These are drugs and biologicals that are 
the following:
    (1) Prescribed by a physician and administered by or under the 
supervision of a physician or by a registered professional nurse; and
    (2) Not excluded from Medicare Part B payment for reasons specified 
in Sec.  410.29.
    (k) Supplies and durable medical equipment. Supplies and durable 
medical equipment include the following:
    (1) Disposable supplies.
    (2) Durable medical equipment of the type specified in Sec.  410.38 
(except for renal dialysis systems) for a patient's use outside the 
CORF, whether purchased or rented.
    (l) Home environment evaluation. A home environment evaluation--
    (1) Is a single home visit to evaluate the potential impact of the 
home situation on the patient's rehabilitation goals.
    (2) Requires the presence of the patient and the physical 
therapist, occupational therapist, or speech-language pathologist, as 
appropriate.

[[Page 66400]]


0
13. Section 410.105 is amended by revising paragraphs (b)(3)(i), 
(b)(3)(ii), (c)(1) introductory text, and (c)(2) to read as follows:


Sec.  410.105  Requirements for coverage of CORF services.

* * * * *
    (b) * * *
    (3) * * *
    (i) Physical therapy, occupational therapy, and speech-language 
pathology services may be furnished away from the premises of the CORF 
including the individual's home when payment is not otherwise made 
under Title XVIII of the Act.
    (ii) The single home environment evaluation visit specified in 
Sec.  410.100(m) is also covered.
    (c) * * *
    (1) The service must be furnished under a written plan of treatment 
that--
    (i) * * *
    (ii) Indicates the diagnosis and rehabilitation goals, and 
prescribes the type, amount, frequency, and duration of the skilled 
rehabilitation services, including physical therapy, occupational 
therapy, speech-language pathology and respiratory therapy services, 
and indicates the other CORF services to be furnished that relate 
directly to such rehabilitation goals.
    (2) The plan must be reviewed at least every 60 days for 
respiratory therapy services and every 90 days for physical therapy, 
occupational therapy and speech-language pathology services by a 
facility physician or the referring physician who, when appropriate, 
consults with the professional personnel providing the services.
* * * * *

Subpart G--Medical Nutrition Therapy

0
14. Section 410.132 is amended by revising paragraph (a) to read as 
follows:


Sec.  410.132  Medical nutrition therapy.

    (a) Conditions for coverage of MNT services. Medicare Part B pays 
for MNT services provided by a registered dietitian or nutrition 
professional as defined in Sec.  410.134 when the beneficiary is 
referred for the service by the treating physician. Except as provided 
at Sec.  410.78, services covered consist of face-to-face nutritional 
assessments and interventions in accordance with nationally-accepted 
dietary or nutritional protocols.
* * * * *

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

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

    Authority: Secs. 1102, 1860D-1 through 1860D-42, 1871, and 1877 
of the Social Security Act (42 U.S.C. 1302, 1395w-101 through 1395w-
152, 1395hh, and 1395nn).

Subpart A--General Exclusions and Exclusion of Particular Services

0
16. Section 411.15 is amended by--
0
A. Revising paragraph (a)(1).
0
B. Adding paragraphs (k)(13) and (k)(14).
    The revision and additions read as follows:


Sec.  411.15  Particular services excluded from coverage.

* * * * *
    (a) * * *
    (1) Examinations performed for a purpose other than treatment or 
diagnosis of a specific illness, symptoms, complaint, or injury, except 
for screening mammography, colorectal cancer screening tests, screening 
pelvic exams, prostate cancer screening tests, glaucoma screening 
exams, initial preventive physical exams, ultrasound screening for 
abdominal aortic aneurysms (AAA), cardiovascular disease screening 
tests, or diabetes screening tests that meet the criteria specified in 
paragraphs (k)(6) through (k)(14) of this section.
* * * * *
    (k) * * *
    (13) In the case of cardiovascular disease screening tests for the 
early detection of cardiovascular disease or abnormalities associated 
with an elevated risk for that disease, subject to the conditions 
specified in Sec.  410.17 of this chapter.
    (14) In the case of diabetes screening tests furnished to an 
individual at risk for diabetes for the purpose of the early detection 
of that disease, subject to the conditions specified in Sec.  410.18 of 
this chapter.
* * * * *

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

0
17. Section 411.351 is amended by revising the definition of ``entity'' 
to read as follows:


Sec.  411.351  Definitions.

* * * * *
    Entity means--
* * * * *
    (3) For purposes of this subpart, ``entity'' does not include a 
physician's practice when it bills Medicare for the technical component 
or professional component of a diagnostic test for which the anti-
markup provision is applicable in accordance with Sec.  414.50 of this 
chapter and section 30.2.9 of the CMS Internet-only Manual, publication 
100-04, Claims Processing Manual, Chapter 1 (general billing 
requirements).

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

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

    Authority: Secs. 1102, 1812(d), 1814(b), 1815, 1833(a), (i), and 
(n), 1861(v), 1871, 1881, 1883, and 1886 of the Social Security Act 
(42 U.S.C. 1302, 1395d(d), 1395f(b), 1395g, 1395l(a), (i), and (n), 
1395x(v), 1395hh, 1395rr, 1395tt, and 1395ww); and sec. 124 of Pub. 
L. 106-133 (113 Stat. 1501A-332).

Subpart A--Introduction and General Rules


Sec.  413.1  [Amended]

0
19. Section 413.1 is amended by--
0
A. Removing paragraphs (a)(2)(iv) and (vi).
0
B. Redesignating paragraphs (a)(2)(v) and (vii) as paragraphs 
(a)(2)(iv) and (v), respectively.

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

0
20. Section 413.184 is amended by revising the section heading as set 
forth below:


Sec.  413.184  Payment exception: Pediatric patient mix.

* * * * *

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

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

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

Subpart B--Physicians and Other Practitioners

0
22. Section 414.50 is revised to read as follows:

[[Page 66401]]

Sec.  414.50  Physician or other supplier billing for diagnostic tests 
performed or interpreted by an outside supplier or at a site other than 
the office of the billing physician or other supplier.

    (a) General rules. (1) The services covered under section 
1861(s)(3) of the Act and paid for under part 414 of this chapter 
(other than clinical diagnostic laboratory tests paid under section 
1833(a)(2)(D) of the Act, which are subject to the special billing 
rules set forth in section 1833(h)(5)(A) of the Act), if a physician or 
other supplier bills for the technical component or professional 
component of a diagnostic test that was ordered by the physician or 
other supplier (or ordered by a party related to such physician or 
other supplier through common ownership or control as described in 
Sec.  413.17 of this chapter) and the diagnostic test is either 
purchased from an outside supplier or performed at a site other than 
the office of the billing physician or other supplier, the payment to 
the billing physician or other supplier (less the applicable 
deductibles and coinsurance paid by the beneficiary or on behalf of the 
beneficiary) for the technical component or professional component of 
the diagnostic test may not exceed the lowest of the following amounts:
    (i) The performing supplier's net charge to the billing physician 
or other supplier.
    (ii) The billing physician or other supplier's actual charge.
    (iii) The fee schedule amount for the test that would be allowed if 
the performing supplier billed directly.
    (2) The following requirements are applicable for purposes of 
paragraph (a) of this section:
    (i) The net charge must be determined without regard to any charge 
that is intended to reflect the cost of equipment or space leased to 
the performing supplier by or through the billing physician or other 
supplier.
    (ii) An ``outside supplier'' is someone who is not an employee of 
the billing physician or other supplier and who does not furnish the 
test or interpretation to the billing physician or other supplier under 
a reassignment that meets the requirements of Sec.  424.80.
    (iii) The ``office of the billing physician or other supplier'' is 
medical office space where the physician or other supplier regularly 
furnishes patient care. With respect to a billing physician or other 
supplier that is a physician organization (as defined at Sec.  411.351 
of this chapter), the ``office of the billing physician or other 
supplier'' is space in which the physician organization provides 
substantially the full range of patient care services that the 
physician organization provides generally.
    (b) Restriction on payment. (1) The billing physician or other 
supplier must identify the performing supplier and indicate the 
performing supplier's net charge for the test. If the billing physician 
or other supplier fails to provide this information, CMS makes no 
payment to the billing physician or other supplier and the billing 
physician or other supplier may not bill the beneficiary.
    (2) Physicians and other suppliers that accept Medicare assignment 
may bill beneficiaries for only the applicable deductibles and 
coinsurance.
    (3) Physicians and other suppliers that do not accept Medicare 
assignment may not bill the beneficiary more than the payment amount 
described in paragraph (a) of this section.

0
23. 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), individual 
medical nutrition therapy, and neurobehavioral status exam furnished 
via an interactive telecommunications system is equal to the current 
fee schedule amount applicable for the service of the physician or 
practitioner.
* * * * *

Subpart G--Payment for New Clinical Diagnostic Laboratory Tests

0
24. Section Sec.  414.502 is amended by adding the definition, ``New 
test'' in alphabetical order to read as follows:


Sec.  414.502  Definitions.

* * * * *
    New test means any clinical diagnostic laboratory test for which a 
new or substantially revised Healthcare Common Procedure Coding System 
Code is assigned on or after January 1, 2005.

0
25. Section 414.506 is amended by revising the introductory text to 
read as follows:


Sec.  414.506  Procedures for public consultation for payment for a new 
clinical diagnostic laboratory test.

    For a new test, CMS determines the basis for and amount of payment 
after performance of the following:
* * * * *

0
26. Section 414.508 is amended by revising paragraph (b)(3) to read as 
follows:


Sec.  414.508  Payment for a new clinical diagnostic laboratory test.

* * * * *
    (b) * * *
    (3) For a new test for which a new or substantially revised HCPCS 
code was assigned on or before December 31, 2007, after the first year 
of gapfilling, CMS determines whether the carrier-specific amounts will 
pay for the test appropriately. If CMS determines that the carrier-
specific amounts will not pay for the test appropriately, CMS may 
crosswalk the test.

0
27. Section 414.509 is added to read as follows:


Sec.  414.509  Reconsideration of basis for and amount of payment for a 
new clinical diagnostic laboratory test.

    For a new test for which a new or substantially revised HCPCS code 
was assigned on or after January 1, 2008, the following reconsideration 
procedures apply:
    (a) Reconsideration of basis for payment. (1) CMS will receive 
reconsideration requests in written format for 60 days after making a 
determination of the basis for payment under Sec.  414.506(d)(2) 
regarding whether CMS should reconsider the basis for payment and why a 
different basis for payment would be more appropriate. If a requestor 
recommends that the basis for payment should be changed from gapfilling 
to crosswalking, the requestor may also recommend the code or codes to 
which to crosswalk the new test.
    (2)(i) A requestor that submitted a request under paragraph (a)(1) 
of this section may also present its reconsideration request at the 
public meeting convened under Sec.  414.506(c), provided that the 
requestor requests an opportunity to present at the public meeting as 
part of its written submission under paragraph (a)(1) of this section.
    (ii) If the requestor presents its reconsideration request at the 
public meeting convened under Sec.  414.506(c), members of public may 
comment on the reconsideration request verbally at the public meeting 
and may submit written comments after the public meeting (within the 
timeframe for public comments established by CMS).

[[Page 66402]]

    (3) Considering reconsideration requests and other comments 
received, CMS may reconsider its determination of the basis for 
payment. As the result of such a reconsideration, CMS may change the 
basis for payment from crosswalking to gapfilling or from gapfilling to 
crosswalking.
    (4) If the basis for payment is revised as the result of a 
reconsideration, the new basis for payment is final and is not subject 
to further reconsideration.
    (b) Reconsideration of amount of payment--(1) Crosswalking. (i) For 
60 days after making a determination under Sec.  414.506(d)(2) of the 
code or codes to which a new test will be crosswalked, CMS receives 
reconsideration requests in written format regarding whether CMS should 
reconsider its determination and the recommended code or codes to which 
to crosswalk the new test.
    (ii)(A) A requestor that submitted a request under paragraph 
(b)(1)(i) of this section may also present its reconsideration request 
at the public meeting convened under Sec.  414.506(c), provided that 
the requestor requests an opportunity to present at the public meeting 
as part of its written submission under paragraph (b)(1)(i) of this 
section.
    (B) If a requestor presents its reconsideration request at the 
public meeting convened under Sec.  414.506(c), members of public may 
comment on the reconsideration request verbally at the public meeting 
and may submit written comments after the public meeting (within the 
timeframe for public comments established by CMS).
    (iii) Considering comments received, CMS may reconsider its 
determination of the amount of payment. As the result of such a 
reconsideration, CMS may change the code or codes to which the new test 
is crosswalked.
    (iv) If CMS changes the basis for payment from gapfilling to 
crosswalking as a result of a reconsideration, the crosswalked amount 
of payment is not subject to reconsideration.
    (2) Gapfilling. (i) By April 30 of the year after CMS makes a 
determination under Sec.  414.506(d)(2) or Sec.  414.509(a)(3) that the 
basis for payment for a new test will be gapfilling, CMS posts interim 
carrier-specific amounts on the CMS Web site.
    (ii) For 60 days after CMS posts interim carrier-specific amounts 
on the CMS Web site, CMS will receive public comments in written format 
regarding the interim carrier-specific amounts.
    (iii) After considering the public comments, CMS will post final 
carrier-specific amounts on the CMS Web site.
    (iv) For 30 days after CMS posts final carrier-specific amounts on 
the CMS Web site, CMS will receive reconsideration requests in written 
format regarding whether CMS should reconsider the final payment 
amounts and the appropriate national limitation amount for the new 
test.
    (v) Considering reconsideration requests received, CMS may 
reconsider its determination of the amount of payment. As the result of 
a reconsideration, CMS may revise the national limitation amount for 
the new test.
    (3) For both gapfilled and crosswalked new tests, if CMS revises 
the amount of payment as the result of a reconsideration, the new 
amount of payment is final and is not subject to further 
reconsideration.
    (c) Effective date. If CMS changes a determination as the result of 
a reconsideration, the new determination regarding the basis for or 
amount of payment is effective January 1 of the year following 
reconsideration. Claims for services with dates of service prior to the 
effective date will not be reopened or otherwise reprocessed.
    (d) Jurisdiction for Reconsideration Decisions. Jurisdiction for 
reconsidering a determination rests exclusively with the Secretary. A 
decision whether to reconsider a determination is committed to the 
discretion of the Secretary. A decision not to reconsider an initial 
determination is not subject to administrative or judicial review.

0
28. Section 414.510 is amended by--
0
A. Revising the section heading to read as set forth below.
0
B. Revising the introductory text.
    The revisions read as follows:


Sec.  414.510  Laboratory date of service for clinical laboratory and 
pathology specimens.

    The date of service for either a clinical laboratory test or the 
technical component of physician pathology service is as follows:
* * * * *

Subpart H--Fee Schedule for Ambulance Services


Sec.  414.620  [Amended]

0
29. In Sec.  414.620, the phrase ``notice in the Federal Register 
without opportunity for prior comment'' is removed and the phrase ``CMS 
by instruction and on the CMS Web site'' is added in its place.

Subpart I--Payment for Drugs and Biologicals

0
30. Section 414.707 is amended by adding paragraph (c) to read as 
follows:


Sec.  414.707  Basis of payment

* * * * *
    (c) Mandatory reporting of anemia quality indicators. The following 
provisions are effective January 1, 2008:
    (1) Each request for payment for anti-anemia drugs furnished to 
treat anemia resulting from the treatment of cancer must report the 
beneficiary's most recent hemoglobin or hematocrit level;
    (2) Each request for payment for use of erythropoiesis stimulating 
agents must report the beneficiary's most recent hemoglobin or 
hematocrit level.

Subpart K--Payment for Drugs and Biologicals Under Part B

0
31. Section 414.904 is amended by revising paragraph (d)(3) to read as 
follows:


Sec.  414.904  Average sales price as the basis for payment.

* * * * *
    (d) * * *
    (3) Widely available market price and average manufacturer price. 
If the Inspector General finds that the average sales price exceeds the 
widely available market price or the average manufacturer price by 5 
percent or more in CY 2005, 2006, 2007 or 2008, the payment limit in 
the quarter following the transmittal of this information to the 
Secretary is the lesser of the widely available market price or 103 
percent of the average manufacturer price.
* * * * *

0
32. Section 414.908 is amended by--
0
A. Revising paragraphs (a)(2)(iv), (a)(3)(x), and (a)(3)(xi).
0
B. Adding paragraph (a)(2)(v).
0
C. Removing paragraph (a)(5).
    The revisions and addition read as follows:


Sec.  414.908  Competitive acquisition program.

    (a) * * *
    (2) * * *
    (iv) The approved CAP vendor refuses to ship to the participating 
CAP physician because the conditions of Sec.  414.914(i) have been met 
(if this subparagraph (a)(2)(iv) applies, the physician can withdraw 
from the CAP category for the remainder of the year immediately upon 
notice to CMS and the approved CAP vendor); or
    (v) Other exigent circumstances defined by CMS are present, 
including--
    (A) If, up to and including 60 days after the effective date of the 
physician's CAP election agreement, the participating CAP physician 
submits a written request to the designated carrier to terminate the 
CAP election agreement

[[Page 66403]]

because CAP participation imposes a burden on the physician's practice. 
The written request must document the burden. The designated carrier 
will process the participating CAP physician's request and CMS will 
approve or deny the request under the dispute resolution process as 
specified under Sec.  414.917 of this subpart.
    (B) If, more than 60 days after the effective date of the 
physician's CAP election agreement, the participating CAP physician 
submits a written request to the designated carrier to terminate the 
CAP election agreement because, based on a change in circumstances of 
which the participating CAP physician was not previously aware, CAP 
participation imposes a burden on the physician's practice. The written 
request must document the burden. The designated carrier will process 
the participating CAP physician's request and CMS will approve or deny 
the request under the dispute resolution process as specified under 
Sec.  414.917 of this subpart.
    (3) * * *
    (x) Agrees to file the Medicare claim within 30 calendar days of 
the date of drug administration.
    (xi) Agrees to submit documentation such as medical records or 
certification, as necessary, to support payment for a CAP drug;
* * * * *

0
33. Section 414.914 is amended by--
0
A. Redesignating paragraph (h) as (i)
0
B. Adding new paragraph (h).
0
C. Revising new paragraphs (i)(1) and (2).
0
D. Removing the reference ``Sec.  414.914(h)'' in paragraph (f)(12) and 
adding in its place the reference ``Sec.  414.914(i)''.
0
E. Revising new paragraph (i)(5).
    The addition and revision read as follows:


Sec.  414.914  Terms of contract.

* * * * *
    (h) The approved CAP vendor must verify drug administration prior 
to collection of any applicable cost sharing amount.
    (1) The approved CAP vendor documents, in writing, the following 
information necessary to verify drug administration:
    (i) Beneficiary name.
    (ii) Health insurance number.
    (iii) Expected date of administration.
    (iv) Actual date of administration.
    (v) Identity of the participating CAP physician.
    (vi) Prescription order number.
    (vii) Identity of the individuals who supply and receive the 
information.
    (viii) Dosage supplied.
    (ix) Dosage administered.
* * * * *
    (2) If the information is obtained verbally, the approved CAP 
vendor must also maintain the following information:
    (i) The identities of individuals who exchanged the information.
    (ii) The date and time that the information was obtained.
    (3) The approved CAP vendor must provide this information to CMS or 
the beneficiary upon request.
    (i) * * *
    (1) Subsequent to receipt of payment by Medicare, or the 
verification of drug administration by the participating CAP physician, 
the approved CAP vendor must bill any applicable supplemental insurance 
policies.
    (2) An approved CAP vendor that has received payment from the 
designated carrier for CAP drugs that have not been administered must 
promptly refund payment for such drugs to the designated carrier and 
must refund any coinsurance and deductible collected from the 
beneficiary and his or her supplemental insurer.
* * * * *
    (5) For purposes of paragraph (i) of this section 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 (i)(5)(ii) of this section, 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 (i)(6), (i)(7), or (i)(8) of this section, 
apply.

0
34. Section 414.916 is amended by revising paragraph (c)(1) to read as 
follows:


Sec.  414.916  Dispute resolution for vendors and beneficiaries.

* * * * *
    (c) * * *
    (1) Right to a reconsideration. A participating CAP physician 
dissatisfied with a determination that his or her CAP election 
agreement has been suspended by CMS or a determination under Sec.  
414.917(d) denying the participating CAP physician's request to 
terminate participation in the CAP under Sec.  414.908(a)(v) is 
entitled to a reconsideration as provided in this subpart.
* * * * *

0
35. Section 414.917 is amended by--
0
A. Revising the section heading as set forth below.
0
B. Adding paragraph (d).
    The revision and addition read as follows:


Sec.  414.917  Dispute resolution and process for suspension or 
termination of approved CAP contract and termination of physician 
participation under exigent circumstances.

* * * * *
    (d) CAP participating physicians' exigent circumstances provision. 
The following process must be completed for participating CAP 
physicians' requests to terminate their participation in the program 
under exigent circumstances provisions described in Sec.  
414.908(a)(2)(v):
    (1) The designated carrier must--
    (i) Determine whether a request to terminate CAP participation was 
related to approved CAP vendor service, and if so, forward the issue to 
the approved CAP vendor's grievance process within 1 business day of 
the receipt of the request; or
    (ii) Continue to investigate, consistent with Sec.  414.916(b)(2) 
of this chapter, and within 2 business days of receipt, do any of the 
following:
    (A) Request a single, 2-business day extension. No later than the 
end of any 2-business day extension, the designated carrier must make 
findings and a recommendation as provided in subparagraph (B) or (C).
    (B) Submit a recommendation and relevant findings to CMS that the 
requesting participating CAP physician be permitted to terminate his or 
her participation in the CAP.
    (C) Submit a recommendation and relevant findings to CMS that the 
requesting participating CAP physician not be permitted to terminate 
his or her participation in the CAP.
    (ii) In the case of a request made under Sec.  414.908(a)(2)(v)(B), 
the designated carrier also shall include in its recommendation its 
finding with respect to whether the request is based on a change in 
circumstances of which the participating CAP physician was previously 
unaware.
    (2) CMS will consider the carrier's findings and recommendation and 
may also make its own findings. As a result, CMS will--
    (i) Approve or deny the request to terminate participation in the 
CAP within 2 business days of receipt of the recommendation.

[[Page 66404]]

    (ii) Communicate the decision to the appropriate Medicare 
contractors and the participating CAP physician.
    (3) A denial of the participating CAP physician's request to 
terminate participation in the CAP must include written notification of 
the right to request reconsideration under Sec.  414.916(c).
    (4) Upon termination of participation in the CAP a physician must--
    (i) Continue to submit claims for drugs supplied and administered 
under the CAP prior to the effective date of the physician's 
termination from the CAP consistent with Sec.  414.908(a) until all 
such claims are timely submitted.
    (ii) Return any unused CAP drugs that had not been administered to 
the beneficiary prior to the effective date of the physician's 
termination from the CAP to the approved CAP vendor consistent with 
applicable law and regulation and any agreement with the approved CAP 
vendor.
    (iii) Cooperate in any post-payment review activities on claims 
submitted under the CAP, as required under section 1847B(a)(3) of the 
Act.
    (5) An approved CAP vendor that has billed and been paid for CAP 
drugs that have not been administered must refund any payments made by 
CMS or the beneficiary and his or her supplemental insurer in 
accordance with Sec.  414.914(h)(3)(i)(2) of this chapter.

0
36. Section 414.930 is added to subpart K to read as follows:


Sec.  414.930  Compendia for determination of medically-accepted 
indications for off-label uses of drugs and biologicals in an anti-
cancer chemotherapeutic regimen.

    (a) Definition. For purposes of this section, compendium means a 
comprehensive listing of FDA-approved drugs and biologicals or a 
comprehensive listing of a specific subset of drugs and biologicals in 
a specialty compendium, for example a compendium of anti-cancer 
treatment. A compendium includes a summary of the pharmacologic 
characteristics of each drug or biological and may include information 
on dosage, as well as recommended or endorsed uses in specific 
diseases. A compendium is indexed by drug or biological.
    (b) Process for listing compendia for determining medically-
accepted uses of drugs and biologicals in anti-cancer treatment. (1) 
The CMS process--
    (i) Receives formal written requests for changes to the list of 
compendia during a 30 day window beginning January 15 each year.
    (ii) Publishes a listing of the timely, complete requests by March 
15th and solicits public comment on the requests for 30 days. The 
listing identifies the requestor and the requested action.
    (iii) Considers a compendium's attainment of the MedCAC (Medicare 
Evidence Development and Coverage Advisory Committee, previously known 
as the MCAC--Medicare Coverage Advisory Committee) recommended 
desirable characteristics of compendia (including explicit listing and 
recommendations) in reviewing requests. CMS may consider additional 
reasonable factors.
    (iv) Considers a compendium's grading of evidence used in making 
recommendations regarding off-label uses and the process by which the 
compendium grades the evidence.
    (v) Publishes its decision no later than 90 days after the close of 
the public comment period.
    (2) Exception. In addition to the annual process outlined in 
paragraph (b)(1) of this section, CMS may internally generate a request 
for changes to the list of compendia at any time.
    (c) Written request for review. (1) CMS will review a complete, 
written request that is submitted in writing, electronically or via 
hard copy (no duplicate submissions) and includes the following:
    (i) The full name and contact information of the requestor.
    (ii) The full identification of the compendium that is the subject 
of the request, including name, publisher, edition if applicable, date 
of publication, and any other information needed for the accurate and 
precise identification of the specific compendium.
    (iii) A complete written copy of the compendium that is the subject 
of the request.
    (iv) The specific action that is requested of CMS.
    (v) Materials that the requestor must submit for CMS review in 
support of the requested action.
    (vi) A single compendium as its subject.
    (d) CMS may at its discretion combine and consider multiple 
requests that refer to the same compendium.
    (e) For the purposes of this section, publication by CMS may be 
accomplished by posting on the CMS Web site.

0
37. Subpart M is added to read as follows:

Subpart M--Payment for Comprehensive Outpatient Rehabilitation 
Facility (CORF) Services


Sec.  414.1100  Basis and Scope.

    This subpart implements sections 1834(k)(1) and (k)(3) of the Act 
by specifying the payment methodology for comprehensive outpatient 
rehabilitation facility services covered under Part B of Title XVIII of 
the Act that are described at section 1861(cc)(1) of the Act.


Sec.  414.1105  Payment for Comprehensive Outpatient Rehabilitation 
Facility (CORF) Services.

    (a) Payment under the physician fee schedule. Except as otherwise 
specified under paragraphs (b), (c), (d), and (e) of this section 
payment for CORF services, as defined under Sec.  410.100 of this 
chapter, is paid the lesser of 80 percent of the following:
    (1) The actual charge for the item or service; or
    (2) The nonfacility amount determined under the physician fee 
schedule established under section 1848(b) of the Act for the item or 
service.
    (b) Payment for physician services. No separate payment for 
physician services that are CORF services under Sec.  410.100(a) of 
this chapter will be made.
    (c) Payment for supplies and durable medical equipment, prosthetic 
and orthotic devices, and drugs and biologicals. Supplies and durable 
medical equipment that are CORF services under Sec.  410.100(l) of this 
chapter, prosthetic device services that are CORF services under Sec.  
410.100(f), orthotic devices that are CORF services under Sec.  
410.100(g) of this chapter and drugs and biologicals that are CORF 
services under Sec.  410.100(k) of this chapter are paid the lesser of 
80 percent of the following:
    (1) The actual charge for the service provided that payment for 
such item is not included in the payment amount for other CORF services 
paid under paragraphs (a) or (d); or
    (2) The amount determined under the DMEPOS fee schedule established 
under part 414 subparts D and F for the item or the single payment 
amount established under the DMEPOS competitive bidding program 
provided that payment for such item is not included in the payment 
amount for other CORF services paid under paragraphs (a) or (d).
    (d) Payment for drugs and biologicals. Drugs and biologicals that 
are CORF services under Sec.  410.100(j) of this chapter, are paid the 
lesser of 80 percent of the following:
    (1) The actual charge for the service provided that payment for 
such item is not included in the payment amount for other CORF services 
paid under paragraphs (a) or (c); or
    (2) The amount determined using the same methodology for drugs (as 
defined

[[Page 66405]]

in Sec.  414.704 of this chapter) described in section 1842(o)(1) of 
the Act provided that payment for such drug is not included in the 
payment amount for other CORF services paid under paragraphs (a) or 
(c).
    (e) Payment for CORF services when no fee schedule amount for the 
service. If there is no fee schedule amount established for a CORF 
service, payment for the item or service will be the lesser of 80 
percent of:
    (i) The actual charge for the service provided that payment for 
such item or service is not included in the payment amount for other 
CORF services paid under paragraphs (a), (c), or (d) of this section.
    (ii) The amount determined under the fee schedule established for a 
comparable service as specified by the Secretary provided that payment 
for such item or service is not included in the payment amount for 
other CORF services paid under paragraphs (a), (c), or (d) of this 
section.

PART 415--SERVICES FURNISHED BY PHYSICIANS IN PROVIDERS, 
SUPERVISING PHYSICIANS IN TEACHING SETTINGS, AND RESIDENTS IN 
CERTAIN SETTINGS

0
38. The authority citation for part 415 continues to read as follows:

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

Subpart C--Part B Carrier Payments for Physician Services to 
Beneficiaries in Providers

0
39. Section 415.130 is amended by revising paragraph (d) to read as 
follows:


Sec.  415.130  Conditions for payment: Physician pathology services.

* * * * *
    (d) Physician pathology services furnished by an independent 
laboratory. The technical component of physician pathology services 
furnished by an independent laboratory to a hospital inpatient or 
outpatient on or before December 31, 2007, may be paid to the 
laboratory by the carrier under the physician fee schedule if the 
Medicare beneficiary is a patient of a covered hospital as defined in 
paragraph (a)(1) of this section. For services furnished after December 
31, 2007, an independent laboratory may not bill the carrier for the 
technical component of physician pathology services furnished to a 
hospital inpatient or outpatient. For services furnished on or after 
January 1, 2008, the date of service policy in Sec.  414.510 of this 
chapter applies for the technical component of specimens for physician 
pathology services.

PART 418--HOSPICE CARE

0
40. The authority citation for part 418 continues to read as follows:

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

Subpart E--Condition of Participation: Other Services

0
41. Section 418.92 is amended by revising paragraph (a) to read as 
follows:


Sec.  418.92  Condition of participation--Physical therapy, 
occupational therapy, and speech-language pathology.

    (a) Physical therapy, occupational therapy, and speech-language 
pathology services must be--
    (1) Available, and when provided, offered in a manner consistent 
with accepted standards of practice; and
    (2) Furnished by personnel who meet the qualifications specified in 
part 484 of this chapter.
* * * * *

PART 423--VOLUNTARY MEDICARE PRESCRIPTION DRUG BENEFIT

0
42. The authority citation for part 423 continues to read as follows:

    Authority: Secs 1102, 1860D-1 through 1860D-42, and 1871 of the 
Social Security Act (42 U.S.C. 1302, 1395w-101 through 1395w-152, 
and 1395hh).

Subpart D--Cost Control and Quality Improvement Requirements

0
43. Section 423.160 is amended by--
0
A. Revising paragraph (a)(3)(i).
0
B. Redesignating paragraphs (a)(3)(ii) and (iii) to (a)(3)(iii) and 
(iv), respectively.
0
C. Adding new paragraph (a)(3)(ii). The revision and addition reads as 
follows:


Sec.  423.160  Standards for electronic prescribing.

    (a) * * *
    (3) * * *
    (i) Entities transmitting prescriptions or prescription-related 
information by means of computer-generated facsimile are exempt from 
the requirement to use the NCPDP SCRIPT Standard adopted by this 
section in transmitting such prescriptions or prescription-related 
information until January 1, 2009;
    (ii) After January 1, 2009, electronic transmission of 
prescriptions or prescription-related information by means of computer-
generated facsimile is only permitted in instances of temporary/
transient transmission failure and communication problems that would 
preclude the use of the NCPDP SCRIPT Standard adopted by this section.
* * * * *

PART 424--CONDITIONS FOR MEDICARE PAYMENT

0
44. 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).

0
45. The heading for subpart B is revised to read as set forth below.

Subpart B--Certification and Plan Requirements

0
46. Section 424.24 is amended by revising paragraphs (c)(2) and (c)(4) 
to read as follows:


Sec.  424.24  Requirements for medical and other health services 
furnished by providers under Medicare Part B.

* * * * *
    (c) * * *
    (2) Timing. The initial certification must be obtained as soon as 
possible after the plan is established.
    (4) Recertification. (i) Timing. Recertification is required at 
least every 90 days.
    (ii) Content. When it is recertified, the plan or other 
documentation in the patient's record must indicate the continuing need 
for physical therapy, occupational therapy or speech-language pathology 
services.
    (iii) Signature. The physician, nurse practitioner, clinical nurse 
specialist, or physician assistant who reviews the plan must recertify 
the plan by signing the medical record.
* * * * *

0
47. Section 424.27 is amended by revising paragraph (b)(1) to read as 
follows:


Sec.  424.27  Requirements for comprehensive outpatient rehabilitation 
facility (CORF) services

* * * * *
    (b) * * *
    (1) Timing. Recertification is required at least every 60 days for 
respiratory therapy services and every 90 days for physical therapy, 
occupational therapy, and speech-language pathology services based on 
review by a facility physician or the referring physician who, when 
appropriate, consults with the professional personnel who furnish the 
services.
* * * * *

0
48. In Sec.  424.32, paragraph (a)(3) is revised to read as follows:

[[Page 66406]]

Sec.  424.32  Basic requirements for all claims.

    (a) * * *
    (3) A claim must be signed by the beneficiary or on behalf of the 
beneficiary (in accordance with Sec.  424.36).
* * * * *

Subpart C--Claims for Payment

0
49. Section 424.36 is amended by--
0
A. Revising paragraph (b)(5).
0
B. Adding paragraph (b)(6).
    The revision and addition read as follows:


Sec.  424.36  Signature requirements.

* * * * *
    (b) * * *
    (5) A representative of the provider or of the nonparticipating 
hospital claiming payment for services it has furnished if the provider 
or nonparticipating hospital is unable to have the claim signed in 
accordance with paragraph (b)(1), (2), (3), or (4) of this section 
after making reasonable efforts to locate and obtain the signature of 
one of the individuals specified in paragraph (b)(1), (2), (3), or (4) 
of this section.
    (6) An ambulance provider or supplier with respect to emergency 
ambulance transport services, if the following conditions and 
documentation requirements are met.
    (i) None of the individuals listed in paragraph (b)(1), (2), (3), 
or (4) of this section was available or willing to sign the claim on 
behalf of the beneficiary at the time the service was provided;
    (ii) The ambulance provider or supplier maintains in its files the 
following information and documentation for a period of at least four 
years from the date of service:
    (A) A contemporaneous statement, signed by an ambulance employee 
present during the trip to the receiving facility, that, at the time 
the service was provided, the beneficiary was physically or mentally 
incapable of signing the claim and that none of the individuals listed 
in paragraph (b)(1), (2), (3), or (4) of this section were available or 
willing to sign the claim on behalf of the beneficiary, and
    (B) Documentation with the date and time the beneficiary was 
transported, and the name and location of the facility that received 
the beneficiary, and
    (C) Either of the following:
    (1) A signed contemporaneous statement from a representative of the 
facility that received the beneficiary, which documents the name of the 
beneficiary and the date and time the beneficiary was received by that 
facility; or
    (2) The requested information from a representative of the facility 
using a secondary form of verification obtained at a later date, but 
prior to submitting the claim to Medicare for payment. Secondary forms 
of verification include a copy of any of the following--
    (i) The signed patient care/trip report;
    (ii) The hospital registration/admissions sheet;
    (iii) The patient medical record;
    (iv) The hospital log; or
    (v) Other internal hospital records.
* * * * *

Subpart F--Limitations on Assignment and Reassignment of Claims

0
50. Section 424.80 is amended by adding paragraph (d)(3) to read as 
follows:


Sec.  424.80  Prohibition of reassignment of claims by suppliers.

* * * * *
    (d) * * *
    (3) Reassignment of the technical or professional component of a 
diagnostic test. If a physician or other supplier bills for the 
technical or professional component of a diagnostic test covered under 
section 1861(s)(3) of the Act and paid for under part 414 of this 
chapter (other than clinical diagnostic laboratory tests paid under 
section 1833(a)(2)(D) of the Act, which are subject to the special 
rules set forth in section 1833(h)(5)(A) of the Act) following a 
reassignment from a physician or other supplier who performed the 
technical or professional component, the amount payable to the billing 
physician or other supplier may be subject to the limits specified in 
Sec.  414.50 of this chapter.

PART 482--CONDITIONS OF PARTICIPATION FOR HOSPITALS

0
51. The authority citation for part 482 continues to read as follows:

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

0
52. Section 482.56 is amended by revising paragraphs (a)(2) and (b) to 
read as follows:


Sec.  482.56  Condition of participation: Rehabilitation services.

    (a) * * *
    (2) Physical therapy, occupational therapy, speech-language 
pathology or audiology services, if provided, must be provided by 
qualified physical therapists, physical therapist assistants, 
occupational therapists, occupational therapy assistants, speech-
language pathologists, or audiologists as defined in part 484 of this 
chapter.
    (b) Standard: Delivery of services. Services must be given in 
accordance with orders of practitioners who are authorized by the 
medical staff to order the services, and the orders must be 
incorporated in the patient's record. The provision of care and the 
personnel qualifications must be in accordance with national acceptable 
standards of practice and must also meet the requirements of Sec.  
409.17

PART 484--HOME HEALTH SERVICES

0
53. The authority citation for part 484 continues to read as follows:

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

Subpart A--General Provisions

0
54. Section 484.4 is amended by revising the definitions of 
``Occupational therapist,'' ``Occupational therapy assistant,'' 
``Physical therapist,'' ``Physical therapist assistant'' and ``Speech 
language pathologist'' to read as follows:


Sec.  484.4  Personnel Qualifications.

* * * * *
    Occupational therapist. A person who--
    (a)(1) Is licensed or otherwise regulated, if applicable, as an 
occupational therapist by the State in which practicing, unless 
licensure does not apply;
    (2) Graduated after successful completion of an occupational 
therapist education program accredited by the Accreditation Council for 
Occupational Therapy Education (ACOTE) of the American Occupational 
Therapy Association, Inc. (AOTA), or successor organizations of ACOTE; 
and
    (3) Is eligible to take, or has successfully completed the entry-
level certification examination for occupational therapists developed 
and administered by the National Board for Certification in 
Occupational Therapy, Inc. (NBCOT).
    (b) On or before December 31, 2009--
    (1) Is licensed or otherwise regulated, if applicable, as an 
occupational therapist by the State in which practicing; or
    (2) When licensure or other regulation does not apply--
    (i) Graduated after successful completion of an occupational 
therapist education program accredited by the Accreditation Council for 
Occupational Therapy Education (ACOTE) of the American Occupational 
Therapy Association, Inc. (AOTA) or successor organizations of ACOTE; 
and

[[Page 66407]]

    (ii) Is eligible to take, or has successfully completed the entry-
level certification examination for occupational therapists developed 
and administered by the National Board for Certification in 
Occupational Therapy, Inc., (NBCOT).
    (c) On or before January 1, 2008--
    (1) Graduated after successful completion of an occupational 
therapy program accredited jointly by the committee on Allied Health 
Education and Accreditation of the American Medical Association and the 
American Occupational Therapy Association; or
    (2) Is eligible for the National Registration Examination of the 
American Occupational Therapy Association or the National Board for 
Certification in Occupational Therapy.
    (d) On or before December 31, 1977--
    (1) Had 2 years of appropriate experience as an occupational 
therapist; and
    (2) Had achieved a satisfactory grade on an occupational therapist 
proficiency examination conducted, approved, or sponsored by the U.S. 
Public Health Service.
    (e) If educated outside the United States--
    (1) Must meet both of the following:
    (i) Graduated after successful completion of an occupational 
therapist education program accredited as substantially equivalent to 
occupational therapist assistant entry level education in the United 
States by one of the following:
    (A) The Accreditation Council for Occupational Therapy Education 
(ACOTE).
    (B) Successor organizations of ACOTE.
    (C) The World Federation of Occupational Therapists.
    (D) A credentialing body approved by the American Occupational 
Therapy Association.
    (ii) Successfully completed the entry-level certification 
examination for occupational therapists developed and administered by 
the National Board for Certification in Occupational Therapy, Inc. 
(NBCOT).
    (2) On or before December 31, 2009, is licensed or otherwise 
regulated, if applicable, as an occupational therapist by the State in 
which practicing.
    Occupational therapy assistant. A person who--
    (a) Meets all of the following:
    (1) Is licensed or otherwise regulated, if applicable, as an 
occupational therapy assistant by the State in which practicing, unless 
licensure does apply.
    (2) Graduated after successful completion of an occupational 
therapy assistant education program accredited by the Accreditation 
Council for Occupational Therapy Education, (ACOTE) of the American 
Occupational Therapy Association, Inc. (AOTA) or its successor 
organizations.
    (3) Is eligible to take or successfully completed the entry-level 
certification examination for occupational therapy assistants developed 
and administered by the National Board for Certification in 
Occupational Therapy, Inc. (NBCOT).
    (b) On or before December 31, 2009--
    (1) Is licensed or otherwise regulated as an occupational therapy 
assistant, if applicable, by the State in which practicing; or any 
qualifications defined by the State in which practicing, unless 
licensure does not apply; or
    (2) Must meet both of the following:
    (i) Completed certification requirements to practice as an 
occupational therapy assistant established by a credentialing 
organization approved by the American Occupational Therapy Association.
    (ii) After January 1, 2010, meets the requirements in paragraph (a) 
of this section.
    (c) After December 31, 1977 and on or before December 31, 2007--
    (1) Completed certification requirements to practice as an 
occupational therapy assistant established by a credentialing 
organization approved by the American Occupational Therapy Association; 
or
    (2) Completed the requirements to practice as an occupational 
therapy assistant applicable in the State in which practicing.
    (d) On or before December 31, 1977--
    (1) Had 2 years of appropriate experience as an occupational 
therapy assistant; and
    (2) Had achieved a satisfactory grade on an occupational therapy 
assistant proficiency examination conducted, approved, or sponsored by 
the U.S. Public Health Service.
    (e) If educated outside the United States, on or after January 1, 
2008--
    (1) Graduated after successful completion of an occupational 
therapy assistant education program that is accredited as substantially 
equivalent to occupational therapist assistant entry level education in 
the United States by--
    (i) The Accreditation Council for Occupational Therapy Education 
(ACOTE).
    (ii) Its successor organizations.
    (iii) The World Federation of Occupational Therapists.
    (iv) By a credentialing body approved by the American Occupational 
Therapy Association; and
    (2) Successfully completed the entry-level certification 
examination for occupational therapy assistants developed and 
administered by the National Board for Certification in Occupational 
Therapy, Inc. (NBCOT).
    Physical therapist. A person who is licensed, if applicable, by the 
State in which practicing, unless licensure does not apply and meets 
one of the following requirements:
    (a)(1) Graduated after successful completion of one of a physical 
therapist eduction program approved by one of the following:
    (i) The Commission on Accreditation in Physical Therapy Education 
(CAPTE).
    (ii) Successor organizations of CAPTE.
    (iii) An education program outside the United States determined to 
be substantially equivalent to physical therapist entry level education 
in the United States by a credentials evaluation organization approved 
by the American Physical Therapy Association or an organization 
identified in 8 CFR 212.15(e) as it relates to physical therapists.
    (2) Passed an examination for physical therapists approved by the 
State in which physical therapy services are provided.
    (b) On or before December 31, 2009--
    (1) Graduated after successful completion of a physical therapy 
curriculum approved by the Commission on Accreditation in Physical 
Therapy Education (CAPTE); or
    (2) Meets both of the following:
    (i) Graduated after successful completion of an education program 
determined to be substantially equivalent to physical therapist entry 
level education in the United States by a credentials evaluation 
organization approved by the American Physical Therapy Association or 
identified in 8 CFR 212.15(e) as it relates to physical therapists.
    (ii) Passed an examination for physical therapists approved by the 
State in which physical therapy services are provided.
    (c) Before January 1, 2008--
    (1) Graduated from a physical therapy curriculum approved by one of 
the following:
    (i) The American Physical Therapy Association.
    (ii) The Committee on Allied Health Education and Accreditation of 
the American Medical Association.
    (iii) The Council on Medical Education of the American Medical 
Association and the American Physical Therapy Association.
    (d) On or before December 31, 1977 was licensed or qualified as a 
physical therapist and meets both of the following:

[[Page 66408]]

    (1) Has 2 years of appropriate experience as a physical therapist.
    (2) Has achieved a satisfactory grade on a proficiency examination 
conducted, approved, or sponsored by the U.S. Public Health Service.
    (e) Before January 1, 1966--
    (1) Was admitted to membership by the American Physical Therapy 
Association;
    (2) Was admitted to registration by the American Registry of 
Physical Therapists; and
    (3) Graduated from a physical therapy curriculum in a 4-year 
college or university approved by a State department of education.
    (f) Before January 1, 1966 was licensed or registered, and before 
January 1, 1970, had 15 years of full-time experience in the treatment 
of illness or injury through the practice of physical therapy in which 
services were rendered under the order and direction of attending and 
referring doctors of medicine or osteopathy.
    (g) If trained outside the United States before January 1, 2008, 
meets the following requirements:
    (1) Was graduated since 1928 from a physical therapy curriculum 
approved in the country in which the curriculum was located and in 
which there is a member organization of the World Confederation for 
Physical Therapy.
    (2) Meets the requirements for membership in a member organization 
of the World Confederation for Physical Therapy.
    Physical therapist assistant. A person who is licensed, registered 
or certified as a physical therapist assistant, if applicable, by the 
State in which practicing, unless licensure does not apply and meets 
one of the following requirements:
    (a)(1)(i) Graduated from a physical therapist assistant curriculum 
approved by the Commission on Accreditation in Physical Therapy 
Education of the American Physical Therapy Association; or if educated 
outside the United States or trained in the United States military, 
graduated from an education program determined to be substantially 
equivalent to physical therapist assistant entry level education in the 
United States by a credentials evaluation organization approved by the 
American Physical Therapy Association or identified at 8 CFR 212.15(e); 
and
    (ii) Passed a national examination for physical therapist 
assistants.
    (b) On or before December 31, 2009, meets one of the following:
    (1) Is licensed, or otherwise regulated in the State in which 
practicing.
    (2) In States where licensure or other regulations do not apply, 
graduated before December 31, 2009, from a 2-year college-level program 
approved by the American Physical Therapy Association and after January 
1, 2010, meets the requirements of paragraph (a) of this definition.
    (c) Before January 1, 2008, where licensure or other regulation 
does not apply, graduated from a 2-year college-level program approved 
by the American Physical Therapy Association.
    (d) On or before December 31, 1977, was licensed or qualified as a 
physical therapist assistant and has achieved a satisfactory grade on a 
proficiency examination conducted, approved, or sponsored by the U.S. 
Public Health Service.
* * * * *
    Speech-language pathologist. A person who meets either of the 
following requirements:
    (a) The education and experience requirements for a Certificate of 
Clinical Competence in speech-language pathology granted by the 
American Speech-Language-Hearing Association.
    (b) The educational requirements for certification and is in the 
process of accumulating the supervised experience required for 
certification.

PART 485--CONDITIONS OF PARTICIPATION: SPECIALIZED PROVIDERS

0
55. The authority citation for part 485 continues to read as follows:

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

Subpart B--Conditions of Participation: Comprehensive Outpatient 
Rehabilitation Facilities

0
56. Section 485.51 is amended by--
0
A. Revising paragraph (a).
0
B. Adding paragraph (c).
    The revision and addition read as follows:


Sec.  485.51  Definition.

* * * * *
    (a) Is established and operated exclusively for the purpose of 
providing diagnostic, therapeutic, and restorative services to 
outpatients for the rehabilitation of injured, disabled, or sick 
persons, at a single fixed location, by or under the supervision of a 
physician except as provided in paragraph (c) of this section;
* * * * *
    (c) Exception. May provide influenza, pneumococcal and Hepatitis B 
vaccines provided the applicable conditions of coverage under Sec.  
410.58 and Sec.  410.63 of this chapter are met.

0
57. Section 485.70 is amended by revising paragraphs (c), (e), and (m) 
to read as follows:


Sec.  485.70  Personnel qualifications.

* * * * *
    (c) An occupational therapist and an occupational therapy assistant 
must meet the qualifications in part 484 of this chapter.
* * * * *
    (e) A physical therapist and a physical therapist assistant must 
meet the qualifications in part 484 of this chapter.
* * * * *
    (m) A speech-language pathologist must meet the qualifications set 
forth in part 484 of this chapter.

Subpart F--Conditions of Participation: Critical Access Hospitals 
(CAHs)

0
58. Section 485.635 is amended by adding paragraph (e) to read as 
follows:


Sec.  485.635  Condition of participation: Provision of services.

* * * * *
    (e) Standard: Rehabilitation Therapy Services. Physical therapy, 
occupational therapy, and speech-language pathology services furnished 
at the CAH, if provided, are provided as direct services by staff 
qualified under State law, and consistent with the requirements for 
therapy services in 409.17.

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

    Dated: October 23, 2007.
Kerry Weems,
Acting Administrator, Centers for Medicare & Medicaid Services.

    Approved: October 31, 2007.
Michael O. Leavitt,
Secretary.

Addendum A:

    Note: These addenda will not appear in the Code of Federal 
Regulations. Addendum A: Explanation and Use of Addendum B.

    The addenda on the following pages provide various data 
pertaining to the Medicare fee schedule for physicians' services 
furnished in 2008. Addendum B contains the RVUs for work, non-
facility PE, facility PE, and malpractice expense, and other 
information for all services included in the PFS.
    In previous years, we have listed many services in Addendum B 
that are not paid under the PFS. To avoid publishing as many pages 
of codes for these services, we are not including clinical 
laboratory codes or the alphanumeric codes (Healthcare Common 
Procedure Coding System (HCPCS) codes not included in CPT) not paid 
under the PFS in Addendum B.

[[Page 66409]]

Addendum B--2008 Relative Value Units and Related Information Used in 
Determining Medicare Payments for 2008

    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). If 
there is an ``NA'' in the non-facility PE RVU column, and the 
contractor determines that this service can be performed in the non-
facility setting, the service will be paid at the facility PE RVU 
rate.
    <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, for example, 
a colonoscopy that is not completed. There will be RVUs for a code 
with this modifier.
    3. Status indicator. This indicator shows whether the CPT/HCPCS 
code is in the PFS and whether it is separately payable if the 
service is covered.
    A = Active code. These codes are separately payable under the 
PFS if covered. There will be RVUs for codes with this status. The 
presence of an ``A'' indicator does not mean that Medicare has made 
a national coverage determination regarding the service. Carriers 
remain responsible for coverage decisions in the absence of a 
national Medicare policy.
    B = Bundled code. Payments for covered services are always 
bundled into payment for other services not specified. If RVUs are 
shown, they are not used for Medicare payment. If these services are 
covered, payment for them is subsumed by the payment for the 
services to which they are incident (an example is a telephone call 
from a hospital nurse regarding care of a patient).
    C = Carriers price the code. Carriers will establish RVUs and 
payment amounts for these services, generally on an individual case 
basis following review of documentation, such as an operative 
report.
    D* = Deleted/discontinued code.
    E = Excluded from the PFS by regulation. These codes are for 
items and services that CMS chose to exclude from the fee schedule 
payment by regulation. No RVUs are shown, and no payment may be made 
under the PFS for these codes. Payment for them, when covered, 
continues under reasonable charge procedures.
    F = Deleted/discontinued codes. (Code not subject to a 90-day 
grace period.) These codes are deleted effective with the beginning 
of the year and are never subject to a grace period. This indicator 
is no longer effective beginning with the 2005 fee schedule as of 
January 1, 2005.
    G = Code not valid for Medicare purposes. Medicare uses another 
code for reporting of, and payment for, these services. (Codes 
subject to a 90-day grace period.) This indicator is no longer 
effective with the 2005 PFS as of January 1, 2005.
    H* = Deleted modifier. For 2000 and later years, either the TC 
or PC component shown for the code has been deleted and the deleted 
component is shown in the database with the H status indicator.
    I = Not valid for Medicare purposes. Medicare uses another code 
for the reporting of, and the payment for these services. (Codes not 
subject to a 90-day grace period.)
    L = Local codes. Carriers will apply this status to all local 
codes in effect on January 1, 1998 or subsequently approved by 
central office for use. Carriers will complete the RVUs and payment 
amounts for these codes.
    M = Measurement codes, used for reporting purposes only. There 
are no RVUs and no payment amounts for these codes. Medicare uses 
them to aid with performance measurement. No separate payment is 
made. These codes should be billed with a zero (($0.00) charge and 
are denied) on the MPFSDB.
    N = Non-covered service. These codes are noncovered services. 
Medicare payment may not be made for these codes. If RVUs are shown, 
they are not used for Medicare payment.
    R = Restricted coverage. Special coverage instructions apply. If 
the service is covered and no RVUs are shown, it is carrier-priced.
    T = There are RVUs for these services, but they are only paid if 
there are no other services payable under the PFS billed on the same 
date by the same provider. If any other services payable under the 
PFS are billed on the same date by the same provider, these services 
are bundled into the service(s) for which payment is made.
    X = Statutory exclusion. These codes represent an item or 
service that is not within the statutory definition of 
``physicians'' services'' for PFS payment purposes. No RVUs are 
shown for these codes, and no payment may be made under the PFS. 
(Examples are ambulance services and clinical diagnostic laboratory 
services.)
    4. Description of code. This is an abbreviated version of the 
narrative description of the code.
    5. Physician work RVUs. These are the RVUs for the physician 
work for this service in 2008.

    Note: The separate budget neutrality adjustor is not reflected 
in these physician work RVUs.

    6. Fully implemented non-facility practice expense RVUs. These 
are the fully implemented resource-based PE RVUs for non-facility 
settings.
    7. Year 2008 Transitional Non-facility practice expense RVUs. 
These are the 2008 resource-based PE RVUs for non-facility settings.
    8. Fully implemented facility practice expense RVUs. These are 
the fully implemented resource-based PE RVUs for facility settings.
    9. Year 2008 Transitional facility practice expense RVUs. These 
are the 2008 resource-based PE RVUs for facility settings.
    10. Malpractice expense RVUs. These are the RVUs for the 
malpractice expense for the service for 2008.
    11. Global period. This indicator shows the number of days in 
the global period for the code (0, 10, or 90 days).
    An explanation of the alpha codes follows:
    MMM = Code describes a service furnished in uncomplicated 
maternity cases including antepartum care, delivery, and postpartum 
care. The usual global surgical concept does not apply. See the 1999 
Physicians' Current Procedural Terminology for specific definitions.
    XXX = The global concept does not apply.
    YYY = The global period is to be set by the carrier (for 
example, unlisted surgery codes).
    ZZZ = Code related to another service that is always included in 
the global period of the other service. (Note: Physician work and PE 
are associated with intra service time and in some instances in the 
post service time.
    *Codes with these indicators had a 90 day grace period before 
January 1, 2005.

[[Page 66410]]




    --------------------
\1\ CPT codes and descriptions only are copyright 2007 American Medical 
Association. All Rights Reserved. Applicable FARS/DFARS apply.

\2\ If values are reflected for codes not payable by Medicare, please 
note that these values have been established as a courtesy to the 
general public and are not used for Medicare payment.

                        Addendum B.--Relative Value Units and Related Information Used in Determining Medicare Payments for 2008
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                                     Fully     Year 2008     Fully     Year 2008
                                                                                    imple-      transi-     imple-      transi-
                                                                       Physician  mented non- tional non-   mented      tional       Mal-
  CPT \1\/HCPCS        Mod           Status          Description       work RVUs   facility    facility    facility    facility    practice     Global
                                                                          \2\       PE RVUs     PE RVUs     PE RVUs     PE RVUs    RVUs \2\
                                                                                      \2\         \2\         \2\         \2\
--------------------------------------------------------------------------------------------------------------------------------------------------------
0016T...........  .............  C............  Thermotx choroid            0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 vasc lesion.
0017T...........  .............  C............  Photocoagulat               0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 macular drusen.
0019T...........  .............  C............  Extracorp shock wv          0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 tx,ms nos.
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                   0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 composition 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/             0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 direct sample.
0041T...........  .............  C............  Detect ur infect            0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 agnt 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.
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.
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              0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 tumor, 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.
0066T...........  .............  N............  Ct                          0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 colonography;screen.
0066T...........  TC...........  N............  Ct                          0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 colonography;screen.
0066T...........  26...........  N............  Ct                          0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 colonography;screen.
0067T...........  .............  C............  Ct colonography;dx..        0.00        0.00        0.00          NA          NA        0.00         XXX
0067T...........  TC...........  C............  Ct colonography;dx..        0.00        0.00        0.00          NA          NA        0.00         XXX
0067T...........  26...........  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             0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 ablate <200.
0072T...........  .............  C............  U/s leiomyomata             0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 ablate >200.
0073T...........  .............  A............  Delivery, comp imrt.        0.00       13.15       15.58          NA          NA        0.13         XXX
0075T...........  .............  C............  Perq stent/chest            0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 vert art.
0075T...........  TC...........  C............  Perq stent/chest            0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 vert art.
0075T...........  26...........  C............  Perq stent/chest            0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 vert art.
0076T...........  .............  C............  S&i stent/chest vert        0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 art.
0076T...........  TC...........  C............  S&i stent/chest vert        0.00        0.00        0.00          NA          NA        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.
0077T...........  .............  C............  Cereb therm                 0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 perfusion 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          0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 rad s&i.
0081T...........  .............  C............  Endovasc visc extnsn        0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 s&i.
0084T...........  .............  C............  Temp prostate               0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 urethral 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                  0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 hyaluronan.
0088T...........  .............  C............  Rf tongue base vol          0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 reduxn.
0089T...........  .............  C............  Actigraphy testing,         0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 3-day.
0090T...........  .............  C............  Cervical artific            0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 disc.
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.
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.
0098T...........  .............  C............  Rev artific disc            0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 addl.
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.

[[Page 66411]]

 
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               0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 sensory 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           0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 test.
0111T...........  .............  C............  Rbc membranes fatty         0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 acids.
0123T...........  .............  C............  Scleral                     0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 fistulization.
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.
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...........  .............  I............  Perq islet                  0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 transplant.
0142T...........  .............  I............  Open islet                  0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 transplant.
0143T...........  .............  I............  Laparoscopic islet          0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 transplnt.
0144T...........  .............  C............  CT heart wo dye;            0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 qual calc.
0144T...........  TC...........  C............  CT heart wo dye;            0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 qual calc.
0144T...........  26...........  C............  CT heart wo dye;            0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 qual calc.
0145T...........  .............  C............  CT heart w/wo dye           0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 funct.
0145T...........  TC...........  C............  CT heart w/wo dye           0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 funct.
0145T...........  26...........  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          NA          NA        0.00         XXX
0146T...........  TC...........  C............  CCTA w/wo dye.......        0.00        0.00        0.00          NA          NA        0.00         XXX
0146T...........  26...........  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          NA          NA        0.00         XXX
                                                 calcium.
0147T...........  TC...........  C............  CCTA w/wo, quan             0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 calcium.
0147T...........  26...........  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          NA          NA        0.00         XXX
0148T...........  TC...........  C............  CCTA w/wo, strxr....        0.00        0.00        0.00          NA          NA        0.00         XXX
0148T...........  26...........  C............  CCTA w/wo, strxr....        0.00        0.00        0.00        0.00        0.00        0.00         XXX
0149T...........  .............  C............  CCTA w/wo, strxr            0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 quan calc.
0149T...........  TC...........  C............  CCTA w/wo, strxr            0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 quan calc.
0149T...........  26...........  C............  CCTA w/wo, strxr            0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 quan calc.
0150T...........  .............  C............  CCTA w/wo, disease          0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 strxr.
0150T...........  TC...........  C............  CCTA w/wo, disease          0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 strxr.
0150T...........  26...........  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-         0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 on.
0151T...........  TC...........  C............  CT heart funct add-         0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 on.
0151T...........  26...........  C............  CT heart funct add-         0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 on.
0155T...........  .............  C............  Lap impl gast curve         0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 electrd.
0156T...........  .............  C............  Lap remv gast curve         0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 electrd.
0157T...........  .............  C............  Open impl gast curve        0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 electrd.
0158T...........  .............  C............  Open remv gast curve        0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 electrd.
0159T...........  .............  C............  Cad breast mri......        0.00        0.00        0.00          NA          NA        0.00         ZZZ
0159T...........  TC...........  C............  Cad breast mri......        0.00        0.00        0.00          NA          NA        0.00         ZZZ
0159T...........  26...........  C............  Cad breast mri......        0.00        0.00        0.00        0.00        0.00        0.00         ZZZ
0160T...........  .............  C............  Tcranial magn stim          0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 tx plan.
0161T...........  .............  C............  Tcranial magn stim          0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 tx deliv.
0162T...........  .............  C............  Anal program gast           0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 neurostim.
0163T...........  .............  C............  Lumb artif                  0.00        0.00        0.00        0.00        0.00        0.00         YYY
                                                 diskectomy addl.
0164T...........  .............  C............  Remove lumb artif           0.00        0.00        0.00        0.00        0.00        0.00         YYY
                                                 disc addl.
0165T...........  .............  C............  Revise lumb artif           0.00        0.00        0.00        0.00        0.00        0.00         YYY
                                                 disc addl.
0166T...........  .............  C............  Tcath vsd close w/o         0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 bypass.
0167T...........  .............  C............  Tcath vsd close w           0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 bypass.
0168T...........  .............  C............  Rhinophototx light          0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 app bilat.
0169T...........  .............  C............  Place stereo cath           0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 brain.
0170T...........  .............  C............  Anorectal fistula           0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 plug rpr.
0171T...........  .............  C............  Lumbar spine proces         0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 distract.
0172T...........  .............  C............  Lumbar spine process        0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 addl.
0173T...........  .............  C............  Iop monit io                0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 pressure.
0174T...........  .............  C............  Cad cxr with interp.        0.00        0.00        0.00        0.00        0.00        0.00         XXX
0175T...........  .............  C............  Cad cxr remote......        0.00        0.00        0.00        0.00        0.00        0.00         XXX
0176T...........  .............  C............  Aqu canal dilat w/o         0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 retent.
0177T...........  .............  C............  Aqu canal dilat w           0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 retent.
0178T...........  .............  C............  64 lead ecg w i&r...        0.00        0.00        0.00        0.00        0.00        0.00         XXX
0179T...........  .............  C............  64 lead ecg w               0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 tracing.
0180T...........  .............  C............  64 lead ecg w i&r           0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 only.
0181T...........  .............  C............  Corneal hysteresis..        0.00        0.00        0.00        0.00        0.00        0.00         XXX
0182T...........  .............  C............  Hdr elect                   0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 brachytherapy.
0183T...........  .............  C............  Wound ultrasound....        0.00        0.00        0.00        0.00        0.00        0.00         XXX
0184T...........  .............  C............  Exc rectal tumor            0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 endoscopic.

[[Page 66412]]

 
0185T...........  .............  C............  Comptr probability          0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 analysis.
0186T...........  .............  C............  Suprachoroidal drug         0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 delivery.
0187T...........  .............  C............  Ophthalmic dx image         0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 anterior.
10021...........  .............  A............  Fna w/o image.......        1.27        2.18        2.17        0.37        0.46        0.10         XXX
10022...........  .............  A............  Fna w/image.........        1.27        2.15        2.35        0.41        0.41        0.08         XXX
10040...........  .............  A............  Acne surgery........        1.19        1.33        1.17        0.98        0.88        0.05         010
10060...........  .............  A............  Drainage of skin            1.19        1.50        1.35        1.08        1.01        0.12         010
                                                 abscess.
10061...........  .............  A............  Drainage of skin            2.42        2.06        1.94        1.51        1.50        0.26         010
                                                 abscess.
10080...........  .............  A............  Drainage of                 1.19        2.68        2.89        1.10        1.10        0.11         010
                                                 pilonidal cyst.
10081...........  .............  A............  Drainage of                 2.47        3.48        3.77        1.45        1.47        0.24         010
                                                 pilonidal cyst.
10120...........  .............  A............  Remove foreign body.        1.23        1.95        2.06        0.94        0.95        0.12         010
10121...........  .............  A............  Remove foreign body.        2.71        3.51        3.51        1.65        1.72        0.33         010
10140...........  .............  A............  Drainage of hematoma/       1.55        2.26        2.01        1.29        1.29        0.19         010
                                                 fluid.
10160...........  .............  A............  Puncture drainage of        1.22        1.85        1.72        1.07        1.08        0.14         010
                                                 lesion.
10180...........  .............  A............  Complex drainage,           2.27        3.25        3.11        1.80        1.89        0.35         010
                                                 wound.
11000...........  .............  A............  Debride infected            0.60        0.72        0.65        0.16        0.19        0.07         000
                                                 skin.
11001...........  .............  A............  Debride infected            0.30        0.23        0.23        0.08        0.10        0.04         ZZZ
                                                 skin add-on.
11004...........  .............  A............  Debride genitalia &        10.80          NA          NA        3.20        3.55        0.67         000
                                                 perineum.
11005...........  .............  A............  Debride abdom wall..       14.24          NA          NA        3.78        4.67        0.96         000
11006...........  .............  A............  Debride genit/per/         13.10          NA          NA        3.95        4.40        1.28         000
                                                 abdom wall.
11008...........  .............  A............  Remove mesh from abd        5.00          NA          NA        1.29        1.66        0.61         ZZZ
                                                 wall.
11010...........  .............  A............  Debride skin, fx....        4.19        6.80        6.83        2.34        2.48        0.66         010
11011...........  .............  A............  Debride skin/muscle,        4.94        7.03        7.59        2.01        2.18        0.74         000
                                                 fx.
11012...........  .............  A............  Debride skin/muscle/        6.87        9.00       10.55        3.10        3.47        1.16         000
                                                 bone, fx.
11040...........  .............  A............  Debride skin,               0.50        0.68        0.60        0.16        0.18        0.06         000
                                                 partial.
11041...........  .............  A............  Debride skin, full..        0.60        0.72        0.69        0.19        0.26        0.10         000
11042...........  .............  A............  Debride skin/tissue.        0.80        0.95        0.96        0.24        0.34        0.13         000
11043...........  .............  A............  Debride tissue/             3.04        3.50        3.44        2.60        2.59        0.32         010
                                                 muscle.
11044...........  .............  A............  Debride tissue/             4.11        4.84        4.64        3.58        3.66        0.43         010
                                                 muscle/bone.
11055...........  .............  R............  Trim skin lesion....        0.43        0.81        0.68        0.11        0.14        0.05         000
11056...........  .............  R............  Trim skin lesions, 2        0.61        0.88        0.76        0.16        0.19        0.07         000
                                                 to 4.
11057...........  .............  R............  Trim skin lesions,          0.79        0.99        0.86        0.20        0.25        0.10         000
                                                 over 4.
11100...........  .............  A............  Biopsy, skin lesion.        0.81        1.88        1.56        0.38        0.38        0.03         000
11101...........  .............  A............  Biopsy, skin add-on.        0.41        0.41        0.37        0.20        0.19        0.02         ZZZ
11200...........  .............  A............  Removal of skin tags        0.79        1.23        1.13        0.90        0.83        0.04         010
11201...........  .............  A............  Remove skin tags add-       0.29        0.16        0.16        0.11        0.12        0.02         ZZZ
                                                 on.
11300...........  .............  A............  Shave skin lesion...        0.51        1.19        1.09        0.21        0.21        0.03         000
11301...........  .............  A............  Shave skin lesion...        0.85        1.51        1.31        0.38        0.38        0.04         000
11302...........  .............  A............  Shave skin lesion...        1.05        1.76        1.53        0.48        0.47        0.05         000
11303...........  .............  A............  Shave skin lesion...        1.24        2.03        1.80        0.55        0.53        0.07         000
11305...........  .............  A............  Shave skin lesion...        0.67        1.06        0.96        0.20        0.24        0.07         000
11306...........  .............  A............  Shave skin lesion...        0.99        1.42        1.26        0.38        0.40        0.07         000
11307...........  .............  A............  Shave skin lesion...        1.14        1.70        1.49        0.47        0.48        0.07         000
11308...........  .............  A............  Shave skin lesion...        1.41        1.70        1.57        0.49        0.54        0.13         000
11310...........  .............  A............  Shave skin lesion...        0.73        1.38        1.24        0.31        0.32        0.04         000
11311...........  .............  A............  Shave skin lesion...        1.05        1.64        1.43        0.48        0.48        0.05         000
11312...........  .............  A............  Shave skin lesion...        1.20        1.92        1.67        0.56        0.55        0.06         000
11313...........  .............  A............  Shave skin lesion...        1.62        2.18        1.99        0.73        0.72        0.10         000
11400...........  .............  A............  Exc tr-ext b9+marg          0.87        1.88        1.94        0.93        0.91        0.06         010
                                                 0.5 < cm.
11401...........  .............  A............  Exc tr-ext b9+marg          1.25        2.19        2.12        1.15        1.08        0.10         010
                                                 0.6-1 cm.
11402...........  .............  A............  Exc tr-ext b9+marg          1.42        2.40        2.31        1.21        1.14        0.13         010
                                                 1.1-2 cm.
11403...........  .............  A............  Exc tr-ext b9+marg          1.81        2.55        2.47        1.56        1.44        0.17         010
                                                 2.1-3 cm.
11404...........  .............  A............  Exc tr-ext b9+marg          2.08        2.85        2.78        1.63        1.51        0.21         010
                                                 3.1-4 cm.
11406...........  .............  A............  Exc tr-ext b9+marg >        3.47        3.53        3.30        2.10        1.87        0.32         010
                                                 4.0 cm.
11420...........  .............  A............  Exc h-f-nk-sp               1.00        1.83        1.79        0.93        0.93        0.09         010
                                                 b9+marg 0.5 <.
11421...........  .............  A............  Exc h-f-nk-sp               1.44        2.21        2.14        1.16        1.13        0.13         010
                                                 b9+marg 0.6-1.
11422...........  .............  A............  Exc h-f-nk-sp               1.65        2.43        2.34        1.53        1.43        0.16         010
                                                 b9+marg 1.1-2.
11423...........  .............  A............  Exc h-f-nk-sp               2.03        2.67        2.62        1.66        1.55        0.20         010
                                                 b9+marg 2.1-3.
11424...........  .............  A............  Exc h-f-nk-sp               2.45        2.97        2.89        1.77        1.68        0.25         010
                                                 b9+marg 3.1-4.
11426...........  .............  A............  Exc h-f-nk-sp               4.04        3.59        3.53        2.31        2.20        0.44         010
                                                 b9+marg > 4 cm.
11440...........  .............  A............  Exc face-mm b9+marg         1.02        2.00        2.10        1.31        1.31        0.08         010
                                                 0.5 < cm.
11441...........  .............  A............  Exc face-mm b9+marg         1.50        2.38        2.35        1.55        1.52        0.13         010
                                                 0.6-1 cm.
11442...........  .............  A............  Exc face-mm b9+marg         1.74        2.64        2.59        1.66        1.61        0.16         010
                                                 1.1-2 cm.
11443...........  .............  A............  Exc face-mm b9+marg         2.31        2.88        2.90        1.84        1.83        0.22         010
                                                 2.1-3 cm.
11444...........  .............  A............  Exc face-mm b9+marg         3.16        3.31        3.39        2.10        2.14        0.30         010
                                                 3.1-4 cm.
11446...........  .............  A............  Exc face-mm b9+marg         4.75        4.09        4.06        2.68        2.73        0.43         010
                                                 > 4 cm.
11450...........  .............  A............  Removal, sweat gland        3.14        5.12        5.07        2.41        2.22        0.34         090
                                                 lesion.
11451...........  .............  A............  Removal, sweat gland        4.35        6.37        6.49        2.91        2.73        0.53         090
                                                 lesion.
11462...........  .............  A............  Removal, sweat gland        2.92        5.32        5.21        2.47        2.24        0.32         090
                                                 lesion.
11463...........  .............  A............  Removal, sweat gland        4.35        6.52        6.67        2.94        2.81        0.54         090
                                                 lesion.
11470...........  .............  A............  Removal, sweat gland        3.66        5.47        5.26        2.62        2.44        0.40         090
                                                 lesion.
11471...........  .............  A............  Removal, sweat gland        4.81        6.50        6.60        3.01        2.88        0.58         090
                                                 lesion.

[[Page 66413]]

 
11600...........  .............  A............  Exc tr-ext mlg+marg         1.58        2.74        2.69        1.14        1.05        0.10         010
                                                 0.5 < cm.
11601...........  .............  A............  Exc tr-ext mlg+marg         2.02        3.44        3.07        1.51        1.36        0.12         010
                                                 0.6-1 cm.
11602...........  .............  A............  Exc tr-ext mlg+marg         2.22        3.84        3.33        1.69        1.47        0.12         010
                                                 1.1-2 cm.
11603...........  .............  A............  Exc tr-ext mlg+marg         2.77        4.05        3.56        1.87        1.60        0.16         010
                                                 2.1-3 cm.
11604...........  .............  A............  Exc tr-ext mlg+marg         3.12        4.33        3.85        1.93        1.66        0.20         010
                                                 3.1-4 cm.
11606...........  .............  A............  Exc tr-ext mlg+marg         4.97        5.49        4.77        2.46        2.10        0.36         010
                                                 > 4 cm.
11620...........  .............  A............  Exc h-f-nk-sp               1.59        2.85        2.72        1.19        1.07        0.09         010
                                                 mlg+marg 0.5 <.
11621...........  .............  A............  Exc h-f-nk-sp               2.03        3.50        3.10        1.54        1.39        0.12         010
                                                 mlg+marg 0.6-1.
11622...........  .............  A............  Exc h-f-nk-sp               2.36        3.90        3.43        1.75        1.57        0.14         010
                                                 mlg+marg 1.1-2.
11623...........  .............  A............  Exc h-f-nk-sp               3.06        4.11        3.72        1.95        1.76        0.20         010
                                                 mlg+marg 2.1-3.
11624...........  .............  A............  Exc h-f-nk-sp               3.57        4.43        4.08        2.08        1.93        0.27         010
                                                 mlg+marg 3.1-4.
11626...........  .............  A............  Exc h-f-nk-sp               4.56        4.96        4.79        2.32        2.36        0.45         010
                                                 mlg+mar > 4 cm.
11640...........  .............  A............  Exc face-mm                 1.62        3.05        2.85        1.29        1.20        0.11         010
                                                 malig+marg 0.5 <.
11641...........  .............  A............  Exc face-mm                 2.12        3.63        3.33        1.61        1.57        0.16         010
                                                 malig+marg 0.6-1.
11642...........  .............  A............  Exc face-mm                 2.57        4.04        3.72        1.84        1.77        0.19         010
                                                 malig+marg 1.1-2.
11643...........  .............  A............  Exc face-mm                 3.37        4.28        4.04        2.11        2.04        0.26         010
                                                 malig+marg 2.1-3.
11644...........  .............  A............  Exc face-mm                 4.29        5.07        4.87        2.46        2.46        0.37         010
                                                 malig+marg 3.1-4.
11646...........  .............  A............  Exc face-mm mlg+marg        6.21        5.90        5.83        3.13        3.30        0.61         010
                                                 > 4 cm.
11719...........  .............  R............  Trim nail(s)........        0.17        0.38        0.31        0.04        0.06        0.02         000
11720...........  .............  A............  Debride nail, 1-5...        0.32        0.47        0.40        0.08        0.10        0.04         000
11721...........  .............  A............  Debride nail, 6 or          0.54        0.55        0.49        0.14        0.17        0.07         000
                                                 more.
11730...........  .............  A............  Removal of nail             1.10        1.33        1.18        0.28        0.36        0.14         000
                                                 plate.
11732...........  .............  A............  Remove nail plate,          0.57        0.54        0.49        0.15        0.18        0.07         ZZZ
                                                 add-on.
11740...........  .............  A............  Drain blood from            0.37        0.80        0.67        0.43        0.39        0.04         000
                                                 under nail.
11750...........  .............  A............  Removal of nail bed.        2.40        2.95        2.56        1.88        1.82        0.22         010
11752...........  .............  A............  Remove nail bed/            3.48        4.06        3.52        2.77        2.88        0.35         010
                                                 finger tip.
11755...........  .............  A............  Biopsy, nail unit...        1.31        2.02        1.79        0.76        0.76        0.14         000
11760...........  .............  A............  Repair of nail bed..        1.60        3.40        3.01        1.43        1.61        0.21         010
11762...........  .............  A............  Reconstruction of           2.91        3.70        3.29        1.68        2.01        0.36         010
                                                 nail bed.
11765...........  .............  A............  Excision of nail            0.71        2.67        2.23        1.01        0.88        0.08         010
                                                 fold, toe.
11770...........  .............  A............  Removal of pilonidal        2.63        3.45        3.47        1.52        1.51        0.33         010
                                                 lesion.
11771...........  .............  A............  Removal of pilonidal        5.98        6.63        6.14        3.69        3.50        0.74         090
                                                 lesion.
11772...........  .............  A............  Removal of pilonidal        7.23        8.03        7.76        5.55        5.31        0.89         090
                                                 lesion.
11900...........  .............  A............  Injection into skin         0.52        0.92        0.78        0.25        0.23        0.02         000
                                                 lesions.
11901...........  .............  A............  Added skin lesions          0.80        1.01        0.83        0.39        0.37        0.03         000
                                                 injection.
11920...........  .............  R............  Correct skin color          1.61        2.34        3.02        1.09        1.09        0.24         000
                                                 defects.
11921...........  .............  R............  Correct skin color          1.93        2.66        3.31        1.25        1.26        0.29         000
                                                 defects.
11922...........  .............  R............  Correct skin color          0.49        0.92        1.03        0.22        0.24        0.07         ZZZ
                                                 defects.
11950...........  .............  R............  Therapy for contour         0.84        0.88        1.01        0.36        0.37        0.06         000
                                                 defects.
11951...........  .............  R............  Therapy for contour         1.19        0.90        1.19        0.36        0.43        0.11         000
                                                 defects.
11952...........  .............  R............  Therapy for contour         1.69        1.63        1.74        0.77        0.72        0.16         000
                                                 defects.
11954...........  .............  R............  Therapy for contour         1.85        1.79        2.11        0.77        0.83        0.25         000
                                                 defects.
11960...........  .............  A............  Insert tissue              11.01          NA          NA       10.56       10.47        1.31         090
                                                 expander(s).
11970...........  .............  A............  Replace tissue              7.86          NA          NA        6.16        6.15        1.05         090
                                                 expander.
11971...........  .............  A............  Remove tissue               3.21        7.39        8.25        4.01        3.90        0.32         090
                                                 expander(s).
11975...........  .............  N............  Insert contraceptive        1.48        1.53        1.47        0.34        0.45        0.17         XXX
                                                 cap.
11976...........  .............  R............  Removal of                  1.78        1.72        1.72        0.47        0.58        0.21         000
                                                 contraceptive cap.
11977...........  .............  N............  Removal/reinsert            3.30        1.98        2.13        0.76        1.01        0.37         XXX
                                                 contra cap.
11980...........  .............  A............  Implant hormone             1.48        1.07        1.07        0.49        0.51        0.13         000
                                                 pellet(s).
11981...........  .............  A............  Insert drug implant         1.48        1.89        1.79        0.58        0.63        0.12         XXX
                                                 device.
11982...........  .............  A............  Remove drug implant         1.78        2.02        1.98        0.70        0.76        0.17         XXX
                                                 device.
11983...........  .............  A............  Remove/insert drug          3.30        2.63        2.46        1.32        1.39        0.23         XXX
                                                 implant.
12001...........  .............  A............  Repair superficial          1.72        1.73        1.86        0.73        0.75        0.15         010
                                                 wound(s).
12002...........  .............  A............  Repair superficial          1.88        1.80        1.92        0.84        0.87        0.17         010
                                                 wound(s).
12004...........  .............  A............  Repair superficial          2.26        2.08        2.20        0.92        0.96        0.21         010
                                                 wound(s).
12005...........  .............  A............  Repair superficial          2.88        2.52        2.67        1.06        1.13        0.27         010
                                                 wound(s).
12006...........  .............  A............  Repair superficial          3.68        3.06        3.22        1.30        1.40        0.35         010
                                                 wound(s).
12007...........  .............  A............  Repair superficial          4.13        3.35        3.58        1.46        1.64        0.45         010
                                                 wound(s).
12011...........  .............  A............  Repair superficial          1.78        1.91        2.02        0.76        0.77        0.16         010
                                                 wound(s).
12013...........  .............  A............  Repair superficial          2.01        2.06        2.17        0.89        0.91        0.18         010
                                                 wound(s).
12014...........  .............  A............  Repair superficial          2.48        2.29        2.43        0.98        1.02        0.23         010
                                                 wound(s).
12015...........  .............  A............  Repair superficial          3.21        2.79        2.96        1.12        1.18        0.29         010
                                                 wound(s).
12016...........  .............  A............  Repair superficial          3.94        3.17        3.36        1.28        1.40        0.37         010
                                                 wound(s).
12017...........  .............  A............  Repair superficial          4.72          NA          NA        1.52        1.71        0.47         010
                                                 wound(s).
12018...........  .............  A............  Repair superficial          5.54          NA          NA        1.92        2.09        0.64         010
                                                 wound(s).
12020...........  .............  A............  Closure of split            2.64        3.69        3.75        1.75        1.84        0.30         010
                                                 wound.
12021...........  .............  A............  Closure of split            1.86        1.85        1.83        1.33        1.37        0.24         010
                                                 wound.
12031...........  .............  A............  Layer closure of            2.17        3.89        3.09        1.77        1.36        0.17         010
                                                 wound(s).
12032...........  .............  A............  Layer closure of            2.49        5.21        4.52        2.28        2.04        0.16         010
                                                 wound(s).
12034...........  .............  A............  Layer closure of            2.94        4.61        3.90        1.99        1.72        0.25         010
                                                 wound(s).
12035...........  .............  A............  Layer closure of            3.44        5.29        5.24        2.11        2.13        0.39         010
                                                 wound(s).
12036...........  .............  A............  Layer closure of            4.06        5.40        5.48        2.23        2.39        0.55         010
                                                 wound(s).

[[Page 66414]]

 
12037...........  .............  A............  Layer closure of            4.68        5.98        6.04        2.63        2.80        0.66         010
                                                 wound(s).
12041...........  .............  A............  Layer closure of            2.39        3.87        3.20        1.77        1.45        0.19         010
                                                 wound(s).
12042...........  .............  A............  Layer closure of            2.76        4.49        3.88        2.12        1.79        0.17         010
                                                 wound(s).
12044...........  .............  A............  Layer closure of            3.16        5.40        4.31        1.95        1.77        0.27         010
                                                 wound(s).
12045...........  .............  A............  Layer closure of            3.65        5.03        5.14        2.06        2.17        0.41         010
                                                 wound(s).
12046...........  .............  A............  Layer closure of            4.26        5.65        6.08        2.29        2.52        0.54         010
                                                 wound(s).
12047...........  .............  A............  Layer closure of            4.66        6.49        6.41        2.66        2.87        0.58         010
                                                 wound(s).
12051...........  .............  A............  Layer closure of            2.49        4.11        3.69        1.92        1.68        0.20         010
                                                 wound(s).
12052...........  .............  A............  Layer closure of            2.81        4.86        4.04        2.56        1.99        0.17         010
                                                 wound(s).
12053...........  .............  A............  Layer closure of            3.14        5.38        4.31        2.12        1.82        0.23         010
                                                 wound(s).
12054...........  .............  A............  Layer closure of            3.47        5.42        4.49        2.05        1.84        0.30         010
                                                 wound(s).
12055...........  .............  A............  Layer closure of            4.44        6.01        5.24        2.09        2.11        0.45         010
                                                 wound(s).
12056...........  .............  A............  Layer closure of            5.25        6.56        6.65        2.58        2.81        0.59         010
                                                 wound(s).
12057...........  .............  A............  Layer closure of            5.97        7.75        6.94        2.93        3.34        0.56         010
                                                 wound(s).
13100...........  .............  A............  Repair of wound or          3.14        4.42        4.23        2.46        2.38        0.26         010
                                                 lesion.
13101...........  .............  A............  Repair of wound or          3.93        5.94        5.30        2.97        2.83        0.26         010
                                                 lesion.
13102...........  .............  A............  Repair wound/lesion         1.24        1.35        1.26        0.53        0.55        0.13         ZZZ
                                                 add-on.
13120...........  .............  A............  Repair of wound or          3.32        4.58        4.36        2.57        2.46        0.26         010
                                                 lesion.
13121...........  .............  A............  Repair of wound or          4.36        6.71        5.78        3.64        3.21        0.25         010
                                                 lesion.
13122...........  .............  A............  Repair wound/lesion         1.44        1.37        1.44        0.58        0.60        0.15         ZZZ
                                                 add-on.
13131...........  .............  A............  Repair of wound or          3.80        5.01        4.68        2.88        2.78        0.26         010
                                                 lesion.
13132...........  .............  A............  Repair of wound or          6.48        7.88        6.89        4.95        4.55        0.32         010
                                                 lesion.
13133...........  .............  A............  Repair wound/lesion         2.19        1.87        1.76        0.98        1.00        0.18         ZZZ
                                                 add-on.
13150...........  .............  A............  Repair of wound or          3.82        4.72        4.79        2.72        2.74        0.34         010
                                                 lesion.
13151...........  .............  A............  Repair of wound or          4.46        5.51        5.15        3.22        3.18        0.31         010
                                                 lesion.
13152...........  .............  A............  Repair of wound or          6.34        7.53        6.78        3.91        3.97        0.40         010
                                                 lesion.
13153...........  .............  A............  Repair wound/lesion         2.38        2.05        1.99        1.03        1.08        0.24         ZZZ
                                                 add-on.
13160...........  .............  A............  Late closure of            11.84          NA          NA        7.02        7.09        1.54         090
                                                 wound.
14000...........  .............  A............  Skin tissue                 6.83        8.94        8.39        6.04        5.75        0.59         090
                                                 rearrangement.
14001...........  .............  A............  Skin tissue                 9.60       11.01       10.21        7.48        7.27        0.82         090
                                                 rearrangement.
14020...........  .............  A............  Skin tissue                 7.66       10.02        9.31        6.88        6.70        0.64         090
                                                 rearrangement.
14021...........  .............  A............  Skin tissue                11.18       12.45       11.21        8.65        8.46        0.81         090
                                                 rearrangement.
14040...........  .............  A............  Skin tissue                 8.44       10.19        9.49        6.98        7.09        0.62         090
                                                 rearrangement.
14041...........  .............  A............  Skin tissue                12.67       13.56       12.07        9.34        9.00        0.73         090
                                                 rearrangement.
14060...........  .............  A............  Skin tissue                 9.07        9.68        9.23        7.17        7.30        0.68         090
                                                 rearrangement.
14061...........  .............  A............  Skin tissue                13.67       14.82       13.21       10.17        9.83        0.76         090
                                                 rearrangement.
14300...........  .............  A............  Skin tissue                13.26       13.51       12.32        9.44        9.30        1.16         090
                                                 rearrangement.
14350...........  .............  A............  Skin tissue                10.82          NA          NA        6.89        7.01        1.34         090
                                                 rearrangement.
15002...........  .............  A............  Wnd prep, ch/inf,           3.65        4.21        4.21        1.68        1.68        0.49         000
                                                 trk/arm/lg.
15003...........  .............  A............  Wnd prep, ch/inf            0.80        0.90        0.90        0.26        0.26        0.11         ZZZ
                                                 addl 100 cm.
15004...........  .............  A............  Wnd prep ch/inf, f/n/       4.58        4.87        4.87        2.01        2.01        0.62         000
                                                 hf/g.
15005...........  .............  A............  Wnd prep, f/n/hf/g,         1.60        1.24        1.24        0.52        0.52        0.22         ZZZ
                                                 addl cm.
15040...........  .............  A............  Harvest cultured            2.00        3.93        4.24        1.05        1.09        0.24         000
                                                 skin graft.
15050...........  .............  A............  Skin pinch graft....        5.37        7.62        7.26        5.00        5.05        0.57         090
15100...........  .............  A............  Skin splt grft, trnk/       9.74        9.76       11.17        6.67        7.24        1.28         090
                                                 arm/leg.
15101...........  .............  A............  Skin splt grft t/a/         1.72        2.47        3.10        0.85        1.01        0.24         ZZZ
                                                 l, add-on.
15110...........  .............  A............  Epidrm autogrft trnk/      10.88        8.74        9.70        6.36        6.68        1.31         090
                                                 arm/leg.
15111...........  .............  A............  Epidrm autogrft t/a/        1.85        0.87        1.08        0.62        0.70        0.26         ZZZ
                                                 l add-on.
15115...........  .............  A............  Epidrm a-grft face/        11.19        9.22        9.22        6.73        7.04        1.15         090
                                                 nck/hf/g.
15116...........  .............  A............  Epidrm a-grft f/n/hf/       2.50        1.19        1.38        0.86        0.99        0.33         ZZZ
                                                 g addl.
15120...........  .............  A............  Skn splt a-grft fac/       10.96       11.34       11.03        7.45        7.61        1.16         090
                                                 nck/hf/g.
15121...........  .............  A............  Skn splt a-grft f/n/        2.67        3.43        3.96        1.29        1.57        0.36         ZZZ
                                                 hf/g add.
15130...........  .............  A............  Derm autograft, trnk/       7.41        7.95        8.90        5.57        5.95        0.97         090
                                                 arm/leg.
15131...........  .............  A............  Derm autograft t/a/l        1.50        0.65        0.86        0.48        0.56        0.21         ZZZ
                                                 add-on.
15135...........  .............  A............  Derm autograft face/       10.91        9.48        9.67        7.04        7.58        1.23         090
                                                 nck/hf/g.
15136...........  .............  A............  Derm autograft, f/n/        1.50        0.66        0.77        0.51        0.59        0.20         ZZZ
                                                 hf/g add.
15150...........  .............  A............  Cult epiderm grft t/        9.30        7.04        7.74        5.75        6.10        1.14         090
                                                 arm/leg.
15151...........  .............  A............  Cult epiderm grft t/        2.00        0.88        1.09        0.67        0.76        0.28         ZZZ
                                                 a/l addl.
15152...........  .............  A............  Cult epiderm graft t/       2.50        1.05        1.30        0.84        0.95        0.35         ZZZ
                                                 a/l +%.
15155...........  .............  A............  Cult epiderm graft,        10.05        7.65        7.73        6.30        6.63        1.05         090
                                                 f/n/hf/g.
15156...........  .............  A............  Cult epidrm grft f/n/       2.75        1.15        1.35        0.94        1.09        0.36         ZZZ
                                                 hfg add.
15157...........  .............  A............  Cult epiderm grft f/        3.00        1.33        1.55        1.03        1.19        0.39         ZZZ
                                                 n/hfg +%.
15170...........  .............  A............  Acell graft trunk/          5.99        4.01        3.92        2.60        2.48        0.55         090
                                                 arms/legs.
15171...........  .............  A............  Acell graft t/arm/          1.55        0.60        0.64        0.46        0.54        0.19         ZZZ
                                                 leg add-on.
15175...........  .............  A............  Acellular graft, f/n/       7.99        4.46        4.94        3.14        3.57        0.82         090
                                                 hf/g.
15176...........  .............  A............  Acell graft, f/n/hf/        2.45        1.04        1.07        0.79        0.89        0.29         ZZZ
                                                 g add-on.
15200...........  .............  A............  Skin full graft,            8.97        9.90        9.65        6.34        6.27        0.98         090
                                                 trunk.
15201...........  .............  A............  Skin full graft             1.32        2.02        2.29        0.47        0.54        0.19         ZZZ
                                                 trunk add-on.
15220...........  .............  A............  Skin full graft sclp/       7.95       10.45        9.82        6.69        6.68        0.84         090
                                                 arm/leg.
15221...........  .............  A............  Skin full graft add-        1.19        2.00        2.16        0.50        0.53        0.16         ZZZ
                                                 on.
15240...........  .............  A............  Skin full grft face/       10.15       12.03       11.11        8.89        8.42        0.92         090
                                                 genit/hf.
15241...........  .............  A............  Skin full graft add-        1.86        2.54        2.49        0.81        0.86        0.23         ZZZ
                                                 on.

[[Page 66415]]

 
15260...........  .............  A............  Skin full graft een        11.39       13.00       11.60        9.33        8.95        0.69         090
                                                 & lips.
15261...........  .............  A............  Skin full graft add-        2.23        2.97        2.83        1.15        1.28        0.21         ZZZ
                                                 on.
15300...........  .............  A............  Apply skinallogrft,         4.65        3.44        3.32        2.15        2.19        0.49         090
                                                 t/arm/lg.
15301...........  .............  A............  Apply sknallogrft t/        1.00        0.46        0.46        0.32        0.36        0.14         ZZZ
                                                 a/l addl.
15320...........  .............  A............  Apply skin allogrft         5.36        3.78        3.70        2.35        2.44        0.58         090
                                                 f/n/hf/g.
15321...........  .............  A............  Aply sknallogrft f/n/       1.50        0.69        0.69        0.51        0.55        0.21         ZZZ
                                                 hfg add.
15330...........  .............  A............  Aply acell alogrft t/       3.99        3.49        3.34        2.14        2.18        0.49         090
                                                 arm/leg.
15331...........  .............  A............  Aply acell grft t/a/        1.00        0.49        0.47        0.36        0.38        0.14         ZZZ
                                                 l add-on.
15335...........  .............  A............  Apply acell graft, f/       4.50        3.32        3.39        2.01        2.22        0.55         090
                                                 n/hf/g.
15336...........  .............  A............  Aply acell grft f/n/        1.43        0.74        0.71        0.51        0.54        0.20         ZZZ
                                                 hf/g add.
15340...........  .............  A............  Apply cult skin             3.76        3.68        3.84        2.64        2.69        0.41         010
                                                 substitute.
15341...........  .............  A............  Apply cult skin sub         0.50        0.64        0.62        0.13        0.17        0.06         ZZZ
                                                 add-on.
15360...........  .............  A............  Apply cult derm sub,        3.93        4.85        4.66        3.53        3.31        0.43         090
                                                 t/a/l.
15361...........  .............  A............  Aply cult derm sub t/       1.15        0.50        0.54        0.32        0.39        0.14         ZZZ
                                                 a/l add.
15365...........  .............  A............  Apply cult derm sub         4.21        4.21        4.38        3.09        3.14        0.46         090
                                                 f/n/hf/g.
15366...........  .............  A............  Apply cult derm f/hf/       1.45        0.67        0.68        0.47        0.53        0.17         ZZZ
                                                 g add.
15400...........  .............  A............  Apply skin                  4.38        4.99        4.50        3.76        3.88        0.47         090
                                                 xenograft, t/a/l.
15401...........  .............  A............  Apply skn xenogrft t/       1.00        1.01        1.45        0.33        0.39        0.14         ZZZ
                                                 a/l add.
15420...........  .............  A............  Apply skin xgraft, f/       4.89        5.43        5.10        4.17        3.98        0.52         090
                                                 n/hf/g.
15421...........  .............  A............  Apply skn xgrft f/n/        1.50        1.16        1.24        0.48        0.55        0.21         ZZZ
                                                 hf/g add.
15430...........  .............  A............  Apply acellular             5.93        6.60        6.75        6.05        6.33        0.66         090
                                                 xenograft.
15431...........  .............  C............  Apply acellular             0.00        0.00        0.00        0.00        0.00        0.00         ZZZ
                                                 xgraft add.
15570...........  .............  A............  Form skin pedicle          10.00       10.08       10.69        6.27        6.51        1.34         090
                                                 flap.
15572...........  .............  A............  Form skin pedicle           9.94        9.78        9.63        6.66        6.55        1.20         090
                                                 flap.
15574...........  .............  A............  Form skin pedicle          10.52       10.54       10.61        7.03        7.41        1.20         090
                                                 flap.
15576...........  .............  A............  Form skin pedicle           9.24        9.66        9.70        6.51        6.70        0.87         090
                                                 flap.
15600...........  .............  A............  Skin graft..........        1.95        5.31        6.45        2.75        2.90        0.27         090
15610...........  .............  A............  Skin graft..........        2.46        5.56        5.12        3.04        3.23        0.35         090
15620...........  .............  A............  Skin graft..........        3.62        6.47        7.12        3.90        3.89        0.35         090
15630...........  .............  A............  Skin graft..........        3.95        7.07        7.05        4.31        4.23        0.34         090
15650...........  .............  A............  Transfer skin               4.64        7.27        7.20        4.38        4.29        0.42         090
                                                 pedicle flap.
15731...........  .............  A............  Forehead flap w/vasc       14.12       11.89       11.89        9.33        9.33        1.28         090
                                                 pedicle.
15732...........  .............  A............  Muscle-skin graft,         19.70       14.64       16.34       11.09       11.65        2.00         090
                                                 head/neck.
15734...........  .............  A............  Muscle-skin graft,         19.62       15.68       16.89       11.84       12.10        2.62         090
                                                 trunk.
15736...........  .............  A............  Muscle-skin graft,         16.92       13.39       15.80        9.59       10.40        2.46         090
                                                 arm.
15738...........  .............  A............  Muscle-skin graft,         18.92       13.76       15.86       10.18       10.95        2.66         090
                                                 leg.
15740...........  .............  A............  Island pedicle flap        11.57       13.56       11.84        9.41        8.83        0.63         090
                                                 graft.
15750...........  .............  A............  Neurovascular              12.73          NA          NA        8.85        8.94        1.42         090
                                                 pedicle graft.
15756...........  .............  A............  Free myo/skin flap         36.74          NA          NA       18.55       19.55        4.62         090
                                                 microvasc.
15757...........  .............  A............  Free skin flap,            36.95          NA          NA       17.85       19.71        3.90         090
                                                 microvasc.
15758...........  .............  A............  Free fascial flap,         36.70          NA          NA       17.56       19.56        4.24         090
                                                 microvasc.
15760...........  .............  A............  Composite skin graft        9.68       10.41       10.21        7.05        7.15        0.85         090
15770...........  .............  A............  Derma-fat-fascia            8.73          NA          NA        6.63        6.66        1.05         090
                                                 graft.
15775...........  .............  R............  Hair transplant             3.95        2.88        3.55        1.23        1.26        0.52         000
                                                 punch grafts.
15776...........  .............  R............  Hair transplant             5.53        4.85        5.10        2.14        2.47        0.72         000
                                                 punch grafts.
15780...........  .............  A............  Abrasion treatment          8.50       11.23       11.37        6.52        7.38        0.67         090
                                                 of skin.
15781...........  .............  A............  Abrasion treatment          4.91        8.67        7.79        5.64        5.50        0.34         090
                                                 of skin.
15782...........  .............  A............  Abrasion treatment          4.36        8.70        9.28        4.96        5.75        0.34         090
                                                 of skin.
15783...........  .............  A............  Abrasion treatment          4.33        7.91        7.39        4.96        4.57        0.28         090
                                                 of skin.
15786...........  .............  A............  Abrasion, lesion,           2.05        3.89        3.62        1.24        1.28        0.11         010
                                                 single.
15787...........  .............  A............  Abrasion, lesions,          0.33        0.83        0.96        0.08        0.12        0.04         ZZZ
                                                 add-on.
15788...........  .............  R............  Chemical peel, face,        2.09        9.45        8.08        4.12        3.60        0.11         090
                                                 epiderm.
15789...........  .............  R............  Chemical peel, face,        4.91        9.42        8.75        5.83        5.31        0.20         090
                                                 dermal.
15792...........  .............  R............  Chemical peel,              1.86        8.97        8.03        4.58        4.51        0.13         090
                                                 nonfacial.
15793...........  .............  A............  Chemical peel,              3.82        8.09        7.19        4.90        4.64        0.19         090
                                                 nonfacial.
15819...........  .............  A............  Plastic surgery,           10.45          NA          NA        6.68        6.93        0.97         090
                                                 neck.
15820...........  .............  A............  Revision of lower           6.09        6.39        6.68        5.19        5.38        0.40         090
                                                 eyelid.
15821...........  .............  A............  Revision of lower           6.66        6.56        6.95        5.28        5.49        0.45         090
                                                 eyelid.
15822...........  .............  A............  Revision of upper           4.51        5.23        5.53        4.09        4.29        0.37         090
                                                 eyelid.
15823...........  .............  A............  Revision of upper           8.12        7.38        7.61        6.10        6.27        0.50         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.
15830...........  .............  R............  Exc skin abd........       16.90          NA          NA        9.81        9.81        2.93         090
15832...........  .............  A............  Excise excessive           12.65          NA          NA        8.27        8.30        1.66         090
                                                 skin tissue.
15833...........  .............  A............  Excise excessive           11.70          NA          NA        7.50        7.85        1.49         090
                                                 skin tissue.
15834...........  .............  A............  Excise excessive           11.97          NA          NA        8.15        7.92        1.61         090
                                                 skin tissue.
15835...........  .............  A............  Excise excessive           12.79          NA          NA        7.85        7.69        1.60         090
                                                 skin tissue.
15836...........  .............  A............  Excise excessive           10.41          NA          NA        6.82        6.80        1.34         090
                                                 skin tissue.
15837...........  .............  A............  Excise excessive            9.37        8.67        8.61        5.78        6.57        1.18         090
                                                 skin tissue.

[[Page 66416]]

 
15838...........  .............  A............  Excise excessive            8.07          NA          NA        5.44        5.75        0.58         090
                                                 skin tissue.
15839...........  .............  A............  Excise excessive           10.32        9.75        9.29        6.46        6.42        1.22         090
                                                 skin tissue.
15840...........  .............  A............  Graft for face nerve       14.76          NA          NA        8.91        9.44        1.32         090
                                                 palsy.
15841...........  .............  A............  Graft for face nerve       25.69          NA          NA       13.52       14.25        2.55         090
                                                 palsy.
15842...........  .............  A............  Flap for face nerve        40.68          NA          NA       20.86       21.88        4.94         090
                                                 palsy.
15845...........  .............  A............  Skin and muscle            14.04          NA          NA        8.35        8.83        0.81         090
                                                 repair, face.
15847...........  .............  C............  Exc skin abd add-on.        0.00        0.00        0.00        0.00        0.00        0.00         YYY
15850...........  .............  B............  Removal of sutures..        0.78        1.20        1.38        0.18        0.24        0.05         XXX
15851...........  .............  A............  Removal of sutures..        0.86        1.33        1.50        0.24        0.27        0.06         000
15852...........  .............  A............  Dressing change not         0.86          NA          NA        0.25        0.29        0.09         000
                                                 for burn.
15860...........  .............  A............  Test for blood flow         1.95          NA          NA        0.64        0.71        0.27         000
                                                 in 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        8.15          NA          NA        5.34        5.45        1.04         090
                                                 ulcer.
15922...........  .............  A............  Removal of tail bone       10.23          NA          NA        7.16        7.18        1.42         090
                                                 ulcer.
15931...........  .............  A............  Remove sacrum               9.96          NA          NA        5.56        5.62        1.25         090
                                                 pressure sore.
15933...........  .............  A............  Remove sacrum              11.60          NA          NA        7.30        7.57        1.52         090
                                                 pressure sore.
15934...........  .............  A............  Remove sacrum              13.54          NA          NA        7.72        7.87        1.79         090
                                                 pressure sore.
15935...........  .............  A............  Remove sacrum              15.58          NA          NA        9.17        9.74        2.10         090
                                                 pressure sore.
15936...........  .............  A............  Remove sacrum              13.04          NA          NA        7.41        7.81        1.77         090
                                                 pressure sore.
15937...........  .............  A............  Remove sacrum              15.00          NA          NA        8.93        9.37        2.07         090
                                                 pressure sore.
15940...........  .............  A............  Remove hip pressure        10.11          NA          NA        5.80        5.99        1.31         090
                                                 sore.
15941...........  .............  A............  Remove hip pressure        12.24          NA          NA        8.42        8.93        1.66         090
                                                 sore.
15944...........  .............  A............  Remove hip pressure        12.27          NA          NA        8.13        8.36        1.65         090
                                                 sore.
15945...........  .............  A............  Remove hip pressure        13.57          NA          NA        8.80        9.22        1.85         090
                                                 sore.
15946...........  .............  A............  Remove hip pressure        23.80          NA          NA       13.69       14.03        3.17         090
                                                 sore.
15950...........  .............  A............  Remove thigh                7.91          NA          NA        5.40        5.40        1.04         090
                                                 pressure sore.
15951...........  .............  A............  Remove thigh               11.41          NA          NA        7.33        7.59        1.49         090
                                                 pressure sore.
15952...........  .............  A............  Remove thigh               12.14          NA          NA        7.45        7.60        1.60         090
                                                 pressure sore.
15953...........  .............  A............  Remove thigh               13.39          NA          NA        8.22        8.61        1.80         090
                                                 pressure sore.
15956...........  .............  A............  Remove thigh               16.59          NA          NA        9.54       10.15        2.22         090
                                                 pressure sore.
15958...........  .............  A............  Remove thigh               16.55          NA          NA       10.42       10.72        2.26         090
                                                 pressure sore.
15999...........  .............  C............  Removal of pressure         0.00        0.00        0.00        0.00        0.00        0.00         YYY
                                                 sore.
16000...........  .............  A............  Initial treatment of        0.89        0.72        0.79        0.23        0.25        0.08         000
                                                 burn(s).
16020...........  .............  A............  Dress/debrid p-thick        0.80        1.11        1.20        0.56        0.57        0.08         000
                                                 burn, s.
16025...........  .............  A............  Dress/debrid p-thick        1.85        1.57        1.67        0.86        0.91        0.19         000
                                                 burn, m.
16030...........  .............  A............  Dress/debrid p-thick        2.08        2.08        2.13        1.02        1.07        0.24         000
                                                 burn, l.
16035...........  .............  A............  Incision of burn            3.74          NA          NA        1.22        1.40        0.46         000
                                                 scab, initi.
16036...........  .............  A............  Escharotomy; add'l          1.50          NA          NA        0.46        0.53        0.20         ZZZ
                                                 incision.
17000...........  .............  A............  Destruct premalg            0.62        1.41        1.19        0.74        0.64        0.03         010
                                                 lesion.
17003...........  .............  A............  Destruct premalg            0.07        0.10        0.11        0.03        0.05        0.01         ZZZ
                                                 les, 2-14.
17004...........  .............  A............  Destroy premlg              1.82        2.44        2.37        1.38        1.48        0.11         010
                                                 lesions 15+.
17106...........  .............  A............  Destruction of skin         4.62        4.69        4.64        3.28        3.30        0.35         090
                                                 lesions.
17107...........  .............  A............  Destruction of skin         9.19        6.97        7.08        4.94        5.20        0.63         090
                                                 lesions.
17108...........  .............  A............  Destruction of skin        13.22        8.86        9.06        6.38        7.02        0.54         090
                                                 lesions.
17110...........  .............  A............  Destruct b9 lesion,         0.67        1.79        1.70        0.88        0.79        0.05         010
                                                 1-14.
17111...........  .............  A............  Destruct lesion, 15         0.94        2.25        1.96        1.11        0.96        0.05         010
                                                 or more.
17250...........  .............  A............  Chemical cautery,           0.50        1.32        1.27        0.38        0.36        0.06         000
                                                 tissue.
17260...........  .............  A............  Destruction of skin         0.93        1.41        1.34        0.71        0.69        0.04         010
                                                 lesions.
17261...........  .............  A............  Destruction of skin         1.19        2.49        2.05        1.07        0.95        0.05         010
                                                 lesions.
17262...........  .............  A............  Destruction of skin         1.60        2.83        2.36        1.27        1.14        0.06         010
                                                 lesions.
17263...........  .............  A............  Destruction of skin         1.81        3.06        2.56        1.37        1.23        0.07         010
                                                 lesions.
17264...........  .............  A............  Destruction of skin         1.96        3.27        2.74        1.43        1.28        0.08         010
                                                 lesions.
17266...........  .............  A............  Destruction of skin         2.36        3.50        3.00        1.59        1.40        0.09         010
                                                 lesions.
17270...........  .............  A............  Destruction of skin         1.34        2.43        2.06        1.10        0.98        0.05         010
                                                 lesions.
17271...........  .............  A............  Destruction of skin         1.51        2.66        2.22        1.22        1.10        0.06         010
                                                 lesions.
17272...........  .............  A............  Destruction of skin         1.79        2.97        2.48        1.36        1.24        0.07         010
                                                 lesions.
17273...........  .............  A............  Destruction of skin         2.07        3.21        2.71        1.49        1.35        0.08         010
                                                 lesions.
17274...........  .............  A............  Destruction of skin         2.61        3.60        3.08        1.74        1.59        0.10         010
                                                 lesions.
17276...........  .............  A............  Destruction of skin         3.22        3.88        3.41        1.97        1.82        0.16         010
                                                 lesions.
17280...........  .............  A............  Destruction of skin         1.19        2.36        1.98        1.03        0.92        0.05         010
                                                 lesions.
17281...........  .............  A............  Destruction of skin         1.74        2.73        2.32        1.33        1.21        0.07         010
                                                 lesions.
17282...........  .............  A............  Destruction of skin         2.06        3.14        2.64        1.49        1.36        0.08         010
                                                 lesions.
17283...........  .............  A............  Destruction of skin         2.66        3.55        3.05        1.76        1.62        0.11         010
                                                 lesions.
17284...........  .............  A............  Destruction of skin         3.23        3.97        3.44        2.02        1.89        0.13         010
                                                 lesions.
17286...........  .............  A............  Destruction of skin         4.45        4.44        4.06        2.49        2.46        0.23         010
                                                 lesions.
17311...........  .............  A............  Mohs, 1 stage, h/n/         6.20       10.70       10.70        3.05        3.05        0.24         000
                                                 hf/g.
17312...........  .............  A............  Mohs addl stage.....        3.30        6.88        6.88        1.62        1.62        0.13         ZZZ
17313...........  .............  A............  Mohs, 1 stage, t/a/l        5.56        9.87        9.87        2.73        2.73        0.22         000
17314...........  .............  A............  Mohs, addl stage, t/        3.06        6.37        6.37        1.50        1.50        0.12         ZZZ
                                                 a/l.

[[Page 66417]]

 
17315...........  .............  A............  Mohs surg, addl             0.87        1.14        1.14        0.43        0.43        0.03         ZZZ
                                                 block.
17340...........  .............  A............  Cryotherapy of skin.        0.76        0.35        0.36        0.38        0.37        0.05         010
17360...........  .............  A............  Skin peel therapy...        1.44        1.86        1.65        1.01        0.94        0.06         010
17380...........  .............  R............  Hair removal by             0.00        0.00        0.00        0.00        0.00        0.00         000
                                                 electrolysis.
17999...........  .............  C............  Skin tissue                 0.00        0.00        0.00        0.00        0.00        0.00         YYY
                                                 procedure.
19000...........  .............  A............  Drainage of breast          0.84        1.91        1.95        0.26        0.29        0.08         000
                                                 lesion.
19001...........  .............  A............  Drain breast lesion         0.42        0.25        0.25        0.14        0.14        0.04         ZZZ
                                                 add-on.
19020...........  .............  A............  Incision of breast          3.74        6.62        6.48        3.03        2.85        0.45         090
                                                 lesion.
19030...........  .............  A............  Injection for breast        1.53        2.66        2.76        0.54        0.52        0.09         000
                                                 x-ray.
19100...........  .............  A............  Bx breast percut w/o        1.27        2.08        2.08        0.33        0.37        0.16         000
                                                 image.
19101...........  .............  A............  Biopsy of breast,           3.20        4.37        4.43        1.78        1.85        0.39         010
                                                 open.
19102...........  .............  A............  Bx breast percut w/         2.00        3.46        3.64        0.68        0.67        0.14         000
                                                 image.
19103...........  .............  A............  Bx breast percut w/         3.69       10.09       10.79        1.19        1.21        0.30         000
                                                 device.
19105...........  .............  A............  Cryosurg ablate fa,         3.69       46.46       46.46        0.99        0.99        0.30         000
                                                 each.
19110...........  .............  A............  Nipple exploration..        4.35        6.06        5.93        3.09        2.98        0.57         090
19112...........  .............  A............  Excise breast duct          3.72        6.22        6.14        3.12        2.90        0.48         090
                                                 fistula.
19120...........  .............  A............  Removal of breast           5.84        5.08        4.81        3.36        3.21        0.73         090
                                                 lesion.
19125...........  .............  A............  Excision, breast            6.59        5.55        5.16        3.64        3.46        0.80         090
                                                 lesion.
19126...........  .............  A............  Excision, addl              2.93          NA          NA        0.75        0.87        0.38         ZZZ
                                                 breast lesion.
19260...........  .............  A............  Removal of chest           17.60          NA          NA       10.14       10.64        2.14         090
                                                 wall lesion.
19271...........  .............  A............  Revision of chest          21.86          NA          NA       15.81       16.87        2.63         090
                                                 wall.
19272...........  .............  A............  Extensive chest wall       24.82          NA          NA       16.95       17.93        3.00         090
                                                 surgery.
19290...........  .............  A............  Place needle wire,          1.27        2.89        2.87        0.45        0.43        0.07         000
                                                 breast.
19291...........  .............  A............  Place needle wire,          0.63        1.14        1.17        0.22        0.21        0.04         ZZZ
                                                 breast.
19295...........  .............  A............  Place breast clip,          0.00        2.28        2.48          NA          NA        0.01         ZZZ
                                                 percut.
19296...........  .............  A............  Place po breast cath        3.63       85.92      105.62        1.19        1.36        0.36         000
                                                 for rad.
19297...........  .............  A............  Place breast cath           1.72          NA          NA        0.44        0.54        0.17         ZZZ
                                                 for rad.
19298...........  .............  A............  Place breast rad            6.00       21.99       32.06        2.10        2.26        0.43         000
                                                 tube/caths.
19300...........  .............  A............  Removal of breast           5.20        8.05        7.59        3.85        3.62        0.69         090
                                                 tissue.
19301...........  .............  A............  Partical mastectomy.       10.00          NA          NA        4.62        4.02        0.79         090
19302...........  .............  A............  P-mastectomy w/ln          13.88          NA          NA        6.14        6.23        1.80         090
                                                 removal.
19303...........  .............  A............  Mast, simple,              15.67          NA          NA        6.99        6.00        1.18         090
                                                 complete.
19304...........  .............  A............  Mast, subq..........        7.81          NA          NA        4.93        4.84        1.04         090
19305...........  .............  A............  Mast, radical.......       17.23          NA          NA        8.11        8.03        1.93         090
19306...........  .............  A............  Mast, rad, urban           17.85          NA          NA        8.71        8.47        2.08         090
                                                 type.
19307...........  .............  A............  Mast, mod rad.......       17.95          NA          NA        8.76        8.48        2.13         090
19316...........  .............  A............  Suspension of breast       10.98          NA          NA        6.94        7.22        1.64         090
19318...........  .............  A............  Reduction of large         15.91          NA          NA        9.90       10.53        2.93         090
                                                 breast.
19324...........  .............  A............  Enlarge breast......        6.65          NA          NA        4.46        4.67        0.84         090
19325...........  .............  A............  Enlarge breast with         8.52          NA          NA        6.40        6.46        1.33         090
                                                 implant.
19328...........  .............  A............  Removal of breast           6.35          NA          NA        4.99        5.00        0.91         090
                                                 implant.
19330...........  .............  A............  Removal of implant          8.39          NA          NA        5.95        5.99        1.26         090
                                                 material.
19340...........  .............  A............  Immediate breast            6.32          NA          NA        2.81        2.96        1.06         ZZZ
                                                 prosthesis.
19342...........  .............  A............  Delayed breast             12.40          NA          NA        8.92        8.92        1.84         090
                                                 prosthesis.
19350...........  .............  A............  Breast                      8.99        9.88       11.86        6.58        6.87        1.41         090
                                                 reconstruction.
19355...........  .............  A............  Correct inverted            8.37        7.40        8.82        4.67        4.68        0.92         090
                                                 nipple(s).
19357...........  .............  A............  Breast                     20.57          NA          NA       15.37       15.49        2.94         090
                                                 reconstruction.
19361...........  .............  A............  Breast reconstr w/         23.17          NA          NA       16.78       14.60        2.93         090
                                                 lat flap.
19364...........  .............  A............  Breast                     42.40          NA          NA       22.15       22.84        6.24         090
                                                 reconstruction.
19366...........  .............  A............  Breast                     21.70          NA          NA        9.90       10.73        3.25         090
                                                 reconstruction.
19367...........  .............  A............  Breast                     26.59          NA          NA       15.17       15.93        4.04         090
                                                 reconstruction.
19368...........  .............  A............  Breast                     33.61          NA          NA       18.01       18.46        5.54         090
                                                 reconstruction.
19369...........  .............  A............  Breast                     31.02          NA          NA       16.31       17.35        4.51         090
                                                 reconstruction.
19370...........  .............  A............  Surgery of breast           8.99          NA          NA        6.78        6.84        1.29         090
                                                 capsule.
19371...........  .............  A............  Removal of breast          10.42          NA          NA        7.68        7.75        1.62         090
                                                 capsule.
19380...........  .............  A............  Revise breast              10.21          NA          NA        7.60        7.65        1.44         090
                                                 reconstruction.
19396...........  .............  A............  Design custom breast        2.17        4.53        2.80        1.28        1.13        0.30         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.        2.14        2.78        2.74        1.52        1.63        0.25         010
20005...........  .............  A............  Incision of deep            3.55        3.66        3.58        2.01        2.13        0.46         010
                                                 abscess.
20100...........  .............  A............  Explore wound, neck.       10.33          NA          NA        3.58        4.02        1.21         010
20101...........  .............  A............  Explore wound, chest        3.22        6.59        6.26        1.53        1.57        0.44         010
20102...........  .............  A............  Explore wound,              3.95        6.94        7.20        1.84        1.87        0.49         010
                                                 abdomen.
20103...........  .............  A............  Explore wound,              5.31        7.80        8.19        2.78        3.09        0.75         010
                                                 extremity.
20150...........  .............  A............  Excise epiphyseal          14.60          NA          NA        7.64        7.33        2.04         090
                                                 bar.
20200...........  .............  A............  Muscle biopsy.......        1.46        3.09        3.06        0.69        0.72        0.23         000
20205...........  .............  A............  Deep muscle biopsy..        2.35        3.82        3.85        1.10        1.14        0.33         000
20206...........  .............  A............  Needle biopsy,              0.99        5.22        5.86        0.57        0.60        0.07         000
                                                 muscle.
20220...........  .............  A............  Bone biopsy, trocar/        1.27        2.71        3.63        0.68        0.73        0.08         000
                                                 needle.
20225...........  .............  A............  Bone biopsy, trocar/        1.87       11.99       18.21        1.02        1.07        0.22         000
                                                 needle.
20240...........  .............  A............  Bone biopsy,                3.25          NA          NA        2.02        2.29        0.44         010
                                                 excisional.
20245...........  .............  A............  Bone biopsy,                8.77          NA          NA        5.74        6.15        1.31         010
                                                 excisional.

[[Page 66418]]

 
20250...........  .............  A............  Open bone biopsy....        5.16          NA          NA        3.63        3.56        1.02         010
20251...........  .............  A............  Open bone biopsy....        5.69          NA          NA        3.84        4.00        1.15         010
20500...........  .............  A............  Injection of sinus          1.25        1.34        1.80        0.88        1.20        0.12         010
                                                 tract.
20501...........  .............  A............  Inject sinus tract          0.76        2.36        2.64        0.27        0.26        0.04         000
                                                 for x-ray.
20520...........  .............  A............  Removal of foreign          1.87        2.60        2.76        1.45        1.61        0.21         010
                                                 body.
20525...........  .............  A............  Removal of foreign          3.51        7.11        8.12        2.21        2.41        0.51         010
                                                 body.
20526...........  .............  A............  Ther injection, carp        0.94        0.81        0.89        0.41        0.46        0.13         000
                                                 tunnel.
20550...........  .............  A............  Inj tendon sheath/          0.75        0.63        0.67        0.28        0.25        0.09         000
                                                 ligament.
20551...........  .............  A............  Inj tendon origin/          0.75        0.64        0.66        0.29        0.31        0.08         000
                                                 insertion.
20552...........  .............  A............  Inj trigger point, 1/       0.66        0.58        0.65        0.24        0.22        0.05         000
                                                 2 muscl.
20553...........  .............  A............  Inject trigger              0.75        0.64        0.73        0.26        0.24        0.04         000
                                                 points, =/> 3.
20555...........  .............  A............  Place ndl musc/tis          6.00          NA          NA        2.18        2.18        0.43         000
                                                 for rt.
20600...........  .............  A............  Drain/inject, joint/        0.66        0.66        0.66        0.31        0.33        0.08         000
                                                 bursa.
20605...........  .............  A............  Drain/inject, joint/        0.68        0.74        0.75        0.32        0.34        0.08         000
                                                 bursa.
20610...........  .............  A............  Drain/inject, joint/        0.79        1.06        1.01        0.40        0.41        0.11         000
                                                 bursa.
20612...........  .............  A............  Aspirate/inj                0.70        0.70        0.70        0.32        0.34        0.10         000
                                                 ganglion cyst.
20615...........  .............  A............  Treatment of bone           2.30        2.71        3.11        1.41        1.63        0.20         010
                                                 cyst.
20650...........  .............  A............  Insert and remove           2.25        2.46        2.41        1.45        1.50        0.31         010
                                                 bone pin.
20660...........  .............  A............  Apply, rem fixation         4.00        1.50        2.27        1.50        1.55        0.59         000
                                                 device.
20661...........  .............  A............  Application of head         5.14          NA          NA        6.04        5.47        1.14         090
                                                 brace.
20662...........  .............  A............  Application of              6.26          NA          NA        4.80        5.16        0.56         090
                                                 pelvis brace.
20663...........  .............  A............  Application of thigh        5.62          NA          NA        4.85        4.84        0.94         090
                                                 brace.
20664...........  .............  A............  Halo brace                  9.86          NA          NA        7.80        7.42        1.75         090
                                                 application.
20665...........  .............  A............  Removal of fixation         1.33        1.37        1.76        0.98        1.16        0.19         010
                                                 device.
20670...........  .............  A............  Removal of support          1.76        6.62        9.07        1.67        1.88        0.28         010
                                                 implant.
20680...........  .............  A............  Removal of support          5.90        8.13        8.46        4.06        3.89        0.56         090
                                                 implant.
20690...........  .............  A............  Apply bone fixation         8.65          NA          NA        4.91        3.71        0.59         090
                                                 device.
20692...........  .............  A............  Apply bone fixation        16.00          NA          NA        9.79        6.78        1.05         090
                                                 device.
20693...........  .............  A............  Adjust bone fixation        5.97          NA          NA        4.49        4.96        0.98         090
                                                 device.
20694...........  .............  A............  Remove bone fixation        4.20        5.31        6.22        3.52        3.78        0.71         090
                                                 device.
20802...........  .............  A............  Replantation, arm,         42.30          NA          NA       13.22       17.08        3.82         090
                                                 complete.
20805...........  .............  A............  Replant forearm,           51.14          NA          NA       17.97       26.13        4.85         090
                                                 complete.
20808...........  .............  A............  Replantation hand,         62.77          NA          NA       30.31       36.25        6.88         090
                                                 complete.
20816...........  .............  A............  Replantation digit,        31.74          NA          NA       16.35       27.06        4.53         090
                                                 complete.
20822...........  .............  A............  Replantation digit,        26.42          NA          NA       15.05       24.81        4.19         090
                                                 complete.
20824...........  .............  A............  Replantation thumb,        31.74          NA          NA       16.19       26.36        4.62         090
                                                 complete.
20827...........  .............  A............  Replantation thumb,        27.24          NA          NA       14.73       25.59        3.67         090
                                                 complete.
20838...........  .............  A............  Replantation foot,         42.56          NA          NA       14.01       18.14        1.12         090
                                                 complete.
20900...........  .............  A............  Removal of bone for         5.77        9.22        8.82        4.90        5.28        0.94         090
                                                 graft.
20902...........  .............  A............  Removal of bone for         7.98          NA          NA        5.98        6.43        1.30         090
                                                 graft.
20910...........  .............  A............  Remove cartilage for        5.41          NA          NA        4.56        4.87        0.71         090
                                                 graft.
20912...........  .............  A............  Remove cartilage for        6.42          NA          NA        4.94        5.37        0.69         090
                                                 graft.
20920...........  .............  A............  Removal of fascia           5.42          NA          NA        4.33        4.28        0.66         090
                                                 for graft.
20922...........  .............  A............  Removal of fascia           6.84        7.56        7.54        4.99        4.93        0.70         090
                                                 for graft.
20924...........  .............  A............  Removal of tendon           6.59          NA          NA        4.97        5.42        1.04         090
                                                 for graft.
20926...........  .............  A............  Removal of tissue           5.70          NA          NA        4.49        4.62        0.87         090
                                                 for graft.
20930...........  .............  B............  Sp bone algrft              0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 morsel add-on.
20931...........  .............  A............  Sp bone algrft              1.81          NA          NA        0.68        0.80        0.43         ZZZ
                                                 struct add-on.
20936...........  .............  B............  Sp bone agrft local         0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 add-on.
20937...........  .............  A............  Sp bone agrft morsel        2.79          NA          NA        1.08        1.26        0.54         ZZZ
                                                 add-on.
20938...........  .............  A............  Sp bone agrft struct        3.02          NA          NA        1.15        1.35        0.64         ZZZ
                                                 add-on.
20950...........  .............  A............  Fluid pressure,             1.26        4.23        5.53        0.88        0.93        0.20         000
                                                 muscle.
20955...........  .............  A............  Fibula bone graft,         40.02          NA          NA       18.53       21.39        4.90         090
                                                 microvasc.
20956...........  .............  A............  Iliac bone graft,          40.93          NA          NA       20.31       22.52        7.03         090
                                                 microvasc.
20957...........  .............  A............  Mt bone graft,             42.33          NA          NA       15.87       17.40        7.07         090
                                                 microvasc.
20962...........  .............  A............  Other bone graft,          39.21          NA          NA       21.29       23.90        6.57         090
                                                 microvasc.
20969...........  .............  A............  Bone/skin graft,           45.11          NA          NA       21.09       23.85        4.80         090
                                                 microvasc.
20970...........  .............  A............  Bone/skin graft,           44.26          NA          NA       20.89       23.13        6.62         090
                                                 iliac crest.
20972...........  .............  A............  Bone/skin graft,           44.19          NA          NA       14.92       17.74        5.32         090
                                                 metatarsal.
20973...........  .............  A............  Bone/skin graft,           46.95          NA          NA       14.15       19.64        5.56         090
                                                 great toe.
20974...........  .............  A............  Electrical bone             0.62        0.98        0.83        0.48        0.51        0.11         000
                                                 stimulation.
20975...........  .............  A............  Electrical bone             2.60          NA          NA        1.46        1.58        0.51         000
                                                 stimulation.
20979...........  .............  A............  Us bone stimulation.        0.62        0.61        0.71        0.20        0.27        0.09         000
20982...........  .............  A............  Ablate, bone                7.27       79.99       94.74        2.68        2.83        0.69         000
                                                 tumor(s) perq.
20985...........  .............  A............  Cptr-asst dir ms px.        2.50        0.99        0.99        0.99        0.99        0.48         ZZZ
20986...........  .............  C............  Cptr-asst dir ms px         0.00        0.00        0.00        0.00        0.00        0.00         ZZZ
                                                 io img.
20987...........  .............  C............  Cptr-asst dir ms px         0.00        0.00        0.00        0.00        0.00        0.00         ZZZ
                                                 pre img.
20999...........  .............  C............  Musculoskeletal             0.00        0.00        0.00        0.00        0.00        0.00         YYY
                                                 surgery.
21010...........  .............  A............  Incision of jaw            10.90          NA          NA        6.29        6.69        1.11         090
                                                 joint.
21015...........  .............  A............  Resection of facial         5.59          NA          NA        4.30        4.65        0.70         090
                                                 tumor.
21025...........  .............  A............  Excision of bone,          11.07       12.54       12.39        8.74        9.04        1.32         090
                                                 lower jaw.
21026...........  .............  A............  Excision of facial          5.54        8.82        8.34        5.93        6.12        0.60         090
                                                 bone(s).

[[Page 66419]]

 
21029...........  .............  A............  Contour of face bone        8.26        9.55        9.46        6.52        6.76        0.94         090
                                                 lesion.
21030...........  .............  A............  Excise max/zygoma b9        4.80        7.19        6.76        4.68        4.85        0.54         090
                                                 tumor.
21031...........  .............  A............  Remove exostosis,           3.26        5.91        5.54        3.47        3.54        0.48         090
                                                 mandible.
21032...........  .............  A............  Remove exostosis,           3.28        6.04        5.69        3.36        3.43        0.47         090
                                                 maxilla.
21034...........  .............  A............  Excise max/zygoma          17.17       13.92       14.92       10.11       11.38        1.72         090
                                                 mlg tumor.
21040...........  .............  A............  Excise mandible             4.80        7.19        6.79        4.64        4.68        0.54         090
                                                 lesion.
21044...........  .............  A............  Removal of jaw bone        12.61          NA          NA        8.10        8.73        1.12         090
                                                 lesion.
21045...........  .............  A............  Extensive jaw              18.13          NA          NA       10.78       11.56        1.52         090
                                                 surgery.
21046...........  .............  A............  Remove mandible cyst       13.97          NA          NA       11.48       11.69        1.86         090
                                                 complex.
21047...........  .............  A............  Excise lwr jaw cyst        19.83          NA          NA       10.21       11.82        2.13         090
                                                 w/repair.
21048...........  .............  A............  Remove maxilla cyst        14.47          NA          NA       11.38       11.75        1.77         090
                                                 complex.
21049...........  .............  A............  Excis uppr jaw cyst        19.08          NA          NA       10.28       11.65        1.59         090
                                                 w/repair.
21050...........  .............  A............  Removal of jaw joint       11.54          NA          NA        8.20        8.82        1.47         090
21060...........  .............  A............  Remove jaw joint           10.91          NA          NA        7.19        7.89        1.38         090
                                                 cartilage.
21070...........  .............  A............  Remove coronoid             8.50          NA          NA        6.26        6.68        1.27         090
                                                 process.
21073...........  .............  A............  Mnpj of tmj w/anesth        3.33        5.50        5.50        2.31        2.31        0.43         090
21076...........  .............  A............  Prepare face/oral          13.40        8.01       10.18        4.68        7.34        2.00         010
                                                 prosthesis.
21077...........  .............  A............  Prepare face/oral          33.70       18.42       24.86       11.82       18.90        4.56         090
                                                 prosthesis.
21079...........  .............  A............  Prepare face/oral          22.31       13.95       17.72        8.09       12.62        3.16         090
                                                 prosthesis.
21080...........  .............  A............  Prepare face/oral          25.06       16.14       20.31        9.01       14.18        3.75         090
                                                 prosthesis.
21081...........  .............  A............  Prepare face/oral          22.85       15.01       18.65        8.40       12.94        3.21         090
                                                 prosthesis.
21082...........  .............  A............  Prepare face/oral          20.84       14.89       17.11        8.26       11.99        3.12         090
                                                 prosthesis.
21083...........  .............  A............  Prepare face/oral          19.27       14.89       16.83        7.77       11.10        2.89         090
                                                 prosthesis.
21084...........  .............  A............  Prepare face/oral          22.48       16.83       19.63        8.94       13.31        2.19         090
                                                 prosthesis.
21085...........  .............  A............  Prepare face/oral           8.99        6.92        7.60        3.51        5.14        1.27         010
                                                 prosthesis.
21086...........  .............  A............  Prepare face/oral          24.88       12.90       18.31        8.44       13.93        3.72         090
                                                 prosthesis.
21087...........  .............  A............  Prepare face/oral          24.88       13.03       18.15        8.54       13.86        3.45         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               4.56       14.86       13.19        5.53        5.13        0.34         090
                                                 fixation.
21110...........  .............  A............  Interdental fixation        5.80       13.04       11.30        9.73        9.04        0.72         090
21116...........  .............  A............  Injection, jaw joint        0.81        2.52        3.42        0.23        0.28        0.06         000
                                                 x-ray.
21120...........  .............  A............  Reconstruction of           4.99        9.64       10.11        6.64        7.06        0.60         090
                                                 chin.
21121...........  .............  A............  Reconstruction of           7.70       10.63       10.18        7.58        7.70        0.90         090
                                                 chin.
21122...........  .............  A............  Reconstruction of           8.59          NA          NA        8.45        8.53        1.07         090
                                                 chin.
21123...........  .............  A............  Reconstruction of          11.22          NA          NA        7.03        8.91        1.40         090
                                                 chin.
21125...........  .............  A............  Augmentation, lower        10.68       63.93       59.56        6.42        7.37        0.79         090
                                                 jaw bone.
21127...........  .............  A............  Augmentation, lower        12.24       84.93       63.85        7.49        8.47        1.52         090
                                                 jaw bone.
21137...........  .............  A............  Reduction of               10.12          NA          NA        7.43        7.58        1.32         090
                                                 forehead.
21138...........  .............  A............  Reduction of               12.73          NA          NA        7.78        8.65        1.75         090
                                                 forehead.
21139...........  .............  A............  Reduction of               14.90          NA          NA        6.98        9.02        1.18         090
                                                 forehead.
21141...........  .............  A............  Reconstruct midface,       19.27          NA          NA       11.85       12.75        2.36         090
                                                 lefort.
21142...........  .............  A............  Reconstruct midface,       19.98          NA          NA       10.07       11.44        2.39         090
                                                 lefort.
21143...........  .............  A............  Reconstruct midface,       20.75          NA          NA       11.80       13.05        1.66         090
                                                 lefort.
21145...........  .............  A............  Reconstruct midface,       23.64          NA          NA       12.96       13.43        2.85         090
                                                 lefort.
21146...........  .............  A............  Reconstruct midface,       24.54          NA          NA        9.17       12.25        3.10         090
                                                 lefort.
21147...........  .............  A............  Reconstruct midface,       26.14          NA          NA       14.29       14.67        1.85         090
                                                 lefort.
21150...........  .............  A............  Reconstruct midface,       25.78          NA          NA       16.90       16.83        2.56         090
                                                 lefort.
21151...........  .............  A............  Reconstruct midface,       28.84          NA          NA       11.60       17.27        2.31         090
                                                 lefort.
21154...........  .............  A............  Reconstruct midface,       31.05          NA          NA       17.87       20.49        2.49         090
                                                 lefort.
21155...........  .............  A............  Reconstruct midface,       34.98          NA          NA       18.15       21.02        6.66         090
                                                 lefort.
21159...........  .............  A............  Reconstruct midface,       42.90          NA          NA       15.12       22.09        8.20         090
                                                 lefort.
21160...........  .............  A............  Reconstruct midface,       46.95          NA          NA       23.21       25.33        4.14         090
                                                 lefort.
21172...........  .............  A............  Reconstruct orbit/         28.07          NA          NA       13.73       13.74        3.56         090
                                                 forehead.
21175...........  .............  A............  Reconstruct orbit/         33.43          NA          NA       13.51       15.65        4.84         090
                                                 forehead.
21179...........  .............  A............  Reconstruct entire         22.53          NA          NA       11.21       12.66        2.81         090
                                                 forehead.
21180...........  .............  A............  Reconstruct entire         25.46          NA          NA       12.98       14.18        3.49         090
                                                 forehead.
21181...........  .............  A............  Contour cranial bone       10.18          NA          NA        6.82        7.14        1.32         090
                                                 lesion.
21182...........  .............  A............  Reconstruct cranial        32.45          NA          NA       15.26       17.18        2.81         090
                                                 bone.
21183...........  .............  A............  Reconstruct cranial        35.57          NA          NA       19.20       20.01        4.48         090
                                                 bone.
21184...........  .............  A............  Reconstruct cranial        38.49          NA          NA       15.61       18.77        5.72         090
                                                 bone.
21188...........  .............  A............  Reconstruction of          22.97          NA          NA       15.63       17.24        1.70         090
                                                 midface.
21193...........  .............  A............  Reconst lwr jaw w/o        18.65          NA          NA        9.80       11.23        2.24         090
                                                 graft.
21194...........  .............  A............  Reconst lwr jaw w/         21.54          NA          NA       12.12       12.93        2.03         090
                                                 graft.
21195...........  .............  A............  Reconst lwr jaw w/o        18.88          NA          NA       13.06       13.94        1.64         090
                                                 fixation.
21196...........  .............  A............  Reconst lwr jaw w/         20.55          NA          NA       13.93       14.81        2.08         090
                                                 fixation.
21198...........  .............  A............  Reconstr lwr jaw           15.48          NA          NA       11.88       12.29        1.44         090
                                                 segment.
21199...........  .............  A............  Reconstr lwr jaw w/        16.62          NA          NA        7.56        8.34        1.39         090
                                                 advance.
21206...........  .............  A............  Reconstruct upper          15.36          NA          NA       10.88       11.75        1.33         090
                                                 jaw bone.
21208...........  .............  A............  Augmentation of            11.15       33.14       27.73        8.00        8.79        1.09         090
                                                 facial bones.
21209...........  .............  A............  Reduction of facial         7.58       12.19       11.49        7.39        7.72        0.90         090
                                                 bones.
21210...........  .............  A............  Face bone graft.....       11.40       43.44       34.15        7.63        8.49        1.30         090

[[Page 66420]]

 
21215...........  .............  A............  Lower jaw bone graft       11.94       86.03       63.95        7.96        8.66        1.53         090
21230...........  .............  A............  Rib cartilage graft.       11.06          NA          NA        7.01        7.52        1.29         090
21235...........  .............  A............  Ear cartilage graft.        7.31       10.10        9.97        6.18        6.29        0.61         090
21240...........  .............  A............  Reconstruction of          15.77          NA          NA        9.43       10.73        2.25         090
                                                 jaw joint.
21242...........  .............  A............  Reconstruction of          14.32          NA          NA        9.01       10.25        1.79         090
                                                 jaw joint.
21243...........  .............  A............  Reconstruction of          24.03          NA          NA       14.14       15.78        3.26         090
                                                 jaw joint.
21244...........  .............  A............  Reconstruction of          13.35          NA          NA       11.51       11.80        1.25         090
                                                 lower jaw.
21245...........  .............  A............  Reconstruction of          12.88       14.20       14.30        8.61        9.23        1.19         090
                                                 jaw.
21246...........  .............  A............  Reconstruction of          12.78          NA          NA        7.42        8.23        1.35         090
                                                 jaw.
21247...........  .............  A............  Reconstruct lower          24.05          NA          NA       12.69       15.01        2.84         090
                                                 jaw bone.
21248...........  .............  A............  Reconstruction of          12.54       12.60       12.36        7.51        8.45        1.55         090
                                                 jaw.
21249...........  .............  A............  Reconstruction of          18.57       15.72       16.22        9.61       11.15        2.49         090
                                                 jaw.
21255...........  .............  A............  Reconstruct lower          18.14          NA          NA       14.03       15.08        2.39         090
                                                 jaw bone.
21256...........  .............  A............  Reconstruction of          17.42          NA          NA        9.57       10.69        1.50         090
                                                 orbit.
21260...........  .............  A............  Revise eye sockets..       17.74          NA          NA       12.95       12.85        0.97         090
21261...........  .............  A............  Revise eye sockets..       33.78          NA          NA       14.74       19.48        3.43         090
21263...........  .............  A............  Revise eye sockets..       30.72          NA          NA       14.03       16.55        2.63         090
21267...........  .............  A............  Revise eye sockets..       20.45          NA          NA       16.03       17.90        1.71         090
21268...........  .............  A............  Revise eye sockets..       26.78          NA          NA       13.13       16.66        3.66         090
21270...........  .............  A............  Augmentation, cheek        10.52       11.15       11.39        5.90        6.57        0.72         090
                                                 bone.
21275...........  .............  A............  Revision,                  11.65          NA          NA        7.15        7.65        1.29         090
                                                 orbitofacial bones.
21280...........  .............  A............  Revision of eyelid..        6.92          NA          NA        5.66        5.79        0.42         090
21282...........  .............  A............  Revision of eyelid..        4.11          NA          NA        4.16        4.32        0.26         090
21295...........  .............  A............  Revision of jaw             1.82          NA          NA        2.23        2.38        0.16         090
                                                 muscle/bone.
21296...........  .............  A............  Revision of jaw             4.67          NA          NA        5.43        5.16        0.34         090
                                                 muscle/bone.
21299...........  .............  C............  Cranio/maxillofacial        0.00        0.00        0.00        0.00        0.00        0.00         YYY
                                                 surgery.
21310...........  .............  A............  Treatment of nose           0.58        1.99        2.14        0.11        0.13        0.05         000
                                                 fracture.
21315...........  .............  A............  Treatment of nose           1.78        4.71        4.47        1.78        1.83        0.14         010
                                                 fracture.
21320...........  .............  A............  Treatment of nose           1.86        4.29        4.10        1.36        1.49        0.18         010
                                                 fracture.
21325...........  .............  A............  Treatment of nose           4.07          NA          NA        6.97        7.79        0.31         090
                                                 fracture.
21330...........  .............  A............  Treatment of nose           5.68          NA          NA        7.62        8.66        0.56         090
                                                 fracture.
21335...........  .............  A............  Treatment of nose           8.91          NA          NA        8.47        9.04        0.74         090
                                                 fracture.
21336...........  .............  A............  Treat nasal septal          6.56          NA          NA        8.66        9.13        0.55         090
                                                 fracture.
21337...........  .............  A............  Treat nasal septal          3.26        6.14        6.13        3.56        3.56        0.28         090
                                                 fracture.
21338...........  .............  A............  Treat nasoethmoid           6.76          NA          NA        9.92       11.97        0.82         090
                                                 fracture.
21339...........  .............  A............  Treat nasoethmoid           8.39          NA          NA        9.82       11.86        0.96         090
                                                 fracture.
21340...........  .............  A............  Treatment of nose          11.33          NA          NA        7.24        7.82        1.15         090
                                                 fracture.
21343...........  .............  A............  Treatment of sinus         14.11          NA          NA       12.79       14.12        1.47         090
                                                 fracture.
21344...........  .............  A............  Treatment of sinus         21.36          NA          NA       13.05       14.77        2.44         090
                                                 fracture.
21345...........  .............  A............  Treat nose/jaw              8.87       10.48       10.16        6.55        6.86        0.92         090
                                                 fracture.
21346...........  .............  A............  Treat nose/jaw             11.29          NA          NA       10.82       11.51        1.21         090
                                                 fracture.
21347...........  .............  A............  Treat nose/jaw             13.37          NA          NA       11.73       13.96        1.47         090
                                                 fracture.
21348...........  .............  A............  Treat nose/jaw             17.36          NA          NA       10.99       11.05        2.49         090
                                                 fracture.
21355...........  .............  A............  Treat cheek bone            4.32        5.90        6.07        3.25        3.36        0.34         010
                                                 fracture.
21356...........  .............  A............  Treat cheek bone            4.70        6.97        7.04        4.05        4.30        0.46         010
                                                 fracture.
21360...........  .............  A............  Treat cheek bone            7.03          NA          NA        5.39        5.66        0.74         090
                                                 fracture.
21365...........  .............  A............  Treat cheek bone           16.52          NA          NA        9.09        9.95        1.70         090
                                                 fracture.
21366...........  .............  A............  Treat cheek bone           18.44          NA          NA       10.50       10.91        2.50         090
                                                 fracture.
21385...........  .............  A............  Treat eye socket            9.46          NA          NA        7.13        7.70        0.97         090
                                                 fracture.
21386...........  .............  A............  Treat eye socket            9.46          NA          NA        6.00        6.53        0.97         090
                                                 fracture.
21387...........  .............  A............  Treat eye socket           10.00          NA          NA        7.44        8.20        1.08         090
                                                 fracture.
21390...........  .............  A............  Treat eye socket           11.07          NA          NA        7.01        7.40        0.90         090
                                                 fracture.
21395...........  .............  A............  Treat eye socket           14.62          NA          NA        8.33        8.68        1.44         090
                                                 fracture.
21400...........  .............  A............  Treat eye socket            1.44        2.70        2.66        1.96        1.92        0.15         090
                                                 fracture.
21401...........  .............  A............  Treat eye socket            3.57        7.03        7.51        3.04        3.27        0.38         090
                                                 fracture.
21406...........  .............  A............  Treat eye socket            7.31          NA          NA        5.29        5.68        0.73         090
                                                 fracture.
21407...........  .............  A............  Treat eye socket            8.91          NA          NA        5.92        6.39        0.94         090
                                                 fracture.
21408...........  .............  A............  Treat eye socket           12.67          NA          NA        7.44        8.16        1.44         090
                                                 fracture.
21421...........  .............  A............  Treat mouth roof            5.80       12.45       10.89        9.20        8.75        0.73         090
                                                 fracture.
21422...........  .............  A............  Treat mouth roof            8.62          NA          NA        7.04        7.56        0.99         090
                                                 fracture.
21423...........  .............  A............  Treat mouth roof           10.71          NA          NA        7.39        8.36        1.27         090
                                                 fracture.
21431...........  .............  A............  Treat craniofacial          7.74          NA          NA       10.83       10.18        0.70         090
                                                 fracture.
21432...........  .............  A............  Treat craniofacial          8.76          NA          NA        6.81        7.43        0.81         090
                                                 fracture.
21433...........  .............  A............  Treat craniofacial         26.13          NA          NA       12.13       14.26        2.79         090
                                                 fracture.
21435...........  .............  A............  Treat craniofacial         20.02          NA          NA       11.07       11.88        1.99         090
                                                 fracture.
21436...........  .............  A............  Treat craniofacial         30.01          NA          NA       13.13       15.67        3.10         090
                                                 fracture.
21440...........  .............  A............  Treat dental ridge          3.28       10.06        8.58        7.45        6.80        0.38         090
                                                 fracture.
21445...........  .............  A............  Treat dental ridge          6.04       12.27       11.01        8.46        8.41        0.78         090
                                                 fracture.
21450...........  .............  A............  Treat lower jaw             3.55       10.50        8.94        7.71        7.29        0.33         090
                                                 fracture.
21451...........  .............  A............  Treat lower jaw             5.46       12.97       11.16        9.67        9.03        0.63         090
                                                 fracture.
21452...........  .............  A............  Treat lower jaw             2.29       12.02       12.52        6.05        5.33        0.27         090
                                                 fracture.
21453...........  .............  A............  Treat lower jaw             6.40       14.80       12.76       11.64       11.18        0.74         090
                                                 fracture.

[[Page 66421]]

 
21454...........  .............  A............  Treat lower jaw             7.17          NA          NA        5.72        5.99        0.82         090
                                                 fracture.
21461...........  .............  A............  Treat lower jaw             9.07       41.68       33.06       12.80       12.73        0.98         090
                                                 fracture.
21462...........  .............  A............  Treat lower jaw            10.77       42.97       35.28       13.40       13.05        1.27         090
                                                 fracture.
21465...........  .............  A............  Treat lower jaw            12.88          NA          NA        8.11        8.96        1.50         090
                                                 fracture.
21470...........  .............  A............  Treat lower jaw            17.24          NA          NA       10.17       11.09        1.97         090
                                                 fracture.
21480...........  .............  A............  Reset dislocated jaw        0.61        1.52        1.64        0.18        0.18        0.06         000
21485...........  .............  A............  Reset dislocated jaw        4.58       12.09       10.15        9.10        8.38        0.51         090
21490...........  .............  A............  Repair dislocated          12.71          NA          NA        8.12        8.90        1.97         090
                                                 jaw.
21495...........  .............  A............  Treat hyoid bone            6.55          NA          NA       10.47        9.44        0.46         090
                                                 fracture.
21497...........  .............  A............  Interdental wiring..        4.45       12.21       10.33        9.34        8.49        0.50         090
21499...........  .............  C............  Head surgery                0.00        0.00        0.00        0.00        0.00        0.00         YYY
                                                 procedure.
21501...........  .............  A............  Drain neck/chest            3.87        6.55        6.49        3.52        3.67        0.43         090
                                                 lesion.
21502...........  .............  A............  Drain chest lesion..        7.43          NA          NA        4.56        5.09        0.97         090
21510...........  .............  A............  Drainage of bone            6.06          NA          NA        4.80        5.23        0.80         090
                                                 lesion.
21550...........  .............  A............  Biopsy of neck/chest        2.08        4.35        3.97        1.78        1.75        0.16         010
21555...........  .............  A............  Remove lesion, neck/        4.40        5.78        5.65        3.43        3.31        0.56         090
                                                 chest.
21556...........  .............  A............  Remove lesion, neck/        5.63          NA          NA        4.14        4.12        0.65         090
                                                 chest.
21557...........  .............  A............  Remove tumor, neck/         8.91          NA          NA        4.51        4.93        1.08         090
                                                 chest.
21600...........  .............  A............  Partial removal of          7.14          NA          NA        5.96        5.85        0.99         090
                                                 rib.
21610...........  .............  A............  Partial removal of         15.76          NA          NA        8.89        8.88        3.08         090
                                                 rib.
21615...........  .............  A............  Removal of rib......       10.31          NA          NA        5.16        5.92        1.45         090
21616...........  .............  A............  Removal of rib and         12.54          NA          NA        6.51        7.26        1.87         090
                                                 nerves.
21620...........  .............  A............  Partial removal of          7.16          NA          NA        4.76        5.36        0.98         090
                                                 sternum.
21627...........  .............  A............  Sternal debridement.        7.18          NA          NA        5.54        5.92        1.02         090
21630...........  .............  A............  Extensive sternum          19.01          NA          NA       10.34       11.09        2.59         090
                                                 surgery.
21632...........  .............  A............  Extensive sternum          19.51          NA          NA        9.42       10.26        2.66         090
                                                 surgery.
21685...........  .............  A............  Hyoid myotomy &            14.89          NA          NA        8.76        9.36        1.06         090
                                                 suspension.
21700...........  .............  A............  Revision of neck            6.23          NA          NA        4.39        4.41        0.32         090
                                                 muscle.
21705...........  .............  A............  Revision of neck            9.83          NA          NA        4.35        4.97        1.43         090
                                                 muscle/rib.
21720...........  .............  A............  Revision of neck            5.72          NA          NA        4.10        3.28        0.91         090
                                                 muscle.
21725...........  .............  A............  Revision of neck            7.10          NA          NA        5.14        5.29        1.21         090
                                                 muscle.
21740...........  .............  A............  Reconstruction of          17.47          NA          NA        8.20        8.35        2.37         090
                                                 sternum.
21742...........  .............  C............  Repair stern/nuss w/        0.00        0.00        0.00        0.00        0.00        0.00         090
                                                 o scope.
21743...........  .............  C............  Repair sternum/nuss         0.00        0.00        0.00        0.00        0.00        0.00         090
                                                 w/scope.
21750...........  .............  A............  Repair of sternum          11.35          NA          NA        5.31        5.71        1.63         090
                                                 separation.
21800...........  .............  A............  Treatment of rib            0.98        1.36        1.35        1.43        1.38        0.09         090
                                                 fracture.
21805...........  .............  A............  Treatment of rib            2.80          NA          NA        3.27        3.23        0.38         090
                                                 fracture.
21810...........  .............  A............  Treatment of rib            6.92          NA          NA        5.37        5.17        0.94         090
                                                 fracture(s).
21820...........  .............  A............  Treat sternum               1.31        1.82        1.82        1.89        1.83        0.16         090
                                                 fracture.
21825...........  .............  A............  Treat sternum               7.65          NA          NA        5.37        5.88        1.11         090
                                                 fracture.
21899...........  .............  C............  Neck/chest surgery          0.00        0.00        0.00        0.00        0.00        0.00         YYY
                                                 procedure.
21920...........  .............  A............  Biopsy soft tissue          2.08        4.43        3.86        1.88        1.67        0.14         010
                                                 of back.
21925...........  .............  A............  Biopsy soft tissue          4.54        5.34        5.25        3.36        3.30        0.60         090
                                                 of back.
21930...........  .............  A............  Remove lesion, back         5.06        6.04        5.88        3.77        3.58        0.66         090
                                                 or flank.
21935...........  .............  A............  Remove tumor, back..       18.38          NA          NA        8.44        9.03        2.48         090
22010...........  .............  A............  I&d, p-spine, c/t/         12.57          NA          NA        8.35        8.61        1.74         090
                                                 cerv-thor.
22015...........  .............  A............  I&d, p-spine, l/s/ls       12.46          NA          NA        8.33        8.58        1.72         090
22100...........  .............  A............  Remove part of neck        10.80          NA          NA        8.19        7.86        2.14         090
                                                 vertebra.
22101...........  .............  A............  Remove part, thorax        10.88          NA          NA        8.11        7.93        1.91         090
                                                 vertebra.
22102...........  .............  A............  Remove part, lumbar        10.88          NA          NA        7.92        8.01        1.88         090
                                                 vertebra.
22103...........  .............  A............  Remove extra spine          2.34          NA          NA        0.90        1.05        0.44         ZZZ
                                                 segment.
22110...........  .............  A............  Remove part of neck        13.80          NA          NA        9.11        9.14        2.77         090
                                                 vertebra.
22112...........  .............  A............  Remove part, thorax        13.87          NA          NA        9.02        9.15        2.53         090
                                                 vertebra.
22114...........  .............  A............  Remove part, lumbar        13.87          NA          NA        9.00        9.13        2.64         090
                                                 vertebra.
22116...........  .............  A............  Remove extra spine          2.32          NA          NA        0.89        1.03        0.50         ZZZ
                                                 segment.
22206...........  .............  A............  Cut spine 3 col,           37.00          NA          NA       17.71       17.71        6.23         090
                                                 thor.
22207...........  .............  A............  Cut spine 3 col,           36.50          NA          NA       17.59       17.59        6.07         090
                                                 lumb.
22208...........  .............  A............  Cut spine 3 col,            9.66        3.72        3.72        3.72        3.72        2.07         ZZZ
                                                 addl seg.
22210...........  .............  A............  Revision of neck           25.13          NA          NA       14.54       14.97        5.46         090
                                                 spine.
22212...........  .............  A............  Revision of thorax         20.74          NA          NA       12.44       12.85        3.91         090
                                                 spine.
22214...........  .............  A............  Revision of lumbar         20.77          NA          NA       12.53       13.17        3.92         090
                                                 spine.
22216...........  .............  A............  Revise, extra spine         6.03          NA          NA        2.32        2.73        1.29         ZZZ
                                                 segment.
22220...........  .............  A............  Revision of neck           22.69          NA          NA       13.35       13.48        5.08         090
                                                 spine.
22222...........  .............  A............  Revision of thorax         22.84          NA          NA       10.46       10.79        4.13         090
                                                 spine.
22224...........  .............  A............  Revision of lumbar         22.84          NA          NA       12.89       13.55        4.19         090
                                                 spine.
22226...........  .............  A............  Revise, extra spine         6.03          NA          NA        2.28        2.68        1.29         ZZZ
                                                 segment.
22305...........  .............  A............  Treat spine process         2.08        2.15        2.23        1.80        1.86        0.39         090
                                                 fracture.
22310...........  .............  A............  Treat spine fracture        3.69        2.98        2.89        2.50        2.42        0.50         090
22315...........  .............  A............  Treat spine fracture        9.91        9.88        9.78        7.43        7.38        1.86         090
22318...........  .............  A............  Treat odontoid fx w/       22.54          NA          NA       13.25       13.31        5.30         090
                                                 o graft.
22319...........  .............  A............  Treat odontoid fx w/       25.15          NA          NA       13.45       14.07        6.05         090
                                                 graft.
22325...........  .............  A............  Treat spine fracture       19.62          NA          NA       12.13       12.10        3.88         090

[[Page 66422]]

 
22326...........  .............  A............  Treat neck spine           20.64          NA          NA       12.02       12.36        4.43         090
                                                 fracture.
22327...........  .............  A............  Treat thorax spine         20.52          NA          NA       12.32       12.34        3.99         090
                                                 fracture.
22328...........  .............  A............  Treat each add spine        4.60          NA          NA        1.76        2.01        0.94         ZZZ
                                                 fx.
22505...........  .............  A............  Manipulation of             1.87          NA          NA        1.10        1.02        0.36         010
                                                 spine.
22520...........  .............  A............  Percut                      9.17       43.78       52.71        4.58        4.84        1.72         010
                                                 vertebroplasty thor.
22521...........  .............  A............  Percut                      8.60       44.96       50.45        4.36        4.65        1.60         010
                                                 vertebroplasty lumb.
22522...........  .............  A............  Percut                      4.30          NA          NA        1.51        1.59        0.82         ZZZ
                                                 vertebroplasty
                                                 add'l.
22523...........  .............  A............  Percut kyphoplasty,         9.21          NA          NA        4.67        5.28        1.72         010
                                                 thor.
22524...........  .............  A............  Percut kyphoplasty,         8.81          NA          NA        4.52        5.11        1.60         010
                                                 lumbar.
22525...........  .............  A............  Percut kyphoplasty,         4.47          NA          NA        1.69        1.98        0.82         ZZZ
                                                 add-on.
22526...........  .............  A............  Idet, single level..        6.07       46.67       46.67        2.04        2.04        1.16         010
22527...........  .............  A............  Idet, 1 or more             3.03       40.35       40.35        0.70        0.70        0.58         ZZZ
                                                 levels.
22532...........  .............  A............  Lat thorax spine           25.81          NA          NA       13.77       14.29        4.35         090
                                                 fusion.
22533...........  .............  A............  Lat lumbar spine           24.61          NA          NA       13.56       13.57        3.16         090
                                                 fusion.
22534...........  .............  A............  Lat thor/lumb, add'l        5.99          NA          NA        2.28        2.65        1.25         ZZZ
                                                 seg.
22548...........  .............  A............  Neck spine fusion...       26.86          NA          NA       14.92       15.36        5.61         090
22554...........  .............  A............  Neck spine fusion...       17.54          NA          NA       10.64       11.49        4.46         090
22556...........  .............  A............  Thorax spine fusion.       24.50          NA          NA       12.95       13.83        4.35         090
22558...........  .............  A............  Lumbar spine fusion.       23.33          NA          NA       11.42       12.35        3.16         090
22585...........  .............  A............  Additional spinal           5.52          NA          NA        2.05        2.42        1.25         ZZZ
                                                 fusion.
22590...........  .............  A............  Spine & skull spinal       21.56          NA          NA       13.07       13.19        4.79         090
                                                 fusion.
22595...........  .............  A............  Neck spinal fusion..       20.44          NA          NA       12.63       12.73        4.41         090
22600...........  .............  A............  Neck spine fusion...       17.20          NA          NA       11.19       11.19        3.73         090
22610...........  .............  A............  Thorax spine fusion.       17.08          NA          NA       10.81       11.11        3.53         090
22612...........  .............  A............  Lumbar spine fusion.       23.38          NA          NA       12.49       13.34        4.47         090
22614...........  .............  A............  Spine fusion, extra         6.43          NA          NA        2.45        2.90        1.38         ZZZ
                                                 segment.
22630...........  .............  A............  Lumbar spine fusion.       21.89          NA          NA       12.53       13.06        4.73         090
22632...........  .............  A............  Spine fusion, extra         5.22          NA          NA        1.99        2.32        1.16         ZZZ
                                                 segment.
22800...........  .............  A............  Fusion of spine.....       19.30          NA          NA       11.15       11.96        3.76         090
22802...........  .............  A............  Fusion of spine.....       31.91          NA          NA       15.98       17.78        6.17         090
22804...........  .............  A............  Fusion of spine.....       37.30          NA          NA       18.11       20.40        7.00         090
22808...........  .............  A............  Fusion of spine.....       27.31          NA          NA       14.05       15.17        4.93         090
22810...........  .............  A............  Fusion of spine.....       31.30          NA          NA       14.90       16.62        5.15         090
22812...........  .............  A............  Fusion of spine.....       34.00          NA          NA       17.37       18.71        5.30         090
22818...........  .............  A............  Kyphectomy, 1-2            34.18          NA          NA       16.61       17.73        6.47         090
                                                 segments.
22819...........  .............  A............  Kyphectomy, 3 or           39.18          NA          NA       18.86       19.45        7.67         090
                                                 more.
22830...........  .............  A............  Exploration of             11.13          NA          NA        7.05        7.50        2.30         090
                                                 spinal fusion.
22840...........  .............  A............  Insert spine               12.52          NA          NA        4.77        5.63        2.79         ZZZ
                                                 fixation device.
22841...........  .............  B............  Insert spine                0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 fixation device.
22842...........  .............  A............  Insert spine               12.56          NA          NA        4.79        5.64        2.75         ZZZ
                                                 fixation device.
22843...........  .............  A............  Insert spine               13.44          NA          NA        5.15        5.88        2.86         ZZZ
                                                 fixation device.
22844...........  .............  A............  Insert spine               16.42          NA          NA        6.40        7.57        3.19         ZZZ
                                                 fixation device.
22845...........  .............  A............  Insert spine               11.94          NA          NA        4.48        5.27        2.86         ZZZ
                                                 fixation device.
22846...........  .............  A............  Insert spine               12.40          NA          NA        4.66        5.49        2.96         ZZZ
                                                 fixation device.
22847...........  .............  A............  Insert spine               13.78          NA          NA        5.19        6.10        3.00         ZZZ
                                                 fixation device.
22848...........  .............  A............  Insert pelv fixation        5.99          NA          NA        2.33        2.76        1.15         ZZZ
                                                 device.
22849...........  .............  A............  Reinsert spinal            19.08          NA          NA       10.16       10.94        3.90         090
                                                 fixation.
22850...........  .............  A............  Remove spine                9.74          NA          NA        6.40        6.69        2.05         090
                                                 fixation device.
22851...........  .............  A............  Apply spine prosth          6.70          NA          NA        2.54        2.95        1.49         ZZZ
                                                 device.
22852...........  .............  A............  Remove spine                9.29          NA          NA        6.17        6.48        1.90         090
                                                 fixation device.
22855...........  .............  A............  Remove spine               15.77          NA          NA        9.17        9.41        3.52         090
                                                 fixation device.
22857...........  .............  R............  Lumbar artif               26.93          NA          NA       14.80       14.80        3.56         090
                                                 diskectomy.
22862...........  .............  R............  Revise lumbar artif        32.43          NA          NA       10.06       10.06        5.36         090
                                                 disc.
22865...........  .............  R............  Remove lumb artif          31.55          NA          NA        9.86        9.86        5.18         090
                                                 disc.
22899...........  .............  C............  Spine surgery               0.00        0.00        0.00        0.00        0.00        0.00         YYY
                                                 procedure.
22900...........  .............  A............  Remove abdominal            6.14          NA          NA        3.53        3.38        0.76         090
                                                 wall lesion.
22999...........  .............  C............  Abdomen surgery             0.00        0.00        0.00        0.00        0.00        0.00         YYY
                                                 procedure.
23000...........  .............  A............  Removal of calcium          4.40        7.88        8.20        3.73        4.07        0.68         090
                                                 deposits.
23020...........  .............  A............  Release shoulder            9.24          NA          NA        6.48        7.02        1.54         090
                                                 joint.
23030...........  .............  A............  Drain shoulder              3.44        6.28        6.83        2.40        2.65        0.57         010
                                                 lesion.
23031...........  .............  A............  Drain shoulder bursa        2.76        6.51        7.18        2.21        2.47        0.46         010
23035...........  .............  A............  Drain shoulder bone         9.04          NA          NA        6.45        7.35        1.47         090
                                                 lesion.
23040...........  .............  A............  Exploratory shoulder        9.63          NA          NA        6.74        7.30        1.60         090
                                                 surgery.
23044...........  .............  A............  Exploratory shoulder        7.48          NA          NA        5.51        5.97        1.24         090
                                                 surgery.
23065...........  .............  A............  Biopsy shoulder             2.28        2.95        2.72        1.74        1.68        0.20         010
                                                 tissues.
23066...........  .............  A............  Biopsy shoulder             4.21        7.75        7.71        3.61        3.79        0.63         090
                                                 tissues.
23075...........  .............  A............  Removal of shoulder         2.41        3.70        3.68        1.72        1.75        0.34         010
                                                 lesion.
23076...........  .............  A............  Removal of shoulder         7.77          NA          NA        5.32        5.43        1.13         090
                                                 lesion.
23077...........  .............  A............  Remove tumor of            18.08          NA          NA        9.60        9.90        2.34         090
                                                 shoulder.
23100...........  .............  A............  Biopsy of shoulder          6.09          NA          NA        4.99        5.32        1.04         090
                                                 joint.
23101...........  .............  A............  Shoulder joint              5.63          NA          NA        4.53        4.93        0.96         090
                                                 surgery.
23105...........  .............  A............  Remove shoulder             8.36          NA          NA        6.09        6.60        1.42         090
                                                 joint lining.

[[Page 66423]]

 
23106...........  .............  A............  Incision of                 6.02          NA          NA        4.78        5.24        0.99         090
                                                 collarbone joint.
23107...........  .............  A............  Explore treat               8.75          NA          NA        6.25        6.82        1.49         090
                                                 shoulder joint.
23120...........  .............  A............  Partial removal,            7.23          NA          NA        5.47        5.96        1.23         090
                                                 collar bone.
23125...........  .............  A............  Removal of collar           9.52          NA          NA        6.39        6.97        1.62         090
                                                 bone.
23130...........  .............  A............  Remove shoulder             7.63          NA          NA        6.07        6.60        1.30         090
                                                 bone, part.
23140...........  .............  A............  Removal of bone             7.01          NA          NA        4.90        5.06        1.08         090
                                                 lesion.
23145...........  .............  A............  Removal of bone             9.28          NA          NA        6.49        6.96        1.49         090
                                                 lesion.
23146...........  .............  A............  Removal of bone             7.96          NA          NA        5.91        6.51        1.35         090
                                                 lesion.
23150...........  .............  A............  Removal of humerus          8.79          NA          NA        6.25        6.58        1.32         090
                                                 lesion.
23155...........  .............  A............  Removal of humerus         10.72          NA          NA        7.25        7.78        1.81         090
                                                 lesion.
23156...........  .............  A............  Removal of humerus          8.99          NA          NA        6.28        6.83        1.50         090
                                                 lesion.
23170...........  .............  A............  Remove collar bone          7.10          NA          NA        5.00        5.51        1.12         090
                                                 lesion.
23172...........  .............  A............  Remove shoulder             7.20          NA          NA        5.51        5.90        1.01         090
                                                 blade lesion.
23174...........  .............  A............  Remove humerus              9.90          NA          NA        7.17        7.76        1.65         090
                                                 lesion.
23180...........  .............  A............  Remove collar bone          8.85          NA          NA        6.41        7.70        1.47         090
                                                 lesion.
23182...........  .............  A............  Remove shoulder             8.47          NA          NA        6.42        7.48        1.37         090
                                                 blade lesion.
23184...........  .............  A............  Remove humerus              9.76          NA          NA        6.92        8.12        1.63         090
                                                 lesion.
23190...........  .............  A............  Partial removal of          7.36          NA          NA        5.31        5.74        1.17         090
                                                 scapula.
23195...........  .............  A............  Removal of head of         10.24          NA          NA        6.91        7.32        1.71         090
                                                 humerus.
23200...........  .............  A............  Removal of collar          12.69          NA          NA        7.11        7.92        1.94         090
                                                 bone.
23210...........  .............  A............  Removal of shoulder        13.16          NA          NA        7.80        8.40        2.03         090
                                                 blade.
23220...........  .............  A............  Partial removal of         15.36          NA          NA        9.14        9.98        2.49         090
                                                 humerus.
23221...........  .............  A............  Partial removal of         18.41          NA          NA       10.61       11.16        3.06         090
                                                 humerus.
23222...........  .............  A............  Partial removal of         25.44          NA          NA       13.33       14.55        3.95         090
                                                 humerus.
23330...........  .............  A............  Remove shoulder             1.87        3.35        3.52        1.51        1.70        0.24         010
                                                 foreign body.
23331...........  .............  A............  Remove shoulder             7.51          NA          NA        5.83        6.31        1.27         090
                                                 foreign body.
23332...........  .............  A............  Remove shoulder            12.23          NA          NA        7.96        8.64        2.03         090
                                                 foreign body.
23350...........  .............  A............  Injection for               1.00        2.73        3.09        0.35        0.34        0.06         000
                                                 shoulder x-ray.
23395...........  .............  A............  Muscle                     18.29          NA          NA       11.20       12.03        2.94         090
                                                 transfer,shoulder/
                                                 arm.
23397...........  .............  A............  Muscle transfers....       16.62          NA          NA        9.54       10.45        2.74         090
23400...........  .............  A............  Fixation of shoulder       13.73          NA          NA        8.54        9.30        2.30         090
                                                 blade.
23405...........  .............  A............  Incision of tendon &        8.43          NA          NA        5.92        6.42        1.45         090
                                                 muscle.
23406...........  .............  A............  Incise tendon(s) &         10.90          NA          NA        6.90        7.62        1.88         090
                                                 muscle(s).
23410...........  .............  A............  Repair rotator cuff,       12.63          NA          NA        7.77        8.59        2.17         090
                                                 acute.
23412...........  .............  A............  Repair rotator cuff,       13.55          NA          NA        8.15        9.02        2.32         090
                                                 chronic.
23415...........  .............  A............  Release of shoulder        10.09          NA          NA        6.58        7.28        1.74         090
                                                 ligament.
23420...........  .............  A............  Repair of shoulder..       14.75          NA          NA        9.70       10.27        2.32         090
23430...........  .............  A............  Repair biceps tendon       10.05          NA          NA        6.77        7.43        1.74         090
23440...........  .............  A............  Remove/transplant          10.53          NA          NA        6.77        7.51        1.83         090
                                                 tendon.
23450...........  .............  A............  Repair shoulder            13.58          NA          NA        8.17        9.00        2.33         090
                                                 capsule.
23455...........  .............  A............  Repair shoulder            14.55          NA          NA        8.55        9.49        2.50         090
                                                 capsule.
23460...........  .............  A............  Repair shoulder            15.68          NA          NA        9.36       10.36        2.67         090
                                                 capsule.
23462...........  .............  A............  Repair shoulder            15.60          NA          NA        9.07        9.91        2.60         090
                                                 capsule.
23465...........  .............  A............  Repair shoulder            16.16          NA          NA        9.49       10.33        2.77         090
                                                 capsule.
23466...........  .............  A............  Repair shoulder            15.55          NA          NA        9.99       10.67        2.47         090
                                                 capsule.
23470...........  .............  A............  Reconstruct shoulder       17.75          NA          NA       10.11       11.18        2.99         090
                                                 joint.
23472...........  .............  A............  Reconstruct shoulder       22.47          NA          NA       12.14       13.27        3.67         090
                                                 joint.
23480...........  .............  A............  Revision of collar         11.42          NA          NA        7.29        8.03        1.95         090
                                                 bone.
23485...........  .............  A............  Revision of collar         13.79          NA          NA        8.20        9.04        2.34         090
                                                 bone.
23490...........  .............  A............  Reinforce clavicle..       12.04          NA          NA        6.74        7.72        1.47         090
23491...........  .............  A............  Reinforce shoulder         14.40          NA          NA        8.71        9.71        2.47         090
                                                 bones.
23500...........  .............  A............  Treat clavicle              2.13        2.64        2.76        2.71        2.62        0.30         090
                                                 fracture.
23505...........  .............  A............  Treat clavicle              3.74        4.01        4.21        3.61        3.73        0.61         090
                                                 fracture.
23515...........  .............  A............  Treat clavicle              9.53          NA          NA        7.00        6.77        1.28         090
                                                 fracture.
23520...........  .............  A............  Treat clavicle              2.21        2.77        2.81        2.84        2.79        0.34         090
                                                 dislocation.
23525...........  .............  A............  Treat clavicle              3.67        4.16        4.35        3.64        3.79        0.46         090
                                                 dislocation.
23530...........  .............  A............  Treat clavicle              7.37          NA          NA        5.30        5.62        1.20         090
                                                 dislocation.
23532...........  .............  A............  Treat clavicle              8.08          NA          NA        6.01        6.49        1.38         090
                                                 dislocation.
23540...........  .............  A............  Treat clavicle              2.28        2.66        2.76        2.73        2.55        0.29         090
                                                 dislocation.
23545...........  .............  A............  Treat clavicle              3.32        3.74        3.96        3.26        3.31        0.35         090
                                                 dislocation.
23550...........  .............  A............  Treat clavicle              7.48          NA          NA        5.54        5.95        1.25         090
                                                 dislocation.
23552...........  .............  A............  Treat clavicle              8.70          NA          NA        6.25        6.78        1.46         090
                                                 dislocation.
23570...........  .............  A............  Treat shoulder blade        2.28        2.78        2.89        2.92        2.91        0.36         090
                                                 fx.
23575...........  .............  A............  Treat shoulder blade        4.12        4.59        4.73        4.08        4.19        0.59         090
                                                 fx.
23585...........  .............  A............  Treat scapula              14.07          NA          NA        8.50        8.07        1.54         090
                                                 fracture.
23600...........  .............  A............  Treat humerus               3.00        4.07        4.31        3.65        3.60        0.48         090
                                                 fracture.
23605...........  .............  A............  Treat humerus               4.94        5.38        5.76        4.59        4.85        0.84         090
                                                 fracture.
23615...........  .............  A............  Treat humerus              12.12          NA          NA        8.05        8.44        1.62         090
                                                 fracture.
23616...........  .............  A............  Treat humerus              18.19          NA          NA       10.45       12.29        3.70         090
                                                 fracture.
23620...........  .............  A............  Treat humerus               2.46        3.41        3.51        3.14        3.06        0.40         090
                                                 fracture.
23625...........  .............  A............  Treat humerus               3.99        4.44        4.69        3.91        4.09        0.67         090
                                                 fracture.
23630...........  .............  A............  Treat humerus              10.39          NA          NA        7.36        7.00        1.27         090
                                                 fracture.

[[Page 66424]]

 
23650...........  .............  A............  Treat shoulder              3.44        3.29        3.53        2.82        2.79        0.30         090
                                                 dislocation.
23655...........  .............  A............  Treat shoulder              4.64          NA          NA        4.15        4.16        0.69         090
                                                 dislocation.
23660...........  .............  A............  Treat shoulder              7.55          NA          NA        5.68        6.03        1.29         090
                                                 dislocation.
23665...........  .............  A............  Treat dislocation/          4.54        4.85        5.09        4.26        4.49        0.71         090
                                                 fracture.
23670...........  .............  A............  Treat dislocation/         12.12          NA          NA        7.92        7.37        1.36         090
                                                 fracture.
23675...........  .............  A............  Treat dislocation/          6.13        6.12        6.47        5.13        5.48        1.01         090
                                                 fracture.
23680...........  .............  A............  Treat dislocation/         12.99          NA          NA        8.23        8.16        1.76         090
                                                 fracture.
23700...........  .............  A............  Fixation of shoulder        2.54          NA          NA        1.90        2.04        0.44         010
23800...........  .............  A............  Fusion of shoulder         14.59          NA          NA        8.86        9.63        2.36         090
                                                 joint.
23802...........  .............  A............  Fusion of shoulder         18.17          NA          NA       11.20       10.68        2.71         090
                                                 joint.
23900...........  .............  A............  Amputation of arm &        20.57          NA          NA       10.41       11.06        3.19         090
                                                 girdle.
23920...........  .............  A............  Amputation at              16.03          NA          NA        9.21        9.56        2.47         090
                                                 shoulder joint.
23921...........  .............  A............  Amputation follow-up        5.61          NA          NA        4.85        4.96        0.78         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             2.96        4.98        5.65        1.98        2.14        0.43         010
                                                 lesion.
23931...........  .............  A............  Drainage of arm             1.81        4.35        5.13        1.75        1.96        0.28         010
                                                 bursa.
23935...........  .............  A............  Drain arm/elbow bone        6.27          NA          NA        5.09        5.50        1.05         090
                                                 lesion.
24000...........  .............  A............  Exploratory elbow           5.99          NA          NA        4.75        5.08        0.97         090
                                                 surgery.
24006...........  .............  A............  Release elbow joint.        9.62          NA          NA        6.59        7.17        1.50         090
24065...........  .............  A............  Biopsy arm/elbow            2.10        4.15        3.68        1.92        1.83        0.17         010
                                                 soft tissue.
24066...........  .............  A............  Biopsy arm/elbow            5.26        8.26        8.60        3.92        4.02        0.80         090
                                                 soft tissue.
24075...........  .............  A............  Remove arm/elbow            3.96        7.18        7.26        3.26        3.33        0.56         090
                                                 lesion.
24076...........  .............  A............  Remove arm/elbow            6.36          NA          NA        4.59        4.72        0.95         090
                                                 lesion.
24077...........  .............  A............  Remove tumor of arm/       11.95          NA          NA        6.85        7.29        1.73         090
                                                 elbow.
24100...........  .............  A............  Biopsy elbow joint          4.98          NA          NA        4.09        4.30        0.85         090
                                                 lining.
24101...........  .............  A............  Explore/treat elbow         6.19          NA          NA        5.04        5.49        1.03         090
                                                 joint.
24102...........  .............  A............  Remove elbow joint          8.15          NA          NA        5.80        6.33        1.33         090
                                                 lining.
24105...........  .............  A............  Removal of elbow            3.67          NA          NA        4.02        4.20        0.61         090
                                                 bursa.
24110...........  .............  A............  Remove humerus              7.46          NA          NA        5.65        6.15        1.28         090
                                                 lesion.
24115...........  .............  A............  Remove/graft bone          10.00          NA          NA        4.32        5.76        1.68         090
                                                 lesion.
24116...........  .............  A............  Remove/graft bone          12.11          NA          NA        7.67        8.37        2.06         090
                                                 lesion.
24120...........  .............  A............  Remove elbow lesion.        6.71          NA          NA        5.17        5.55        1.10         090
24125...........  .............  A............  Remove/graft bone           8.02          NA          NA        5.99        6.07        1.06         090
                                                 lesion.
24126...........  .............  A............  Remove/graft bone           8.50          NA          NA        6.00        6.51        1.16         090
                                                 lesion.
24130...........  .............  A............  Removal of head of          6.31          NA          NA        5.12        5.57        1.04         090
                                                 radius.
24134...........  .............  A............  Removal of arm bone        10.10          NA          NA        6.90        7.87        1.64         090
                                                 lesion.
24136...........  .............  A............  Remove radius bone          8.29          NA          NA        5.76        6.49        1.38         090
                                                 lesion.
24138...........  .............  A............  Remove elbow bone           8.33          NA          NA        6.48        7.13        1.34         090
                                                 lesion.
24140...........  .............  A............  Partial removal of          9.43          NA          NA        6.57        7.83        1.51         090
                                                 arm bone.
24145...........  .............  A............  Partial removal of          7.70          NA          NA        5.64        6.84        1.25         090
                                                 radius.
24147...........  .............  A............  Partial removal of          7.69          NA          NA        6.28        7.43        1.30         090
                                                 elbow.
24149...........  .............  A............  Radical resection of       15.92          NA          NA       10.76       11.19        2.35         090
                                                 elbow.
24150...........  .............  A............  Extensive humerus          13.70          NA          NA        8.49        9.24        2.33         090
                                                 surgery.
24151...........  .............  A............  Extensive humerus          16.08          NA          NA        9.68       10.59        2.60         090
                                                 surgery.
24152...........  .............  A............  Extensive radius           10.24          NA          NA        6.16        6.94        1.48         090
                                                 surgery.
24153...........  .............  A............  Extensive radius           11.73          NA          NA        4.87        5.22        0.74         090
                                                 surgery.
24155...........  .............  A............  Removal of elbow           11.97          NA          NA        7.41        7.90        1.93         090
                                                 joint.
24160...........  .............  A............  Remove elbow joint          7.89          NA          NA        5.82        6.35        1.30         090
                                                 implant.
24164...........  .............  A............  Remove radius head          6.34          NA          NA        4.89        5.33        1.03         090
                                                 implant.
24200...........  .............  A............  Removal of arm              1.78        2.74        3.07        1.36        1.49        0.20         010
                                                 foreign body.
24201...........  .............  A............  Removal of arm              4.61        7.79        8.80        3.66        3.94        0.72         090
                                                 foreign body.
24220...........  .............  A............  Injection for elbow         1.31        2.66        3.14        0.46        0.45        0.08         000
                                                 x-ray.
24300...........  .............  A............  Manipulate elbow w/         3.86          NA          NA        5.16        5.43        0.65         090
                                                 anesth.
24301...........  .............  A............  Muscle/tendon              10.26          NA          NA        6.83        7.50        1.66         090
                                                 transfer.
24305...........  .............  A............  Arm tendon                  7.51          NA          NA        5.65        6.18        1.15         090
                                                 lengthening.
24310...........  .............  A............  Revision of arm             6.03          NA          NA        4.73        5.15        0.96         090
                                                 tendon.
24320...........  .............  A............  Repair of arm tendon       10.74          NA          NA        7.02        7.27        1.74         090
24330...........  .............  A............  Revision of arm             9.67          NA          NA        6.63        7.25        1.60         090
                                                 muscles.
24331...........  .............  A............  Revision of arm            10.83          NA          NA        6.94        7.81        1.78         090
                                                 muscles.
24332...........  .............  A............  Tenolysis, triceps..        7.77          NA          NA        5.91        6.34        1.23         090
24340...........  .............  A............  Repair of biceps            7.96          NA          NA        5.96        6.47        1.36         090
                                                 tendon.
24341...........  .............  A............  Repair arm tendon/          9.24          NA          NA        7.52        7.71        1.36         090
                                                 muscle.
24342...........  .............  A............  Repair of ruptured         10.74          NA          NA        7.06        7.79        1.86         090
                                                 tendon.
24343...........  .............  A............  Repr elbow lat              8.99          NA          NA        6.98        7.56        1.43         090
                                                 ligmnt w/tiss.
24344...........  .............  A............  Reconstruct elbow          14.97          NA          NA        9.95       10.73        2.37         090
                                                 lat ligmnt.
24345...........  .............  A............  Repr elbw med ligmnt        8.99          NA          NA        6.93        7.47        1.44         090
                                                 w/tissu.
24346...........  .............  A............  Reconstruct elbow          14.97          NA          NA       10.03       10.68        2.34         090
                                                 med ligmnt.
24357...........  .............  A............  Repair elbow, perc..        5.32          NA          NA        4.72        5.15        0.87         090
24358...........  .............  A............  Repair elbow w/deb,         6.54          NA          NA        5.27        5.73        1.07         090
                                                 open.
24359...........  .............  A............  Repair elbow deb/           8.86          NA          NA        6.19        6.19        1.41         090
                                                 attch open.
24360...........  .............  A............  Reconstruct elbow          12.53          NA          NA        7.84        8.65        2.06         090
                                                 joint.
24361...........  .............  A............  Reconstruct elbow          14.27          NA          NA        8.75        9.66        2.19         090
                                                 joint.

[[Page 66425]]

 
24362...........  .............  A............  Reconstruct elbow          15.18          NA          NA        5.73        7.88        2.61         090
                                                 joint.
24363...........  .............  A............  Replace elbow joint.       22.47          NA          NA       12.16       12.93        3.02         090
24365...........  .............  A............  Reconstruct head of         8.51          NA          NA        5.96        6.58        1.41         090
                                                 radius.
24366...........  .............  A............  Reconstruct head of         9.25          NA          NA        6.30        6.92        1.52         090
                                                 radius.
24400...........  .............  A............  Revision of humerus.       11.19          NA          NA        7.49        8.17        1.93         090
24410...........  .............  A............  Revision of humerus.       14.96          NA          NA        9.24        9.77        2.58         090
24420...........  .............  A............  Revision of humerus.       13.58          NA          NA        8.50        9.52        2.18         090
24430...........  .............  A............  Repair of humerus...       15.07          NA          NA        9.22        9.48        2.22         090
24435...........  .............  A............  Repair humerus with        14.74          NA          NA        9.80       10.34        2.28         090
                                                 graft.
24470...........  .............  A............  Revision of elbow           8.81          NA          NA        5.65        6.68        1.48         090
                                                 joint.
24495...........  .............  A............  Decompression of            8.30          NA          NA        6.41        7.57        1.18         090
                                                 forearm.
24498...........  .............  A............  Reinforce humerus...       12.16          NA          NA        7.66        8.46        2.07         090
24500...........  .............  A............  Treat humerus               3.29        4.45        4.64        3.80        3.74        0.50         090
                                                 fracture.
24505...........  .............  A............  Treat humerus               5.25        5.83        6.21        4.87        5.13        0.89         090
                                                 fracture.
24515...........  .............  A............  Treat humerus              11.97          NA          NA        8.03        8.71        2.03         090
                                                 fracture.
24516...........  .............  A............  Treat humerus              12.07          NA          NA        7.64        8.37        2.03         090
                                                 fracture.
24530...........  .............  A............  Treat humerus               3.57        4.73        4.97        4.00        4.02        0.57         090
                                                 fracture.
24535...........  .............  A............  Treat humerus               6.96        6.81        7.32        5.86        6.24        1.18         090
                                                 fracture.
24538...........  .............  A............  Treat humerus               9.63          NA          NA        7.18        7.94        1.64         090
                                                 fracture.
24545...........  .............  A............  Treat humerus              12.99          NA          NA        8.27        8.36        1.83         090
                                                 fracture.
24546...........  .............  A............  Treat humerus              14.73          NA          NA        9.10       10.20        2.74         090
                                                 fracture.
24560...........  .............  A............  Treat humerus               2.87        4.11        4.29        3.43        3.31        0.44         090
                                                 fracture.
24565...........  .............  A............  Treat humerus               5.64        5.93        6.27        5.04        5.28        0.93         090
                                                 fracture.
24566...........  .............  A............  Treat humerus               8.86          NA          NA        6.79        7.47        1.30         090
                                                 fracture.
24575...........  .............  A............  Treat humerus               9.53          NA          NA        6.96        7.68        1.87         090
                                                 fracture.
24576...........  .............  A............  Treat humerus               2.94        4.41        4.58        3.71        3.71        0.46         090
                                                 fracture.
24577...........  .............  A............  Treat humerus               5.87        6.03        6.48        5.08        5.46        0.95         090
                                                 fracture.
24579...........  .............  A............  Treat humerus              11.26          NA          NA        7.74        8.28        2.03         090
                                                 fracture.
24582...........  .............  A............  Treat humerus               9.89          NA          NA        8.17        8.64        1.48         090
                                                 fracture.
24586...........  .............  A............  Treat elbow fracture       15.64          NA          NA        9.31       10.27        2.65         090
24587...........  .............  A............  Treat elbow fracture       15.65          NA          NA        9.31       10.16        2.53         090
24600...........  .............  A............  Treat elbow                 4.28        3.86        4.36        3.28        3.39        0.50         090
                                                 dislocation.
24605...........  .............  A............  Treat elbow                 5.50          NA          NA        4.91        5.13        0.89         090
                                                 dislocation.
24615...........  .............  A............  Treat elbow                 9.72          NA          NA        6.55        7.18        1.60         090
                                                 dislocation.
24620...........  .............  A............  Treat elbow fracture        7.07          NA          NA        5.48        5.87        1.07         090
24635...........  .............  A............  Treat elbow fracture        8.64          NA          NA        6.55       10.29        2.29         090
24640...........  .............  A............  Treat elbow                 1.22        1.52        1.68        0.83        0.81        0.12         010
                                                 dislocation.
24650...........  .............  A............  Treat radius                2.22        3.42        3.60        2.99        2.87        0.35         090
                                                 fracture.
24655...........  .............  A............  Treat radius                4.48        5.18        5.56        4.40        4.59        0.70         090
                                                 fracture.
24665...........  .............  A............  Treat radius                8.22          NA          NA        6.51        7.01        1.41         090
                                                 fracture.
24666...........  .............  A............  Treat radius                9.74          NA          NA        6.95        7.50        1.62         090
                                                 fracture.
24670...........  .............  A............  Treat ulnar fracture        2.60        3.72        3.91        3.15        3.11        0.41         090
24675...........  .............  A............  Treat ulnar fracture        4.79        5.37        5.68        4.57        4.77        0.81         090
24685...........  .............  A............  Treat ulnar fracture        8.21          NA          NA        6.51        7.01        1.52         090
24800...........  .............  A............  Fusion of elbow            11.27          NA          NA        6.88        7.81        1.63         090
                                                 joint.
24802...........  .............  A............  Fusion/graft of            14.18          NA          NA        8.02        9.20        2.38         090
                                                 elbow joint.
24900...........  .............  A............  Amputation of upper        10.04          NA          NA        6.41        6.73        1.53         090
                                                 arm.
24920...........  .............  A............  Amputation of upper        10.02          NA          NA        6.03        6.48        1.61         090
                                                 arm.
24925...........  .............  A............  Amputation follow-up        7.19          NA          NA        4.94        5.51        1.14         090
                                                 surgery.
24930...........  .............  A............  Amputation follow-up       10.72          NA          NA        6.19        6.71        1.68         090
                                                 surgery.
24931...........  .............  A............  Amputate upper arm &       13.32          NA          NA        5.07        5.40        1.90         090
                                                 implant.
24935...........  .............  A............  Revision of                16.30          NA          NA       10.46        9.24        2.14         090
                                                 amputation.
24940...........  .............  C............  Revision of upper           0.00        0.00        0.00        0.00        0.00        0.00         090
                                                 arm.
24999...........  .............  C............  Upper arm/elbow             0.00        0.00        0.00        0.00        0.00        0.00         YYY
                                                 surgery.
25000...........  .............  A............  Incision of tendon          3.44          NA          NA        3.98        5.42        0.55         090
                                                 sheath.
25001...........  .............  A............  Incise flexor carpi         3.68          NA          NA        3.94        4.08        0.55         090
                                                 radialis.
25020...........  .............  A............  Decompress forearm 1        5.97          NA          NA        6.94        8.25        0.93         090
                                                 space.
25023...........  .............  A............  Decompress forearm 1       13.69          NA          NA       11.32       13.12        2.04         090
                                                 space.
25024...........  .............  A............  Decompress forearm 2       10.62          NA          NA        7.08        7.27        1.36         090
                                                 spaces.
25025...........  .............  A............  Decompress forearm 2       17.77          NA          NA        9.69        9.83        1.83         090
                                                 spaces.
25028...........  .............  A............  Drainage of forearm         5.30          NA          NA        6.19        7.17        0.81         090
                                                 lesion.
25031...........  .............  A............  Drainage of forearm         4.18          NA          NA        3.49        5.70        0.63         090
                                                 bursa.
25035...........  .............  A............  Treat forearm bone          7.54          NA          NA        5.62        9.60        1.24         090
                                                 lesion.
25040...........  .............  A............  Explore/treat wrist         7.41          NA          NA        5.39        6.34        1.15         090
                                                 joint.
25065...........  .............  A............  Biopsy forearm soft         2.01        4.33        3.77        1.98        1.94        0.15         010
                                                 tissues.
25066...........  .............  A............  Biopsy forearm soft         4.18          NA          NA        3.83        5.45        0.64         090
                                                 tissues.
25075...........  .............  A............  Removal forearm             3.78          NA          NA        3.31        4.60        0.55         090
                                                 lesion subcu.
25076...........  .............  A............  Removal forearm             4.97          NA          NA        4.11        6.82        0.74         090
                                                 lesion deep.
25077...........  .............  A............  Remove tumor,               9.90          NA          NA        6.17        9.13        1.42         090
                                                 forearm/wrist.
25085...........  .............  A............  Incision of wrist           5.55          NA          NA        4.61        5.86        0.85         090
                                                 capsule.
25100...........  .............  A............  Biopsy of wrist             3.94          NA          NA        3.77        4.52        0.59         090
                                                 joint.
25101...........  .............  A............  Explore/treat wrist         4.74          NA          NA        4.35        5.12        0.75         090
                                                 joint.

[[Page 66426]]

 
25105...........  .............  A............  Remove wrist joint          5.91          NA          NA        4.97        6.13        0.92         090
                                                 lining.
25107...........  .............  A............  Remove wrist joint          7.50          NA          NA        6.24        7.28        0.99         090
                                                 cartilage.
25109...........  .............  A............  Excise tendon               6.81          NA          NA        5.23        5.23        0.96         090
                                                 forearm/wrist.
25110...........  .............  A............  Remove wrist tendon         3.96          NA          NA        3.62        5.33        0.62         090
                                                 lesion.
25111...........  .............  A............  Remove wrist tendon         3.44          NA          NA        3.61        4.15        0.53         090
                                                 lesion.
25112...........  .............  A............  Reremove wrist              4.58          NA          NA        4.07        4.66        0.70         090
                                                 tendon lesion.
25115...........  .............  A............  Remove wrist/forearm        9.89          NA          NA        7.33       10.68        1.31         090
                                                 lesion.
25116...........  .............  A............  Remove wrist/forearm        7.38          NA          NA        6.18        9.66        1.11         090
                                                 lesion.
25118...........  .............  A............  Excise wrist tendon         4.42          NA          NA        4.14        4.94        0.68         090
                                                 sheath.
25119...........  .............  A............  Partial removal of          6.10          NA          NA        5.06        6.33        0.96         090
                                                 ulna.
25120...........  .............  A............  Removal of forearm          6.16          NA          NA        5.09        8.58        1.00         090
                                                 lesion.
25125...........  .............  A............  Remove/graft forearm        7.55          NA          NA        5.68        9.26        1.06         090
                                                 lesion.
25126...........  .............  A............  Remove/graft forearm        7.62          NA          NA        5.86        9.43        1.27         090
                                                 lesion.
25130...........  .............  A............  Removal of wrist            5.32          NA          NA        4.72        5.57        0.80         090
                                                 lesion.
25135...........  .............  A............  Remove & graft wrist        6.96          NA          NA        5.62        6.56        1.02         090
                                                 lesion.
25136...........  .............  A............  Remove & graft wrist        6.03          NA          NA        5.09        5.84        1.03         090
                                                 lesion.
25145...........  .............  A............  Remove forearm bone         6.43          NA          NA        5.21        8.63        1.01         090
                                                 lesion.
25150...........  .............  A............  Partial removal of          7.27          NA          NA        5.53        6.86        1.14         090
                                                 ulna.
25151...........  .............  A............  Partial removal of          7.57          NA          NA        5.64        9.18        1.18         090
                                                 radius.
25170...........  .............  A............  Extensive forearm          11.34          NA          NA        7.36       11.25        1.78         090
                                                 surgery.
25210...........  .............  A............  Removal of wrist            6.01          NA          NA        5.04        5.91        0.88         090
                                                 bone.
25215...........  .............  A............  Removal of wrist            8.02          NA          NA        6.02        7.39        1.19         090
                                                 bones.
25230...........  .............  A............  Partial removal of          5.28          NA          NA        4.49        5.32        0.79         090
                                                 radius.
25240...........  .............  A............  Partial removal of          5.22          NA          NA        4.46        5.70        0.81         090
                                                 ulna.
25246...........  .............  A............  Injection for wrist         1.45        2.73        3.08        0.53        0.50        0.09         000
                                                 x-ray.
25248...........  .............  A............  Remove forearm              5.20          NA          NA        4.04        6.28        0.72         090
                                                 foreign body.
25250...........  .............  A............  Removal of wrist            6.66          NA          NA        5.27        5.68        1.01         090
                                                 prosthesis.
25251...........  .............  A............  Removal of wrist            9.70          NA          NA        6.74        7.33        1.26         090
                                                 prosthesis.
25259...........  .............  A............  Manipulate wrist w/         3.86          NA          NA        5.15        5.43        0.62         090
                                                 anesthes.
25260...........  .............  A............  Repair forearm              7.89          NA          NA        6.37        9.84        1.19         090
                                                 tendon/muscle.
25263...........  .............  A............  Repair forearm              7.90          NA          NA        6.09        9.67        1.18         090
                                                 tendon/muscle.
25265...........  .............  A............  Repair forearm              9.96          NA          NA        7.10       10.70        1.47         090
                                                 tendon/muscle.
25270...........  .............  A............  Repair forearm              6.06          NA          NA        4.97        8.49        0.95         090
                                                 tendon/muscle.
25272...........  .............  A............  Repair forearm              7.10          NA          NA        5.48        9.13        1.11         090
                                                 tendon/muscle.
25274...........  .............  A............  Repair forearm              8.82          NA          NA        6.37        9.99        1.36         090
                                                 tendon/muscle.
25275...........  .............  A............  Repair forearm              8.82          NA          NA        6.48        7.02        1.31         090
                                                 tendon sheath.
25280...........  .............  A............  Revise wrist/forearm        7.28          NA          NA        5.55        9.09        1.08         090
                                                 tendon.
25290...........  .............  A............  Incise wrist/forearm        5.34          NA          NA        4.50        9.74        0.82         090
                                                 tendon.
25295...........  .............  A............  Release wrist/              6.61          NA          NA        5.29        8.72        1.00         090
                                                 forearm tendon.
25300...........  .............  A............  Fusion of tendons at        8.88          NA          NA        6.65        7.55        1.26         090
                                                 wrist.
25301...........  .............  A............  Fusion of tendons at        8.47          NA          NA        6.18        7.12        1.29         090
                                                 wrist.
25310...........  .............  A............  Transplant forearm          8.26          NA          NA        5.93        9.48        1.21         090
                                                 tendon.
25312...........  .............  A............  Transplant forearm          9.70          NA          NA        6.70       10.32        1.41         090
                                                 tendon.
25315...........  .............  A............  Revise palsy hand          10.56          NA          NA        7.10       10.74        1.58         090
                                                 tendon(s).
25316...........  .............  A............  Revise palsy hand          12.76          NA          NA        7.81       12.01        1.75         090
                                                 tendon(s).
25320...........  .............  A............  Repair/revise wrist        12.38          NA          NA        9.86       10.62        1.61         090
                                                 joint.
25332...........  .............  A............  Revise wrist joint..       11.60          NA          NA        7.60        8.39        1.84         090
25335...........  .............  A............  Realignment of hand.       13.25          NA          NA        8.30        9.94        1.93         090
25337...........  .............  A............  Reconstruct ulna/          11.44          NA          NA        8.62        9.85        1.61         090
                                                 radioulnar.
25350...........  .............  A............  Revision of radius..        8.97          NA          NA        6.34       10.15        1.46         090
25355...........  .............  A............  Revision of radius..       10.41          NA          NA        6.74       10.67        1.74         090
25360...........  .............  A............  Revision of ulna....        8.62          NA          NA        6.23       10.05        1.41         090
25365...........  .............  A............  Revise radius & ulna       12.77          NA          NA        8.17       11.90        2.16         090
25370...........  .............  A............  Revise radius or           13.93          NA          NA        9.00       12.53        2.29         090
                                                 ulna.
25375...........  .............  A............  Revise radius & ulna       13.41          NA          NA        8.36       12.39        2.27         090
25390...........  .............  A............  Shorten radius or          10.58          NA          NA        7.06       10.82        1.65         090
                                                 ulna.
25391...........  .............  A............  Lengthen radius or         14.14          NA          NA        8.66       12.60        2.22         090
                                                 ulna.
25392...........  .............  A............  Shorten radius &           14.44          NA          NA        8.90       12.43        2.11         090
                                                 ulna.
25393...........  .............  A............  Lengthen radius &          16.42          NA          NA        9.55       13.56        2.77         090
                                                 ulna.
25394...........  .............  A............  Repair carpal bone,        10.71          NA          NA        6.94        7.50        1.59         090
                                                 shorten.
25400...........  .............  A............  Repair radius or           11.16          NA          NA        7.26       11.22        1.83         090
                                                 ulna.
25405...........  .............  A............  Repair/graft radius        14.87          NA          NA        8.92       13.09        2.33         090
                                                 or ulna.
25415...........  .............  A............  Repair radius & ulna       13.66          NA          NA        8.79       12.64        2.18         090
25420...........  .............  A............  Repair/graft radius        16.89          NA          NA        9.92       14.09        2.62         090
                                                 & ulna.
25425...........  .............  A............  Repair/graft radius        13.58          NA          NA        8.48       14.93        2.09         090
                                                 or ulna.
25426...........  .............  A............  Repair/graft radius        16.31          NA          NA        9.19       12.86        2.55         090
                                                 & ulna.
25430...........  .............  A............  Vasc graft into             9.57          NA          NA        7.03        7.18        1.27         090
                                                 carpal bone.
25431...........  .............  A............  Repair nonunion            10.75          NA          NA        7.15        7.77        1.91         090
                                                 carpal bone.
25440...........  .............  A............  Repair/graft wrist         10.56          NA          NA        6.89        8.14        1.63         090
                                                 bone.
25441...........  .............  A............  Reconstruct wrist          13.15          NA          NA        8.10        9.05        2.08         090
                                                 joint.
25442...........  .............  A............  Reconstruct wrist          10.98          NA          NA        7.50        8.19        1.53         090
                                                 joint.
25443...........  .............  A............  Reconstruct wrist          10.52          NA          NA        7.21        7.99        1.37         090
                                                 joint.

[[Page 66427]]

 
25444...........  .............  A............  Reconstruct wrist          11.28          NA          NA        7.43        8.23        1.72         090
                                                 joint.
25445...........  .............  A............  Reconstruct wrist           9.76          NA          NA        6.69        7.34        1.55         090
                                                 joint.
25446...........  .............  A............  Wrist replacement...       17.16          NA          NA        9.98       10.94        2.48         090
25447...........  .............  A............  Repair wrist               10.95          NA          NA        7.86        8.26        1.61         090
                                                 joint(s).
25449...........  .............  A............  Remove wrist joint         14.80          NA          NA        8.95        9.81        2.22         090
                                                 implant.
25450...........  .............  A............  Revision of wrist           7.94          NA          NA        3.84        7.01        1.36         090
                                                 joint.
25455...........  .............  A............  Revision of wrist           9.57          NA          NA        6.84        8.85        0.96         090
                                                 joint.
25490...........  .............  A............  Reinforce radius....        9.61          NA          NA        6.57       10.15        1.43         090
25491...........  .............  A............  Reinforce ulna......       10.03          NA          NA        6.78       10.62        1.60         090
25492...........  .............  A............  Reinforce radius and       12.52          NA          NA        8.33       11.81        2.15         090
                                                 ulna.
25500...........  .............  A............  Treat fracture of           2.51        3.30        3.44        2.86        2.79        0.35         090
                                                 radius.
25505...........  .............  A............  Treat fracture of           5.30        5.82        6.18        4.98        5.20        0.90         090
                                                 radius.
25515...........  .............  A............  Treat fracture of           8.64          NA          NA        6.46        6.96        1.59         090
                                                 radius.
25520...........  .............  A............  Treat fracture of           6.35        5.69        6.27        5.14        5.60        1.08         090
                                                 radius.
25525...........  .............  A............  Treat fracture of          10.37          NA          NA        7.41        8.70        2.13         090
                                                 radius.
25526...........  .............  A............  Treat fracture of          12.96          NA          NA        8.68       11.09        2.20         090
                                                 radius.
25530...........  .............  A............  Treat fracture of           2.15        3.48        3.62        2.97        2.92        0.34         090
                                                 ulna.
25535...........  .............  A............  Treat fracture of           5.22        5.57        5.79        4.83        5.06        0.89         090
                                                 ulna.
25545...........  .............  A............  Treat fracture of           7.78          NA          NA        6.23        6.94        1.53         090
                                                 ulna.
25560...........  .............  A............  Treat fracture              2.50        3.36        3.53        2.85        2.73        0.35         090
                                                 radius & ulna.
25565...........  .............  A............  Treat fracture              5.71        5.90        6.30        4.92        5.17        0.93         090
                                                 radius & ulna.
25574...........  .............  A............  Treat fracture              8.64          NA          NA        6.55        6.87        1.21         090
                                                 radius & ulna.
25575...........  .............  A............  Treat fracture             12.10          NA          NA        8.36        8.93        1.82         090
                                                 radius/ulna.
25600...........  .............  A............  Treat fracture              2.69        3.68        3.88        3.17        3.07        0.42         090
                                                 radius/ulna.
25605...........  .............  A............  Treat fracture              7.02        6.86        7.04        6.13        6.17        1.00         090
                                                 radius/ulna.
25606...........  .............  A............  Treat fx distal             8.10          NA          NA        6.69        7.82        1.26         090
                                                 radial.
25607...........  .............  A............  Treat fx rad extra-         9.35          NA          NA        7.19        7.19        1.36         090
                                                 articul.
25608...........  .............  A............  Treat fx rad intra-        10.86          NA          NA        7.79        7.79        1.84         090
                                                 articul.
25609...........  .............  A............  Treat fx radial 3+         14.12          NA          NA        9.65        9.65        2.38         090
                                                 frag.
25622...........  .............  A............  Treat wrist bone            2.68        3.90        4.08        3.35        3.23        0.41         090
                                                 fracture.
25624...........  .............  A............  Treat wrist bone            4.62        5.63        5.96        4.77        4.92        0.76         090
                                                 fracture.
25628...........  .............  A............  Treat wrist bone            9.51          NA          NA        6.84        7.33        1.37         090
                                                 fracture.
25630...........  .............  A............  Treat wrist bone            2.94        3.75        3.96        3.25        3.09        0.45         090
                                                 fracture.
25635...........  .............  A............  Treat wrist bone            4.47        5.11        5.53        4.34        4.12        0.74         090
                                                 fracture.
25645...........  .............  A............  Treat wrist bone            7.31          NA          NA        5.55        6.09        1.20         090
                                                 fracture.
25650...........  .............  A............  Treat wrist bone            3.12        3.84        4.07        3.44        3.31        0.45         090
                                                 fracture.
25651...........  .............  A............  Pin ulnar styloid           5.68          NA          NA        5.15        5.31        0.86         090
                                                 fracture.
25652...........  .............  A............  Treat fracture ulnar        7.92          NA          NA        6.16        6.58        1.21         090
                                                 styloid.
25660...........  .............  A............  Treat wrist                 4.84          NA          NA        4.32        4.51        0.58         090
                                                 dislocation.
25670...........  .............  A............  Treat wrist                 7.98          NA          NA        5.81        6.40        1.28         090
                                                 dislocation.
25671...........  .............  A............  Pin radioulnar              6.32          NA          NA        5.53        5.84        1.00         090
                                                 dislocation.
25675...........  .............  A............  Treat wrist                 4.75        4.71        5.18        3.99        4.32        0.62         090
                                                 dislocation.
25676...........  .............  A............  Treat wrist                 8.17          NA          NA        6.13        6.71        1.34         090
                                                 dislocation.
25680...........  .............  A............  Treat wrist fracture        6.08          NA          NA        4.38        4.56        0.78         090
25685...........  .............  A............  Treat wrist fracture        9.97          NA          NA        6.62        7.21        1.60         090
25690...........  .............  A............  Treat wrist                 5.58          NA          NA        4.85        5.17        0.88         090
                                                 dislocation.
25695...........  .............  A............  Treat wrist                 8.40          NA          NA        6.00        6.54        1.32         090
                                                 dislocation.
25800...........  .............  A............  Fusion of wrist             9.95          NA          NA        6.79        7.94        1.57         090
                                                 joint.
25805...........  .............  A............  Fusion/graft of            11.59          NA          NA        7.67        8.96        1.81         090
                                                 wrist joint.
25810...........  .............  A............  Fusion/graft of            11.75          NA          NA        8.03        8.97        1.68         090
                                                 wrist joint.
25820...........  .............  A............  Fusion of hand bones        7.52          NA          NA        6.41        7.12        1.22         090
25825...........  .............  A............  Fuse hand bones with        9.54          NA          NA        7.65        8.44        1.41         090
                                                 graft.
25830...........  .............  A............  Fusion, radioulnar         10.69          NA          NA       10.57       12.49        1.55         090
                                                 jnt/ulna.
25900...........  .............  A............  Amputation of               9.46          NA          NA        6.73        9.64        1.30         090
                                                 forearm.
25905...........  .............  A............  Amputation of               9.48          NA          NA        6.06        9.17        1.40         090
                                                 forearm.
25907...........  .............  A............  Amputation follow-up        7.98          NA          NA        5.77        8.76        1.10         090
                                                 surgery.
25909...........  .............  A............  Amputation follow-up        9.20          NA          NA        6.32        9.30        1.44         090
                                                 surgery.
25915...........  .............  A............  Amputation of              17.38          NA          NA        5.97       12.42        2.94         090
                                                 forearm.
25920...........  .............  A............  Amputate hand at            8.92          NA          NA        6.59        7.21        1.35         090
                                                 wrist.
25922...........  .............  A............  Amputate hand at            7.54          NA          NA        6.27        6.66        1.12         090
                                                 wrist.
25924...........  .............  A............  Amputation follow-up        8.70          NA          NA        6.12        7.10        1.32         090
                                                 surgery.
25927...........  .............  A............  Amputation of hand..        8.98          NA          NA        8.65       10.16        1.27         090
25929...........  .............  A............  Amputation follow-up        7.71          NA          NA        5.66        5.77        1.14         090
                                                 surgery.
25931...........  .............  A............  Amputation follow-up        7.93          NA          NA        8.32        9.89        1.15         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          1.56        4.06        4.81        1.52        1.57        0.18         010
                                                 abscess.
26011...........  .............  A............  Drainage of finger          2.21        6.24        7.53        1.96        2.14        0.33         010
                                                 abscess.
26020...........  .............  A............  Drain hand tendon           4.97          NA          NA        4.74        5.05        0.73         090
                                                 sheath.
26025...........  .............  A............  Drainage of palm            4.99          NA          NA        4.46        4.78        0.76         090
                                                 bursa.
26030...........  .............  A............  Drainage of palm            6.16          NA          NA        5.00        5.36        0.92         090
                                                 bursa(s).
26034...........  .............  A............  Treat hand bone             6.49          NA          NA        5.57        5.96        1.01         090
                                                 lesion.
26035...........  .............  A............  Decompress fingers/        11.14          NA          NA        8.12        7.99        1.47         090
                                                 hand.

[[Page 66428]]

 
26037...........  .............  A............  Decompress fingers/         7.48          NA          NA        5.49        5.91        1.13         090
                                                 hand.
26040...........  .............  A............  Release palm                3.38          NA          NA        3.60        3.82        0.53         090
                                                 contracture.
26045...........  .............  A............  Release palm                5.62          NA          NA        4.88        5.26        0.93         090
                                                 contracture.
26055...........  .............  A............  Incise finger tendon        3.00        9.04       11.69        3.82        3.88        0.43         090
                                                 sheath.
26060...........  .............  A............  Incision of finger          2.85          NA          NA        3.05        3.28        0.45         090
                                                 tendon.
26070...........  .............  A............  Explore/treat hand          3.73          NA          NA        3.05        3.21        0.48         090
                                                 joint.
26075...........  .............  A............  Explore/treat finger        3.83          NA          NA        3.37        3.57        0.53         090
                                                 joint.
26080...........  .............  A............  Explore/treat finger        4.36          NA          NA        4.32        4.58        0.66         090
                                                 joint.
26100...........  .............  A............  Biopsy hand joint           3.71          NA          NA        3.66        3.89        0.54         090
                                                 lining.
26105...........  .............  A............  Biopsy finger joint         3.75          NA          NA        3.68        3.95        0.59         090
                                                 lining.
26110...........  .............  A............  Biopsy finger joint         3.57          NA          NA        3.60        3.82        0.53         090
                                                 lining.
26115...........  .............  A............  Removal hand lesion         3.92        9.83       11.46        4.23        4.49        0.59         090
                                                 subcut.
26116...........  .............  A............  Removal hand lesion,        5.61          NA          NA        5.30        5.65        0.84         090
                                                 deep.
26117...........  .............  A............  Remove tumor, hand/         8.62          NA          NA        6.18        6.62        1.26         090
                                                 finger.
26121...........  .............  A............  Release palm                7.61          NA          NA        5.92        6.44        1.17         090
                                                 contracture.
26123...........  .............  A............  Release palm               10.63          NA          NA        8.21        8.53        1.43         090
                                                 contracture.
26125...........  .............  A............  Release palm                4.60          NA          NA        1.87        2.15        0.70         ZZZ
                                                 contracture.
26130...........  .............  A............  Remove wrist joint          5.48          NA          NA        4.88        5.11        0.94         090
                                                 lining.
26135...........  .............  A............  Revise finger joint,        7.02          NA          NA        5.47        5.96        1.07         090
                                                 each.
26140...........  .............  A............  Revise finger joint,        6.23          NA          NA        5.16        5.60        0.92         090
                                                 each.
26145...........  .............  A............  Tendon excision,            6.38          NA          NA        5.18        5.62        0.97         090
                                                 palm/finger.
26160...........  .............  A............  Remove tendon sheath        3.46        9.03       10.70        3.94        4.03        0.49         090
                                                 lesion.
26170...........  .............  A............  Removal of palm             4.82          NA          NA        4.37        4.65        0.69         090
                                                 tendon, each.
26180...........  .............  A............  Removal of finger           5.24          NA          NA        4.71        5.06        0.78         090
                                                 tendon.
26185...........  .............  A............  Remove finger bone..        6.32          NA          NA        5.73        5.88        0.81         090
26200...........  .............  A............  Remove hand bone            5.56          NA          NA        4.55        4.95        0.88         090
                                                 lesion.
26205...........  .............  A............  Remove/graft bone           7.82          NA          NA        5.85        6.37        1.20         090
                                                 lesion.
26210...........  .............  A............  Removal of finger           5.21          NA          NA        4.73        5.08        0.79         090
                                                 lesion.
26215...........  .............  A............  Remove/graft finger         7.16          NA          NA        5.54        5.92        0.98         090
                                                 lesion.
26230...........  .............  A............  Partial removal of          6.38          NA          NA        4.95        5.43        1.01         090
                                                 hand bone.
26235...........  .............  A............  Partial removal,            6.24          NA          NA        4.94        5.38        0.95         090
                                                 finger bone.
26236...........  .............  A............  Partial removal,            5.37          NA          NA        4.57        4.95        0.81         090
                                                 finger bone.
26250...........  .............  A............  Extensive hand              7.61          NA          NA        5.71        6.07        1.07         090
                                                 surgery.
26255...........  .............  A............  Extensive hand             12.80          NA          NA        8.28        8.82        1.69         090
                                                 surgery.
26260...........  .............  A............  Extensive finger            7.09          NA          NA        5.46        5.82        1.01         090
                                                 surgery.
26261...........  .............  A............  Extensive finger            9.28          NA          NA        6.72        6.44        1.14         090
                                                 surgery.
26262...........  .............  A............  Partial removal of          5.72          NA          NA        4.74        5.04        0.88         090
                                                 finger.
26320...........  .............  A............  Removal of implant          4.02          NA          NA        3.79        4.05        0.59         090
                                                 from hand.
26340...........  .............  A............  Manipulate finger w/        2.62          NA          NA        4.60        4.74        0.39         090
                                                 anesth.
26350...........  .............  A............  Repair finger/hand          6.07          NA          NA        9.52       12.06        0.93         090
                                                 tendon.
26352...........  .............  A............  Repair/graft hand           7.75          NA          NA       10.06       12.70        1.13         090
                                                 tendon.
26356...........  .............  A............  Repair finger/hand         10.22          NA          NA       13.70       16.03        1.21         090
                                                 tendon.
26357...........  .............  A............  Repair finger/hand          8.65          NA          NA       10.35       12.99        1.33         090
                                                 tendon.
26358...........  .............  A............  Repair/graft hand           9.22          NA          NA       10.94       13.79        1.38         090
                                                 tendon.
26370...........  .............  A............  Repair finger/hand          7.17          NA          NA        9.50       12.30        1.12         090
                                                 tendon.
26372...........  .............  A............  Repair/graft hand           8.89          NA          NA       10.53       13.52        1.40         090
                                                 tendon.
26373...........  .............  A............  Repair finger/hand          8.29          NA          NA       10.16       13.10        1.23         090
                                                 tendon.
26390...........  .............  A............  Revise hand/finger          9.31          NA          NA        9.20       11.24        1.40         090
                                                 tendon.
26392...........  .............  A............  Repair/graft hand          10.38          NA          NA       11.16       13.94        1.57         090
                                                 tendon.
26410...........  .............  A............  Repair hand tendon..        4.68          NA          NA        7.63        9.78        0.73         090
26412...........  .............  A............  Repair/graft hand           6.37          NA          NA        8.62       10.94        0.97         090
                                                 tendon.
26415...........  .............  A............  Excision, hand/             8.40          NA          NA        7.46        9.62        0.98         090
                                                 finger tendon.
26416...........  .............  A............  Graft hand or finger        9.44          NA          NA        9.04       11.81        0.79         090
                                                 tendon.
26418...........  .............  A............  Repair finger tendon        4.33          NA          NA        8.14       10.23        0.67         090
26420...........  .............  A............  Repair/graft finger         6.83          NA          NA        8.80       11.21        1.07         090
                                                 tendon.
26426...........  .............  A............  Repair finger/hand          6.21          NA          NA        5.11        9.13        0.95         090
                                                 tendon.
26428...........  .............  A............  Repair/graft finger         7.28          NA          NA        9.25       11.55        1.09         090
                                                 tendon.
26432...........  .............  A............  Repair finger tendon        4.07          NA          NA        6.78        8.52        0.64         090
26433...........  .............  A............  Repair finger tendon        4.61          NA          NA        7.01        8.90        0.72         090
26434...........  .............  A............  Repair/graft finger         6.15          NA          NA        7.93        9.73        0.93         090
                                                 tendon.
26437...........  .............  A............  Realignment of              5.88          NA          NA        7.81        9.68        0.89         090
                                                 tendons.
26440...........  .............  A............  Release palm/finger         5.07          NA          NA        8.48       10.95        0.75         090
                                                 tendon.
26442...........  .............  A............  Release palm &              9.50          NA          NA       11.81       13.87        1.20         090
                                                 finger tendon.
26445...........  .............  A............  Release hand/finger         4.36          NA          NA        8.23       10.68        0.65         090
                                                 tendon.
26449...........  .............  A............  Release forearm/hand        8.34          NA          NA        7.27       11.52        1.06         090
                                                 tendon.
26450...........  .............  A............  Incision of palm            3.71          NA          NA        5.19        6.26        0.59         090
                                                 tendon.
26455...........  .............  A............  Incision of finger          3.68          NA          NA        5.15        6.21        0.58         090
                                                 tendon.
26460...........  .............  A............  Incise hand/finger          3.50          NA          NA        5.11        6.12        0.55         090
                                                 tendon.
26471...........  .............  A............  Fusion of finger            5.79          NA          NA        7.79        9.51        0.88         090
                                                 tendons.
26474...........  .............  A............  Fusion of finger            5.38          NA          NA        7.60        9.49        0.76         090
                                                 tendons.
26476...........  .............  A............  Tendon lengthening..        5.24          NA          NA        7.35        9.14        0.79         090
26477...........  .............  A............  Tendon shortening...        5.21          NA          NA        7.57        9.31        0.81         090

[[Page 66429]]

 
26478...........  .............  A............  Lengthening of hand         5.86          NA          NA        7.78        9.80        0.90         090
                                                 tendon.
26479...........  .............  A............  Shortening of hand          5.80          NA          NA        7.73        9.64        0.92         090
                                                 tendon.
26480...........  .............  A............  Transplant hand             6.76          NA          NA        9.65       12.34        1.02         090
                                                 tendon.
26483...........  .............  A............  Transplant/graft            8.36          NA          NA       10.22       12.85        1.26         090
                                                 hand tendon.
26485...........  .............  A............  Transplant palm             7.77          NA          NA       10.07       12.71        1.15         090
                                                 tendon.
26489...........  .............  A............  Transplant/graft            9.74          NA          NA       10.82       11.43        1.26         090
                                                 palm tendon.
26490...........  .............  A............  Revise thumb tendon.        8.48          NA          NA        8.87       10.84        1.21         090
26492...........  .............  A............  Tendon transfer with        9.70          NA          NA        9.82       11.71        1.40         090
                                                 graft.
26494...........  .............  A............  Hand tendon/muscle          8.54          NA          NA        9.23       11.10        1.28         090
                                                 transfer.
26496...........  .............  A............  Revise thumb tendon.        9.66          NA          NA        9.57       11.40        1.45         090
26497...........  .............  A............  Finger tendon               9.64          NA          NA        9.52       11.54        1.41         090
                                                 transfer.
26498...........  .............  A............  Finger tendon              14.07          NA          NA       11.65       13.90        2.11         090
                                                 transfer.
26499...........  .............  A............  Revision of finger..        9.05          NA          NA        8.84       10.94        1.35         090
26500...........  .............  A............  Hand tendon                 6.02          NA          NA        7.74        9.59        0.90         090
                                                 reconstruction.
26502...........  .............  A............  Hand tendon                 7.20          NA          NA        8.32       10.17        1.13         090
                                                 reconstruction.
26508...........  .............  A............  Release thumb               6.07          NA          NA        7.80        9.73        0.98         090
                                                 contracture.
26510...........  .............  A............  Thumb tendon                5.49          NA          NA        7.63        9.48        0.79         090
                                                 transfer.
26516...........  .............  A............  Fusion of knuckle           7.21          NA          NA        8.30       10.26        1.10         090
                                                 joint.
26517...........  .............  A............  Fusion of knuckle           8.96          NA          NA        8.99       11.24        1.41         090
                                                 joints.
26518...........  .............  A............  Fusion of knuckle           9.15          NA          NA        8.96       11.17        1.35         090
                                                 joints.
26520...........  .............  A............  Release knuckle             5.36          NA          NA        8.86       11.37        0.80         090
                                                 contracture.
26525...........  .............  A............  Release finger              5.39          NA          NA        8.88       11.42        0.81         090
                                                 contracture.
26530...........  .............  A............  Revise knuckle joint        6.76          NA          NA        5.41        5.77        1.04         090
26531...........  .............  A............  Revise knuckle with         7.99          NA          NA        6.16        6.64        1.17         090
                                                 implant.
26535...........  .............  A............  Revise finger joint.        5.30          NA          NA        4.09        3.91        0.71         090
26536...........  .............  A............  Revise/implant              6.44          NA          NA        9.24        9.44        0.96         090
                                                 finger joint.
26540...........  .............  A............  Repair hand joint...        6.49          NA          NA        8.05        9.96        0.99         090
26541...........  .............  A............  Repair hand joint           8.69          NA          NA        9.11       11.25        1.28         090
                                                 with graft.
26542...........  .............  A............  Repair hand joint           6.84          NA          NA        8.19       10.11        1.02         090
                                                 with graft.
26545...........  .............  A............  Reconstruct finger          6.99          NA          NA        8.45       10.29        1.05         090
                                                 joint.
26546...........  .............  A............  Repair nonunion hand       10.53          NA          NA       11.42       13.22        1.44         090
26548...........  .............  A............  Reconstruct finger          8.10          NA          NA        8.80       10.82        1.20         090
                                                 joint.
26550...........  .............  A............  Construct thumb            21.54          NA          NA       14.53       16.05        2.46         090
                                                 replacement.
26551...........  .............  A............  Great toe-hand             48.23          NA          NA       17.15       24.79        7.98         090
                                                 transfer.
26553...........  .............  A............  Single transfer, toe-      47.92          NA          NA       27.34       25.01        2.42         090
                                                 hand.
26554...........  .............  A............  Double transfer, toe-      56.73          NA          NA       35.78       36.65        9.44         090
                                                 hand.
26555...........  .............  A............  Positional change of       16.94          NA          NA       13.99       16.08        2.49         090
                                                 finger.
26556...........  .............  A............  Toe joint transfer..       49.43          NA          NA       18.03       25.67        2.58         090
26560...........  .............  A............  Repair of web finger        5.43          NA          NA        6.65        8.22        0.85         090
26561...........  .............  A............  Repair of web finger       10.98          NA          NA        9.50       10.92        1.45         090
26562...........  .............  A............  Repair of web finger       16.40          NA          NA        8.76       12.95        2.24         090
26565...........  .............  A............  Correct metacarpal          6.80          NA          NA        8.15       10.07        1.00         090
                                                 flaw.
26567...........  .............  A............  Correct finger              6.88          NA          NA        8.11       10.03        1.04         090
                                                 deformity.
26568...........  .............  A............  Lengthen metacarpal/        9.15          NA          NA       10.69       13.05        1.49         090
                                                 finger.
26580...........  .............  A............  Repair hand                19.50          NA          NA        9.73       11.68        2.29         090
                                                 deformity.
26587...........  .............  A............  Reconstruct extra          14.36          NA          NA        8.01        8.61        1.53         090
                                                 finger.
26590...........  .............  A............  Repair finger              18.51          NA          NA       12.41       13.17        2.78         090
                                                 deformity.
26591...........  .............  A............  Repair muscles of           3.30          NA          NA        6.21        7.91        0.48         090
                                                 hand.
26593...........  .............  A............  Release muscles of          5.38          NA          NA        7.79        9.46        0.78         090
                                                 hand.
26596...........  .............  A............  Excision                    9.02          NA          NA        7.48        8.15        1.43         090
                                                 constricting tissue.
26600...........  .............  A............  Treat metacarpal            2.48        3.83        3.72        3.49        3.07        0.30         090
                                                 fracture.
26605...........  .............  A............  Treat metacarpal            2.92        4.08        4.32        3.50        3.58        0.49         090
                                                 fracture.
26607...........  .............  A............  Treat metacarpal            5.40          NA          NA        4.88        5.58        0.87         090
                                                 fracture.
26608...........  .............  A............  Treat metacarpal            5.43          NA          NA        5.22        5.74        0.88         090
                                                 fracture.
26615...........  .............  A............  Treat metacarpal            6.91          NA          NA        6.01        5.66        0.86         090
                                                 fracture.
26641...........  .............  A............  Treat thumb                 4.01        4.03        4.30        3.40        3.46        0.39         090
                                                 dislocation.
26645...........  .............  A............  Treat thumb fracture        4.47        4.60        4.88        3.92        4.05        0.67         090
26650...........  .............  A............  Treat thumb fracture        5.19          NA          NA        4.88        5.78        0.94         090
26665...........  .............  A............  Treat thumb fracture        7.78          NA          NA        6.31        6.46        0.90         090
26670...........  .............  A............  Treat hand                  3.74        3.62        3.94        3.03        2.99        0.39         090
                                                 dislocation.
26675...........  .............  A............  Treat hand                  4.71        5.25        5.36        4.51        4.49        0.77         090
                                                 dislocation.
26676...........  .............  A............  Pin hand dislocation        5.60          NA          NA        5.56        6.12        0.91         090
26685...........  .............  A............  Treat hand                  6.91          NA          NA        5.97        6.05        1.09         090
                                                 dislocation.
26686...........  .............  A............  Treat hand                  8.06          NA          NA        6.07        6.48        1.24         090
                                                 dislocation.
26700...........  .............  A............  Treat knuckle               3.74        3.30        3.53        2.93        2.89        0.35         090
                                                 dislocation.
26705...........  .............  A............  Treat knuckle               4.26        4.74        5.04        4.04        4.17        0.66         090
                                                 dislocation.
26706...........  .............  A............  Pin knuckle                 5.19          NA          NA        4.70        4.89        0.81         090
                                                 dislocation.
26715...........  .............  A............  Treat knuckle               6.87          NA          NA        5.99        5.75        0.91         090
                                                 dislocation.
26720...........  .............  A............  Treat finger                1.70        2.58        2.68        2.30        2.18        0.24         090
                                                 fracture, each.
26725...........  .............  A............  Treat finger                3.39        4.08        4.42        3.41        3.45        0.53         090
                                                 fracture, each.
26727...........  .............  A............  Treat finger                5.30          NA          NA        5.18        5.70        0.84         090
                                                 fracture, each.
26735...........  .............  A............  Treat finger                7.26          NA          NA        6.12        5.84        0.95         090
                                                 fracture, each.

[[Page 66430]]

 
26740...........  .............  A............  Treat finger                1.99        3.01        3.07        2.71        2.71        0.31         090
                                                 fracture, each.
26742...........  .............  A............  Treat finger                3.90        4.26        4.62        3.56        3.72        0.58         090
                                                 fracture, each.
26746...........  .............  A............  Treat finger                9.59          NA          NA        7.19        6.38        0.91         090
                                                 fracture, each.
26750...........  .............  A............  Treat finger                1.74        2.25        2.36        2.26        2.14        0.22         090
                                                 fracture, each.
26755...........  .............  A............  Treat finger                3.15        3.74        4.08        2.94        2.97        0.42         090
                                                 fracture, each.
26756...........  .............  A............  Pin finger fracture,        4.46          NA          NA        4.86        5.29        0.71         090
                                                 each.
26765...........  .............  A............  Treat finger                5.70          NA          NA        5.47        4.93        0.66         090
                                                 fracture, each.
26770...........  .............  A............  Treat finger                3.07        2.92        3.17        2.54        2.48        0.27         090
                                                 dislocation.
26775...........  .............  A............  Treat finger                3.78        4.62        4.90        3.88        3.84        0.54         090
                                                 dislocation.
26776...........  .............  A............  Pin finger                  4.87          NA          NA        4.98        5.49        0.77         090
                                                 dislocation.
26785...........  .............  A............  Treat finger                6.44          NA          NA        5.77        5.15        0.68         090
                                                 dislocation.
26820...........  .............  A............  Thumb fusion with           8.33          NA          NA        8.96       11.10        1.30         090
                                                 graft.
26841...........  .............  A............  Fusion of thumb.....        7.21          NA          NA        8.76       10.99        1.18         090
26842...........  .............  A............  Thumb fusion with           8.37          NA          NA        9.01       11.19        1.32         090
                                                 graft.
26843...........  .............  A............  Fusion of hand joint        7.67          NA          NA        8.56       10.45        1.15         090
26844...........  .............  A............  Fusion/graft of hand        8.86          NA          NA        9.15       11.25        1.33         090
                                                 joint.
26850...........  .............  A............  Fusion of knuckle...        7.03          NA          NA        8.26       10.23        1.06         090
26852...........  .............  A............  Fusion of knuckle           8.59          NA          NA        9.13       11.01        1.22         090
                                                 with graft.
26860...........  .............  A............  Fusion of finger            4.76          NA          NA        7.53        9.35        0.73         090
                                                 joint.
26861...........  .............  A............  Fusion of finger            1.74          NA          NA        0.70        0.81        0.27         ZZZ
                                                 jnt, add-on.
26862...........  .............  A............  Fusion/graft of             7.44          NA          NA        8.66       10.50        1.10         090
                                                 finger joint.
26863...........  .............  A............  Fuse/graft added            3.89          NA          NA        1.58        1.85        0.56         ZZZ
                                                 joint.
26910...........  .............  A............  Amputate metacarpal         7.67          NA          NA        8.27        9.74        1.16         090
                                                 bone.
26951...........  .............  A............  Amputation of finger/       5.85          NA          NA        8.39        9.27        0.71         090
                                                 thumb.
26952...........  .............  A............  Amputation of finger/       6.37          NA          NA        7.90        9.78        0.95         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          7.84          NA          NA        6.20        6.70        1.22         090
                                                 lesion.
26991...........  .............  A............  Drainage of pelvis          6.97        8.61        9.88        4.88        5.15        1.11         090
                                                 bursa.
26992...........  .............  A............  Drainage of bone           13.37          NA          NA        8.41        9.39        2.17         090
                                                 lesion.
27000...........  .............  A............  Incision of hip             5.66          NA          NA        4.51        4.90        0.98         090
                                                 tendon.
27001...........  .............  A............  Incision of hip             7.05          NA          NA        5.22        5.66        1.24         090
                                                 tendon.
27003...........  .............  A............  Incision of hip             7.70          NA          NA        5.72        6.10        1.12         090
                                                 tendon.
27005...........  .............  A............  Incision of hip             9.96          NA          NA        6.48        7.15        1.73         090
                                                 tendon.
27006...........  .............  A............  Incision of hip             9.99          NA          NA        6.75        7.36        1.70         090
                                                 tendons.
27025...........  .............  A............  Incision of hip/           12.66          NA          NA        8.20        8.37        1.85         090
                                                 thigh fascia.
27030...........  .............  A............  Drainage of hip            13.54          NA          NA        8.03        8.83        2.27         090
                                                 joint.
27033...........  .............  A............  Exploration of hip         13.99          NA          NA        8.39        9.15        2.33         090
                                                 joint.
27035...........  .............  A............  Denervation of hip         17.23          NA          NA        8.52        9.87        2.16         090
                                                 joint.
27036...........  .............  A............  Excision of hip            14.18          NA          NA        8.91        9.45        2.27         090
                                                 joint/muscle.
27040...........  .............  A............  Biopsy of soft              2.89        5.19        5.21        1.87        1.94        0.27         010
                                                 tissues.
27041...........  .............  A............  Biopsy of soft             10.07          NA          NA        5.73        6.18        1.35         090
                                                 tissues.
27047...........  .............  A............  Remove hip/pelvis           7.51        7.02        7.06        4.49        4.63        1.03         090
                                                 lesion.
27048...........  .............  A............  Remove hip/pelvis           6.44          NA          NA        4.60        4.70        0.92         090
                                                 lesion.
27049...........  .............  A............  Remove tumor, hip/         15.20          NA          NA        8.16        8.28        2.07         090
                                                 pelvis.
27050...........  .............  A............  Biopsy of sacroiliac        4.65          NA          NA        3.01        3.71        0.60         090
                                                 joint.
27052...........  .............  A............  Biopsy of hip joint.        7.27          NA          NA        5.64        5.76        1.08         090
27054...........  .............  A............  Removal of hip joint        9.09          NA          NA        6.49        6.91        1.47         090
                                                 lining.
27060...........  .............  A............  Removal of ischial          5.78          NA          NA        4.36        4.37        0.80         090
                                                 bursa.
27062...........  .............  A............  Remove femur lesion/        5.66          NA          NA        4.60        4.89        0.93         090
                                                 bursa.
27065...........  .............  A............  Removal of hip bone         6.44          NA          NA        4.99        5.21        1.01         090
                                                 lesion.
27066...........  .............  A............  Removal of hip bone        11.06          NA          NA        7.43        7.93        1.80         090
                                                 lesion.
27067...........  .............  A............  Remove/graft hip           14.57          NA          NA        8.83        9.74        1.85         090
                                                 bone lesion.
27070...........  .............  A............  Partial removal of         11.44          NA          NA        8.02        8.58        1.75         090
                                                 hip bone.
27071...........  .............  A............  Partial removal of         12.25          NA          NA        8.47        9.29        1.93         090
                                                 hip bone.
27075...........  .............  A............  Extensive hip              36.77          NA          NA       16.13       17.66        5.66         090
                                                 surgery.
27076...........  .............  A............  Extensive hip              24.25          NA          NA       12.82       13.66        3.71         090
                                                 surgery.
27077...........  .............  A............  Extensive hip              42.54          NA          NA       19.92       21.29        6.14         090
                                                 surgery.
27078...........  .............  A............  Extensive hip              14.54          NA          NA        8.81        9.37        2.23         090
                                                 surgery.
27079...........  .............  A............  Extensive hip              14.91          NA          NA        8.00        8.77        1.95         090
                                                 surgery.
27080...........  .............  A............  Removal of tail bone        6.80          NA          NA        4.58        4.70        0.93         090
27086...........  .............  A............  Remove hip foreign          1.89        3.66        4.10        1.48        1.65        0.25         010
                                                 body.
27087...........  .............  A............  Remove hip foreign          8.72          NA          NA        5.65        6.15        1.35         090
                                                 body.
27090...........  .............  A............  Removal of hip             11.57          NA          NA        7.40        8.09        1.95         090
                                                 prosthesis.
27091...........  .............  A............  Removal of hip             24.15          NA          NA       12.90       13.44        3.85         090
                                                 prosthesis.
27093...........  .............  A............  Injection for hip x-        1.30        3.15        3.80        0.47        0.48        0.13         000
                                                 ray.
27095...........  .............  A............  Injection for hip x-        1.50        3.71        4.71        0.51        0.51        0.14         000
                                                 ray.
27096...........  .............  A............  Inject sacroiliac           1.40        2.52        3.43        0.33        0.33        0.08         000
                                                 joint.
27097...........  .............  A............  Revision of hip             9.16          NA          NA        6.33        6.37        1.57         090
                                                 tendon.
27098...........  .............  A............  Transfer tendon to          9.20          NA          NA        4.91        5.96        0.95         090
                                                 pelvis.
27100...........  .............  A............  Transfer of                11.21          NA          NA        7.39        8.03        1.86         090
                                                 abdominal muscle.
27105...........  .............  A............  Transfer of spinal         11.90          NA          NA        7.35        8.25        1.73         090
                                                 muscle.
27110...........  .............  A............  Transfer of                13.63          NA          NA        8.27        8.69        2.19         090
                                                 iliopsoas muscle.

[[Page 66431]]

 
27111...........  .............  A............  Transfer of                12.46          NA          NA        8.06        8.60        1.95         090
                                                 iliopsoas muscle.
27120...........  .............  A............  Reconstruction of          19.10          NA          NA       10.81       11.32        3.09         090
                                                 hip socket.
27122...........  .............  A............  Reconstruction of          15.95          NA          NA        9.43       10.23        2.62         090
                                                 hip socket.
27125...........  .............  A............  Partial hip                16.46          NA          NA        9.59       10.10        2.55         090
                                                 replacement.
27130...........  .............  A............  Total hip                  21.61          NA          NA       11.76       12.53        3.51         090
                                                 arthroplasty.
27132...........  .............  A............  Total hip                  25.49          NA          NA       13.42       14.52        4.05         090
                                                 arthroplasty.
27134...........  .............  A............  Revise hip joint           30.13          NA          NA       14.67       16.23        4.95         090
                                                 replacement.
27137...........  .............  A............  Revise hip joint           22.55          NA          NA       11.72       12.82        3.68         090
                                                 replacement.
27138...........  .............  A............  Revise hip joint           23.55          NA          NA       12.10       13.24        3.85         090
                                                 replacement.
27140...........  .............  A............  Transplant femur           12.66          NA          NA        7.87        8.64        2.12         090
                                                 ridge.
27146...........  .............  A............  Incision of hip bone       18.72          NA          NA       10.68       11.40        2.97         090
27147...........  .............  A............  Revision of hip bone       21.87          NA          NA       12.00       12.62        3.58         090
27151...........  .............  A............  Incision of hip            23.92          NA          NA       12.87       10.41        3.92         090
                                                 bones.
27156...........  .............  A............  Revision of hip            26.03          NA          NA       13.71       14.88        4.22         090
                                                 bones.
27158...........  .............  A............  Revision of pelvis..       20.89          NA          NA       11.51       11.23        3.17         090
27161...........  .............  A............  Incision of neck of        17.74          NA          NA       10.35       11.22        2.95         090
                                                 femur.
27165...........  .............  A............  Incision/fixation of       20.06          NA          NA       11.56       12.23        3.11         090
                                                 femur.
27170...........  .............  A............  Repair/graft femur         17.46          NA          NA        9.75       10.52        2.82         090
                                                 head/neck.
27175...........  .............  A............  Treat slipped               9.29          NA          NA        5.16        5.91        1.46         090
                                                 epiphysis.
27176...........  .............  A............  Treat slipped              12.78          NA          NA        8.17        8.59        2.23         090
                                                 epiphysis.
27177...........  .............  A............  Treat slipped              15.94          NA          NA        9.63       10.26        2.62         090
                                                 epiphysis.
27178...........  .............  A............  Treat slipped              12.78          NA          NA        7.97        8.19        2.09         090
                                                 epiphysis.
27179...........  .............  A............  Revise head/neck of        13.83          NA          NA        8.56        9.27        2.26         090
                                                 femur.
27181...........  .............  A............  Treat slipped              15.98          NA          NA        9.73        9.96        1.57         090
                                                 epiphysis.
27185...........  .............  A............  Revision of femur           9.67          NA          NA        6.64        7.08        2.40         090
                                                 epiphysis.
27187...........  .............  A............  Reinforce hip bones.       14.09          NA          NA        8.68        9.50        2.38         090
27193...........  .............  A............  Treat pelvic ring           5.98        4.62        4.85        4.75        4.92        0.96         090
                                                 fracture.
27194...........  .............  A............  Treat pelvic ring          10.08          NA          NA        6.60        7.12        1.65         090
                                                 fracture.
27200...........  .............  A............  Treat tail bone             1.87        2.07        2.15        2.22        2.19        0.28         090
                                                 fracture.
27202...........  .............  A............  Treat tail bone             7.25          NA          NA        4.90       10.88        1.06         090
                                                 fracture.
27215...........  .............  A............  Treat pelvic               10.45          NA          NA        6.54        6.81        1.98         090
                                                 fracture(s).
27216...........  .............  A............  Treat pelvic ring          15.73          NA          NA        9.13        9.36        2.64         090
                                                 fracture.
27217...........  .............  A............  Treat pelvic ring          14.65          NA          NA        8.62        9.38        2.42         090
                                                 fracture.
27218...........  .............  A............  Treat pelvic ring          20.93          NA          NA       11.32       11.35        3.49         090
                                                 fracture.
27220...........  .............  A............  Treat hip socket            6.72        5.24        5.48        5.14        5.39        1.07         090
                                                 fracture.
27222...........  .............  A............  Treat hip socket           13.97          NA          NA        8.51        9.24        2.20         090
                                                 fracture.
27226...........  .............  A............  Treat hip wall             15.45          NA          NA        8.92        8.36        2.49         090
                                                 fracture.
27227...........  .............  A............  Treat hip                  25.21          NA          NA       13.37       14.38        4.06         090
                                                 fracture(s).
27228...........  .............  A............  Treat hip                  29.13          NA          NA       14.83       16.22        4.67         090
                                                 fracture(s).
27230...........  .............  A............  Treat thigh fracture        5.69        4.93        5.22        4.86        4.98        0.95         090
27232...........  .............  A............  Treat thigh fracture       11.66          NA          NA        6.09        6.63        1.86         090
27235...........  .............  A............  Treat thigh fracture       12.88          NA          NA        7.97        8.71        2.12         090
27236...........  .............  A............  Treat thigh fracture       17.43          NA          NA       10.13       10.58        2.72         090
27238...........  .............  A............  Treat thigh fracture        5.64          NA          NA        4.65        4.89        0.89         090
27240...........  .............  A............  Treat thigh fracture       13.66          NA          NA        8.20        8.83        2.17         090
27244...........  .............  A............  Treat thigh fracture       17.08          NA          NA        9.61       10.45        2.78         090
27245...........  .............  A............  Treat thigh fracture       21.09          NA          NA       11.33       12.53        3.53         090
27246...........  .............  A............  Treat thigh fracture        4.75        3.91        4.18        3.94        4.18        0.81         090
27248...........  .............  A............  Treat thigh fracture       10.64          NA          NA        6.37        7.29        1.82         090
27250...........  .............  A............  Treat hip                   7.21          NA          NA        4.29        4.45        0.62         090
                                                 dislocation.
27252...........  .............  A............  Treat hip                  10.92          NA          NA        6.48        6.95        1.66         090
                                                 dislocation.
27253...........  .............  A............  Treat hip                  13.46          NA          NA        8.16        8.97        2.25         090
                                                 dislocation.
27254...........  .............  A............  Treat hip                  18.80          NA          NA       10.53       11.27        3.18         090
                                                 dislocation.
27256...........  .............  A............  Treat hip                   4.25        2.52        3.02        1.41        1.74        0.46         010
                                                 dislocation.
27257...........  .............  A............  Treat hip                   5.35          NA          NA        2.54        2.67        0.69         010
                                                 dislocation.
27258...........  .............  A............  Treat hip                  16.04          NA          NA        9.47       10.17        2.65         090
                                                 dislocation.
27259...........  .............  A............  Treat hip                  23.03          NA          NA       12.77       13.44        3.75         090
                                                 dislocation.
27265...........  .............  A............  Treat hip                   5.12          NA          NA        3.94        4.36        0.63         090
                                                 dislocation.
27266...........  .............  A............  Treat hip                   7.67          NA          NA        5.50        5.92        1.29         090
                                                 dislocation.
27267...........  .............  A............  Cltx thigh fx.......        5.38          NA          NA        4.39        4.39        0.89         090
27268...........  .............  A............  Cltx thigh fx w/mnpj        7.00          NA          NA        5.02        5.02        1.16         090
27269...........  .............  A............  Optx thigh fx.......       18.75          NA          NA        9.88        9.88        2.93         090
27275...........  .............  A............  Manipulation of hip         2.29          NA          NA        1.85        1.97        0.39         010
                                                 joint.
27280...........  .............  A............  Fusion of sacroiliac       14.49          NA          NA        8.87        9.56        2.54         090
                                                 joint.
27282...........  .............  A............  Fusion of pubic            11.71          NA          NA        7.77        7.88        1.87         090
                                                 bones.
27284...........  .............  A............  Fusion of hip joint.       24.91          NA          NA       12.00       13.37        3.93         090
27286...........  .............  A............  Fusion of hip joint.       24.97          NA          NA       12.60       14.19        3.13         090
27290...........  .............  A............  Amputation of leg at       24.38          NA          NA       12.10       13.07        3.44         090
                                                 hip.
27295...........  .............  A............  Amputation of leg at       19.54          NA          NA        9.57       10.44        2.96         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            6.67        8.19        9.13        4.64        4.89        1.04         090
                                                 lesion.
27303...........  .............  A............  Drainage of bone            8.52          NA          NA        5.99        6.48        1.43         090
                                                 lesion.

[[Page 66432]]

 
27305...........  .............  A............  Incise thigh tendon         6.09          NA          NA        4.68        4.93        1.01         090
                                                 & fascia.
27306...........  .............  A............  Incision of thigh           4.66          NA          NA        4.07        4.39        0.85         090
                                                 tendon.
27307...........  .............  A............  Incision of thigh           5.97          NA          NA        4.74        5.06        1.04         090
                                                 tendons.
27310...........  .............  A............  Exploration of knee         9.88          NA          NA        6.77        7.17        1.61         090
                                                 joint.
27323...........  .............  A............  Biopsy, thigh soft          2.30        4.19        3.85        1.93        1.90        0.24         010
                                                 tissues.
27324...........  .............  A............  Biopsy, thigh soft          4.95          NA          NA        3.82        4.00        0.75         090
                                                 tissues.
27325...........  .............  A............  Neurectomy,                 7.09          NA          NA        4.99        4.96        1.09         090
                                                 hamstring.
27326...........  .............  A............  Neurectomy,                 6.36          NA          NA        5.12        5.17        1.06         090
                                                 popliteal.
27327...........  .............  A............  Removal of thigh            4.52        6.03        6.01        3.57        3.65        0.64         090
                                                 lesion.
27328...........  .............  A............  Removal of thigh            5.62          NA          NA        4.06        4.21        0.84         090
                                                 lesion.
27329...........  .............  A............  Remove tumor, thigh/       15.68          NA          NA        8.46        8.74        2.15         090
                                                 knee.
27330...........  .............  A............  Biopsy, knee joint          5.02          NA          NA        4.26        4.41        0.86         090
                                                 lining.
27331...........  .............  A............  Explore/treat knee          5.93          NA          NA        4.79        5.16        1.02         090
                                                 joint.
27332...........  .............  A............  Removal of knee             8.34          NA          NA        6.12        6.62        1.43         090
                                                 cartilage.
27333...........  .............  A............  Removal of knee             7.43          NA          NA        5.68        6.17        1.26         090
                                                 cartilage.
27334...........  .............  A............  Remove knee joint           9.07          NA          NA        6.43        6.92        1.51         090
                                                 lining.
27335...........  .............  A............  Remove knee joint          10.43          NA          NA        7.01        7.61        1.75         090
                                                 lining.
27340...........  .............  A............  Removal of kneecap          4.23          NA          NA        4.03        4.29        0.72         090
                                                 bursa.
27345...........  .............  A............  Removal of knee cyst        5.98          NA          NA        4.88        5.25        1.00         090
27347...........  .............  A............  Remove knee cyst....        6.58          NA          NA        5.25        5.34        0.98         090
27350...........  .............  A............  Removal of kneecap..        8.54          NA          NA        6.24        6.74        1.41         090
27355...........  .............  A............  Remove femur lesion.        7.89          NA          NA        5.80        6.29        1.32         090
27356...........  .............  A............  Remove femur lesion/        9.97          NA          NA        6.83        7.34        1.65         090
                                                 graft.
27357...........  .............  A............  Remove femur lesion/       11.02          NA          NA        7.47        8.08        1.96         090
                                                 graft.
27358...........  .............  A............  Remove femur lesion/        4.73          NA          NA        1.81        2.16        0.82         ZZZ
                                                 fixation.
27360...........  .............  A............  Partial removal, leg       11.34          NA          NA        8.04        8.79        1.84         090
                                                 bone(s).
27365...........  .............  A............  Extensive leg              17.93          NA          NA       10.40       11.04        2.80         090
                                                 surgery.
27370...........  .............  A............  Injection for knee x-       0.96        2.99        3.36        0.36        0.34        0.08         000
                                                 ray.
27372...........  .............  A............  Removal of foreign          5.12        8.30        9.17        4.04        4.36        0.84         090
                                                 body.
27380...........  .............  A............  Repair of kneecap           7.34          NA          NA        6.05        6.66        1.24         090
                                                 tendon.
27381...........  .............  A............  Repair/graft kneecap       10.64          NA          NA        7.56        8.32        1.80         090
                                                 tendon.
27385...........  .............  A............  Repair of thigh             8.00          NA          NA        6.30        6.96        1.36         090
                                                 muscle.
27386...........  .............  A............  Repair/graft of            10.99          NA          NA        7.92        8.71        1.86         090
                                                 thigh muscle.
27390...........  .............  A............  Incision of thigh           5.44          NA          NA        4.46        4.78        0.92         090
                                                 tendon.
27391...........  .............  A............  Incision of thigh           7.38          NA          NA        5.54        6.05        1.23         090
                                                 tendons.
27392...........  .............  A............  Incision of thigh           9.51          NA          NA        6.66        7.12        1.57         090
                                                 tendons.
27393...........  .............  A............  Lengthening of thigh        6.50          NA          NA        4.95        5.39        1.10         090
                                                 tendon.
27394...........  .............  A............  Lengthening of thigh        8.68          NA          NA        6.14        6.68        1.47         090
                                                 tendons.
27395...........  .............  A............  Lengthening of thigh       12.10          NA          NA        7.92        8.62        2.05         090
                                                 tendons.
27396...........  .............  A............  Transplant of thigh         8.04          NA          NA        5.82        6.41        1.34         090
                                                 tendon.
27397...........  .............  A............  Transplants of thigh       12.46          NA          NA        8.34        8.69        1.83         090
                                                 tendons.
27400...........  .............  A............  Revise thigh muscles/       9.21          NA          NA        6.51        6.88        1.31         090
                                                 tendons.
27403...........  .............  A............  Repair of knee              8.51          NA          NA        6.02        6.60        1.44         090
                                                 cartilage.
27405...........  .............  A............  Repair of knee              8.96          NA          NA        6.38        6.93        1.51         090
                                                 ligament.
27407...........  .............  A............  Repair of knee             10.71          NA          NA        6.82        7.57        1.79         090
                                                 ligament.
27409...........  .............  A............  Repair of knee             13.57          NA          NA        8.25        9.10        2.25         090
                                                 ligaments.
27412...........  .............  A............  Autochondrocyte            24.53          NA          NA       13.64       14.22        4.36         090
                                                 implant knee.
27415...........  .............  A............  Osteochondral knee         19.79          NA          NA       11.77       12.16        4.36         090
                                                 allograft.
27416...........  .............  A............  Osteochondral knee         14.00          NA          NA        8.38        8.38        2.32         090
                                                 autograft.
27418...........  .............  A............  Repair degenerated         11.46          NA          NA        7.57        8.23        1.89         090
                                                 kneecap.
27420...........  .............  A............  Revision of unstable       10.14          NA          NA        6.90        7.50        1.72         090
                                                 kneecap.
27422...........  .............  A............  Revision of unstable       10.09          NA          NA        6.87        7.49        1.71         090
                                                 kneecap.
27424...........  .............  A............  Revision/removal of        10.12          NA          NA        6.89        7.49        1.71         090
                                                 kneecap.
27425...........  .............  A............  Lat retinacular             5.28          NA          NA        4.70        5.11        0.90         090
                                                 release open.
27427...........  .............  A............  Reconstruction, knee        9.67          NA          NA        6.69        7.24        1.63         090
27428...........  .............  A............  Reconstruction, knee       15.33          NA          NA       10.03       10.63        2.43         090
27429...........  .............  A............  Reconstruction, knee       17.24          NA          NA       11.25       11.83        2.71         090
27430...........  .............  A............  Revision of thigh          10.04          NA          NA        6.84        7.41        1.70         090
                                                 muscles.
27435...........  .............  A............  Incision of knee           10.68          NA          NA        7.58        8.03        1.70         090
                                                 joint.
27437...........  .............  A............  Revise kneecap......        8.82          NA          NA        6.18        6.71        1.49         090
27438...........  .............  A............  Revise kneecap with        11.77          NA          NA        7.49        8.01        1.96         090
                                                 implant.
27440...........  .............  A............  Revision of knee           10.97          NA          NA        6.99        6.49        1.82         090
                                                 joint.
27441...........  .............  A............  Revision of knee           11.42          NA          NA        7.35        7.03        1.89         090
                                                 joint.
27442...........  .............  A............  Revision of knee           12.25          NA          NA        7.64        8.27        2.10         090
                                                 joint.
27443...........  .............  A............  Revision of knee           11.29          NA          NA        7.34        8.03        1.91         090
                                                 joint.
27445...........  .............  A............  Revision of knee           18.52          NA          NA       10.40       11.38        3.09         090
                                                 joint.
27446...........  .............  A............  Revision of knee           16.26          NA          NA        9.28       10.27        2.81         090
                                                 joint.
27447...........  .............  A............  Total knee                 23.04          NA          NA       12.56       13.58        3.80         090
                                                 arthroplasty.
27448...........  .............  A............  Incision of thigh...       11.48          NA          NA        7.31        7.95        1.95         090
27450...........  .............  A............  Incision of thigh...       14.47          NA          NA        8.83        9.70        2.43         090
27454...........  .............  A............  Realignment of thigh       18.97          NA          NA       10.72       11.61        3.13         090
                                                 bone.
27455...........  .............  A............  Realignment of knee.       13.24          NA          NA        8.30        9.09        2.25         090

[[Page 66433]]

 
27457...........  .............  A............  Realignment of knee.       13.92          NA          NA        8.22        9.07        2.35         090
27465...........  .............  A............  Shortening of thigh        18.44          NA          NA       10.28       10.25        2.48         090
                                                 bone.
27466...........  .............  A............  Lengthening of thigh       17.13          NA          NA       10.05       10.94        2.78         090
                                                 bone.
27468...........  .............  A............  Shorten/lengthen           19.82          NA          NA       11.16       11.75        3.31         090
                                                 thighs.
27470...........  .............  A............  Repair of thigh.....       16.97          NA          NA       10.15       10.96        2.80         090
27472...........  .............  A............  Repair/graft of            18.57          NA          NA       10.63       11.65        3.08         090
                                                 thigh.
27475...........  .............  A............  Surgery to stop leg         8.82          NA          NA        6.19        6.70        1.36         090
                                                 growth.
27477...........  .............  A............  Surgery to stop leg        10.03          NA          NA        6.59        7.16        1.74         090
                                                 growth.
27479...........  .............  A............  Surgery to stop leg        13.04          NA          NA        8.84        9.24        2.79         090
                                                 growth.
27485...........  .............  A............  Surgery to stop leg         9.02          NA          NA        6.21        6.80        1.53         090
                                                 growth.
27486...........  .............  A............  Revise/replace knee        20.92          NA          NA       11.62       12.55        3.37         090
                                                 joint.
27487...........  .............  A............  Revise/replace knee        26.91          NA          NA       13.97       15.25        4.40         090
                                                 joint.
27488...........  .............  A............  Removal of knee            17.40          NA          NA       10.24       10.96        2.75         090
                                                 prosthesis.
27495...........  .............  A............  Reinforce thigh.....       16.40          NA          NA        9.59       10.49        2.72         090
27496...........  .............  A............  Decompression of            6.66          NA          NA        4.97        5.29        0.99         090
                                                 thigh/knee.
27497...........  .............  A............  Decompression of            7.70          NA          NA        4.98        5.21        1.15         090
                                                 thigh/knee.
27498...........  .............  A............  Decompression of            8.54          NA          NA        5.18        5.57        1.24         090
                                                 thigh/knee.
27499...........  .............  A............  Decompression of            9.31          NA          NA        5.98        6.40        1.47         090
                                                 thigh/knee.
27500...........  .............  A............  Treatment of thigh          6.21        5.36        5.74        4.58        4.78        1.02         090
                                                 fracture.
27501...........  .............  A............  Treatment of thigh          6.34        5.00        5.40        4.91        5.15        1.03         090
                                                 fracture.
27502...........  .............  A............  Treatment of thigh         11.24          NA          NA        6.85        7.48        1.79         090
                                                 fracture.
27503...........  .............  A............  Treatment of thigh         11.13          NA          NA        7.21        7.74        1.85         090
                                                 fracture.
27506...........  .............  A............  Treatment of thigh         19.42          NA          NA       11.35       12.07        3.04         090
                                                 fracture.
27507...........  .............  A............  Treatment of thigh         14.39          NA          NA        8.12        8.98        2.43         090
                                                 fracture.
27508...........  .............  A............  Treatment of thigh          6.08        5.68        6.07        5.05        5.26        0.97         090
                                                 fracture.
27509...........  .............  A............  Treatment of thigh          8.02          NA          NA        6.53        7.24        1.34         090
                                                 fracture.
27510...........  .............  A............  Treatment of thigh          9.68          NA          NA        6.26        6.79        1.53         090
                                                 fracture.
27511...........  .............  A............  Treatment of thigh         14.97          NA          NA        8.10        9.65        2.38         090
                                                 fracture.
27513...........  .............  A............  Treatment of thigh         19.11          NA          NA        9.74       11.81        3.13         090
                                                 fracture.
27514...........  .............  A............  Treatment of thigh         14.46          NA          NA        7.88       10.61        3.01         090
                                                 fracture.
27516...........  .............  A............  Treat thigh fx              5.45        5.71        6.03        5.07        5.29        0.81         090
                                                 growth plate.
27517...........  .............  A............  Treat thigh fx              8.98          NA          NA        6.41        6.93        1.22         090
                                                 growth plate.
27519...........  .............  A............  Treat thigh fx             13.11          NA          NA        7.38        9.48        2.56         090
                                                 growth plate.
27520...........  .............  A............  Treat kneecap               2.93        4.10        4.31        3.52        3.48        0.47         090
                                                 fracture.
27524...........  .............  A............  Treat kneecap              10.25          NA          NA        6.93        7.58        1.75         090
                                                 fracture.
27530...........  .............  A............  Treat knee fracture.        3.97        4.82        5.06        4.26        4.34        0.65         090
27532...........  .............  A............  Treat knee fracture.        7.43        6.39        6.87        5.62        6.03        1.26         090
27535...........  .............  A............  Treat knee fracture.       13.27          NA          NA        7.44        8.77        2.01         090
27536...........  .............  A............  Treat knee fracture.       17.19          NA          NA       10.19       10.89        2.74         090
27538...........  .............  A............  Treat knee                  4.95        5.51        5.82        4.89        5.04        0.84         090
                                                 fracture(s).
27540...........  .............  A............  Treat knee fracture.       11.16          NA          NA        7.38        8.44        2.28         090
27550...........  .............  A............  Treat knee                  5.84        5.21        5.61        4.50        4.71        0.76         090
                                                 dislocation.
27552...........  .............  A............  Treat knee                  8.04          NA          NA        6.08        6.51        1.36         090
                                                 dislocation.
27556...........  .............  A............  Treat knee                 12.86          NA          NA        7.25        9.45        2.51         090
                                                 dislocation.
27557...........  .............  A............  Treat knee                 15.76          NA          NA        8.44       10.78        2.98         090
                                                 dislocation.
27558...........  .............  A............  Treat knee                 18.25          NA          NA        9.28       11.16        3.09         090
                                                 dislocation.
27560...........  .............  A............  Treat kneecap               3.88        4.24        4.54        3.71        3.45        0.40         090
                                                 dislocation.
27562...........  .............  A............  Treat kneecap               5.86          NA          NA        4.61        4.69        0.94         090
                                                 dislocation.
27566...........  .............  A............  Treat kneecap              12.59          NA          NA        7.88        8.60        2.13         090
                                                 dislocation.
27570...........  .............  A............  Fixation of knee            1.76          NA          NA        1.61        1.69        0.30         010
                                                 joint.
27580...........  .............  A............  Fusion of knee......       20.90          NA          NA       12.17       13.48        3.38         090
27590...........  .............  A............  Amputate leg at            13.35          NA          NA        6.01        6.34        1.75         090
                                                 thigh.
27591...........  .............  A............  Amputate leg at            13.82          NA          NA        7.34        7.99        2.03         090
                                                 thigh.
27592...........  .............  A............  Amputate leg at            10.86          NA          NA        5.45        5.81        1.45         090
                                                 thigh.
27594...........  .............  A............  Amputation follow-up        7.17          NA          NA        4.72        4.94        1.02         090
                                                 surgery.
27596...........  .............  A............  Amputation follow-up       11.15          NA          NA        5.97        6.39        1.57         090
                                                 surgery.
27598...........  .............  A............  Amputate lower leg         11.08          NA          NA        6.19        6.60        1.65         090
                                                 at knee.
27599...........  .............  C............  Leg surgery                 0.00        0.00        0.00        0.00        0.00        0.00         YYY
                                                 procedure.
27600...........  .............  A............  Decompression of            5.94          NA          NA        3.79        4.16        0.86         090
                                                 lower leg.
27601...........  .............  A............  Decompression of            5.94          NA          NA        4.17        4.51        0.80         090
                                                 lower leg.
27602...........  .............  A............  Decompression of            7.71          NA          NA        4.29        4.71        1.10         090
                                                 lower leg.
27603...........  .............  A............  Drain lower leg             5.12        7.04        7.26        3.90        4.03        0.74         090
                                                 lesion.
27604...........  .............  A............  Drain lower leg             4.51        6.48        6.28        3.42        3.69        0.69         090
                                                 bursa.
27605...........  .............  A............  Incision of achilles        2.89        5.15        6.41        1.74        2.03        0.41         010
                                                 tendon.
27606...........  .............  A............  Incision of achilles        4.15          NA          NA        2.62        2.99        0.69         010
                                                 tendon.
27607...........  .............  A............  Treat lower leg bone        8.51          NA          NA        5.70        5.93        1.31         090
                                                 lesion.
27610...........  .............  A............  Explore/treat ankle         9.01          NA          NA        6.10        6.55        1.40         090
                                                 joint.
27612...........  .............  A............  Exploration of ankle        8.01          NA          NA        5.17        5.63        1.13         090
                                                 joint.
27613...........  .............  A............  Biopsy lower leg            2.19        3.91        3.57        1.77        1.79        0.20         010
                                                 soft tissue.
27614...........  .............  A............  Biopsy lower leg            5.71        7.75        7.44        3.93        4.18        0.78         090
                                                 soft tissue.
27615...........  .............  A............  Remove tumor, lower        12.93          NA          NA        7.27        8.33        1.84         090
                                                 leg.
27618...........  .............  A............  Remove lower leg            5.14        6.43        6.22        3.80        3.89        0.72         090
                                                 lesion.

[[Page 66434]]

 
27619...........  .............  A............  Remove lower leg            8.47        9.99        9.75        5.27        5.61        1.25         090
                                                 lesion.
27620...........  .............  A............  Explore/treat ankle         6.04          NA          NA        4.56        5.01        0.97         090
                                                 joint.
27625...........  .............  A............  Remove ankle joint          8.37          NA          NA        5.49        5.98        1.28         090
                                                 lining.
27626...........  .............  A............  Remove ankle joint          8.98          NA          NA        5.77        6.34        1.48         090
                                                 lining.
27630...........  .............  A............  Removal of tendon           4.85        7.98        7.76        3.80        4.09        0.74         090
                                                 lesion.
27635...........  .............  A............  Remove lower leg            7.91          NA          NA        5.63        6.18        1.31         090
                                                 bone lesion.
27637...........  .............  A............  Remove/graft leg           10.17          NA          NA        6.90        7.59        1.66         090
                                                 bone lesion.
27638...........  .............  A............  Remove/graft leg           10.87          NA          NA        7.04        7.66        1.85         090
                                                 bone lesion.
27640...........  .............  A............  Partial removal of         12.10          NA          NA        7.46        8.88        1.89         090
                                                 tibia.
27641...........  .............  A............  Partial removal of          9.73          NA          NA        6.09        7.21        1.46         090
                                                 fibula.
27645...........  .............  A............  Extensive lower leg        14.78          NA          NA        8.73       10.38        2.42         090
                                                 surgery.
27646...........  .............  A............  Extensive lower leg        13.21          NA          NA        7.64        9.33        2.06         090
                                                 surgery.
27647...........  .............  A............  Extensive ankle/heel       12.85          NA          NA        6.54        7.07        1.76         090
                                                 surgery.
27648...........  .............  A............  Injection for ankle         0.96        2.88        3.20        0.34        0.34        0.08         000
                                                 x-ray.
27650...........  .............  A............  Repair achilles             9.94          NA          NA        6.15        6.83        1.59         090
                                                 tendon.
27652...........  .............  A............  Repair/graft               10.64          NA          NA        6.44        7.23        1.72         090
                                                 achilles tendon.
27654...........  .............  A............  Repair of achilles         10.32          NA          NA        5.98        6.56        1.58         090
                                                 tendon.
27656...........  .............  A............  Repair leg fascia           4.62        7.95        8.24        3.58        3.67        0.69         090
                                                 defect.
27658...........  .............  A............  Repair of leg               5.03          NA          NA        3.88        4.22        0.79         090
                                                 tendon, each.
27659...........  .............  A............  Repair of leg               6.99          NA          NA        4.67        5.16        1.09         090
                                                 tendon, each.
27664...........  .............  A............  Repair of leg               4.64          NA          NA        3.88        4.21        0.76         090
                                                 tendon, each.
27665...........  .............  A............  Repair of leg               5.46          NA          NA        4.32        4.64        0.89         090
                                                 tendon, each.
27675...........  .............  A............  Repair lower leg            7.24          NA          NA        4.67        5.20        1.11         090
                                                 tendons.
27676...........  .............  A............  Repair lower leg            8.61          NA          NA        5.72        6.23        1.37         090
                                                 tendons.
27680...........  .............  A............  Release of lower leg        5.79          NA          NA        4.16        4.63        0.93         090
                                                 tendon.
27681...........  .............  A............  Release of lower leg        6.94          NA          NA        5.09        5.50        1.15         090
                                                 tendons.
27685...........  .............  A............  Revision of lower           6.57        8.77        8.03        4.57        5.02        0.97         090
                                                 leg tendon.
27686...........  .............  A............  Revise lower leg            7.64          NA          NA        5.28        5.89        1.24         090
                                                 tendons.
27687...........  .............  A............  Revision of calf            6.30          NA          NA        4.47        4.89        1.00         090
                                                 tendon.
27690...........  .............  A............  Revise lower leg            8.96          NA          NA        5.37        5.86        1.33         090
                                                 tendon.
27691...........  .............  A............  Revise lower leg           10.28          NA          NA        6.65        7.20        1.64         090
                                                 tendon.
27692...........  .............  A............  Revise additional           1.87          NA          NA        0.71        0.82        0.32         ZZZ
                                                 leg tendon.
27695...........  .............  A............  Repair of ankle             6.58          NA          NA        4.87        5.37        1.05         090
                                                 ligament.
27696...........  .............  A............  Repair of ankle             8.46          NA          NA        5.25        5.84        1.28         090
                                                 ligaments.
27698...........  .............  A............  Repair of ankle             9.49          NA          NA        5.87        6.40        1.47         090
                                                 ligament.
27700...........  .............  A............  Revision of ankle           9.54          NA          NA        5.20        5.44        1.30         090
                                                 joint.
27702...........  .............  A............  Reconstruct ankle          14.28          NA          NA        8.64        9.55        2.38         090
                                                 joint.
27703...........  .............  A............  Reconstruction,            16.79          NA          NA        9.77       10.50        2.77         090
                                                 ankle joint.
27704...........  .............  A............  Removal of ankle            7.69          NA          NA        5.61        5.60        1.27         090
                                                 implant.
27705...........  .............  A............  Incision of tibia...       10.74          NA          NA        6.95        7.56        1.81         090
27707...........  .............  A............  Incision of fibula..        4.67          NA          NA        4.48        4.71        0.76         090
27709...........  .............  A............  Incision of tibia &        17.32          NA          NA        9.95        9.04        1.74         090
                                                 fibula.
27712...........  .............  A............  Realignment of lower       15.67          NA          NA        9.44       10.09        2.48         090
                                                 leg.
27715...........  .............  A............  Revision of lower          15.36          NA          NA        9.03        9.89        2.50         090
                                                 leg.
27720...........  .............  A............  Repair of tibia.....       12.22          NA          NA        7.92        8.66        2.05         090
27722...........  .............  A............  Repair/graft of            12.31          NA          NA        7.88        8.50        2.06         090
                                                 tibia.
27724...........  .............  A............  Repair/graft of            19.18          NA          NA       10.28       11.32        3.17         090
                                                 tibia.
27725...........  .............  A............  Repair of lower leg.       17.15          NA          NA       10.58       11.24        2.72         090
27726...........  .............  A............  Repair fibula              14.20          NA          NA        7.67        7.67        1.43         090
                                                 nonunion.
27727...........  .............  A............  Repair of lower leg.       14.69          NA          NA        9.06        9.70        2.44         090
27730...........  .............  A............  Repair of tibia             7.59          NA          NA        5.30        5.86        1.73         090
                                                 epiphysis.
27732...........  .............  A............  Repair of fibula            5.37          NA          NA        4.16        4.54        0.77         090
                                                 epiphysis.
27734...........  .............  A............  Repair lower leg            8.72          NA          NA        6.16        6.22        1.35         090
                                                 epiphyses.
27740...........  .............  A............  Repair of leg               9.49          NA          NA        6.60        7.29        1.62         090
                                                 epiphyses.
27742...........  .............  A............  Repair of leg              10.49          NA          NA        4.60        5.08        1.80         090
                                                 epiphyses.
27745...........  .............  A............  Reinforce tibia.....       10.37          NA          NA        6.99        7.58        1.76         090
27750...........  .............  A............  Treatment of tibia          3.26        4.32        4.54        3.73        3.79        0.55         090
                                                 fracture.
27752...........  .............  A............  Treatment of tibia          6.15        5.94        6.29        5.10        5.39        1.01         090
                                                 fracture.
27756...........  .............  A............  Treatment of tibia          7.33          NA          NA        5.75        6.10        1.17         090
                                                 fracture.
27758...........  .............  A............  Treatment of tibia         12.40          NA          NA        8.02        8.60        2.04         090
                                                 fracture.
27759...........  .............  A............  Treatment of tibia         14.31          NA          NA        8.66        9.48        2.39         090
                                                 fracture.
27760...........  .............  A............  Cltx medial ankle fx        3.09        4.28        4.47        3.67        3.63        0.48         090
27762...........  .............  A............  Cltx med ankle fx w/        5.33        5.47        5.90        4.65        4.96        0.85         090
                                                 mnpj.
27766...........  .............  A............  Optx medial ankle fx        7.73          NA          NA        6.12        6.67        1.44         090
27767...........  .............  A............  Cltx post ankle fx..        2.50        3.62        3.62        3.65        3.65        0.30         090
27768...........  .............  A............  Cltx post ankle fx w/       5.00          NA          NA        4.29        4.29        0.79         090
                                                 mnpj.
27769...........  .............  A............  Optx post ankle fx..       10.00          NA          NA        6.07        6.07        1.45         090
27780...........  .............  A............  Treatment of fibula         2.72        3.86        4.02        3.31        3.26        0.41         090
                                                 fracture.
27781...........  .............  A............  Treatment of fibula         4.47        4.87        5.18        4.26        4.45        0.73         090
                                                 fracture.
27784...........  .............  A............  Treatment of fibula         9.51          NA          NA        6.84        6.65        1.23         090
                                                 fracture.
27786...........  .............  A............  Treatment of ankle          2.91        4.05        4.25        3.43        3.38        0.46         090
                                                 fracture.
27788...........  .............  A............  Treatment of ankle          4.52        4.96        5.30        4.23        4.44        0.74         090
                                                 fracture.

[[Page 66435]]

 
27792...........  .............  A............  Treatment of ankle          9.55          NA          NA        6.80        6.88        1.32         090
                                                 fracture.
27808...........  .............  A............  Treatment of ankle          2.91        4.39        4.59        3.70        3.70        0.46         090
                                                 fracture.
27810...........  .............  A............  Treatment of ankle          5.20        5.40        5.82        4.55        4.85        0.82         090
                                                 fracture.
27814...........  .............  A............  Treatment of ankle         10.46          NA          NA        7.23        7.89        1.86         090
                                                 fracture.
27816...........  .............  A............  Treatment of ankle          2.96        3.99        4.18        3.33        3.37        0.43         090
                                                 fracture.
27818...........  .............  A............  Treatment of ankle          5.57        5.41        5.89        4.44        4.80        0.82         090
                                                 fracture.
27822...........  .............  A............  Treatment of ankle         11.03          NA          NA        8.20        9.42        1.92         090
                                                 fracture.
27823...........  .............  A............  Treatment of ankle         12.98          NA          NA        8.93       10.19        2.26         090
                                                 fracture.
27824...........  .............  A............  Treat lower leg             3.20        3.65        3.85        3.47        3.51        0.45         090
                                                 fracture.
27825...........  .............  A............  Treat lower leg             6.60        5.78        6.19        4.75        5.07        1.02         090
                                                 fracture.
27826...........  .............  A............  Treat lower leg            10.92          NA          NA        8.20        8.51        1.47         090
                                                 fracture.
27827...........  .............  A............  Treat lower leg            14.56          NA          NA       10.17       11.47        2.44         090
                                                 fracture.
27828...........  .............  A............  Treat lower leg            18.20          NA          NA       11.56       12.74        2.82         090
                                                 fracture.
27829...........  .............  A............  Treat lower leg             8.64          NA          NA        6.97        6.87        0.95         090
                                                 joint.
27830...........  .............  A............  Treat lower leg             3.85        4.09        4.24        3.56        3.70        0.54         090
                                                 dislocation.
27831...........  .............  A............  Treat lower leg             4.62          NA          NA        4.05        4.25        0.73         090
                                                 dislocation.
27832...........  .............  A............  Treat lower leg            10.01          NA          NA        6.83        6.50        1.03         090
                                                 dislocation.
27840...........  .............  A............  Treat ankle                 4.65          NA          NA        3.65        3.70        0.46         090
                                                 dislocation.
27842...........  .............  A............  Treat ankle                 6.34          NA          NA        4.85        4.98        1.00         090
                                                 dislocation.
27846...........  .............  A............  Treat ankle                10.16          NA          NA        6.76        7.34        1.71         090
                                                 dislocation.
27848...........  .............  A............  Treat ankle                11.56          NA          NA        7.31        8.51        1.95         090
                                                 dislocation.
27860...........  .............  A............  Fixation of ankle           2.36          NA          NA        1.68        1.83        0.39         010
                                                 joint.
27870...........  .............  A............  Fusion of ankle            15.21          NA          NA        9.07        9.79        2.37         090
                                                 joint, open.
27871...........  .............  A............  Fusion of                   9.42          NA          NA        6.53        7.05        1.59         090
                                                 tibiofibular joint.
27880...........  .............  A............  Amputation of lower        15.24          NA          NA        6.64        6.88        1.76         090
                                                 leg.
27881...........  .............  A............  Amputation of lower        13.32          NA          NA        7.37        8.11        1.99         090
                                                 leg.
27882...........  .............  A............  Amputation of lower         9.67          NA          NA        4.90        5.69        1.29         090
                                                 leg.
27884...........  .............  A............  Amputation follow-up        8.64          NA          NA        5.10        5.43        1.22         090
                                                 surgery.
27886...........  .............  A............  Amputation follow-up        9.88          NA          NA        5.65        6.08        1.40         090
                                                 surgery.
27888...........  .............  A............  Amputation of foot         10.23          NA          NA        6.00        6.75        1.51         090
                                                 at ankle.
27889...........  .............  A............  Amputation of foot         10.72          NA          NA        5.43        5.95        1.46         090
                                                 at ankle.
27892...........  .............  A............  Decompression of leg        7.82          NA          NA        5.09        5.34        1.10         090
27893...........  .............  A............  Decompression of leg        7.78          NA          NA        5.12        5.29        1.10         090
27894...........  .............  A............  Decompression of leg       12.42          NA          NA        7.33        7.55        1.65         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        2.75        4.00        3.49        1.61        1.78        0.33         010
                                                 foot.
28002...........  .............  A............  Treatment of foot           5.78        6.67        5.83        3.57        3.67        0.61         010
                                                 infection.
28003...........  .............  A............  Treatment of foot           8.95        7.77        7.00        4.55        4.89        1.12         090
                                                 infection.
28005...........  .............  A............  Treat foot bone             9.30          NA          NA        5.52        5.78        1.16         090
                                                 lesion.
28008...........  .............  A............  Incision of foot            4.50        6.17        5.36        3.00        3.10        0.57         090
                                                 fascia.
28010...........  .............  A............  Incision of toe             2.89        2.86        2.62        2.35        2.36        0.36         090
                                                 tendon.
28011...........  .............  A............  Incision of toe             4.19        3.79        3.55        3.03        3.16        0.59         090
                                                 tendons.
28020...........  .............  A............  Exploration of foot         5.06        7.36        6.68        3.58        3.85        0.72         090
                                                 joint.
28022...........  .............  A............  Exploration of foot         4.72        6.92        6.06        3.33        3.59        0.62         090
                                                 joint.
28024...........  .............  A............  Exploration of toe          4.43        6.55        5.88        3.11        3.52        0.58         090
                                                 joint.
28035...........  .............  A............  Decompression of            5.14        7.27        6.56        3.54        3.81        0.70         090
                                                 tibia nerve.
28043...........  .............  A............  Excision of foot            3.58        4.78        4.29        2.73        2.95        0.46         090
                                                 lesion.
28045...........  .............  A............  Excision of foot            4.77        7.02        6.20        3.24        3.42        0.63         090
                                                 lesion.
28046...........  .............  A............  Resection of tumor,        10.55       10.36        9.56        5.76        6.11        1.36         090
                                                 foot.
28050...........  .............  A............  Biopsy of foot joint        4.30        6.94        5.91        3.29        3.44        0.60         090
                                                 lining.
28052...........  .............  A............  Biopsy of foot joint        3.98        6.30        5.60        2.87        3.15        0.53         090
                                                 lining.
28054...........  .............  A............  Biopsy of toe joint         3.49        6.25        5.48        2.79        3.01        0.46         090
                                                 lining.
28055...........  .............  A............  Neurectomy, foot....        6.20          NA          NA        3.44        3.54        0.74         090
28060...........  .............  A............  Partial removal,            5.29        7.07        6.27        3.54        3.70        0.70         090
                                                 foot fascia.
28062...........  .............  A............  Removal of foot             6.58        7.82        7.17        3.82        3.91        0.83         090
                                                 fascia.
28070...........  .............  A............  Removal of foot             5.15        7.36        6.29        3.54        3.67        0.73         090
                                                 joint lining.
28072...........  .............  A............  Removal of foot             4.63        7.56        6.54        3.60        3.95        0.68         090
                                                 joint lining.
28080...........  .............  A............  Removal of foot             4.65        7.66        6.38        4.19        3.93        0.47         090
                                                 lesion.
28086...........  .............  A............  Excise foot tendon          4.83        7.86        7.92        3.81        4.24        0.76         090
                                                 sheath.
28088...........  .............  A............  Excise foot tendon          3.90        7.00        6.37        3.19        3.54        0.61         090
                                                 sheath.
28090...........  .............  A............  Removal of foot             4.46        6.77        5.95        3.18        3.31        0.59         090
                                                 lesion.
28092...........  .............  A............  Removal of toe              3.69        6.46        5.84        2.98        3.25        0.49         090
                                                 lesions.
28100...........  .............  A............  Removal of ankle/           5.72        8.09        8.02        3.99        4.34        0.82         090
                                                 heel lesion.
28102...........  .............  A............  Remove/graft foot           7.80          NA          NA        4.84        5.39        1.14         090
                                                 lesion.
28103...........  .............  A............  Remove/graft foot           6.56          NA          NA        4.02        4.31        0.91         090
                                                 lesion.
28104...........  .............  A............  Removal of foot             5.17        7.23        6.35        3.46        3.69        0.70         090
                                                 lesion.
28106...........  .............  A............  Remove/graft foot           7.23          NA          NA        4.22        4.32        0.97         090
                                                 lesion.
28107...........  .............  A............  Remove/graft foot           5.62        7.69        7.11        3.66        3.93        0.74         090
                                                 lesion.
28108...........  .............  A............  Removal of toe              4.21        6.35        5.46        2.98        3.12        0.53         090
                                                 lesions.
28110...........  .............  A............  Part removal of             4.13        6.92        6.07        3.06        3.14        0.54         090
                                                 metatarsal.
28111...........  .............  A............  Part removal of             5.06        7.09        6.68        3.20        3.42        0.67         090
                                                 metatarsal.
28112...........  .............  A............  Part removal of             4.54        7.18        6.49        3.24        3.40        0.61         090
                                                 metatarsal.

[[Page 66436]]

 
28113...........  .............  A............  Part removal of             5.88        8.36        7.20        4.61        4.46        0.63         090
                                                 metatarsal.
28114...........  .............  A............  Removal of                 11.61       13.38       12.49        8.29        8.33        1.42         090
                                                 metatarsal heads.
28116...........  .............  A............  Revision of foot....        8.94        9.44        8.11        5.34        5.25        1.03         090
28118...........  .............  A............  Removal of heel bone        6.02        7.92        7.08        4.02        4.18        0.84         090
28119...........  .............  A............  Removal of heel spur        5.45        7.21        6.31        3.57        3.65        0.70         090
28120...........  .............  A............  Part removal of             5.64        8.08        7.68        3.96        4.18        0.77         090
                                                 ankle/heel.
28122...........  .............  A............  Partial removal of          7.56        8.46        7.64        4.77        5.02        0.98         090
                                                 foot bone.
28124...........  .............  A............  Partial removal of          4.88        6.77        5.88        3.46        3.55        0.60         090
                                                 toe.
28126...........  .............  A............  Partial removal of          3.56        5.96        5.08        2.66        2.82        0.45         090
                                                 toe.
28130...........  .............  A............  Removal of ankle            9.30          NA          NA        6.15        6.43        1.26         090
                                                 bone.
28140...........  .............  A............  Removal of                  7.03        7.81        7.51        4.11        4.43        0.92         090
                                                 metatarsal.
28150...........  .............  A............  Removal of toe......        4.14        6.35        5.59        2.97        3.13        0.53         090
28153...........  .............  A............  Partial removal of          3.71        6.21        5.26        2.89        2.78        0.47         090
                                                 toe.
28160...........  .............  A............  Partial removal of          3.79        6.31        5.43        2.92        3.13        0.49         090
                                                 toe.
28171...........  .............  A............  Extensive foot              9.85          NA          NA        5.25        5.34        1.33         090
                                                 surgery.
28173...........  .............  A............  Extensive foot              9.05        8.72        8.15        4.61        4.90        1.12         090
                                                 surgery.
28175...........  .............  A............  Extensive foot              6.17        7.14        6.42        3.62        3.66        0.73         090
                                                 surgery.
28190...........  .............  A............  Removal of foot             1.98        4.01        3.70        1.34        1.41        0.22         010
                                                 foreign body.
28192...........  .............  A............  Removal of foot             4.69        6.71        6.09        3.19        3.41        0.61         090
                                                 foreign body.
28193...........  .............  A............  Removal of foot             5.79        7.33        6.47        3.63        3.77        0.73         090
                                                 foreign body.
28200...........  .............  A............  Repair of foot              4.65        6.87        5.98        3.23        3.39        0.61         090
                                                 tendon.
28202...........  .............  A............  Repair/graft of foot        6.96        7.76        7.48        3.93        4.21        0.91         090
                                                 tendon.
28208...........  .............  A............  Repair of foot              4.42        6.69        5.75        3.18        3.24        0.58         090
                                                 tendon.
28210...........  .............  A............  Repair/graft of foot        6.41        7.62        6.91        3.93        3.97        0.81         090
                                                 tendon.
28220...........  .............  A............  Release of foot             4.58        6.41        5.54        3.07        3.25        0.57         090
                                                 tendon.
28222...........  .............  A............  Release of foot             5.67        6.92        6.08        3.34        3.73        0.69         090
                                                 tendons.
28225...........  .............  A............  Release of foot             3.70        6.01        5.14        2.71        2.81        0.46         090
                                                 tendon.
28226...........  .............  A............  Release of foot             4.58        6.88        5.83        3.25        3.49        0.58         090
                                                 tendons.
28230...........  .............  A............  Incision of foot            4.28        6.26        5.46        2.87        3.27        0.55         090
                                                 tendon(s).
28232...........  .............  A............  Incision of toe             3.43        5.93        5.22        2.67        2.99        0.44         090
                                                 tendon.
28234...........  .............  A............  Incision of foot            3.43        6.29        5.48        3.05        3.20        0.44         090
                                                 tendon.
28238...........  .............  A............  Revision of foot            7.85        8.38        7.81        4.37        4.64        1.06         090
                                                 tendon.
28240...........  .............  A............  Release of big toe..        4.40        6.35        5.49        2.95        3.21        0.58         090
28250...........  .............  A............  Revision of foot            5.97        7.55        6.58        3.82        3.97        0.82         090
                                                 fascia.
28260...........  .............  A............  Release of midfoot          8.08        8.44        7.38        4.61        4.80        1.14         090
                                                 joint.
28261...........  .............  A............  Revision of foot           12.91       10.66        9.63        6.33        6.81        1.57         090
                                                 tendon.
28262...........  .............  A............  Revision of foot and       17.01       15.52       14.53        9.72       10.31        2.60         090
                                                 ankle.
28264...........  .............  A............  Release of midfoot         10.53       10.31        9.02        5.95        6.61        1.54         090
                                                 joint.
28270...........  .............  A............  Release of foot             4.82        6.91        5.90        3.44        3.58        0.62         090
                                                 contracture.
28272...........  .............  A............  Release of toe              3.84        5.83        5.00        2.65        2.75        0.46         090
                                                 joint, each.
28280...........  .............  A............  Fusion of toes......        5.24        7.28        6.76        3.54        4.01        0.73         090
28285...........  .............  A............  Repair of hammertoe.        4.65        6.70        5.78        3.34        3.38        0.59         090
28286...........  .............  A............  Repair of hammertoe.        4.61        6.52        5.65        3.06        3.15        0.57         090
28288...........  .............  A............  Partial removal of          5.81        8.59        7.26        4.69        4.78        0.65         090
                                                 foot bone.
28289...........  .............  A............  Repair hallux               8.11        9.42        8.70        5.33        5.55        1.02         090
                                                 rigidus.
28290...........  .............  A............  Correction of bunion        5.72        8.18        7.21        3.96        4.34        0.82         090
28292...........  .............  A............  Correction of bunion        8.72       10.33        8.89        6.15        5.84        0.91         090
28293...........  .............  A............  Correction of bunion       11.10       14.46       12.60        6.91        6.50        1.13         090
28294...........  .............  A............  Correction of bunion        8.63        9.45        8.44        4.77        4.74        1.09         090
28296...........  .............  A............  Correction of bunion        9.31        9.57        8.86        4.79        5.10        1.19         090
28297...........  .............  A............  Correction of bunion        9.31       10.46        9.70        5.33        5.79        1.32         090
28298...........  .............  A............  Correction of bunion        8.01        9.29        8.25        4.59        4.79        1.05         090
28299...........  .............  A............  Correction of bunion       11.39       10.54        9.65        5.72        5.89        1.37         090
28300...........  .............  A............  Incision of heel            9.61          NA          NA        6.03        6.53        1.54         090
                                                 bone.
28302...........  .............  A............  Incision of ankle           9.62          NA          NA        6.21        6.54        1.42         090
                                                 bone.
28304...........  .............  A............  Incision of midfoot         9.29        9.55        8.74        5.08        5.40        1.27         090
                                                 bones.
28305...........  .............  A............  Incise/graft midfoot       10.63          NA          NA        5.78        6.25        1.27         090
                                                 bones.
28306...........  .............  A............  Incision of                 5.91        8.41        7.62        3.89        4.03        0.84         090
                                                 metatarsal.
28307...........  .............  A............  Incision of                 6.39        9.27       10.14        4.33        4.81        0.90         090
                                                 metatarsal.
28308...........  .............  A............  Incision of                 5.36        7.91        6.83        3.82        3.75        0.70         090
                                                 metatarsal.
28309...........  .............  A............  Incision of                13.96          NA          NA        7.68        7.81        2.05         090
                                                 metatarsals.
28310...........  .............  A............  Revision of big toe.        5.48        7.54        6.64        3.42        3.48        0.70         090
28312...........  .............  A............  Revision of toe.....        4.60        7.37        6.40        3.23        3.43        0.63         090
28313...........  .............  A............  Repair deformity of         5.06        7.26        6.27        3.60        4.21        0.73         090
                                                 toe.
28315...........  .............  A............  Removal of sesamoid         4.91        6.67        5.78        3.22        3.27        0.63         090
                                                 bone.
28320...........  .............  A............  Repair of foot bones        9.25          NA          NA        5.68        6.19        1.43         090
28322...........  .............  A............  Repair of                   8.41        9.74        9.45        5.31        5.82        1.27         090
                                                 metatarsals.
28340...........  .............  A............  Resect enlarged toe         7.04        8.09        7.26        4.07        4.15        0.84         090
                                                 tissue.
28341...........  .............  A............  Resect enlarged toe.        8.60        8.59        7.76        4.42        4.61        1.01         090
28344...........  .............  A............  Repair extra toe(s).        4.31        6.41        6.07        2.93        3.28        0.51         090
28345...........  .............  A............  Repair webbed toe(s)        5.98        7.61        6.90        3.78        4.23        0.80         090
28360...........  .............  A............  Reconstruct cleft          14.67          NA          NA        6.34        8.41        2.29         090
                                                 foot.

[[Page 66437]]

 
28400...........  .............  A............  Treatment of heel           2.22        3.36        3.49        2.91        2.98        0.35         090
                                                 fracture.
28405...........  .............  A............  Treatment of heel           4.63        4.42        4.62        3.67        4.14        0.73         090
                                                 fracture.
28406...........  .............  A............  Treatment of heel           6.44          NA          NA        5.55        6.17        1.11         090
                                                 fracture.
28415...........  .............  A............  Treat heel fracture.       15.96          NA          NA       10.23       11.75        2.67         090
28420...........  .............  A............  Treat/graft heel           17.29          NA          NA       10.27       11.59        2.81         090
                                                 fracture.
28430...........  .............  A............  Treatment of ankle          2.14        3.12        3.25        2.57        2.57        0.31         090
                                                 fracture.
28435...........  .............  A............  Treatment of ankle          3.45        3.98        3.93        3.26        3.50        0.55         090
                                                 fracture.
28436...........  .............  A............  Treatment of ankle          4.78          NA          NA        4.74        5.32        0.81         090
                                                 fracture.
28445...........  .............  A............  Treat ankle fracture       15.53          NA          NA        9.48       10.25        2.59         090
28446...........  .............  A............  Osteochondral talus        17.50          NA          NA       10.34       10.34        2.45         090
                                                 autogrft.
28450...........  .............  A............  Treat midfoot               1.95        2.91        3.01        2.41        2.44        0.28         090
                                                 fracture, each.
28455...........  .............  A............  Treat midfoot               3.15        3.74        3.58        3.10        3.26        0.44         090
                                                 fracture, each.
28456...........  .............  A............  Treat midfoot               2.75          NA          NA        3.72        3.94        0.44         090
                                                 fracture.
28465...........  .............  A............  Treat midfoot               8.64          NA          NA        6.06        6.18        1.10         090
                                                 fracture, each.
28470...........  .............  A............  Treat metatarsal            1.99        2.80        2.96        2.36        2.40        0.30         090
                                                 fracture.
28475...........  .............  A............  Treat metatarsal            2.97        3.13        3.23        2.51        2.86        0.44         090
                                                 fracture.
28476...........  .............  A............  Treat metatarsal            3.46          NA          NA        4.32        4.65        0.54         090
                                                 fracture.
28485...........  .............  A............  Treat metatarsal            7.28          NA          NA        5.56        5.50        0.83         090
                                                 fracture.
28490...........  .............  A............  Treat big toe               1.12        2.09        2.05        1.67        1.65        0.14         090
                                                 fracture.
28495...........  .............  A............  Treat big toe               1.62        2.46        2.32        1.86        1.96        0.20         090
                                                 fracture.
28496...........  .............  A............  Treat big toe               2.39        7.41        7.83        2.99        3.09        0.36         090
                                                 fracture.
28505...........  .............  A............  Treat big toe               7.28        8.45        8.27        4.81        4.36        0.56         090
                                                 fracture.
28510...........  .............  A............  Treatment of toe            1.12        1.68        1.60        1.61        1.57        0.14         090
                                                 fracture.
28515...........  .............  A............  Treatment of toe            1.50        2.22        2.06        1.82        1.86        0.18         090
                                                 fracture.
28525...........  .............  A............  Treat toe fracture..        5.46        8.11        7.81        4.31        3.87        0.49         090
28530...........  .............  A............  Treat sesamoid bone         1.08        1.62        1.53        1.34        1.39        0.14         090
                                                 fracture.
28531...........  .............  A............  Treat sesamoid bone         2.51        6.54        6.90        2.42        2.24        0.34         090
                                                 fracture.
28540...........  .............  A............  Treat foot                  2.10        2.74        2.57        2.30        2.35        0.26         090
                                                 dislocation.
28545...........  .............  A............  Treat foot                  2.51        3.43        2.88        2.81        2.57        0.37         090
                                                 dislocation.
28546...........  .............  A............  Treat foot                  3.28        8.05        7.48        3.64        4.01        0.52         090
                                                 dislocation.
28555...........  .............  A............  Repair foot                 9.49       10.80       10.35        6.29        5.98        1.04         090
                                                 dislocation.
28570...........  .............  A............  Treat foot                  1.70        2.49        2.45        1.91        2.12        0.23         090
                                                 dislocation.
28575...........  .............  A............  Treat foot                  3.38        4.41        4.06        3.71        3.71        0.56         090
                                                 dislocation.
28576...........  .............  A............  Treat foot                  4.48          NA          NA        4.06        4.11        0.69         090
                                                 dislocation.
28585...........  .............  A............  Repair foot                10.92       11.56        9.44        6.96        6.40        1.25         090
                                                 dislocation.
28600...........  .............  A............  Treat foot                  1.94        3.02        2.92        2.37        2.53        0.27         090
                                                 dislocation.
28605...........  .............  A............  Treat foot                  2.78        3.89        3.50        3.27        3.19        0.40         090
                                                 dislocation.
28606...........  .............  A............  Treat foot                  4.97          NA          NA        4.11        4.40        0.82         090
                                                 dislocation.
28615...........  .............  A............  Repair foot                10.46          NA          NA        8.13        8.08        1.30         090
                                                 dislocation.
28630...........  .............  A............  Treat toe                   1.72        1.84        1.70        0.91        0.95        0.20         010
                                                 dislocation.
28635...........  .............  A............  Treat toe                   1.93        2.27        2.15        1.33        1.43        0.26         010
                                                 dislocation.
28636...........  .............  A............  Treat toe                   2.77        4.38        4.12        2.05        2.34        0.43         010
                                                 dislocation.
28645...........  .............  A............  Repair toe                  7.28        8.33        6.64        4.61        3.94        0.57         090
                                                 dislocation.
28660...........  .............  A............  Treat toe                   1.25        1.30        1.28        0.78        0.78        0.13         010
                                                 dislocation.
28665...........  .............  A............  Treat toe                   1.94        1.82        1.62        1.32        1.37        0.26         010
                                                 dislocation.
28666...........  .............  A............  Treat toe                   2.66          NA          NA        1.82        2.20        0.43         010
                                                 dislocation.
28675...........  .............  A............  Repair of toe               5.46        8.23        7.68        4.44        3.90        0.45         090
                                                 dislocation.
28705...........  .............  A............  Fusion of foot bones       20.12          NA          NA       10.64       11.54        3.09         090
28715...........  .............  A............  Fusion of foot bones       14.40          NA          NA        8.48        9.11        2.17         090
28725...........  .............  A............  Fusion of foot bones       11.97          NA          NA        6.82        7.52        1.87         090
28730...........  .............  A............  Fusion of foot bones       12.21          NA          NA        7.75        8.11        1.71         090
28735...........  .............  A............  Fusion of foot bones       12.03          NA          NA        6.96        7.39        1.69         090
28737...........  .............  A............  Revision of foot           10.83          NA          NA        6.06        6.43        1.47         090
                                                 bones.
28740...........  .............  A............  Fusion of foot bones        9.09       10.86       10.86        5.98        6.22        1.22         090
28750...........  .............  A............  Fusion of big toe           8.37       10.76       11.33        5.88        6.27        1.13         090
                                                 joint.
28755...........  .............  A............  Fusion of big toe           4.79        7.25        6.67        3.35        3.55        0.65         090
                                                 joint.
28760...........  .............  A............  Fusion of big toe           8.94        9.86        8.91        5.26        5.39        1.05         090
                                                 joint.
28800...........  .............  A............  Amputation of               8.65          NA          NA        5.00        5.40        1.15         090
                                                 midfoot.
28805...........  .............  A............  Amputation thru            12.55          NA          NA        5.89        5.77        1.18         090
                                                 metatarsal.
28810...........  .............  A............  Amputation toe &            6.52          NA          NA        4.06        4.26        0.86         090
                                                 metatarsal.
28820...........  .............  A............  Amputation of toe...        4.89        7.64        7.59        3.55        3.66        0.61         090
28825...........  .............  A............  Partial amputation          3.71        7.13        7.06        3.12        3.30        0.50         090
                                                 of toe.
28890...........  .............  A............  High energy eswt,           3.36        4.56        5.14        2.20        2.14        0.41         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        4.00        3.48        1.64        1.69        0.41         000
                                                 cast.
29010...........  .............  A............  Application of body         2.06        4.38        3.83        1.62        1.70        0.45         000
                                                 cast.
29015...........  .............  A............  Application of body         2.41        3.61        3.29        1.56        1.58        0.28         000
                                                 cast.
29020...........  .............  A............  Application of body         2.11        3.81        3.49        1.41        1.41        0.28         000
                                                 cast.
29025...........  .............  A............  Application of body         2.40        4.04        3.59        1.76        1.81        0.44         000
                                                 cast.
29035...........  .............  A............  Application of body         1.77        3.70        3.65        1.48        1.53        0.28         000
                                                 cast.
29040...........  .............  A............  Application of body         2.22        3.28        2.87        1.34        1.42        0.36         000
                                                 cast.
29044...........  .............  A............  Application of body         2.12        3.57        3.77        1.47        1.69        0.35         000
                                                 cast.

[[Page 66438]]

 
29046...........  .............  A............  Application of body         2.41        4.49        3.86        1.91        2.00        0.42         000
                                                 cast.
29049...........  .............  A............  Application of              0.89        1.11        1.21        0.59        0.56        0.13         000
                                                 figure eight.
29055...........  .............  A............  Application of              1.78        2.82        2.90        1.23        1.35        0.30         000
                                                 shoulder cast.
29058...........  .............  A............  Application of              1.31        1.26        1.41        0.67        0.70        0.17         000
                                                 shoulder cast.
29065...........  .............  A............  Application of long         0.87        1.28        1.30        0.70        0.73        0.15         000
                                                 arm cast.
29075...........  .............  A............  Application of              0.77        1.23        1.24        0.66        0.67        0.13         000
                                                 forearm cast.
29085...........  .............  A............  Apply hand/wrist            0.87        1.26        1.27        0.68        0.66        0.14         000
                                                 cast.
29086...........  .............  A............  Apply finger cast...        0.62        1.07        1.02        0.55        0.52        0.07         000
29105...........  .............  A............  Apply long arm              0.87        1.09        1.16        0.53        0.52        0.12         000
                                                 splint.
29125...........  .............  A............  Apply forearm splint        0.59        0.97        0.99        0.42        0.41        0.07         000
29126...........  .............  A............  Apply forearm splint        0.77        1.01        1.11        0.48        0.47        0.07         000
29130...........  .............  A............  Application of              0.50        0.43        0.45        0.18        0.18        0.06         000
                                                 finger splint.
29131...........  .............  A............  Application of              0.55        0.59        0.66        0.24        0.24        0.03         000
                                                 finger splint.
29200...........  .............  A............  Strapping of chest..        0.65        0.60        0.66        0.34        0.34        0.04         000
29220...........  .............  A............  Strapping of low            0.64        0.65        0.68        0.38        0.38        0.04         000
                                                 back.
29240...........  .............  A............  Strapping of                0.71        0.68        0.76        0.40        0.38        0.06         000
                                                 shoulder.
29260...........  .............  A............  Strapping of elbow          0.55        0.67        0.70        0.37        0.35        0.05         000
                                                 or wrist.
29280...........  .............  A............  Strapping of hand or        0.51        0.67        0.73        0.37        0.35        0.03         000
                                                 finger.
29305...........  .............  A............  Application of hip          2.03        3.28        3.31        1.56        1.66        0.35         000
                                                 cast.
29325...........  .............  A............  Application of hip          2.32        3.33        3.43        1.58        1.77        0.40         000
                                                 casts.
29345...........  .............  A............  Application of long         1.40        1.66        1.71        0.94        1.00        0.24         000
                                                 leg cast.
29355...........  .............  A............  Application of long         1.53        1.62        1.66        0.93        1.03        0.26         000
                                                 leg cast.
29358...........  .............  A............  Apply long leg cast         1.43        2.01        2.03        0.91        1.00        0.25         000
                                                 brace.
29365...........  .............  A............  Application of long         1.18        1.58        1.62        0.85        0.90        0.20         000
                                                 leg cast.
29405...........  .............  A............  Apply short leg cast        0.86        1.19        1.20        0.65        0.68        0.14         000
29425...........  .............  A............  Apply short leg cast        1.01        1.22        1.22        0.65        0.70        0.15         000
29435...........  .............  A............  Apply short leg cast        1.18        1.52        1.54        0.81        0.87        0.20         000
29440...........  .............  A............  Addition of walker          0.57        0.64        0.67        0.26        0.26        0.08         000
                                                 to cast.
29445...........  .............  A............  Apply rigid leg cast        1.78        1.56        1.68        0.89        0.92        0.27         000
29450...........  .............  A............  Application of leg          2.08        1.59        1.53        0.90        0.99        0.27         000
                                                 cast.
29505...........  .............  A............  Application, long           0.69        1.07        1.12        0.45        0.45        0.08         000
                                                 leg splint.
29515...........  .............  A............  Application lower           0.73        0.96        0.91        0.46        0.46        0.09         000
                                                 leg splint.
29520...........  .............  A............  Strapping of hip....        0.54        0.66        0.75        0.37        0.42        0.03         000
29530...........  .............  A............  Strapping of knee...        0.57        0.65        0.72        0.36        0.35        0.05         000
29540...........  .............  A............  Strapping of ankle          0.51        0.55        0.48        0.31        0.31        0.06         000
                                                 and/or ft.
29550...........  .............  A............  Strapping of toes...        0.47        0.56        0.49        0.30        0.29        0.06         000
29580...........  .............  A............  Application of paste        0.55        0.71        0.68        0.33        0.34        0.07         000
                                                 boot.
29590...........  .............  A............  Application of foot         0.76        0.59        0.55        0.26        0.27        0.09         000
                                                 splint.
29700...........  .............  A............  Removal/revision of         0.57        0.95        0.92        0.25        0.26        0.08         000
                                                 cast.
29705...........  .............  A............  Removal/revision of         0.76        0.76        0.79        0.36        0.37        0.13         000
                                                 cast.
29710...........  .............  A............  Removal/revision of         1.34        1.32        1.42        0.55        0.62        0.20         000
                                                 cast.
29715...........  .............  A............  Removal/revision of         0.94        1.20        1.18        0.43        0.42        0.09         000
                                                 cast.
29720...........  .............  A............  Repair of body cast.        0.68        1.17        1.16        0.35        0.37        0.12         000
29730...........  .............  A............  Windowing of cast...        0.75        0.74        0.77        0.34        0.34        0.12         000
29740...........  .............  A............  Wedging of cast.....        1.12        1.03        1.09        0.47        0.48        0.18         000
29750...........  .............  A............  Wedging of clubfoot         1.26        1.06        1.06        0.52        0.55        0.21         000
                                                 cast.
29799...........  .............  C............  Casting/strapping           0.00        0.00        0.00        0.00        0.00        0.00         YYY
                                                 procedure.
29800...........  .............  A............  Jaw arthroscopy/            6.73          NA          NA        4.62        5.79        0.99         090
                                                 surgery.
29804...........  .............  A............  Jaw arthroscopy/            8.71          NA          NA        5.69        6.65        1.38         090
                                                 surgery.
29805...........  .............  A............  Shoulder                    5.94          NA          NA        4.71        5.19        1.02         090
                                                 arthroscopy, dx.
29806...........  .............  A............  Shoulder arthroscopy/      14.95          NA          NA        9.35       10.25        2.50         090
                                                 surgery.
29807...........  .............  A............  Shoulder arthroscopy/      14.48          NA          NA        9.19       10.09        2.42         090
                                                 surgery.
29819...........  .............  A............  Shoulder arthroscopy/       7.68          NA          NA        5.62        6.20        1.32         090
                                                 surgery.
29820...........  .............  A............  Shoulder arthroscopy/       7.12          NA          NA        5.17        5.70        1.22         090
                                                 surgery.
29821...........  .............  A............  Shoulder arthroscopy/       7.78          NA          NA        5.65        6.22        1.33         090
                                                 surgery.
29822...........  .............  A............  Shoulder arthroscopy/       7.49          NA          NA        5.57        6.13        1.28         090
                                                 surgery.
29823...........  .............  A............  Shoulder arthroscopy/       8.24          NA          NA        6.04        6.63        1.41         090
                                                 surgery.
29824...........  .............  A............  Shoulder arthroscopy/       8.82          NA          NA        6.53        7.03        1.42         090
                                                 surgery.
29825...........  .............  A............  Shoulder arthroscopy/       7.68          NA          NA        5.63        6.19        1.32         090
                                                 surgery.
29826...........  .............  A............  Shoulder arthroscopy/       9.05          NA          NA        6.18        6.85        1.55         090
                                                 surgery.
29827...........  .............  A............  Arthroscop rotator         15.44          NA          NA        9.31       10.41        2.67         090
                                                 cuff repr.
29828...........  .............  A............  Arthroscopy biceps         13.00          NA          NA        8.17        8.17        2.17         090
                                                 tenodesis.
29830...........  .............  A............  Elbow arthroscopy...        5.80          NA          NA        4.48        4.91        0.99         090
29834...........  .............  A............  Elbow arthroscopy/          6.33          NA          NA        4.85        5.34        1.08         090
                                                 surgery.
29835...........  .............  A............  Elbow arthroscopy/          6.53          NA          NA        4.96        5.42        1.13         090
                                                 surgery.
29836...........  .............  A............  Elbow arthroscopy/          7.61          NA          NA        5.54        6.16        1.22         090
                                                 surgery.
29837...........  .............  A............  Elbow arthroscopy/          6.92          NA          NA        5.06        5.59        1.19         090
                                                 surgery.
29838...........  .............  A............  Elbow arthroscopy/          7.77          NA          NA        5.65        6.27        1.30         090
                                                 surgery.
29840...........  .............  A............  Wrist arthroscopy...        5.59          NA          NA        4.62        4.97        0.84         090
29843...........  .............  A............  Wrist arthroscopy/          6.06          NA          NA        4.80        5.21        0.92         090
                                                 surgery.
29844...........  .............  A............  Wrist arthroscopy/          6.42          NA          NA        4.87        5.35        1.04         090
                                                 surgery.
29845...........  .............  A............  Wrist arthroscopy/          7.58          NA          NA        5.59        6.03        0.99         090
                                                 surgery.

[[Page 66439]]

 
29846...........  .............  A............  Wrist arthroscopy/          6.80          NA          NA        5.11        5.58        1.07         090
                                                 surgery.
29847...........  .............  A............  Wrist arthroscopy/          7.13          NA          NA        5.27        5.73        1.08         090
                                                 surgery.
29848...........  .............  A............  Wrist endoscopy/            6.24          NA          NA        5.27        5.44        0.86         090
                                                 surgery.
29850...........  .............  A............  Knee arthroscopy/           8.18          NA          NA        4.72        4.88        1.25         090
                                                 surgery.
29851...........  .............  A............  Knee arthroscopy/          13.08          NA          NA        8.21        9.00        2.35         090
                                                 surgery.
29855...........  .............  A............  Tibial arthroscopy/        10.60          NA          NA        7.27        8.02        1.85         090
                                                 surgery.
29856...........  .............  A............  Tibial arthroscopy/        14.12          NA          NA        8.69        9.67        2.40         090
                                                 surgery.
29860...........  .............  A............  Hip arthroscopy, dx.        8.85          NA          NA        6.24        6.60        1.36         090
29861...........  .............  A............  Hip arthroscopy/            9.95          NA          NA        6.39        6.86        1.59         090
                                                 surgery.
29862...........  .............  A............  Hip arthroscopy/           10.97          NA          NA        7.57        8.06        1.62         090
                                                 surgery.
29863...........  .............  A............  Hip arthroscopy/           10.97          NA          NA        7.48        7.99        1.42         090
                                                 surgery.
29866...........  .............  A............  Autgrft implnt, knee       14.48          NA          NA        9.46       10.40        2.40         090
                                                 w/scope.
29867...........  .............  A............  Allgrft implnt, knee       18.18          NA          NA       11.03       12.12        2.79         090
                                                 w/scope.
29868...........  .............  A............  Meniscal trnspl,           24.89          NA          NA       13.79       15.29        4.36         090
                                                 knee w/scpe.
29870...........  .............  A............  Knee arthroscopy, dx        5.11          NA          NA        4.18        4.53        0.85         090
29871...........  .............  A............  Knee arthroscopy/           6.60          NA          NA        5.05        5.46        1.14         090
                                                 drainage.
29873...........  .............  A............  Knee arthroscopy/           6.09          NA          NA        5.59        6.08        1.04         090
                                                 surgery.
29874...........  .............  A............  Knee arthroscopy/           7.10          NA          NA        5.08        5.58        1.11         090
                                                 surgery.
29875...........  .............  A............  Knee arthroscopy/           6.36          NA          NA        4.88        5.37        1.09         090
                                                 surgery.
29876...........  .............  A............  Knee arthroscopy/           8.72          NA          NA        6.18        6.60        1.37         090
                                                 surgery.
29877...........  .............  A............  Knee arthroscopy/           8.15          NA          NA        5.97        6.36        1.28         090
                                                 surgery.
29879...........  .............  A............  Knee arthroscopy/           8.84          NA          NA        6.23        6.67        1.39         090
                                                 surgery.
29880...........  .............  A............  Knee arthroscopy/           9.30          NA          NA        6.42        6.89        1.47         090
                                                 surgery.
29881...........  .............  A............  Knee arthroscopy/           8.56          NA          NA        6.13        6.55        1.34         090
                                                 surgery.
29882...........  .............  A............  Knee arthroscopy/           9.45          NA          NA        6.45        6.84        1.50         090
                                                 surgery.
29883...........  .............  A............  Knee arthroscopy/          11.61          NA          NA        7.58        8.32        1.93         090
                                                 surgery.
29884...........  .............  A............  Knee arthroscopy/           8.13          NA          NA        5.96        6.33        1.27         090
                                                 surgery.
29885...........  .............  A............  Knee arthroscopy/          10.03          NA          NA        7.03        7.49        1.58         090
                                                 surgery.
29886...........  .............  A............  Knee arthroscopy/           8.34          NA          NA        6.03        6.44        1.30         090
                                                 surgery.
29887...........  .............  A............  Knee arthroscopy/           9.98          NA          NA        6.96        7.44        1.57         090
                                                 surgery.
29888...........  .............  A............  Knee arthroscopy/          14.14          NA          NA        8.26        9.23        2.42         090
                                                 surgery.
29889...........  .............  A............  Knee arthroscopy/          17.15          NA          NA       10.61       11.52        2.79         090
                                                 surgery.
29891...........  .............  A............  Ankle arthroscopy/          9.47          NA          NA        6.64        7.07        1.39         090
                                                 surgery.
29892...........  .............  A............  Ankle arthroscopy/         10.07          NA          NA        6.38        7.06        1.41         090
                                                 surgery.
29893...........  .............  A............  Scope, plantar              6.08        8.83        7.56        4.66        4.32        0.63         090
                                                 fasciotomy.
29894...........  .............  A............  Ankle arthroscopy/          7.26          NA          NA        4.72        5.09        1.15         090
                                                 surgery.
29895...........  .............  A............  Ankle arthroscopy/          7.04          NA          NA        4.51        4.99        1.11         090
                                                 surgery.
29897...........  .............  A............  Ankle arthroscopy/          7.23          NA          NA        4.81        5.35        1.17         090
                                                 surgery.
29898...........  .............  A............  Ankle arthroscopy/          8.38          NA          NA        5.24        5.71        1.28         090
                                                 surgery.
29899...........  .............  A............  Ankle arthroscopy/         15.21          NA          NA        9.20        9.87        2.41         090
                                                 surgery.
29900...........  .............  A............  Mcp joint                   5.74          NA          NA        4.66        5.26        0.94         090
                                                 arthroscopy, dx.
29901...........  .............  A............  Mcp joint                   6.45          NA          NA        5.09        5.68        1.06         090
                                                 arthroscopy, surg.
29902...........  .............  A............  Mcp joint                   7.02          NA          NA        4.70        5.62        1.12         090
                                                 arthroscopy, surg.
29904...........  .............  A............  Subtalar arthro w/fb        8.50          NA          NA        5.89        5.89        1.25         090
                                                 rmvl.
29905...........  .............  A............  Subtalar arthro w/          9.00          NA          NA        6.51        6.51        1.32         090
                                                 exc.
29906...........  .............  A............  Subtalar arthro w/          9.47          NA          NA        6.87        6.87        1.39         090
                                                 deb.
29907...........  .............  A............  Subtalar arthro w/         12.00          NA          NA        7.86        7.86        1.90         090
                                                 fusion.
29999...........  .............  C............  Arthroscopy of joint        0.00        0.00        0.00        0.00        0.00        0.00         YYY
30000...........  .............  A............  Drainage of nose            1.45        4.01        4.04        1.34        1.36        0.12         010
                                                 lesion.
30020...........  .............  A............  Drainage of nose            1.45        4.16        3.72        1.39        1.43        0.12         010
                                                 lesion.
30100...........  .............  A............  Intranasal biopsy...        0.94        2.58        2.28        0.75        0.78        0.07         000
30110...........  .............  A............  Removal of nose             1.65        3.90        3.57        1.45        1.51        0.14         010
                                                 polyp(s).
30115...........  .............  A............  Removal of nose             4.38          NA          NA        5.99        5.87        0.41         090
                                                 polyp(s).
30117...........  .............  A............  Removal of                  3.20       18.15       15.64        4.91        4.77        0.26         090
                                                 intranasal lesion.
30118...........  .............  A............  Removal of                  9.81          NA          NA        8.55        8.87        0.78         090
                                                 intranasal lesion.
30120...........  .............  A............  Revision of nose....        5.31        7.07        6.78        5.09        5.54        0.52         090
30124...........  .............  A............  Removal of nose             3.14          NA          NA        3.68        3.64        0.25         090
                                                 lesion.
30125...........  .............  A............  Removal of nose             7.21          NA          NA        7.40        7.86        0.63         090
                                                 lesion.
30130...........  .............  A............  Excise inferior             3.41          NA          NA        5.63        5.61        0.31         090
                                                 turbinate.
30140...........  .............  A............  Resect inferior             3.48          NA          NA        7.10        6.64        0.35         090
                                                 turbinate.
30150...........  .............  A............  Partial removal of          9.44          NA          NA        9.02       10.01        0.93         090
                                                 nose.
30160...........  .............  A............  Removal of nose.....        9.88          NA          NA        8.87        9.54        0.88         090
30200...........  .............  A............  Injection treatment         0.78        2.02        1.82        0.67        0.70        0.06         000
                                                 of nose.
30210...........  .............  A............  Nasal sinus therapy.        1.10        2.51        2.30        1.27        1.29        0.09         010
30220...........  .............  A............  Insert nasal septal         1.56        5.81        5.02        1.42        1.47        0.12         010
                                                 button.
30300...........  .............  A............  Remove nasal foreign        1.06        4.29        4.46        1.87        1.89        0.08         010
                                                 body.
30310...........  .............  A............  Remove nasal foreign        1.98          NA          NA        2.91        3.00        0.16         010
                                                 body.
30320...........  .............  A............  Remove nasal foreign        4.56          NA          NA        6.35        6.69        0.39         090
                                                 body.
30400...........  .............  R............  Reconstruction of          10.58          NA          NA       13.90       14.69        1.04         090
                                                 nose.
30410...........  .............  R............  Reconstruction of          13.72          NA          NA       15.32       16.84        1.42         090
                                                 nose.
30420...........  .............  R............  Reconstruction of          16.62          NA          NA       15.82       16.86        1.46         090
                                                 nose.
30430...........  .............  R............  Revision of nose....        7.96          NA          NA       13.24       14.62        0.77         090

[[Page 66440]]

 
30435...........  .............  R............  Revision of nose....       12.45          NA          NA       15.42       17.38        1.22         090
30450...........  .............  R............  Revision of nose....       19.38          NA          NA       16.88       19.38        1.97         090
30460...........  .............  A............  Revision of nose....       10.24          NA          NA        7.48        8.71        1.03         090
30462...........  .............  A............  Revision of nose....       20.12          NA          NA       14.64       17.44        2.54         090
30465...........  .............  A............  Repair nasal               12.20          NA          NA       11.07       11.52        1.06         090
                                                 stenosis.
30520...........  .............  A............  Repair of nasal             6.85          NA          NA        8.04        7.35        0.46         090
                                                 septum.
30540...........  .............  A............  Repair nasal defect.        7.81          NA          NA        8.54        8.91        0.67         090
30545...........  .............  A............  Repair nasal defect.       11.50          NA          NA       11.08       11.48        1.71         090
30560...........  .............  A............  Release of nasal            1.28        5.28        5.02        2.02        2.08        0.10         010
                                                 adhesions.
30580...........  .............  A............  Repair upper jaw            6.76        8.13        7.95        4.69        5.24        0.89         090
                                                 fistula.
30600...........  .............  A............  Repair mouth/nose           6.07        7.67        7.59        4.18        4.60        0.70         090
                                                 fistula.
30620...........  .............  A............  Intranasal                  6.04          NA          NA        8.66        8.75        0.57         090
                                                 reconstruction.
30630...........  .............  A............  Repair nasal septum         7.18          NA          NA        7.73        7.83        0.61         090
                                                 defect.
30801...........  .............  A............  Ablate inf                  1.11        4.30        4.21        2.12        2.02        0.09         010
                                                 turbinate, superf.
30802...........  .............  A............  Cauterization, inner        2.05        4.97        4.79        2.51        2.44        0.16         010
                                                 nose.
30901...........  .............  A............  Control of nosebleed        1.21        1.27        1.31        0.30        0.31        0.11         000
30903...........  .............  A............  Control of nosebleed        1.54        3.27        2.99        0.43        0.46        0.13         000
30905...........  .............  A............  Control of nosebleed        1.97        3.93        3.72        0.51        0.63        0.17         000
30906...........  .............  A............  Repeat control of           2.45        4.28        4.08        0.76        0.98        0.20         000
                                                 nosebleed.
30915...........  .............  A............  Ligation, nasal             7.36          NA          NA        6.46        6.57        0.58         090
                                                 sinus artery.
30920...........  .............  A............  Ligation, upper jaw        11.03          NA          NA        8.96        8.96        0.80         090
                                                 artery.
30930...........  .............  A............  Ther fx, nasal inf          1.28          NA          NA        1.64        1.63        0.12         010
                                                 turbinate.
30999...........  .............  C............  Nasal surgery               0.00        0.00        0.00        0.00        0.00        0.00         YYY
                                                 procedure.
31000...........  .............  A............  Irrigation,                 1.17        3.22        3.03        1.34        1.37        0.09         010
                                                 maxillary sinus.
31002...........  .............  A............  Irrigation, sphenoid        1.93          NA          NA        2.69        2.96        0.15         010
                                                 sinus.
31020...........  .............  A............  Exploration,                2.99        8.60        8.56        5.54        5.36        0.29         090
                                                 maxillary sinus.
31030...........  .............  A............  Exploration,                5.95       10.40       10.94        6.44        6.55        0.60         090
                                                 maxillary sinus.
31032...........  .............  A............  Explore sinus,              6.61          NA          NA        7.00        7.11        0.59         090
                                                 remove polyps.
31040...........  .............  A............  Exploration behind          9.66          NA          NA        7.37        8.59        0.87         090
                                                 upper jaw.
31050...........  .............  A............  Exploration,                5.31          NA          NA        6.50        6.43        0.49         090
                                                 sphenoid sinus.
31051...........  .............  A............  Sphenoid sinus              7.16          NA          NA        8.36        8.30        0.62         090
                                                 surgery.
31070...........  .............  A............  Exploration of              4.32          NA          NA        6.18        6.06        0.38         090
                                                 frontal sinus.
31075...........  .............  A............  Exploration of              9.40          NA          NA        9.32        9.52        0.75         090
                                                 frontal sinus.
31080...........  .............  A............  Removal of frontal         12.54          NA          NA       10.61       12.07        1.23         090
                                                 sinus.
31081...........  .............  A............  Removal of frontal         13.99          NA          NA       15.36       14.67        2.47         090
                                                 sinus.
31084...........  .............  A............  Removal of frontal         14.75          NA          NA       12.87       13.18        1.19         090
                                                 sinus.
31085...........  .............  A............  Removal of frontal         15.44          NA          NA       14.42       14.19        1.73         090
                                                 sinus.
31086...........  .............  A............  Removal of frontal         14.16          NA          NA       12.77       13.02        1.07         090
                                                 sinus.
31087...........  .............  A............  Removal of frontal         14.39          NA          NA       11.64       12.08        1.44         090
                                                 sinus.
31090...........  .............  A............  Exploration of             10.88          NA          NA       13.40       12.97        0.94         090
                                                 sinuses.
31200...........  .............  A............  Removal of ethmoid          5.03          NA          NA        7.43        8.32        0.29         090
                                                 sinus.
31201...........  .............  A............  Removal of ethmoid          8.49          NA          NA        8.99        9.08        0.82         090
                                                 sinus.
31205...........  .............  A............  Removal of ethmoid         10.47          NA          NA        9.51       10.69        0.67         090
                                                 sinus.
31225...........  .............  A............  Removal of upper jaw       26.44          NA          NA       17.88       17.85        1.59         090
31230...........  .............  A............  Removal of upper jaw       30.56          NA          NA       19.48       19.41        1.78         090
31231...........  .............  A............  Nasal endoscopy, dx.        1.10        3.59        3.49        0.77        0.82        0.09         000
31233...........  .............  A............  Nasal/sinus                 2.18        4.26        4.28        1.12        1.30        0.20         000
                                                 endoscopy, dx.
31235...........  .............  A............  Nasal/sinus                 2.64        4.64        4.77        1.26        1.49        0.26         000
                                                 endoscopy, dx.
31237...........  .............  A............  Nasal/sinus                 2.98        4.90        5.05        1.39        1.63        0.28         000
                                                 endoscopy, surg.
31238...........  .............  A............  Nasal/sinus                 3.26        4.82        5.03        1.48        1.79        0.27         000
                                                 endoscopy, surg.
31239...........  .............  A............  Nasal/sinus                 9.23          NA          NA        6.42        7.21        0.62         010
                                                 endoscopy, surg.
31240...........  .............  A............  Nasal/sinus                 2.61          NA          NA        1.27        1.50        0.24         000
                                                 endoscopy, surg.
31254...........  .............  A............  Revision of ethmoid         4.64          NA          NA        1.93        2.39        0.45         000
                                                 sinus.
31255...........  .............  A............  Removal of ethmoid          6.95          NA          NA        2.69        3.40        0.73         000
                                                 sinus.
31256...........  .............  A............  Exploration                 3.29          NA          NA        1.49        1.80        0.33         000
                                                 maxillary sinus.
31267...........  .............  A............  Endoscopy, maxillary        5.45          NA          NA        2.20        2.74        0.55         000
                                                 sinus.
31276...........  .............  A............  Sinus endoscopy,            8.84          NA          NA        3.31        4.21        0.92         000
                                                 surgical.
31287...........  .............  A............  Nasal/sinus                 3.91          NA          NA        1.69        2.07        0.39         000
                                                 endoscopy, surg.
31288...........  .............  A............  Nasal/sinus                 4.57          NA          NA        1.91        2.36        0.46         000
                                                 endoscopy, surg.
31290...........  .............  A............  Nasal/sinus                18.50          NA          NA        9.04       10.54        1.40         010
                                                 endoscopy, surg.
31291...........  .............  A............  Nasal/sinus                19.45          NA          NA        9.53       11.00        1.69         010
                                                 endoscopy, surg.
31292...........  .............  A............  Nasal/sinus                15.79          NA          NA        8.05        9.33        1.21         010
                                                 endoscopy, surg.
31293...........  .............  A............  Nasal/sinus                17.36          NA          NA        8.68       10.02        1.28         010
                                                 endoscopy, surg.
31294...........  .............  A............  Nasal/sinus                20.20          NA          NA        9.66       11.26        1.53         010
                                                 endoscopy, surg.
31299...........  .............  C............  Sinus surgery               0.00        0.00        0.00        0.00        0.00        0.00         YYY
                                                 procedure.
31300...........  .............  A............  Removal of larynx          15.71          NA          NA       14.57       14.77        1.17         090
                                                 lesion.
31320...........  .............  A............  Diagnostic incision,        5.62          NA          NA       10.14       10.22        0.46         090
                                                 larynx.
31360...........  .............  A............  Removal of larynx...       29.57          NA          NA       20.06       18.39        1.38         090
31365...........  .............  A............  Removal of larynx...       38.47          NA          NA       22.97       21.66        1.98         090
31367...........  .............  A............  Partial removal of         30.23          NA          NA       22.50       22.19        1.79         090
                                                 larynx.
31368...........  .............  A............  Partial removal of         33.85          NA          NA       24.58       25.03        2.21         090
                                                 larynx.
31370...........  .............  A............  Partial removal of         27.23          NA          NA       22.13       22.19        1.75         090
                                                 larynx.

[[Page 66441]]

 
31375...........  .............  A............  Partial removal of         25.73          NA          NA       21.14       20.75        1.63         090
                                                 larynx.
31380...........  .............  A............  Partial removal of         25.23          NA          NA       20.78       20.69        1.71         090
                                                 larynx.
31382...........  .............  A............  Partial removal of         28.23          NA          NA       22.68       22.14        1.68         090
                                                 larynx.
31390...........  .............  A............  Removal of larynx &        42.17          NA          NA       25.96       25.16        2.24         090
                                                 pharynx.
31395...........  .............  A............  Reconstruct larynx &       43.46          NA          NA       28.50       28.39        2.49         090
                                                 pharynx.
31400...........  .............  A............  Revision of larynx..       11.48          NA          NA       12.49       13.12        0.83         090
31420...........  .............  A............  Removal of                 11.32          NA          NA        8.58        9.06        0.83         090
                                                 epiglottis.
31500...........  .............  A............  Insert emergency            2.33          NA          NA        0.42        0.48        0.17         000
                                                 airway.
31502...........  .............  A............  Change of windpipe          0.65          NA          NA        0.21        0.25        0.05         000
                                                 airway.
31505...........  .............  A............  Diagnostic                  0.61        1.42        1.43        0.59        0.60        0.05         000
                                                 laryngoscopy.
31510...........  .............  A............  Laryngoscopy with           1.92        3.22        3.26        1.00        1.12        0.16         000
                                                 biopsy.
31511...........  .............  A............  Remove foreign body,        2.16        2.94        3.03        1.03        1.04        0.19         000
                                                 larynx.
31512...........  .............  A............  Removal of larynx           2.07        2.97        3.08        1.06        1.21        0.18         000
                                                 lesion.
31513...........  .............  A............  Injection into vocal        2.10          NA          NA        1.08        1.27        0.17         000
                                                 cord.
31515...........  .............  A............  Laryngoscopy for            1.80        3.19        3.37        0.88        0.97        0.14         000
                                                 aspiration.
31520...........  .............  A............  Dx laryngoscopy,            2.56          NA          NA        1.21        1.38        0.20         000
                                                 newborn.
31525...........  .............  A............  Dx laryngoscopy excl        2.63        3.45        3.54        1.23        1.44        0.21         000
                                                 nb.
31526...........  .............  A............  Dx laryngoscopy w/          2.57          NA          NA        1.25        1.48        0.21         000
                                                 oper scope.
31527...........  .............  A............  Laryngoscopy for            3.27          NA          NA        1.40        1.63        0.26         000
                                                 treatment.
31528...........  .............  A............  Laryngoscopy and            2.37          NA          NA        1.09        1.27        0.19         000
                                                 dilation.
31529...........  .............  A............  Laryngoscopy and            2.68          NA          NA        1.25        1.48        0.22         000
                                                 dilation.
31530...........  .............  A............  Laryngoscopy w/fb           3.38          NA          NA        1.45        1.70        0.29         000
                                                 removal.
31531...........  .............  A............  Laryngoscopy w/fb &         3.58          NA          NA        1.58        1.93        0.29         000
                                                 op scope.
31535...........  .............  A............  Laryngoscopy w/             3.16          NA          NA        1.44        1.72        0.26         000
                                                 biopsy.
31536...........  .............  A............  Laryngoscopy w/bx &         3.55          NA          NA        1.57        1.91        0.29         000
                                                 op scope.
31540...........  .............  A............  Laryngoscopy w/exc          4.12          NA          NA        1.76        2.15        0.33         000
                                                 of tumor.
31541...........  .............  A............  Larynscop w/tumr exc        4.52          NA          NA        1.89        2.34        0.37         000
                                                 + scope.
31545...........  .............  A............  Remove vc lesion w/         6.30          NA          NA        2.51        2.99        0.37         000
                                                 scope.
31546...........  .............  A............  Remove vc lesion            9.73          NA          NA        3.43        4.20        0.78         000
                                                 scope/graft.
31560...........  .............  A............  Laryngoscop w/              5.45          NA          NA        2.15        2.65        0.43         000
                                                 arytenoidectom.
31561...........  .............  A............  Larynscop, remve            5.99          NA          NA        2.32        2.84        0.49         000
                                                 cart + scop.
31570...........  .............  A............  Laryngoscope w/vc           3.86        4.26        4.96        1.64        2.01        0.31         000
                                                 inj.
31571...........  .............  A............  Laryngoscop w/vc inj        4.26          NA          NA        1.81        2.20        0.35         000
                                                 + scope.
31575...........  .............  A............  Diagnostic                  1.10        1.69        1.80        0.76        0.82        0.09         000
                                                 laryngoscopy.
31576...........  .............  A............  Laryngoscopy with           1.97        3.52        3.59        1.04        1.16        0.14         000
                                                 biopsy.
31577...........  .............  A............  Remove foreign body,        2.47        3.37        3.56        1.17        1.35        0.21         000
                                                 larynx.
31578...........  .............  A............  Removal of larynx           2.84        3.99        4.13        1.34        1.43        0.23         000
                                                 lesion.
31579...........  .............  A............  Diagnostic                  2.26        2.86        3.32        1.15        1.31        0.18         000
                                                 laryngoscopy.
31580...........  .............  A............  Revision of larynx..       14.46          NA          NA       13.82       14.86        1.00         090
31582...........  .............  A............  Revision of larynx..       22.87          NA          NA       22.55       24.16        1.76         090
31584...........  .............  A............  Treat larynx               20.35          NA          NA       15.26       16.70        1.72         090
                                                 fracture.
31587...........  .............  A............  Revision of larynx..       15.12          NA          NA        8.63        8.95        0.97         090
31588...........  .............  A............  Revision of larynx..       14.62          NA          NA       12.50       13.05        1.06         090
31590...........  .............  A............  Reinnervate larynx..        7.63          NA          NA       12.78       14.15        0.84         090
31595...........  .............  A............  Larynx nerve surgery        8.75          NA          NA        9.64       10.09        0.68         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          NA        2.28        2.73        0.80         000
31601...........  .............  A............  Incision of windpipe        4.44          NA          NA        1.74        2.07        0.40         000
31603...........  .............  A............  Incision of windpipe        4.14          NA          NA        1.19        1.45        0.44         000
31605...........  .............  A............  Incision of windpipe        3.57          NA          NA        0.82        1.00        0.40         000
31610...........  .............  A............  Incision of windpipe        9.29          NA          NA        7.72        7.99        0.79         090
31611...........  .............  A............  Surgery/speech              5.92          NA          NA        7.07        7.06        0.46         090
                                                 prosthesis.
31612...........  .............  A............  Puncture/clear              0.91        1.09        1.09        0.26        0.30        0.08         000
                                                 windpipe.
31613...........  .............  A............  Repair windpipe             4.63          NA          NA        6.13        6.06        0.42         090
                                                 opening.
31614...........  .............  A............  Repair windpipe             8.47          NA          NA        9.57        9.14        0.58         090
                                                 opening.
31615...........  .............  A............  Visualization of            2.09        2.37        2.48        1.04        1.12        0.16         000
                                                 windpipe.
31620...........  .............  A............  Endobronchial us add-       1.40        6.01        5.83        0.33        0.44        0.11         ZZZ
                                                 on.
31622...........  .............  A............  Dx bronchoscope/wash        2.78        5.23        5.44        0.90        0.98        0.18         000
31623...........  .............  A............  Dx bronchoscope/            2.88        5.97        6.20        0.89        0.97        0.13         000
                                                 brush.
31624...........  .............  A............  Dx bronchoscope/            2.88        5.33        5.55        0.89        0.97        0.13         000
                                                 lavage.
31625...........  .............  A............  Bronchoscopy w/             3.36        5.48        5.64        1.01        1.11        0.18         000
                                                 biopsy(s).
31628...........  .............  A............  Bronchoscopy/lung           3.80        6.95        6.98        1.10        1.20        0.18         000
                                                 bx, each.
31629...........  .............  A............  Bronchoscopy/needle         4.09       12.00       13.12        1.17        1.28        0.16         000
                                                 bx, each.
31630...........  .............  A............  Bronchoscopy dilate/        3.81          NA          NA        1.27        1.49        0.32         000
                                                 fx repr.
31631...........  .............  A............  Bronchoscopy, dilate        4.36          NA          NA        1.42        1.59        0.34         000
                                                 w/stent.
31632...........  .............  A............  Bronchoscopy/lung           1.03        0.85        0.83        0.24        0.27        0.18         ZZZ
                                                 bx, add'l.
31633...........  .............  A............  Bronchoscopy/needle         1.32        0.99        0.95        0.31        0.35        0.16         ZZZ
                                                 bx add'l.
31635...........  .............  A............  Bronchoscopy w/fb           3.67        5.19        5.65        1.13        1.28        0.24         000
                                                 removal.
31636...........  .............  A............  Bronchoscopy, bronch        4.30          NA          NA        1.34        1.55        0.31         000
                                                 stents.
31637...........  .............  A............  Bronchoscopy, stent         1.58          NA          NA        0.41        0.48        0.13         ZZZ
                                                 add-on.
31638...........  .............  A............  Bronchoscopy, revise        4.88          NA          NA        1.54        1.76        0.22         000
                                                 stent.
31640...........  .............  A............  Bronchoscopy w/tumor        4.93          NA          NA        1.53        1.80        0.46         000
                                                 excise.

[[Page 66442]]

 
31641...........  .............  A............  Bronchoscopy, treat         5.02          NA          NA        1.49        1.68        0.35         000
                                                 blockage.
31643...........  .............  A............  Diag bronchoscope/          3.49          NA          NA        1.04        1.13        0.20         000
                                                 catheter.
31645...........  .............  A............  Bronchoscopy, clear         3.16        4.72        4.93        0.96        1.04        0.16         000
                                                 airways.
31646...........  .............  A............  Bronchoscopy,               2.72        4.41        4.63        0.85        0.92        0.14         000
                                                 reclear airway.
31656...........  .............  A............  Bronchoscopy, inj           2.17        5.68        6.48        0.68        0.76        0.15         000
                                                 for x-ray.
31715...........  .............  A............  Injection for               1.11          NA          NA        0.25        0.29        0.07         000
                                                 bronchus x-ray.
31717...........  .............  A............  Bronchial brush             2.12        5.84        7.04        0.72        0.75        0.14         000
                                                 biopsy.
31720...........  .............  A............  Clearance of airways        1.06          NA          NA        0.27        0.30        0.07         000
31725...........  .............  A............  Clearance of airways        1.96          NA          NA        0.41        0.49        0.14         000
31730...........  .............  A............  Intro, windpipe wire/       2.85       25.71       13.95        0.74        0.87        0.21         000
                                                 tube.
31750...........  .............  A............  Repair of windpipe..       15.19          NA          NA       17.44       17.49        1.05         090
31755...........  .............  A............  Repair of windpipe..       17.19          NA          NA       23.97       24.24        1.29         090
31760...........  .............  A............  Repair of windpipe..       23.36          NA          NA        9.77       10.24        2.95         090
31766...........  .............  A............  Reconstruction of          31.58          NA          NA       11.68       12.66        4.53         090
                                                 windpipe.
31770...........  .............  A............  Repair/graft of            23.48          NA          NA        8.53        9.38        2.84         090
                                                 bronchus.
31775...........  .............  A............  Reconstruct bronchus       24.51          NA          NA        9.50       10.64        3.02         090
31780...........  .............  A............  Reconstruct windpipe       19.70          NA          NA        8.79        9.92        1.65         090
31781...........  .............  A............  Reconstruct windpipe       24.77          NA          NA        9.66       10.89        2.25         090
31785...........  .............  A............  Remove windpipe            18.29          NA          NA        7.67        8.92        1.59         090
                                                 lesion.
31786...........  .............  A............  Remove windpipe            25.34          NA          NA        9.61       11.35        3.30         090
                                                 lesion.
31800...........  .............  A............  Repair of windpipe          8.10          NA          NA        8.67        8.95        0.79         090
                                                 injury.
31805...........  .............  A............  Repair of windpipe         13.34          NA          NA        6.21        6.71        1.83         090
                                                 injury.
31820...........  .............  A............  Closure of windpipe         4.58        5.85        5.76        3.26        3.45        0.38         090
                                                 lesion.
31825...........  .............  A............  Repair of windpipe          6.98        7.44        7.55        4.47        4.92        0.53         090
                                                 defect.
31830...........  .............  A............  Revise windpipe scar        4.54        5.93        5.84        3.56        3.77        0.44         090
31899...........  .............  C............  Airways surgical            0.00        0.00        0.00        0.00        0.00        0.00         YYY
                                                 procedure.
32035...........  .............  A............  Exploration of chest       11.20          NA          NA        6.08        5.96        1.26         090
32036...........  .............  A............  Exploration of chest       12.21          NA          NA        6.29        6.36        1.43         090
32095...........  .............  A............  Biopsy through chest       10.06          NA          NA        5.10        5.23        1.22         090
                                                 wall.
32100...........  .............  A............  Exploration/biopsy         16.08          NA          NA        7.00        7.41        2.24         090
                                                 of chest.
32110...........  .............  A............  Explore/repair chest       25.15          NA          NA        9.87       10.29        3.22         090
32120...........  .............  A............  Re-exploration of          14.27          NA          NA        6.78        6.92        1.63         090
                                                 chest.
32124...........  .............  A............  Explore chest free         15.33          NA          NA        6.95        7.08        1.90         090
                                                 adhesions.
32140...........  .............  A............  Removal of lung            16.54          NA          NA        7.39        7.53        1.97         090
                                                 lesion(s).
32141...........  .............  A............  Remove/treat lung          27.10          NA          NA       10.17        8.86        2.01         090
                                                 lesions.
32150...........  .............  A............  Removal of lung            16.70          NA          NA        7.50        7.55        2.01         090
                                                 lesion(s).
32151...........  .............  A............  Remove lung foreign        16.82          NA          NA        7.91        7.95        2.04         090
                                                 body.
32160...........  .............  A............  Open chest heart           13.02          NA          NA        5.84        5.55        1.31         090
                                                 massage.
32200...........  .............  A............  Drain, open, lung          18.48          NA          NA        8.76        8.68        2.14         090
                                                 lesion.
32201...........  .............  A............  Drain, percut, lung         3.99       19.84       20.27        1.42        1.36        0.24         000
                                                 lesion.
32215...........  .............  A............  Treat chest lining..       12.93          NA          NA        6.23        6.56        1.69         090
32220...........  .............  A............  Release of lung.....       26.41          NA          NA       11.90       12.42        3.57         090
32225...........  .............  A............  Partial release of         16.63          NA          NA        7.45        7.55        2.07         090
                                                 lung.
32310...........  .............  A............  Removal of chest           15.16          NA          NA        6.92        7.15        2.00         090
                                                 lining.
32320...........  .............  A............  Free/remove chest          27.04          NA          NA       11.44       11.79        3.52         090
                                                 lining.
32400...........  .............  A............  Needle biopsy chest         1.76        2.15        2.14        0.57        0.56        0.10         000
                                                 lining.
32402...........  .............  A............  Open biopsy chest           8.89          NA          NA        4.68        4.89        1.07         090
                                                 lining.
32405...........  .............  A............  Biopsy, lung or             1.93        0.69        0.68        0.69        0.66        0.11         000
                                                 mediastinum.
32420...........  .............  A............  Puncture/clear lung.        2.18          NA          NA        0.71        0.69        0.12         000
32421...........  .............  A............  Thoracentesis for           1.54        2.40        2.73        0.47        0.47        0.08         000
                                                 aspiration.
32422...........  .............  A............  Thoracentesis w/tube        2.19        2.87        3.04        1.03        1.04        0.12         000
                                                 insert.
32440...........  .............  A............  Removal of lung.....       27.17          NA          NA       10.91       11.90        3.69         090
32442...........  .............  A............  Sleeve pneumonectomy       56.37          NA          NA       18.71       16.73        3.85         090
32445...........  .............  A............  Removal of lung.....       63.60          NA          NA       22.77       18.41        3.72         090
32480...........  .............  A............  Partial removal of         25.71          NA          NA       10.18       11.12        3.50         090
                                                 lung.
32482...........  .............  A............  Bilobectomy.........       27.28          NA          NA       11.08       11.99        3.67         090
32484...........  .............  A............  Segmentectomy.......       25.30          NA          NA        9.56       10.47        3.04         090
32486...........  .............  A............  Sleeve lobectomy....       42.80          NA          NA       14.60       13.92        3.52         090
32488...........  .............  A............  Completion                 42.83          NA          NA       15.56       14.67        3.81         090
                                                 pneumonectomy.
32491...........  .............  R............  Lung volume                25.09          NA          NA       10.42       11.52        2.99         090
                                                 reduction.
32500...........  .............  A............  Partial removal of         24.48          NA          NA       10.26       11.30        3.26         090
                                                 lung.
32501...........  .............  A............  Repair bronchus add-        4.68          NA          NA        1.33        1.43        0.65         ZZZ
                                                 on.
32503...........  .............  A............  Resect apical lung         31.61          NA          NA       12.08       13.57        4.38         090
                                                 tumor.
32504...........  .............  A............  Resect apical lung         36.41          NA          NA       13.46       15.06        5.09         090
                                                 tum/chest.
32540...........  .............  A............  Removal of lung            30.22          NA          NA       11.48       10.55        2.08         090
                                                 lesion.
32550...........  .............  A............  Insert pleural cath.        4.17       14.95       17.45        1.51        1.58        0.42         000
32551...........  .............  A............  Insertion of chest          3.29          NA          NA        0.97        1.16        0.43         000
                                                 tube.
32560...........  .............  A............  Treat lung lining           2.19        5.05        5.75        0.58        0.64        0.23         000
                                                 chemically.
32601...........  .............  A............  Thoracoscopy,               5.45          NA          NA        2.06        2.21        0.80         000
                                                 diagnostic.
32602...........  .............  A............  Thoracoscopy,               5.95          NA          NA        2.22        2.37        0.87         000
                                                 diagnostic.
32603...........  .............  A............  Thoracoscopy,               7.80          NA          NA        2.74        2.88        1.14         000
                                                 diagnostic.
32604...........  .............  A............  Thoracoscopy,               8.77          NA          NA        3.05        3.25        1.25         000
                                                 diagnostic.

[[Page 66443]]

 
32605...........  .............  A............  Thoracoscopy,               6.92          NA          NA        2.57        2.74        1.00         000
                                                 diagnostic.
32606...........  .............  A............  Thoracoscopy,               8.39          NA          NA        2.97        3.15        1.22         000
                                                 diagnostic.
32650...........  .............  A............  Thoracoscopy,              10.77          NA          NA        5.24        6.00        1.58         090
                                                 surgical.
32651...........  .............  A............  Thoracoscopy,              18.70          NA          NA        7.69        7.46        1.87         090
                                                 surgical.
32652...........  .............  A............  Thoracoscopy,              29.00          NA          NA       11.13       10.63        2.73         090
                                                 surgical.
32653...........  .............  A............  Thoracoscopy,              18.09          NA          NA        7.45        7.21        1.89         090
                                                 surgical.
32654...........  .............  A............  Thoracoscopy,              20.44          NA          NA        7.95        7.74        1.63         090
                                                 surgical.
32655...........  .............  A............  Thoracoscopy,              16.09          NA          NA        6.88        7.06        1.90         090
                                                 surgical.
32656...........  .............  A............  Thoracoscopy,              13.18          NA          NA        5.95        6.94        1.90         090
                                                 surgical.
32657...........  .............  A............  Thoracoscopy,              12.85          NA          NA        5.97        6.82        2.00         090
                                                 surgical.
32658...........  .............  A............  Thoracoscopy,              11.65          NA          NA        5.50        6.42        1.70         090
                                                 surgical.
32659...........  .............  A............  Thoracoscopy,              11.86          NA          NA        5.79        6.62        1.62         090
                                                 surgical.
32660...........  .............  A............  Thoracoscopy,              17.69          NA          NA        7.58        8.53        2.09         090
                                                 surgical.
32661...........  .............  A............  Thoracoscopy,              13.27          NA          NA        6.05        6.91        1.93         090
                                                 surgical.
32662...........  .............  A............  Thoracoscopy,              14.91          NA          NA        6.63        7.73        2.18         090
                                                 surgical.
32663...........  .............  A............  Thoracoscopy,              24.56          NA          NA        9.39       10.07        2.73         090
                                                 surgical.
32664...........  .............  A............  Thoracoscopy,              14.22          NA          NA        5.61        6.62        2.33         090
                                                 surgical.
32665...........  .............  A............  Thoracoscopy,              21.45          NA          NA        8.56        8.34        2.16         090
                                                 surgical.
32800...........  .............  A............  Repair lung hernia..       15.59          NA          NA        6.92        7.16        1.99         090
32810...........  .............  A............  Close chest after          14.83          NA          NA        6.97        7.24        1.94         090
                                                 drainage.
32815...........  .............  A............  Close bronchial            49.79          NA          NA       18.57       14.77        3.28         090
                                                 fistula.
32820...........  .............  A............  Reconstruct injured        22.33          NA          NA       10.56       11.36        2.53         090
                                                 chest.
32850...........  .............  X............  Donor pneumonectomy.        0.00        0.00        0.00        0.00        0.00        0.00         XXX
32851...........  .............  A............  Lung transplant,           40.94          NA          NA       20.17       23.91        5.58         090
                                                 single.
32852...........  .............  A............  Lung transplant with       44.65          NA          NA       22.56       27.85        6.02         090
                                                 bypass.
32853...........  .............  A............  Lung transplant,           50.11          NA          NA       22.77       27.25        7.07         090
                                                 double.
32854...........  .............  A............  Lung transplant with       53.88          NA          NA       25.76       30.24        7.22         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)...       23.69          NA          NA        9.56        9.72        2.94         090
32905...........  .............  A............  Revise & repair            23.17          NA          NA        9.52        9.82        3.16         090
                                                 chest wall.
32906...........  .............  A............  Revise & repair            29.18          NA          NA       11.03       11.54        3.98         090
                                                 chest wall.
32940...........  .............  A............  Revision of lung....       21.22          NA          NA        8.48        8.98        2.89         090
32960...........  .............  A............  Therapeutic                 1.84        1.61        1.67        0.68        0.62        0.16         000
                                                 pneumothorax.
32997...........  .............  A............  Total lung lavage...        7.31          NA          NA        1.83        1.87        0.55         000
32998...........  .............  A............  Perq rf ablate tx,          5.68       70.18       70.18        1.98        1.98        0.36         000
                                                 pul tumor.
32999...........  .............  C............  Chest surgery               0.00        0.00        0.00        0.00        0.00        0.00         YYY
                                                 procedure.
33010...........  .............  A............  Drainage of heart           2.24          NA          NA        1.04        0.91        0.14         000
                                                 sac.
33011...........  .............  A............  Repeat drainage of          2.24          NA          NA        1.12        0.97        0.15         000
                                                 heart sac.
33015...........  .............  A............  Incision of heart           8.44          NA          NA        5.15        5.05        0.65         090
                                                 sac.
33020...........  .............  A............  Incision of heart          14.87          NA          NA        6.37        6.57        1.80         090
                                                 sac.
33025...........  .............  A............  Incision of heart          13.65          NA          NA        5.84        6.09        1.81         090
                                                 sac.
33030...........  .............  A............  Partial removal of         22.27          NA          NA        9.11        9.31        2.84         090
                                                 heart sac.
33031...........  .............  A............  Partial removal of         25.30          NA          NA        9.57        9.80        3.14         090
                                                 heart sac.
33050...........  .............  A............  Removal of heart sac       16.85          NA          NA        7.36        7.60        2.15         090
                                                 lesion.
33120...........  .............  A............  Removal of heart           27.33          NA          NA       10.55       11.06        3.70         090
                                                 lesion.
33130...........  .............  A............  Removal of heart           24.05          NA          NA        9.36        9.73        3.01         090
                                                 lesion.
33140...........  .............  A............  Heart revascularize        28.26          NA          NA       10.29       10.58        2.86         090
                                                 (tmr).
33141...........  .............  A............  Heart tmr w/other           2.54          NA          NA        0.78        1.18        0.69         ZZZ
                                                 procedure.
33202...........  .............  A............  Insert epicard             13.15          NA          NA        6.07        6.07        1.71         090
                                                 eltrd, open.
33203...........  .............  A............  Insert epicard             13.92          NA          NA        6.13        6.13        1.39         090
                                                 eltrd, endo.
33206...........  .............  A............  Insertion of heart          7.31          NA          NA        5.12        4.79        0.52         090
                                                 pacemaker.
33207...........  .............  A............  Insertion of heart          8.00          NA          NA        5.22        4.94        0.59         090
                                                 pacemaker.
33208...........  .............  A............  Insertion of heart          8.72          NA          NA        5.65        5.21        0.56         090
                                                 pacemaker.
33210...........  .............  A............  Insertion of heart          3.30          NA          NA        1.66        1.45        0.18         000
                                                 electrode.
33211...........  .............  A............  Insertion of heart          3.39          NA          NA        1.59        1.45        0.21         000
                                                 electrode.
33212...........  .............  A............  Insertion of pulse          5.51          NA          NA        3.70        3.53        0.43         090
                                                 generator.
33213...........  .............  A............  Insertion of pulse          6.36          NA          NA        4.21        3.96        0.45         090
                                                 generator.
33214...........  .............  A............  Upgrade of pacemaker        7.78          NA          NA        5.36        5.12        0.58         090
                                                 system.
33215...........  .............  A............  Reposition pacing-          4.89          NA          NA        3.48        3.33        0.37         090
                                                 defib lead.
33216...........  .............  A............  Insert lead pace-           5.81          NA          NA        4.54        4.37        0.36         090
                                                 defib, one.
33217...........  .............  A............  Insert lead pace-           5.78          NA          NA        4.43        4.33        0.39         090
                                                 defib, dual.
33218...........  .............  A............  Repair lead pace-           5.97          NA          NA        4.82        4.56        0.37         090
                                                 defib, one.
33220...........  .............  A............  Repair lead pace-           6.05          NA          NA        4.78        4.52        0.37         090
                                                 defib, dual.
33222...........  .............  A............  Revise pocket,              5.01          NA          NA        4.30        4.29        0.42         090
                                                 pacemaker.
33223...........  .............  A............  Revise pocket,              6.49          NA          NA        4.87        4.73        0.45         090
                                                 pacing-defib.
33224...........  .............  A............  Insert pacing lead &        9.04          NA          NA        4.90        4.45        0.54         000
                                                 connect.
33225...........  .............  A............  L ventric pacing            8.33          NA          NA        4.35        3.80        0.45         ZZZ
                                                 lead add-on.
33226...........  .............  A............  Reposition l ventric        8.68          NA          NA        4.73        4.28        0.59         000
                                                 lead.
33233...........  .............  A............  Removal of pacemaker        3.33          NA          NA        3.26        3.27        0.22         090
                                                 system.
33234...........  .............  A............  Removal of pacemaker        7.85          NA          NA        5.48        5.19        0.56         090
                                                 system.
33235...........  .............  A............  Removal pacemaker           9.93          NA          NA        7.23        7.02        0.73         090
                                                 electrode.

[[Page 66444]]

 
33236...........  .............  A............  Remove electrode/          12.64          NA          NA        6.37        6.90        1.69         090
                                                 thoracotomy.
33237...........  .............  A............  Remove electrode/          13.75          NA          NA        8.01        7.89        1.59         090
                                                 thoracotomy.
33238...........  .............  A............  Remove electrode/          15.28          NA          NA        8.04        8.12        2.03         090
                                                 thoracotomy.
33240...........  .............  A............  Insert pulse                7.61          NA          NA        5.25        4.91        0.41         090
                                                 generator.
33241...........  .............  A............  Remove pulse                3.26          NA          NA        3.00        2.98        0.18         090
                                                 generator.
33243...........  .............  A............  Remove eltrd/              23.42          NA          NA       10.93       11.19        2.10         090
                                                 thoracotomy.
33244...........  .............  A............  Remove eltrd,              13.84          NA          NA        9.43        9.16        0.99         090
                                                 transven.
33249...........  .............  A............  Eltrd/insert pace-         15.02          NA          NA       10.15        9.25        0.77         090
                                                 defib.
33250...........  .............  A............  Ablate heart               25.78          NA          NA       10.88       10.94        3.19         090
                                                 dysrhythm focus.
33251...........  .............  A............  Ablate heart               28.80          NA          NA       10.95       11.30        3.60         090
                                                 dysrhythm focus.
33254...........  .............  A............  Ablate atria, lmtd..       23.58          NA          NA        9.76        9.76        3.35         090
33255...........  .............  A............  Ablate atria w/o           28.91          NA          NA       11.36       11.36        3.94         090
                                                 bypass, ext.
33256...........  .............  A............  Ablate atria w/            34.77          NA          NA       13.11       13.11        4.95         090
                                                 bypass, exten.
33257...........  .............  A............  Ablate atria, lmtd,         9.63          NA          NA        5.46        5.46        0.89         ZZZ
                                                 add-on.
33258...........  .............  A............  Ablate atria, x10sv,       11.00          NA          NA        5.98        5.98        1.09         ZZZ
                                                 add-on.
33259...........  .............  A............  Ablate atria w/            14.14          NA          NA        7.79        7.79        1.78         ZZZ
                                                 bypass add-on.
33261...........  .............  A............  Ablate heart               28.80          NA          NA       11.68       11.72        3.46         090
                                                 dysrhythm focus.
33265...........  .............  A............  Ablate atria, lmtd,        23.58          NA          NA        9.76        9.76        3.35         090
                                                 endo.
33266...........  .............  A............  Ablate atria, x10sv,       32.91          NA          NA       12.55       12.55        4.80         090
                                                 endo.
33282...........  .............  A............  Implant pat-active          4.70          NA          NA        4.23        4.12        0.23         090
                                                 ht record.
33284...........  .............  A............  Remove pat-active ht        3.04          NA          NA        3.37        3.45        0.14         090
                                                 record.
33300...........  .............  A............  Repair of heart            44.89          NA          NA       15.05       12.14        2.66         090
                                                 wound.
33305...........  .............  A............  Repair of heart            76.85          NA          NA       25.11       17.85        3.13         090
                                                 wound.
33310...........  .............  A............  Exploratory heart          20.22          NA          NA        8.35        8.96        2.59         090
                                                 surgery.
33315...........  .............  A............  Exploratory heart          26.05          NA          NA       10.34       10.61        3.28         090
                                                 surgery.
33320...........  .............  A............  Repair major blood         18.46          NA          NA        8.00        8.11        2.08         090
                                                 vessel(s).
33321...........  .............  A............  Repair major vessel.       20.71          NA          NA        8.37        9.07        2.91         090
33322...........  .............  A............  Repair major blood         24.30          NA          NA        9.54        9.95        2.86         090
                                                 vessel(s).
33330...........  .............  A............  Insert major vessel        25.17          NA          NA        9.49        9.87        2.82         090
                                                 graft.
33332...........  .............  A............  Insert major vessel        24.46          NA          NA        9.45        9.98        3.03         090
                                                 graft.
33335...........  .............  A............  Insert major vessel        33.79          NA          NA       12.48       12.90        4.28         090
                                                 graft.
33400...........  .............  A............  Repair of aortic           41.37          NA          NA       14.56       15.11        4.11         090
                                                 valve.
33401...........  .............  A............  Valvuloplasty, open.       24.41          NA          NA       10.27       11.88        3.57         090
33403...........  .............  A............  Valvuloplasty, w/cp        25.39          NA          NA       12.52       13.41        3.55         090
                                                 bypass.
33404...........  .............  A............  Prepare heart-aorta        31.25          NA          NA       12.00       13.27        4.33         090
                                                 conduit.
33405...........  .............  A............  Replacement of             41.19          NA          NA       15.10       16.69        5.33         090
                                                 aortic valve.
33406...........  .............  A............  Replacement of             52.55          NA          NA       18.36       18.74        5.45         090
                                                 aortic valve.
33410...........  .............  A............  Replacement of             46.28          NA          NA       16.51       16.54        4.69         090
                                                 aortic valve.
33411...........  .............  A............  Replacement of             61.94          NA          NA       21.08       19.90        5.48         090
                                                 aortic valve.
33412...........  .............  A............  Replacement of             43.77          NA          NA       16.20       18.30        6.39         090
                                                 aortic valve.
33413...........  .............  A............  Replacement of             59.74          NA          NA       23.52       22.16        6.53         090
                                                 aortic valve.
33414...........  .............  A............  Repair of aortic           39.29          NA          NA       14.27       14.20        4.57         090
                                                 valve.
33415...........  .............  A............  Revision,                  37.19          NA          NA       13.14       12.57        4.14         090
                                                 subvalvular tissue.
33416...........  .............  A............  Revise ventricle           36.43          NA          NA       13.23       13.36        4.57         090
                                                 muscle.
33417...........  .............  A............  Repair of aortic           29.17          NA          NA       11.69       12.65        4.10         090
                                                 valve.
33420...........  .............  A............  Revision of mitral         25.67          NA          NA        9.49        9.52        1.82         090
                                                 valve.
33422...........  .............  A............  Revision of mitral         29.61          NA          NA       11.35       12.50        3.94         090
                                                 valve.
33425...........  .............  A............  Repair of mitral           49.83          NA          NA       17.59       15.32        4.07         090
                                                 valve.
33426...........  .............  A............  Repair of mitral           43.15          NA          NA       15.74       16.43        5.03         090
                                                 valve.
33427...........  .............  A............  Repair of mitral           44.70          NA          NA       15.69       17.52        6.09         090
                                                 valve.
33430...........  .............  A............  Replacement of             50.75          NA          NA       18.55       17.91        5.10         090
                                                 mitral valve.
33460...........  .............  A............  Revision of                44.62          NA          NA       14.70       13.00        3.45         090
                                                 tricuspid valve.
33463...........  .............  A............  Valvuloplasty,             56.95          NA          NA       19.71       16.31        3.87         090
                                                 tricuspid.
33463...........  .............  A............  Valvuloplasty,             56.95          NA          NA       19.71       16.31        3.87         090
                                                 tricuspid.
33464...........  .............  A............  Valvuloplasty,             44.49          NA          NA       15.83       14.67        4.15         090
                                                 tricuspid.
33465...........  .............  A............  Replace tricuspid          50.59          NA          NA       17.63       15.29        4.39         090
                                                 valve.
33468...........  .............  A............  Revision of                32.82          NA          NA       15.23       14.44        4.07         090
                                                 tricuspid valve.
33470...........  .............  A............  Revision of                21.32          NA          NA        7.92        9.30        1.03         090
                                                 pulmonary valve.
33471...........  .............  A............  Valvotomy, pulmonary       22.83          NA          NA       11.58       10.67        3.39         090
                                                 valve.
33472...........  .............  A............  Revision of                22.90          NA          NA        8.78       10.31        3.55         090
                                                 pulmonary valve.
33474...........  .............  A............  Revision of                39.27          NA          NA       12.93       11.90        3.22         090
                                                 pulmonary valve.
33475...........  .............  A............  Replacement,               42.27          NA          NA       15.05       15.21        4.93         090
                                                 pulmonary valve.
33476...........  .............  A............  Revision of heart          26.41          NA          NA       10.36       11.15        2.42         090
                                                 chamber.
33478...........  .............  A............  Revision of heart          27.38          NA          NA       11.01       12.03        3.89         090
                                                 chamber.
33496...........  .............  A............  Repair, prosth valve       29.71          NA          NA       11.08       11.91        4.13         090
                                                 clot.
33500...........  .............  A............  Repair heart vessel        27.82          NA          NA       11.02       11.24        3.87         090
                                                 fistula.
33501...........  .............  A............  Repair heart vessel        19.43          NA          NA        7.99        8.13        1.91         090
                                                 fistula.
33502...........  .............  A............  Coronary artery            21.69          NA          NA        9.33       10.19        3.00         090
                                                 correction.
33503...........  .............  A............  Coronary artery            22.29          NA          NA       12.31       11.02        1.78         090
                                                 graft.
33504...........  .............  A............  Coronary artery            25.30          NA          NA       10.58       11.19        3.36         090
                                                 graft.
33505...........  .............  A............  Repair artery w/           38.35          NA          NA       15.12       14.01        2.19         090
                                                 tunnel.
33506...........  .............  A............  Repair artery,             37.80          NA          NA       12.69       13.62        4.66         090
                                                 translocation.

[[Page 66445]]

 
33507...........  .............  A............  Repair art,                31.35          NA          NA       11.08       12.36        4.06         090
                                                 intramural.
33508...........  .............  A............  Endoscopic vein             0.31          NA          NA        0.09        0.10        0.04         ZZZ
                                                 harvest.
33510...........  .............  A............  CABG, vein, single..       34.87          NA          NA       12.90       14.61        4.41         090
33511...........  .............  A............  CABG, vein, two.....       38.34          NA          NA       14.15       15.60        4.56         090
33512...........  .............  A............  CABG, vein, three...       43.87          NA          NA       15.93       16.76        4.67         090
33513...........  .............  A............  CABG, vein, four....       45.26          NA          NA       16.36       17.07        4.88         090
33514...........  .............  A............  CABG, vein, five....       47.97          NA          NA       17.33       17.69        4.77         090
33516...........  .............  A............  Cabg, vein, six or         49.65          NA          NA       17.95       18.37        5.13         090
                                                 more.
33517...........  .............  A............  CABG, artery-vein,          3.61          NA          NA        1.08        0.96        0.39         ZZZ
                                                 single.
33518...........  .............  A............  CABG, artery-vein,          7.93          NA          NA        2.36        1.97        0.73         ZZZ
                                                 two.
33519...........  .............  A............  CABG, artery-vein,         10.49          NA          NA        3.14        2.73        1.04         ZZZ
                                                 three.
33521...........  .............  A............  CABG, artery-vein,         12.59          NA          NA        3.77        3.42        1.37         ZZZ
                                                 four.
33522...........  .............  A............  CABG, artery-vein,         14.14          NA          NA        4.23        4.02        1.78         ZZZ
                                                 five.
33523...........  .............  A............  Cabg, art-vein, six        16.08          NA          NA        4.78        4.65        2.13         ZZZ
                                                 or more.
33530...........  .............  A............  Coronary artery,           10.13          NA          NA        2.95        2.43        0.88         ZZZ
                                                 bypass/reop.
33533...........  .............  A............  CABG, arterial,            33.64          NA          NA       12.55       14.50        4.56         090
                                                 single.
33534...........  .............  A............  CABG, arterial, two.       39.77          NA          NA       14.73       16.22        4.70         090
33535...........  .............  A............  CABG, arterial,            44.64          NA          NA       16.29       17.20        5.03         090
                                                 three.
33536...........  .............  A............  Cabg, arterial, four       48.32          NA          NA       17.31       17.80        5.44         090
                                                 or more.
33542...........  .............  A............  Removal of heart           48.08          NA          NA       16.88       14.93        4.38         090
                                                 lesion.
33545...........  .............  A............  Repair of heart            56.93          NA          NA       20.13       17.87        5.21         090
                                                 damage.
33548...........  .............  A............  Restore/remodel,           53.96          NA          NA       19.32       19.30        5.53         090
                                                 ventricle.
33572...........  .............  A............  Open coronary               4.44          NA          NA        1.31        1.38        0.65         ZZZ
                                                 endarterectomy.
33600...........  .............  A............  Closure of valve....       30.15          NA          NA       12.14       12.32        4.42         090
33602...........  .............  A............  Closure of valve....       29.18          NA          NA       11.16       11.80        3.82         090
33606...........  .............  A............  Anastomosis/artery-        31.37          NA          NA       11.90       12.78        4.41         090
                                                 aorta.
33608...........  .............  A............  Repair anomaly w/          31.72          NA          NA       12.85       13.47        4.74         090
                                                 conduit.
33610...........  .............  A............  Repair by                  31.24          NA          NA       13.54       13.57        4.56         090
                                                 enlargement.
33611...........  .............  A............  Repair double              35.49          NA          NA       12.36       13.24        4.37         090
                                                 ventricle.
33612...........  .............  A............  Repair double              36.49          NA          NA       14.30       14.72        5.30         090
                                                 ventricle.
33615...........  .............  A............  Repair, modified           35.76          NA          NA       13.78       13.46        4.32         090
                                                 fontan.
33617...........  .............  A............  Repair single              38.96          NA          NA       13.94       14.96        5.66         090
                                                 ventricle.
33619...........  .............  A............  Repair single              48.60          NA          NA       17.97       19.38        6.46         090
                                                 ventricle.
33641...........  .............  A............  Repair heart septum        29.50          NA          NA       10.88       10.22        3.23         090
                                                 defect.
33645...........  .............  A............  Revision of heart          27.98          NA          NA       10.66       11.21        3.79         090
                                                 veins.
33647...........  .............  A............  Repair heart septum        29.37          NA          NA       12.70       13.23        3.32         090
                                                 defects.
33660...........  .............  A............  Repair of heart            31.75          NA          NA       11.82       12.65        4.49         090
                                                 defects.
33665...........  .............  A............  Repair of heart            34.77          NA          NA       12.16       12.99        4.00         090
                                                 defects.
33670...........  .............  A............  Repair of heart            36.58          NA          NA       15.62       14.39        4.65         090
                                                 chambers.
33675...........  .............  A............  Close mult vsd......       35.87          NA          NA       15.74       15.74        4.95         090
33676...........  .............  A............  Close mult vsd w/          36.87          NA          NA       16.04       16.04        5.44         090
                                                 resection.
33677...........  .............  A............  Cl mult vsd w/rem          38.37          NA          NA       16.61       16.61        5.68         090
                                                 pul band.
33681...........  .............  A............  Repair heart septum        32.16          NA          NA       12.87       13.77        4.45         090
                                                 defect.
33684...........  .............  A............  Repair heart septum        34.29          NA          NA       13.28       13.45        3.39         090
                                                 defect.
33688...........  .............  A............  Repair heart septum        34.67          NA          NA       11.61       11.04        4.73         090
                                                 defect.
33690...........  .............  A............  Reinforce pulmonary        20.20          NA          NA        8.63        9.39        1.97         090
                                                 artery.
33692...........  .............  A............  Repair of heart            31.38          NA          NA       19.57       16.74        4.58         090
                                                 defects.
33694...........  .............  A............  Repair of heart            35.49          NA          NA       10.04       12.12        5.28         090
                                                 defects.
33697...........  .............  A............  Repair of heart            37.49          NA          NA       16.93       15.90        4.09         090
                                                 defects.
33702...........  .............  A............  Repair of heart            27.11          NA          NA       10.52       11.54        3.68         090
                                                 defects.
33710...........  .............  A............  Repair of heart            30.28          NA          NA       11.25       12.60        4.43         090
                                                 defects.
33720...........  .............  A............  Repair of heart            27.13          NA          NA       10.68       11.48        3.84         090
                                                 defect.
33722...........  .............  A............  Repair of heart            29.05          NA          NA       10.60       12.22        1.30         090
                                                 defect.
33724...........  .............  A............  Repair venous              27.55          NA          NA       10.37       10.37        4.00         090
                                                 anomaly.
33726...........  .............  A............  Repair pul venous          37.04          NA          NA       13.21       13.21        5.03         090
                                                 stenosis.
33730...........  .............  A............  Repair heart-vein          36.01          NA          NA       12.85       13.48        5.03         090
                                                 defect(s).
33732...........  .............  A............  Repair heart-vein          28.80          NA          NA       12.65       13.01        3.68         090
                                                 defect.
33735...........  .............  A............  Revision of heart          22.04          NA          NA       11.03        9.99        1.92         090
                                                 chamber.
33736...........  .............  A............  Revision of heart          24.16          NA          NA       12.06       11.95        3.09         090
                                                 chamber.
33737...........  .............  A............  Revision of heart          22.34          NA          NA        9.12       10.02        3.25         090
                                                 chamber.
33750...........  .............  A............  Major vessel shunt..       22.06          NA          NA        9.42        9.81        1.16         090
33755...........  .............  A............  Major vessel shunt..       22.44          NA          NA        7.79        8.29        3.26         090
33762...........  .............  A............  Major vessel shunt..       22.44          NA          NA        8.68        9.41        3.14         090
33764...........  .............  A............  Major vessel shunt &       22.44          NA          NA        8.94        9.58        3.01         090
                                                 graft.
33766...........  .............  A............  Major vessel shunt..       23.41          NA          NA        8.47       10.06        3.70         090
33767...........  .............  A............  Major vessel shunt..       25.14          NA          NA        8.50       10.11        3.82         090
33768...........  .............  A............  Cavopulmonary               8.00          NA          NA        1.84        2.25        1.19         ZZZ
                                                 shunting.
33770...........  .............  A............  Repair great vessels       39.02          NA          NA       11.91       13.29        5.74         090
                                                 defect.
33771...........  .............  A............  Repair great vessels       40.58          NA          NA       13.07       12.73        5.68         090
                                                 defect.
33774...........  .............  A............  Repair great vessels       31.54          NA          NA       12.19       13.42        4.81         090
                                                 defect.
33775...........  .............  A............  Repair great vessels       32.83          NA          NA       10.09       12.54        4.99         090
                                                 defect.
33776...........  .............  A............  Repair great vessels       34.53          NA          NA       10.24       13.02        5.09         090
                                                 defect.

[[Page 66446]]

 
33777...........  .............  A............  Repair great vessels       33.95          NA          NA        9.91       12.76        5.49         090
                                                 defect.
33778...........  .............  A............  Repair great vessels       42.62          NA          NA       14.91       15.90        6.20         090
                                                 defect.
33779...........  .............  A............  Repair great vessels       43.15          NA          NA       12.44       13.90        2.92         090
                                                 defect.
33780...........  .............  A............  Repair great vessels       43.85          NA          NA       13.13       16.10        3.68         090
                                                 defect.
33781...........  .............  A............  Repair great vessels       43.16          NA          NA       11.11       12.22        5.97         090
                                                 defect.
33786...........  .............  A............  Repair arterial            41.74          NA          NA       14.09       15.40        5.71         090
                                                 trunk.
33788...........  .............  A............  Revision of                27.26          NA          NA        8.24       10.09        4.03         090
                                                 pulmonary artery.
33800...........  .............  A............  Aortic suspension...       17.23          NA          NA        6.82        7.46        2.46         090
33802...........  .............  A............  Repair vessel defect       18.24          NA          NA        7.94        8.58        2.27         090
33803...........  .............  A............  Repair vessel defect       20.18          NA          NA        6.38        8.07        3.20         090
33813...........  .............  A............  Repair septal defect       21.23          NA          NA        8.80        9.85        3.13         090
33814...........  .............  A............  Repair septal defect       26.41          NA          NA       10.39       11.52        3.85         090
33820...........  .............  A............  Revise major vessel.       16.61          NA          NA        6.95        7.65        2.35         090
33822...........  .............  A............  Revise major vessel.       17.63          NA          NA        5.93        7.44        2.68         090
33824...........  .............  A............  Revise major vessel.       20.10          NA          NA        8.45        9.21        2.89         090
33840...........  .............  A............  Remove aorta               21.21          NA          NA        9.33        9.81        2.16         090
                                                 constriction.
33845...........  .............  A............  Remove aorta               22.77          NA          NA        9.37       10.36        3.22         090
                                                 constriction.
33851...........  .............  A............  Remove aorta               21.85          NA          NA        8.87        9.77        3.18         090
                                                 constriction.
33852...........  .............  A............  Repair septal defect       24.28          NA          NA       14.75       13.05        2.16         090
33853...........  .............  A............  Repair septal defect       32.35          NA          NA       12.24       13.53        4.48         090
33860...........  .............  A............  Ascending aortic           59.33          NA          NA       20.20       18.32        5.76         090
                                                 graft.
33861...........  .............  A............  Ascending aortic           43.94          NA          NA       15.69       16.69        6.37         090
                                                 graft.
33863...........  .............  A............  Ascending aortic           58.71          NA          NA       19.58       19.13        6.59         090
                                                 graft.
33864...........  .............  A............  Ascending aortic           60.00          NA          NA       20.09       20.09        6.73         090
                                                 graft.
33870...........  .............  A............  Transverse aortic          45.93          NA          NA       16.27       17.32        6.62         090
                                                 arch graft.
33875...........  .............  A............  Thoracic aortic            35.68          NA          NA       12.90       13.49        4.89         090
                                                 graft.
33877...........  .............  A............  Thoracoabdominal           68.85          NA          NA       21.00       18.65        5.94         090
                                                 graft.
33880...........  .............  A............  Endovasc taa repr          34.48          NA          NA       10.91       12.19        2.75         090
                                                 incl subcl.
33881...........  .............  A............  Endovasc taa repr w/       29.48          NA          NA        9.66       10.80        2.33         090
                                                 o subcl.
33883...........  .............  A............  Insert endovasc            20.99          NA          NA        7.23        8.20        2.11         090
                                                 prosth, taa.
33884...........  .............  A............  Endovasc prosth,            8.20          NA          NA        2.08        2.33        0.86         ZZZ
                                                 taa, add-on.
33886...........  .............  A............  Endovasc prosth,           17.99          NA          NA        6.33        7.28        1.80         090
                                                 delayed.
33889...........  .............  A............  Artery transpose/          15.92          NA          NA        3.98        4.58        2.18         000
                                                 endovas taa.
33891...........  .............  A............  Car-car bp grft/           20.00          NA          NA        5.81        6.38        2.73         000
                                                 endovas taa.
33910...........  .............  A............  Remove lung artery         29.59          NA          NA       11.34       11.38        3.70         090
                                                 emboli.
33915...........  .............  A............  Remove lung artery         24.83          NA          NA        9.11        9.37        1.44         090
                                                 emboli.
33916...........  .............  A............  Surgery of great           28.30          NA          NA       10.82       11.07        3.67         090
                                                 vessel.
33917...........  .............  A............  Repair pulmonary           25.14          NA          NA       10.02       11.10        3.70         090
                                                 artery.
33920...........  .............  A............  Repair pulmonary           32.58          NA          NA        9.46       11.64        4.38         090
                                                 atresia.
33922...........  .............  A............  Transect pulmonary         24.09          NA          NA       10.24       10.57        3.10         090
                                                 artery.
33924...........  .............  A............  Remove pulmonary            5.49          NA          NA        1.59        1.72        0.82         ZZZ
                                                 shunt.
33925...........  .............  A............  Rpr pul art unifocal       31.25          NA          NA       16.42       15.54        4.61         090
                                                 w/o cpb.
33926...........  .............  A............  Repr pul art,              44.68          NA          NA       14.79       16.23        6.22         090
                                                 unifocal w/cpb.
33930...........  .............  X............  Removal of donor            0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 heart/lung.
33933...........  .............  C............  Prepare donor heart/        0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 lung.
33935...........  .............  R............  Transplantation,           61.68          NA          NA       22.94       25.84        9.06         090
                                                 heart/lung.
33940...........  .............  X............  Removal of donor            0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 heart.
33944...........  .............  C............  Prepare donor heart.        0.00        0.00        0.00        0.00        0.00        0.00         XXX
33945...........  .............  R............  Transplantation of         89.08          NA          NA       30.37       25.87        6.26         090
                                                 heart.
33960...........  .............  A............  External circulation       19.33          NA          NA        5.25        5.08        2.67         000
                                                 assist.
33961...........  .............  A............  External circulation       10.91          NA          NA        2.98        3.30        0.88         ZZZ
                                                 assist.
33967...........  .............  A............  Insert ia percut            4.84          NA          NA        2.40        2.12        0.35         000
                                                 device.
33968...........  .............  A............  Remove aortic assist        0.64          NA          NA        0.26        0.24        0.07         000
                                                 device.
33970...........  .............  A............  Aortic circulation          6.74          NA          NA        2.53        2.41        0.82         000
                                                 assist.
33971...........  .............  A............  Aortic circulation         11.91          NA          NA        6.00        6.00        1.25         090
                                                 assist.
33973...........  .............  A............  Insert balloon              9.75          NA          NA        3.94        3.62        1.26         000
                                                 device.
33974...........  .............  A............  Remove intra-aortic        14.93          NA          NA        7.73        7.80        1.74         090
                                                 balloon.
33975...........  .............  A............  Implant ventricular        20.97          NA          NA        6.29        6.29        3.07         XXX
                                                 device.
33976...........  .............  A............  Implant ventricular        22.97          NA          NA        7.66        7.60        3.26         XXX
                                                 device.
33977...........  .............  A............  Remove ventricular         20.07          NA          NA        9.41       10.23        2.81         090
                                                 device.
33978...........  .............  A............  Remove ventricular         22.51          NA          NA       10.42       11.08        3.31         090
                                                 device.
33979...........  .............  A............  Insert                     45.93          NA          NA       13.28       14.09        6.97         XXX
                                                 intracorporeal
                                                 device.
33980...........  .............  A............  Remove                     64.86          NA          NA       23.06       24.14        8.59         090
                                                 intracorporeal
                                                 device.
33999...........  .............  C............  Cardiac surgery             0.00        0.00        0.00        0.00        0.00        0.00         YYY
                                                 procedure.
34001...........  .............  A............  Removal of artery          17.78          NA          NA        6.36        6.53        1.85         090
                                                 clot.
34051...........  .............  A............  Removal of artery          16.91          NA          NA        7.43        7.60        2.21         090
                                                 clot.
34101...........  .............  A............  Removal of artery          10.85          NA          NA        4.30        4.82        1.41         090
                                                 clot.
34111...........  .............  A............  Removal of arm             10.85          NA          NA        4.28        4.82        1.40         090
                                                 artery clot.
34151...........  .............  A............  Removal of artery          26.41          NA          NA        8.65        9.52        3.56         090
                                                 clot.
34201...........  .............  A............  Removal of artery          19.38          NA          NA        6.54        5.98        1.45         090
                                                 clot.
34203...........  .............  A............  Removal of leg             17.73          NA          NA        6.38        7.21        2.36         090
                                                 artery clot.
34401...........  .............  A............  Removal of vein clot       26.41          NA          NA        9.26        9.96        3.10         090

[[Page 66447]]

 
34421...........  .............  A............  Removal of vein clot       13.29          NA          NA        5.19        5.74        1.55         090
34451...........  .............  A............  Removal of vein clot       28.41          NA          NA        9.38       10.40        3.84         090
34471...........  .............  A............  Removal of vein clot       21.00          NA          NA        7.86        6.58        1.18         090
34490...........  .............  A............  Removal of vein clot       10.83          NA          NA        4.34        4.88        1.41         090
34501...........  .............  A............  Repair valve,              16.74          NA          NA        6.42        7.45        2.35         090
                                                 femoral vein.
34502...........  .............  A............  Reconstruct vena           27.86          NA          NA       10.47       11.38        3.63         090
                                                 cava.
34510...........  .............  A............  Transposition of           19.80          NA          NA        7.52        8.46        2.33         090
                                                 vein valve.
34520...........  .............  A............  Cross-over vein            19.05          NA          NA        7.01        7.73        2.29         090
                                                 graft.
34530...........  .............  A............  Leg vein fusion.....       17.77          NA          NA        6.76        7.68        1.74         090
34800...........  .............  A............  Endovas aaa repr w/        21.46          NA          NA        7.25        8.20        2.46         090
                                                 sm tube.
34802...........  .............  A............  Endovas aaa repr w/2-      23.71          NA          NA        8.17        8.97        2.33         090
                                                 p part.
34803...........  .............  A............  Endovas aaa repr w/3-      24.74          NA          NA        8.01        9.11        2.01         090
                                                 p part.
34804...........  .............  A............  Endovas aaa repr w/1-      23.71          NA          NA        8.06        8.93        2.30         090
                                                 p part.
34805...........  .............  A............  Endovas aaa repr w/        22.59          NA          NA        7.26        8.45        2.01         090
                                                 long tube.
34806...........  .............  A............  Aneurysm press              2.06        0.51        0.51        0.51        0.51        0.30         ZZZ
                                                 sensor add-on.
34808...........  .............  A............  Endovas iliac a             4.12          NA          NA        1.05        1.21        0.59         ZZZ
                                                 device addon.
34812...........  .............  A............  Xpose for                   6.74          NA          NA        1.66        1.95        1.18         000
                                                 endoprosth, femorl.
34813...........  .............  A............  Femoral endovas             4.79          NA          NA        1.16        1.36        0.67         ZZZ
                                                 graft add-on.
34820...........  .............  A............  Xpose for                   9.74          NA          NA        2.45        2.84        1.50         000
                                                 endoprosth, iliac.
34825...........  .............  A............  Endovasc extend            12.72          NA          NA        5.14        5.64        1.28         090
                                                 prosth, init.
34826...........  .............  A............  Endovasc exten              4.12          NA          NA        1.14        1.25        0.44         ZZZ
                                                 prosth, add'l.
34830...........  .............  A............  Open aortic tube           35.10          NA          NA       10.33       12.01        4.55         090
                                                 prosth repr.
34831...........  .............  A............  Open aortoiliac            37.85          NA          NA       11.27       11.49        4.89         090
                                                 prosth repr.
34832...........  .............  A............  Open aortofemor            37.85          NA          NA       11.80       13.21        4.85         090
                                                 prosth repr.
34833...........  .............  A............  Xpose for                  11.98          NA          NA        3.29        3.86        1.70         000
                                                 endoprosth, iliac.
34834...........  .............  A............  Xpose, endoprosth,          5.34          NA          NA        1.57        1.88        0.76         000
                                                 brachial.
34900...........  .............  A............  Endovasc iliac repr        16.77          NA          NA        6.05        6.81        2.00         090
                                                 w/graft.
35001...........  .............  A............  Repair defect of           20.70          NA          NA        7.70        8.62        2.81         090
                                                 artery.
35002...........  .............  A............  Repair artery              22.12          NA          NA        7.51        8.60        3.00         090
                                                 rupture, neck.
35005...........  .............  A............  Repair defect of           19.18          NA          NA        8.52        8.68        1.77         090
                                                 artery.
35011...........  .............  A............  Repair defect of           18.50          NA          NA        6.29        7.13        2.55         090
                                                 artery.
35013...........  .............  A............  Repair artery              23.10          NA          NA        7.76        8.71        3.10         090
                                                 rupture, arm.
35021...........  .............  A............  Repair defect of           22.09          NA          NA        8.46        8.93        2.87         090
                                                 artery.
35022...........  .............  A............  Repair artery              25.62          NA          NA       10.57       10.21        3.17         090
                                                 rupture, chest.
35045...........  .............  A............  Repair defect of arm       17.94          NA          NA        6.27        6.88        2.45         090
                                                 artery.
35081...........  .............  A............  Repair defect of           33.37          NA          NA       10.70       11.08        4.01         090
                                                 artery.
35082...........  .............  A............  Repair artery              41.93          NA          NA       12.76       14.02        5.44         090
                                                 rupture, aorta.
35091...........  .............  A............  Repair defect of           35.35          NA          NA        9.99       11.77        5.14         090
                                                 artery.
35092...........  .............  A............  Repair artery              50.81          NA          NA       14.50       16.06        6.40         090
                                                 rupture, aorta.
35102...........  .............  A............  Repair defect of           36.37          NA          NA       11.28       11.82        4.48         090
                                                 artery.
35103...........  .............  A............  Repair artery              43.49          NA          NA       12.63       14.23        5.76         090
                                                 rupture, groin.
35111...........  .............  A............  Repair defect of           26.17          NA          NA        8.50        9.48        3.47         090
                                                 artery.
35112...........  .............  A............  Repair artery              32.44          NA          NA       10.07       11.01        4.08         090
                                                 rupture,spleen.
35121...........  .............  A............  Repair defect of           31.41          NA          NA        9.96       11.16        4.30         090
                                                 artery.
35122...........  .............  A............  Repair artery              37.76          NA          NA       11.51       12.65        4.75         090
                                                 rupture, belly.
35131...........  .............  A............  Repair defect of           26.29          NA          NA        8.63        9.68        3.80         090
                                                 artery.
35132...........  .............  A............  Repair artery              32.44          NA          NA       10.28       11.32        4.30         090
                                                 rupture, groin.
35141...........  .............  A............  Repair defect of           20.83          NA          NA        6.93        7.92        2.90         090
                                                 artery.
35142...........  .............  A............  Repair artery              25.03          NA          NA        8.24        9.30        3.36         090
                                                 rupture, thigh.
35151...........  .............  A............  Repair defect of           23.61          NA          NA        7.64        8.81        3.24         090
                                                 artery.
35152...........  .............  A............  Repair artery              27.53          NA          NA        9.11       10.24        3.61         090
                                                 rupture, knee.
35180...........  .............  A............  Repair blood vessel        15.01          NA          NA        6.25        6.60        1.00         090
                                                 lesion.
35182...........  .............  A............  Repair blood vessel        31.58          NA          NA       10.82       11.81        4.36         090
                                                 lesion.
35184...........  .............  A............  Repair blood vessel        18.72          NA          NA        6.50        7.39        2.53         090
                                                 lesion.
35188...........  .............  A............  Repair blood vessel        15.05          NA          NA        6.28        6.95        2.16         090
                                                 lesion.
35189...........  .............  A............  Repair blood vessel        29.85          NA          NA       10.67       11.30        4.01         090
                                                 lesion.
35190...........  .............  A............  Repair blood vessel        13.33          NA          NA        5.23        5.85        1.80         090
                                                 lesion.
35201...........  .............  A............  Repair blood vessel        16.84          NA          NA        6.31        7.15        2.34         090
                                                 lesion.
35206...........  .............  A............  Repair blood vessel        13.76          NA          NA        5.30        5.92        1.87         090
                                                 lesion.
35207...........  .............  A............  Repair blood vessel        10.85          NA          NA        6.63        6.99        1.48         090
                                                 lesion.
35211...........  .............  A............  Repair blood vessel        24.50          NA          NA        9.70       10.15        3.20         090
                                                 lesion.
35216...........  .............  A............  Repair blood vessel        36.47          NA          NA       13.56       11.26        2.65         090
                                                 lesion.
35221...........  .............  A............  Repair blood vessel        26.54          NA          NA        8.33        9.13        3.37         090
                                                 lesion.
35226...........  .............  A............  Repair blood vessel        15.22          NA          NA        5.79        6.61        2.02         090
                                                 lesion.
35231...........  .............  A............  Repair blood vessel        21.08          NA          NA        7.72        8.74        2.89         090
                                                 lesion.
35236...........  .............  A............  Repair blood vessel        17.94          NA          NA        6.29        7.08        2.43         090
                                                 lesion.
35241...........  .............  A............  Repair blood vessel        25.50          NA          NA       10.02       10.56        3.53         090
                                                 lesion.
35246...........  .............  A............  Repair blood vessel        28.15          NA          NA       10.10       10.76        3.86         090
                                                 lesion.
35251...........  .............  A............  Repair blood vessel        31.83          NA          NA        9.45       10.61        4.13         090
                                                 lesion.
35256...........  .............  A............  Repair blood vessel        18.98          NA          NA        6.37        7.35        2.63         090
                                                 lesion.
35261...........  .............  A............  Repair blood vessel        18.88          NA          NA        6.97        7.49        2.61         090
                                                 lesion.
35266...........  .............  A............  Repair blood vessel        15.75          NA          NA        5.47        6.23        2.10         090
                                                 lesion.

[[Page 66448]]

 
35271...........  .............  A............  Repair blood vessel        24.50          NA          NA        9.68       10.09        3.16         090
                                                 lesion.
35276...........  .............  A............  Repair blood vessel        25.72          NA          NA        9.78       10.48        3.49         090
                                                 lesion.
35281...........  .............  A............  Repair blood vessel        29.93          NA          NA        9.28       10.48        3.97         090
                                                 lesion.
35286...........  .............  A............  Repair blood vessel        17.06          NA          NA        6.31        7.17        2.35         090
                                                 lesion.
35301...........  .............  A............  Rechanneling of            19.53          NA          NA        6.68        7.55        2.68         090
                                                 artery.
35302...........  .............  A............  Rechanneling of            21.27          NA          NA        6.90        6.90        2.98         090
                                                 artery.
35303...........  .............  A............  Rechanneling of            23.52          NA          NA        7.45        7.45        3.26         090
                                                 artery.
35304...........  .............  A............  Rechanneling of            24.52          NA          NA        7.70        7.70        3.41         090
                                                 artery.
35305...........  .............  A............  Rechanneling of            23.52          NA          NA        7.45        7.45        3.26         090
                                                 artery.
35306...........  .............  A............  Rechanneling of             9.25          NA          NA        2.28        2.28        1.34         ZZZ
                                                 artery.
35311...........  .............  A............  Rechanneling of            28.52          NA          NA        9.63       10.68        3.42         090
                                                 artery.
35321...........  .............  A............  Rechanneling of            16.51          NA          NA        5.77        6.57        2.25         090
                                                 artery.
35331...........  .............  A............  Rechanneling of            27.61          NA          NA        8.81       10.01        3.83         090
                                                 artery.
35341...........  .............  A............  Rechanneling of            26.10          NA          NA        8.24        9.55        3.78         090
                                                 artery.
35351...........  .............  A............  Rechanneling of            24.53          NA          NA        7.64        8.61        3.35         090
                                                 artery.
35355...........  .............  A............  Rechanneling of            19.78          NA          NA        6.35        7.21        2.67         090
                                                 artery.
35361...........  .............  A............  Rechanneling of            30.11          NA          NA        9.59       10.64        4.15         090
                                                 artery.
35363...........  .............  A............  Rechanneling of            32.22          NA          NA       10.43       11.50        4.33         090
                                                 artery.
35371...........  .............  A............  Rechanneling of            15.23          NA          NA        5.33        6.14        2.14         090
                                                 artery.
35372...........  .............  A............  Rechanneling of            18.50          NA          NA        6.12        7.08        2.63         090
                                                 artery.
35390...........  .............  A............  Reoperation, carotid        3.19          NA          NA        0.82        0.94        0.46         ZZZ
                                                 add-on.
35400...........  .............  A............  Angioscopy..........        3.00          NA          NA        0.72        0.91        0.43         ZZZ
35450...........  .............  A............  Repair arterial            10.05          NA          NA        2.97        3.26        1.25         000
                                                 blockage.
35452...........  .............  A............  Repair arterial             6.90          NA          NA        2.06        2.33        0.94         000
                                                 blockage.
35454...........  .............  A............  Repair arterial             6.03          NA          NA        1.76        2.04        0.87         000
                                                 blockage.
35456...........  .............  A............  Repair arterial             7.34          NA          NA        2.12        2.44        1.04         000
                                                 blockage.
35458...........  .............  A............  Repair arterial             9.48          NA          NA        2.80        3.13        1.26         000
                                                 blockage.
35459...........  .............  A............  Repair arterial             8.62          NA          NA        2.65        2.91        1.21         000
                                                 blockage.
35460...........  .............  A............  Repair venous               6.03          NA          NA        1.74        2.01        0.83         000
                                                 blockage.
35470...........  .............  A............  Repair arterial             8.62       61.12       74.97        3.44        3.39        0.69         000
                                                 blockage.
35471...........  .............  A............  Repair arterial            10.05       65.97       83.09        4.68        4.31        0.67         000
                                                 blockage.
35472...........  .............  A............  Repair arterial             6.90       47.48       55.90        2.81        2.78        0.58         000
                                                 blockage.
35473...........  .............  A............  Repair arterial             6.03       46.50       53.15        2.49        2.46        0.51         000
                                                 blockage.
35474...........  .............  A............  Repair arterial             7.35       60.37       74.03        2.98        2.93        0.57         000
                                                 blockage.
35475...........  .............  R............  Repair arterial             9.48       48.63       52.35        3.38        3.47        0.62         000
                                                 blockage.
35476...........  .............  A............  Repair venous               6.03       37.11       40.91        2.23        2.29        0.34         000
                                                 blockage.
35480...........  .............  A............  Atherectomy, open...       11.06          NA          NA        4.04        4.04        1.28         000
35481...........  .............  A............  Atherectomy, open...        7.60          NA          NA        2.57        2.72        1.13         000
35482...........  .............  A............  Atherectomy, open...        6.64          NA          NA        2.01        2.28        0.89         000
35483...........  .............  A............  Atherectomy, open...        8.09          NA          NA        2.56        2.79        1.15         000
35484...........  .............  A............  Atherectomy, open...       10.42          NA          NA        2.90        3.33        1.27         000
35485...........  .............  A............  Atherectomy, open...        9.48          NA          NA        2.87        3.20        1.35         000
35490...........  .............  A............  Atherectomy,               11.06          NA          NA        5.17        4.93        0.71         000
                                                 percutaneous.
35491...........  .............  A............  Atherectomy,                7.60          NA          NA        3.85        3.57        0.74         000
                                                 percutaneous.
35492...........  .............  A............  Atherectomy,                6.64          NA          NA        3.48        3.34        0.43         000
                                                 percutaneous.
35493...........  .............  A............  Atherectomy,                8.09          NA          NA        3.96        3.88        0.56         000
                                                 percutaneous.
35494...........  .............  A............  Atherectomy,               10.42          NA          NA        5.15        4.80        0.59         000
                                                 percutaneous.
35495...........  .............  A............  Atherectomy,                9.48          NA          NA        4.45        4.42        0.69         000
                                                 percutaneous.
35500...........  .............  A............  Harvest vein for            6.44          NA          NA        1.59        1.81        0.93         ZZZ
                                                 bypass.
35501...........  .............  A............  Artery bypass graft.       28.99          NA          NA       11.06        9.75        4.10         090
35506...........  .............  A............  Artery bypass graft.       25.23          NA          NA        8.31        8.88        2.87         090
35508...........  .............  A............  Artery bypass graft.       25.99          NA          NA        8.76        9.10        2.78         090
35509...........  .............  A............  Artery bypass graft.       27.99          NA          NA       10.77        9.77        3.92         090
35510...........  .............  A............  Artery bypass graft.       24.29          NA          NA        7.69        8.93        2.12         090
35511...........  .............  A............  Artery bypass graft.       22.12          NA          NA        7.65        8.50        2.91         090
35512...........  .............  A............  Artery bypass graft.       23.79          NA          NA        7.47        8.73        2.12         090
35515...........  .............  A............  Artery bypass graft.       25.99          NA          NA        9.08        9.18        2.78         090
35516...........  .............  A............  Artery bypass graft.       24.11          NA          NA        7.45        7.12        2.34         090
35518...........  .............  A............  Artery bypass graft.       22.57          NA          NA        7.32        8.14        3.03         090
35521...........  .............  A............  Artery bypass graft.       24.00          NA          NA        7.94        8.88        3.13         090
35522...........  .............  A............  Artery bypass graft.       23.05          NA          NA        7.39        8.57        2.12         090
35523...........  .............  A............  Artery bypass graft.       24.00          NA          NA        9.20        9.20        2.14         090
35525...........  .............  A............  Artery bypass graft.       21.59          NA          NA        7.03        8.20        2.12         090
35526...........  .............  A............  Artery bypass graft.       31.47          NA          NA       14.03       13.26        3.63         090
35531...........  .............  A............  Artery bypass graft.       38.98          NA          NA       11.46       12.96        5.18         090
35533...........  .............  A............  Artery bypass graft.       29.79          NA          NA        9.49       10.60        3.85         090
35536...........  .............  A............  Artery bypass graft.       33.60          NA          NA        9.50       11.22        4.62         090
35537...........  .............  A............  Artery bypass graft.       41.75          NA          NA       13.08       13.08        5.72         090
35538...........  .............  A............  Artery bypass graft.       46.82          NA          NA       14.43       14.43        6.39         090
35539...........  .............  A............  Artery bypass graft.       43.98          NA          NA       13.46       13.46        6.02         090
35540...........  .............  A............  Artery bypass graft.       49.20          NA          NA       14.80       14.80        6.76         090
35548...........  .............  A............  Artery bypass graft.       22.57          NA          NA        7.73        8.57        2.98         090

[[Page 66449]]

 
35549...........  .............  A............  Artery bypass graft.       24.34          NA          NA        8.73        9.55        3.30         090
35551...........  .............  A............  Artery bypass graft.       27.72          NA          NA        9.37       10.42        3.75         090
35556...........  .............  A............  Artery bypass graft.       26.62          NA          NA        8.63        9.17        3.10         090
35558...........  .............  A............  Artery bypass graft.       23.00          NA          NA        7.86        8.70        3.00         090
35560...........  .............  A............  Artery bypass graft.       33.90          NA          NA       10.61       11.96        4.75         090
35563...........  .............  A............  Artery bypass graft.       25.99          NA          NA        8.87        9.69        3.52         090
35565...........  .............  A............  Artery bypass graft.       25.00          NA          NA        8.16        9.14        3.30         090
35566...........  .............  A............  Artery bypass graft.       32.22          NA          NA        9.84       10.61        3.83         090
35571...........  .............  A............  Artery bypass graft.       25.39          NA          NA        8.08        9.46        3.43         090
35572...........  .............  A............  Harvest                     6.81          NA          NA        1.92        2.08        0.99         ZZZ
                                                 femoropopliteal
                                                 vein.
35583...........  .............  A............  Vein bypass graft...       27.62          NA          NA        8.63        9.39        3.17         090
35585...........  .............  A............  Vein bypass graft...       32.22          NA          NA       10.10       11.15        4.02         090
35587...........  .............  A............  Vein bypass graft...       26.08          NA          NA        8.50        9.97        3.52         090
35600...........  .............  A............  Harvest art for cabg        4.94          NA          NA        1.52        1.57        0.73         ZZZ
                                                 add-on.
35601...........  .............  A............  Artery bypass graft.       26.99          NA          NA       10.42        9.52        3.72         090
35606...........  .............  A............  Artery bypass graft.       22.36          NA          NA        7.30        8.15        2.70         090
35612...........  .............  A............  Artery bypass graft.       16.71          NA          NA        6.31        7.09        2.09         090
35616...........  .............  A............  Artery bypass graft.       21.74          NA          NA        7.12        7.61        2.20         090
35621...........  .............  A............  Artery bypass graft.       20.95          NA          NA        6.77        7.72        2.92         090
35623...........  .............  A............  Bypass graft, not          25.79          NA          NA        8.43        9.46        3.46         090
                                                 vein.
35626...........  .............  A............  Artery bypass graft.       29.06          NA          NA       10.27       11.12        4.08         090
35631...........  .............  A............  Artery bypass graft.       35.90          NA          NA       10.55       12.18        4.96         090
35636...........  .............  A............  Artery bypass graft.       31.62          NA          NA        9.71       11.00        4.10         090
35637...........  .............  A............  Artery bypass graft.       32.92          NA          NA       10.64       10.64        4.44         090
35638...........  .............  A............  Artery bypass graft.       33.47          NA          NA       10.78       10.78        4.52         090
35642...........  .............  A............  Artery bypass graft.       18.85          NA          NA        6.21        7.45        2.28         090
35645...........  .............  A............  Artery bypass graft.       18.34          NA          NA        7.97        8.12        2.50         090
35646...........  .............  A............  Artery bypass graft.       32.84          NA          NA       10.44       11.77        4.44         090
35647...........  .............  A............  Artery bypass graft.       29.62          NA          NA        9.65       10.70        3.99         090
35650...........  .............  A............  Artery bypass graft.       20.08          NA          NA        6.92        7.64        2.72         090
35651...........  .............  A............  Artery bypass graft.       25.97          NA          NA        8.70        9.71        3.36         090
35654...........  .............  A............  Artery bypass graft.       26.17          NA          NA        8.35        9.50        3.53         090
35656...........  .............  A............  Artery bypass graft.       20.39          NA          NA        6.83        7.71        2.80         090
35661...........  .............  A............  Artery bypass graft.       20.22          NA          NA        7.04        7.98        2.72         090
35663...........  .............  A............  Artery bypass graft.       23.80          NA          NA        7.89        8.93        3.11         090
35665...........  .............  A............  Artery bypass graft.       22.22          NA          NA        7.35        8.40        3.01         090
35666...........  .............  A............  Artery bypass graft.       23.53          NA          NA        8.50        9.56        3.16         090
35671...........  .............  A............  Artery bypass graft.       20.64          NA          NA        7.62        8.49        2.78         090
35681...........  .............  A............  Composite bypass            1.60          NA          NA        0.40        0.47        0.23         ZZZ
                                                 graft.
35682...........  .............  A............  Composite bypass            7.19          NA          NA        1.69        2.04        1.03         ZZZ
                                                 graft.
35683...........  .............  A............  Composite bypass            8.49          NA          NA        1.96        2.39        1.20         ZZZ
                                                 graft.
35685...........  .............  A............  Bypass graft patency/       4.04          NA          NA        0.96        1.15        0.58         ZZZ
                                                 patch.
35686...........  .............  A............  Bypass graft/av fist        3.34          NA          NA        0.85        0.99        0.47         ZZZ
                                                 patency.
35691...........  .............  A............  Arterial                   18.32          NA          NA        5.94        7.17        2.59         090
                                                 transposition.
35693...........  .............  A............  Arterial                   15.64          NA          NA        6.11        6.91        2.22         090
                                                 transposition.
35694...........  .............  A............  Arterial                   19.19          NA          NA        6.31        7.45        2.70         090
                                                 transposition.
35695...........  .............  A............  Arterial                   19.97          NA          NA        6.70        7.62        2.74         090
                                                 transposition.
35697...........  .............  A............  Reimplant artery            3.00          NA          NA        0.74        0.88        0.41         ZZZ
                                                 each.
35700...........  .............  A............  Reoperation, bypass         3.08          NA          NA        0.76        0.89        0.44         ZZZ
                                                 graft.
35701...........  .............  A............  Exploration, carotid        9.11          NA          NA        4.31        4.73        1.12         090
                                                 artery.
35721...........  .............  A............  Exploration, femoral        7.66          NA          NA        3.83        4.13        1.03         090
                                                 artery.
35741...........  .............  A............  Exploration                 8.61          NA          NA        3.86        4.26        1.12         090
                                                 popliteal artery.
35761...........  .............  A............  Exploration of              5.84          NA          NA        3.43        3.72        0.75         090
                                                 artery/vein.
35800...........  .............  A............  Explore neck vessels        7.99          NA          NA        3.95        4.30        0.95         090
35820...........  .............  A............  Explore chest              36.81          NA          NA       12.90       10.05        1.95         090
                                                 vessels.
35840...........  .............  A............  Explore abdominal          10.87          NA          NA        4.81        5.04        1.34         090
                                                 vessels.
35860...........  .............  A............  Explore limb vessels        6.72          NA          NA        3.38        3.70        0.78         090
35870...........  .............  A............  Repair vessel graft        24.39          NA          NA        7.91        8.84        3.01         090
                                                 defect.
35875...........  .............  A............  Removal of clot in         10.64          NA          NA        4.28        4.73        1.41         090
                                                 graft.
35876...........  .............  A............  Removal of clot in         17.74          NA          NA        5.94        6.72        2.40         090
                                                 graft.
35879...........  .............  A............  Revise graft w/vein.       17.28          NA          NA        5.97        6.83        2.28         090
35881...........  .............  A............  Revise graft w/vein.       19.22          NA          NA        6.46        7.56        2.56         090
35883...........  .............  A............  Revise graft w/            23.07          NA          NA        8.49        8.49        3.19         090
                                                 nonauto graft.
35884...........  .............  A............  Revise graft w/vein.       24.57          NA          NA        8.93        8.93        3.41         090
35901...........  .............  A............  Excision, graft,            8.26          NA          NA        4.24        4.77        1.15         090
                                                 neck.
35903...........  .............  A............  Excision, graft,            9.44          NA          NA        4.60        5.37        1.30         090
                                                 extremity.
35905...........  .............  A............  Excision, graft,           33.39          NA          NA       10.65       11.91        4.44         090
                                                 thorax.
35907...........  .............  A............  Excision, graft,           37.14          NA          NA       10.87       12.51        4.92         090
                                                 abdomen.
36000...........  .............  A............  Place needle in vein        0.18        0.46        0.51        0.06        0.06        0.01         XXX
36002...........  .............  A............  Pseudoaneurysm              1.96        2.24        2.55        0.85        0.91        0.17         000
                                                 injection trt.
36005...........  .............  A............  Injection ext               0.95        8.46        8.05        0.39        0.35        0.05         000
                                                 venography.
36010...........  .............  A............  Place catheter in           2.43       11.09       15.19        0.78        0.79        0.20         XXX
                                                 vein.

[[Page 66450]]

 
36011...........  .............  A............  Place catheter in           3.14       19.61       23.71        1.01        1.03        0.27         XXX
                                                 vein.
36012...........  .............  A............  Place catheter in           3.51       20.23       19.58        1.28        1.23        0.23         XXX
                                                 vein.
36013...........  .............  A............  Place catheter in           2.52       18.76       20.06        0.93        0.81        0.25         XXX
                                                 artery.
36014...........  .............  A............  Place catheter in           3.02       18.94       19.52        1.11        1.07        0.19         XXX
                                                 artery.
36015...........  .............  A............  Place catheter in           3.51       18.54       21.09        1.05        1.12        0.21         XXX
                                                 artery.
36100...........  .............  A............  Establish access to         3.02       11.23       11.65        1.21        1.16        0.26         XXX
                                                 artery.
36120...........  .............  A............  Establish access to         2.01        9.20        9.95        0.59        0.62        0.14         XXX
                                                 artery.
36140...........  .............  A............  Establish access to         2.01       10.47       11.62        0.71        0.67        0.16         XXX
                                                 artery.
36145...........  .............  A............  Artery to vein shunt        2.01       10.28       11.41        0.66        0.66        0.11         XXX
36160...........  .............  A............  Establish access to         2.52       11.54       12.51        1.05        0.94        0.26         XXX
                                                 aorta.
36200...........  .............  A............  Place catheter in           3.02       13.65       15.08        1.02        1.01        0.24         XXX
                                                 aorta.
36215...........  .............  A............  Place catheter in           4.67       25.94       26.48        1.89        1.75        0.27         XXX
                                                 artery.
36216...........  .............  A............  Place catheter in           5.27       28.03       28.54        2.09        1.94        0.31         XXX
                                                 artery.
36217...........  .............  A............  Place catheter in           6.29       45.85       50.63        2.43        2.30        0.44         XXX
                                                 artery.
36218...........  .............  A............  Place catheter in           1.01        3.76        4.42        0.39        0.36        0.07         ZZZ
                                                 artery.
36245...........  .............  A............  Place catheter in           4.67       28.77       30.42        2.11        1.89        0.31         XXX
                                                 artery.
36246...........  .............  A............  Place catheter in           5.27       27.41       28.68        1.99        1.91        0.38         XXX
                                                 artery.
36247...........  .............  A............  Place catheter in           6.29       45.15       47.31        2.36        2.25        0.47         XXX
                                                 artery.
36248...........  .............  A............  Place catheter in           1.01        3.17        3.61        0.38        0.36        0.07         ZZZ
                                                 artery.
36260...........  .............  A............  Insertion of                9.82          NA          NA        4.64        4.76        1.29         090
                                                 infusion pump.
36261...........  .............  A............  Revision of infusion        5.55          NA          NA        3.06        3.36        0.70         090
                                                 pump.
36262...........  .............  A............  Removal of infusion         4.05          NA          NA        2.71        2.73        0.54         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        0.28        0.09        0.09        0.03         XXX
                                                 jugular.
36405...........  .............  A............  Bl draw < 3 yrs             0.31        0.27        0.27        0.08        0.08        0.03         XXX
                                                 scalp vein.
36406...........  .............  A............  Bl draw < 3 yrs             0.18        0.25        0.26        0.04        0.05        0.01         XXX
                                                 other vein.
36410...........  .............  A............  Non-routine bl draw         0.18        0.32        0.30        0.05        0.05        0.01         XXX
                                                 > 3 yrs.
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          NA          NA        0.21        0.24        0.07         XXX
                                                 < 1 yr.
36425...........  .............  A............  Vein access cutdown         0.76          NA          NA        0.21        0.21        0.06         XXX
                                                 > 1 yr.
36430...........  .............  A............  Blood transfusion           0.00        0.93        0.97          NA          NA        0.06         XXX
                                                 service.
36440...........  .............  A............  Bl push transfuse, 2        1.03          NA          NA        0.25        0.27        0.10         XXX
                                                 yr or <.
36450...........  .............  A............  Bl exchange/                2.23          NA          NA        0.77        0.74        0.21         XXX
                                                 transfuse, nb.
36455...........  .............  A............  Bl exchange/                2.43          NA          NA        0.66        0.84        0.15         XXX
                                                 transfuse non-nb.
36460...........  .............  A............  Transfusion service,        6.58          NA          NA        1.81        2.03        0.79         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        2.41        2.54        0.64        0.68        0.12         010
                                                 vein.
36471...........  .............  A............  Injection therapy of        1.60        2.56        2.82        0.79        0.87        0.19         010
                                                 veins.
36475...........  .............  A............  Endovenous rf, 1st          6.72       35.74       43.55        1.88        2.20        0.37         000
                                                 vein.
36476...........  .............  A............  Endovenous rf, vein         3.38        6.14        7.00        0.83        0.98        0.18         ZZZ
                                                 add-on.
36478...........  .............  A............  Endovenous laser,           6.72       26.95       36.85        2.04        2.29        0.37         000
                                                 1st vein.
36479...........  .............  A............  Endovenous laser            3.38        6.35        7.17        0.95        1.04        0.18         ZZZ
                                                 vein addon.
36481...........  .............  A............  Insertion of                6.98          NA          NA        2.35        2.47        0.55         000
                                                 catheter, vein.
36500...........  .............  A............  Insertion of                3.51          NA          NA        1.25        1.31        0.20         000
                                                 catheter, vein.
36510...........  .............  A............  Insertion of                1.09        1.08        2.48        0.30        0.45        0.10         000
                                                 catheter, vein.
36511...........  .............  A............  Apheresis wbc.......        1.74          NA          NA        0.57        0.65        0.08         000
36512...........  .............  A............  Apheresis rbc.......        1.74          NA          NA        0.60        0.67        0.08         000
36513...........  .............  A............  Apheresis platelets.        1.74          NA          NA        0.55        0.64        0.17         000
36514...........  .............  A............  Apheresis plasma....        1.74       10.49       13.73        0.53        0.62        0.08         000
36515...........  .............  A............  Apheresis, adsorp/          1.74       45.46       55.86        0.48        0.57        0.08         000
                                                 reinfuse.
36516...........  .............  A............  Apheresis, selective        1.22       49.53       66.77        0.39        0.43        0.08         000
36522...........  .............  A............  Photopheresis.......        1.67       37.40       34.87        0.94        0.95        0.13         000
36555...........  .............  A............  Insert non-tunnel cv        2.68        3.81        4.78        0.59        0.69        0.11         000
                                                 cath.
36556...........  .............  A............  Insert non-tunnel cv        2.50        2.85        4.24        0.55        0.65        0.19         000
                                                 cath.
36557...........  .............  A............  Insert tunneled cv          5.11       15.09       18.11        2.29        2.47        0.57         010
                                                 cath.
36558...........  .............  A............  Insert tunneled cv          4.81       14.84       17.93        2.35        2.45        0.57         010
                                                 cath.
36560...........  .............  A............  Insert tunneled cv          6.26       21.31       25.48        2.72        2.87        0.57         010
                                                 cath.
36561...........  .............  A............  Insert tunneled cv          6.01       22.24       25.90        2.64        2.79        0.57         010
                                                 cath.
36563...........  .............  A............  Insert tunneled cv          6.21       23.09       24.91        2.60        2.79        0.84         010
                                                 cath.
36565...........  .............  A............  Insert tunneled cv          6.01       17.51       21.10        2.47        2.71        0.57         010
                                                 cath.
36566...........  .............  A............  Insert tunneled cv          6.51      111.82       68.65        2.60        2.85        0.57         010
                                                 cath.
36568...........  .............  A............  Insert picc cath....        1.92        5.87        6.70        0.59        0.59        0.11         000
36569...........  .............  A............  Insert picc cath....        1.82        4.47        5.90        0.67        0.62        0.19         000
36570...........  .............  A............  Insert picvad cath..        5.33       21.23       27.19        2.10        2.41        0.57         010
36571...........  .............  A............  Insert picvad cath..        5.31       24.50       28.86        2.44        2.58        0.57         010
36575...........  .............  A............  Repair tunneled cv          0.67        3.30        3.67        0.23        0.25        0.20         000
                                                 cath.
36576...........  .............  A............  Repair tunneled cv          3.21        5.90        6.42        1.56        1.70        0.19         010
                                                 cath.
36578...........  .............  A............  Replace tunneled cv         3.51        9.16       10.14        2.00        2.15        0.19         010
                                                 cath.
36580...........  .............  A............  Replace cvad cath...        1.31        3.96        5.45        0.43        0.42        0.19         000
36581...........  .............  A............  Replace tunneled cv         3.45       15.49       17.49        1.73        1.83        0.19         010
                                                 cath.

[[Page 66451]]

 
36582...........  .............  A............  Replace tunneled cv         5.21       21.53       23.76        2.45        2.66        0.19         010
                                                 cath.
36583...........  .............  A............  Replace tunneled cv         5.26       21.57       23.80        2.48        2.68        0.19         010
                                                 cath.
36584...........  .............  A............  Replace picc cath...        1.20        3.96        5.47        0.61        0.58        0.19         000
36585...........  .............  A............  Replace picvad cath.        4.81       22.54       25.17        2.42        2.58        0.19         010
36589...........  .............  A............  Removal tunneled cv         2.27        1.86        2.05        1.23        1.31        0.24         010
                                                 cath.
36590...........  .............  A............  Removal tunneled cv         3.32        3.62        3.49        1.59        1.65        0.44         010
                                                 cath.
36591...........  .............  T............  Draw blood off              0.00        0.54        0.54          NA          NA        0.01         XXX
                                                 venous device.
36592...........  .............  T............  Collect blood from          0.00        0.67        0.67          NA          NA        0.01         XXX
                                                 picc.
36593...........  .............  A............  Declot vascular             0.00        0.82        0.60          NA          NA        0.37         XXX
                                                 device.
36595...........  .............  A............  Mech remov tunneled         3.59       10.83       14.04        1.38        1.41        0.21         000
                                                 cv cath.
36596...........  .............  A............  Mech remov tunneled         0.75        2.57        3.13        0.43        0.47        0.05         000
                                                 cv cath.
36597...........  .............  A............  Reposition venous           1.21        2.04        2.22        0.46        0.45        0.07         000
                                                 catheter.
36598...........  .............  T............  Inj w/fluor, eval cv        0.74        2.22        2.43        0.27        1.45        0.05         000
                                                 device.
36600...........  .............  A............  Withdrawal of               0.32        0.50        0.49        0.07        0.08        0.02         XXX
                                                 arterial blood.
36620...........  .............  A............  Insertion catheter,         1.15          NA          NA        0.15        0.19        0.07         000
                                                 artery.
36625...........  .............  A............  Insertion catheter,         2.11          NA          NA        0.50        0.52        0.26         000
                                                 artery.
36640...........  .............  A............  Insertion catheter,         2.10          NA          NA        0.91        0.97        0.21         000
                                                 artery.
36660...........  .............  A............  Insertion catheter,         1.40          NA          NA        0.41        0.42        0.14         000
                                                 artery.
36680...........  .............  A............  Insert needle, bone         1.20          NA          NA        0.28        0.38        0.11         000
                                                 cavity.
36800...........  .............  A............  Insertion of cannula        2.43          NA          NA        1.53        1.67        0.25         000
36810...........  .............  A............  Insertion of cannula        3.96          NA          NA        1.32        1.50        0.45         000
36815...........  .............  A............  Insertion of cannula        2.62          NA          NA        1.04        1.10        0.35         000
36818...........  .............  A............  Av fuse, uppr arm,         11.81          NA          NA        4.49        5.26        1.90         090
                                                 cephalic.
36819...........  .............  A............  Av fuse, uppr arm,         14.39          NA          NA        5.11        5.74        1.96         090
                                                 basilic.
36820...........  .............  A............  Av fusion/forearm          14.39          NA          NA        5.24        5.81        1.95         090
                                                 vein.
36821...........  .............  A............  Av fusion direct any        9.15          NA          NA        3.94        4.29        1.23         090
                                                 site.
36822...........  .............  A............  Insertion of                5.51          NA          NA        3.74        4.06        0.79         090
                                                 cannula(s).
36823...........  .............  A............  Insertion of               22.82          NA          NA        8.63        9.00        2.89         090
                                                 cannula(s).
36825...........  .............  A............  Artery-vein                10.00          NA          NA        4.22        4.63        1.35         090
                                                 autograft.
36830...........  .............  A............  Artery-vein                12.00          NA          NA        4.13        4.68        1.66         090
                                                 nonautograft.
36831...........  .............  A............  Open thrombect av           8.01          NA          NA        3.18        3.56        1.09         090
                                                 fistula.
36832...........  .............  A............  Av fistula revision,       10.50          NA          NA        3.74        4.23        1.44         090
                                                 open.
36833...........  .............  A............  Av fistula revision.       11.95          NA          NA        4.12        4.66        1.65         090
36834...........  .............  A............  Repair A-V aneurysm.       11.11          NA          NA        4.21        4.50        1.37         090
36835...........  .............  A............  Artery to vein shunt        7.43          NA          NA        3.74        4.03        0.98         090
36838...........  .............  A............  Dist revas ligation,       21.59          NA          NA        7.04        8.21        3.02         090
                                                 hemo.
36860...........  .............  A............  External cannula            2.01        3.36        2.57        0.63        0.65        0.11         000
                                                 declotting.
36861...........  .............  A............  Cannula declotting..        2.52          NA          NA        1.22        1.35        0.27         000
36870...........  .............  A............  Percut thrombect av         5.17       40.78       46.89        2.76        2.95        0.29         090
                                                 fistula.
37140...........  .............  A............  Revision of                25.12          NA          NA        8.92        9.70        2.02         090
                                                 circulation.
37145...........  .............  A............  Revision of                26.13          NA          NA       10.45       10.65        3.26         090
                                                 circulation.
37160...........  .............  A............  Revision of                23.13          NA          NA        7.92        8.59        2.82         090
                                                 circulation.
37180...........  .............  A............  Revision of                26.13          NA          NA        9.27        9.78        3.35         090
                                                 circulation.
37181...........  .............  A............  Splice spleen/kidney       28.26          NA          NA        8.83        9.91        3.41         090
                                                 veins.
37182...........  .............  A............  Insert hepatic shunt       16.97          NA          NA        6.33        6.19        1.00         000
                                                 (tips).
37183...........  .............  A............  Remove hepatic shunt        7.99          NA          NA        3.09        3.05        0.47         000
                                                 (tips).
37184...........  .............  A............  Prim art mech               8.66       49.91       60.78        3.23        3.29        0.55         000
                                                 thrombectomy.
37185...........  .............  A............  Prim art m-thrombect        3.28       16.38       19.62        1.12        1.11        0.21         ZZZ
                                                 add-on.
37186...........  .............  A............  Sec art m-thrombect         4.92       34.90       42.13        1.79        1.72        0.32         ZZZ
                                                 add-on.
37187...........  .............  A............  Venous mech                 8.03       48.21       59.18        2.99        3.06        0.51         000
                                                 thrombectomy.
37188...........  .............  A............  Venous m-                   5.71       42.22       52.08        2.18        2.27        0.37         000
                                                 thrombectomy add-on.
37195...........  .............  C............  Thrombolytic                0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 therapy, stroke.
37200...........  .............  A............  Transcatheter biopsy        4.55          NA          NA        1.65        1.57        0.27         000
37201...........  .............  A............  Transcatheter               4.99          NA          NA        2.33        2.44        0.33         000
                                                 therapy infuse.
37202...........  .............  A............  Transcatheter               5.67          NA          NA        3.34        3.18        0.43         000
                                                 therapy infuse.
37203...........  .............  A............  Transcatheter               5.02       30.10       31.48        2.07        2.05        0.29         000
                                                 retrieval.
37204...........  .............  A............  Transcatheter              18.11          NA          NA        6.23        6.07        1.48         000
                                                 occlusion.
37205...........  .............  A............  Transcath iv stent,         8.27      108.64       56.20        3.25        3.50        0.60         000
                                                 percut.
37206...........  .............  A............  Transcath iv stent/         4.12       66.45       33.94        1.58        1.50        0.31         ZZZ
                                                 perc addl.
37207...........  .............  A............  Transcath iv stent,         8.27          NA          NA        2.37        2.77        1.17         000
                                                 open.
37208...........  .............  A............  Transcath iv stent/         4.12          NA          NA        1.01        1.19        0.59         ZZZ
                                                 open addl.
37209...........  .............  A............  Change iv cath at           2.27          NA          NA        0.77        0.75        0.15         000
                                                 thromb tx.
37210...........  .............  A............  Embolization uterine       10.60       83.21       83.21        3.68        3.68        0.60         000
                                                 fibroid.
37215...........  .............  R............  Transcath stent, cca       19.58          NA          NA        9.93        9.51        1.09         090
                                                 w/eps.
37216...........  .............  N............  Transcath stent, cca       18.85          NA          NA        5.75        7.28        1.04         090
                                                 w/o eps.
37250...........  .............  A............  Iv us first vessel          2.10          NA          NA        0.77        0.76        0.21         ZZZ
                                                 add-on.
37251...........  .............  A............  Iv us each add              1.60          NA          NA        0.50        0.52        0.19         ZZZ
                                                 vessel add-on.
37500...........  .............  A............  Endoscopy ligate           11.54          NA          NA        5.35        6.10        1.54         090
                                                 perf veins.
37501...........  .............  C............  Vascular endoscopy          0.00        0.00        0.00        0.00        0.00        0.00         YYY
                                                 procedure.
37565...........  .............  A............  Ligation of neck           11.97          NA          NA        5.13        5.38        1.33         090
                                                 vein.
37600...........  .............  A............  Ligation of neck           12.34          NA          NA        4.91        5.77        1.41         090
                                                 artery.
37605...........  .............  A............  Ligation of neck           14.20          NA          NA        5.44        6.17        1.99         090
                                                 artery.

[[Page 66452]]

 
37606...........  .............  A............  Ligation of neck            8.72          NA          NA        4.86        4.71        1.23         090
                                                 artery.
37607...........  .............  A............  Ligation of a-v             6.19          NA          NA        3.02        3.29        0.85         090
                                                 fistula.
37609...........  .............  A............  Temporal artery             3.02        4.19        4.34        1.82        1.89        0.36         010
                                                 procedure.
37615...........  .............  A............  Ligation of neck            7.72          NA          NA        4.09        4.10        0.68         090
                                                 artery.
37616...........  .............  A............  Ligation of chest          18.89          NA          NA        7.92        8.00        2.33         090
                                                 artery.
37617...........  .............  A............  Ligation of abdomen        23.71          NA          NA        7.88        8.52        2.98         090
                                                 artery.
37618...........  .............  A............  Ligation of                 5.95          NA          NA        3.36        3.48        0.67         090
                                                 extremity artery.
37620...........  .............  A............  Revision of major          11.49          NA          NA        5.45        5.58        0.91         090
                                                 vein.
37650...........  .............  A............  Revision of major           8.41          NA          NA        4.23        4.45        1.01         090
                                                 vein.
37660...........  .............  A............  Revision of major          22.20          NA          NA        7.58        8.32        2.49         090
                                                 vein.
37700...........  .............  A............  Revise leg vein.....        3.76          NA          NA        2.38        2.59        0.53         090
37718...........  .............  A............  Ligate/strip short          7.05          NA          NA        3.47        3.76        0.14         090
                                                 leg vein.
37722...........  .............  A............  Ligate/strip long           8.08          NA          NA        3.68        4.04        0.86         090
                                                 leg vein.
37735...........  .............  A............  Removal of leg veins/      10.81          NA          NA        4.68        5.09        1.48         090
                                                 lesion.
37760...........  .............  A............  Ligation, leg veins,       10.69          NA          NA        4.48        4.91        1.44         090
                                                 open.
37765...........  .............  A............  Phleb veins extrem          7.63          NA          NA        3.57        4.09        0.48         090
                                                 10-20.
37766...........  .............  A............  Phleb veins extrem          9.58          NA          NA        4.13        4.72        0.48         090
                                                 20+.
37780...........  .............  A............  Revision of leg vein        3.87          NA          NA        2.39        2.62        0.53         090
37785...........  .............  A............  Ligate/divide/excise        3.87        4.91        5.05        2.57        2.65        0.54         090
                                                 vein.
37788...........  .............  A............  Revascularization,         23.21          NA          NA       12.03       10.56        2.26         090
                                                 penis.
37790...........  .............  A............  Penile venous               8.37          NA          NA        5.15        4.76        0.59         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,         19.47          NA          NA        6.84        6.50        1.92         090
                                                 total.
38101...........  .............  A............  Removal of spleen,         19.47          NA          NA        6.91        6.71        2.05         090
                                                 partial.
38102...........  .............  A............  Removal of spleen,          4.79          NA          NA        1.23        1.43        0.63         ZZZ
                                                 total.
38115...........  .............  A............  Repair of ruptured         21.80          NA          NA        7.43        7.04        2.09         090
                                                 spleen.
38120...........  .............  A............  Laparoscopy,               16.97          NA          NA        6.92        7.15        2.25         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        2.64          NA          NA        1.09        0.99        0.14         000
                                                 x-ray.
38204...........  .............  B............  Bl donor search             2.00        0.46        0.46        0.46        0.46        0.06         XXX
                                                 management.
38205...........  .............  R............  Harvest allogenic           1.50          NA          NA        0.53        0.60        0.07         000
                                                 stem cells.
38206...........  .............  R............  Harvest auto stem           1.50          NA          NA        0.55        0.61        0.07         000
                                                 cells.
38207...........  .............  I............  Cryopreserve stem           0.89        0.40        0.40        0.40        0.40        0.01         XXX
                                                 cells.
38208...........  .............  I............  Thaw preserved stem         0.56        0.25        0.25        0.25        0.25        0.02         XXX
                                                 cells.
38209...........  .............  I............  Wash harvest stem           0.24        0.11        0.11        0.11        0.11        0.01         XXX
                                                 cells.
38210...........  .............  I............  T-cell depletion of         1.57        0.71        0.71        0.71        0.71        0.03         XXX
                                                 harvest.
38211...........  .............  I............  Tumor cell deplete          1.42        0.64        0.64        0.64        0.64        0.02         XXX
                                                 of harvst.
38212...........  .............  I............  Rbc depletion of            0.94        0.42        0.42        0.42        0.42        0.02         XXX
                                                 harvest.
38213...........  .............  I............  Platelet deplete of         0.24        0.11        0.11        0.11        0.11        0.01         XXX
                                                 harvest.
38214...........  .............  I............  Volume deplete of           0.81        0.36        0.36        0.36        0.36        0.01         XXX
                                                 harvest.
38215...........  .............  I............  Harvest stem cell           0.94        0.42        0.42        0.42        0.42        0.02         XXX
                                                 concentrte.
38220...........  .............  A............  Bone marrow                 1.08        2.67        3.20        0.45        0.48        0.05         XXX
                                                 aspiration.
38221...........  .............  A............  Bone marrow biopsy..        1.37        2.78        3.36        0.57        0.61        0.07         XXX
38230...........  .............  R............  Bone marrow                 4.80          NA          NA        3.13        3.17        0.48         010
                                                 collection.
38240...........  .............  R............  Bone marrow/stem            2.24          NA          NA        0.93        0.98        0.11         XXX
                                                 transplant.
38241...........  .............  R............  Bone marrow/stem            2.24          NA          NA        0.94        0.99        0.11         XXX
                                                 transplant.
38242...........  .............  A............  Lymphocyte infuse           1.71          NA          NA        0.67        0.72        0.08         000
                                                 transplant.
38300...........  .............  A............  Drainage, lymph node        2.28        4.22        4.26        2.03        2.04        0.25         010
                                                 lesion.
38305...........  .............  A............  Drainage, lymph node        6.55          NA          NA        4.20        4.32        0.88         090
                                                 lesion.
38308...........  .............  A............  Incision of lymph           6.73          NA          NA        3.54        3.64        0.85         090
                                                 channels.
38380...........  .............  A............  Thoracic duct               8.34          NA          NA        5.05        5.37        0.74         090
                                                 procedure.
38381...........  .............  A............  Thoracic duct              13.32          NA          NA        6.07        6.47        1.85         090
                                                 procedure.
38382...........  .............  A............  Thoracic duct              10.51          NA          NA        5.43        5.59        1.37         090
                                                 procedure.
38500...........  .............  A............  Biopsy/removal,             3.76        3.75        3.72        2.02        2.05        0.49         010
                                                 lymph nodes.
38505...........  .............  A............  Needle biopsy, lymph        1.14        2.11        2.08        0.73        0.76        0.09         000
                                                 nodes.
38510...........  .............  A............  Biopsy/removal,             6.69        5.38        5.46        3.08        3.28        0.72         010
                                                 lymph nodes.
38520...........  .............  A............  Biopsy/removal,             6.95          NA          NA        3.75        3.90        0.84         090
                                                 lymph nodes.
38525...........  .............  A............  Biopsy/removal,             6.35          NA          NA        3.47        3.38        0.80         090
                                                 lymph nodes.
38530...........  .............  A............  Biopsy/removal,             8.26          NA          NA        4.12        4.25        1.12         090
                                                 lymph nodes.
38542...........  .............  A............  Explore deep                6.08          NA          NA        3.96        4.22        0.60         090
                                                 node(s), neck.
38550...........  .............  A............  Removal, neck/armpit        6.99          NA          NA        4.28        4.09        0.88         090
                                                 lesion.
38555...........  .............  A............  Removal, neck/armpit       15.42          NA          NA        7.45        7.98        1.76         090
                                                 lesion.
38562...........  .............  A............  Removal, pelvic            10.92          NA          NA        5.76        5.76        1.20         090
                                                 lymph nodes.
38564...........  .............  A............  Removal, abdomen           11.29          NA          NA        5.20        5.22        1.32         090
                                                 lymph nodes.
38570...........  .............  A............  Laparoscopy, lymph          9.28          NA          NA        4.03        4.00        1.13         010
                                                 node biop.
38571...........  .............  A............  Laparoscopy,               14.70          NA          NA        6.79        6.22        1.15         010
                                                 lymphadenectomy.
38572...........  .............  A............  Laparoscopy,               16.86          NA          NA        5.93        6.50        1.91         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           12.68          NA          NA        6.51        6.37        0.72         090
                                                 nodes, neck.
38720...........  .............  A............  Removal of lymph           21.72          NA          NA       10.16        9.76        1.20         090
                                                 nodes, neck.
38724...........  .............  A............  Removal of lymph           23.72          NA          NA       10.92       10.37        1.28         090
                                                 nodes, neck.
38740...........  .............  A............  Remove armpit lymph        10.57          NA          NA        5.00        4.96        1.32         090
                                                 nodes.

[[Page 66453]]

 
38745...........  .............  A............  Remove armpit lymph        13.71          NA          NA        6.04        6.06        1.74         090
                                                 nodes.
38746...........  .............  A............  Remove thoracic             4.88          NA          NA        1.42        1.51        0.72         ZZZ
                                                 lymph nodes.
38747...........  .............  A............  Remove abdominal            4.88          NA          NA        1.26        1.46        0.64         ZZZ
                                                 lymph nodes.
38760...........  .............  A............  Remove groin lymph         13.49          NA          NA        5.91        6.02        1.72         090
                                                 nodes.
38765...........  .............  A............  Remove groin lymph         21.78          NA          NA        8.34        8.57        2.48         090
                                                 nodes.
38770...........  .............  A............  Remove pelvis lymph        13.98          NA          NA        6.71        6.22        1.40         090
                                                 nodes.
38780...........  .............  A............  Remove abdomen lymph       17.56          NA          NA        7.98        8.08        1.89         090
                                                 nodes.
38790...........  .............  A............  Inject for lymphatic        1.29          NA          NA        0.75        0.75        0.13         000
                                                 x-ray.
38792...........  .............  A............  Identify sentinel           0.52          NA          NA        0.49        0.46        0.06         000
                                                 node.
38794...........  .............  A............  Access thoracic             4.51          NA          NA        3.17        3.31        0.32         090
                                                 lymph 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        7.49          NA          NA        4.27        4.46        0.89         090
39010...........  .............  A............  Exploration of chest       13.11          NA          NA        6.33        6.93        1.76         090
39200...........  .............  A............  Removal chest lesion       15.04          NA          NA        6.19        6.86        2.03         090
39220...........  .............  A............  Removal chest lesion       19.47          NA          NA        7.99        8.67        2.46         090
39400...........  .............  A............  Visualization of            8.00          NA          NA        4.15        4.50        0.82         010
                                                 chest.
39499...........  .............  C............  Chest procedure.....        0.00        0.00        0.00        0.00        0.00        0.00         YYY
39501...........  .............  A............  Repair diaphragm           13.89          NA          NA        5.81        6.13        1.78         090
                                                 laceration.
39502...........  .............  A............  Repair                     17.09          NA          NA        6.58        6.86        2.17         090
                                                 paraesophageal
                                                 hernia.
39503...........  .............  A............  Repair of diaphragm       108.67          NA          NA       27.38       30.37       10.98         090
                                                 hernia.
39520...........  .............  A............  Repair of diaphragm        16.63          NA          NA        6.79        7.41        2.24         090
                                                 hernia.
39530...........  .............  A............  Repair of diaphragm        16.22          NA          NA        6.23        6.68        2.11         090
                                                 hernia.
39531...........  .............  A............  Repair of diaphragm        17.23          NA          NA        6.58        6.98        2.22         090
                                                 hernia.
39540...........  .............  A............  Repair of diaphragm        14.51          NA          NA        5.70        5.96        1.80         090
                                                 hernia.
39541...........  .............  A............  Repair of diaphragm        15.67          NA          NA        6.06        6.32        1.93         090
                                                 hernia.
39545...........  .............  A............  Revision of                14.58          NA          NA        6.92        7.23        1.84         090
                                                 diaphragm.
39560...........  .............  A............  Resect diaphragm,          12.97          NA          NA        5.52        5.90        1.59         090
                                                 simple.
39561...........  .............  A............  Resect diaphragm,          19.75          NA          NA        9.31        9.32        2.45         090
                                                 complex.
39599...........  .............  C............  Diaphragm surgery           0.00        0.00        0.00        0.00        0.00        0.00         YYY
                                                 procedure.
40490...........  .............  A............  Biopsy of lip.......        1.22        2.08        1.85        0.57        0.59        0.05         000
40500...........  .............  A............  Partial excision of         4.35        7.90        7.40        4.36        4.34        0.38         090
                                                 lip.
40510...........  .............  A............  Partial excision of         4.74        6.73        6.67        3.62        3.81        0.49         090
                                                 lip.
40520...........  .............  A............  Partial excision of         4.71        6.99        7.26        3.81        3.96        0.52         090
                                                 lip.
40525...........  .............  A............  Reconstruct lip with        7.61          NA          NA        5.33        5.81        0.85         090
                                                 flap.
40527...........  .............  A............  Reconstruct lip with        9.20          NA          NA        6.13        6.74        0.97         090
                                                 flap.
40530...........  .............  A............  Partial removal of          5.45        7.58        7.69        4.26        4.42        0.55         090
                                                 lip.
40650...........  .............  A............  Repair lip..........        3.69        5.98        6.38        3.16        3.23        0.38         090
40652...........  .............  A............  Repair lip..........        4.32        7.25        7.49        4.11        4.18        0.52         090
40654...........  .............  A............  Repair lip..........        5.37        8.08        8.34        4.68        4.80        0.60         090
40700...........  .............  A............  Repair cleft lip/          13.97          NA          NA        8.65        8.86        0.95         090
                                                 nasal.
40701...........  .............  A............  Repair cleft lip/          17.03          NA          NA        7.81        9.56        1.65         090
                                                 nasal.
40702...........  .............  A............  Repair cleft lip/          14.09          NA          NA        5.81        7.03        1.23         090
                                                 nasal.
40720...........  .............  A............  Repair cleft lip/          14.54          NA          NA        9.52        9.70        1.80         090
                                                 nasal.
40761...........  .............  A............  Repair cleft lip/          15.69          NA          NA        9.28        9.77        1.94         090
                                                 nasal.
40799...........  .............  C............  Lip surgery                 0.00        0.00        0.00        0.00        0.00        0.00         YYY
                                                 procedure.
40800...........  .............  A............  Drainage of mouth           1.19        3.84        3.40        1.88        1.83        0.13         010
                                                 lesion.
40801...........  .............  A............  Drainage of mouth           2.57        4.88        4.45        2.58        2.66        0.31         010
                                                 lesion.
40804...........  .............  A............  Removal, foreign            1.26        3.78        3.59        1.83        1.84        0.11         010
                                                 body, mouth.
40805...........  .............  A............  Removal, foreign            2.73        5.13        4.80        2.65        2.73        0.32         010
                                                 body, mouth.
40806...........  .............  A............  Incision of lip fold        0.31        2.43        2.13        0.51        0.50        0.04         000
40808...........  .............  A............  Biopsy of mouth             0.98        3.60        3.13        1.62        1.55        0.10         010
                                                 lesion.
40810...........  .............  A............  Excision of mouth           1.33        3.68        3.28        1.72        1.69        0.13         010
                                                 lesion.
40812...........  .............  A............  Excise/repair mouth         2.33        4.54        4.13        2.28        2.34        0.28         010
                                                 lesion.
40814...........  .............  A............  Excise/repair mouth         3.45        5.69        5.31        3.69        3.79        0.41         090
                                                 lesion.
40816...........  .............  A............  Excision of mouth           3.70        5.90        5.53        3.77        3.88        0.40         090
                                                 lesion.
40818...........  .............  A............  Excise oral mucosa          2.72        5.82        5.49        3.74        3.85        0.21         090
                                                 for graft.
40819...........  .............  A............  Excise lip or cheek         2.45        4.93        4.50        3.10        3.10        0.29         090
                                                 fold.
40820...........  .............  A............  Treatment of mouth          1.30        5.30        4.61        2.94        2.69        0.11         010
                                                 lesion.
40830...........  .............  A............  Repair mouth                1.78        4.04        3.88        2.00        2.05        0.19         010
                                                 laceration.
40831...........  .............  A............  Repair mouth                2.50        5.24        4.94        2.70        2.87        0.30         010
                                                 laceration.
40840...........  .............  R............  Reconstruction of           9.03       10.01        9.90        5.58        6.27        1.08         090
                                                 mouth.
40842...........  .............  R............  Reconstruction of           9.03       10.20       10.13        5.72        6.25        1.08         090
                                                 mouth.
40843...........  .............  R............  Reconstruction of          12.62       11.33       11.63        5.74        6.77        1.39         090
                                                 mouth.
40844...........  .............  R............  Reconstruction of          16.57       15.21       15.48        9.11       10.33        2.00         090
                                                 mouth.
40845...........  .............  R............  Reconstruction of          19.13       16.02       16.54       10.21       11.71        2.01         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           1.32        2.55        2.43        1.33        1.37        0.12         010
                                                 lesion.
41005...........  .............  A............  Drainage of mouth           1.28        4.32        3.83        1.77        1.74        0.12         010
                                                 lesion.
41006...........  .............  A............  Drainage of mouth           3.28        5.43        5.11        2.82        2.99        0.35         090
                                                 lesion.
41007...........  .............  A............  Drainage of mouth           3.14        5.34        5.24        2.72        2.87        0.31         090
                                                 lesion.
41008...........  .............  A............  Drainage of mouth           3.40        5.51        5.09        2.84        3.02        0.42         090
                                                 lesion.
41009...........  .............  A............  Drainage of mouth           3.63        5.83        5.40        3.14        3.35        0.47         090
                                                 lesion.

[[Page 66454]]

 
41010...........  .............  A............  Incision of tongue          1.08        3.90        3.66        1.56        1.58        0.07         010
                                                 fold.
41015...........  .............  A............  Drainage of mouth           4.00        6.29        5.84        3.98        4.06        0.46         090
                                                 lesion.
41016...........  .............  A............  Drainage of mouth           4.11        6.22        5.92        4.07        4.14        0.53         090
                                                 lesion.
41017...........  .............  A............  Drainage of mouth           4.11        6.37        6.00        4.12        4.21        0.53         090
                                                 lesion.
41018...........  .............  A............  Drainage of mouth           5.14        6.75        6.44        4.48        4.52        0.68         090
                                                 lesion.
41019...........  .............  A............  Place needles h&n           8.84          NA          NA        3.28        3.28        0.59         000
                                                 for rt.
41100...........  .............  A............  Biopsy of tongue....        1.39        2.68        2.55        1.17        1.29        0.15         010
41105...........  .............  A............  Biopsy of tongue....        1.44        2.67        2.49        1.20        1.26        0.13         010
41108...........  .............  A............  Biopsy of floor of          1.07        2.52        2.30        1.08        1.10        0.10         010
                                                 mouth.
41110...........  .............  A............  Excision of tongue          1.53        3.65        3.32        1.64        1.64        0.13         010
                                                 lesion.
41112...........  .............  A............  Excision of tongue          2.77        5.26        4.86        3.24        3.23        0.28         090
                                                 lesion.
41113...........  .............  A............  Excision of tongue          3.23        5.51        5.12        3.39        3.43        0.34         090
                                                 lesion.
41114...........  .............  A............  Excision of tongue          8.71          NA          NA        6.30        6.74        0.83         090
                                                 lesion.
41115...........  .............  A............  Excision of tongue          1.76        4.18        3.74        1.72        1.79        0.18         010
                                                 fold.
41116...........  .............  A............  Excision of mouth           2.47        5.56        4.95        2.80        2.80        0.23         090
                                                 lesion.
41120...........  .............  A............  Partial removal of         10.91          NA          NA       14.32       14.81        0.79         090
                                                 tongue.
41130...........  .............  A............  Partial removal of         15.51          NA          NA       15.88       16.03        0.93         090
                                                 tongue.
41135...........  .............  A............  Tongue and neck            29.83          NA          NA       21.84       22.53        1.89         090
                                                 surgery.
41140...........  .............  A............  Removal of tongue...       28.81          NA          NA       23.56       25.11        2.27         090
41145...........  .............  A............  Tongue removal, neck       37.59          NA          NA       28.79       29.66        2.55         090
                                                 surgery.
41150...........  .............  A............  Tongue, mouth, jaw         29.52          NA          NA       23.02       23.86        1.95         090
                                                 surgery.
41153...........  .............  A............  Tongue, mouth, neck        33.28          NA          NA       23.92       24.46        2.01         090
                                                 surgery.
41155...........  .............  A............  Tongue, jaw, & neck        43.96          NA          NA       27.59       27.19        2.34         090
                                                 surgery.
41250...........  .............  A............  Repair tongue               1.93        3.86        3.30        1.61        1.39        0.18         010
                                                 laceration.
41251...........  .............  A............  Repair tongue               2.29        3.48        3.38        1.78        1.66        0.22         010
                                                 laceration.
41252...........  .............  A............  Repair tongue               2.99        4.59        4.24        2.12        2.19        0.29         010
                                                 laceration.
41500...........  .............  A............  Fixation of tongue..        3.74          NA          NA        7.52        7.48        0.30         090
41510...........  .............  A............  Tongue to lip               3.45          NA          NA        6.47        7.20        0.20         090
                                                 surgery.
41520...........  .............  A............  Reconstruction,             2.77        5.80        5.21        3.26        3.44        0.27         090
                                                 tongue fold.
41599...........  .............  C............  Tongue and mouth            0.00        0.00        0.00        0.00        0.00        0.00         YYY
                                                 surgery.
41800...........  .............  A............  Drainage of gum             1.21        4.80        3.69        2.12        1.70        0.12         010
                                                 lesion.
41805...........  .............  A............  Removal foreign             1.28        4.64        3.65        2.70        2.46        0.13         010
                                                 body, gum.
41806...........  .............  A............  Removal foreign             2.73        5.82        4.70        3.34        3.19        0.37         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             2.35        4.80        4.34        1.85        1.86        0.31         010
                                                 lesion.
41823...........  .............  R............  Excision of gum             3.63        6.45        6.01        3.73        3.87        0.47         090
                                                 lesion.
41825...........  .............  A............  Excision of gum             1.35        3.69        3.37        1.46        1.85        0.15         010
                                                 lesion.
41826...........  .............  A............  Excision of gum             2.35        5.09        3.76        2.57        2.34        0.30         010
                                                 lesion.
41827...........  .............  A............  Excision of gum             3.72        6.64        6.08        3.38        3.52        0.35         090
                                                 lesion.
41828...........  .............  R............  Excision of gum             3.11        4.09        3.94        1.64        2.30        0.44         010
                                                 lesion.
41830...........  .............  R............  Removal of gum              3.38        5.98        5.47        3.11        3.37        0.44         010
                                                 tissue.
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..........        2.90        6.04        5.53        3.30        3.38        0.30         090
41874...........  .............  R............  Repair tooth socket.        3.13        5.66        5.25        2.72        2.94        0.45         090
41899...........  .............  C............  Dental surgery              0.00        0.00        0.00        0.00        0.00        0.00         YYY
                                                 procedure.
42000...........  .............  A............  Drainage mouth roof         1.25        2.48        2.52        1.20        1.22        0.12         010
                                                 lesion.
42100...........  .............  A............  Biopsy roof of mouth        1.33        2.27        2.18        1.26        1.31        0.13         010
42104...........  .............  A............  Excision lesion,            1.66        3.57        3.06        1.67        1.60        0.16         010
                                                 mouth roof.
42106...........  .............  A............  Excision lesion,            2.12        4.45        3.83        2.07        2.25        0.25         010
                                                 mouth roof.
42107...........  .............  A............  Excision lesion,            4.48        6.53        6.12        3.69        3.82        0.44         090
                                                 mouth roof.
42120...........  .............  A............  Remove palate/lesion       11.70          NA          NA       12.28       12.02        0.52         090
42140...........  .............  A............  Excision of uvula...        1.65        4.58        4.15        2.11        2.10        0.13         090
42145...........  .............  A............  Repair palate,              9.63          NA          NA        7.48        7.48        0.65         090
                                                 pharynx/uvula.
42160...........  .............  A............  Treatment mouth roof        1.82        3.77        4.01        1.69        1.99        0.17         010
                                                 lesion.
42180...........  .............  A............  Repair palate.......        2.52        3.37        3.22        1.86        1.98        0.21         010
42182...........  .............  A............  Repair palate.......        3.84        3.99        3.93        2.39        2.71        0.40         010
42200...........  .............  A............  Reconstruct cleft          12.41          NA          NA        8.62        9.41        1.27         090
                                                 palate.
42205...........  .............  A............  Reconstruct cleft          13.57          NA          NA        7.36        8.71        1.58         090
                                                 palate.
42210...........  .............  A............  Reconstruct cleft          14.91          NA          NA       10.24       10.84        2.17         090
                                                 palate.
42215...........  .............  A............  Reconstruct cleft           8.88          NA          NA        7.41        8.24        1.31         090
                                                 palate.
42220...........  .............  A............  Reconstruct cleft           7.07          NA          NA        7.21        6.99        0.73         090
                                                 palate.
42225...........  .............  A............  Reconstruct cleft           9.66          NA          NA       12.23       14.64        0.86         090
                                                 palate.
42226...........  .............  A............  Lengthening of             10.24          NA          NA       11.89       13.29        1.01         090
                                                 palate.
42227...........  .............  A............  Lengthening of              9.81          NA          NA       11.20       13.37        0.98         090
                                                 palate.
42235...........  .............  A............  Repair palate.......        7.92          NA          NA       10.34       11.09        0.72         090
42260...........  .............  A............  Repair nose to lip         10.10        9.73        9.96        6.02        6.54        1.26         090
                                                 fistula.
42280...........  .............  A............  Preparation, palate         1.56        2.23        2.10        0.83        0.98        0.19         010
                                                 mold.
42281...........  .............  A............  Insertion, palate           1.95        3.03        2.83        1.69        1.78        0.17         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        1.95        3.13        2.98        1.74        1.77        0.16         010
                                                 gland.

[[Page 66455]]

 
42305...........  .............  A............  Drainage of salivary        6.23          NA          NA        3.99        4.35        0.51         090
                                                 gland.
42310...........  .............  A............  Drainage of salivary        1.58        2.29        2.28        1.39        1.46        0.13         010
                                                 gland.
42320...........  .............  A............  Drainage of salivary        2.37        3.74        3.50        1.88        1.99        0.21         010
                                                 gland.
42330...........  .............  A............  Removal of salivary         2.23        3.41        3.27        1.73        1.79        0.19         010
                                                 stone.
42335...........  .............  A............  Removal of salivary         3.35        5.77        5.33        2.85        2.99        0.29         090
                                                 stone.
42340...........  .............  A............  Removal of salivary         4.64        6.70        6.37        3.48        3.70        0.42         090
                                                 stone.
42400...........  .............  A............  Biopsy of salivary          0.78        2.00        1.82        0.65        0.68        0.06         000
                                                 gland.
42405...........  .............  A............  Biopsy of salivary          3.31        3.96        3.98        2.15        2.30        0.28         010
                                                 gland.
42408...........  .............  A............  Excision of salivary        4.58        6.41        6.16        3.27        3.44        0.45         090
                                                 cyst.
42409...........  .............  A............  Drainage of salivary        2.85        5.31        4.91        2.53        2.65        0.27         090
                                                 cyst.
42410...........  .............  A............  Excise parotid gland/       9.46          NA          NA        5.36        5.79        0.91         090
                                                 lesion.
42415...........  .............  A............  Excise parotid gland/      17.99          NA          NA        8.62        9.74        1.43         090
                                                 lesion.
42420...........  .............  A............  Excise parotid gland/      20.87          NA          NA        9.56       10.97        1.65         090
                                                 lesion.
42425...........  .............  A............  Excise parotid gland/      13.31          NA          NA        6.83        7.72        1.05         090
                                                 lesion.
42426...........  .............  A............  Excise parotid gland/      22.54          NA          NA       10.00       11.50        1.81         090
                                                 lesion.
42440...........  .............  A............  Excise submaxillary         7.05          NA          NA        3.86        4.32        0.59         090
                                                 gland.
42450...........  .............  A............  Excise sublingual           4.66        6.38        6.14        4.02        4.14        0.42         090
                                                 gland.
42500...........  .............  A............  Repair salivary duct        4.34        6.11        5.90        3.86        4.02        0.41         090
42505...........  .............  A............  Repair salivary duct        6.23        7.27        7.19        4.71        5.04        0.55         090
42507...........  .............  A............  Parotid duct                6.16          NA          NA        6.33        6.43        0.49         090
                                                 diversion.
42508...........  .............  A............  Parotid duct                9.22          NA          NA        8.07        8.20        1.04         090
                                                 diversion.
42509...........  .............  A............  Parotid duct               11.65          NA          NA        8.91        9.55        0.93         090
                                                 diversion.
42510...........  .............  A............  Parotid duct                8.26          NA          NA        6.89        7.34        0.66         090
                                                 diversion.
42550...........  .............  A............  Injection for               1.25        2.28        2.74        0.44        0.43        0.07         000
                                                 salivary x-ray.
42600...........  .............  A............  Closure of salivary         4.86        6.57        6.57        3.42        3.77        0.43         090
                                                 fistula.
42650...........  .............  A............  Dilation of salivary        0.77        1.28        1.19        0.66        0.68        0.07         000
                                                 duct.
42660...........  .............  A............  Dilation of salivary        1.13        1.46        1.40        0.75        0.80        0.09         000
                                                 duct.
42665...........  .............  A............  Ligation of salivary        2.57        5.00        4.58        2.40        2.49        0.23         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          1.64        2.97        2.81        1.65        1.67        0.13         010
                                                 abscess.
42720...........  .............  A............  Drainage of throat          6.31        4.69        4.76        3.17        3.48        0.44         010
                                                 abscess.
42725...........  .............  A............  Drainage of throat         12.28          NA          NA        7.08        7.65        0.91         090
                                                 abscess.
42800...........  .............  A............  Biopsy of throat....        1.41        2.46        2.32        1.30        1.35        0.11         010
42802...........  .............  A............  Biopsy of throat....        1.56        4.13        4.44        1.67        1.87        0.12         010
42804...........  .............  A............  Biopsy of upper nose/       1.26        3.58        3.66        1.50        1.62        0.10         010
                                                 throat.
42806...........  .............  A............  Biopsy of upper nose/       1.60        3.83        3.95        1.61        1.77        0.13         010
                                                 throat.
42808...........  .............  A............  Excise pharynx              2.32        3.22        3.15        1.60        1.77        0.19         010
                                                 lesion.
42809...........  .............  A............  Remove pharynx              1.83        2.23        2.28        1.32        1.32        0.16         010
                                                 foreign body.
42810...........  .............  A............  Excision of neck            3.30        6.22        5.96        3.73        3.63        0.29         090
                                                 cyst.
42815...........  .............  A............  Excision of neck            7.23          NA          NA        6.25        6.33        0.61         090
                                                 cyst.
42820...........  .............  A............  Remove tonsils and          4.17          NA          NA        2.85        3.07        0.31         090
                                                 adenoids.
42821...........  .............  A............  Remove tonsils and          4.31          NA          NA        2.99        3.24        0.35         090
                                                 adenoids.
42825...........  .............  A............  Removal of tonsils..        3.45          NA          NA        2.90        3.03        0.25         090
42826...........  .............  A............  Removal of tonsils..        3.40          NA          NA        2.68        2.86        0.27         090
42830...........  .............  A............  Removal of adenoids.        2.60          NA          NA        2.43        2.49        0.20         090
42831...........  .............  A............  Removal of adenoids.        2.75          NA          NA        2.66        2.75        0.22         090
42835...........  .............  A............  Removal of adenoids.        2.33          NA          NA        1.78        2.12        0.21         090
42836...........  .............  A............  Removal of adenoids.        3.21          NA          NA        2.64        2.80        0.26         090
42842...........  .............  A............  Extensive surgery of       12.02          NA          NA       12.03       11.51        0.71         090
                                                 throat.
42844...........  .............  A............  Extensive surgery of       17.57          NA          NA       15.46       15.84        1.16         090
                                                 throat.
42845...........  .............  A............  Extensive surgery of       32.35          NA          NA       21.14       22.16        1.99         090
                                                 throat.
42860...........  .............  A............  Excision of tonsil          2.25          NA          NA        2.30        2.35        0.18         090
                                                 tags.
42870...........  .............  A............  Excision of lingual         5.44          NA          NA        8.70        8.63        0.44         090
                                                 tonsil.
42890...........  .............  A............  Partial removal of         18.92          NA          NA       15.24       14.69        1.05         090
                                                 pharynx.
42892...........  .............  A............  Revision of                25.77          NA          NA       19.20       18.18        1.28         090
                                                 pharyngeal walls.
42894...........  .............  A............  Revision of                33.61          NA          NA       23.53       22.77        1.87         090
                                                 pharyngeal walls.
42900...........  .............  A............  Repair throat wound.        5.26          NA          NA        2.95        3.30        0.50         010
42950...........  .............  A............  Reconstruction of           8.16          NA          NA       11.06       11.46        0.72         090
                                                 throat.
42953...........  .............  A............  Repair throat,              9.33          NA          NA       13.77       15.54        0.88         090
                                                 esophagus.
42955...........  .............  A............  Surgical opening of         7.92          NA          NA       10.10       10.38        0.80         090
                                                 throat.
42960...........  .............  A............  Control throat              2.35          NA          NA        1.71        1.84        0.19         010
                                                 bleeding.
42961...........  .............  A............  Control throat              5.69          NA          NA        4.48        4.72        0.45         090
                                                 bleeding.
42962...........  .............  A............  Control throat              7.31          NA          NA        5.18        5.54        0.58         090
                                                 bleeding.
42970...........  .............  A............  Control nose/throat         5.76          NA          NA        3.58        3.88        0.39         090
                                                 bleeding.
42971...........  .............  A............  Control nose/throat         6.54          NA          NA        4.50        4.81        0.51         090
                                                 bleeding.
42972...........  .............  A............  Control nose/throat         7.53          NA          NA        4.98        5.34        0.62         090
                                                 bleeding.
42999...........  .............  C............  Throat surgery              0.00        0.00        0.00        0.00        0.00        0.00         YYY
                                                 procedure.
43020...........  .............  A............  Incision of                 8.14          NA          NA        4.57        4.99        0.87         090
                                                 esophagus.
43030...........  .............  A............  Throat muscle               7.91          NA          NA        4.51        5.00        0.70         090
                                                 surgery.
43045...........  .............  A............  Incision of                21.70          NA          NA        9.30        9.99        2.59         090
                                                 esophagus.
43100...........  .............  A............  Excision of                 9.55          NA          NA        5.20        5.71        0.93         090
                                                 esophagus lesion.
43101...........  .............  A............  Excision of                16.99          NA          NA        7.16        7.52        2.32         090
                                                 esophagus lesion.

[[Page 66456]]

 
43107...........  .............  A............  Removal of esophagus       43.97          NA          NA       16.25       17.25        5.24         090
43108...........  .............  A............  Removal of esophagus       82.66          NA          NA       24.46       19.33        4.08         090
43112...........  .............  A............  Removal of esophagus       47.27          NA          NA       17.00       18.18        5.81         090
43113...........  .............  A............  Removal of esophagus       79.85          NA          NA       25.34       20.22        4.43         090
43116...........  .............  A............  Partial removal of         92.78          NA          NA       30.30       23.49        3.06         090
                                                 esophagus.
43117...........  .............  A............  Partial removal of         43.52          NA          NA       15.14       16.20        5.19         090
                                                 esophagus.
43118...........  .............  A............  Partial removal of         66.86          NA          NA       21.50       17.64        4.11         090
                                                 esophagus.
43121...........  .............  A............  Partial removal of         51.22          NA          NA       18.26       15.96        3.91         090
                                                 esophagus.
43122...........  .............  A............  Partial removal of         43.97          NA          NA       15.60       16.49        5.42         090
                                                 esophagus.
43123...........  .............  A............  Partial removal of         82.91          NA          NA       25.75       19.92        4.16         090
                                                 esophagus.
43124...........  .............  A............  Removal of esophagus       68.83          NA          NA       24.34       18.71        3.74         090
43130...........  .............  A............  Removal of esophagus       12.41          NA          NA        6.37        6.96        1.16         090
                                                 pouch.
43135...........  .............  A............  Removal of esophagus       26.09          NA          NA        9.92        9.00        2.34         090
                                                 pouch.
43200...........  .............  A............  Esophagus endoscopy.        1.59        3.72        3.92        0.98        1.02        0.13         000
43201...........  .............  A............  Esoph scope w/              2.09        5.62        5.12        1.19        1.14        0.15         000
                                                 submucous inj.
43202...........  .............  A............  Esophagus endoscopy,        1.89        5.16        5.35        0.98        0.96        0.15         000
                                                 biopsy.
43204...........  .............  A............  Esoph scope w/              3.76          NA          NA        2.01        1.76        0.30         000
                                                 sclerosis inj.
43205...........  .............  A............  Esophagus endoscopy/        3.78          NA          NA        2.06        1.79        0.28         000
                                                 ligation.
43215...........  .............  A............  Esophagus endoscopy.        2.60          NA          NA        1.29        1.24        0.22         000
43216...........  .............  A............  Esophagus endoscopy/        2.40        3.08        2.07        1.26        1.16        0.20         000
                                                 lesion.
43217...........  .............  A............  Esophagus endoscopy.        2.90        6.57        6.76        1.38        1.28        0.26         000
43219...........  .............  A............  Esophagus endoscopy.        2.80          NA          NA        1.55        1.45        0.24         000
43220...........  .............  A............  Esoph endoscopy,            2.10          NA          NA        1.13        1.05        0.17         000
                                                 dilation.
43226...........  .............  A............  Esoph endoscopy,            2.34          NA          NA        1.29        1.16        0.19         000
                                                 dilation.
43227...........  .............  A............  Esoph endoscopy,            3.59          NA          NA        1.77        1.61        0.28         000
                                                 repair.
43228...........  .............  A............  Esoph endoscopy,            3.76          NA          NA        1.89        1.72        0.34         000
                                                 ablation.
43231...........  .............  A............  Esoph endoscopy w/us        3.19          NA          NA        1.76        1.53        0.23         000
                                                 exam.
43232...........  .............  A............  Esoph endoscopy w/us        4.47          NA          NA        2.39        2.10        0.34         000
                                                 fn bx.
43234...........  .............  A............  Upper GI endoscopy,         2.01        4.98        5.15        1.02        0.94        0.17         000
                                                 exam.
43235...........  .............  A............  Uppr gi endoscopy,          2.39        5.29        5.22        1.35        1.18        0.19         000
                                                 diagnosis.
43236...........  .............  A............  Uppr gi scope w/            2.92        6.71        6.55        1.65        1.43        0.21         000
                                                 submuc inj.
43237...........  .............  A............  Endoscopic us exam,         3.98          NA          NA        2.16        1.87        0.43         000
                                                 esoph.
43238...........  .............  A............  Uppr gi endoscopy w/        5.02          NA          NA        2.56        2.26        0.43         000
                                                 us fn bx.
43239...........  .............  A............  Upper GI endoscopy,         2.87        6.05        5.88        1.56        1.37        0.22         000
                                                 biopsy.
43240...........  .............  A............  Esoph endoscope w/          6.85          NA          NA        3.28        2.94        0.56         000
                                                 drain cyst.
43241...........  .............  A............  Upper GI endoscopy          2.59          NA          NA        1.40        1.25        0.21         000
                                                 with tube.
43242...........  .............  A............  Uppr gi endoscopy w/        7.30          NA          NA        3.67        3.20        0.53         000
                                                 us fn bx.
43243...........  .............  A............  Upper gi endoscopy &        4.56          NA          NA        2.35        2.07        0.33         000
                                                 inject.
43244...........  .............  A............  Upper GI endoscopy/         5.04          NA          NA        2.64        2.30        0.37         000
                                                 ligation.
43245...........  .............  A............  Uppr gi scope dilate        3.18          NA          NA        1.63        1.46        0.26         000
                                                 strictr.
43246...........  .............  A............  Place gastrostomy           4.32          NA          NA        2.11        1.90        0.34         000
                                                 tube.
43247...........  .............  A............  Operative upper GI          3.38          NA          NA        1.78        1.57        0.27         000
                                                 endoscopy.
43248...........  .............  A............  Uppr gi endoscopy/          3.15          NA          NA        1.77        1.54        0.23         000
                                                 guide wire.
43249...........  .............  A............  Esoph endoscopy,            2.90          NA          NA        1.62        1.41        0.22         000
                                                 dilation.
43250...........  .............  A............  Upper GI endoscopy/         3.20          NA          NA        1.61        1.46        0.26         000
                                                 tumor.
43251...........  .............  A............  Operative upper GI          3.69          NA          NA        1.92        1.70        0.29         000
                                                 endoscopy.
43255...........  .............  A............  Operative upper GI          4.81          NA          NA        2.52        2.20        0.35         000
                                                 endoscopy.
43256...........  .............  A............  Uppr gi endoscopy w/        4.34          NA          NA        2.25        1.98        0.32         000
                                                 stent.
43257...........  .............  A............  Uppr gi scope w/            5.50          NA          NA        2.14        2.17        0.36         000
                                                 thrml txmnt.
43258...........  .............  A............  Operative upper GI          4.54          NA          NA        2.37        2.07        0.33         000
                                                 endoscopy.
43259...........  .............  A............  Endoscopic                  5.19          NA          NA        2.69        2.34        0.35         000
                                                 ultrasound exam.
43260...........  .............  A............  Endo                        5.95          NA          NA        3.06        2.67        0.43         000
                                                 cholangiopancreatog
                                                 raph.
43261...........  .............  A............  Endo                        6.26          NA          NA        3.20        2.80        0.46         000
                                                 cholangiopancreatog
                                                 raph.
43262...........  .............  A............  Endo                        7.38          NA          NA        3.73        3.25        0.54         000
                                                 cholangiopancreatog
                                                 raph.
43263...........  .............  A............  Endo                        7.28          NA          NA        3.63        3.20        0.54         000
                                                 cholangiopancreatog
                                                 raph.
43264...........  .............  A............  Endo                        8.89          NA          NA        4.44        3.87        0.65         000
                                                 cholangiopancreatog
                                                 raph.
43265...........  .............  A............  Endo                       10.00          NA          NA        4.98        4.34        0.73         000
                                                 cholangiopancreatog
                                                 raph.
43267...........  .............  A............  Endo                        7.38          NA          NA        3.39        3.09        0.54         000
                                                 cholangiopancreatog
                                                 raph.
43268...........  .............  A............  Endo                        7.38          NA          NA        3.88        3.38        0.54         000
                                                 cholangiopancreatog
                                                 raph.
43269...........  .............  A............  Endo                        8.20          NA          NA        4.10        3.58        0.60         000
                                                 cholangiopancreatog
                                                 raph.
43271...........  .............  A............  Endo                        7.38          NA          NA        3.70        3.24        0.54         000
                                                 cholangiopancreatog
                                                 raph.
43272...........  .............  A............  Endo                        7.38          NA          NA        3.77        3.28        0.54         000
                                                 cholangiopancreatog
                                                 raph.
43280...........  .............  A............  Laparoscopy,               18.00          NA          NA        6.65        6.96        2.28         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.        9.21          NA          NA        5.41        5.89        1.12         090
43305...........  .............  A............  Repair esophagus and       17.98          NA          NA        8.33        9.51        1.54         090
                                                 fistula.
43310...........  .............  A............  Repair of esophagus.       26.18          NA          NA        9.81       10.43        3.61         090
43312...........  .............  A............  Repair esophagus and       29.23          NA          NA       10.27       11.07        4.01         090
                                                 fistula.
43313...........  .............  A............  Esophagoplasty             48.17          NA          NA       17.46       18.13        5.47         090
                                                 congenital.
43314...........  .............  A............  Tracheo-                   53.15          NA          NA       15.09       17.13        6.65         090
                                                 esophagoplasty cong.
43320...........  .............  A............  Fuse esophagus &           23.18          NA          NA        8.60        8.90        2.74         090
                                                 stomach.
43324...........  .............  A............  Revise esophagus &         22.86          NA          NA        8.34        8.55        2.76         090
                                                 stomach.

[[Page 66457]]

 
43325...........  .............  A............  Revise esophagus &         22.47          NA          NA        8.38        8.58        2.60         090
                                                 stomach.
43326...........  .............  A............  Revise esophagus &         22.15          NA          NA        9.20        9.24        2.85         090
                                                 stomach.
43330...........  .............  A............  Repair of esophagus.       22.06          NA          NA        8.09        8.31        2.63         090
43331...........  .............  A............  Repair of esophagus.       22.93          NA          NA        9.82        9.80        2.94         090
43340...........  .............  A............  Fuse esophagus &           22.86          NA          NA        9.27        9.12        2.46         090
                                                 intestine.
43341...........  .............  A............  Fuse esophagus &           24.10          NA          NA        9.65        9.83        2.92         090
                                                 intestine.
43350...........  .............  A............  Surgical opening,          19.31          NA          NA        8.75        8.59        1.42         090
                                                 esophagus.
43351...........  .............  A............  Surgical opening,          21.87          NA          NA       10.86       10.32        2.47         090
                                                 esophagus.
43352...........  .............  A............  Surgical opening,          17.68          NA          NA        7.94        8.16        2.06         090
                                                 esophagus.
43360...........  .............  A............  Gastrointestinal           39.90          NA          NA       14.88       14.97        4.97         090
                                                 repair.
43361...........  .............  A............  Gastrointestinal           45.50          NA          NA       18.13       17.50        4.50         090
                                                 repair.
43400...........  .............  A............  Ligate esophagus           25.47          NA          NA       13.58       11.51        1.96         090
                                                 veins.
43401...........  .............  A............  Esophagus surgery          26.36          NA          NA        9.54        9.51        3.05         090
                                                 for veins.
43405...........  .............  A............  Ligate/staple              24.55          NA          NA       10.66       10.12        2.84         090
                                                 esophagus.
43410...........  .............  A............  Repair esophagus           16.28          NA          NA        7.66        7.64        1.72         090
                                                 wound.
43415...........  .............  A............  Repair esophagus           28.70          NA          NA       11.83       11.78        3.53         090
                                                 wound.
43420...........  .............  A............  Repair esophagus           16.65          NA          NA        7.47        7.43        1.43         090
                                                 opening.
43425...........  .............  A............  Repair esophagus           24.91          NA          NA       10.45       10.21        3.03         090
                                                 opening.
43450...........  .............  A............  Dilate esophagus....        1.38        2.67        2.65        0.93        0.81        0.11         000
43453...........  .............  A............  Dilate esophagus....        1.51        6.31        6.18        1.01        0.87        0.11         000
43456...........  .............  A............  Dilate esophagus....        2.57       13.01       13.37        1.45        1.27        0.20         000
43458...........  .............  A............  Dilate esophagus....        3.06        6.92        6.78        1.59        1.43        0.24         000
43460...........  .............  A............  Pressure treatment          3.79          NA          NA        1.76        1.62        0.31         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        12.71          NA          NA        5.29        5.12        1.45         090
                                                 stomach.
43501...........  .............  A............  Surgical repair of         22.47          NA          NA        8.09        8.19        2.65         090
                                                 stomach.
43502...........  .............  A............  Surgical repair of         25.56          NA          NA        8.96        9.21        3.10         090
                                                 stomach.
43510...........  .............  A............  Surgical opening of        15.01          NA          NA        9.13        7.85        1.48         090
                                                 stomach.
43520...........  .............  A............  Incision of pyloric        11.21          NA          NA        4.81        5.03        1.36         090
                                                 muscle.
43600...........  .............  A............  Biopsy of stomach...        1.91          NA          NA        0.77        0.71        0.14         000
43605...........  .............  A............  Biopsy of stomach...       13.64          NA          NA        5.36        5.32        1.58         090
43610...........  .............  A............  Excision of stomach        16.26          NA          NA        6.03        6.08        1.94         090
                                                 lesion.
43611...........  .............  A............  Excision of stomach        20.25          NA          NA        7.48        7.52        2.36         090
                                                 lesion.
43620...........  .............  A............  Removal of stomach..       33.91          NA          NA       11.09       11.44        3.96         090
43621...........  .............  A............  Removal of stomach..       39.40          NA          NA       12.39       12.17        4.04         090
43622...........  .............  A............  Removal of stomach..       39.90          NA          NA       12.49       12.53        4.30         090
43631...........  .............  A............  Removal of stomach,        24.38          NA          NA        8.58        8.87        2.99         090
                                                 partial.
43632...........  .............  A............  Removal of stomach,        35.01          NA          NA       11.26       10.21        2.99         090
                                                 partial.
43633...........  .............  A............  Removal of stomach,        33.01          NA          NA       10.75       10.03        3.06         090
                                                 partial.
43634...........  .............  A............  Removal of stomach,        36.51          NA          NA       11.78       10.93        3.33         090
                                                 partial.
43635...........  .............  A............  Removal of stomach,         2.06          NA          NA        0.52        0.61        0.27         ZZZ
                                                 partial.
43640...........  .............  A............  Vagotomy & pylorus         19.43          NA          NA        7.34        7.29        2.26         090
                                                 repair.
43641...........  .............  A............  Vagotomy & pylorus         19.68          NA          NA        7.62        7.49        2.25         090
                                                 repair.
43644...........  .............  A............  Lap gastric bypass/        29.24          NA          NA       10.10       10.65        3.16         090
                                                 roux-en-y.
43645...........  .............  A............  Lap gastr bypass           31.37          NA          NA       10.48       11.24        3.54         090
                                                 incl smll i.
43647...........  .............  C............  Lap impl electrode,         0.00        0.00        0.00        0.00        0.00        0.00         YYY
                                                 antrum.
43648...........  .............  C............  Lap revise/remv             0.00        0.00        0.00        0.00        0.00        0.00         YYY
                                                 eltrd antrum.
43651...........  .............  A............  Laparoscopy, vagus         10.13          NA          NA        4.61        4.68        1.33         090
                                                 nerve.
43652...........  .............  A............  Laparoscopy, vagus         12.13          NA          NA        5.22        5.49        1.55         090
                                                 nerve.
43653...........  .............  A............  Laparoscopy,                8.38          NA          NA        4.46        4.32        1.01         090
                                                 gastrostomy.
43659...........  .............  C............  Laparoscope proc,           0.00        0.00        0.00        0.00        0.00        0.00         YYY
                                                 stom.
43752...........  .............  A............  Nasal/orogastric w/         0.81          NA          NA        0.26        0.26        0.02         000
                                                 stent.
43760...........  .............  A............  Change gastrostomy          0.90        5.98        4.03        0.33        0.39        0.09         000
                                                 tube.
43761...........  .............  A............  Reposition                  2.01        1.04        1.10        0.70        0.68        0.13         000
                                                 gastrostomy tube.
43770...........  .............  A............  Lap place gastr adj        17.85          NA          NA        7.40        7.55        2.19         090
                                                 device.
43771...........  .............  A............  Lap revise gastr adj       20.64          NA          NA        8.12        8.35        2.55         090
                                                 device.
43772...........  .............  A............  Lap rmvl gastr adj         15.62          NA          NA        5.99        6.21        1.93         090
                                                 device.
43773...........  .............  A............  Lap replace gastr          20.64          NA          NA        8.10        8.34        2.56         090
                                                 adj device.
43774...........  .............  A............  Lap rmvl gastr adj         15.66          NA          NA        6.18        6.37        1.85         090
                                                 all parts.
43800...........  .............  A............  Reconstruction of          15.35          NA          NA        5.81        5.85        1.82         090
                                                 pylorus.
43810...........  .............  A............  Fusion of stomach          16.80          NA          NA        6.13        6.15        1.94         090
                                                 and bowel.
43820...........  .............  A............  Fusion of stomach          22.40          NA          NA        8.07        7.23        2.04         090
                                                 and bowel.
43825...........  .............  A............  Fusion of stomach          21.63          NA          NA        7.89        7.95        2.54         090
                                                 and bowel.
43830...........  .............  A............  Place gastrostomy          10.75          NA          NA        5.17        5.00        1.25         090
                                                 tube.
43831...........  .............  A............  Place gastrostomy           8.38          NA          NA        4.92        4.71        1.03         090
                                                 tube.
43832...........  .............  A............  Place gastrostomy          17.26          NA          NA        7.06        6.95        1.98         090
                                                 tube.
43840...........  .............  A............  Repair of stomach          22.70          NA          NA        8.14        7.45        2.06         090
                                                 lesion.
43842...........  .............  N............  V-band gastroplasty.       20.90          NA          NA        6.75        7.26        2.45         090
43843...........  .............  A............  Gastroplasty w/o v-        21.08          NA          NA        7.84        7.79        2.46         090
                                                 band.
43845...........  .............  A............  Gastroplasty               33.12          NA          NA       12.88       11.82        4.06         090
                                                 duodenal switch.
43846...........  .............  A............  Gastric bypass for         27.23          NA          NA        9.97        9.99        3.19         090
                                                 obesity.

[[Page 66458]]

 
43847...........  .............  A............  Gastric bypass incl        30.10          NA          NA       10.51       10.70        3.56         090
                                                 small i.
43848...........  .............  A............  Revision                   32.57          NA          NA       11.29       11.55        3.88         090
                                                 gastroplasty.
43850...........  .............  A............  Revise stomach-bowel       27.45          NA          NA        9.49        9.65        3.28         090
                                                 fusion.
43855...........  .............  A............  Revise stomach-bowel       28.56          NA          NA        9.70       10.01        3.47         090
                                                 fusion.
43860...........  .............  A............  Revise stomach-bowel       27.76          NA          NA        9.47        9.71        3.31         090
                                                 fusion.
43865...........  .............  A............  Revise stomach-bowel       28.92          NA          NA        9.73       10.11        3.51         090
                                                 fusion.
43870...........  .............  A............  Repair stomach             11.36          NA          NA        4.95        4.73        1.27         090
                                                 opening.
43880...........  .............  A............  Repair stomach-bowel       27.05          NA          NA        9.27        9.58        3.27         090
                                                 fistula.
43881...........  .............  C............  Impl/redo electrd,          0.00        0.00        0.00        0.00        0.00        0.00         YYY
                                                 antrum.
43882...........  .............  C............  Revise/remove               0.00        0.00        0.00        0.00        0.00        0.00         YYY
                                                 electrd antrum.
43886...........  .............  A............  Revise gastric port,        4.54          NA          NA        3.44        3.29        0.25         090
                                                 open.
43887...........  .............  A............  Remove gastric port,        4.24          NA          NA        3.05        2.91        0.51         090
                                                 open.
43888...........  .............  A............  Change gastric port,        6.34          NA          NA        4.01        3.88        0.70         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           18.38          NA          NA        6.58        6.64        2.15         090
                                                 adhesion.
44010...........  .............  A............  Incision of small          14.18          NA          NA        5.53        5.48        1.64         090
                                                 bowel.
44015...........  .............  A............  Insert needle cath          2.62          NA          NA        0.68        0.78        0.35         ZZZ
                                                 bowel.
44020...........  .............  A............  Explore small              16.14          NA          NA        6.00        5.96        1.86         090
                                                 intestine.
44021...........  .............  A............  Decompress small           16.23          NA          NA        6.15        6.05        1.87         090
                                                 bowel.
44025...........  .............  A............  Incision of large          16.43          NA          NA        6.05        6.03        1.90         090
                                                 bowel.
44050...........  .............  A............  Reduce bowel               15.44          NA          NA        5.82        5.88        1.86         090
                                                 obstruction.
44055...........  .............  A............  Correct malrotation        25.53          NA          NA        8.48        8.60        2.91         090
                                                 of bowel.
44100...........  .............  A............  Biopsy of bowel.....        2.01          NA          NA        0.91        0.81        0.17         000
44110...........  .............  A............  Excise intestine           13.96          NA          NA        5.50        5.36        1.55         090
                                                 lesion(s).
44111...........  .............  A............  Excision of bowel          16.44          NA          NA        6.09        6.10        1.87         090
                                                 lesion(s).
44120...........  .............  A............  Removal of small           20.74          NA          NA        7.14        7.11        2.25         090
                                                 intestine.
44121...........  .............  A............  Removal of small            4.44          NA          NA        1.12        1.32        0.58         ZZZ
                                                 intestine.
44125...........  .............  A............  Removal of small           19.93          NA          NA        7.03        7.14        2.27         090
                                                 intestine.
44126...........  .............  A............  Enterectomy w/o            42.02          NA          NA       13.59       13.85        4.69         090
                                                 taper, cong.
44127...........  .............  A............  Enterectomy w/taper,       49.09          NA          NA       15.63       15.67        5.77         090
                                                 cong.
44128...........  .............  A............  Enterectomy cong,           4.44          NA          NA        1.21        1.37        0.61         ZZZ
                                                 add-on.
44130...........  .............  A............  Bowel to bowel             21.98          NA          NA        7.97        7.09        1.88         090
                                                 fusion.
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                   0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 transplant, live.
44137...........  .............  C............  Remove intestinal           0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 allograft.
44139...........  .............  A............  Mobilization of             2.23          NA          NA        0.56        0.66        0.28         ZZZ
                                                 colon.
44140...........  .............  A............  Partial removal of         22.46          NA          NA        8.06        8.35        2.71         090
                                                 colon.
44141...........  .............  A............  Partial removal of         29.75          NA          NA       11.83       10.93        2.53         090
                                                 colon.
44143...........  .............  A............  Partial removal of         27.63          NA          NA       10.28       10.48        3.05         090
                                                 colon.
44144...........  .............  A............  Partial removal of         29.75          NA          NA       10.62       10.11        2.86         090
                                                 colon.
44145...........  .............  A............  Partial removal of         28.45          NA          NA        9.48       10.13        3.29         090
                                                 colon.
44146...........  .............  A............  Partial removal of         35.14          NA          NA       13.36       13.10        3.41         090
                                                 colon.
44147...........  .............  A............  Partial removal of         33.56          NA          NA       10.77        9.73        2.56         090
                                                 colon.
44150...........  .............  A............  Removal of colon....       29.99          NA          NA       12.60       12.30        3.04         090
44151...........  .............  A............  Removal of colon/          34.73          NA          NA       13.91       13.65        3.49         090
                                                 ileostomy.
44155...........  .............  A............  Removal of colon/          34.23          NA          NA       13.44       13.37        3.28         090
                                                 ileostomy.
44156...........  .............  A............  Removal of colon/          37.23          NA          NA       14.48       14.75        3.95         090
                                                 ileostomy.
44157...........  .............  A............  Colectomy w/ileoanal       35.49          NA          NA       17.08       17.08        3.93         090
                                                 anast.
44158...........  .............  A............  Colectomy w/neo-           36.49          NA          NA       17.42       17.42        4.06         090
                                                 rectum pouch.
44160...........  .............  A............  Removal of colon....       20.78          NA          NA        7.51        7.62        2.37         090
44180...........  .............  A............  Lap, enterolysis....       15.19          NA          NA        5.80        6.01        1.86         090
44186...........  .............  A............  Lap, jejunostomy....       10.30          NA          NA        4.58        4.68        1.27         090
44187...........  .............  A............  Lap, ileo/jejuno-          17.27          NA          NA        8.12        8.19        1.96         090
                                                 stomy.
44188...........  .............  A............  Lap, colostomy......       19.20          NA          NA        8.67        8.75        2.24         090
44202...........  .............  A............  Lap, enterectomy....       23.26          NA          NA        8.31        8.61        2.85         090
44203...........  .............  A............  Lap resect s/               4.44          NA          NA        1.12        1.31        0.57         ZZZ
                                                 intestine, addl.
44204...........  .............  A............  Laparo partial             26.29          NA          NA        8.88        9.41        3.11         090
                                                 colectomy.
44205...........  .............  A............  Lap colectomy part w/      22.86          NA          NA        7.80        8.32        2.75         090
                                                 ileum.
44206...........  .............  A............  Lap part colectomy w/      29.63          NA          NA       10.46       10.85        3.46         090
                                                 stoma.
44207...........  .............  A............  L colectomy/               31.79          NA          NA       10.10       10.78        3.67         090
                                                 coloproctostomy.
44208...........  .............  A............  L colectomy/               33.86          NA          NA       12.01       12.57        3.88         090
                                                 coloproctostomy.
44210...........  .............  A............  Laparo total               29.88          NA          NA       11.17       11.52        3.42         090
                                                 proctocolectomy.
44211...........  .............  A............  Lap colectomy w/           36.87          NA          NA       13.58       14.12        4.17         090
                                                 proctectomy.
44212...........  .............  A............  Laparo total               34.37          NA          NA       13.03       13.35        3.78         090
                                                 proctocolectomy.
44213...........  .............  A............  Lap, mobil splenic          3.50          NA          NA        0.86        1.04        0.44         ZZZ
                                                 fl add-on.
44227...........  .............  A............  Lap, close                 28.49          NA          NA        9.48       10.05        3.38         090
                                                 enterostomy.
44238...........  .............  C............  Laparoscope proc,           0.00        0.00        0.00        0.00        0.00        0.00         YYY
                                                 intestine.
44300...........  .............  A............  Open bowel to skin..       13.65          NA          NA        5.55        5.52        1.60         090
44310...........  .............  A............  Ileostomy/                 17.49          NA          NA        6.40        6.54        1.99         090
                                                 jejunostomy.
44312...........  .............  A............  Revision of                 9.33          NA          NA        4.65        4.32        0.92         090
                                                 ileostomy.

[[Page 66459]]

 
44314...........  .............  A............  Revision of                16.61          NA          NA        6.77        6.66        1.75         090
                                                 ileostomy.
44316...........  .............  A............  Devise bowel pouch..       23.46          NA          NA        8.87        8.70        2.38         090
44320...........  .............  A............  Colostomy...........       19.75          NA          NA        7.59        7.62        2.26         090
44322...........  .............  A............  Colostomy with             13.15          NA          NA        9.10        8.83        1.54         090
                                                 biopsies.
44340...........  .............  A............  Revision of                 9.12          NA          NA        4.93        4.60        0.99         090
                                                 colostomy.
44345...........  .............  A............  Revision of                17.06          NA          NA        6.92        6.90        1.97         090
                                                 colostomy.
44346...........  .............  A............  Revision of                19.47          NA          NA        7.52        7.45        2.13         090
                                                 colostomy.
44360...........  .............  A............  Small bowel                 2.59          NA          NA        1.50        1.30        0.19         000
                                                 endoscopy.
44361...........  .............  A............  Small bowel                 2.87          NA          NA        1.63        1.41        0.21         000
                                                 endoscopy/biopsy.
44363...........  .............  A............  Small bowel                 3.49          NA          NA        1.85        1.61        0.27         000
                                                 endoscopy.
44364...........  .............  A............  Small bowel                 3.73          NA          NA        1.97        1.73        0.27         000
                                                 endoscopy.
44365...........  .............  A............  Small bowel                 3.31          NA          NA        1.74        1.55        0.24         000
                                                 endoscopy.
44366...........  .............  A............  Small bowel                 4.40          NA          NA        2.37        2.05        0.32         000
                                                 endoscopy.
44369...........  .............  A............  Small bowel                 4.51          NA          NA        2.36        2.05        0.33         000
                                                 endoscopy.
44370...........  .............  A............  Small bowel                 4.79          NA          NA        2.56        2.26        0.37         000
                                                 endoscopy/stent.
44372...........  .............  A............  Small bowel                 4.40          NA          NA        2.12        1.93        0.35         000
                                                 endoscopy.
44373...........  .............  A............  Small bowel                 3.49          NA          NA        1.76        1.59        0.27         000
                                                 endoscopy.
44376...........  .............  A............  Small bowel                 5.25          NA          NA        2.47        2.25        0.42         000
                                                 endoscopy.
44377...........  .............  A............  Small bowel                 5.52          NA          NA        2.76        2.45        0.40         000
                                                 endoscopy/biopsy.
44378...........  .............  A............  Small bowel                 7.12          NA          NA        3.57        3.13        0.52         000
                                                 endoscopy.
44379...........  .............  A............  S bowel endoscope w/        7.46          NA          NA        3.92        3.42        0.62         000
                                                 stent.
44380...........  .............  A............  Small bowel                 1.05          NA          NA        0.74        0.65        0.08         000
                                                 endoscopy.
44382...........  .............  A............  Small bowel                 1.27          NA          NA        0.84        0.73        0.12         000
                                                 endoscopy.
44383...........  .............  A............  Ileoscopy w/stent...        2.94          NA          NA        1.61        1.44        0.21         000
44385...........  .............  A............  Endoscopy of bowel          1.82        4.90        4.12        0.89        0.82        0.15         000
                                                 pouch.
44386...........  .............  A............  Endoscopy, bowel            2.12        6.65        6.64        1.02        0.95        0.20         000
                                                 pouch/biop.
44388...........  .............  A............  Colonoscopy.........        2.82        6.12        5.60        1.35        1.25        0.26         000
44389...........  .............  A............  Colonoscopy with            3.13        7.11        6.86        1.57        1.42        0.27         000
                                                 biopsy.
44390...........  .............  A............  Colonoscopy for             3.82        8.33        7.72        1.92        1.70        0.32         000
                                                 foreign body.
44391...........  .............  A............  Colonoscopy for             4.31        8.93        8.83        2.21        1.95        0.34         000
                                                 bleeding.
44392...........  .............  A............  Colonoscopy &               3.81        7.36        6.97        1.72        1.60        0.34         000
                                                 polypectomy.
44393...........  .............  A............  Colonoscopy, lesion         4.83        8.03        7.46        2.13        2.00        0.42         000
                                                 removal.
44394...........  .............  A............  Colonoscopy w/snare.        4.42        8.50        8.15        2.07        1.89        0.38         000
44397...........  .............  A............  Colonoscopy w/stent.        4.70          NA          NA        2.16        1.97        0.39         000
44500...........  .............  A............  Intro,                      0.49          NA          NA        0.17        0.17        0.03         000
                                                 gastrointestinal
                                                 tube.
44602...........  .............  A............  Suture, small              24.64          NA          NA        7.61        7.00        2.12         090
                                                 intestine.
44603...........  .............  A............  Suture, small              28.03          NA          NA        8.96        8.11        2.42         090
                                                 intestine.
44604...........  .............  A............  Suture, large              18.06          NA          NA        6.06        6.25        2.12         090
                                                 intestine.
44605...........  .............  A............  Repair of bowel            22.00          NA          NA        7.82        8.10        2.52         090
                                                 lesion.
44615...........  .............  A............  Intestinal                 18.08          NA          NA        6.53        6.60        2.07         090
                                                 stricturoplasty.
44620...........  .............  A............  Repair bowel opening       14.35          NA          NA        5.50        5.41        1.51         090
44625...........  .............  A............  Repair bowel opening       17.20          NA          NA        6.14        6.22        1.86         090
44626...........  .............  A............  Repair bowel opening       27.82          NA          NA        8.88        9.34        3.27         090
44640...........  .............  A............  Repair bowel-skin          24.12          NA          NA        8.01        8.29        2.78         090
                                                 fistula.
44650...........  .............  A............  Repair bowel fistula       25.04          NA          NA        8.30        8.59        2.93         090
44660...........  .............  A............  Repair bowel-bladder       23.83          NA          NA        9.75        9.04        2.14         090
                                                 fistula.
44661...........  .............  A............  Repair bowel-bladder       27.27          NA          NA        9.39        9.47        2.81         090
                                                 fistula.
44680...........  .............  A............  Surgical revision,         17.88          NA          NA        6.68        6.56        2.00         090
                                                 intestine.
44700...........  .............  A............  Suspend bowel w/           17.40          NA          NA        6.15        6.40        1.84         090
                                                 prosthesis.
44701...........  .............  A............  Intraop colon lavage        3.10          NA          NA        0.76        0.91        0.37         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          NA        1.27        1.48        0.37         XXX
                                                 venous.
44721...........  .............  A............  Prep donor intestine/       7.00          NA          NA        1.78        2.08        0.97         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          11.94          NA          NA        5.49        5.43        1.47         090
                                                 pouch.
44820...........  .............  A............  Excision of                13.63          NA          NA        5.56        5.52        1.59         090
                                                 mesentery lesion.
44850...........  .............  A............  Repair of mesentery.       12.03          NA          NA        5.01        5.00        1.39         090
44899...........  .............  C............  Bowel surgery               0.00        0.00        0.00        0.00        0.00        0.00         YYY
                                                 procedure.
44900...........  .............  A............  Drain app abscess,         12.44          NA          NA        5.02        4.85        1.33         090
                                                 open.
44901...........  .............  A............  Drain app abscess,          3.37       19.79       23.83        1.20        1.15        0.22         000
                                                 percut.
44950...........  .............  A............  Appendectomy........       10.52          NA          NA        4.04        4.17        1.31         090
44955...........  .............  A............  Appendectomy add-on.        1.53          NA          NA        0.40        0.47        0.20         ZZZ
44960...........  .............  A............  Appendectomy........       14.39          NA          NA        5.40        5.37        1.63         090
44970...........  .............  A............  Laparoscopy,                9.35          NA          NA        4.19        4.13        1.14         090
                                                 appendectomy.
44979...........  .............  C............  Laparoscope proc,           0.00        0.00        0.00        0.00        0.00        0.00         YYY
                                                 app.
45000...........  .............  A............  Drainage of pelvic          6.20          NA          NA        3.57        3.26        0.52         090
                                                 abscess.
45005...........  .............  A............  Drainage of rectal          2.00        3.98        4.01        1.59        1.58        0.25         010
                                                 abscess.
45020...........  .............  A............  Drainage of rectal          8.43          NA          NA        4.54        3.91        0.55         090
                                                 abscess.
45100...........  .............  A............  Biopsy of rectum....        3.96          NA          NA        2.81        2.59        0.44         090
45108...........  .............  A............  Removal of anorectal        5.04          NA          NA        3.09        2.93        0.59         090
                                                 lesion.
45110...........  .............  A............  Removal of rectum...       30.57          NA          NA       11.84       12.12        3.36         090
45111...........  .............  A............  Partial removal of         17.89          NA          NA        6.99        7.07        2.07         090
                                                 rectum.

[[Page 66460]]

 
45112...........  .............  A............  Removal of rectum...       33.05          NA          NA       10.30       11.02        3.43         090
45113...........  .............  A............  Partial proctectomy.       33.09          NA          NA       11.57       12.08        3.49         090
45114...........  .............  A............  Partial removal of         30.63          NA          NA       10.28       10.57        3.36         090
                                                 rectum.
45116...........  .............  A............  Partial removal of         27.56          NA          NA        9.64        9.83        2.88         090
                                                 rectum.
45119...........  .............  A............  Remove rectum w/           33.35          NA          NA       11.53       11.99        3.36         090
                                                 reservoir.
45120...........  .............  A............  Removal of rectum...       26.25          NA          NA        9.26        9.69        2.90         090
45121...........  .............  A............  Removal of rectum          28.93          NA          NA       10.03       10.56        3.25         090
                                                 and colon.
45123...........  .............  A............  Partial proctectomy.       18.70          NA          NA        6.94        6.89        1.86         090
45126...........  .............  A............  Pelvic exenteration.       48.89          NA          NA       17.87       18.53        4.33         090
45130...........  .............  A............  Excision of rectal         18.37          NA          NA        6.66        6.71        1.80         090
                                                 prolapse.
45135...........  .............  A............  Excision of rectal         22.15          NA          NA        8.60        8.50        2.36         090
                                                 prolapse.
45136...........  .............  A............  Excise ileoanal            30.63          NA          NA       11.94       12.23        2.82         090
                                                 reservior.
45150...........  .............  A............  Excision of rectal          5.77          NA          NA        3.34        3.15        0.61         090
                                                 stricture.
45160...........  .............  A............  Excision of rectal         16.17          NA          NA        6.43        6.54        1.68         090
                                                 lesion.
45170...........  .............  A............  Excision of rectal         12.48          NA          NA        5.36        5.29        1.35         090
                                                 lesion.
45190...........  .............  A............  Destruction, rectal        10.29          NA          NA        5.52        5.07        1.13         090
                                                 tumor.
45300...........  .............  A............  Proctosigmoidoscopy         0.80        1.96        1.74        0.45        0.37        0.04         000
                                                 dx.
45303...........  .............  A............  Proctosigmoidoscopy         1.50       19.91       19.29        0.66        0.49        0.05         000
                                                 dilate.
45305...........  .............  A............  Proctosigmoidoscopy         1.25        3.19        2.91        0.59        0.55        0.11         000
                                                 w/bx.
45307...........  .............  A............  Proctosigmoidoscopy         1.70        3.25        3.14        0.70        0.59        0.11         000
                                                 fb.
45308...........  .............  A............  Proctosigmoidoscopy         1.40        3.40        2.70        0.63        0.53        0.09         000
                                                 removal.
45309...........  .............  A............  Proctosigmoidoscopy         1.50        3.53        3.17        0.67        0.75        0.22         000
                                                 removal.
45315...........  .............  A............  Proctosigmoidoscopy         1.80        3.82        3.34        0.87        0.75        0.15         000
                                                 removal.
45317...........  .............  A............  Proctosigmoidoscopy         2.00        3.36        2.90        0.76        0.71        0.15         000
                                                 bleed.
45320...........  .............  A............  Proctosigmoidoscopy         1.78        3.40        3.15        0.80        0.75        0.16         000
                                                 ablate.
45321...........  .............  A............  Proctosigmoidoscopy         1.75          NA          NA        0.86        0.71        0.13         000
                                                 volvul.
45327...........  .............  A............  Proctosigmoidoscopy         2.00          NA          NA        0.91        0.80        0.16         000
                                                 w/stent.
45330...........  .............  A............  Diagnostic                  0.96        2.52        2.40        0.62        0.56        0.08         000
                                                 sigmoidoscopy.
45331...........  .............  A............  Sigmoidoscopy and           1.15        3.28        3.17        0.79        0.69        0.09         000
                                                 biopsy.
45332...........  .............  A............  Sigmoidoscopy w/fb          1.79        5.53        5.26        0.99        0.90        0.16         000
                                                 removal.
45333...........  .............  A............  Sigmoidoscopy &             1.79        5.66        5.26        0.99        0.89        0.15         000
                                                 polypectomy.
45334...........  .............  A............  Sigmoidoscopy for           2.73          NA          NA        1.53        1.34        0.20         000
                                                 bleeding.
45335...........  .............  A............  Sigmoidoscopy w/            1.46        5.34        4.27        0.90        0.79        0.11         000
                                                 submuc inj.
45337...........  .............  A............  Sigmoidoscopy &             2.36          NA          NA        1.25        1.12        0.21         000
                                                 decompress.
45338...........  .............  A............  Sigmoidoscopy w/tumr        2.34        5.90        5.56        1.28        1.14        0.19         000
                                                 remove.
45339...........  .............  A............  Sigmoidoscopy w/            3.14        5.73        4.59        1.66        1.47        0.26         000
                                                 ablate tumr.
45340...........  .............  A............  Sig w/balloon               1.89       10.25        8.21        1.03        0.93        0.15         000
                                                 dilation.
45341...........  .............  A............  Sigmoidoscopy w/            2.60          NA          NA        1.47        1.27        0.19         000
                                                 ultrasound.
45342...........  .............  A............  Sigmoidoscopy w/us          4.05          NA          NA        2.17        1.85        0.30         000
                                                 guide bx.
45345...........  .............  A............  Sigmoidoscopy w/            2.92          NA          NA        1.50        1.33        0.23         000
                                                 stent.
45355...........  .............  A............  Surgical colonoscopy        3.51          NA          NA        1.58        1.48        0.36         000
45378...........  .............  A............  Diagnostic                  3.69        6.38        6.26        1.82        1.64        0.30         000
                                                 colonoscopy.
45378...........  53...........  A............  Diagnostic                  0.96        2.52        2.40        0.62        0.56        0.08         000
                                                 colonoscopy.
45379...........  .............  A............  Colonoscopy w/fb            4.68        8.07        7.86        2.17        1.99        0.39         000
                                                 removal.
45380...........  .............  A............  Colonoscopy and             4.43        7.75        7.47        2.23        1.98        0.35         000
                                                 biopsy.
45381...........  .............  A............  Colonoscopy,                4.19        7.72        7.41        2.16        1.90        0.30         000
                                                 submucous inj.
45382...........  .............  A............  Colonoscopy/control         5.68       10.35       10.14        2.88        2.53        0.41         000
                                                 bleeding.
45383...........  .............  A............  Lesion removal              5.86        8.55        8.23        2.63        2.43        0.48         000
                                                 colonoscopy.
45384...........  .............  A............  Lesion remove               4.69        7.19        6.99        2.18        2.00        0.38         000
                                                 colonoscopy.
45385...........  .............  A............  Lesion removal              5.30        8.37        8.08        2.59        2.31        0.42         000
                                                 colonoscopy.
45386...........  .............  A............  Colonoscopy dilate          4.57       12.35       12.38        2.17        1.98        0.39         000
                                                 stricture.
45387...........  .............  A............  Colonoscopy w/stent.        5.90          NA          NA        2.80        2.57        0.48         000
45391...........  .............  A............  Colonoscopy w/              5.09          NA          NA        2.60        2.29        0.42         000
                                                 endoscope us.
45392...........  .............  A............  Colonoscopy w/              6.54          NA          NA        3.21        2.85        0.42         000
                                                 endoscopic fnb.
45395...........  .............  A............  Lap, removal of            32.79          NA          NA       12.94       13.30        3.63         090
                                                 rectum.
45397...........  .............  A............  Lap, remove rectum w/      36.29          NA          NA       13.38       13.82        3.67         090
                                                 pouch.
45400...........  .............  A............  Laparoscopic proc...       19.31          NA          NA        7.07        7.45        2.03         090
45402...........  .............  A............  Lap proctopexy w/sig       26.38          NA          NA        8.73        9.35        2.82         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....        7.64          NA          NA        4.46        3.99        0.75         090
45505...........  .............  A............  Repair of rectum....        8.20          NA          NA        5.04        4.44        0.86         090
45520...........  .............  A............  Treatment of rectal         0.55        2.86        2.25        0.38        0.38        0.05         000
                                                 prolapse.
45540...........  .............  A............  Correct rectal             18.02          NA          NA        5.83        6.31        1.85         090
                                                 prolapse.
45541...........  .............  A............  Correct rectal             14.72          NA          NA        6.59        6.26        1.55         090
                                                 prolapse.
45550...........  .............  A............  Repair rectum/remove       24.67          NA          NA        8.95        9.08        2.62         090
                                                 sigmoid.
45560...........  .............  A............  Repair of rectocele.       11.42          NA          NA        5.52        5.28        1.13         090
45562...........  .............  A............  Exploration/repair         17.82          NA          NA        8.10        7.54        1.84         090
                                                 of rectum.
45563...........  .............  A............  Exploration/repair         26.22          NA          NA       10.75       10.62        3.11         090
                                                 of rectum.
45800...........  .............  A............  Repair rect/bladder        20.18          NA          NA        9.14        8.28        1.86         090
                                                 fistula.
45805...........  .............  A............  Repair fistula w/          23.19          NA          NA        9.92        9.71        2.03         090
                                                 colostomy.
45820...........  .............  A............  Repair rectourethral       20.24          NA          NA        9.09        8.35        1.58         090
                                                 fistula.
45825...........  .............  A............  Repair fistula w/          24.01          NA          NA        9.46        9.63        2.32         090
                                                 colostomy.

[[Page 66461]]

 
45900...........  .............  A............  Reduction of rectal         2.96          NA          NA        1.65        1.57        0.30         010
                                                 prolapse.
45905...........  .............  A............  Dilation of anal            2.32          NA          NA        1.60        1.51        0.27         010
                                                 sphincter.
45910...........  .............  A............  Dilation of rectal          2.82          NA          NA        1.84        1.75        0.30         010
                                                 narrowing.
45915...........  .............  A............  Remove rectal               3.16        4.20        4.26        2.01        2.05        0.30         010
                                                 obstruction.
45990...........  .............  A............  Surg dx exam,               1.80          NA          NA        0.72        0.76        0.17         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..        2.94        3.26        2.80        2.35        2.10        0.31         010
46030...........  .............  A............  Removal of rectal           1.24        1.88        1.61        0.81        0.76        0.14         010
                                                 marker.
46040...........  .............  A............  Incision of rectal          5.26        6.53        6.01        3.98        3.78        0.62         090
                                                 abscess.
46045...........  .............  A............  Incision of rectal          5.79          NA          NA        3.94        3.41        0.54         090
                                                 abscess.
46050...........  .............  A............  Incision of anal            1.21        3.19        2.87        0.98        0.91        0.14         010
                                                 abscess.
46060...........  .............  A............  Incision of rectal          6.24          NA          NA        4.41        3.83        0.67         090
                                                 abscess.
46070...........  .............  A............  Incision of anal            2.74          NA          NA        2.35        2.09        0.36         090
                                                 septum.
46080...........  .............  A............  Incision of anal            2.50        3.06        2.71        1.12        1.12        0.30         010
                                                 sphincter.
46083...........  .............  A............  Incise external             1.42        2.36        2.44        0.96        0.94        0.15         010
                                                 hemorrhoid.
46200...........  .............  A............  Removal of anal             3.48        6.29        5.07        3.73        3.29        0.39         090
                                                 fissure.
46210...........  .............  A............  Removal of anal             2.73        5.82        5.46        3.30        2.96        0.31         090
                                                 crypt.
46211...........  .............  A............  Removal of anal             4.31        7.84        6.62        4.66        4.08        0.48         090
                                                 crypts.
46220...........  .............  A............  Removal of anal tag.        1.58        3.02        2.66        1.10        1.02        0.17         010
46221...........  .............  A............  Ligation of                 2.31        3.73        3.19        2.00        1.87        0.23         010
                                                 hemorrhoid(s).
46230...........  .............  A............  Removal of anal tags        2.59        3.50        3.29        1.33        1.31        0.30         010
46250...........  .............  A............  Hemorrhoidectomy....        4.17        5.95        5.63        2.83        2.72        0.48         090
46255...........  .............  A............  Hemorrhoidectomy....        4.88        6.34        6.08        3.06        2.95        0.58         090
46257...........  .............  A............  Remove hemorrhoids &        5.68          NA          NA        3.84        3.36        0.64         090
                                                 fissure.
46258...........  .............  A............  Remove hemorrhoids &        6.28          NA          NA        3.95        3.61        0.68         090
                                                 fistula.
46260...........  .............  A............  Hemorrhoidectomy....        6.65          NA          NA        4.06        3.62        0.76         090
46261...........  .............  A............  Remove hemorrhoids &        7.63          NA          NA        4.29        3.94        0.79         090
                                                 fissure.
46262...........  .............  A............  Remove hemorrhoids &        7.80          NA          NA        4.65        4.19        0.83         090
                                                 fistula.
46270...........  .............  A............  Removal of anal             4.81        6.38        5.68        3.91        3.37        0.46         090
                                                 fistula.
46275...........  .............  A............  Removal of anal             5.31        6.62        5.62        3.97        3.47        0.52         090
                                                 fistula.
46280...........  .............  A............  Removal of anal             6.28          NA          NA        4.27        3.76        0.66         090
                                                 fistula.
46285...........  .............  A............  Removal of anal             5.31        6.53        5.14        3.95        3.35        0.44         090
                                                 fistula.
46288...........  .............  A............  Repair anal fistula.        7.68          NA          NA        4.67        4.17        0.79         090
46320...........  .............  A............  Removal of                  1.62        2.41        2.26        0.88        0.86        0.18         010
                                                 hemorrhoid clot.
46500...........  .............  A............  Injection into              1.64        3.60        2.86        1.25        1.20        0.16         010
                                                 hemorrhoid(s).
46505...........  .............  A............  Chemodenervation            3.13        3.28        3.16        2.28        2.12        0.14         010
                                                 anal musc.
46600...........  .............  A............  Diagnostic anoscopy.        0.55        1.37        1.46        0.38        0.36        0.05         000
46604...........  .............  A............  Anoscopy and                1.03       12.51       10.81        0.51        0.56        0.12         000
                                                 dilation.
46606...........  .............  A............  Anoscopy and biopsy.        1.20        3.87        3.82        0.58        0.50        0.09         000
46608...........  .............  A............  Anoscopy, remove for        1.30        3.76        4.08        0.58        0.61        0.16         000
                                                 body.
46610...........  .............  A............  Anoscopy, remove            1.28        3.79        3.91        0.59        0.60        0.15         000
                                                 lesion.
46611...........  .............  A............  Anoscopy............        1.30        2.53        2.93        0.57        0.67        0.19         000
46612...........  .............  A............  Anoscopy, remove            1.50        4.70        4.94        0.72        0.85        0.28         000
                                                 lesions.
46614...........  .............  A............  Anoscopy, control           1.00        1.93        2.13        0.52        0.68        0.20         000
                                                 bleeding.
46615...........  .............  A............  Anoscopy............        1.50        1.74        2.11        0.64        0.85        0.33         000
46700...........  .............  A............  Repair of anal              9.68          NA          NA        5.15        4.67        0.94         090
                                                 stricture.
46705...........  .............  A............  Repair of anal              7.32          NA          NA        4.06        3.87        0.91         090
                                                 stricture.
46706...........  .............  A............  Repr of anal fistula        2.41          NA          NA        1.49        1.37        0.28         010
                                                 w/glue.
46710...........  .............  A............  Repr per/vag pouch         17.01          NA          NA        7.54        7.64        1.38         090
                                                 sngl proc.
46712...........  .............  A............  Repr per/vag pouch         36.32          NA          NA       14.00       14.52        3.67         090
                                                 dbl proc.
46715...........  .............  A............  Rep perf anoper             7.54          NA          NA        3.75        3.66        0.92         090
                                                 fistu.
46716...........  .............  A............  Rep perf anoper/           17.14          NA          NA        9.59        8.77        1.58         090
                                                 vestib fistu.
46730...........  .............  A............  Construction of            30.17          NA          NA       12.49       12.25        2.47         090
                                                 absent anus.
46735...........  .............  A............  Construction of            35.66          NA          NA       15.00       14.27        3.21         090
                                                 absent anus.
46740...........  .............  A............  Construction of            33.42          NA          NA       15.28       14.25        2.42         090
                                                 absent anus.
46742...........  .............  A............  Repair of                  39.66          NA          NA       13.75       15.56        3.20         090
                                                 imperforated anus.
46744...........  .............  A............  Repair of cloacal          58.46          NA          NA       18.13       19.61        6.40         090
                                                 anomaly.
46746...........  .............  A............  Repair of cloacal          64.93          NA          NA       19.66       22.39        7.70         090
                                                 anomaly.
46748...........  .............  A............  Repair of cloacal          70.91          NA          NA       21.04       22.33        3.37         090
                                                 anomaly.
46750...........  .............  A............  Repair of anal             12.02          NA          NA        5.76        5.40        1.10         090
                                                 sphincter.
46751...........  .............  A............  Repair of anal              9.19          NA          NA        5.02        5.22        0.94         090
                                                 sphincter.
46753...........  .............  A............  Reconstruction of           8.81          NA          NA        4.59        4.21        0.94         090
                                                 anus.
46754...........  .............  A............  Removal of suture           2.88        3.63        3.61        2.21        1.94        0.19         010
                                                 from anus.
46760...........  .............  A............  Repair of anal             17.21          NA          NA        8.05        7.56        1.59         090
                                                 sphincter.
46761...........  .............  A............  Repair of anal             15.16          NA          NA        6.47        6.23        1.43         090
                                                 sphincter.
46762...........  .............  A............  Implant artificial         14.66          NA          NA        7.07        6.29        1.24         090
                                                 sphincter.
46900...........  .............  A............  Destruction, anal           1.91        3.65        3.12        1.31        1.29        0.17         010
                                                 lesion(s).
46910...........  .............  A............  Destruction, anal           1.88        3.88        3.39        1.20        1.13        0.19         010
                                                 lesion(s).
46916...........  .............  A............  Cryosurgery, anal           1.88        3.77        3.46        1.58        1.48        0.11         010
                                                 lesion(s).
46917...........  .............  A............  Laser surgery, anal         1.88        8.78        8.95        1.22        1.17        0.21         010
                                                 lesions.
46922...........  .............  A............  Excision of anal            1.88        4.14        3.70        1.20        1.13        0.22         010
                                                 lesion(s).
46924...........  .............  A............  Destruction, anal           2.78        9.57        9.13        1.51        1.43        0.26         010
                                                 lesion(s).

[[Page 66462]]

 
46934...........  .............  A............  Destruction of              3.79        5.56        5.31        2.87        2.91        0.32         090
                                                 hemorrhoids.
46935...........  .............  A............  Destruction of              2.44        3.86        3.66        1.11        1.16        0.23         010
                                                 hemorrhoids.
46936...........  .............  A............  Destruction of              3.70        6.23        5.55        2.65        2.57        0.34         090
                                                 hemorrhoids.
46937...........  .............  A............  Cryotherapy of              2.70        3.40        3.09        1.43        1.32        0.14         010
                                                 rectal lesion.
46938...........  .............  A............  Cryotherapy of              4.70        5.62        4.80        3.55        3.30        0.58         090
                                                 rectal lesion.
46940...........  .............  A............  Treatment of anal           2.33        2.84        2.42        1.04        1.06        0.23         010
                                                 fissure.
46942...........  .............  A............  Treatment of anal           2.05        2.80        2.32        0.96        0.99        0.19         010
                                                 fissure.
46945...........  .............  A............  Ligation of                 2.13        4.79        4.03        2.98        2.72        0.19         090
                                                 hemorrhoids.
46946...........  .............  A............  Ligation of                 2.60        4.63        4.17        2.64        2.52        0.27         090
                                                 hemorrhoids.
46947...........  .............  A............  Hemorrhoidopexy by          5.49          NA          NA        3.10        2.91        0.75         090
                                                 stapling.
46999...........  .............  C............  Anus surgery                0.00        0.00        0.00        0.00        0.00        0.00         YYY
                                                 procedure.
47000...........  .............  A............  Needle biopsy of            1.90        7.66        5.36        0.70        0.66        0.12         000
                                                 liver.
47001...........  .............  A............  Needle biopsy, liver        1.90          NA          NA        0.48        0.57        0.25         ZZZ
                                                 add-on.
47010...........  .............  A............  Open drainage, liver       19.27          NA          NA        8.31        8.35        1.81         090
                                                 lesion.
47011...........  .............  A............  Percut drain, liver         3.69          NA          NA        1.32        1.26        0.22         000
                                                 lesion.
47015...........  .............  A............  Inject/aspirate            18.37          NA          NA        8.16        7.82        1.84         090
                                                 liver cyst.
47100...........  .............  A............  Wedge biopsy of            12.78          NA          NA        6.31        6.17        1.53         090
                                                 liver.
47120...........  .............  A............  Partial removal of         38.82          NA          NA       14.07       14.60        4.66         090
                                                 liver.
47122...........  .............  A............  Extensive removal of       59.35          NA          NA       18.74       20.08        7.21         090
                                                 liver.
47125...........  .............  A............  Partial removal of         52.91          NA          NA       17.16       18.33        6.47         090
                                                 liver.
47130...........  .............  A............  Partial removal of         57.06          NA          NA       18.10       19.53        6.96         090
                                                 liver.
47133...........  .............  X............  Removal of donor            0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 liver.
47135...........  .............  R............  Transplantation of         83.29          NA          NA       27.72       29.60        9.96         090
                                                 liver.
47136...........  .............  R............  Transplantation of         70.39          NA          NA       24.53       25.76        8.44         090
                                                 liver.
47140...........  .............  A............  Partial removal,           59.22          NA          NA       21.60       21.93        5.19         090
                                                 donor liver.
47141...........  .............  A............  Partial removal,           71.27          NA          NA       25.33       26.11        5.19         090
                                                 donor liver.
47142...........  .............  A............  Partial removal,           79.21          NA          NA       27.34       28.39        5.19         090
                                                 donor 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,           0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 lobe split.
47146...........  .............  A............  Prep donor liver/           6.00          NA          NA        1.52        1.78        0.83         XXX
                                                 venous.
47147...........  .............  A............  Prep donor liver/           7.00          NA          NA        1.77        2.08        0.97         XXX
                                                 arterial.
47300...........  .............  A............  Surgery for liver          18.01          NA          NA        7.74        7.48        1.99         090
                                                 lesion.
47350...........  .............  A............  Repair liver wound..       22.36          NA          NA        8.77        8.81        2.59         090
47360...........  .............  A............  Repair liver wound..       31.18          NA          NA       11.24       11.40        3.38         090
47361...........  .............  A............  Repair liver wound..       52.47          NA          NA       17.38       17.94        5.87         090
47362...........  .............  A............  Repair liver wound..       23.41          NA          NA        9.30        9.00        2.51         090
47370...........  .............  A............  Laparo ablate liver        20.67          NA          NA        7.69        7.90        2.56         090
                                                 tumor rf.
47371...........  .............  A............  Laparo ablate liver        20.67          NA          NA        7.89        8.01        2.61         090
                                                 cryosurg.
47379...........  .............  C............  Laparoscope                 0.00        0.00        0.00        0.00        0.00        0.00         YYY
                                                 procedure, liver.
47380...........  .............  A............  Open ablate liver          24.43          NA          NA        8.60        8.97        2.87         090
                                                 tumor rf.
47381...........  .............  A............  Open ablate liver          24.72          NA          NA        9.31        9.44        2.85         090
                                                 tumor cryo.
47382...........  .............  A............  Percut ablate liver        15.19          NA          NA        6.20        6.14        0.96         010
                                                 rf.
47399...........  .............  C............  Liver surgery               0.00        0.00        0.00        0.00        0.00        0.00         YYY
                                                 procedure.
47400...........  .............  A............  Incision of liver          36.23          NA          NA       13.01       13.21        3.08         090
                                                 duct.
47420...........  .............  A............  Incision of bile           21.92          NA          NA        8.54        8.65        2.63         090
                                                 duct.
47425...........  .............  A............  Incision of bile           22.20          NA          NA        8.64        8.72        2.62         090
                                                 duct.
47460...........  .............  A............  Incise bile duct           20.41          NA          NA        9.13        8.74        2.21         090
                                                 sphincter.
47480...........  .............  A............  Incision of                13.12          NA          NA        6.64        6.27        1.42         090
                                                 gallbladder.
47490...........  .............  A............  Incision of                 8.05          NA          NA        5.29        5.43        0.43         090
                                                 gallbladder.
47500...........  .............  A............  Injection for liver         1.96          NA          NA        0.71        0.67        0.12         000
                                                 x-rays.
47505...........  .............  A............  Injection for liver         0.76          NA          NA        0.27        0.26        0.04         000
                                                 x-rays.
47510...........  .............  A............  Insert catheter,            7.94          NA          NA        4.63        4.82        0.46         090
                                                 bile duct.
47511...........  .............  A............  Insert bile duct           10.74          NA          NA        5.04        5.06        0.62         090
                                                 drain.
47525...........  .............  A............  Change bile duct            5.55       14.85       14.96        2.69        2.74        0.33         010
                                                 catheter.
47530...........  .............  A............  Revise/reinsert bile        5.96       30.56       32.16        3.44        3.58        0.37         090
                                                 tube.
47550...........  .............  A............  Bile duct endoscopy         3.02          NA          NA        0.78        0.90        0.40         ZZZ
                                                 add-on.
47552...........  .............  A............  Biliary endoscopy           6.03          NA          NA        2.48        2.43        0.42         000
                                                 thru skin.
47553...........  .............  A............  Biliary endoscopy           6.34          NA          NA        2.25        2.16        0.37         000
                                                 thru skin.
47554...........  .............  A............  Biliary endoscopy           9.05          NA          NA        3.29        3.32        0.96         000
                                                 thru skin.
47555...........  .............  A............  Biliary endoscopy           7.55          NA          NA        2.74        2.60        0.45         000
                                                 thru skin.
47556...........  .............  A............  Biliary endoscopy           8.55          NA          NA        3.09        2.93        0.50         000
                                                 thru skin.
47560...........  .............  A............  Laparoscopy w/              4.88          NA          NA        1.24        1.45        0.65         000
                                                 cholangio.
47561...........  .............  A............  Laparo w/cholangio/         5.17          NA          NA        1.58        1.75        0.66         000
                                                 biopsy.
47562...........  .............  A............  Laparoscopic               11.63          NA          NA        5.26        5.12        1.46         090
                                                 cholecystectomy.
47563...........  .............  A............  Laparo                     12.03          NA          NA        5.06        5.18        1.58         090
                                                 cholecystectomy/
                                                 graph.
47564...........  .............  A............  Laparo                     14.21          NA          NA        5.41        5.68        1.89         090
                                                 cholecystectomy/
                                                 explr.
47570...........  .............  A............  Laparo                     12.56          NA          NA        4.96        5.16        1.65         090
                                                 cholecystoenterosto
                                                 my.
47579...........  .............  C............  Laparoscope proc,           0.00        0.00        0.00        0.00        0.00        0.00         YYY
                                                 biliary.
47600...........  .............  A............  Removal of                 17.35          NA          NA        7.22        6.67        1.80         090
                                                 gallbladder.
47605...........  .............  A............  Removal of                 15.90          NA          NA        6.38        6.43        1.95         090
                                                 gallbladder.
47610...........  .............  A............  Removal of                 20.84          NA          NA        7.65        7.78        2.49         090
                                                 gallbladder.

[[Page 66463]]

 
47612...........  .............  A............  Removal of                 21.13          NA          NA        7.67        7.77        2.48         090
                                                 gallbladder.
47620...........  .............  A............  Removal of                 22.99          NA          NA        8.15        8.33        2.74         090
                                                 gallbladder.
47630...........  .............  A............  Remove bile duct            9.57          NA          NA        4.73        4.80        0.65         090
                                                 stone.
47700...........  .............  A............  Exploration of bile        16.39          NA          NA        7.30        7.35        2.07         090
                                                 ducts.
47701...........  .............  A............  Bile duct revision..       28.62          NA          NA       10.64       11.05        3.68         090
47711...........  .............  A............  Excision of bile           25.77          NA          NA        9.64        9.77        3.05         090
                                                 duct tumor.
47712...........  .............  A............  Excision of bile           33.59          NA          NA       11.65       12.02        3.93         090
                                                 duct tumor.
47715...........  .............  A............  Excision of bile           21.42          NA          NA        8.60        8.51        2.49         090
                                                 duct cyst.
47720...........  .............  A............  Fuse gallbladder &         18.21          NA          NA        7.70        7.58        2.11         090
                                                 bowel.
47721...........  .............  A............  Fuse upper gi              21.86          NA          NA        8.54        8.54        2.53         090
                                                 structures.
47740...........  .............  A............  Fuse gallbladder &         21.10          NA          NA        8.33        8.34        2.42         090
                                                 bowel.
47741...........  .............  A............  Fuse gallbladder &         24.08          NA          NA        9.24        9.26        2.83         090
                                                 bowel.
47760...........  .............  A............  Fuse bile ducts and        38.14          NA          NA       13.03       11.93        3.42         090
                                                 bowel.
47765...........  .............  A............  Fuse liver ducts &         52.01          NA          NA       16.94       13.86        3.30         090
                                                 bowel.
47780...........  .............  A............  Fuse bile ducts and        42.14          NA          NA       14.11       12.65        3.50         090
                                                 bowel.
47785...........  .............  A............  Fuse bile ducts and        56.01          NA          NA       17.84       15.36        4.10         090
                                                 bowel.
47800...........  .............  A............  Reconstruction of          26.04          NA          NA        9.77        9.90        3.08         090
                                                 bile ducts.
47801...........  .............  A............  Placement, bile duct       17.47          NA          NA        8.43        8.28        1.16         090
                                                 support.
47802...........  .............  A............  Fuse liver duct &          24.80          NA          NA        9.68        9.66        2.86         090
                                                 intestine.
47900...........  .............  A............  Suture bile duct           22.31          NA          NA        8.85        8.85        2.65         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.       31.82          NA          NA       10.86       11.17        3.48         090
48001...........  .............  A............  Placement of drain,        39.56          NA          NA       12.76       13.30        4.69         090
                                                 pancreas.
48020...........  .............  A............  Removal of                 18.96          NA          NA        7.59        7.44        2.13         090
                                                 pancreatic stone.
48100...........  .............  A............  Biopsy of pancreas,        14.38          NA          NA        5.95        5.77        1.62         090
                                                 open.
48102...........  .............  A............  Needle biopsy,              4.68        9.60        8.77        1.91        1.93        0.28         010
                                                 pancreas.
48105...........  .............  A............  Resect/debride             49.05          NA          NA       15.76       16.15        5.56         090
                                                 pancreas.
48120...........  .............  A............  Removal of pancreas        18.33          NA          NA        6.85        6.84        2.10         090
                                                 lesion.
48140...........  .............  A............  Partial removal of         26.19          NA          NA        9.37        9.45        3.03         090
                                                 pancreas.
48145...........  .............  A............  Partial removal of         27.26          NA          NA        9.55        9.68        3.18         090
                                                 pancreas.
48146...........  .............  A............  Pancreatectomy......       30.42          NA          NA       11.93       11.94        3.50         090
48148...........  .............  A............  Removal of                 20.26          NA          NA        8.20        7.89        2.30         090
                                                 pancreatic duct.
48150...........  .............  A............  Partial removal of         52.63          NA          NA       18.01       18.74        6.32         090
                                                 pancreas.
48152...........  .............  A............  Pancreatectomy......       48.47          NA          NA       16.82       17.50        5.80         090
48153...........  .............  A............  Pancreatectomy......       52.61          NA          NA       17.89       18.70        6.31         090
48154...........  .............  A............  Pancreatectomy......       48.70          NA          NA       17.05       17.62        5.84         090
48155...........  .............  A............  Removal of pancreas.       29.27          NA          NA       11.96       11.80        3.27         090
48160...........  .............  N............  Pancreas removal/           0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 transplant.
48400...........  .............  A............  Injection, intraop          1.95          NA          NA        0.66        0.65        0.15         ZZZ
                                                 add-on.
48500...........  .............  A............  Surgery of                 18.03          NA          NA        7.66        7.49        2.03         090
                                                 pancreatic cyst.
48510...........  .............  A............  Drain pancreatic           17.06          NA          NA        7.60        7.51        1.83         090
                                                 pseudocyst.
48511...........  .............  A............  Drain pancreatic            3.99       20.17       20.53        1.43        1.37        0.24         000
                                                 pseudocyst.
48520...........  .............  A............  Fuse pancreas cyst         18.07          NA          NA        6.82        6.76        2.06         090
                                                 and bowel.
48540...........  .............  A............  Fuse pancreas cyst         21.86          NA          NA        7.80        7.94        2.61         090
                                                 and bowel.
48545...........  .............  A............  Pancreatorrhaphy....       22.10          NA          NA        8.41        8.19        2.38         090
48547...........  .............  A............  Duodenal exclusion..       30.25          NA          NA       10.28       10.37        3.42         090
48548...........  .............  A............  Fuse pancreas and          27.96          NA          NA        9.88       10.01        3.28         090
                                                 bowel.
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          NA        1.14        1.30        0.31         XXX
                                                 venous.
48554...........  .............  R............  Transpl allograft          37.03          NA          NA       20.51       19.37        4.19         090
                                                 pancreas.
48556...........  .............  A............  Removal, allograft         19.24          NA          NA        9.22        8.64        2.08         090
                                                 pancreas.
48999...........  .............  C............  Pancreas surgery            0.00        0.00        0.00        0.00        0.00        0.00         YYY
                                                 procedure.
49000...........  .............  A............  Exploration of             12.44          NA          NA        5.20        5.29        1.52         090
                                                 abdomen.
49002...........  .............  A............  Reopening of abdomen       17.55          NA          NA        6.38        5.69        1.37         090
49010...........  .............  A............  Exploration behind         15.98          NA          NA        6.19        6.04        1.51         090
                                                 abdomen.
49020...........  .............  A............  Drain abdominal            26.46          NA          NA        9.88       10.03        2.85         090
                                                 abscess.
49021...........  .............  A............  Drain abdominal             3.37       19.63       20.33        1.21        1.16        0.20         000
                                                 abscess.
49040...........  .............  A............  Drain, open, abdom         16.41          NA          NA        6.51        6.46        1.70         090
                                                 abscess.
49041...........  .............  A............  Drain, percut, abdom        3.99       19.91       19.71        1.43        1.37        0.24         000
                                                 abscess.
49060...........  .............  A............  Drain, open, retrop        18.42          NA          NA        7.24        7.33        1.75         090
                                                 abscess.
49061...........  .............  A............  Drain, percut,              3.69       19.74       19.68        1.33        1.27        0.22         000
                                                 retroper absc.
49062...........  .............  A............  Drain to peritoneal        12.12          NA          NA        5.11        5.27        1.39         090
                                                 cavity.
49080...........  .............  A............  Puncture, peritoneal        1.35        2.73        3.35        0.48        0.47        0.08         000
                                                 cavity.
49081...........  .............  A............  Removal of abdominal        1.26        2.93        2.76        0.47        0.45        0.09         000
                                                 fluid.
49180...........  .............  A............  Biopsy, abdominal           1.73        2.47        2.79        0.62        0.59        0.10         000
                                                 mass.
49203...........  .............  A............  Exc abd tum 5 cm or        20.00          NA          NA        7.65        7.65        2.27         090
                                                 less.
49204...........  .............  A............  Exc abd tum over 5         26.00          NA          NA        9.26        9.26        2.94         090
                                                 cm.
49205...........  .............  A............  Exc abd tum over 10        30.00          NA          NA       10.34       10.34        3.40         090
                                                 cm.
49215...........  .............  A............  Excise sacral spine        37.66          NA          NA       12.67       13.35        4.38         090
                                                 tumor.
49220...........  .............  A............  Multiple surgery,          15.70          NA          NA        6.45        6.54        1.89         090
                                                 abdomen.
49250...........  .............  A............  Excision of                 8.93          NA          NA        4.34        4.30        1.08         090
                                                 umbilicus.

[[Page 66464]]

 
49255...........  .............  A............  Removal of omentum..       12.41          NA          NA        5.62        5.61        1.43         090
49320...........  .............  A............  Diag laparo separate        5.09          NA          NA        2.44        2.53        0.65         010
                                                 proc.
49321...........  .............  A............  Laparoscopy, biopsy.        5.39          NA          NA        2.56        2.60        0.70         010
49322...........  .............  A............  Laparoscopy,                5.96          NA          NA        2.63        2.81        0.71         010
                                                 aspiration.
49323...........  .............  A............  Laparo drain               10.13          NA          NA        4.68        4.58        1.20         090
                                                 lymphocele.
49324...........  .............  A............  Lap insertion perm          6.27          NA          NA        2.78        2.78        0.73         010
                                                 ip cath.
49325...........  .............  A............  Lap revision perm ip        6.77          NA          NA        2.91        2.91        0.86         010
                                                 cath.
49326...........  .............  A............  Lap w/omentopexy add-       3.50          NA          NA        0.92        0.92        0.44         ZZZ
                                                 on.
49329...........  .............  C............  Laparo proc, abdm/          0.00        0.00        0.00        0.00        0.00        0.00         YYY
                                                 per/oment.
49400...........  .............  A............  Air injection into          1.88        2.47        2.77        0.62        0.62        0.15         000
                                                 abdomen.
49402...........  .............  A............  Remove foreign body,       14.01          NA          NA        5.51        5.50        1.62         090
                                                 adbomen.
49419...........  .............  A............  Insrt abdom cath for        7.03          NA          NA        3.43        3.49        0.81         090
                                                 chemotx.
49420...........  .............  A............  Insert abdom drain,         2.22          NA          NA        1.18        1.13        0.21         000
                                                 temp.
49421...........  .............  A............  Insert abdom drain,         5.87          NA          NA        3.12        3.13        0.74         090
                                                 perm.
49422...........  .............  A............  Remove perm cannula/        6.26          NA          NA        2.61        2.75        0.83         010
                                                 catheter.
49423...........  .............  A............  Exchange drainage           1.46       13.08       13.57        0.56        0.54        0.09         000
                                                 catheter.
49424...........  .............  A............  Assess cyst,                0.76        3.08        3.39        0.30        0.30        0.04         000
                                                 contrast inject.
49425...........  .............  A............  Insert abdomen-            12.13          NA          NA        5.29        5.44        1.54         090
                                                 venous drain.
49426...........  .............  A............  Revise abdomen-            10.33          NA          NA        4.56        4.66        1.28         090
                                                 venous shunt.
49427...........  .............  A............  Injection, abdominal        0.89          NA          NA        0.32        0.31        0.07         000
                                                 shunt.
49428...........  .............  A............  Ligation of shunt...        6.79          NA          NA        2.99        3.45        0.80         010
49429...........  .............  A............  Removal of shunt....        7.41          NA          NA        2.99        3.20        1.02         010
49435...........  .............  A............  Insert subq exten to        2.25          NA          NA        0.61        0.61        0.28         ZZZ
                                                 ip cath.
49436...........  .............  A............  Embedded ip cath            2.69          NA          NA        1.66        1.66        0.28         010
                                                 exit-site.
49440...........  .............  A............  Place gastrostomy           4.18       25.03       25.03        1.81        1.81        0.49         010
                                                 tube perc.
49441...........  .............  A............  Place duod/jej tube         4.77       30.10       30.10        2.00        2.00        0.29         010
                                                 perc.
49442...........  .............  A............  Place cecostomy tube        4.00       24.43       24.43        1.63        1.63        0.24         010
                                                 perc.
49446...........  .............  A............  Change g-tube to g-j        3.31       25.74       25.74        1.15        1.15        0.18         000
                                                 perc.
49450...........  .............  A............  Replace g/c tube            1.36       18.94       18.94        0.44        0.44        0.08         000
                                                 perc.
49451...........  .............  A............  Replace duod/jej            1.84       19.69       19.69        0.64        0.64        0.11         000
                                                 tube perc.
49452...........  .............  A............  Replace g-j tube            2.86       23.48       23.48        1.00        1.00        0.18         000
                                                 perc.
49460...........  .............  A............  Fix g/colon tube w/         0.96       20.56       20.56        0.31        0.31        0.05         000
                                                 device.
49465...........  .............  A............  Fluoro exam of g/           0.62        3.88        3.88        0.22        0.22        0.03         000
                                                 colon tube.
49491...........  .............  A............  Rpr hern preemie           12.42          NA          NA        4.61        4.83        1.40         090
                                                 reduc.
49492...........  .............  A............  Rpr ing hern premie,       15.32          NA          NA        6.22        6.16        1.81         090
                                                 blocked.
49495...........  .............  A............  Rpr ing hernia baby,        6.15          NA          NA        3.06        3.01        0.74         090
                                                 reduc.
49496...........  .............  A............  Rpr ing hernia baby,        9.32          NA          NA        4.44        4.35        1.07         090
                                                 blocked.
49500...........  .............  A............  Rpr ing hernia,             5.76          NA          NA        3.64        3.38        0.71         090
                                                 init, reduce.
49501...........  .............  A............  Rpr ing hernia, init        9.28          NA          NA        4.26        4.23        1.12         090
                                                 blocked.
49505...........  .............  A............  Prp i/hern init             7.88          NA          NA        3.88        3.81        1.03         090
                                                 reduc >5 yr.
49507...........  .............  A............  Prp i/hern init             9.97          NA          NA        4.45        4.45        1.27         090
                                                 block >5 yr.
49520...........  .............  A............  Rerepair ing hernia,        9.91          NA          NA        4.37        4.40        1.28         090
                                                 reduce.
49521...........  .............  A............  Rerepair ing hernia,       12.36          NA          NA        4.98        5.11        1.59         090
                                                 blocked.
49525...........  .............  A............  Repair ing hernia,          8.85          NA          NA        4.12        4.09        1.13         090
                                                 sliding.
49540...........  .............  A............  Repair lumbar hernia       10.66          NA          NA        4.57        4.65        1.37         090
49550...........  .............  A............  Rpr rem hernia,             8.91          NA          NA        4.11        4.11        1.14         090
                                                 init, reduce.
49553...........  .............  A............  Rpr fem hernia, init        9.84          NA          NA        4.41        4.41        1.24         090
                                                 blocked.
49555...........  .............  A............  Rerepair fem hernia,        9.31          NA          NA        4.20        4.23        1.20         090
                                                 reduce.
49557...........  .............  A............  Rerepair fem hernia,       11.54          NA          NA        4.83        4.90        1.47         090
                                                 blocked.
49560...........  .............  A............  Rpr ventral hern           11.84          NA          NA        4.87        5.00        1.52         090
                                                 init, reduc.
49561...........  .............  A............  Rpr ventral hern           15.30          NA          NA        5.79        5.92        1.89         090
                                                 init, block.
49565...........  .............  A............  Rerepair ventrl            12.29          NA          NA        5.08        5.15        1.52         090
                                                 hern, reduce.
49566...........  .............  A............  Rerepair ventrl            15.45          NA          NA        5.85        5.98        1.91         090
                                                 hern, block.
49568...........  .............  A............  Hernia repair w/mesh        4.88          NA          NA        1.24        1.45        0.64         ZZZ
49570...........  .............  A............  Rpr epigastric hern,        5.97          NA          NA        3.38        3.27        0.75         090
                                                 reduce.
49572...........  .............  A............  Rpr epigastric hern,        7.79          NA          NA        3.82        3.64        0.88         090
                                                 blocked.
49580...........  .............  A............  Rpr umbil hern,             4.39          NA          NA        2.94        2.77        0.54         090
                                                 reduc < 5 yr.
49582...........  .............  A............  Rpr umbil hern,             7.05          NA          NA        3.69        3.57        0.88         090
                                                 block < 5 yr.
49585...........  .............  A............  Rpr umbil hern,             6.51          NA          NA        3.51        3.40        0.82         090
                                                 reduc > 5 yr.
49587...........  .............  A............  Rpr umbil hern,             7.96          NA          NA        3.86        3.79        0.99         090
                                                 block > 5 yr.
49590...........  .............  A............  Repair spigelian            8.82          NA          NA        4.08        4.08        1.13         090
                                                 hernia.
49600...........  .............  A............  Repair umbilical           11.47          NA          NA        5.38        5.35        1.32         090
                                                 lesion.
49605...........  .............  A............  Repair umbilical           86.85          NA          NA       27.56       28.02        9.39         090
                                                 lesion.
49606...........  .............  A............  Repair umbilical           18.92          NA          NA        6.77        7.22        2.46         090
                                                 lesion.
49610...........  .............  A............  Repair umbilical           10.83          NA          NA        5.28        5.24        1.07         090
                                                 lesion.
49611...........  .............  A............  Repair umbilical            9.26          NA          NA        4.21        5.59        0.78         090
                                                 lesion.
49650...........  .............  A............  Laparo hernia repair        6.30          NA          NA        3.34        3.27        0.93         090
                                                 initial.
49651...........  .............  A............  Laparo hernia repair        8.29          NA          NA        4.22        4.13        1.14         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          NA        6.28        6.25        1.62         090
                                                 wall.
49904...........  .............  A............  Omental flap, extra-       22.16          NA          NA       11.88       13.54        2.70         090
                                                 abdom.
49905...........  .............  A............  Omental flap, intra-        6.54          NA          NA        1.69        1.99        0.75         ZZZ
                                                 abdom.

[[Page 66465]]

 
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             12.13          NA          NA        6.73        5.97        0.93         090
                                                 kidney.
50020...........  .............  A............  Renal abscess, open        17.88          NA          NA        8.48        8.11        1.34         090
                                                 drain.
50021...........  .............  A............  Renal abscess,              3.37       21.09       21.36        1.22        1.16        0.20         000
                                                 percut drain.
50040...........  .............  A............  Drainage of kidney..       16.48          NA          NA        8.82        7.81        1.03         090
50045...........  .............  A............  Exploration of             16.67          NA          NA        8.14        7.36        1.24         090
                                                 kidney.
50060...........  .............  A............  Removal of kidney          20.80          NA          NA       10.81        9.31        1.36         090
                                                 stone.
50065...........  .............  A............  Incision of kidney..       22.17          NA          NA       11.51        8.79        1.59         090
50070...........  .............  A............  Incision of kidney..       21.70          NA          NA       11.32        9.76        1.44         090
50075...........  .............  A............  Removal of kidney          26.91          NA          NA       13.49       11.69        1.81         090
                                                 stone.
50080...........  .............  A............  Removal of kidney          15.61          NA          NA        8.55        7.41        1.04         090
                                                 stone.
50081...........  .............  A............  Removal of kidney          23.32          NA          NA       12.17       10.46        1.54         090
                                                 stone.
50100...........  .............  A............  Revise kidney blood        17.30          NA          NA        6.51        7.14        2.07         090
                                                 vessels.
50120...........  .............  A............  Exploration of             17.06          NA          NA        9.11        7.93        1.21         090
                                                 kidney.
50125...........  .............  A............  Explore and drain          17.67          NA          NA        9.71        8.33        1.43         090
                                                 kidney.
50130...........  .............  A............  Removal of kidney          18.67          NA          NA       10.05        8.60        1.22         090
                                                 stone.
50135...........  .............  A............  Exploration of             20.44          NA          NA       10.69        9.23        1.33         090
                                                 kidney.
50200...........  .............  A............  Biopsy of kidney....        2.63          NA          NA        1.19        1.24        0.16         000
50205...........  .............  A............  Biopsy of kidney....       12.19          NA          NA        5.51        5.25        1.30         090
50220...........  .............  A............  Remove kidney, open.       18.53          NA          NA        9.51        8.37        1.35         090
50225...........  .............  A............  Removal kidney open,       21.73          NA          NA       11.01        9.57        1.50         090
                                                 complex.
50230...........  .............  A............  Removal kidney open,       23.68          NA          NA       11.64       10.10        1.55         090
                                                 radical.
50234...........  .............  A............  Removal of kidney &        23.90          NA          NA       12.03       10.42        1.59         090
                                                 ureter.
50236...........  .............  A............  Removal of kidney &        26.74          NA          NA       13.90       12.07        1.77         090
                                                 ureter.
50240...........  .............  A............  Partial removal of         24.01          NA          NA       12.60       10.80        1.55         090
                                                 kidney.
50250...........  .............  A............  Cryoablate renal           22.06          NA          NA       11.48       10.31        1.39         090
                                                 mass open.
50280...........  .............  A............  Removal of kidney          16.94          NA          NA        9.06        7.87        1.19         090
                                                 lesion.
50290...........  .............  A............  Removal of kidney          16.00          NA          NA        7.73        7.09        1.41         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,             22.28          NA          NA       12.30       11.47        2.36         090
                                                 living 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            0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 graft.
50327...........  .............  A............  Prep renal graft/           4.00          NA          NA        1.09        1.22        0.29         XXX
                                                 venous.
50328...........  .............  A............  Prep renal graft/           3.50          NA          NA        0.98        1.08        0.26         XXX
                                                 arterial.
50329...........  .............  A............  Prep renal graft/           3.34          NA          NA        1.05        1.09        0.25         XXX
                                                 ureteral.
50340...........  .............  A............  Removal of kidney...       13.86          NA          NA        7.80        7.14        1.65         090
50360...........  .............  A............  Transplantation of         40.45          NA          NA       18.66       17.06        3.82         090
                                                 kidney.
50365...........  .............  A............  Transplantation of         45.68          NA          NA       19.40       18.79        4.43         090
                                                 kidney.
50370...........  .............  A............  Remove transplanted        18.68          NA          NA        9.18        8.16        1.68         090
                                                 kidney.
50380...........  .............  A............  Reimplantation of          29.66          NA          NA       16.19       14.10        2.51         090
                                                 kidney.
50382...........  .............  A............  Change ureter stent,        5.50       26.34       31.22        2.05        1.96        0.34         000
                                                 percut.
50384...........  .............  A............  Remove ureter stent,        5.00       20.66       27.93        1.86        1.78        0.31         000
                                                 percut.
50385...........  .............  A............  Change stent via            4.44       30.61       30.61        2.05        2.05        0.27         000
                                                 transureth.
50386...........  .............  A............  Remove stent via            3.30       19.36       19.36        1.60        1.60        0.20         000
                                                 transureth.
50387...........  .............  A............  Change ext/int              2.00       12.60       15.40        0.73        0.70        0.12         000
                                                 ureter stent.
50389...........  .............  A............  Remove renal tube w/        1.10        6.67        9.71        0.40        0.38        0.07         000
                                                 fluoro.
50390...........  .............  A............  Drainage of kidney          1.96          NA          NA        0.71        0.67        0.12         000
                                                 lesion.
50391...........  .............  A............  Instll rx agnt into         1.96        1.38        1.48        0.72        0.67        0.14         000
                                                 rnal tub.
50392...........  .............  A............  Insert kidney drain.        3.37          NA          NA        1.52        1.52        0.20         000
50393...........  .............  A............  Insert ureteral tube        4.15          NA          NA        1.80        1.79        0.25         000
50394...........  .............  A............  Injection for kidney        0.76        1.87        2.28        0.58        0.62        0.05         000
                                                 x-ray.
50395...........  .............  A............  Create passage to           3.37          NA          NA        1.56        1.53        0.21         000
                                                 kidney.
50396...........  .............  A............  Measure kidney              2.09          NA          NA        1.08        1.08        0.13         000
                                                 pressure.
50398...........  .............  A............  Change kidney tube..        1.46       11.83       14.07        0.56        0.54        0.09         000
50400...........  .............  A............  Revision of kidney/        21.12          NA          NA       10.94        9.40        1.38         090
                                                 ureter.
50405...........  .............  A............  Revision of kidney/        25.68          NA          NA       12.90       10.96        1.79         090
                                                 ureter.
50500...........  .............  A............  Repair of kidney           21.07          NA          NA        8.69        8.53        2.02         090
                                                 wound.
50520...........  .............  A............  Close kidney-skin          18.73          NA          NA        9.24        8.33        1.49         090
                                                 fistula.
50525...........  .............  A............  Repair renal-abdomen       24.21          NA          NA       11.79       10.39        1.84         090
                                                 fistula.
50526...........  .............  A............  Repair renal-abdomen       26.13          NA          NA        8.15        9.00        1.97         090
                                                 fistula.
50540...........  .............  A............  Revision of                20.95          NA          NA       10.61        9.46        1.36         090
                                                 horseshoe kidney.
50541...........  .............  A............  Laparo ablate renal        16.76          NA          NA        8.69        7.58        1.13         090
                                                 cyst.
50542...........  .............  A............  Laparo ablate renal        21.18          NA          NA       11.17        9.65        1.39         090
                                                 mass.
50543...........  .............  A............  Laparo partial             27.18          NA          NA       14.08       12.13        1.81         090
                                                 nephrectomy.
50544...........  .............  A............  Laparoscopy,               23.27          NA          NA       11.43        9.97        1.58         090
                                                 pyeloplasty.
50545...........  .............  A............  Laparo radical             24.93          NA          NA       12.14       10.66        1.71         090
                                                 nephrectomy.
50546...........  .............  A............  Laparoscopic               21.69          NA          NA       11.28        9.81        1.57         090
                                                 nephrectomy.
50547...........  .............  A............  Laparo removal donor       26.24          NA          NA       12.47       11.78        2.77         090
                                                 kidney.
50548...........  .............  A............  Laparo remove w/           25.26          NA          NA       12.10       10.64        1.73         090
                                                 ureter.
50549...........  .............  C............  Laparoscope proc,           0.00        0.00        0.00        0.00        0.00        0.00         YYY
                                                 renal.
50551...........  .............  A............  Kidney endoscopy....        5.59        4.59        4.36        2.64        2.31        0.40         000

[[Page 66466]]

 
50553...........  .............  A............  Kidney endoscopy....        5.98        4.49        4.42        2.63        2.40        0.39         000
50555...........  .............  A............  Kidney endoscopy &          6.52        5.09        4.95        3.02        2.68        0.45         000
                                                 biopsy.
50557...........  .............  A............  Kidney endoscopy &          6.61        5.26        4.92        3.07        2.68        0.47         000
                                                 treatment.
50561...........  .............  A............  Kidney endoscopy &          7.58        5.80        5.44        3.40        3.02        0.54         000
                                                 treatment.
50562...........  .............  A............  Renal scope w/tumor        10.90          NA          NA        5.36        4.83        0.73         090
                                                 resect.
50570...........  .............  A............  Kidney endoscopy....        9.53          NA          NA        4.14        3.68        0.68         000
50572...........  .............  A............  Kidney endoscopy....       10.33          NA          NA        4.31        3.90        0.85         000
50574...........  .............  A............  Kidney endoscopy &         11.00          NA          NA        4.79        4.26        0.77         000
                                                 biopsy.
50575...........  .............  A............  Kidney endoscopy....       13.96          NA          NA        5.95        5.29        0.99         000
50576...........  .............  A............  Kidney endoscopy &         10.97          NA          NA        4.77        4.22        0.78         000
                                                 treatment.
50580...........  .............  A............  Kidney endoscopy &         11.84          NA          NA        5.09        4.52        0.83         000
                                                 treatment.
50590...........  .............  A............  Fragmenting of              9.64       17.08       14.73        6.12        5.11        0.65         090
                                                 kidney stone.
50592...........  .............  A............  Perc rf ablate renal        6.77       75.40      112.17        3.00        2.99        0.43         010
                                                 tumor.
50593...........  .............  A............  Perc cryo ablate            9.08      114.48      114.48        3.44        3.44        0.58         010
                                                 renal tum.
50600...........  .............  A............  Exploration of             17.04          NA          NA        8.50        7.58        1.13         090
                                                 ureter.
50605...........  .............  A............  Insert ureteral            16.66          NA          NA        7.88        7.31        1.45         090
                                                 support.
50610...........  .............  A............  Removal of ureter          17.12          NA          NA        8.97        7.96        1.43         090
                                                 stone.
50620...........  .............  A............  Removal of ureter          16.30          NA          NA        8.87        7.60        1.07         090
                                                 stone.
50630...........  .............  A............  Removal of ureter          16.08          NA          NA        8.19        7.23        1.09         090
                                                 stone.
50650...........  .............  A............  Removal of ureter...       18.67          NA          NA        9.95        8.58        1.23         090
50660...........  .............  A............  Removal of ureter...       20.87          NA          NA       10.72        9.33        1.38         090
50684...........  .............  A............  Injection for ureter        0.76        3.96        4.46        0.63        0.55        0.05         000
                                                 x-ray.
50686...........  .............  A............  Measure ureter              1.51        2.29        2.87        0.81        0.82        0.11         000
                                                 pressure.
50688...........  .............  A............  Change of ureter            1.18          NA          NA        0.95        1.00        0.07         010
                                                 tube/stent.
50690...........  .............  A............  Injection for ureter        1.16        1.45        1.64        0.75        0.73        0.07         000
                                                 x-ray.
50700...........  .............  A............  Revision of ureter..       16.54          NA          NA        8.75        7.93        1.27         090
50715...........  .............  A............  Release of ureter...       20.49          NA          NA        8.53        8.63        2.14         090
50722...........  .............  A............  Release of ureter...       17.80          NA          NA        7.26        7.53        1.91         090
50725...........  .............  A............  Release/revise             20.05          NA          NA        8.81        8.42        1.52         090
                                                 ureter.
50727...........  .............  A............  Revise ureter.......        8.17          NA          NA        5.72        5.00        0.61         090
50728...........  .............  A............  Revise ureter.......       12.00          NA          NA        6.74        6.15        1.00         090
50740...........  .............  A............  Fusion of ureter &         19.92          NA          NA        8.96        8.34        1.97         090
                                                 kidney.
50750...........  .............  A............  Fusion of ureter &         21.07          NA          NA       11.07        9.52        1.38         090
                                                 kidney.
50760...........  .............  A............  Fusion of ureters...       19.92          NA          NA        9.88        8.77        1.55         090
50770...........  .............  A............  Splicing of ureters.       21.07          NA          NA       10.87        9.41        1.45         090
50780...........  .............  A............  Reimplant ureter in        19.80          NA          NA       10.10        8.84        1.51         090
                                                 bladder.
50782...........  .............  A............  Reimplant ureter in        19.51          NA          NA        9.88        9.32        1.61         090
                                                 bladder.
50783...........  .............  A............  Reimplant ureter in        20.52          NA          NA       10.11        9.15        1.99         090
                                                 bladder.
50785...........  .............  A............  Reimplant ureter in        22.08          NA          NA       11.18        9.73        1.45         090
                                                 bladder.
50800...........  .............  A............  Implant ureter in          16.23          NA          NA        9.16        7.81        1.19         090
                                                 bowel.
50810...........  .............  A............  Fusion of ureter &         22.38          NA          NA       10.56        9.82        2.32         090
                                                 bowel.
50815...........  .............  A............  Urine shunt to             22.06          NA          NA       11.45        9.94        1.54         090
                                                 intestine.
50820...........  .............  A............  Construct bowel            23.89          NA          NA       11.84       10.24        1.90         090
                                                 bladder.
50825...........  .............  A............  Construct bowel            30.48          NA          NA       14.89       13.00        2.08         090
                                                 bladder.
50830...........  .............  A............  Revise urine flow...       33.57          NA          NA       15.60       13.88        2.38         090
50840...........  .............  A............  Replace ureter by          22.19          NA          NA       11.92       10.16        1.47         090
                                                 bowel.
50845...........  .............  A............  Appendico-                 22.21          NA          NA       12.05       10.47        1.57         090
                                                 vesicostomy.
50860...........  .............  A............  Transplant ureter to       16.93          NA          NA        9.21        7.91        1.29         090
                                                 skin.
50900...........  .............  A............  Repair of ureter....       14.89          NA          NA        7.98        7.06        1.14         090
50920...........  .............  A............  Closure ureter/skin        15.66          NA          NA        8.51        7.54        1.01         090
                                                 fistula.
50930...........  .............  A............  Closure ureter/bowel       20.04          NA          NA        9.48        8.72        1.28         090
                                                 fistula.
50940...........  .............  A............  Release of ureter...       15.78          NA          NA        7.78        7.08        1.26         090
50945...........  .............  A............  Laparoscopy                17.87          NA          NA        9.28        8.15        1.36         090
                                                 ureterolithotomy.
50947...........  .............  A............  Laparo new ureter/         25.63          NA          NA       12.28       10.98        2.17         090
                                                 bladder.
50948...........  .............  A............  Laparo new ureter/         23.69          NA          NA       11.17        9.93        1.71         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        4.82        4.55        2.76        2.40        0.41         000
50953...........  .............  A............  Endoscopy of ureter.        6.23        4.92        4.66        3.21        2.79        0.43         000
50955...........  .............  A............  Ureter endoscopy &          6.74        5.14        5.77        3.45        3.06        0.48         000
                                                 biopsy.
50957...........  .............  A............  Ureter endoscopy &          6.78        5.37        4.96        3.14        2.75        0.48         000
                                                 treatment.
50961...........  .............  A............  Ureter endoscopy &          6.04        4.74        4.55        2.79        2.48        0.41         000
                                                 treatment.
50970...........  .............  A............  Ureter endoscopy....        7.13          NA          NA        3.24        2.85        0.52         000
50972...........  .............  A............  Ureter endoscopy &          6.88          NA          NA        3.05        2.76        0.49         000
                                                 catheter.
50974...........  .............  A............  Ureter endoscopy &          9.16          NA          NA        3.76        3.43        0.64         000
                                                 biopsy.
50976...........  .............  A............  Ureter endoscopy &          9.03          NA          NA        3.85        3.45        0.66         000
                                                 treatment.
50980...........  .............  A............  Ureter endoscopy &          6.84          NA          NA        3.12        2.75        0.48         000
                                                 treatment.
51020...........  .............  A............  Incise & treat              7.56          NA          NA        5.38        4.62        0.47         090
                                                 bladder.
51030...........  .............  A............  Incise & treat              7.68          NA          NA        4.89        4.43        0.58         090
                                                 bladder.
51040...........  .............  A............  Incise & drain              4.43          NA          NA        3.68        3.22        0.31         090
                                                 bladder.
51045...........  .............  A............  Incise bladder/drain        7.68          NA          NA        5.14        4.53        0.52         090
                                                 ureter.
51050...........  .............  A............  Removal of bladder          7.87          NA          NA        5.32        4.48        0.49         090
                                                 stone.
51060...........  .............  A............  Removal of ureter           9.82          NA          NA        6.42        5.45        0.62         090
                                                 stone.

[[Page 66467]]

 
51065...........  .............  A............  Remove ureter               9.82          NA          NA        6.24        5.29        0.63         090
                                                 calculus.
51080...........  .............  A............  Drainage of bladder         6.61          NA          NA        4.60        4.07        0.43         090
                                                 abscess.
51100...........  .............  A............  Drain bladder by            0.78        0.92        0.92        0.27        0.27        0.05         000
                                                 needle.
51101...........  .............  A............  Drain bladder by            1.02        2.40        2.40        0.34        0.34        0.10         000
                                                 trocar/cath.
51102...........  .............  A............  Drain bl w/cath             4.27        4.74        4.74        2.36        2.36        0.28         010
                                                 insertion.
51500...........  .............  A............  Removal of bladder         10.92          NA          NA        5.75        5.37        1.03         090
                                                 cyst.
51520...........  .............  A............  Removal of bladder         10.08          NA          NA        6.31        5.48        0.69         090
                                                 lesion.
51525...........  .............  A............  Removal of bladder         15.29          NA          NA        8.46        7.29        0.99         090
                                                 lesion.
51530...........  .............  A............  Removal of bladder         13.58          NA          NA        7.38        6.56        1.05         090
                                                 lesion.
51535...........  .............  A............  Repair of ureter           13.77          NA          NA        7.37        6.74        1.23         090
                                                 lesion.
51550...........  .............  A............  Partial removal of         17.10          NA          NA        8.70        7.71        1.31         090
                                                 bladder.
51555...........  .............  A............  Partial removal of         23.03          NA          NA       11.34       10.00        1.70         090
                                                 bladder.
51565...........  .............  A............  Revise bladder &           23.50          NA          NA       12.11       10.53        1.63         090
                                                 ureter(s).
51570...........  .............  A............  Removal of bladder..       27.31          NA          NA       13.48       11.60        1.72         090
51575...........  .............  A............  Removal of bladder &       34.00          NA          NA       16.43       14.22        2.17         090
                                                 nodes.
51580...........  .............  A............  Remove bladder/            35.14          NA          NA       17.57       15.02        2.25         090
                                                 revise tract.
51585...........  .............  A............  Removal of bladder &       39.41          NA          NA       19.24       16.46        2.49         090
                                                 nodes.
51590...........  .............  A............  Remove bladder/            36.15          NA          NA       17.22       14.91        2.28         090
                                                 revise tract.
51595...........  .............  A............  Remove bladder/            41.12          NA          NA       19.56       16.83        2.60         090
                                                 revise tract.
51596...........  .............  A............  Remove bladder/            44.01          NA          NA       21.18       18.19        2.78         090
                                                 create pouch.
51597...........  .............  A............  Removal of pelvic          42.61          NA          NA       20.17       17.49        2.82         090
                                                 structures.
51600...........  .............  A............  Injection for               0.88        4.23        4.64        0.32        0.31        0.06         000
                                                 bladder x-ray.
51605...........  .............  A............  Preparation for             0.64          NA          NA        0.43        0.39        0.04         000
                                                 bladder xray.
51610...........  .............  A............  Injection for               1.05        1.91        2.10        0.70        0.65        0.07         000
                                                 bladder x-ray.
51700...........  .............  A............  Irrigation of               0.88        1.50        1.55        0.34        0.31        0.06         000
                                                 bladder.
51701...........  .............  A............  Insert bladder              0.50        1.04        1.31        0.24        0.22        0.04         000
                                                 catheter.
51702...........  .............  A............  Insert temp bladder         0.50        1.53        1.80        0.33        0.29        0.04         000
                                                 cath.
51703...........  .............  A............  Insert bladder cath,        1.47        2.26        2.49        0.80        0.68        0.10         000
                                                 complex.
51705...........  .............  A............  Change of bladder           1.03        2.02        2.15        0.84        0.73        0.07         010
                                                 tube.
51710...........  .............  A............  Change of bladder           1.50        2.72        3.03        1.17        0.97        0.11         010
                                                 tube.
51715...........  .............  A............  Endoscopic injection/       3.73        4.41        4.15        1.72        1.54        0.29         000
                                                 implant.
51720...........  .............  A............  Treatment of bladder        1.50        1.61        1.68        0.74        0.71        0.14         000
                                                 lesion.
51725...........  .............  A............  Simple                      1.51        4.22        4.90          NA          NA        0.16         000
                                                 cystometrogram.
51725...........  TC...........  A............  Simple                      0.00        3.67        4.38          NA          NA        0.04         000
                                                 cystometrogram.
51725...........  26...........  A............  Simple                      1.51        0.55        0.52        0.55        0.52        0.12         000
                                                 cystometrogram.
51726...........  .............  A............  Complex                     1.71        7.11        7.30          NA          NA        0.18         000
                                                 cystometrogram.
51726...........  TC...........  A............  Complex                     0.00        6.47        6.70          NA          NA        0.05         000
                                                 cystometrogram.
51726...........  26...........  A............  Complex                     1.71        0.64        0.60        0.64        0.60        0.13         000
                                                 cystometrogram.
51736...........  .............  A............  Urine flow                  0.61        0.94        0.76          NA          NA        0.06         000
                                                 measurement.
51736...........  TC...........  A............  Urine flow                  0.00        0.70        0.54          NA          NA        0.01         000
                                                 measurement.
51736...........  26...........  A............  Urine flow                  0.61        0.24        0.22        0.24        0.22        0.05         000
                                                 measurement.
51741...........  .............  A............  Electro-                    1.14        1.27        1.02          NA          NA        0.11         000
                                                 uroflowmetry, first.
51741...........  TC...........  A............  Electro-                    0.00        0.83        0.62          NA          NA        0.02         000
                                                 uroflowmetry, first.
51741...........  26...........  A............  Electro-                    1.14        0.44        0.40        0.44        0.40        0.09         000
                                                 uroflowmetry, first.
51772...........  .............  A............  Urethra pressure            1.61        5.06        5.31          NA          NA        0.20         000
                                                 profile.
51772...........  TC...........  A............  Urethra pressure            0.00        4.51        4.76          NA          NA        0.05         000
                                                 profile.
51772...........  26...........  A............  Urethra pressure            1.61        0.55        0.55        0.55        0.55        0.15         000
                                                 profile.
51784...........  .............  A............  Anal/urinary muscle         1.53        4.12        4.05          NA          NA        0.16         000
                                                 study.
51784...........  TC...........  A............  Anal/urinary muscle         0.00        3.56        3.52          NA          NA        0.04         000
                                                 study.
51784...........  26...........  A............  Anal/urinary muscle         1.53        0.56        0.53        0.56        0.53        0.12         000
                                                 study.
51785...........  .............  A............  Anal/urinary muscle         1.53        4.55        4.49          NA          NA        0.15         000
                                                 study.
51785...........  TC...........  A............  Anal/urinary muscle         0.00        3.99        3.96          NA          NA        0.04         000
                                                 study.
51785...........  26...........  A............  Anal/urinary muscle         1.53        0.56        0.53        0.56        0.53        0.11         000
                                                 study.
51792...........  .............  A............  Urinary reflex study        1.10        5.05        5.52          NA          NA        0.20         000
51792...........  TC...........  A............  Urinary reflex study        0.00        4.66        5.12          NA          NA        0.13         000
51792...........  26...........  A............  Urinary reflex study        1.10        0.39        0.40        0.39        0.40        0.07         000
51795...........  .............  A............  Urine voiding               1.53        6.72        7.00          NA          NA        0.22         000
                                                 pressure study.
51795...........  TC...........  A............  Urine voiding               0.00        6.15        6.47          NA          NA        0.10         000
                                                 pressure study.
51795...........  26...........  A............  Urine voiding               1.53        0.57        0.53        0.57        0.53        0.12         000
                                                 pressure study.
51797...........  .............  A............  Intraabdominal              0.80        2.43        4.11          NA          NA        0.17         ZZZ
                                                 pressure test.
51797...........  TC...........  A............  Intraabdominal              0.00        2.14        3.70          NA          NA        0.05         ZZZ
                                                 pressure test.
51797...........  26...........  A............  Intraabdominal              0.80        0.29        0.41        0.29        0.41        0.12         ZZZ
                                                 pressure test.
51798...........  .............  A............  Us urine capacity           0.00        0.59        0.47          NA          NA        0.08         XXX
                                                 measure.
51800...........  .............  A............  Revision of bladder/       18.74          NA          NA        9.71        8.63        1.32         090
                                                 urethra.
51820...........  .............  A............  Revision of urinary        19.41          NA          NA        9.74        9.01        1.75         090
                                                 tract.
51840...........  .............  A............  Attach bladder/            11.28          NA          NA        5.75        5.66        1.06         090
                                                 urethra.
51841...........  .............  A............  Attach bladder/            13.60          NA          NA        6.85        6.61        1.24         090
                                                 urethra.
51845...........  .............  A............  Repair bladder neck.       10.07          NA          NA        5.88        5.31        0.79         090
51860...........  .............  A............  Repair of bladder          12.49          NA          NA        6.73        6.24        1.16         090
                                                 wound.
51865...........  .............  A............  Repair of bladder          15.69          NA          NA        8.32        7.49        1.23         090
                                                 wound.
51880...........  .............  A............  Repair of bladder           7.81          NA          NA        4.72        4.34        0.72         090
                                                 opening.
51900...........  .............  A............  Repair bladder/            14.48          NA          NA        7.97        7.01        1.21         090
                                                 vagina lesion.

[[Page 66468]]

 
51920...........  .............  A............  Close bladder-uterus       13.26          NA          NA        8.03        6.83        1.18         090
                                                 fistula.
51925...........  .............  A............  Hysterectomy/bladder       17.35          NA          NA       12.40       10.50        2.04         090
                                                 repair.
51940...........  .............  A............  Correction of              30.48          NA          NA       11.72       11.89        2.15         090
                                                 bladder defect.
51960...........  .............  A............  Revision of bladder        25.20          NA          NA       12.88       11.25        1.63         090
                                                 & bowel.
51980...........  .............  A............  Construct bladder          12.44          NA          NA        7.06        6.21        0.86         090
                                                 opening.
51990...........  .............  A............  Laparo urethral            13.26          NA          NA        5.92        6.03        1.39         090
                                                 suspension.
51992...........  .............  A............  Laparo sling               14.77          NA          NA        6.51        6.35        1.41         090
                                                 operation.
51999...........  .............  C............  Laparoscope proc,           0.00        0.00        0.00        0.00        0.00        0.00         YYY
                                                 bla.
52000...........  .............  A............  Cystoscopy..........        2.23        3.66        3.48        1.31        1.03        0.14         000
52001...........  .............  A............  Cystoscopy, removal         5.44        5.04        5.05        2.56        2.21        0.39         000
                                                 of clots.
52005...........  .............  A............  Cystoscopy & ureter         2.37        5.73        5.64        1.37        1.13        0.17         000
                                                 catheter.
52007...........  .............  A............  Cystoscopy and              3.02       10.70       13.57        1.61        1.38        0.22         000
                                                 biopsy.
52010...........  .............  A............  Cystoscopy & duct           3.02        8.07        9.41        1.62        1.38        0.21         000
                                                 catheter.
52204...........  .............  A............  Cystoscopy w/               2.59        8.30       11.40        1.37        1.14        0.17         000
                                                 biopsy(s).
52214...........  .............  A............  Cystoscopy and              3.70       19.87       28.97        1.83        1.58        0.26         000
                                                 treatment.
52224...........  .............  A............  Cystoscopy and              3.14       19.05       27.74        1.60        1.37        0.22         000
                                                 treatment.
52234...........  .............  A............  Cystoscopy and              4.62          NA          NA        2.27        1.96        0.33         000
                                                 treatment.
52235...........  .............  A............  Cystoscopy and              5.44          NA          NA        2.63        2.28        0.39         000
                                                 treatment.
52240...........  .............  A............  Cystoscopy and              9.71          NA          NA        4.34        3.82        0.69         000
                                                 treatment.
52250...........  .............  A............  Cystoscopy and              4.49          NA          NA        2.29        1.97        0.32         000
                                                 radiotracer.
52260...........  .............  A............  Cystoscopy and              3.91          NA          NA        1.93        1.67        0.28         000
                                                 treatment.
52265...........  .............  A............  Cystoscopy and              2.94        7.48       10.41        1.46        1.28        0.22         000
                                                 treatment.
52270...........  .............  A............  Cystoscopy & revise         3.36        7.02        9.02        1.74        1.49        0.24         000
                                                 urethra.
52275...........  .............  A............  Cystoscopy & revise         4.69        9.29       12.42        2.27        1.96        0.33         000
                                                 urethra.
52276...........  .............  A............  Cystoscopy and              4.99          NA          NA        2.44        2.11        0.35         000
                                                 treatment.
52277...........  .............  A............  Cystoscopy and              6.16          NA          NA        2.90        2.56        0.44         000
                                                 treatment.
52281...........  .............  A............  Cystoscopy and              2.80        5.28        6.18        1.54        1.31        0.20         000
                                                 treatment.
52282...........  .............  A............  Cystoscopy, implant         6.39          NA          NA        2.95        2.59        0.45         000
                                                 stent.
52283...........  .............  A............  Cystoscopy and              3.73        4.06        4.00        1.86        1.62        0.26         000
                                                 treatment.
52285...........  .............  A............  Cystoscopy and              3.60        4.32        4.16        1.83        1.58        0.26         000
                                                 treatment.
52290...........  .............  A............  Cystoscopy and              4.58          NA          NA        2.26        1.95        0.32         000
                                                 treatment.
52300...........  .............  A............  Cystoscopy and              5.30          NA          NA        2.55        2.23        0.38         000
                                                 treatment.
52301...........  .............  A............  Cystoscopy and              5.50          NA          NA        2.68        2.33        0.46         000
                                                 treatment.
52305...........  .............  A............  Cystoscopy and              5.30          NA          NA        2.48        2.17        0.38         000
                                                 treatment.
52310...........  .............  A............  Cystoscopy and              2.81        4.00        4.34        1.42        1.23        0.20         000
                                                 treatment.
52315...........  .............  A............  Cystoscopy and              5.20        6.62        7.64        2.47        2.15        0.37         000
                                                 treatment.
52317...........  .............  A............  Remove bladder stone        6.71       17.04       22.98        2.99        2.63        0.48         000
52318...........  .............  A............  Remove bladder stone        9.18          NA          NA        4.03        3.56        0.65         000
52320...........  .............  A............  Cystoscopy and              4.69          NA          NA        2.20        1.91        0.33         000
                                                 treatment.
52325...........  .............  A............  Cystoscopy, stone           6.15          NA          NA        2.78        2.44        0.44         000
                                                 removal.
52327...........  .............  A............  Cystoscopy, inject          5.18        2.04       16.92        2.04        1.93        0.37         000
                                                 material.
52330...........  .............  A............  Cystoscopy and              5.03       20.39       29.59        2.34        2.05        0.36         000
                                                 treatment.
52332...........  .............  A............  Cystoscopy and              2.83       12.41        9.07        1.55        1.30        0.21         000
                                                 treatment.
52334...........  .............  A............  Create passage to           4.82          NA          NA        2.33        2.03        0.35         000
                                                 kidney.
52341...........  .............  A............  Cysto w/ureter              6.11          NA          NA        3.03        2.62        0.43         000
                                                 stricture tx.
52342...........  .............  A............  Cysto w/up stricture        6.61          NA          NA        3.25        2.80        0.46         000
                                                 tx.
52343...........  .............  A............  Cysto w/renal               7.31          NA          NA        3.48        3.03        0.51         000
                                                 stricture tx.
52344...........  .............  A............  Cysto/uretero,              7.81          NA          NA        3.90        3.34        0.55         000
                                                 stricture tx.
52345...........  .............  A............  Cysto/uretero w/up          8.31          NA          NA        4.10        3.53        0.58         000
                                                 stricture.
52346...........  .............  A............  Cystouretero w/renal        9.34          NA          NA        4.50        3.89        0.65         000
                                                 strict.
52351...........  .............  A............  Cystouretero & or           5.85          NA          NA        2.95        2.55        0.41         000
                                                 pyeloscope.
52352...........  .............  A............  Cystouretero w/stone        6.87          NA          NA        3.46        2.98        0.49         000
                                                 remove.
52353...........  .............  A............  Cystouretero w/             7.96          NA          NA        3.90        3.37        0.57         000
                                                 lithotripsy.
52354...........  .............  A............  Cystouretero w/             7.33          NA          NA        3.64        3.15        0.52         000
                                                 biopsy.
52355...........  .............  A............  Cystouretero w/             8.81          NA          NA        4.24        3.69        0.63         000
                                                 excise tumor.
52400...........  .............  A............  Cystouretero w/            10.06          NA          NA        5.39        4.56        0.68         090
                                                 congen repr.
52402...........  .............  A............  Cystourethro cut            5.27          NA          NA        2.15        1.92        0.40         000
                                                 ejacul duct.
52450...........  .............  A............  Incision of prostate        7.63          NA          NA        5.47        4.57        0.54         090
52500...........  .............  A............  Revision of bladder         9.39          NA          NA        6.17        5.04        0.60         090
                                                 neck.
52601...........  .............  A............  Prostatectomy (TURP)       15.13          NA          NA        8.42        6.75        0.87         090
52606...........  .............  A............  Control postop              8.84          NA          NA        5.47        4.51        0.57         090
                                                 bleeding.
52612...........  .............  A............  Prostatectomy, first        9.07          NA          NA        5.87        4.80        0.56         090
                                                 stage.
52614...........  .............  A............  Prostatectomy,              7.81          NA          NA        5.37        4.35        0.48         090
                                                 second stage.
52620...........  .............  A............  Remove residual             7.19          NA          NA        4.61        3.79        0.47         090
                                                 prostate.
52630...........  .............  A............  Remove prostate             7.65          NA          NA        4.79        3.99        0.51         090
                                                 regrowth.
52640...........  .............  A............  Relieve bladder             6.89          NA          NA        4.41        3.68        0.47         090
                                                 contracture.
52647...........  .............  A............  Laser surgery of           11.15       41.90       57.90        6.88        5.70        0.73         090
                                                 prostate.
52648...........  .............  A............  Laser surgery of           12.00       42.44       58.17        7.21        6.00        0.79         090
                                                 prostate.
52649...........  .............  A............  2Prostate laser            17.16          NA          NA        9.31        9.31        1.11         090
                                                 enucleation.
52700...........  .............  A............  Drainage of prostate        7.39          NA          NA        4.89        4.04        0.48         090
                                                 abscess.
53000...........  .............  A............  Incision of urethra.        2.30          NA          NA        1.78        1.66        0.16         010
53010...........  .............  A............  Incision of urethra.        4.35          NA          NA        3.83        3.37        0.24         090

[[Page 66469]]

 
53020...........  .............  A............  Incision of urethra.        1.77          NA          NA        0.95        0.81        0.13         000
53025...........  .............  A............  Incision of urethra.        1.13          NA          NA        0.82        0.66        0.08         000
53040...........  .............  A............  Drainage of urethra         6.49          NA          NA        4.40        3.91        0.45         090
                                                 abscess.
53060...........  .............  A............  Drainage of urethra         2.65        2.09        2.09        1.54        1.45        0.28         010
                                                 abscess.
53080...........  .............  A............  Drainage of urinary         6.82          NA          NA        4.96        5.46        0.52         090
                                                 leakage.
53085...........  .............  A............  Drainage of urinary        11.05          NA          NA        4.41        5.90        0.92         090
                                                 leakage.
53200...........  .............  A............  Biopsy of urethra...        2.59        1.70        1.51        1.29        1.13        0.20         000
53210...........  .............  A............  Removal of urethra..       13.59          NA          NA        7.75        6.79        0.89         090
53215...........  .............  A............  Removal of urethra..       16.72          NA          NA        9.11        7.87        1.10         090
53220...........  .............  A............  Treatment of urethra        7.53          NA          NA        4.97        4.34        0.49         090
                                                 lesion.
53230...........  .............  A............  Removal of urethra         10.31          NA          NA        6.36        5.53        0.73         090
                                                 lesion.
53235...........  .............  A............  Removal of urethra         10.86          NA          NA        6.92        5.90        0.72         090
                                                 lesion.
53240...........  .............  A............  Surgery for urethra         6.98          NA          NA        4.86        4.19        0.52         090
                                                 pouch.
53250...........  .............  A............  Removal of urethra          6.42          NA          NA        4.38        3.83        0.49         090
                                                 gland.
53260...........  .............  A............  Treatment of urethra        3.00        2.45        2.35        1.83        1.62        0.25         010
                                                 lesion.
53265...........  .............  A............  Treatment of urethra        3.14        2.93        2.82        1.98        1.70        0.24         010
                                                 lesion.
53270...........  .............  A............  Removal of urethra          3.11        2.46        2.33        1.84        1.69        0.30         010
                                                 gland.
53275...........  .............  A............  Repair of urethra           4.54          NA          NA        2.76        2.51        0.32         010
                                                 defect.
53400...........  .............  A............  Revise urethra,            13.98          NA          NA        8.16        7.09        0.98         090
                                                 stage 1.
53405...........  .............  A............  Revise urethra,            15.51          NA          NA        8.68        7.49        1.10         090
                                                 stage 2.
53410...........  .............  A............  Reconstruction of          17.53          NA          NA        9.66        8.35        1.16         090
                                                 urethra.
53415...........  .............  A............  Reconstruction of          20.55          NA          NA       10.68        9.00        1.37         090
                                                 urethra.
53420...........  .............  A............  Reconstruct urethra,       15.04          NA          NA        7.11        6.69        0.96         090
                                                 stage 1.
53425...........  .............  A............  Reconstruct urethra,       16.94          NA          NA        8.99        7.93        1.13         090
                                                 stage 2.
53430...........  .............  A............  Reconstruction of          17.30          NA          NA        8.80        7.89        1.15         090
                                                 urethra.
53431...........  .............  A............  Reconstruct urethra/       21.03          NA          NA       10.97        9.50        1.41         090
                                                 bladder.
53440...........  .............  A............  Male sling procedure       15.34          NA          NA        9.18        7.57        0.96         090
53442...........  .............  A............  Remove/revise male         13.29          NA          NA        8.35        6.89        0.82         090
                                                 sling.
53444...........  .............  A............  Insert tandem cuff..       14.06          NA          NA        8.01        6.94        0.94         090
53445...........  .............  A............  Insert uro/ves nck         15.21          NA          NA        8.74        7.91        0.99         090
                                                 sphincter.
53446...........  .............  A............  Remove uro sphincter       10.89          NA          NA        6.99        6.10        0.72         090
53447...........  .............  A............  Remove/replace ur          14.15          NA          NA        8.37        7.39        0.95         090
                                                 sphincter.
53448...........  .............  A............  Remov/replc ur             23.26          NA          NA       12.31       10.67        1.50         090
                                                 sphinctr comp.
53449...........  .............  A............  Repair uro sphincter       10.43          NA          NA        6.60        5.66        0.68         090
53450...........  .............  A............  Revision of urethra.        6.67          NA          NA        4.75        4.02        0.43         090
53460...........  .............  A............  Revision of urethra.        7.65          NA          NA        5.04        4.36        0.50         090
53500...........  .............  A............  Urethrlys, transvag        12.87          NA          NA        7.40        6.80        0.90         090
                                                 w/ scope.
53502...........  .............  A............  Repair of urethra           8.16          NA          NA        5.10        4.54        0.62         090
                                                 injury.
53505...........  .............  A............  Repair of urethra           8.16          NA          NA        5.37        4.62        0.54         090
                                                 injury.
53510...........  .............  A............  Repair of urethra          10.83          NA          NA        6.82        5.99        0.74         090
                                                 injury.
53515...........  .............  A............  Repair of urethra          14.09          NA          NA        7.95        6.94        1.05         090
                                                 injury.
53520...........  .............  A............  Repair of urethra           9.35          NA          NA        6.20        5.33        0.61         090
                                                 defect.
53600...........  .............  A............  Dilate urethra              1.21        1.15        1.14        0.57        0.50        0.09         000
                                                 stricture.
53601...........  .............  A............  Dilate urethra              0.98        1.36        1.31        0.52        0.44        0.07         000
                                                 stricture.
53605...........  .............  A............  Dilate urethra              1.28          NA          NA        0.51        0.46        0.09         000
                                                 stricture.
53620...........  .............  A............  Dilate urethra              1.62        1.70        1.84        0.83        0.71        0.11         000
                                                 stricture.
53621...........  .............  A............  Dilate urethra              1.35        1.81        1.94        0.67        0.58        0.10         000
                                                 stricture.
53660...........  .............  A............  Dilation of urethra.        0.71        1.32        1.31        0.45        0.38        0.05         000
53661...........  .............  A............  Dilation of urethra.        0.72        1.29        1.29        0.41        0.35        0.05         000
53665...........  .............  A............  Dilation of urethra.        0.76          NA          NA        0.27        0.26        0.06         000
53850...........  .............  A............  Prostatic microwave         9.98       49.19       71.60        5.86        4.90        0.67         090
                                                 thermotx.
53852...........  .............  A............  Prostatic rf               10.68       46.31       67.52        6.65        5.51        0.70         090
                                                 thermotx.
53853...........  .............  A............  Prostatic water             5.54       29.06       42.19        4.34        3.60        0.37         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.        1.56        2.69        2.80        1.48        1.20        0.11         010
54001...........  .............  A............  Slitting of prepuce.        2.21        3.05        3.12        1.67        1.39        0.15         010
54015...........  .............  A............  Drain penis lesion..        5.33          NA          NA        3.21        2.88        0.38         010
54050...........  .............  A............  Destruction, penis          1.26        2.10        1.87        1.39        1.21        0.08         010
                                                 lesion(s).
54055...........  .............  A............  Destruction, penis          1.23        1.97        1.77        1.23        1.01        0.08         010
                                                 lesion(s).
54056...........  .............  A............  Cryosurgery, penis          1.26        2.37        2.03        1.53        1.33        0.06         010
                                                 lesion(s).
54057...........  .............  A............  Laser surg, penis           1.26        2.63        2.42        1.36        1.10        0.09         010
                                                 lesion(s).
54060...........  .............  A............  Excision of penis           1.95        3.08        3.09        1.63        1.34        0.13         010
                                                 lesion(s).
54065...........  .............  A............  Destruction, penis          2.44        3.29        2.96        1.99        1.61        0.13         010
                                                 lesion(s).
54100...........  .............  A............  Biopsy of penis.....        1.90        3.34        3.07        1.36        1.09        0.10         000
54105...........  .............  A............  Biopsy of penis.....        3.51        3.97        4.12        2.43        2.18        0.25         010
54110...........  .............  A............  Treatment of penis         10.79          NA          NA        6.71        5.73        0.72         090
                                                 lesion.
54111...........  .............  A............  Treat penis lesion,        14.29          NA          NA        8.02        6.89        0.96         090
                                                 graft.
54112...........  .............  A............  Treat penis lesion,        16.83          NA          NA        9.30        8.04        1.11         090
                                                 graft.
54115...........  .............  A............  Treatment of penis          6.82        5.75        5.06        4.94        4.19        0.43         090
                                                 lesion.
54120...........  .............  A............  Partial removal of         10.88          NA          NA        6.72        5.69        0.68         090
                                                 penis.
54125...........  .............  A............  Removal of penis....       14.43          NA          NA        8.06        6.94        0.95         090
54130...........  .............  A............  Remove penis & nodes       21.66          NA          NA       11.56        9.86        1.52         090

[[Page 66470]]

 
54135...........  .............  A............  Remove penis & nodes       27.99          NA          NA       14.10       12.13        1.88         090
54150...........  .............  A............  Circumcision w/             1.90        2.39        3.13        0.73        0.72        0.16         000
                                                 regionl block.
54160...........  .............  A............  Circumcision,               2.50        3.80        3.97        1.48        1.28        0.19         010
                                                 neonate.
54161...........  .............  A............  Circum 28 days or           3.29          NA          NA        2.20        1.88        0.23         010
                                                 older.
54162...........  .............  A............  Lysis penil circumic        3.27        4.00        4.32        2.26        1.85        0.21         010
                                                 lesion.
54163...........  .............  A............  Repair of                   3.27          NA          NA        2.85        2.43        0.21         010
                                                 circumcision.
54164...........  .............  A............  Frenulotomy of penis        2.77          NA          NA        2.65        2.24        0.18         010
54200...........  .............  A............  Treatment of penis          1.08        2.01        1.90        1.30        1.13        0.08         010
                                                 lesion.
54205...........  .............  A............  Treatment of penis          8.84          NA          NA        6.05        5.36        0.56         090
                                                 lesion.
54220...........  .............  A............  Treatment of penis          2.42        3.31        3.58        1.35        1.15        0.17         000
                                                 lesion.
54230...........  .............  A............  Prepare penis study.        1.34        1.40        1.24        0.90        0.77        0.09         000
54231...........  .............  A............  Dynamic                     2.04        1.97        1.67        1.24        1.06        0.16         000
                                                 cavernosometry.
54235...........  .............  A............  Penile injection....        1.19        1.39        1.17        0.89        0.73        0.08         000
54240...........  .............  A............  Penis study.........        1.31        1.51        1.26          NA          NA        0.17         000
54240...........  TC...........  A............  Penis study.........        0.00        1.03        0.81          NA          NA        0.06         000
54240...........  26...........  A............  Penis study.........        1.31        0.48        0.45        0.48        0.45        0.11         000
54250...........  .............  A............  Penis study.........        2.22        1.22        1.06          NA          NA        0.18         000
54250...........  TC...........  A............  Penis study.........        0.00        0.37        0.28          NA          NA        0.02         000
54250...........  26...........  A............  Penis study.........        2.22        0.85        0.78        0.85        0.78        0.16         000
54300...........  .............  A............  Revision of penis...       11.07          NA          NA        6.70        6.13        0.76         090
54304...........  .............  A............  Revision of penis...       13.15          NA          NA        7.79        7.05        0.88         090
54308...........  .............  A............  Reconstruction of          12.49          NA          NA        4.75        5.35        0.84         090
                                                 urethra.
54312...........  .............  A............  Reconstruction of          14.36          NA          NA        8.86        7.92        1.24         090
                                                 urethra.
54316...........  .............  A............  Reconstruction of          17.90          NA          NA        9.93        8.93        1.21         090
                                                 urethra.
54318...........  .............  A............  Reconstruction of          12.28          NA          NA        4.83        5.30        1.39         090
                                                 urethra.
54322...........  .............  A............  Reconstruction of          13.85          NA          NA        7.93        7.19        0.92         090
                                                 urethra.
54324...........  .............  A............  Reconstruction of          17.40          NA          NA        9.74        8.84        1.14         090
                                                 urethra.
54326...........  .............  A............  Reconstruction of          16.87          NA          NA        9.15        8.46        1.11         090
                                                 urethra.
54328...........  .............  A............  Revise penis/urethra       16.74          NA          NA        9.47        8.35        0.98         090
54332...........  .............  A............  Revise penis/urethra       18.22          NA          NA       10.06        8.88        1.21         090
54336...........  .............  A............  Revise penis/urethra       21.44          NA          NA        7.31        8.79        2.21         090
54340...........  .............  A............  Secondary urethral          9.58          NA          NA        6.35        5.69        0.63         090
                                                 surgery.
54344...........  .............  A............  Secondary urethral         16.91          NA          NA        9.53        8.63        1.54         090
                                                 surgery.
54348...........  .............  A............  Secondary urethral         18.17          NA          NA       10.12        9.22        1.23         090
                                                 surgery.
54352...........  .............  A............  Reconstruct urethra/       25.95          NA          NA       13.98       12.57        2.25         090
                                                 penis.
54360...........  .............  A............  Penis plastic              12.65          NA          NA        7.44        6.73        0.84         090
                                                 surgery.
54380...........  .............  A............  Repair penis........       14.03          NA          NA        8.03        7.32        0.93         090
54385...........  .............  A............  Repair penis........       16.38          NA          NA       11.29        9.77        0.86         090
54390...........  .............  A............  Repair penis and           22.59          NA          NA        7.41        8.41        1.54         090
                                                 bladder.
54400...........  .............  A............  Insert semi-rigid           9.09          NA          NA        5.74        5.04        0.64         090
                                                 prosthesis.
54401...........  .............  A............  Insert self-contd          10.26          NA          NA        8.14        6.93        0.73         090
                                                 prosthesis.
54405...........  .............  A............  Insert multi-comp          14.39          NA          NA        8.11        7.01        0.95         090
                                                 penis pros.
54406...........  .............  A............  Remove muti-comp           12.76          NA          NA        7.59        6.50        0.86         090
                                                 penis pros.
54408...........  .............  A............  Repair multi-comp          13.73          NA          NA        8.24        6.98        0.90         090
                                                 penis pros.
54410...........  .............  A............  Remove/replace penis       16.48          NA          NA        9.34        7.97        1.10         090
                                                 prosth.
54411...........  .............  A............  Remov/replc penis          18.14          NA          NA       10.39        8.71        1.13         090
                                                 pros, comp.
54415...........  .............  A............  Remove self-contd           8.75          NA          NA        6.00        5.09        0.58         090
                                                 penis pros.
54416...........  .............  A............  Remv/repl penis            11.87          NA          NA        7.89        6.63        0.77         090
                                                 contain pros.
54417...........  .............  A............  Remv/replc penis           15.94          NA          NA        9.09        7.63        1.00         090
                                                 pros, compl.
54420...........  .............  A............  Revision of penis...       12.26          NA          NA        7.38        6.47        0.81         090
54430...........  .............  A............  Revision of penis...       10.93          NA          NA        6.96        6.03        0.72         090
54435...........  .............  A............  Revision of penis...        6.71          NA          NA        4.99        4.30        0.43         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        0.85        0.90        0.48        0.46        0.08         000
54500...........  .............  A............  Biopsy of testis....        1.31          NA          NA        0.76        0.66        0.10         000
54505...........  .............  A............  Biopsy of testis....        3.47          NA          NA        2.44        2.18        0.27         010
54512...........  .............  A............  Excise lesion testis        9.23          NA          NA        5.66        4.89        0.67         090
54520...........  .............  A............  Removal of testis...        5.25          NA          NA        3.71        3.25        0.50         090
54522...........  .............  A............  Orchiectomy, partial       10.15          NA          NA        5.58        5.22        0.89         090
54530...........  .............  A............  Removal of testis...        9.31          NA          NA        6.05        5.14        0.66         090
54535...........  .............  A............  Extensive testis           13.06          NA          NA        6.90        6.22        0.95         090
                                                 surgery.
54550...........  .............  A............  Exploration for             8.31          NA          NA        5.20        4.50        0.59         090
                                                 testis.
54560...........  .............  A............  Exploration for            11.97          NA          NA        6.87        6.00        0.90         090
                                                 testis.
54600...........  .............  A............  Reduce testis               7.54          NA          NA        5.11        4.32        0.51         090
                                                 torsion.
54620...........  .............  A............  Suspension of testis        5.16          NA          NA        3.22        2.82        0.37         010
54640...........  .............  A............  Suspension of testis        7.57          NA          NA        5.34        4.53        0.62         090
54650...........  .............  A............  Orchiopexy (Fowler-        12.24          NA          NA        5.65        5.52        1.16         090
                                                 Stephens).
54660...........  .............  A............  Revision of testis..        5.64          NA          NA        4.34        3.67        0.44         090
54670...........  .............  A............  Repair testis injury        6.57          NA          NA        4.79        4.16        0.47         090
54680...........  .............  A............  Relocation of              13.91          NA          NA        7.69        6.92        1.16         090
                                                 testis(es).
54690...........  .............  A............  Laparoscopy,               11.60          NA          NA        5.58        5.25        1.02         090
                                                 orchiectomy.
54692...........  .............  A............  Laparoscopy,               13.64          NA          NA        7.55        6.49        1.30         090
                                                 orchiopexy.

[[Page 66471]]

 
54699...........  .............  C............  Laparoscope proc,           0.00        0.00        0.00        0.00        0.00        0.00         YYY
                                                 testis.
54700...........  .............  A............  Drainage of scrotum.        3.44          NA          NA        2.37        2.15        0.28         010
54800...........  .............  A............  Biopsy of epididymis        2.33          NA          NA        1.22        1.06        0.23         000
54830...........  .............  A............  Remove epididymis           5.91          NA          NA        4.43        3.72        0.41         090
                                                 lesion.
54840...........  .............  A............  Remove epididymis           5.22          NA          NA        3.79        3.28        0.37         090
                                                 lesion.
54860...........  .............  A............  Removal of                  6.85          NA          NA        4.86        4.08        0.45         090
                                                 epididymis.
54861...........  .............  A............  Removal of                  9.57          NA          NA        6.24        5.27        0.63         090
                                                 epididymis.
54865...........  .............  A............  Explore epididymis..        5.67          NA          NA        4.26        3.59        0.40         090
54900...........  .............  A............  Fusion of spermatic        14.05          NA          NA        5.24        5.51        0.93         090
                                                 ducts.
54901...........  .............  A............  Fusion of spermatic        18.92          NA          NA       10.50        9.00        1.83         090
                                                 ducts.
55000...........  .............  A............  Drainage of                 1.43        1.85        1.96        0.91        0.78        0.11         000
                                                 hydrocele.
55040...........  .............  A............  Removal of hydrocele        5.39          NA          NA        3.95        3.42        0.43         090
55041...........  .............  A............  Removal of                  8.41          NA          NA        5.68        4.82        0.60         090
                                                 hydroceles.
55060...........  .............  A............  Repair of hydrocele.        6.05          NA          NA        4.45        3.76        0.46         090
55100...........  .............  A............  Drainage of scrotum         2.40        3.49        3.58        2.10        1.83        0.17         010
                                                 abscess.
55110...........  .............  A............  Explore scrotum.....        6.23          NA          NA        4.48        3.80        0.43         090
55120...........  .............  A............  Removal of scrotum          5.62          NA          NA        4.20        3.57        0.39         090
                                                 lesion.
55150...........  .............  A............  Removal of scrotum..        8.01          NA          NA        5.44        4.63        0.56         090
55175...........  .............  A............  Revision of scrotum.        5.77          NA          NA        4.33        3.66        0.37         090
55180...........  .............  A............  Revision of scrotum.       11.63          NA          NA        7.26        6.31        0.90         090
55200...........  .............  A............  Incision of sperm           4.50        8.00       10.15        3.30        2.84        0.33         090
                                                 duct.
55250...........  .............  A............  Removal of sperm            3.32        7.82        9.64        3.06        2.64        0.25         090
                                                 duct(s).
55300...........  .............  A............  Prepare, sperm duct         3.50          NA          NA        1.75        1.53        0.25         000
                                                 x-ray.
55400...........  .............  A............  Repair of sperm duct        8.53          NA          NA        5.40        4.73        0.64         090
55450...........  .............  A............  Ligation of sperm           4.38        5.46        6.22        2.56        2.21        0.29         010
                                                 duct.
55500...........  .............  A............  Removal of hydrocele        6.12          NA          NA        4.19        3.64        0.55         090
55520...........  .............  A............  Removal of sperm            6.56          NA          NA        3.81        3.53        0.75         090
                                                 cord lesion.
55530...........  .............  A............  Revise spermatic            5.69          NA          NA        4.08        3.54        0.45         090
                                                 cord veins.
55535...........  .............  A............  Revise spermatic            7.09          NA          NA        4.83        4.11        0.47         090
                                                 cord veins.
55540...........  .............  A............  Revise hernia &             8.20          NA          NA        4.24        4.02        0.94         090
                                                 sperm veins.
55550...........  .............  A............  Laparo ligate               7.10          NA          NA        4.54        3.92        0.57         090
                                                 spermatic vein.
55559...........  .............  C............  Laparo proc,                0.00        0.00        0.00        0.00        0.00        0.00         YYY
                                                 spermatic cord.
55600...........  .............  A............  Incise sperm duct           6.91          NA          NA        4.90        4.11        0.62         090
                                                 pouch.
55605...........  .............  A............  Incise sperm duct           8.63          NA          NA        4.62        4.45        0.64         090
                                                 pouch.
55650...........  .............  A............  Remove sperm duct          12.52          NA          NA        7.39        6.33        0.92         090
                                                 pouch.
55680...........  .............  A............  Remove sperm pouch          5.59          NA          NA        3.92        3.44        0.47         090
                                                 lesion.
55700...........  .............  A............  Biopsy of prostate..        2.58        3.71        3.95        1.32        0.98        0.11         000
55705...........  .............  A............  Biopsy of prostate..        4.58          NA          NA        2.85        2.57        0.32         010
55720...........  .............  A............  Drainage of prostate        7.67          NA          NA        4.88        4.34        0.95         090
                                                 abscess.
55725...........  .............  A............  Drainage of prostate        9.90          NA          NA        6.27        5.37        0.70         090
                                                 abscess.
55801...........  .............  A............  Removal of prostate.       19.62          NA          NA       10.33        8.96        1.34         090
55810...........  .............  A............  Extensive prostate         24.14          NA          NA       12.33       10.62        1.60         090
                                                 surgery.
55812...........  .............  A............  Extensive prostate         29.69          NA          NA       14.19       12.57        2.05         090
                                                 surgery.
55815...........  .............  A............  Extensive prostate         32.75          NA          NA       16.18       14.02        2.17         090
                                                 surgery.
55821...........  .............  A............  Removal of prostate.       15.63          NA          NA        8.66        7.43        1.01         090
55831...........  .............  A............  Removal of prostate.       17.06          NA          NA        9.23        7.93        1.10         090
55840...........  .............  A............  Extensive prostate         24.45          NA          NA       12.67       10.97        1.61         090
                                                 surgery.
55842...........  .............  A............  Extensive prostate         26.31          NA          NA       13.46       11.64        1.73         090
                                                 surgery.
55845...........  .............  A............  Extensive prostate         30.52          NA          NA       14.85       12.87        2.03         090
                                                 surgery.
55860...........  .............  A............  Surgical exposure,         15.71          NA          NA        8.53        7.46        1.02         090
                                                 prostate.
55862...........  .............  A............  Extensive prostate         19.89          NA          NA       10.69        9.26        1.49         090
                                                 surgery.
55865...........  .............  A............  Extensive prostate         24.39          NA          NA       12.40       10.82        1.63         090
                                                 surgery.
55866...........  .............  A............  Laparo radical             32.25          NA          NA       15.94       13.82        2.17         090
                                                 prostatectomy.
55870...........  .............  A............  Electroejaculation..        2.58        2.49        2.01        1.45        1.26        0.16         000
55873...........  .............  A............  Cryoablate prostate.       20.25          NA          NA       11.27       10.10        1.38         090
55875...........  .............  A............  Transperi needle           13.31          NA          NA        7.83        6.83        0.89         090
                                                 place, pros.
55876...........  .............  A............  Place rt device/            1.73        2.07        2.07        1.05        1.05        0.28         000
                                                 marker, pros.
55899...........  .............  C............  Genital surgery             0.00        0.00        0.00        0.00        0.00        0.00         YYY
                                                 procedure.
55920...........  .............  A............  Place needles pelvic        8.31          NA          NA        3.13        3.13        0.58         000
                                                 for rt.
55970...........  .............  N............  Sex transformation,         0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 M to F.
55980...........  .............  N............  Sex transformation,         0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 F to M.
56405...........  .............  A............  I & D of vulva/             1.46        1.18        1.25        1.16        1.15        0.17         010
                                                 perineum.
56420...........  .............  A............  Drainage of gland           1.41        1.52        1.90        0.78        0.91        0.16         010
                                                 abscess.
56440...........  .............  A............  Surgery for vulva           2.86          NA          NA        1.56        1.63        0.34         010
                                                 lesion.
56441...........  .............  A............  Lysis of labial             1.99        1.71        1.76        1.56        1.48        0.20         010
                                                 lesion(s).
56442...........  .............  A............  Hymenotomy..........        0.68          NA          NA        0.52        0.51        0.08         000
56501...........  .............  A............  Destroy, vulva              1.55        1.63        1.71        1.21        1.22        0.18         010
                                                 lesions, sim.
56515...........  .............  A............  Destroy vulva lesion/       3.03        2.39        2.47        1.74        1.78        0.33         010
                                                 s compl.
56605...........  .............  A............  Biopsy of vulva/            1.10        0.92        1.00        0.34        0.40        0.13         000
                                                 perineum.
56606...........  .............  A............  Biopsy of vulva/            0.55        0.36        0.42        0.15        0.19        0.07         ZZZ
                                                 perineum.
56620...........  .............  A............  Partial removal of          8.44          NA          NA        4.39        4.59        0.90         090
                                                 vulva.
56625...........  .............  A............  Complete removal of         9.55          NA          NA        4.81        5.06        1.02         090
                                                 vulva.

[[Page 66472]]

 
56630...........  .............  A............  Extensive vulva            14.67          NA          NA        6.28        6.55        1.49         090
                                                 surgery.
56631...........  .............  A............  Extensive vulva            18.81          NA          NA        7.78        8.29        1.96         090
                                                 surgery.
56632...........  .............  A............  Extensive vulva            21.61          NA          NA        9.29        9.40        2.39         090
                                                 surgery.
56633...........  .............  A............  Extensive vulva            19.47          NA          NA        7.80        8.19        1.98         090
                                                 surgery.
56634...........  .............  A............  Extensive vulva            20.48          NA          NA        8.18        8.80        2.17         090
                                                 surgery.
56637...........  .............  A............  Extensive vulva            24.57          NA          NA        9.30       10.18        2.61         090
                                                 surgery.
56640...........  .............  A............  Extensive vulva            24.65          NA          NA        8.83        9.72        2.89         090
                                                 surgery.
56700...........  .............  A............  Partial removal of          2.79          NA          NA        1.77        1.80        0.30         010
                                                 hymen.
56740...........  .............  A............  Remove vagina gland         4.83          NA          NA        2.33        2.45        0.56         010
                                                 lesion.
56800...........  .............  A............  Repair of vagina....        3.90          NA          NA        1.96        2.08        0.44         010
56805...........  .............  A............  Repair clitoris.....       19.75          NA          NA        7.68        8.54        2.15         090
56810...........  .............  A............  Repair of perineum..        4.26          NA          NA        2.04        2.16        0.49         010
56820...........  .............  A............  Exam of vulva w/            1.50        1.19        1.25        0.53        0.59        0.18         000
                                                 scope.
56821...........  .............  A............  Exam/biopsy of vulva        2.05        1.53        1.64        0.68        0.79        0.25         000
                                                 w/scope.
57000...........  .............  A............  Exploration of              2.99          NA          NA        1.75        1.73        0.31         010
                                                 vagina.
57010...........  .............  A............  Drainage of pelvic          6.74          NA          NA        3.80        3.80        0.71         090
                                                 abscess.
57020...........  .............  A............  Drainage of pelvic          1.50        0.77        0.85        0.45        0.52        0.18         000
                                                 fluid.
57022...........  .............  A............  I & d vaginal               2.70          NA          NA        1.42        1.45        0.26         010
                                                 hematoma, pp.
57023...........  .............  A............  I & d vag hematoma,         5.13          NA          NA        2.37        2.47        0.58         010
                                                 non-ob.
57061...........  .............  A............  Destroy vag lesions,        1.27        1.52        1.58        1.11        1.12        0.15         010
                                                 simple.
57065...........  .............  A............  Destroy vag lesions,        2.63        2.02        2.16        1.49        1.58        0.31         010
                                                 complex.
57100...........  .............  A............  Biopsy of vagina....        1.20        0.95        1.01        0.37        0.42        0.14         000
57105...........  .............  A............  Biopsy of vagina....        1.71        1.59        1.69        1.33        1.37        0.20         010
57106...........  .............  A............  Remove vagina wall,         7.35          NA          NA        4.27        4.22        0.73         090
                                                 partial.
57107...........  .............  A............  Remove vagina              24.43          NA          NA        9.05        9.75        2.72         090
                                                 tissue, part.
57109...........  .............  A............  Vaginectomy partial        28.25          NA          NA       10.25       10.74        3.22         090
                                                 w/nodes.
57110...........  .............  A............  Remove vagina wall,        15.38          NA          NA        6.19        6.73        1.74         090
                                                 complete.
57111...........  .............  A............  Remove vagina              28.25          NA          NA       10.42       11.51        3.18         090
                                                 tissue, compl.
57112...........  .............  A............  Vaginectomy w/nodes,       30.37          NA          NA       10.61       11.35        3.08         090
                                                 compl.
57120...........  .............  A............  Closure of vagina...        8.18          NA          NA        4.19        4.39        0.89         090
57130...........  .............  A............  Remove vagina lesion        2.44        1.96        2.06        1.47        1.50        0.29         010
57135...........  .............  A............  Remove vagina lesion        2.68        2.03        2.15        1.53        1.59        0.31         010
57150...........  .............  A............  Treat vagina                0.55        0.58        0.84        0.15        0.18        0.07         000
                                                 infection.
57155...........  .............  A............  Insert uteri tandems/       6.79          NA          NA        3.49        4.02        0.43         090
                                                 ovoids.
57160...........  .............  A............  Insert pessary/other        0.89        1.04        1.03        0.25        0.30        0.10         000
                                                 device.
57170...........  .............  A............  Fitting of diaphragm/       0.91        0.57        1.02        0.25        0.29        0.11         000
                                                 cap.
57180...........  .............  A............  Treat vaginal               1.60        1.86        2.01        0.93        1.09        0.19         010
                                                 bleeding.
57200...........  .............  A............  Repair of vagina....        4.34          NA          NA        2.99        2.94        0.46         090
57210...........  .............  A............  Repair vagina/              5.63          NA          NA        3.27        3.35        0.62         090
                                                 perineum.
57220...........  .............  A............  Revision of urethra.        4.77          NA          NA        3.00        3.05        0.51         090
57230...........  .............  A............  Repair of urethral          6.22          NA          NA        3.64        3.52        0.54         090
                                                 lesion.
57240...........  .............  A............  Repair bladder &           11.42          NA          NA        5.48        4.65        0.62         090
                                                 vagina.
57250...........  .............  A............  Repair rectum &            11.42          NA          NA        5.03        4.30        0.65         090
                                                 vagina.
57260...........  .............  A............  Repair of vagina....       14.36          NA          NA        5.85        5.34        0.97         090
57265...........  .............  A............  Extensive repair of        15.86          NA          NA        6.32        6.17        1.32         090
                                                 vagina.
57267...........  .............  A............  Insert mesh/pelvic          4.88          NA          NA        1.49        1.73        0.64         ZZZ
                                                 flr addon.
57268...........  .............  A............  Repair of bowel             7.47          NA          NA        4.33        4.26        0.79         090
                                                 bulge.
57270...........  .............  A............  Repair of bowel            13.57          NA          NA        5.83        6.04        1.42         090
                                                 pouch.
57280...........  .............  A............  Suspension of vagina       16.62          NA          NA        6.96        7.16        1.68         090
57282...........  .............  A............  Colpopexy,                  7.84          NA          NA        4.49        4.49        1.02         090
                                                 extraperitoneal.
57283...........  .............  A............  Colpopexy,                 11.58          NA          NA        5.11        5.51        1.02         090
                                                 intraperitoneal.
57284...........  .............  A............  Repair paravag             14.25          NA          NA        5.98        6.56        1.41         090
                                                 defect, open.
57285...........  .............  A............  Repair paravag             11.52          NA          NA        5.16        5.16        0.63         090
                                                 defect, vag.
57287...........  .............  A............  Revise/remove sling        11.49          NA          NA        6.35        5.91        0.90         090
                                                 repair.
57288...........  .............  A............  Repair bladder             14.01          NA          NA        7.01        6.46        1.12         090
                                                 defect.
57289...........  .............  A............  Repair bladder &           12.69          NA          NA        6.70        6.37        1.21         090
                                                 vagina.
57291...........  .............  A............  Construction of             8.54          NA          NA        4.89        4.90        0.93         090
                                                 vagina.
57292...........  .............  A............  Construct vagina           13.91          NA          NA        5.90        6.41        1.58         090
                                                 with graft.
57295...........  .............  A............  Revise vag graft via        7.74          NA          NA        4.08        4.25        0.91         090
                                                 vagina.
57296...........  .............  A............  Revise vag graft,          16.46          NA          NA        6.66        6.66        1.68         090
                                                 open abd.
57300...........  .............  A............  Repair rectum-vagina        8.58          NA          NA        4.43        4.35        0.87         090
                                                 fistula.
57305...........  .............  A............  Repair rectum-vagina       15.24          NA          NA        6.19        6.23        1.73         090
                                                 fistula.
57307...........  .............  A............  Fistula repair &           17.02          NA          NA        6.90        6.95        2.02         090
                                                 colostomy.
57308...........  .............  A............  Fistula repair,            10.48          NA          NA        4.96        5.02        1.14         090
                                                 transperine.
57310...........  .............  A............  Repair                      7.55          NA          NA        5.01        4.42        0.54         090
                                                 urethrovaginal
                                                 lesion.
57311...........  .............  A............  Repair                      8.81          NA          NA        5.51        4.81        0.65         090
                                                 urethrovaginal
                                                 lesion.
57320...........  .............  A............  Repair bladder-             8.78          NA          NA        5.28        4.82        0.69         090
                                                 vagina lesion.
57330...........  .............  A............  Repair bladder-            13.11          NA          NA        7.20        6.45        1.06         090
                                                 vagina lesion.
57335...........  .............  A............  Repair vagina.......       19.87          NA          NA        7.82        8.42        1.92         090
57400...........  .............  A............  Dilation of vagina..        2.27          NA          NA        1.00        1.05        0.26         000
57410...........  .............  A............  Pelvic examination..        1.75          NA          NA        0.91        0.90        0.18         000
57415...........  .............  A............  Remove vaginal              2.44          NA          NA        1.49        1.45        0.24         010
                                                 foreign body.

[[Page 66473]]

 
57420...........  .............  A............  Exam of vagina w/           1.60        1.23        1.29        0.56        0.61        0.19         000
                                                 scope.
57421...........  .............  A............  Exam/biopsy of vag w/       2.20        1.59        1.72        0.72        0.84        0.27         000
                                                 scope.
57423...........  .............  A............  Repair paravag             16.00          NA          NA        6.51        6.51        1.65         090
                                                 defect, lap.
57425...........  .............  A............  Laparoscopy, surg,         16.93          NA          NA        6.90        6.77        1.76         090
                                                 colpopexy.
57452...........  .............  A............  Exam of cervix w/           1.50        1.18        1.23        0.74        0.75        0.18         000
                                                 scope.
57454...........  .............  A............  Bx/curett of cervix         2.33        1.39        1.51        0.95        1.05        0.28         000
                                                 w/scope.
57455...........  .............  A............  Biopsy of cervix w/         1.99        1.50        1.61        0.66        0.76        0.24         000
                                                 scope.
57456...........  .............  A............  Endocerv curettage w/       1.85        1.45        1.55        0.62        0.72        0.22         000
                                                 scope.
57460...........  .............  A............  Bx of cervix w/             2.83        4.28        5.06        1.09        1.23        0.34         000
                                                 scope, leep.
57461...........  .............  A............  Conz of cervix w/           3.43        4.56        5.33        1.05        1.26        0.41         000
                                                 scope, leep.
57500...........  .............  A............  Biopsy of cervix....        1.20        2.01        2.28        0.64        0.64        0.12         000
57505...........  .............  A............  Endocervical                1.16        1.32        1.39        1.07        1.08        0.14         010
                                                 curettage.
57510...........  .............  A............  Cauterization of            1.90        1.30        1.43        0.89        0.97        0.23         010
                                                 cervix.
57511...........  .............  A............  Cryocautery of              1.92        1.60        1.71        1.26        1.31        0.23         010
                                                 cervix.
57513...........  .............  A............  Laser surgery of            1.92        1.57        1.64        1.28        1.34        0.23         010
                                                 cervix.
57520...........  .............  A............  Conization of cervix        4.06        3.38        3.65        2.51        2.69        0.49         090
57522...........  .............  A............  Conization of cervix        3.62        2.77        2.96        2.25        2.35        0.41         090
57530...........  .............  A............  Removal of cervix...        5.19          NA          NA        3.10        3.24        0.58         090
57531...........  .............  A............  Removal of cervix,         29.77          NA          NA       10.85       12.00        3.35         090
                                                 radical.
57540...........  .............  A............  Removal of residual        13.19          NA          NA        5.44        5.83        1.49         090
                                                 cervix.
57545...........  .............  A............  Remove cervix/repair       14.00          NA          NA        5.72        6.19        1.52         090
                                                 pelvis.
57550...........  .............  A............  Removal of residual         6.24          NA          NA        3.61        3.71        0.67         090
                                                 cervix.
57555...........  .............  A............  Remove cervix/repair        9.84          NA          NA        4.75        4.91        1.09         090
                                                 vagina.
57556...........  .............  A............  Remove cervix,              9.26          NA          NA        4.60        4.72        0.92         090
                                                 repair bowel.
57558...........  .............  A............  D&c of cervical             1.69        1.34        1.40        1.05        1.09        0.20         010
                                                 stump.
57700...........  .............  A............  Revision of cervix..        4.22          NA          NA        3.28        3.19        0.41         090
57720...........  .............  A............  Revision of cervix..        4.53          NA          NA        2.93        3.02        0.49         090
57800...........  .............  A............  Dilation of cervical        0.77        0.72        0.74        0.41        0.44        0.09         000
                                                 canal.
58100...........  .............  A............  Biopsy of uterus            1.53        1.14        1.23        0.58        0.65        0.18         000
                                                 lining.
58110...........  .............  A............  Bx done w/colposcopy        0.77        0.39        0.47        0.21        0.26        0.09         ZZZ
                                                 add-on.
58120...........  .............  A............  Dilation and                3.54        2.70        2.50        1.65        1.76        0.39         010
                                                 curettage.
58140...........  .............  A............  Myomectomy abdom           15.69          NA          NA        6.17        6.64        1.82         090
                                                 method.
58145...........  .............  A............  Myomectomy vag              8.81          NA          NA        4.23        4.50        0.97         090
                                                 method.
58146...........  .............  A............  Myomectomy abdom           20.24          NA          NA        7.34        8.17        2.33         090
                                                 complex.
58150...........  .............  A............  Total hysterectomy..       17.21          NA          NA        6.55        7.01        1.85         090
58152...........  .............  A............  Total hysterectomy..       21.73          NA          NA        8.02        8.93        2.48         090
58180...........  .............  A............  Partial hysterectomy       16.50          NA          NA        6.33        6.89        1.64         090
58200...........  .............  A............  Extensive                  23.00          NA          NA        8.14        9.06        2.55         090
                                                 hysterectomy.
58210...........  .............  A............  Extensive                  30.76          NA          NA       10.71       11.95        3.38         090
                                                 hysterectomy.
58240...........  .............  A............  Removal of pelvis          49.02          NA          NA       17.62       17.61        4.23         090
                                                 contents.
58260...........  .............  A............  Vaginal hysterectomy       14.02          NA          NA        5.78        6.23        1.57         090
58262...........  .............  A............  Vag hyst including t/      15.81          NA          NA        6.23        6.80        1.80         090
                                                 o.
58263...........  .............  A............  Vag hyst w/t/o & vag       17.10          NA          NA        6.63        7.25        1.95         090
                                                 repair.
58267...........  .............  A............  Vag hyst w/urinary         18.23          NA          NA        6.96        7.66        2.07         090
                                                 repair.
58270...........  .............  A............  Vag hyst w/                15.20          NA          NA        5.93        6.49        1.74         090
                                                 enterocele repair.
58275...........  .............  A............  Hysterectomy/revise        16.90          NA          NA        6.60        7.18        1.92         090
                                                 vagina.
58280...........  .............  A............  Hysterectomy/revise        18.20          NA          NA        6.95        7.60        2.07         090
                                                 vagina.
58285...........  .............  A............  Extensive                  23.30          NA          NA        7.93        8.93        2.71         090
                                                 hysterectomy.
58290...........  .............  A............  Vag hyst complex....       20.17          NA          NA        7.34        8.23        2.30         090
58291...........  .............  A............  Vag hyst incl t/o,         21.96          NA          NA        7.81        8.84        2.53         090
                                                 complex.
58292...........  .............  A............  Vag hyst t/o &             23.25          NA          NA        8.20        9.28        2.68         090
                                                 repair, compl.
58293...........  .............  A............  Vag hyst w/uro             24.23          NA          NA        8.50        9.57        2.79         090
                                                 repair, compl.
58294...........  .............  A............  Vag hyst w/                21.45          NA          NA        7.50        8.52        2.40         090
                                                 enterocele, compl.
58300...........  .............  N............  Insert intrauterine         1.01        0.63        1.02        0.23        0.31        0.12         XXX
                                                 device.
58301...........  .............  A............  Remove intrauterine         1.27        1.04        1.18        0.34        0.41        0.15         000
                                                 device.
58321...........  .............  A............  Artificial                  0.92        0.94        1.04        0.23        0.30        0.10         000
                                                 insemination.
58322...........  .............  A............  Artificial                  1.10        1.03        1.11        0.31        0.36        0.13         000
                                                 insemination.
58323...........  .............  A............  Sperm washing.......        0.23        0.16        0.34        0.07        0.08        0.03         000
58340...........  .............  A............  Catheter for                0.88        2.15        2.66        0.56        0.61        0.09         000
                                                 hysterography.
58345...........  .............  A............  Reopen fallopian            4.67          NA          NA        2.11        2.27        0.41         010
                                                 tube.
58346...........  .............  A............  Insert heyman uteri         7.48          NA          NA        3.73        3.83        0.56         090
                                                 capsule.
58350...........  .............  A............  Reopen fallopian            1.03        1.35        1.42        0.88        0.90        0.12         010
                                                 tube.
58353...........  .............  A............  Endometr ablate,            3.57       22.81       29.23        1.71        1.88        0.43         010
                                                 thermal.
58356...........  .............  A............  Endometrial                 6.36       43.33       52.36        1.85        2.27        0.82         010
                                                 cryoablation.
58400...........  .............  A............  Suspension of uterus        7.06          NA          NA        3.86        3.89        0.75         090
58410...........  .............  A............  Suspension of uterus       13.70          NA          NA        5.55        5.99        1.45         090
58520...........  .............  A............  Repair of ruptured         13.38          NA          NA        5.48        5.76        1.47         090
                                                 uterus.
58540...........  .............  A............  Revision of uterus..       15.61          NA          NA        6.14        6.54        1.79         090
58541...........  .............  A............  Lsh, uterus 250 g or       14.57          NA          NA        6.12        6.12        1.68         090
                                                 less.
58542...........  .............  A............  Lsh w/t/o ut 250 g         16.43          NA          NA        6.63        6.63        1.69         090
                                                 or less.
58543...........  .............  A............  Lsh uterus above 250       16.74          NA          NA        6.71        6.71        1.73         090
                                                 g.
58544...........  .............  A............  Lsh w/t/o uterus           18.24          NA          NA        7.11        7.11        1.89         090
                                                 above 250 g.

[[Page 66474]]

 
58545...........  .............  A............  Laparoscopic               15.45          NA          NA        5.86        6.52        1.78         090
                                                 myomectomy.
58546...........  .............  A............  Laparo-myomectomy,         19.84          NA          NA        7.04        7.98        2.31         090
                                                 complex.
58548...........  .............  A............  Lap radical hyst....       31.45          NA          NA       12.45       12.45        3.52         090
58550...........  .............  A............  Laparo-asst vag            14.97          NA          NA        6.12        6.70        1.73         090
                                                 hysterectomy.
58552...........  .............  A............  Laparo-vag hyst incl       16.78          NA          NA        6.55        7.28        1.73         090
                                                 t/o.
58553...........  .............  A............  Laparo-vag hyst,           19.96          NA          NA        7.08        8.00        2.31         090
                                                 complex.
58554...........  .............  A............  Laparo-vag hyst w/t/       22.98          NA          NA        8.23        9.31        2.28         090
                                                 o, compl.
58555...........  .............  A............  Hysteroscopy, dx,           3.33        2.75        2.47        1.23        1.39        0.40         000
                                                 sep proc.
58558...........  .............  A............  Hysteroscopy, biopsy        4.74        3.62        2.90        1.65        1.91        0.57         000
58559...........  .............  A............  Hysteroscopy, lysis.        6.16          NA          NA        2.04        2.38        0.74         000
58560...........  .............  A............  Hysteroscopy, resect        6.99          NA          NA        2.31        2.70        0.84         000
                                                 septum.
58561...........  .............  A............  Hysteroscopy, remove        9.99          NA          NA        3.11        3.69        1.21         000
                                                 myoma.
58562...........  .............  A............  Hysteroscopy, remove        5.20        3.52        2.94        1.75        2.05        0.63         000
                                                 fb.
58563...........  .............  A............  Hysteroscopy,               6.16       37.22       46.69        2.04        2.40        0.74         000
                                                 ablation.
58565...........  .............  A............  Hysteroscopy,               7.06       41.94       45.74        3.37        3.63        1.19         090
                                                 sterilization.
58570...........  .............  A............  Tlh, uterus 250 g or       15.75          NA          NA        6.45        6.45        1.82         090
                                                 less.
58571...........  .............  A............  Tlh w/t/o 250 g or         17.56          NA          NA        6.94        6.94        1.81         090
                                                 less.
58572...........  .............  A............  Tlh, uterus over 250       19.96          NA          NA        7.59        7.59        2.31         090
                                                 g.
58573...........  .............  A............  Tlh w/t/o uterus           22.98          NA          NA        8.41        8.41        2.28         090
                                                 over 250 g.
58578...........  .............  C............  Laparo proc, uterus.        0.00        0.00        0.00        0.00        0.00        0.00         YYY
58579...........  .............  C............  Hysteroscope                0.00        0.00        0.00        0.00        0.00        0.00         YYY
                                                 procedure.
58600...........  .............  A............  Division of                 5.86          NA          NA        2.92        3.12        0.66         090
                                                 fallopian tube.
58605...........  .............  A............  Division of                 5.25          NA          NA        2.71        2.91        0.59         090
                                                 fallopian tube.
58611...........  .............  A............  Ligate oviduct(s)           1.45          NA          NA        0.40        0.48        0.18         ZZZ
                                                 add-on.
58615...........  .............  A............  Occlude fallopian           3.91          NA          NA        2.03        2.37        0.47         010
                                                 tube(s).
58660...........  .............  A............  Laparoscopy, lysis..       11.54          NA          NA        4.49        4.87        1.40         090
58661...........  .............  A............  Laparoscopy, remove        11.30          NA          NA        3.98        4.55        1.34         010
                                                 adnexa.
58662...........  .............  A............  Laparoscopy, excise        12.08          NA          NA        4.75        5.27        1.43         090
                                                 lesions.
58670...........  .............  A............  Laparoscopy, tubal          5.86          NA          NA        2.94        3.11        0.67         090
                                                 cautery.
58671...........  .............  A............  Laparoscopy, tubal          5.86          NA          NA        2.93        3.10        0.68         090
                                                 block.
58672...........  .............  A............  Laparoscopy,               12.88          NA          NA        4.77        5.47        1.60         090
                                                 fimbrioplasty.
58673...........  .............  A............  Laparoscopy,               13.99          NA          NA        5.12        5.84        1.70         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       12.84          NA          NA        5.48        5.73        1.51         090
                                                 tube.
58720...........  .............  A............  Removal of ovary/          12.08          NA          NA        5.08        5.43        1.39         090
                                                 tube(s).
58740...........  .............  A............  Revise fallopian           14.79          NA          NA        6.05        6.59        1.72         090
                                                 tube(s).
58750...........  .............  A............  Repair oviduct......       15.56          NA          NA        6.04        6.70        1.85         090
58752...........  .............  A............  Revise ovarian             15.56          NA          NA        5.98        6.46        1.81         090
                                                 tube(s).
58760...........  .............  A............  Remove tubal               13.85          NA          NA        5.58        6.14        1.80         090
                                                 obstruction.
58770...........  .............  A............  Create new tubal           14.69          NA          NA        5.74        6.32        1.74         090
                                                 opening.
58800...........  .............  A............  Drainage of ovarian         4.54        3.21        3.42        2.69        2.79        0.43         090
                                                 cyst(s).
58805...........  .............  A............  Drainage of ovarian         6.34          NA          NA        3.50        3.50        0.69         090
                                                 cyst(s).
58820...........  .............  A............  Drain ovary abscess,        4.62          NA          NA        2.90        3.09        0.52         090
                                                 open.
58822...........  .............  A............  Drain ovary abscess,       11.71          NA          NA        5.15        5.18        1.16         090
                                                 percut.
58823...........  .............  A............  Drain pelvic                3.37       19.98       20.64        1.16        1.14        0.24         000
                                                 abscess, percut.
58825...........  .............  A............  Transposition,             11.70          NA          NA        4.83        5.31        1.32         090
                                                 ovary(s).
58900...........  .............  A............  Biopsy of ovary(s)..        6.51          NA          NA        3.55        3.56        0.69         090
58920...........  .............  A............  Partial removal of         11.87          NA          NA        5.05        5.31        1.43         090
                                                 ovary(s).
58925...........  .............  A............  Removal of ovarian         12.33          NA          NA        5.24        5.46        1.41         090
                                                 cyst(s).
58940...........  .............  A............  Removal of ovary(s).        8.12          NA          NA        4.03        4.06        0.91         090
58943...........  .............  A............  Removal of ovary(s).       19.42          NA          NA        7.17        7.90        2.23         090
58950...........  .............  A............  Resect ovarian             18.24          NA          NA        7.24        7.82        2.05         090
                                                 malignancy.
58951...........  .............  A............  Resect ovarian             24.15          NA          NA        8.59        9.51        2.64         090
                                                 malignancy.
58952...........  .............  A............  Resect ovarian             27.15          NA          NA        9.81       10.77        3.03         090
                                                 malignancy.
58953...........  .............  A............  Tah, rad dissect for       33.97          NA          NA       11.62       13.08        3.84         090
                                                 debulk.
58954...........  .............  A............  Tah rad debulk/lymph       36.97          NA          NA       12.51       14.10        4.18         090
                                                 remove.
58956...........  .............  A............  Bso, omentectomy w/        22.65          NA          NA        8.58        9.44        4.01         090
                                                 tah.
58957...........  .............  A............  Resect recurrent gyn       26.06          NA          NA        9.55        9.55        2.95         090
                                                 mal.
58958...........  .............  A............  Resect recur gyn mal       29.06          NA          NA       10.35       10.35        3.29         090
                                                 w/lym.
58960...........  .............  A............  Exploration of             15.68          NA          NA        6.24        6.79        1.80         090
                                                 abdomen.
58970...........  .............  A............  Retrieval of oocyte.        3.52        1.85        2.08        1.28        1.38        0.43         000
58974...........  .............  C............  Transfer of embryo..        0.00        0.00        0.00        0.00        0.00        0.00         000
58976...........  .............  A............  Transfer of embryo..        3.82        1.94        2.31        1.20        1.51        0.47         000
58999...........  .............  C............  Genital surgery             0.00        0.00        0.00        0.00        0.00        0.00         YYY
                                                 procedure.
59000...........  .............  A............  Amniocentesis,              1.30        1.75        1.91        0.55        0.61        0.31         000
                                                 diagnostic.
59001...........  .............  A............  Amniocentesis,              3.00          NA          NA        1.07        1.24        0.71         000
                                                 therapeutic.
59012...........  .............  A............  Fetal cord                  3.44          NA          NA        1.13        1.33        0.82         000
                                                 puncture,prenatal.
59015...........  .............  A............  Chorion biopsy......        2.20        1.42        1.48        0.79        0.91        0.52         000
59020...........  .............  A............  Fetal contract              0.66        1.07        0.92          NA          NA        0.26         000
                                                 stress test.
59020...........  TC...........  A............  Fetal contract              0.00        0.89        0.70          NA          NA        0.10         000
                                                 stress test.
59020...........  26...........  A............  Fetal contract              0.66        0.18        0.22        0.18        0.22        0.16         000
                                                 stress test.
59025...........  .............  A............  Fetal non-stress            0.53        0.63        0.54          NA          NA        0.15         000
                                                 test.

[[Page 66475]]

 
59025...........  TC...........  A............  Fetal non-stress            0.00        0.48        0.36          NA          NA        0.02         000
                                                 test.
59025...........  26...........  A............  Fetal non-stress            0.53        0.15        0.18        0.15        0.18        0.13         000
                                                 test.
59030...........  .............  A............  Fetal scalp blood           1.99          NA          NA        0.46        0.61        0.47         000
                                                 sample.
59050...........  .............  A............  Fetal monitor w/            0.89          NA          NA        0.27        0.31        0.21         XXX
                                                 report.
59051...........  .............  A............  Fetal monitor/              0.74          NA          NA        0.20        0.25        0.17         XXX
                                                 interpret only.
59070...........  .............  A............  Transabdom                  5.24        4.39        4.77        1.76        2.04        0.28         000
                                                 amnioinfus w/us.
59072...........  .............  A............  Umbilical cord              8.99          NA          NA        2.39        2.75        0.16         000
                                                 occlud w/us.
59074...........  .............  A............  Fetal fluid drainage        5.24        3.60        4.08        1.53        1.92        0.28         000
                                                 w/us.
59076...........  .............  A............  Fetal shunt                 8.99          NA          NA        2.39        2.75        0.16         000
                                                 placement, w/us.
59100...........  .............  A............  Remove uterus lesion       13.26          NA          NA        5.55        6.00        2.95         090
59120...........  .............  A............  Treat ectopic              12.56          NA          NA        5.39        5.82        2.73         090
                                                 pregnancy.
59121...........  .............  A............  Treat ectopic              12.64          NA          NA        5.34        5.83        2.79         090
                                                 pregnancy.
59130...........  .............  A............  Treat ectopic              14.98          NA          NA        6.73        5.76        3.39         090
                                                 pregnancy.
59135...........  .............  A............  Treat ectopic              14.82          NA          NA        5.08        6.15        3.31         090
                                                 pregnancy.
59136...........  .............  A............  Treat ectopic              14.15          NA          NA        4.93        5.76        3.14         090
                                                 pregnancy.
59140...........  .............  A............  Treat ectopic               5.86          NA          NA        3.30        2.76        1.29         090
                                                 pregnancy.
59150...........  .............  A............  Treat ectopic              12.19          NA          NA        5.23        5.61        2.79         090
                                                 pregnancy.
59151...........  .............  A............  Treat ectopic              12.01          NA          NA        4.86        5.45        2.74         090
                                                 pregnancy.
59160...........  .............  A............  D & c after delivery        2.73        1.98        2.64        1.17        1.65        0.64         010
59200...........  .............  A............  Insert cervical             0.79        0.94        1.06        0.22        0.26        0.19         000
                                                 dilator.
59300...........  .............  A............  Episiotomy or               2.41        2.19        2.18        1.00        0.98        0.57         000
                                                 vaginal repair.
59320...........  .............  A............  Revision of cervix..        2.48          NA          NA        1.00        1.12        0.59         000
59325...........  .............  A............  Revision of cervix..        4.06          NA          NA        1.44        1.66        0.88         000
59350...........  .............  A............  Repair of uterus....        4.94          NA          NA        1.21        1.54        1.17         000
59400...........  .............  A............  Obstetrical care....       26.80          NA          NA       14.08       14.69        5.50         MMM
59409...........  .............  A............  Obstetrical care....       13.48          NA          NA        3.70        4.50        3.22         MMM
59410...........  .............  A............  Obstetrical care....       15.29          NA          NA        4.91        5.60        3.52         MMM
59412...........  .............  A............  Antepartum                  1.71          NA          NA        0.64        0.72        0.40         MMM
                                                 manipulation.
59414...........  .............  A............  Deliver placenta....        1.61          NA          NA        0.44        0.54        0.38         MMM
59425...........  .............  A............  Antepartum care only        6.22        4.24        4.22        1.68        1.77        1.14         MMM
59426...........  .............  A............  Antepartum care only       11.04        7.78        7.66        2.99        3.10        1.98         MMM
59430...........  .............  A............  Care after delivery.        2.13        1.08        1.15        0.71        0.82        0.50         MMM
59510...........  .............  A............  Cesarean delivery...       30.34          NA          NA       15.96       16.61        6.25         MMM
59514...........  .............  A............  Cesarean delivery          15.95          NA          NA        4.42        5.32        3.80         MMM
                                                 only.
59515...........  .............  A............  Cesarean delivery...       18.26          NA          NA        6.13        6.98        4.13         MMM
59525...........  .............  A............  Remove uterus after         8.53          NA          NA        2.25        2.77        1.95         ZZZ
                                                 cesarean.
59610...........  .............  A............  Vbac delivery.......       28.21          NA          NA       14.93       15.39        5.87         MMM
59612...........  .............  A............  Vbac delivery only..       15.04          NA          NA        4.19        5.12        3.59         MMM
59614...........  .............  A............  Vbac care after            16.59          NA          NA        5.11        6.02        3.89         MMM
                                                 delivery.
59618...........  .............  A............  Attempted vbac             31.78          NA          NA       16.35       17.28        6.61         MMM
                                                 delivery.
59620...........  .............  A............  Attempted vbac             17.50          NA          NA        4.66        5.71        4.17         MMM
                                                 delivery only.
59622...........  .............  A............  Attempted vbac after       19.70          NA          NA        6.70        7.66        4.50         MMM
                                                 care.
59812...........  .............  A............  Treatment of                4.39        3.10        2.82        2.35        2.45        0.95         090
                                                 miscarriage.
59820...........  .............  A............  Care of miscarriage.        4.68        4.07        4.24        3.46        3.51        0.95         090
59821...........  .............  A............  Treatment of                4.97        3.91        4.09        3.23        3.32        1.06         090
                                                 miscarriage.
59830...........  .............  A............  Treat uterus                6.51          NA          NA        3.44        3.71        1.44         090
                                                 infection.
59840...........  .............  R............  Abortion............        3.01        2.00        2.06        1.77        1.95        0.71         010
59841...........  .............  R............  Abortion............        5.57        3.11        3.30        2.54        2.76        1.24         010
59850...........  .............  R............  Abortion............        5.90          NA          NA        2.45        2.85        1.28         090
59851...........  .............  R............  Abortion............        5.92          NA          NA        3.28        3.51        1.28         090
59852...........  .............  R............  Abortion............        8.23          NA          NA        3.82        4.43        1.81         090
59855...........  .............  R............  Abortion............        6.38          NA          NA        3.07        3.31        1.45         090
59856...........  .............  R............  Abortion............        7.74          NA          NA        3.31        3.68        1.79         090
59857...........  .............  R............  Abortion............        9.30          NA          NA        3.64        4.17        2.02         090
59866...........  .............  R............  Abortion (mpr)......        3.99          NA          NA        1.36        1.63        0.87         000
59870...........  .............  A............  Evacuate mole of            6.40          NA          NA        4.38        4.43        1.42         090
                                                 uterus.
59871...........  .............  A............  Remove cerclage             2.13          NA          NA        0.90        1.02        0.50         000
                                                 suture.
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        1.78        2.08        2.00        1.70        1.70        0.15         010
                                                 cyst.
60100...........  .............  A............  Biopsy of thyroid...        1.56        1.31        1.35        0.52        0.52        0.10         000
60200...........  .............  A............  Remove thyroid              9.91          NA          NA        5.50        5.74        1.01         090
                                                 lesion.
60210...........  .............  A............  Partial thyroid            11.15          NA          NA        5.22        5.43        1.23         090
                                                 excision.
60212...........  .............  A............  Partial thyroid            16.32          NA          NA        6.94        7.30        1.95         090
                                                 excision.
60220...........  .............  A............  Partial removal of         12.29          NA          NA        5.66        5.90        1.32         090
                                                 thyroid.
60225...........  .............  A............  Partial removal of         14.67          NA          NA        6.91        7.15        1.64         090
                                                 thyroid.
60240...........  .............  A............  Removal of thyroid..       16.18          NA          NA        6.40        6.99        1.86         090
60252...........  .............  A............  Removal of thyroid..       21.88          NA          NA        8.82        9.45        2.30         090
60254...........  .............  A............  Extensive thyroid          28.29          NA          NA       11.21       12.67        2.61         090
                                                 surgery.
60260...........  .............  A............  Repeat thyroid             18.18          NA          NA        7.40        8.02        1.94         090
                                                 surgery.
60270...........  .............  A............  Removal of thyroid..       23.07          NA          NA        9.31        9.88        2.33         090

[[Page 66476]]

 
60271...........  .............  A............  Removal of thyroid..       17.54          NA          NA        7.14        7.86        1.75         090
60280...........  .............  A............  Remove thyroid duct         6.05          NA          NA        4.47        4.56        0.54         090
                                                 lesion.
60281...........  .............  A............  Remove thyroid duct         8.71          NA          NA        5.31        5.57        0.73         090
                                                 lesion.
60300...........  .............  A............  Aspir/inj thyroid           0.97        1.94        1.67        0.30        0.31        0.07         000
                                                 cyst.
60500...........  .............  A............  Explore parathyroid        16.69          NA          NA        6.85        7.12        2.01         090
                                                 glands.
60502...........  .............  A............  Re-explore                 21.01          NA          NA        8.60        8.97        2.54         090
                                                 parathyroids.
60505...........  .............  A............  Explore parathyroid        22.91          NA          NA        9.38       10.15        2.65         090
                                                 glands.
60512...........  .............  A............  Autotransplant              4.44          NA          NA        1.21        1.41        0.53         ZZZ
                                                 parathyroid.
60520...........  .............  A............  Removal of thymus          17.07          NA          NA        7.01        7.64        2.20         090
                                                 gland.
60521...........  .............  A............  Removal of thymus          19.11          NA          NA        8.12        8.83        2.82         090
                                                 gland.
60522...........  .............  A............  Removal of thymus          23.37          NA          NA        9.60       10.43        3.27         090
                                                 gland.
60540...........  .............  A............  Explore adrenal            17.91          NA          NA        8.24        7.91        1.75         090
                                                 gland.
60545...........  .............  A............  Explore adrenal            20.82          NA          NA        8.94        8.73        2.08         090
                                                 gland.
60600...........  .............  A............  Remove carotid body        24.99          NA          NA        8.82        9.89        2.20         090
                                                 lesion.
60605...........  .............  A............  Remove carotid body        31.86          NA          NA       12.13       12.19        2.50         090
                                                 lesion.
60650...........  .............  A............  Laparoscopy                20.63          NA          NA        8.08        8.03        2.29         090
                                                 adrenalectomy.
60659...........  .............  C............  Laparo proc,                0.00        0.00        0.00        0.00        0.00        0.00         YYY
                                                 endocrine.
60699...........  .............  C............  Endocrine surgery           0.00        0.00        0.00        0.00        0.00        0.00         YYY
                                                 procedure.
61000...........  .............  A............  Remove cranial              1.58          NA          NA        1.24        1.09        0.13         000
                                                 cavity fluid.
61001...........  .............  A............  Remove cranial              1.49          NA          NA        1.08        1.07        0.16         000
                                                 cavity fluid.
61020...........  .............  A............  Remove brain cavity         1.51          NA          NA        1.63        1.48        0.34         000
                                                 fluid.
61026...........  .............  A............  Injection into brain        1.69          NA          NA        1.30        1.34        0.33         000
                                                 canal.
61050...........  .............  A............  Remove brain canal          1.51          NA          NA        1.15        1.21        0.11         000
                                                 fluid.
61055...........  .............  A............  Injection into brain        2.10          NA          NA        1.33        1.37        0.17         000
                                                 canal.
61070...........  .............  A............  Brain canal shunt           0.89          NA          NA        1.16        1.08        0.17         000
                                                 procedure.
61105...........  .............  A............  Twist drill hole....        5.40          NA          NA        4.90        4.41        1.32         090
61107...........  .............  A............  Drill skull for             4.99          NA          NA        1.83        2.18        1.29         000
                                                 implantation.
61108...........  .............  A............  Drill skull for            11.51          NA          NA        8.34        7.74        2.64         090
                                                 drainage.
61120...........  .............  A............  Burr hole for               9.52          NA          NA        6.77        6.38        2.10         090
                                                 puncture.
61140...........  .............  A............  Pierce skull for           17.10          NA          NA       10.40       10.14        4.12         090
                                                 biopsy.
61150...........  .............  A............  Pierce skull for           18.80          NA          NA       10.67       10.52        4.32         090
                                                 drainage.
61151...........  .............  A............  Pierce skull for           13.41          NA          NA        8.43        8.12        3.01         090
                                                 drainage.
61154...........  .............  A............  Pierce skull &             16.92          NA          NA       10.82       10.15        4.21         090
                                                 remove clot.
61156...........  .............  A............  Pierce skull for           17.37          NA          NA        9.71        9.77        4.23         090
                                                 drainage.
61210...........  .............  A............  Pierce skull,               5.83          NA          NA        2.15        2.53        1.50         000
                                                 implant device.
61215...........  .............  A............  Insert brain-fluid          5.77          NA          NA        5.44        4.72        1.26         090
                                                 device.
61250...........  .............  A............  Pierce skull &             11.41          NA          NA        7.37        7.11        2.77         090
                                                 explore.
61253...........  .............  A............  Pierce skull &             13.41          NA          NA        7.48        7.60        2.62         090
                                                 explore.
61304...........  .............  A............  Open skull for             23.31          NA          NA       12.53       12.68        5.63         090
                                                 exploration.
61305...........  .............  A............  Open skull for             28.51          NA          NA       14.95       15.13        6.09         090
                                                 exploration.
61312...........  .............  A............  Open skull for             30.07          NA          NA       15.22       15.12        6.36         090
                                                 drainage.
61313...........  .............  A............  Open skull for             27.94          NA          NA       15.35       15.07        6.45         090
                                                 drainage.
61314...........  .............  A............  Open skull for             25.77          NA          NA       14.14       13.58        6.28         090
                                                 drainage.
61315...........  .............  A............  Open skull for             29.52          NA          NA       15.49       15.75        7.16         090
                                                 drainage.
61316...........  .............  A............  Implt cran bone flap        1.39          NA          NA        0.51        0.55        0.35         ZZZ
                                                 to abdo.
61320...........  .............  A............  Open skull for             27.32          NA          NA       14.23       14.48        6.62         090
                                                 drainage.
61321...........  .............  A............  Open skull for             30.40          NA          NA       16.05       16.08        7.14         090
                                                 drainage.
61322...........  .............  A............  Decompressive              34.08          NA          NA       17.46       16.56        7.63         090
                                                 craniotomy.
61323...........  .............  A............  Decompressive              34.93          NA          NA       17.29       16.68        8.03         090
                                                 lobectomy.
61330...........  .............  A............  Decompress eye             25.17          NA          NA       11.52       12.62        2.32         090
                                                 socket.
61332...........  .............  A............  Explore/biopsy eye         28.50          NA          NA       12.95       14.27        4.83         090
                                                 socket.
61333...........  .............  A............  Explore orbit/remove       29.17          NA          NA       12.87       14.22        3.92         090
                                                 lesion.
61334...........  .............  A............  Explore orbit/remove       19.50          NA          NA        9.01        9.81        1.75         090
                                                 object.
61340...........  .............  A............  Subtemporal                20.01          NA          NA       11.67       11.39        4.84         090
                                                 decompression.
61343...........  .............  A............  Incise skull (press        31.73          NA          NA       15.92       16.36        7.64         090
                                                 relief).
61345...........  .............  A............  Relieve cranial            29.10          NA          NA       14.84       15.11        7.04         090
                                                 pressure.
61440...........  .............  A............  Incise skull for           28.53          NA          NA       15.22       14.70        6.90         090
                                                 surgery.
61450...........  .............  A............  Incise skull for           27.59          NA          NA       14.05       14.16        5.79         090
                                                 surgery.
61458...........  .............  A............  Incise skull for           28.71          NA          NA       14.87       15.18        7.03         090
                                                 brain wound.
61460...........  .............  A............  Incise skull for           30.11          NA          NA       14.56       15.48        6.04         090
                                                 surgery.
61470...........  .............  A............  Incise skull for           27.52          NA          NA       14.04       13.94        5.90         090
                                                 surgery.
61480...........  .............  A............  Incise skull for           27.95          NA          NA        8.13       11.70        6.73         090
                                                 surgery.
61490...........  .............  A............  Incise skull for           27.12          NA          NA       14.21       14.26        6.92         090
                                                 surgery.
61500...........  .............  A............  Removal of skull           19.05          NA          NA       10.68       10.74        4.11         090
                                                 lesion.
61501...........  .............  A............  Remove infected            16.22          NA          NA        9.44        9.32        3.22         090
                                                 skull bone.
61510...........  .............  A............  Removal of brain           30.63          NA          NA       16.93       16.81        7.35         090
                                                 lesion.
61512...........  .............  A............  Remove brain lining        36.99          NA          NA       18.44       19.05        9.08         090
                                                 lesion.
61514...........  .............  A............  Removal of brain           27.10          NA          NA       14.40       14.41        6.54         090
                                                 abscess.
61516...........  .............  A............  Removal of brain           26.45          NA          NA       14.04       14.15        6.35         090
                                                 lesion.
61517...........  .............  A............  Implt brain chemotx         1.38          NA          NA        0.51        0.57        0.35         ZZZ
                                                 add-on.
61518...........  .............  A............  Removal of brain           39.69          NA          NA       20.29       20.68        9.65         090
                                                 lesion.
61519...........  .............  A............  Remove brain lining        43.28          NA          NA       20.63       21.63       10.63         090
                                                 lesion.

[[Page 66477]]

 
61520...........  .............  A............  Removal of brain           56.89          NA          NA       25.93       28.12       11.21         090
                                                 lesion.
61521...........  .............  A............  Removal of brain           46.84          NA          NA       22.14       23.17       11.39         090
                                                 lesion.
61522...........  .............  A............  Removal of brain           31.41          NA          NA       15.75       16.08        7.62         090
                                                 abscess.
61524...........  .............  A............  Removal of brain           29.76          NA          NA       15.68       15.67        7.16         090
                                                 lesion.
61526...........  .............  A............  Removal of brain           53.90          NA          NA       22.50       25.98        7.07         090
                                                 lesion.
61530...........  .............  A............  Removal of brain           45.43          NA          NA       19.47       22.25        6.15         090
                                                 lesion.
61531...........  .............  A............  Implant brain              16.28          NA          NA       10.45        9.79        3.79         090
                                                 electrodes.
61533...........  .............  A............  Implant brain              21.36          NA          NA       11.78       11.65        5.12         090
                                                 electrodes.
61534...........  .............  A............  Removal of brain           22.88          NA          NA       13.11       12.59        5.44         090
                                                 lesion.
61535...........  .............  A............  Remove brain               13.05          NA          NA        8.83        8.12        3.02         090
                                                 electrodes.
61536...........  .............  A............  Removal of brain           37.59          NA          NA       18.51       19.14        9.21         090
                                                 lesion.
61537...........  .............  A............  Removal of brain           36.35          NA          NA       17.02       15.87        6.94         090
                                                 tissue.
61538...........  .............  A............  Removal of brain           39.35          NA          NA       18.35       16.82        6.94         090
                                                 tissue.
61539...........  .............  A............  Removal of brain           34.15          NA          NA       16.81       17.28        8.32         090
                                                 tissue.
61540...........  .............  A............  Removal of brain           31.30          NA          NA       16.28       16.76        8.32         090
                                                 tissue.
61541...........  .............  A............  Incision of brain          30.81          NA          NA       16.07       16.13        6.60         090
                                                 tissue.
61542...........  .............  A............  Removal of brain           33.03          NA          NA       16.76       17.29        8.03         090
                                                 tissue.
61543...........  .............  A............  Removal of brain           31.18          NA          NA       13.84       15.11        7.56         090
                                                 tissue.
61544...........  .............  A............  Remove & treat brain       27.26          NA          NA       14.26       14.04        5.97         090
                                                 lesion.
61545...........  .............  A............  Excision of brain          46.23          NA          NA       22.80       23.50       10.63         090
                                                 tumor.
61546...........  .............  A............  Removal of pituitary       33.31          NA          NA       16.72       17.10        7.67         090
                                                 gland.
61548...........  .............  A............  Removal of pituitary       23.27          NA          NA       11.60       12.19        3.43         090
                                                 gland.
61550...........  .............  A............  Release of skull           15.44          NA          NA        5.65        6.29        0.98         090
                                                 seams.
61552...........  .............  A............  Release of skull           20.27          NA          NA       12.14       10.62        1.06         090
                                                 seams.
61556...........  .............  A............  Incise skull/sutures       24.00          NA          NA       13.27       12.31        4.65         090
61557...........  .............  A............  Incise skull/sutures       23.16          NA          NA       13.62       13.62        5.80         090
61558...........  .............  A............  Excision of skull/         26.35          NA          NA       14.68       14.43        1.36         090
                                                 sutures.
61559...........  .............  A............  Excision of skull/         33.82          NA          NA       18.36       18.83        8.51         090
                                                 sutures.
61563...........  .............  A............  Excision of skull          28.35          NA          NA       13.07       14.15        5.17         090
                                                 tumor.
61564...........  .............  A............  Excision of skull          34.59          NA          NA       17.89       18.08        8.78         090
                                                 tumor.
61566...........  .............  A............  Removal of brain           32.32          NA          NA       16.63       17.19        6.94         090
                                                 tissue.
61567...........  .............  A............  Incision of brain          36.84          NA          NA       19.05       19.85        6.54         090
                                                 tissue.
61570...........  .............  A............  Remove foreign body,       26.38          NA          NA       14.00       13.95        5.88         090
                                                 brain.
61571...........  .............  A............  Incise skull for           28.29          NA          NA       14.62       14.88        6.79         090
                                                 brain wound.
61575...........  .............  A............  Skull base/brainstem       36.43          NA          NA       16.08       17.85        5.34         090
                                                 surgery.
61576...........  .............  A............  Skull base/brainstem       55.11          NA          NA       28.06       31.39        5.58         090
                                                 surgery.
61580...........  .............  A............  Craniofacial               34.34          NA          NA       22.82       24.19        3.37         090
                                                 approach, skull.
61581...........  .............  A............  Craniofacial               38.88          NA          NA       27.80       25.62        3.92         090
                                                 approach, skull.
61582...........  .............  A............  Craniofacial               34.93          NA          NA       30.44       28.86        7.21         090
                                                 approach, skull.
61583...........  .............  A............  Craniofacial               38.41          NA          NA       25.86       25.48        9.21         090
                                                 approach, skull.
61584...........  .............  A............  Orbitocranial              37.61          NA          NA       26.01       25.26        8.18         090
                                                 approach/skull.
61585...........  .............  A............  Orbitocranial              42.46          NA          NA       25.10       25.79        7.03         090
                                                 approach/skull.
61586...........  .............  A............  Resect nasopharynx,        27.28          NA          NA       22.61       22.59        4.37         090
                                                 skull.
61590...........  .............  A............  Infratemporal              46.87          NA          NA       24.78       26.69        5.31         090
                                                 approach/skull.
61591...........  .............  A............  Infratemporal              46.87          NA          NA       24.57       27.04        5.66         090
                                                 approach/skull.
61592...........  .............  A............  Orbitocranial              42.98          NA          NA       26.77       26.63       10.07         090
                                                 approach/skull.
61595...........  .............  A............  Transtemporal              33.57          NA          NA       21.12       21.73        3.98         090
                                                 approach/skull.
61596...........  .............  A............  Transcochlear              39.31          NA          NA       20.92       22.67        3.40         090
                                                 approach/skull.
61597...........  .............  A............  Transcondylar              40.73          NA          NA       23.25       23.11        8.84         090
                                                 approach/skull.
61598...........  .............  A............  Transpetrosal              36.41          NA          NA       22.13       22.68        5.70         090
                                                 approach/skull.
61600...........  .............  A............  Resect/excise              29.84          NA          NA       19.74       19.75        3.79         090
                                                 cranial lesion.
61601...........  .............  A............  Resect/excise              31.04          NA          NA       22.35       21.42        6.63         090
                                                 cranial lesion.
61605...........  .............  A............  Resect/excise              32.40          NA          NA       19.44       20.69        2.86         090
                                                 cranial lesion.
61606...........  .............  A............  Resect/excise              41.94          NA          NA       23.74       24.44        8.97         090
                                                 cranial lesion.
61607...........  .............  A............  Resect/excise              40.82          NA          NA       20.98       22.37        6.90         090
                                                 cranial lesion.
61608...........  .............  A............  Resect/excise              45.45          NA          NA       26.29       26.43       10.75         090
                                                 cranial lesion.
61609...........  .............  A............  Transect artery,            9.88          NA          NA        3.25        4.05        2.56         ZZZ
                                                 sinus.
61610...........  .............  A............  Transect artery,           29.63          NA          NA       11.05       12.09        7.68         ZZZ
                                                 sinus.
61611...........  .............  A............  Transect artery,            7.41          NA          NA        1.70        2.76        1.89         ZZZ
                                                 sinus.
61612...........  .............  A............  Transect artery,           27.84          NA          NA        6.40        9.85        4.31         ZZZ
                                                 sinus.
61613...........  .............  A............  Remove aneurysm,           44.94          NA          NA       27.32       26.78        8.45         090
                                                 sinus.
61615...........  .............  A............  Resect/excise              35.63          NA          NA       21.27       21.99        4.73         090
                                                 lesion, skull.
61616...........  .............  A............  Resect/excise              46.60          NA          NA       27.21       27.92        8.26         090
                                                 lesion, skull.
61618...........  .............  A............  Repair dura.........       18.58          NA          NA       10.42       10.43        3.72         090
61619...........  .............  A............  Repair dura.........       22.01          NA          NA       11.66       11.95        3.95         090
61623...........  .............  A............  Endovasc tempory            9.95          NA          NA        3.72        3.90        1.05         000
                                                 vessel occl.
61624...........  .............  A............  Transcath occlusion,       20.12          NA          NA        7.29        7.09        1.96         000
                                                 cns.
61626...........  .............  A............  Transcath occlusion,       16.60          NA          NA        5.97        5.74        1.24         000
                                                 non-cns.
61630...........  .............  N............  Intracranial               22.07          NA          NA        6.43        9.46        2.02         090
                                                 angioplasty.
61635...........  .............  N............  Intracran angioplsty       24.28          NA          NA        6.94       10.24        2.21         090
                                                 w/stent.
61640...........  .............  N............  Dilate ic vasospasm,       12.32          NA          NA        2.83        2.83        0.71         000
                                                 init.
61641...........  .............  N............  Dilate ic vasospasm         4.33          NA          NA        0.99        0.99        0.25         ZZZ
                                                 add-on.

[[Page 66478]]

 
61642...........  .............  N............  Dilate ic vasospasm         8.66          NA          NA        1.99        1.99        0.50         ZZZ
                                                 add-on.
61680...........  .............  A............  Intracranial vessel        32.40          NA          NA       16.73       17.07        7.95         090
                                                 surgery.
61682...........  .............  A............  Intracranial vessel        63.31          NA          NA       27.51       29.85       15.90         090
                                                 surgery.
61684...........  .............  A............  Intracranial vessel        41.49          NA          NA       20.35       21.17       10.31         090
                                                 surgery.
61686...........  .............  A............  Intracranial vessel        67.32          NA          NA       30.44       32.57       16.71         090
                                                 surgery.
61690...........  .............  A............  Intracranial vessel        31.18          NA          NA       16.50       16.61        6.94         090
                                                 surgery.
61692...........  .............  A............  Intracranial vessel        54.43          NA          NA       24.32       25.89       13.43         090
                                                 surgery.
61697...........  .............  A............  Brain aneurysm repr,       63.22          NA          NA       28.60       28.30       12.85         090
                                                 complx.
61698...........  .............  A............  Brain aneurysm repr,       69.45          NA          NA       30.55       28.62       12.54         090
                                                 complx.
61700...........  .............  A............  Brain aneurysm repr,       50.44          NA          NA       24.00       25.89       13.02         090
                                                 simple.
61702...........  .............  A............  Inner skull vessel         59.86          NA          NA       27.47       26.74       10.79         090
                                                 surgery.
61703...........  .............  A............  Clamp neck artery...       18.70          NA          NA       10.05       10.25        4.06         090
61705...........  .............  A............  Revise circulation         37.97          NA          NA       18.30       18.77        8.87         090
                                                 to head.
61708...........  .............  A............  Revise circulation         37.07          NA          NA       14.86       15.00        2.51         090
                                                 to head.
61710...........  .............  A............  Revise circulation         31.19          NA          NA       13.77       13.70        4.52         090
                                                 to head.
61711...........  .............  A............  Fusion of skull            38.10          NA          NA       18.59       19.19        9.42         090
                                                 arteries.
61720...........  .............  A............  Incise skull/brain         17.52          NA          NA        7.88        8.92        2.79         090
                                                 surgery.
61735...........  .............  A............  Incise skull/brain         22.22          NA          NA        9.16       10.66        2.73         090
                                                 surgery.
61750...........  .............  A............  Incise skull/brain         19.73          NA          NA       10.94       10.77        4.72         090
                                                 biopsy.
61751...........  .............  A............  Brain biopsy w/ct/mr       18.64          NA          NA       11.35       11.08        4.56         090
                                                 guide.
61760...........  .............  A............  Implant brain              22.24          NA          NA       12.05       10.38        5.42         090
                                                 electrodes.
61770...........  .............  A............  Incise skull for           23.09          NA          NA        9.88       11.06        3.55         090
                                                 treatment.
61790...........  .............  A............  Treat trigeminal           11.50          NA          NA        7.69        6.80        2.82         090
                                                 nerve.
61791...........  .............  A............  Treat trigeminal           15.31          NA          NA        8.20        8.56        3.40         090
                                                 tract.
61793...........  .............  A............  Focus radiation beam       17.75          NA          NA        9.54        9.83        4.46         090
61795...........  .............  A............  Brain surgery using         4.03          NA          NA        1.43        1.73        0.79         ZZZ
                                                 computer.
61850...........  .............  A............  Implant                    13.26          NA          NA        7.88        7.77        3.22         090
                                                 neuroelectrodes.
61860...........  .............  A............  Implant                    22.16          NA          NA       11.59       11.82        4.95         090
                                                 neuroelectrodes.
61863...........  .............  A............  Implant                    20.56          NA          NA       12.40       12.08        5.43         090
                                                 neuroelectrode.
61864...........  .............  A............  Implant                     4.49          NA          NA        1.67        1.98        5.43         ZZZ
                                                 neuroelectrde, addl.
61867...........  .............  A............  Implant                    32.88          NA          NA       16.35       17.18        5.43         090
                                                 neuroelectrode.
61868...........  .............  A............  Implant                     7.91          NA          NA        2.94        3.47        5.43         ZZZ
                                                 neuroelectrde,
                                                 add'l.
61870...........  .............  A............  Implant                    16.24          NA          NA        9.68        9.69        3.87         090
                                                 neuroelectrodes.
61875...........  .............  A............  Implant                    16.36          NA          NA        5.33        6.94        2.95         090
                                                 neuroelectrodes.
61880...........  .............  A............  Revise/remove               6.87          NA          NA        5.17        4.87        1.66         090
                                                 neuroelectrode.
61885...........  .............  A............  Insrt/redo neurostim        7.37          NA          NA        7.05        6.18        1.59         090
                                                 1 array.
61886...........  .............  A............  Implant neurostim           9.73          NA          NA        8.51        7.43        1.97         090
                                                 arrays.
61888...........  .............  A............  Revise/remove               5.20          NA          NA        3.46        3.57        1.33         010
                                                 neuroreceiver.
62000...........  .............  A............  Treat skull fracture       13.83          NA          NA        7.61        6.56        1.06         090
62005...........  .............  A............  Treat skull fracture       17.53          NA          NA        9.58        9.19        3.87         090
62010...........  .............  A............  Treatment of head          21.30          NA          NA       11.80       11.75        5.14         090
                                                 injury.
62100...........  .............  A............  Repair brain fluid         23.40          NA          NA       12.08       12.43        4.84         090
                                                 leakage.
62115...........  .............  A............  Reduction of skull         22.71          NA          NA       13.87       12.75        5.51         090
                                                 defect.
62116...........  .............  A............  Reduction of skull         24.90          NA          NA       13.33       13.34        6.11         090
                                                 defect.
62117...........  .............  A............  Reduction of skull         28.26          NA          NA       12.73       14.04        4.53         090
                                                 defect.
62120...........  .............  A............  Repair skull cavity        24.39          NA          NA       17.31       17.89        3.00         090
                                                 lesion.
62121...........  .............  A............  Incise skull repair.       22.93          NA          NA       14.23       14.83        4.17         090
62140...........  .............  A............  Repair of skull            14.45          NA          NA        8.63        8.47        3.47         090
                                                 defect.
62141...........  .............  A............  Repair of skull            15.97          NA          NA        9.33        9.18        3.76         090
                                                 defect.
62142...........  .............  A............  Remove skull plate/        11.73          NA          NA        7.78        7.38        2.73         090
                                                 flap.
62143...........  .............  A............  Replace skull plate/       14.05          NA          NA        8.72        8.38        3.37         090
                                                 flap.
62145...........  .............  A............  Repair of skull &          19.99          NA          NA       10.25       10.56        4.50         090
                                                 brain.
62146...........  .............  A............  Repair of skull with       17.18          NA          NA        9.51        9.57        3.62         090
                                                 graft.
62147...........  .............  A............  Repair of skull with       20.57          NA          NA       10.98       11.14        4.32         090
                                                 graft.
62148...........  .............  A............  Retr bone flap to           2.00          NA          NA        0.74        0.80        0.48         ZZZ
                                                 fix skull.
62160...........  .............  A............  Neuroendoscopy add-         3.00          NA          NA        1.11        1.32        0.77         ZZZ
                                                 on.
62161...........  .............  A............  Dissect brain w/           21.10          NA          NA       12.14       12.11        5.19         090
                                                 scope.
62162...........  .............  A............  Remove colloid cyst        26.67          NA          NA       14.63       14.73        5.91         090
                                                 w/scope.
62163...........  .............  A............  Neuroendoscopy w/fb        16.40          NA          NA        9.24        9.58        4.01         090
                                                 removal.
62164...........  .............  A............  Remove brain tumor w/      29.27          NA          NA       15.91       15.42        5.38         090
                                                 scope.
62165...........  .............  A............  Remove pituit tumor        23.10          NA          NA       11.76       12.57        3.01         090
                                                 w/scope.
62180...........  .............  A............  Establish brain            22.45          NA          NA       12.36       12.32        4.98         090
                                                 cavity shunt.
62190...........  .............  A............  Establish brain            12.07          NA          NA        7.36        7.22        2.80         090
                                                 cavity shunt.
62192...........  .............  A............  Establish brain            13.25          NA          NA        8.01        7.81        3.02         090
                                                 cavity shunt.
62194...........  .............  A............  Replace/irrigate            5.68          NA          NA        3.14        2.79        0.92         010
                                                 catheter.
62200...........  .............  A............  Establish brain            19.19          NA          NA       10.69       10.76        4.65         090
                                                 cavity shunt.
62201...........  .............  A............  Brain cavity shunt w/      15.89          NA          NA       10.34        9.89        3.68         090
                                                 scope.
62220...........  .............  A............  Establish brain            14.00          NA          NA        8.61        8.29        3.35         090
                                                 cavity shunt.
62223...........  .............  A............  Establish brain            13.90          NA          NA        9.35        8.79        3.14         090
                                                 cavity shunt.
62225...........  .............  A............  Replace/irrigate            6.11          NA          NA        5.48        4.78        1.39         090
                                                 catheter.
62230...........  .............  A............  Replace/revise brain       11.35          NA          NA        7.20        6.84        2.71         090
                                                 shunt.
62252...........  .............  A............  Csf shunt reprogram.        0.74        1.77        1.62          NA          NA        0.21         XXX

[[Page 66479]]

 
62252...........  TC...........  A............  Csf shunt reprogram.        0.00        1.50        1.30          NA          NA        0.02         XXX
62252...........  26...........  A............  Csf shunt reprogram.        0.74        0.27        0.32        0.27        0.32        0.19         XXX
62256...........  .............  A............  Remove brain cavity         7.30          NA          NA        5.90        5.29        1.72         090
                                                 shunt.
62258...........  .............  A............  Replace brain cavity       15.54          NA          NA        9.29        9.00        3.74         090
                                                 shunt.
62263...........  .............  A............  Epidural lysis mult         6.41        9.45       11.07        2.97        3.08        0.41         010
                                                 sessions.
62264...........  .............  A............  Epidural lysis on           4.42        5.62        6.67        1.24        1.33        0.27         010
                                                 single day.
62268...........  .............  A............  Drain spinal cord           4.73        6.69        9.11        1.80        1.97        0.43         000
                                                 cyst.
62269...........  .............  A............  Needle biopsy,              5.01        6.25       10.46        1.48        1.73        0.37         000
                                                 spinal cord.
62270...........  .............  A............  Spinal fluid tap,           1.37        2.39        2.69        0.57        0.57        0.08         000
                                                 diagnostic.
62272...........  .............  A............  Drain cerebro spinal        1.35        3.13        3.37        0.62        0.66        0.18         000
                                                 fluid.
62273...........  .............  A............  Inject epidural             2.15        1.67        2.19        0.57        0.64        0.13         000
                                                 patch.
62280...........  .............  A............  Treat spinal cord           2.63        4.62        5.77        1.15        1.08        0.30         010
                                                 lesion.
62281...........  .............  A............  Treat spinal cord           2.66        4.07        4.86        1.02        0.96        0.19         010
                                                 lesion.
62282...........  .............  A............  Treat spinal canal          2.33        4.08        6.22        1.11        1.01        0.17         010
                                                 lesion.
62284...........  .............  A............  Injection for               1.54        3.79        4.37        0.71        0.70        0.13         000
                                                 myelogram.
62287...........  .............  A............  Percutaneous                8.88          NA          NA        4.30        4.92        0.58         090
                                                 diskectomy.
62290...........  .............  A............  Inject for spine            3.00        4.50        5.81        1.15        1.26        0.23         000
                                                 disk x-ray.
62291...........  .............  A............  Inject for spine            2.91        4.23        5.08        1.08        1.15        0.26         000
                                                 disk x-ray.
62292...........  .............  A............  Injection into disk         9.14          NA          NA        2.87        3.67        0.82         090
                                                 lesion.
62294...........  .............  A............  Injection into             12.77          NA          NA        6.49        6.03        1.24         090
                                                 spinal artery.
62310...........  .............  A............  Inject spine c/t....        1.91        3.00        3.90        0.56        0.60        0.12         000
62311...........  .............  A............  Inject spine l/s            1.54        2.66        3.79        0.52        0.56        0.09         000
                                                 (cd).
62318...........  .............  A............  Inject spine w/cath,        2.04        3.09        4.40        0.43        0.54        0.12         000
                                                 c/t.
62319...........  .............  A............  Inject spine w/cath         1.87        2.79        3.88        0.44        0.52        0.11         000
                                                 l/s (cd).
62350...........  .............  A............  Implant spinal canal        8.04          NA          NA        3.98        3.96        1.02         090
                                                 cath.
62351...........  .............  A............  Implant spinal canal       11.54          NA          NA        7.64        7.38        2.25         090
                                                 cath.
62355...........  .............  A............  Remove spinal canal         6.60          NA          NA        3.52        3.34        0.71         090
                                                 catheter.
62360...........  .............  A............  Insert spine                3.68          NA          NA        3.17        2.92        0.34         090
                                                 infusion device.
62361...........  .............  A............  Implant spine               6.59          NA          NA        4.06        3.99        0.80         090
                                                 infusion pump.
62362...........  .............  A............  Implant spine               8.58          NA          NA        4.65        4.50        1.18         090
                                                 infusion pump.
62365...........  .............  A............  Remove spine                6.57          NA          NA        3.71        3.64        0.86         090
                                                 infusion device.
62367...........  .............  A............  Analyze spine               0.48        0.42        0.52        0.11        0.11        0.03         XXX
                                                 infusion pump.
62368...........  .............  A............  Analyze spine               0.75        0.58        0.63        0.17        0.17        0.06         XXX
                                                 infusion pump.
63001...........  .............  A............  Removal of spinal          17.51          NA          NA        9.76        9.63        3.77         090
                                                 lamina.
63003...........  .............  A............  Removal of spinal          17.64          NA          NA        9.72        9.79        3.73         090
                                                 lamina.
63005...........  .............  A............  Removal of spinal          16.28          NA          NA        9.73        9.85        3.35         090
                                                 lamina.
63011...........  .............  A............  Removal of spinal          15.78          NA          NA        9.00        8.63        3.38         090
                                                 lamina.
63012...........  .............  A............  Removal of spinal          16.72          NA          NA        9.75        9.93        3.49         090
                                                 lamina.
63015...........  .............  A............  Removal of spinal          20.70          NA          NA       11.83       11.85        4.76         090
                                                 lamina.
63016...........  .............  A............  Removal of spinal          21.90          NA          NA       11.64       11.71        4.59         090
                                                 lamina.
63017...........  .............  A............  Removal of spinal          17.18          NA          NA       10.34       10.36        3.64         090
                                                 lamina.
63020...........  .............  A............  Neck spine disk            16.05          NA          NA        9.87        9.77        3.72         090
                                                 surgery.
63030...........  .............  A............  Low back disk              13.03          NA          NA        8.59        8.50        3.01         090
                                                 surgery.
63035...........  .............  A............  Spinal disk surgery         3.15          NA          NA        1.19        1.39        0.79         ZZZ
                                                 add-on.
63040...........  .............  A............  Laminotomy, single         20.18          NA          NA       11.01       11.25        4.68         090
                                                 cervical.
63042...........  .............  A............  Laminotomy, single         18.61          NA          NA       10.57       10.95        4.26         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          17.82          NA          NA       10.33       10.34        3.99         090
                                                 lamina.
63046...........  .............  A............  Removal of spinal          17.12          NA          NA        9.78        9.98        3.56         090
                                                 lamina.
63047...........  .............  A............  Removal of spinal          15.22          NA          NA        9.32        9.61        3.24         090
                                                 lamina.
63048...........  .............  A............  Remove spinal lamina        3.47          NA          NA        1.32        1.49        0.72         ZZZ
                                                 add-on.
63050...........  .............  A............  Cervical                   21.88          NA          NA       11.81       11.82        4.67         090
                                                 laminoplasty.
63051...........  .............  A............  C-laminoplasty w/          25.38          NA          NA       13.07       13.26        4.67         090
                                                 graft/plate.
63055...........  .............  A............  Decompress spinal          23.42          NA          NA       12.44       12.78        5.29         090
                                                 cord.
63056...........  .............  A............  Decompress spinal          21.73          NA          NA       11.37       11.96        4.76         090
                                                 cord.
63057...........  .............  A............  Decompress spine            5.25          NA          NA        1.98        2.30        1.22         ZZZ
                                                 cord add-on.
63064...........  .............  A............  Decompress spinal          26.09          NA          NA       13.20       13.81        5.71         090
                                                 cord.
63066...........  .............  A............  Decompress spine            3.26          NA          NA        1.21        1.43        0.69         ZZZ
                                                 cord add-on.
63075...........  .............  A............  Neck spine disk            19.47          NA          NA       11.00       11.54        4.63         090
                                                 surgery.
63076...........  .............  A............  Neck spine disk             4.04          NA          NA        1.51        1.78        0.96         ZZZ
                                                 surgery.
63077...........  .............  A............  Spine disk surgery,        22.75          NA          NA       11.06       11.92        3.99         090
                                                 thorax.
63078...........  .............  A............  Spine disk surgery,         3.28          NA          NA        1.21        1.42        0.66         ZZZ
                                                 thorax.
63081...........  .............  A............  Removal of vertebral       25.97          NA          NA       13.48       13.89        5.56         090
                                                 body.
63082...........  .............  A............  Remove vertebral            4.36          NA          NA        1.64        1.93        1.02         ZZZ
                                                 body add-on.
63085...........  .............  A............  Removal of vertebral       29.34          NA          NA       13.52       14.49        4.49         090
                                                 body.
63086...........  .............  A............  Remove vertebral            3.19          NA          NA        1.17        1.38        0.59         ZZZ
                                                 body add-on.
63087...........  .............  A............  Removal of vertebral       37.38          NA          NA       16.63       18.03        6.22         090
                                                 body.
63088...........  .............  A............  Remove vertebral            4.32          NA          NA        1.59        1.88        0.82         ZZZ
                                                 body add-on.
63090...........  .............  A............  Removal of vertebral       30.78          NA          NA       14.38       15.20        4.22         090
                                                 body.
63091...........  .............  A............  Remove vertebral            3.03          NA          NA        1.14        1.30        0.48         ZZZ
                                                 body add-on.
63101...........  .............  A............  Removal of vertebral       33.92          NA          NA       17.02       18.14        5.71         090
                                                 body.

[[Page 66480]]

 
63102...........  .............  A............  Removal of vertebral       33.92          NA          NA       16.81       18.04        5.71         090
                                                 body.
63103...........  .............  A............  Remove vertebral            4.82          NA          NA        1.74        2.12        0.69         ZZZ
                                                 body add-on.
63170...........  .............  A............  Incise spinal cord         22.08          NA          NA       10.43       11.14        4.87         090
                                                 tract(s).
63172...........  .............  A............  Drainage of spinal         19.66          NA          NA       11.06       10.85        4.49         090
                                                 cyst.
63173...........  .............  A............  Drainage of spinal         24.18          NA          NA       13.55       13.17        5.70         090
                                                 cyst.
63180...........  .............  A............  Revise spinal cord         20.40          NA          NA       10.93       10.95        3.96         090
                                                 ligaments.
63182...........  .............  A............  Revise spinal cord         22.69          NA          NA        7.17        9.06        5.32         090
                                                 ligaments.
63185...........  .............  A............  Incise spinal column/      16.36          NA          NA        9.79        8.94        2.80         090
                                                 nerves.
63190...........  .............  A............  Incise spinal column/      18.76          NA          NA        9.59        9.86        3.25         090
                                                 nerves.
63191...........  .............  A............  Incise spinal column/      18.79          NA          NA        4.10        7.28        6.36         090
                                                 nerves.
63194...........  .............  A............  Incise spinal column       21.97          NA          NA       11.18       11.44        3.27         090
                                                 & cord.
63195...........  .............  A............  Incise spinal column       21.54          NA          NA       12.09       11.56        4.88         090
                                                 & cord.
63196...........  .............  A............  Incise spinal column       25.14          NA          NA       13.77       13.57        5.78         090
                                                 & cord.
63197...........  .............  A............  Incise spinal column       23.95          NA          NA        7.46        9.83        5.38         090
                                                 & cord.
63198...........  .............  A............  Incise spinal column       29.75          NA          NA        8.92        8.67        6.45         090
                                                 & cord.
63199...........  .............  A............  Incise spinal column       31.32          NA          NA        9.28       12.15        1.40         090
                                                 & cord.
63200...........  .............  A............  Release of spinal          21.31          NA          NA       12.09       11.68        4.97         090
                                                 cord.
63250...........  .............  A............  Revise spinal cord         43.73          NA          NA       20.89       20.40        9.04         090
                                                 vessels.
63251...........  .............  A............  Revise spinal cord         44.49          NA          NA       21.51       22.04       10.44         090
                                                 vessels.
63252...........  .............  A............  Revise spinal cord         44.48          NA          NA       20.85       21.53       10.67         090
                                                 vessels.
63265...........  .............  A............  Excise intraspinal         23.69          NA          NA       12.98       12.87        5.45         090
                                                 lesion.
63266...........  .............  A............  Excise intraspinal         24.55          NA          NA       13.16       13.16        5.56         090
                                                 lesion.
63267...........  .............  A............  Excise intraspinal         19.32          NA          NA       11.12       11.09        4.38         090
                                                 lesion.
63268...........  .............  A............  Excise intraspinal         19.89          NA          NA       11.24       10.80        3.70         090
                                                 lesion.
63270...........  .............  A............  Excise intraspinal         29.67          NA          NA       15.34       15.39        6.84         090
                                                 lesion.
63271...........  .............  A............  Excise intraspinal         29.79          NA          NA       15.30       15.43        6.92         090
                                                 lesion.
63272...........  .............  A............  Excise intraspinal         27.37          NA          NA       14.28       14.47        6.20         090
                                                 lesion.
63273...........  .............  A............  Excise intraspinal         26.34          NA          NA       14.06       14.19        5.76         090
                                                 lesion.
63275...........  .............  A............  Biopsy/excise spinal       25.73          NA          NA       13.73       13.74        5.82         090
                                                 tumor.
63276...........  .............  A............  Biopsy/excise spinal       25.56          NA          NA       13.50       13.58        5.85         090
                                                 tumor.
63277...........  .............  A............  Biopsy/excise spinal       22.26          NA          NA       12.11       12.31        5.03         090
                                                 tumor.
63278...........  .............  A............  Biopsy/excise spinal       21.99          NA          NA       11.91       12.14        4.56         090
                                                 tumor.
63280...........  .............  A............  Biopsy/excise spinal       30.14          NA          NA       15.86       16.08        7.29         090
                                                 tumor.
63281...........  .............  A............  Biopsy/excise spinal       29.84          NA          NA       15.85       16.00        7.19         090
                                                 tumor.
63282...........  .............  A............  Biopsy/excise spinal       28.00          NA          NA       14.99       15.15        6.78         090
                                                 tumor.
63283...........  .............  A............  Biopsy/excise spinal       26.61          NA          NA       14.67       14.65        6.28         090
                                                 tumor.
63285...........  .............  A............  Biopsy/excise spinal       37.90          NA          NA       18.07       19.00        9.21         090
                                                 tumor.
63286...........  .............  A............  Biopsy/excise spinal       37.47          NA          NA       18.69       19.28        9.24         090
                                                 tumor.
63287...........  .............  A............  Biopsy/excise spinal       39.93          NA          NA       19.59       20.00        9.42         090
                                                 tumor.
63290...........  .............  A............  Biopsy/excise spinal       40.67          NA          NA       19.26       19.92        9.05         090
                                                 tumor.
63295...........  .............  A............  Repair of                   5.25          NA          NA        1.95        2.05        1.03         ZZZ
                                                 laminectomy defect.
63300...........  .............  A............  Removal of vertebral       26.67          NA          NA       13.78       14.03        5.99         090
                                                 body.
63301...........  .............  A............  Removal of vertebral       31.42          NA          NA       14.19       14.87        5.41         090
                                                 body.
63302...........  .............  A............  Removal of vertebral       31.00          NA          NA       13.77       14.80        5.55         090
                                                 body.
63303...........  .............  A............  Removal of vertebral       33.42          NA          NA       14.98       15.94        4.69         090
                                                 body.
63304...........  .............  A............  Removal of vertebral       33.70          NA          NA       17.56       17.40        6.43         090
                                                 body.
63305...........  .............  A............  Removal of vertebral       36.09          NA          NA       16.97       17.50        5.73         090
                                                 body.
63306...........  .............  A............  Removal of vertebral       35.40          NA          NA       16.63       17.20        8.35         090
                                                 body.
63307...........  .............  A............  Removal of vertebral       34.81          NA          NA       14.81       15.80        4.47         090
                                                 body.
63308...........  .............  A............  Remove vertebral            5.24          NA          NA        1.95        2.27        1.29         ZZZ
                                                 body add-on.
63600...........  .............  A............  Remove spinal cord         15.02          NA          NA        4.03        4.71        1.52         090
                                                 lesion.
63610...........  .............  A............  Stimulation of              8.72       13.93       36.79        1.49        1.87        0.86         000
                                                 spinal cord.
63615...........  .............  A............  Remove lesion of           17.22          NA          NA        8.51        8.89        2.85         090
                                                 spinal cord.
63650...........  .............  A............  Implant                     7.57          NA          NA        2.92        3.04        0.53         090
                                                 neuroelectrodes.
63655...........  .............  A............  Implant                    11.43          NA          NA        7.62        7.25        2.44         090
                                                 neuroelectrodes.
63660...........  .............  A............  Revise/remove               6.87          NA          NA        3.42        3.51        0.78         090
                                                 neuroelectrode.
63685...........  .............  A............  Insrt/redo spine n          7.87          NA          NA        3.65        3.89        1.05         090
                                                 generator.
63688...........  .............  A............  Revise/remove               6.10          NA          NA        3.53        3.54        0.89         090
                                                 neuroreceiver.
63700...........  .............  A............  Repair of spinal           17.32          NA          NA        9.94       10.12        3.53         090
                                                 herniation.
63702...........  .............  A............  Repair of spinal           19.26          NA          NA        9.97       10.49        4.13         090
                                                 herniation.
63704...........  .............  A............  Repair of spinal           22.23          NA          NA       11.65       12.28        4.58         090
                                                 herniation.
63706...........  .............  A............  Repair of spinal           25.15          NA          NA       14.29       13.93        6.25         090
                                                 herniation.
63707...........  .............  A............  Repair spinal fluid        12.52          NA          NA        7.82        7.76        2.52         090
                                                 leakage.
63709...........  .............  A............  Repair spinal fluid        15.52          NA          NA        8.96        9.17        3.10         090
                                                 leakage.
63710...........  .............  A............  Graft repair of            15.27          NA          NA        9.18        9.10        3.41         090
                                                 spine defect.
63740...........  .............  A............  Install spinal shunt       12.50          NA          NA        8.27        7.80        2.94         090
63741...........  .............  A............  Install spinal shunt        9.02          NA          NA        4.93        4.84        1.66         090
63744...........  .............  A............  Revision of spinal          8.86          NA          NA        5.75        5.50        1.90         090
                                                 shunt.
63746...........  .............  A............  Removal of spinal           7.25          NA          NA        5.68        4.72        1.53         090
                                                 shunt.
64400...........  .............  A............  N block inj,                1.11        1.41        1.65        0.44        0.44        0.07         000
                                                 trigeminal.
64402...........  .............  A............  N block inj, facial.        1.25        1.41        1.51        0.49        0.55        0.09         000
64405...........  .............  A............  N block inj,                1.32        1.16        1.31        0.49        0.48        0.08         000
                                                 occipital.

[[Page 66481]]

 
64408...........  .............  A............  N block inj, vagus..        1.41        1.45        1.51        0.71        0.78        0.10         000
64410...........  .............  A............  N block inj, phrenic        1.43        1.92        2.21        0.56        0.51        0.09         000
64412...........  .............  A............  N block inj, spinal         1.18        2.13        2.39        0.58        0.51        0.08         000
                                                 accessor.
64413...........  .............  A............  N block inj,                1.40        1.31        1.57        0.48        0.49        0.08         000
                                                 cervical plexus.
64415...........  .............  A............  N block inj,                1.48        1.41        2.11        0.30        0.38        0.09         000
                                                 brachial plexus.
64416...........  .............  A............  N block cont infuse,        3.85          NA          NA        0.46        0.63        0.31         010
                                                 b plex.
64417...........  .............  A............  N block inj,                1.44        1.43        2.23        0.32        0.40        0.11         000
                                                 axillary.
64418...........  .............  A............  N block inj,                1.32        1.89        2.26        0.52        0.48        0.07         000
                                                 suprascapular.
64420...........  .............  A............  N block inj,                1.18        2.40        3.14        0.44        0.43        0.08         000
                                                 intercost, sng.
64421...........  .............  A............  N block inj,                1.68        3.55        4.81        0.53        0.52        0.11         000
                                                 intercost, mlt.
64425...........  .............  A............  N block inj, ilio-          1.75        1.29        1.47        0.53        0.53        0.13         000
                                                 ing/hypogi.
64430...........  .............  A............  N block inj,                1.46        2.39        2.45        0.77        0.66        0.10         000
                                                 pudendal.
64435...........  .............  A............  N block inj,                1.45        1.99        2.26        0.55        0.62        0.16         000
                                                 paracervical.
64445...........  .............  A............  N block inj,                1.48        1.62        2.15        0.50        0.50        0.10         000
                                                 sciatic, sng.
64446...........  .............  A............  N blk inj, sciatic,         3.61          NA          NA        0.48        0.74        0.20         010
                                                 cont inf.
64447...........  .............  A............  N block inj fem,            1.50          NA          NA        0.17        0.30        0.09         000
                                                 single.
64448...........  .............  A............  N block inj fem,            3.36          NA          NA        0.39        0.60        0.18         010
                                                 cont inf.
64449...........  .............  A............  N block inj, lumbar         3.24          NA          NA        0.42        0.69        0.15         010
                                                 plexus.
64450...........  .............  A............  N block, other              1.27        1.27        1.25        0.49        0.48        0.13         000
                                                 peripheral.
64470...........  .............  A............  Inj paravertebral c/        1.85        3.82        5.52        0.70        0.70        0.11         000
                                                 t.
64472...........  .............  A............  Inj paravertebral c/        1.29        1.22        1.78        0.33        0.33        0.08         ZZZ
                                                 t add-on.
64475...........  .............  A............  Inj paravertebral l/        1.41        3.64        5.26        0.58        0.60        0.10         000
                                                 s.
64476...........  .............  A............  Inj paravertebral l/        0.98        1.10        1.61        0.22        0.23        0.07         ZZZ
                                                 s add-on.
64479...........  .............  A............  Inj foramen epidural        2.20        3.75        5.62        0.81        0.85        0.12         000
                                                 c/t.
64480...........  .............  A............  Inj foramen epidural        1.54        1.55        2.19        0.39        0.43        0.10         ZZZ
                                                 add-on.
64483...........  .............  A............  Inj foramen epidural        1.90        3.81        5.85        0.75        0.79        0.11         000
                                                 l/s.
64484...........  .............  A............  Inj foramen epidural        1.33        1.62        2.45        0.32        0.35        0.08         ZZZ
                                                 add-on.
64505...........  .............  A............  N block,                    1.36        1.13        1.18        0.74        0.70        0.10         000
                                                 spenopalatine gangl.
64508...........  .............  A............  N block, carotid            1.12        2.03        2.68        0.56        0.65        0.07         000
                                                 sinus s/p.
64510...........  .............  A............  N block, stellate           1.22        1.90        2.67        0.43        0.47        0.07         000
                                                 ganglion.
64517...........  .............  A............  N block inj, hypogas        2.20        1.72        2.22        0.68        0.77        0.11         000
                                                 plxs.
64520...........  .............  A............  N block, lumbar/            1.35        2.57        3.85        0.51        0.53        0.08         000
                                                 thoracic.
64530...........  .............  A............  N block inj, celiac         1.58        2.79        3.62        0.65        0.65        0.10         000
                                                 pelus.
64550...........  .............  A............  Apply                       0.18        0.20        0.24        0.05        0.05        0.01         000
                                                 neurostimulator.
64553...........  .............  A............  Implant                     2.33        2.64        2.74        1.44        1.65        0.18         010
                                                 neuroelectrodes.
64555...........  .............  A............  Implant                     2.29        2.78        2.94        1.49        1.34        0.19         010
                                                 neuroelectrodes.
64560...........  .............  A............  Implant                     2.38        2.41        2.52        1.26        1.27        0.22         010
                                                 neuroelectrodes.
64561...........  .............  A............  Implant                     7.07       19.59       24.81        3.76        3.26        0.51         010
                                                 neuroelectrodes.
64565...........  .............  A............  Implant                     1.78        2.47        2.87        1.29        1.27        0.13         010
                                                 neuroelectrodes.
64573...........  .............  A............  Implant                     8.15          NA          NA        5.16        5.20        1.60         090
                                                 neuroelectrodes.
64575...........  .............  A............  Implant                     4.37          NA          NA        2.05        2.36        0.61         090
                                                 neuroelectrodes.
64577...........  .............  A............  Implant                     4.64          NA          NA        4.78        4.03        1.04         090
                                                 neuroelectrodes.
64580...........  .............  A............  Implant                     4.14          NA          NA        2.70        3.13        0.36         090
                                                 neuroelectrodes.
64581...........  .............  A............  Implant                    14.15          NA          NA        6.60        5.98        1.05         090
                                                 neuroelectrodes.
64585...........  .............  A............  Revise/remove               2.08        5.91        8.59        2.28        2.21        0.20         010
                                                 neuroelectrode.
64590...........  .............  A............  Insrt/redo pn/gastr         2.42        6.40        6.77        2.45        2.37        0.19         010
                                                 stimul.
64595...........  .............  A............  Revise/rmv pn/gastr         1.75        6.44        8.41        2.17        2.05        0.19         010
                                                 stimul.
64600...........  .............  A............  Injection treatment         3.46        5.42        7.38        1.63        1.64        0.34         010
                                                 of nerve.
64605...........  .............  A............  Injection treatment         5.62        7.21        8.38        2.26        2.22        0.79         010
                                                 of nerve.
64610...........  .............  A............  Injection treatment         7.17        9.17        9.01        3.43        3.57        1.58         010
                                                 of nerve.
64612...........  .............  A............  Destroy nerve, face         1.98        1.58        2.03        1.33        1.32        0.11         010
                                                 muscle.
64613...........  .............  A............  Destroy nerve, neck         1.98        1.37        2.15        1.14        1.18        0.11         010
                                                 muscle.
64614...........  .............  A............  Destroy nerve,              2.20        1.61        2.42        1.30        1.31        0.10         010
                                                 extrem musc.
64620...........  .............  A............  Injection treatment         2.86        3.30        4.18        1.11        1.22        0.20         010
                                                 of nerve.
64622...........  .............  A............  Destr paravertebrl          3.02        4.05        5.90        1.25        1.31        0.18         010
                                                 nerve l/s.
64623...........  .............  A............  Destr paravertebral         0.99        1.68        2.32        0.22        0.22        0.06         ZZZ
                                                 n add-on.
64626...........  .............  A............  Destr paravertebrl          3.82        4.74        6.25        1.87        1.92        0.20         010
                                                 nerve c/t.
64627...........  .............  A............  Destr paravertebral         1.16        2.37        3.45        0.25        0.26        0.07         ZZZ
                                                 n add-on.
64630...........  .............  A............  Injection treatment         3.02        2.76        2.75        1.84        1.62        0.22         010
                                                 of nerve.
64640...........  .............  A............  Injection treatment         2.78        2.42        3.30        1.42        1.63        0.29         010
                                                 of nerve.
64650...........  .............  A............  Chemodenerv eccrine         0.70        0.72        0.79        0.16        0.23        0.06         000
                                                 glands.
64653...........  .............  A............  Chemodenerv eccrine         0.88        0.75        0.83        0.19        0.28        0.08         000
                                                 glands.
64680...........  .............  A............  Injection treatment         2.64        4.25        5.48        1.20        1.31        0.18         010
                                                 of nerve.
64681...........  .............  A............  Injection treatment         3.78        4.81        7.05        1.27        1.67        0.28         010
                                                 of nerve.
64702...........  .............  A............  Revise finger/toe           6.10          NA          NA        5.19        4.52        0.61         090
                                                 nerve.
64704...........  .............  A............  Revise hand/foot            4.61          NA          NA        3.28        3.29        0.61         090
                                                 nerve.
64708...........  .............  A............  Revise arm/leg nerve        6.22          NA          NA        4.20        4.53        0.96         090
64712...........  .............  A............  Revision of sciatic         7.98          NA          NA        4.37        4.66        0.95         090
                                                 nerve.
64713...........  .............  A............  Revision of arm            11.29          NA          NA        6.04        5.96        1.83         090
                                                 nerve(s).
64714...........  .............  A............  Revise low back            10.44          NA          NA        4.36        4.28        1.19         090
                                                 nerve(s).
64716...........  .............  A............  Revision of cranial         6.86          NA          NA        5.45        5.71        0.63         090
                                                 nerve.
64718...........  .............  A............  Revise ulnar nerve          7.06          NA          NA        6.20        6.09        1.05         090
                                                 at elbow.

[[Page 66482]]

 
64719...........  .............  A............  Revise ulnar nerve          4.89          NA          NA        4.14        4.33        0.77         090
                                                 at wrist.
64721...........  .............  A............  Carpal tunnel               4.84        4.70        5.03        4.65        5.00        0.73         090
                                                 surgery.
64722...........  .............  A............  Relieve pressure on         4.74          NA          NA        2.99        3.02        0.48         090
                                                 nerve(s).
64726...........  .............  A............  Release foot/toe            4.21          NA          NA        2.80        2.79        0.54         090
                                                 nerve.
64727...........  .............  A............  Internal nerve              3.10          NA          NA        1.19        1.34        0.48         ZZZ
                                                 revision.
64732...........  .............  A............  Incision of brow            4.81          NA          NA        3.66        3.58        0.98         090
                                                 nerve.
64734...........  .............  A............  Incision of cheek           5.45          NA          NA        4.43        4.24        0.89         090
                                                 nerve.
64736...........  .............  A............  Incision of chin            5.13          NA          NA        3.72        3.87        0.52         090
                                                 nerve.
64738...........  .............  A............  Incision of jaw             6.26          NA          NA        4.64        4.62        1.08         090
                                                 nerve.
64740...........  .............  A............  Incision of tongue          6.12          NA          NA        4.98        5.05        0.69         090
                                                 nerve.
64742...........  .............  A............  Incision of facial          6.75          NA          NA        4.28        4.49        0.73         090
                                                 nerve.
64744...........  .............  A............  Incise nerve, back          5.64          NA          NA        4.04        3.90        1.16         090
                                                 of head.
64746...........  .............  A............  Incise diaphragm            6.46          NA          NA        3.86        4.18        0.82         090
                                                 nerve.
64752...........  .............  A............  Incision of vagus           7.59          NA          NA        3.79        4.03        0.93         090
                                                 nerve.
64755...........  .............  A............  Incision of stomach        14.97          NA          NA        5.50        5.56        1.84         090
                                                 nerves.
64760...........  .............  A............  Incision of vagus           7.49          NA          NA        3.78        3.61        0.81         090
                                                 nerve.
64761...........  .............  A............  Incision of pelvis          6.94          NA          NA        4.32        3.92        0.53         090
                                                 nerve.
64763...........  .............  A............  Incise hip/thigh            7.46          NA          NA        3.91        4.55        0.94         090
                                                 nerve.
64766...........  .............  A............  Incise hip/thigh            9.34          NA          NA        4.73        4.99        1.06         090
                                                 nerve.
64771...........  .............  A............  Sever cranial nerve.        8.02          NA          NA        5.63        5.59        1.23         090
64772...........  .............  A............  Incision of spinal          7.74          NA          NA        5.12        5.01        1.40         090
                                                 nerve.
64774...........  .............  A............  Remove skin nerve           5.70          NA          NA        4.03        3.93        0.74         090
                                                 lesion.
64776...........  .............  A............  Remove digit nerve          5.52          NA          NA        3.72        3.70        0.76         090
                                                 lesion.
64778...........  .............  A............  Digit nerve surgery         3.11          NA          NA        1.21        1.35        0.46         ZZZ
                                                 add-on.
64782...........  .............  A............  Remove limb nerve           6.76          NA          NA        4.22        3.99        0.86         090
                                                 lesion.
64783...........  .............  A............  Limb nerve surgery          3.71          NA          NA        1.36        1.60        0.51         ZZZ
                                                 add-on.
64784...........  .............  A............  Remove nerve lesion.       10.49          NA          NA        6.40        6.49        1.38         090
64786...........  .............  A............  Remove sciatic nerve       16.12          NA          NA        8.43        9.13        2.61         090
                                                 lesion.
64787...........  .............  A............  Implant nerve end...        4.29          NA          NA        1.64        1.88        0.58         ZZZ
64788...........  .............  A............  Remove skin nerve           5.14          NA          NA        4.05        3.76        0.73         090
                                                 lesion.
64790...........  .............  A............  Removal of nerve           11.97          NA          NA        6.97        7.08        2.11         090
                                                 lesion.
64792...........  .............  A............  Removal of nerve           15.71          NA          NA        8.29        8.56        2.49         090
                                                 lesion.
64795...........  .............  A............  Biopsy of nerve.....        3.01          NA          NA        1.43        1.49        0.52         000
64802...........  .............  A............  Remove sympathetic         10.24          NA          NA        3.50        4.31        1.29         090
                                                 nerves.
64804...........  .............  A............  Remove sympathetic         15.78          NA          NA        5.96        6.56        2.15         090
                                                 nerves.
64809...........  .............  A............  Remove sympathetic         14.61          NA          NA        7.03        6.39        1.50         090
                                                 nerves.
64818...........  .............  A............  Remove sympathetic         11.24          NA          NA        4.32        4.80        1.33         090
                                                 nerves.
64820...........  .............  A............  Remove sympathetic         10.64          NA          NA        6.93        7.02        1.49         090
                                                 nerves.
64821...........  .............  A............  Remove sympathetic          9.19          NA          NA        6.53        6.93        1.24         090
                                                 nerves.
64822...........  .............  A............  Remove sympathetic          9.19          NA          NA        6.42        6.82        1.30         090
                                                 nerves.
64823...........  .............  A............  Remove sympathetic         10.80          NA          NA        6.46        7.29        1.57         090
                                                 nerves.
64831...........  .............  A............  Repair of digit            10.23          NA          NA        6.61        6.84        1.41         090
                                                 nerve.
64832...........  .............  A............  Repair nerve add-on.        5.65          NA          NA        2.31        2.62        0.85         ZZZ
64834...........  .............  A............  Repair of hand or          10.71          NA          NA        6.44        6.76        1.54         090
                                                 foot nerve.
64835...........  .............  A............  Repair of hand or          11.60          NA          NA        6.90        7.29        1.74         090
                                                 foot nerve.
64836...........  .............  A............  Repair of hand or          11.60          NA          NA        7.06        7.36        1.68         090
                                                 foot nerve.
64837...........  .............  A............  Repair nerve add-on.        6.25          NA          NA        2.57        2.90        0.97         ZZZ
64840...........  .............  A............  Repair of leg nerve.       13.87          NA          NA        7.51        7.88        1.37         090
64856...........  .............  A............  Repair/transpose           14.94          NA          NA        8.47        8.83        2.13         090
                                                 nerve.
64857...........  .............  A............  Repair arm/leg nerve       15.69          NA          NA        8.75        9.19        2.22         090
64858...........  .............  A............  Repair sciatic nerve       17.69          NA          NA        9.55       10.16        3.34         090
64859...........  .............  A............  Nerve surgery.......        4.25          NA          NA        1.75        1.97        0.67         ZZZ
64861...........  .............  A............  Repair of arm nerves       20.74          NA          NA       10.00       10.88        4.09         090
64862...........  .............  A............  Repair of low back         20.94          NA          NA       10.12       11.02        4.32         090
                                                 nerves.
64864...........  .............  A............  Repair of facial           13.31          NA          NA        7.46        8.11        1.26         090
                                                 nerve.
64865...........  .............  A............  Repair of facial           15.96          NA          NA       11.52       12.52        1.50         090
                                                 nerve.
64866...........  .............  A............  Fusion of facial/          16.70          NA          NA       11.09       12.13        2.05         090
                                                 other nerve.
64868...........  .............  A............  Fusion of facial/          14.80          NA          NA        9.78       10.60        1.43         090
                                                 other nerve.
64870...........  .............  A............  Fusion of facial/          16.95          NA          NA        8.05        8.39        1.30         090
                                                 other nerve.
64872...........  .............  A............  Subsequent repair of        1.99          NA          NA        0.78        0.93        0.29         ZZZ
                                                 nerve.
64874...........  .............  A............  Repair & revise             2.98          NA          NA        1.26        1.39        0.42         ZZZ
                                                 nerve add-on.
64876...........  .............  A............  Repair nerve/shorten        3.37          NA          NA        1.42        1.58        0.47         ZZZ
                                                 bone.
64885...........  .............  A............  Nerve graft, head or       17.50          NA          NA        8.94       10.26        1.63         090
                                                 neck.
64886...........  .............  A............  Nerve graft, head or       20.72          NA          NA       10.36       11.95        2.09         090
                                                 neck.
64890...........  .............  A............  Nerve graft, hand or       16.11          NA          NA        8.97        9.48        2.30         090
                                                 foot.
64891...........  .............  A............  Nerve graft, hand or       17.22          NA          NA        9.65        8.61        1.63         090
                                                 foot.
64892...........  .............  A............  Nerve graft, arm or        15.61          NA          NA        9.12        8.99        2.48         090
                                                 leg.
64893...........  .............  A............  Nerve graft, arm or        16.74          NA          NA        9.62        9.74        2.62         090
                                                 leg.
64895...........  .............  A............  Nerve graft, hand or       20.26          NA          NA       11.03       10.34        2.58         090
                                                 foot.
64896...........  .............  A............  Nerve graft, hand or       21.81          NA          NA       11.65       11.31        3.17         090
                                                 foot.
64897...........  .............  A............  Nerve graft, arm or        19.25          NA          NA       10.49       10.58        2.55         090
                                                 leg.
64898...........  .............  A............  Nerve graft, arm or        20.82          NA          NA       11.45       11.61        2.78         090
                                                 leg.

[[Page 66483]]

 
64901...........  .............  A............  Nerve graft add-on..       10.20          NA          NA        3.62        4.44        1.37         ZZZ
64902...........  .............  A............  Nerve graft add-on..       11.81          NA          NA        4.65        5.31        1.55         ZZZ
64905...........  .............  A............  Nerve pedicle              14.98          NA          NA        6.99        7.74        2.01         090
                                                 transfer.
64907...........  .............  A............  Nerve pedicle              19.90          NA          NA        6.35        9.43        3.17         090
                                                 transfer.
64910...........  .............  A............  Nerve repair w/            11.21          NA          NA        4.66        4.66        1.74         090
                                                 allograft.
64911...........  .............  A............  Neurorraphy w/vein         14.21          NA          NA        5.31        5.31        1.91         090
                                                 autograft.
64999...........  .............  C............  Nervous system              0.00        0.00        0.00        0.00        0.00        0.00         YYY
                                                 surgery.
65091...........  .............  A............  Revise eye..........        7.13          NA          NA        6.72        7.53        0.32         090
65093...........  .............  A............  Revise eye with             6.93          NA          NA        6.78        7.75        0.34         090
                                                 implant.
65101...........  .............  A............  Removal of eye......        8.10          NA          NA        7.95        8.74        0.35         090
65103...........  .............  A............  Remove eye/insert           8.64          NA          NA        8.11        8.92        0.37         090
                                                 implant.
65105...........  .............  A............  Remove eye/attach           9.70          NA          NA        8.76        9.61        0.42         090
                                                 implant.
65110...........  .............  A............  Removal of eye......       15.42          NA          NA       11.41       12.54        0.81         090
65112...........  .............  A............  Remove eye/revise          18.18          NA          NA       13.29       14.71        1.30         090
                                                 socket.
65114...........  .............  A............  Remove eye/revise          19.32          NA          NA       13.55       14.94        1.02         090
                                                 socket.
65125...........  .............  A............  Revise ocular               3.18        6.70        7.75        3.16        3.38        0.19         090
                                                 implant.
65130...........  .............  A............  Insert ocular               8.22          NA          NA        7.67        8.41        0.35         090
                                                 implant.
65135...........  .............  A............  Insert ocular               8.40          NA          NA        7.73        8.52        0.36         090
                                                 implant.
65140...........  .............  A............  Attach ocular               9.23          NA          NA        8.37        9.12        0.40         090
                                                 implant.
65150...........  .............  A............  Revise ocular               6.32          NA          NA        6.29        7.12        0.31         090
                                                 implant.
65155...........  .............  A............  Reinsert ocular             9.87          NA          NA        8.76        9.62        0.50         090
                                                 implant.
65175...........  .............  A............  Removal of ocular           7.22          NA          NA        7.04        7.75        0.31         090
                                                 implant.
65205...........  .............  A............  Remove foreign body         0.71        0.57        0.60        0.32        0.30        0.03         000
                                                 from eye.
65210...........  .............  A............  Remove foreign body         0.84        0.71        0.76        0.39        0.38        0.04         000
                                                 from eye.
65220...........  .............  A............  Remove foreign body         0.71        0.59        0.62        0.28        0.28        0.05         000
                                                 from eye.
65222...........  .............  A............  Remove foreign body         0.93        0.78        0.83        0.41        0.39        0.04         000
                                                 from eye.
65235...........  .............  A............  Remove foreign body         8.78          NA          NA        6.77        6.76        0.37         090
                                                 from eye.
65260...........  .............  A............  Remove foreign body        12.29          NA          NA        8.73        9.19        0.57         090
                                                 from eye.
65265...........  .............  A............  Remove foreign body        14.06          NA          NA        9.58       10.10        0.62         090
                                                 from eye.
65270...........  .............  A............  Repair of eye wound.        1.92        3.82        4.52        1.20        1.29        0.09         010
65272...........  .............  A............  Repair of eye wound.        4.49        6.29        7.00        3.15        3.22        0.19         090
65273...........  .............  A............  Repair of eye wound.        5.03          NA          NA        3.36        3.47        0.22         090
65275...........  .............  A............  Repair of eye wound.        6.14        6.29        6.30        3.89        3.92        0.26         090
65280...........  .............  A............  Repair of eye wound.        8.87          NA          NA        5.83        6.03        0.38         090
65285...........  .............  A............  Repair of eye wound.       14.43          NA          NA        8.38        8.79        0.64         090
65286...........  .............  A............  Repair of eye wound.        6.45        8.69        9.91        4.38        4.49        0.27         090
65290...........  .............  A............  Repair of eye socket        6.35          NA          NA        4.43        4.58        0.31         090
                                                 wound.
65400...........  .............  A............  Removal of eye              7.27        7.43        7.88        5.83        5.98        0.30         090
                                                 lesion.
65410...........  .............  A............  Biopsy of cornea....        1.47        1.66        1.89        0.86        0.91        0.07         000
65420...........  .............  A............  Removal of eye              4.24        6.84        7.85        3.95        4.19        0.21         090
                                                 lesion.
65426...........  .............  A............  Removal of eye              5.93        8.08        9.12        4.49        4.70        0.25         090
                                                 lesion.
65430...........  .............  A............  Corneal smear.......        1.47        1.08        1.18        0.86        0.92        0.07         000
65435...........  .............  A............  Curette/treat cornea        0.92        0.85        0.93        0.64        0.68        0.04         000
65436...........  .............  A............  Curette/treat cornea        4.72        3.75        3.92        3.43        3.55        0.21         090
65450...........  .............  A............  Treatment of corneal        3.35        3.67        3.87        3.59        3.76        0.16         090
                                                 lesion.
65600...........  .............  A............  Revision of cornea..        4.07        4.42        4.71        3.38        3.36        0.17         090
65710...........  .............  A............  Corneal transplant..       14.09          NA          NA       10.13       10.66        0.61         090
65730...........  .............  A............  Corneal transplant..       15.99          NA          NA       10.94       11.48        0.70         090
65750...........  .............  A............  Corneal transplant..       16.60          NA          NA       10.60       11.28        0.74         090
65755...........  .............  A............  Corneal transplant..       16.49          NA          NA       10.56       11.22        0.73         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         19.41          NA          NA       11.64       12.42        0.87         090
                                                 implant.
65771...........  .............  N............  Radial keratotomy...        0.00        0.00        0.00        0.00        0.00        0.00         XXX
65772...........  .............  A............  Correction of               4.96        4.84        5.18        3.91        4.02        0.21         090
                                                 astigmatism.
65775...........  .............  A............  Correction of               6.73          NA          NA        5.29        5.62        0.28         090
                                                 astigmatism.
65780...........  .............  A............  Ocular reconst,            10.43          NA          NA        8.91        9.60        0.44         090
                                                 transplant.
65781...........  .............  A............  Ocular reconst,            17.84          NA          NA       11.56       12.61        0.44         090
                                                 transplant.
65782...........  .............  A............  Ocular reconst,            15.16          NA          NA       10.17       11.08        0.44         090
                                                 transplant.
65800...........  .............  A............  Drainage of eye.....        1.91        1.39        1.59        1.02        1.10        0.09         000
65805...........  .............  A............  Drainage of eye.....        1.91        1.69        1.93        1.02        1.10        0.09         000
65810...........  .............  A............  Drainage of eye.....        5.67          NA          NA        4.66        4.68        0.24         090
65815...........  .............  A............  Drainage of eye.....        5.85        7.90        8.95        4.57        4.69        0.25         090
65820...........  .............  A............  Relieve inner eye           8.72          NA          NA        7.49        8.27        0.40         090
                                                 pressure.
65850...........  .............  A............  Incision of eye.....       11.24          NA          NA        7.31        7.87        0.52         090
65855...........  .............  A............  Laser surgery of eye        3.90        3.48        3.89        2.62        2.86        0.19         010
65860...........  .............  A............  Incise inner eye            3.56        3.25        3.64        2.07        2.29        0.18         090
                                                 adhesions.
65865...........  .............  A............  Incise inner eye            5.66          NA          NA        4.68        5.15        0.28         090
                                                 adhesions.
65870...........  .............  A............  Incise inner eye            7.21          NA          NA        5.69        6.05        0.31         090
                                                 adhesions.
65875...........  .............  A............  Incise inner eye            7.61          NA          NA        6.12        6.45        0.32         090
                                                 adhesions.
65880...........  .............  A............  Incise inner eye            8.16          NA          NA        6.29        6.66        0.35         090
                                                 adhesions.

[[Page 66484]]

 
65900...........  .............  A............  Remove eye lesion...       12.26          NA          NA        8.88        9.56        0.54         090
65920...........  .............  A............  Remove implant of           9.74          NA          NA        7.45        7.81        0.41         090
                                                 eye.
65930...........  .............  A............  Remove blood clot           8.24          NA          NA        5.76        6.30        0.37         090
                                                 from eye.
66020...........  .............  A............  Injection treatment         1.61        2.42        2.77        1.27        1.35        0.08         010
                                                 of eye.
66030...........  .............  A............  Injection treatment         1.27        2.29        2.63        1.15        1.21        0.06         010
                                                 of eye.
66130...........  .............  A............  Remove eye lesion...        7.74        7.50        8.56        4.86        5.23        0.38         090
66150...........  .............  A............  Glaucoma surgery....       10.18          NA          NA        8.80        9.10        0.46         090
66155...........  .............  A............  Glaucoma surgery....       10.17          NA          NA        8.80        9.07        0.41         090
66160...........  .............  A............  Glaucoma surgery....       12.04          NA          NA        9.46        9.82        0.50         090
66165...........  .............  A............  Glaucoma surgery....        9.89          NA          NA        8.76        9.00        0.40         090
66170...........  .............  A............  Glaucoma surgery....       14.57          NA          NA       11.52       11.87        0.60         090
66172...........  .............  A............  Incision of eye.....       18.26          NA          NA       14.61       14.90        0.74         090
66180...........  .............  A............  Implant eye shunt...       16.02          NA          NA        9.68       10.21        0.71         090
66185...........  .............  A............  Revise eye shunt....        9.35          NA          NA        7.03        7.20        0.40         090
66220...........  .............  A............  Repair eye lesion...        8.98          NA          NA        7.16        7.13        0.40         090
66225...........  .............  A............  Repair/graft eye           12.38          NA          NA        8.10        8.42        0.55         090
                                                 lesion.
66250...........  .............  A............  Follow-up surgery of        6.92        9.22       10.45        5.24        5.36        0.30         090
                                                 eye.
66500...........  .............  A............  Incision of iris....        3.75          NA          NA        3.94        4.29        0.18         090
66505...........  .............  A............  Incision of iris....        4.13          NA          NA        4.30        4.64        0.20         090
66600...........  .............  A............  Remove iris and             9.89          NA          NA        8.24        8.23        0.43         090
                                                 lesion.
66605...........  .............  A............  Removal of iris.....       13.99          NA          NA        9.44        9.73        0.77         090
66625...........  .............  A............  Removal of iris.....        5.19          NA          NA        4.20        4.46        0.26         090
66630...........  .............  A............  Removal of iris.....        7.10          NA          NA        5.33        5.52        0.31         090
66635...........  .............  A............  Removal of iris.....        7.19          NA          NA        5.36        5.55        0.31         090
66680...........  .............  A............  Repair iris &               6.24          NA          NA        5.05        5.16        0.27         090
                                                 ciliary body.
66682...........  .............  A............  Repair iris &               7.15          NA          NA        6.70        6.65        0.31         090
                                                 ciliary body.
66700...........  .............  A............  Destruction, ciliary        5.06        4.77        5.01        3.58        3.76        0.24         090
                                                 body.
66710...........  .............  A............  Ciliary transsleral         5.06        4.59        4.88        3.59        3.72        0.23         090
                                                 therapy.
66711...........  .............  A............  Ciliary endoscopic          7.70          NA          NA        6.28        6.37        0.30         090
                                                 ablation.
66720...........  .............  A............  Destruction, ciliary        4.86        5.36        5.58        4.31        4.51        0.26         090
                                                 body.
66740...........  .............  A............  Destruction, ciliary        5.06        4.52        4.80        3.60        3.78        0.23         090
                                                 body.
66761...........  .............  A............  Revision of iris....        4.87        5.01        5.30        4.18        4.24        0.20         090
66762...........  .............  A............  Revision of iris....        5.25        5.09        5.37        4.06        4.17        0.23         090
66770...........  .............  A............  Removal of inner eye        5.98        5.52        5.80        4.58        4.69        0.26         090
                                                 lesion.
66820...........  .............  A............  Incision, secondary         3.93          NA          NA        4.61        5.21        0.19         090
                                                 cataract.
66821...........  .............  A............  After cataract laser        3.32        3.82        3.95        3.41        3.51        0.11         090
                                                 surgery.
66825...........  .............  A............  Reposition                  8.82          NA          NA        7.76        8.41        0.40         090
                                                 intraocular lens.
66830...........  .............  A............  Removal of lens             9.27          NA          NA        6.36        6.65        0.36         090
                                                 lesion.
66840...........  .............  A............  Removal of lens             8.98          NA          NA        6.28        6.57        0.39         090
                                                 material.
66850...........  .............  A............  Removal of lens            10.32          NA          NA        7.06        7.35        0.45         090
                                                 material.
66852...........  .............  A............  Removal of lens            11.18          NA          NA        7.38        7.73        0.49         090
                                                 material.
66920...........  .............  A............  Extraction of lens..        9.93          NA          NA        6.63        6.96        0.44         090
66930...........  .............  A............  Extraction of lens..       11.38          NA          NA        7.44        7.79        0.49         090
66940...........  .............  A............  Extraction of lens..       10.14          NA          NA        6.99        7.29        0.43         090
66982...........  .............  A............  Cataract surgery,          14.83          NA          NA        8.94        9.40        0.63         090
                                                 complex.
66983...........  .............  A............  Cataract surg w/iol,       10.20          NA          NA        6.50        6.31        0.14         090
                                                 1 stage.
66984...........  .............  A............  Cataract surg w/iol,       10.36          NA          NA        6.44        6.93        0.39         090
                                                 1 stage.
66985...........  .............  A............  Insert lens                 9.73          NA          NA        7.12        7.28        0.36         090
                                                 prosthesis.
66986...........  .............  A............  Exchange lens              12.26          NA          NA        8.04        8.61        0.60         090
                                                 prosthesis.
66990...........  .............  A............  Ophthalmic endoscope        1.51          NA          NA        0.54        0.61        0.07         ZZZ
                                                 add-on.
66999...........  .............  C............  Eye surgery                 0.00        0.00        0.00        0.00        0.00        0.00         YYY
                                                 procedure.
67005...........  .............  A............  Partial removal of          5.77          NA          NA        4.57        4.71        0.28         090
                                                 eye fluid.
67010...........  .............  A............  Partial removal of          6.94          NA          NA        4.99        5.20        0.34         090
                                                 eye fluid.
67015...........  .............  A............  Release of eye fluid        7.00          NA          NA        5.69        6.07        0.34         090
67025...........  .............  A............  Replace eye fluid...        7.91        7.85        8.53        5.91        6.06        0.34         090
67027...........  .............  A............  Implant eye drug           11.43          NA          NA        7.36        7.67        0.54         090
                                                 system.
67028...........  .............  A............  Injection eye drug..        2.52        2.15        2.42        1.24        1.35        0.12         000
67030...........  .............  A............  Incise inner eye            5.91          NA          NA        5.59        5.72        0.24         090
                                                 strands.
67031...........  .............  A............  Laser surgery, eye          4.34        4.09        4.34        3.42        3.53        0.18         090
                                                 strands.
67036...........  .............  A............  Removal of inner eye       13.09          NA          NA        8.05        8.58        0.58         090
                                                 fluid.
67039...........  .............  A............  Laser treatment of         16.39          NA          NA       10.68       11.43        0.71         090
                                                 retina.
67040...........  .............  A............  Laser treatment of         19.23          NA          NA       11.98       12.83        0.85         090
                                                 retina.
67041...........  .............  A............  Vit for macular            19.00          NA          NA       10.36       10.36        0.86         090
                                                 pucker.
67042...........  .............  A............  Vit for macular hole       22.13          NA          NA       11.48       11.48        1.00         090
67043...........  .............  A............  Vit for membrane           22.94          NA          NA       12.34       12.34        1.04         090
                                                 dissect.
67101...........  .............  A............  Repair detached             8.60        8.48        8.80        6.16        6.34        0.37         090
                                                 retina.
67105...........  .............  A............  Repair detached             8.35        7.40        7.74        5.78        5.96        0.37         090
                                                 retina.
67107...........  .............  A............  Repair detached            16.35          NA          NA       10.33       10.81        0.73         090
                                                 retina.
67108...........  .............  A............  Repair detached            22.49          NA          NA       12.92       13.66        1.02         090
                                                 retina.
67110...........  .............  A............  Repair detached            10.02        8.91        9.57        6.95        7.17        0.44         090
                                                 retina.
67112...........  .............  A............  Rerepair detached          18.45          NA          NA       10.84       11.32        0.83         090
                                                 retina.
67113...........  .............  A............  Repair retinal             22.49          NA          NA       12.75       12.75        1.13         090
                                                 detach, cplx.

[[Page 66485]]

 
67115...........  .............  A............  Release encircling          5.93          NA          NA        4.92        5.00        0.25         090
                                                 material.
67120...........  .............  A............  Remove eye implant          6.92        7.34        7.96        5.27        5.40        0.29         090
                                                 material.
67121...........  .............  A............  Remove eye implant         12.00          NA          NA        7.94        8.23        0.53         090
                                                 material.
67141...........  .............  A............  Treatment of retina.        6.00        5.40        5.63        4.65        4.75        0.26         090
67145...........  .............  A............  Treatment of retina.        6.17        5.33        5.53        4.70        4.81        0.27         090
67208...........  .............  A............  Treatment of retinal        7.50        5.64        5.88        5.19        5.35        0.33         090
                                                 lesion.
67210...........  .............  A............  Treatment of retinal        9.35        5.91        6.24        5.43        5.65        0.44         090
                                                 lesion.
67218...........  .............  A............  Treatment of retinal       20.22          NA          NA       10.60       11.37        0.92         090
                                                 lesion.
67220...........  .............  A............  Treatment of choroid       14.19        9.20        9.81        8.15        8.58        0.65         090
                                                 lesion.
67221...........  .............  R............  Ocular photodynamic         3.45        2.91        3.62        1.38        1.59        0.20         000
                                                 ther.
67225...........  .............  A............  Eye photodynamic            0.47        0.22        0.24        0.17        0.19        0.02         ZZZ
                                                 ther add-on.
67227...........  .............  A............  Treatment of retinal        7.38        5.99        6.28        5.15        5.34        0.33         090
                                                 lesion.
67228...........  .............  A............  Treatment of retinal       13.67       13.58       12.52       10.18        9.36        0.63         090
                                                 lesion.
67229...........  .............  A............  Tr retinal les             16.00          NA          NA        9.51        9.51        0.71         090
                                                 preterm inf.
67250...........  .............  A............  Reinforce eye wall..        9.46          NA          NA        7.66        8.41        0.47         090
67255...........  .............  A............  Reinforce/graft eye         9.97          NA          NA        8.42        9.15        0.44         090
                                                 wall.
67299...........  .............  C............  Eye surgery                 0.00        0.00        0.00        0.00        0.00        0.00         YYY
                                                 procedure.
67311...........  .............  A............  Revise eye muscle...        7.59          NA          NA        5.49        5.76        0.37         090
67312...........  .............  A............  Revise two eye              9.48          NA          NA        6.19        6.47        0.43         090
                                                 muscles.
67314...........  .............  A............  Revise eye muscle...        8.59          NA          NA        6.15        6.35        0.39         090
67316...........  .............  A............  Revise two eye             10.73          NA          NA        6.91        7.20        0.49         090
                                                 muscles.
67318...........  .............  A............  Revise eye muscle(s)        8.92          NA          NA        6.50        6.71        0.41         090
67320...........  .............  A............  Revise eye muscle(s)        5.40          NA          NA        1.92        1.94        0.22         ZZZ
                                                 add-on.
67331...........  .............  A............  Eye surgery follow-         5.13          NA          NA        1.81        1.82        0.21         ZZZ
                                                 up add-on.
67332...........  .............  A............  Rerevise eye muscles        5.56          NA          NA        1.97        2.00        0.23         ZZZ
                                                 add-on.
67334...........  .............  A............  Revise eye muscle w/        5.05          NA          NA        1.80        1.80        0.20         ZZZ
                                                 suture.
67335...........  .............  A............  Eye suture during           2.49          NA          NA        0.88        1.00        0.13         ZZZ
                                                 surgery.
67340...........  .............  A............  Revise eye muscle           6.00          NA          NA        2.13        2.17        0.25         ZZZ
                                                 add-on.
67343...........  .............  A............  Release eye tissue..        8.29          NA          NA        6.06        6.28        0.37         090
67345...........  .............  A............  Destroy nerve of eye        2.98        2.17        2.38        1.69        1.85        0.17         010
                                                 muscle.
67346...........  .............  A............  Biopsy, eye muscle..        2.87          NA          NA        1.62        1.75        0.15         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         10.97          NA          NA        9.41       10.33        0.56         090
                                                 socket.
67405...........  .............  A............  Explore/drain eye           9.00          NA          NA        8.33        9.05        0.44         090
                                                 socket.
67412...........  .............  A............  Explore/treat eye          10.17          NA          NA        8.52        9.72        0.48         090
                                                 socket.
67413...........  .............  A............  Explore/treat eye          10.09          NA          NA        8.69        9.73        0.50         090
                                                 socket.
67414...........  .............  A............  Explr/decompress eye       17.78          NA          NA       11.62       11.83        0.65         090
                                                 socket.
67415...........  .............  A............  Aspiration, orbital         1.76          NA          NA        0.62        0.69        0.09         000
                                                 contents.
67420...........  .............  A............  Explore/treat eye          21.62          NA          NA       14.22       15.80        1.15         090
                                                 socket.
67430...........  .............  A............  Explore/treat eye          14.99          NA          NA       11.86       13.37        0.86         090
                                                 socket.
67440...........  .............  A............  Explore/drain eye          14.56          NA          NA       11.86       13.06        0.70         090
                                                 socket.
67445...........  .............  A............  Explr/decompress eye       18.96          NA          NA       12.13       13.02        0.90         090
                                                 socket.
67450...........  .............  A............  Explore/biopsy eye         15.11          NA          NA       12.29       13.48        0.68         090
                                                 socket.
67500...........  .............  A............  Inject/treat eye            1.44        0.57        0.62        0.44        0.37        0.05         000
                                                 socket.
67505...........  .............  A............  Inject/treat eye            1.27        0.65        0.67        0.50        0.41        0.05         000
                                                 socket.
67515...........  .............  A............  Inject/treat eye            1.40        0.77        0.68        0.61        0.49        0.03         000
                                                 socket.
67550...........  .............  A............  Insert eye socket          11.52          NA          NA        9.81       10.55        0.72         090
                                                 implant.
67560...........  .............  A............  Revise eye socket          11.93          NA          NA        9.77       10.57        0.60         090
                                                 implant.
67570...........  .............  A............  Decompress optic           14.21          NA          NA       11.00       12.28        0.68         090
                                                 nerve.
67599...........  .............  C............  Orbit surgery               0.00        0.00        0.00        0.00        0.00        0.00         YYY
                                                 procedure.
67700...........  .............  A............  Drainage of eyelid          1.37        4.30        5.16        1.17        1.22        0.07         010
                                                 abscess.
67710...........  .............  A............  Incision of eyelid..        1.04        3.70        4.53        1.07        1.14        0.05         010
67715...........  .............  A............  Incision of eyelid          1.24        3.83        4.60        1.15        1.22        0.06         010
                                                 fold.
67800...........  .............  A............  Remove eyelid lesion        1.39        1.39        1.50        0.90        0.97        0.07         010
67801...........  .............  A............  Remove eyelid               1.89        1.67        1.82        1.07        1.17        0.09         010
                                                 lesions.
67805...........  .............  A............  Remove eyelid               2.24        2.18        2.35        1.40        1.52        0.11         010
                                                 lesions.
67808...........  .............  A............  Remove eyelid               4.47          NA          NA        3.60        3.69        0.19         090
                                                 lesion(s).
67810...........  .............  A............  Biopsy of eyelid....        1.48        3.93        3.63        0.68        0.68        0.06         000
67820...........  .............  A............  Revise eyelashes....        0.71        0.43        0.52        0.50        0.53        0.04         000
67825...........  .............  A............  Revise eyelashes....        1.40        1.40        1.57        1.26        1.33        0.07         010
67830...........  .............  A............  Revise eyelashes....        1.72        3.99        4.76        1.32        1.41        0.08         010
67835...........  .............  A............  Revise eyelashes....        5.61          NA          NA        4.12        4.37        0.28         090
67840...........  .............  A............  Remove eyelid lesion        2.06        3.90        4.69        1.45        1.55        0.10         010
67850...........  .............  A............  Treat eyelid lesion.        1.71        3.28        3.33        1.44        1.45        0.07         010
67875...........  .............  A............  Closure of eyelid by        1.35        2.38        2.84        0.83        0.88        0.07         000
                                                 suture.
67880...........  .............  A............  Revision of eyelid..        4.47        5.43        6.02        3.56        3.68        0.19         090
67882...........  .............  A............  Revision of eyelid..        5.87        6.35        6.99        4.45        4.63        0.25         090
67900...........  .............  A............  Repair brow defect..        6.69        7.36        8.21        4.60        4.93        0.38         090
67901...........  .............  A............  Repair eyelid defect        7.47        8.98        7.19        5.28        5.34        0.54         090
67902...........  .............  A............  Repair eyelid defect        9.68          NA          NA        6.33        5.90        0.60         090
67903...........  .............  A............  Repair eyelid defect        6.42        6.62        8.09        4.33        4.92        0.47         090
67904...........  .............  A............  Repair eyelid defect        7.83        8.16        8.89        5.37        5.30        0.41         090

[[Page 66486]]

 
67906...........  .............  A............  Repair eyelid defect        6.84          NA          NA        4.46        4.74        0.46         090
67908...........  .............  A............  Repair eyelid defect        5.19        5.55        6.09        4.12        4.73        0.28         090
67909...........  .............  A............  Revise eyelid defect        5.46        6.17        7.10        4.16        4.55        0.31         090
67911...........  .............  A............  Revise eyelid defect        7.38          NA          NA        5.04        4.91        0.31         090
67912...........  .............  A............  Correction eyelid w/        6.23       13.12       16.02        4.73        5.13        0.28         090
                                                 implant.
67914...........  .............  A............  Repair eyelid defect        3.70        4.74        5.54        2.67        2.86        0.19         090
67915...........  .............  A............  Repair eyelid defect        3.21        4.31        5.15        2.43        2.61        0.16         090
67916...........  .............  A............  Repair eyelid defect        5.37        6.36        7.20        4.14        4.45        0.28         090
67917...........  .............  A............  Repair eyelid defect        6.08        6.72        7.58        4.40        4.73        0.36         090
67921...........  .............  A............  Repair eyelid defect        3.42        4.61        5.40        2.55        2.72        0.17         090
67922...........  .............  A............  Repair eyelid defect        3.09        4.15        5.03        2.33        2.54        0.15         090
67923...........  .............  A............  Repair eyelid defect        5.94        6.43        7.27        4.32        4.64        0.30         090
67924...........  .............  A............  Repair eyelid defect        5.84        6.90        7.91        4.05        4.36        0.30         090
67930...........  .............  A............  Repair eyelid wound.        3.62        4.36        5.04        1.78        1.97        0.19         010
67935...........  .............  A............  Repair eyelid wound.        6.27        6.76        7.63        3.58        3.99        0.39         090
67938...........  .............  A............  Remove eyelid               1.35        3.83        4.60        1.22        1.24        0.06         010
                                                 foreign body.
67950...........  .............  A............  Revision of eyelid..        5.88        6.65        7.64        4.37        4.79        0.36         090
67961...........  .............  A............  Revision of eyelid..        5.75        6.81        7.74        4.30        4.66        0.33         090
67966...........  .............  A............  Revision of eyelid..        8.83        8.04        8.58        5.74        5.65        0.37         090
67971...........  .............  A............  Reconstruction of           9.87          NA          NA        6.17        6.72        0.53         090
                                                 eyelid.
67973...........  .............  A............  Reconstruction of          12.96          NA          NA        7.70        8.51        0.75         090
                                                 eyelid.
67974...........  .............  A............  Reconstruction of          12.93          NA          NA        7.68        8.45        0.75         090
                                                 eyelid.
67975...........  .............  A............  Reconstruction of           9.21          NA          NA        5.94        6.44        0.50         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         1.39        1.23        1.32        1.05        1.13        0.06         010
                                                 lining.
68040...........  .............  A............  Treatment of eyelid         0.85        0.60        0.65        0.35        0.39        0.04         000
                                                 lesions.
68100...........  .............  A............  Biopsy of eyelid            1.35        2.36        2.80        0.86        0.90        0.07         000
                                                 lining.
68110...........  .............  A............  Remove eyelid lining        1.79        3.07        3.58        1.48        1.56        0.09         010
                                                 lesion.
68115...........  .............  A............  Remove eyelid lining        2.38        4.32        5.14        1.69        1.80        0.12         010
                                                 lesion.
68130...........  .............  A............  Remove eyelid lining        4.99        6.63        7.67        4.02        4.31        0.24         090
                                                 lesion.
68135...........  .............  A............  Remove eyelid lining        1.86        1.58        1.70        1.47        1.56        0.09         010
                                                 lesion.
68200...........  .............  A............  Treat eyelid by             0.49        0.45        0.49        0.29        0.31        0.02         000
                                                 injection.
68320...........  .............  A............  Revise/graft eyelid         6.44        9.15       10.21        5.30        5.41        0.27         090
                                                 lining.
68325...........  .............  A............  Revise/graft eyelid         8.43          NA          NA        6.09        6.32        0.44         090
                                                 lining.
68326...........  .............  A............  Revise/graft eyelid         8.22          NA          NA        5.91        6.16        0.35         090
                                                 lining.
68328...........  .............  A............  Revise/graft eyelid         9.25          NA          NA        6.37        6.83        0.54         090
                                                 lining.
68330...........  .............  A............  Revise eyelid lining        5.63        7.40        8.41        4.44        4.58        0.24         090
68335...........  .............  A............  Revise/graft eyelid         8.26          NA          NA        5.91        6.14        0.36         090
                                                 lining.
68340...........  .............  A............  Separate eyelid             4.84        6.87        7.87        3.86        3.98        0.21         090
                                                 adhesions.
68360...........  .............  A............  Revise eyelid lining        5.04        6.43        7.23        3.95        4.06        0.22         090
68362...........  .............  A............  Revise eyelid lining        8.41          NA          NA        5.97        6.18        0.36         090
68371...........  .............  A............  Harvest eye tissue,         4.97          NA          NA        4.05        4.39        0.44         010
                                                 alograft.
68399...........  .............  C............  Eyelid lining               0.00        0.00        0.00        0.00        0.00        0.00         YYY
                                                 surgery.
68400...........  .............  A............  Incise/drain tear           1.71        4.42        5.16        1.21        1.52        0.08         010
                                                 gland.
68420...........  .............  A............  Incise/drain tear           2.32        4.58        5.39        1.41        1.76        0.11         010
                                                 sac.
68440...........  .............  A............  Incise tear duct            0.96        1.25        1.67        1.18        1.22        0.05         010
                                                 opening.
68500...........  .............  A............  Removal of tear            12.49          NA          NA        9.51        9.62        0.55         090
                                                 gland.
68505...........  .............  A............  Partial removal,           12.41          NA          NA        8.90        9.77        0.55         090
                                                 tear gland.
68510...........  .............  A............  Biopsy of tear gland        4.60        5.21        6.27        2.02        2.06        0.23         000
68520...........  .............  A............  Removal of tear sac.        8.58          NA          NA        6.49        6.95        0.37         090
68525...........  .............  A............  Biopsy of tear sac..        4.42          NA          NA        1.56        1.79        0.22         000
68530...........  .............  A............  Clearance of tear           3.67        5.59        6.88        2.07        2.36        0.18         010
                                                 duct.
68540...........  .............  A............  Remove tear gland          11.93          NA          NA        8.48        8.93        0.52         090
                                                 lesion.
68550...........  .............  A............  Remove tear gland          14.86          NA          NA        9.66       10.50        0.80         090
                                                 lesion.
68700...........  .............  A............  Repair tear ducts...        7.67          NA          NA        5.55        5.77        0.32         090
68705...........  .............  A............  Revise tear duct            2.08        3.03        3.60        1.58        1.69        0.10         010
                                                 opening.
68720...........  .............  A............  Create tear sac             9.78          NA          NA        6.87        7.36        0.44         090
                                                 drain.
68745...........  .............  A............  Create tear duct            9.70          NA          NA        6.97        7.41        0.52         090
                                                 drain.
68750...........  .............  A............  Create tear duct            9.87          NA          NA        7.42        7.84        0.43         090
                                                 drain.
68760...........  .............  A............  Close tear duct             1.75        2.58        3.06        1.45        1.54        0.09         010
                                                 opening.
68761...........  .............  A............  Close tear duct             1.38        1.83        2.05        1.25        1.28        0.06         010
                                                 opening.
68770...........  .............  A............  Close tear system           8.09          NA          NA        5.74        4.46        0.35         090
                                                 fistula.
68801...........  .............  A............  Dilate tear duct            0.96        1.77        1.86        1.41        1.44        0.05         010
                                                 opening.
68810...........  .............  A............  Probe nasolacrimal          2.63        3.39        3.52        2.68        2.67        0.10         010
                                                 duct.
68811...........  .............  A............  Probe nasolacrimal          2.39          NA          NA        2.12        2.27        0.13         010
                                                 duct.
68815...........  .............  A............  Probe nasolacrimal          3.24        6.41        7.32        2.43        2.62        0.17         010
                                                 duct.
68816...........  .............  A............  Probe nl duct w/            3.00       12.73       12.73        2.51        2.51        0.16         010
                                                 balloon.
68840...........  .............  A............  Explore/irrigate            1.27        1.51        1.55        1.28        1.20        0.06         010
                                                 tear ducts.
68850...........  .............  A............  Injection for tear          0.80        0.72        0.80        0.60        0.64        0.04         000
                                                 sac 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          1.47        2.88        2.88        1.34        1.35        0.12         010
                                                 lesion.
69005...........  .............  A............  Drain external ear          2.13        2.99        2.96        1.61        1.72        0.17         010
                                                 lesion.

[[Page 66487]]

 
69020...........  .............  A............  Drain outer ear             1.50        4.09        4.04        1.90        1.98        0.12         010
                                                 canal lesion.
69090...........  .............  N............  Pierce earlobes.....        0.00        0.00        0.00        0.00        0.00        0.00         XXX
69100...........  .............  A............  Biopsy of external          0.81        1.85        1.78        0.39        0.39        0.03         000
                                                 ear.
69105...........  .............  A............  Biopsy of external          0.85        2.64        2.49        0.71        0.74        0.07         000
                                                 ear canal.
69110...........  .............  A............  Remove external ear,        3.47        7.83        7.29        4.44        4.45        0.30         090
                                                 partial.
69120...........  .............  A............  Removal of external         4.08          NA          NA        5.36        5.77        0.38         090
                                                 ear.
69140...........  .............  A............  Remove ear canal            8.03          NA          NA       13.21       13.24        0.65         090
                                                 lesion(s).
69145...........  .............  A............  Remove ear canal            2.65        7.03        6.40        3.37        3.33        0.21         090
                                                 lesion(s).
69150...........  .............  A............  Extensive ear canal        13.49          NA          NA       11.45       12.42        1.22         090
                                                 surgery.
69155...........  .............  A............  Extensive ear/neck         23.06          NA          NA       16.98       18.25        1.93         090
                                                 surgery.
69200...........  .............  A............  Clear outer ear             0.77        2.15        2.27        0.61        0.58        0.06         000
                                                 canal.
69205...........  .............  A............  Clear outer ear             1.20          NA          NA        1.24        1.30        0.10         010
                                                 canal.
69210...........  .............  A............  Remove impacted ear         0.61        0.58        0.60        0.17        0.20        0.05         000
                                                 wax.
69220...........  .............  A............  Clean out mastoid           0.83        2.56        2.46        0.68        0.70        0.07         000
                                                 cavity.
69222...........  .............  A............  Clean out mastoid           1.42        3.97        3.91        1.90        1.98        0.12         010
                                                 cavity.
69300...........  .............  R............  Revise external ear.        6.69       10.71        7.46        5.18        4.70        0.72         YYY
69310...........  .............  A............  Rebuild outer ear          10.85          NA          NA       15.48       15.88        0.85         090
                                                 canal.
69320...........  .............  A............  Rebuild outer ear          17.03          NA          NA       20.05       20.94        1.37         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        2.81        2.49        0.68        0.67        0.07         000
                                                 canal.
69401...........  .............  A............  Inflate middle ear          0.63        1.53        1.38        0.59        0.62        0.05         000
                                                 canal.
69405...........  .............  A............  Catheterize middle          2.65        3.65        3.58        1.96        2.14        0.21         010
                                                 ear canal.
69420...........  .............  A............  Incision of eardrum.        1.35        3.32        3.23        1.56        1.57        0.11         010
69421...........  .............  A............  Incision of eardrum.        1.75          NA          NA        1.85        2.01        0.15         010
69424...........  .............  A............  Remove ventilating          0.85        2.34        2.26        0.68        0.68        0.07         000
                                                 tube.
69433...........  .............  A............  Create eardrum              1.54        3.32        3.20        1.59        1.61        0.13         010
                                                 opening.
69436...........  .............  A............  Create eardrum              1.98          NA          NA        1.90        2.09        0.19         010
                                                 opening.
69440...........  .............  A............  Exploration of              7.62          NA          NA        9.11        8.94        0.61         090
                                                 middle ear.
69450...........  .............  A............  Eardrum revision....        5.61          NA          NA        7.61        7.32        0.45         090
69501...........  .............  A............  Mastoidectomy.......        9.12          NA          NA        8.65        8.82        0.73         090
69502...........  .............  A............  Mastoidectomy.......       12.44          NA          NA       11.04       11.31        1.00         090
69505...........  .............  A............  Remove mastoid             13.05          NA          NA       16.14       16.66        1.05         090
                                                 structures.
69511...........  .............  A............  Extensive mastoid          13.58          NA          NA       16.32       16.89        1.09         090
                                                 surgery.
69530...........  .............  A............  Extensive mastoid          20.24          NA          NA       19.65       20.63        1.54         090
                                                 surgery.
69535...........  .............  A............  Remove part of             37.27          NA          NA       26.75       29.34        2.93         090
                                                 temporal bone.
69540...........  .............  A............  Remove ear lesion...        1.22        3.90        3.82        1.85        1.91        0.10         010
69550...........  .............  A............  Remove ear lesion...       11.04          NA          NA       14.27       14.56        0.89         090
69552...........  .............  A............  Remove ear lesion...       19.69          NA          NA       18.18       19.42        1.59         090
69554...........  .............  A............  Remove ear lesion...       35.71          NA          NA       23.98       27.15        2.92         090
69601...........  .............  A............  Mastoid surgery            13.31          NA          NA       11.91       12.29        1.07         090
                                                 revision.
69602...........  .............  A............  Mastoid surgery            13.64          NA          NA       12.80       13.01        1.10         090
                                                 revision.
69603...........  .............  A............  Mastoid surgery            14.08          NA          NA       16.43       17.39        1.14         090
                                                 revision.
69604...........  .............  A............  Mastoid surgery            14.08          NA          NA       12.77       13.23        1.14         090
                                                 revision.
69605...........  .............  A............  Mastoid surgery            18.55          NA          NA       19.28       20.11        1.50         090
                                                 revision.
69610...........  .............  A............  Repair of eardrum...        4.44        4.91        5.23        2.58        2.93        0.36         010
69620...........  .............  A............  Repair of eardrum...        5.94       10.90       11.01        5.83        6.06        0.48         090
69631...........  .............  A............  Repair eardrum              9.93          NA          NA       11.52       11.36        0.80         090
                                                 structures.
69632...........  .............  A............  Rebuild eardrum            12.82          NA          NA       13.30       13.38        1.03         090
                                                 structures.
69633...........  .............  A............  Rebuild eardrum            12.17          NA          NA       13.08       13.06        0.98         090
                                                 structures.
69635...........  .............  A............  Repair eardrum             13.39          NA          NA       16.28       16.51        1.08         090
                                                 structures.
69636...........  .............  A............  Rebuild eardrum            15.29          NA          NA       18.19       18.74        1.23         090
                                                 structures.
69637...........  .............  A............  Rebuild eardrum            15.18          NA          NA       18.10       18.66        1.22         090
                                                 structures.
69641...........  .............  A............  Revise middle ear &        12.77          NA          NA       12.47       12.62        1.03         090
                                                 mastoid.
69642...........  .............  A............  Revise middle ear &        16.91          NA          NA       15.52       15.90        1.36         090
                                                 mastoid.
69643...........  .............  A............  Revise middle ear &        15.45          NA          NA       14.15       14.48        1.24         090
                                                 mastoid.
69644...........  .............  A............  Revise middle ear &        17.09          NA          NA       18.72       19.56        1.37         090
                                                 mastoid.
69645...........  .............  A............  Revise middle ear &        16.57          NA          NA       18.58       19.30        1.33         090
                                                 mastoid.
69646...........  .............  A............  Revise middle ear &        18.23          NA          NA       19.10       19.92        1.46         090
                                                 mastoid.
69650...........  .............  A............  Release middle ear          9.71          NA          NA        9.53        9.72        0.78         090
                                                 bone.
69660...........  .............  A............  Revise middle ear          11.94          NA          NA       10.49       10.83        0.96         090
                                                 bone.
69661...........  .............  A............  Revise middle ear          15.80          NA          NA       13.46       14.07        1.27         090
                                                 bone.
69662...........  .............  A............  Revise middle ear          15.49          NA          NA       12.50       13.12        1.25         090
                                                 bone.
69666...........  .............  A............  Repair middle ear           9.80          NA          NA        9.80        9.88        0.79         090
                                                 structures.
69667...........  .............  A............  Repair middle ear           9.81          NA          NA        9.83        9.90        0.79         090
                                                 structures.
69670...........  .............  A............  Remove mastoid air         11.62          NA          NA       11.24       11.47        0.93         090
                                                 cells.
69676...........  .............  A............  Remove middle ear           9.58          NA          NA       10.60       10.67        0.81         090
                                                 nerve.
69700...........  .............  A............  Close mastoid               8.28          NA          NA        8.67        8.96        0.67         090
                                                 fistula.
69710...........  .............  N............  Implant/replace             0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 hearing aid.
69711...........  .............  A............  Remove/repair              10.50          NA          NA       10.40       10.59        0.83         090
                                                 hearing aid.
69714...........  .............  A............  Implant temple bone        14.31          NA          NA       11.78       12.22        1.13         090
                                                 w/stimul.
69715...........  .............  A............  Temple bne implnt w/       18.80          NA          NA       13.32       14.17        1.48         090
                                                 stimulat.
69717...........  .............  A............  Temple bone implant        15.29          NA          NA       11.95       13.21        0.90         090
                                                 revision.

[[Page 66488]]

 
69718...........  .............  A............  Revise temple bone         19.05          NA          NA       13.40       14.35        3.22         090
                                                 implant.
69720...........  .............  A............  Release facial nerve       14.57          NA          NA       14.01       14.26        1.16         090
69725...........  .............  A............  Release facial nerve       27.44          NA          NA       18.01       19.07        2.45         090
69740...........  .............  A............  Repair facial nerve.       16.18          NA          NA       11.58       12.49        1.27         090
69745...........  .............  A............  Repair facial nerve.       16.91          NA          NA        9.93       12.44        1.14         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....        8.61          NA          NA        9.61        9.54        0.69         090
69802...........  .............  A............  Incise inner ear....       13.39          NA          NA       11.86       12.09        1.06         090
69805...........  .............  A............  Explore inner ear...       14.55          NA          NA       10.89       11.38        1.12         090
69806...........  .............  A............  Explore inner ear...       12.52          NA          NA       10.39       10.71        1.00         090
69820...........  .............  A............  Establish inner ear        10.40          NA          NA       10.24       10.73        0.90         090
                                                 window.
69840...........  .............  A............  Revise inner ear           10.32          NA          NA       11.37       12.27        0.79         090
                                                 window.
69905...........  .............  A............  Remove inner ear....       11.15          NA          NA       11.03       11.19        0.90         090
69910...........  .............  A............  Remove inner ear &         13.80          NA          NA       10.88       11.39        1.07         090
                                                 mastoid.
69915...........  .............  A............  Incise inner ear           22.65          NA          NA       14.81       15.63        1.70         090
                                                 nerve.
69930...........  .............  A............  Implant cochlear           17.60          NA          NA       13.10       13.92        1.36         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           27.44          NA          NA       16.84       17.86        2.29         090
                                                 nerve.
69955...........  .............  A............  Release facial nerve       29.22          NA          NA       19.38       20.37        2.49         090
69960...........  .............  A............  Release inner ear          29.22          NA          NA       17.90       18.97        2.18         090
                                                 canal.
69970...........  .............  A............  Remove inner ear           32.21          NA          NA       19.51       21.39        2.42         090
                                                 lesion.
69979...........  .............  C............  Temporal bone               0.00        0.00        0.00        0.00        0.00        0.00         YYY
                                                 surgery.
69990...........  .............  R............  Microsurgery add-on.        3.46          NA          NA        1.27        1.53        0.89         ZZZ
70010...........  .............  A............  Contrast x-ray of           1.19        2.82        3.76          NA          NA        0.27         XXX
                                                 brain.
70010...........  TC...........  A............  Contrast x-ray of           0.00        2.40        3.36          NA          NA        0.22         XXX
                                                 brain.
70010...........  26...........  A............  Contrast x-ray of           1.19        0.42        0.40        0.42        0.40        0.05         XXX
                                                 brain.
70015...........  .............  A............  Contrast x-ray of           1.19        2.92        2.33          NA          NA        0.16         XXX
                                                 brain.
70015...........  TC...........  A............  Contrast x-ray of           0.00        2.49        1.92          NA          NA        0.08         XXX
                                                 brain.
70015...........  26...........  A............  Contrast x-ray of           1.19        0.43        0.41        0.43        0.41        0.08         XXX
                                                 brain.
70030...........  .............  A............  X-ray eye for               0.17        0.61        0.54          NA          NA        0.03         XXX
                                                 foreign body.
70030...........  TC...........  A............  X-ray eye for               0.00        0.55        0.48          NA          NA        0.02         XXX
                                                 foreign body.
70030...........  26...........  A............  X-ray eye for               0.17        0.06        0.06        0.06        0.06        0.01         XXX
                                                 foreign body.
70100...........  .............  A............  X-ray exam of jaw...        0.18        0.63        0.61          NA          NA        0.03         XXX
70100...........  TC...........  A............  X-ray exam of jaw...        0.00        0.58        0.55          NA          NA        0.02         XXX
70100...........  26...........  A............  X-ray exam of jaw...        0.18        0.05        0.06        0.05        0.06        0.01         XXX
70110...........  .............  A............  X-ray exam of jaw...        0.25        0.81        0.75          NA          NA        0.05         XXX
70110...........  TC...........  A............  X-ray exam of jaw...        0.00        0.72        0.67          NA          NA        0.04         XXX
70110...........  26...........  A............  X-ray exam of jaw...        0.25        0.09        0.08        0.09        0.08        0.01         XXX
70120...........  .............  A............  X-ray exam of               0.18        0.69        0.69          NA          NA        0.05         XXX
                                                 mastoids.
70120...........  TC...........  A............  X-ray exam of               0.00        0.64        0.63          NA          NA        0.04         XXX
                                                 mastoids.
70120...........  26...........  A............  X-ray exam of               0.18        0.05        0.06        0.05        0.06        0.01         XXX
                                                 mastoids.
70130...........  .............  A............  X-ray exam of               0.34        1.15        1.02          NA          NA        0.07         XXX
                                                 mastoids.
70130...........  TC...........  A............  X-ray exam of               0.00        1.04        0.91          NA          NA        0.05         XXX
                                                 mastoids.
70130...........  26...........  A............  X-ray exam of               0.34        0.11        0.11        0.11        0.11        0.02         XXX
                                                 mastoids.
70134...........  .............  A............  X-ray exam of middle        0.34        0.92        0.87          NA          NA        0.07         XXX
                                                 ear.
70134...........  TC...........  A............  X-ray exam of middle        0.00        0.80        0.76          NA          NA        0.05         XXX
                                                 ear.
70134...........  26...........  A............  X-ray exam of middle        0.34        0.12        0.11        0.12        0.11        0.02         XXX
                                                 ear.
70140...........  .............  A............  X-ray exam of facial        0.19        0.54        0.62          NA          NA        0.05         XXX
                                                 bones.
70140...........  TC...........  A............  X-ray exam of facial        0.00        0.49        0.56          NA          NA        0.04         XXX
                                                 bones.
70140...........  26...........  A............  X-ray exam of facial        0.19        0.05        0.06        0.05        0.06        0.01         XXX
                                                 bones.
70150...........  .............  A............  X-ray exam of facial        0.26        0.85        0.85          NA          NA        0.06         XXX
                                                 bones.
70150...........  TC...........  A............  X-ray exam of facial        0.00        0.77        0.77          NA          NA        0.05         XXX
                                                 bones.
70150...........  26...........  A............  X-ray exam of facial        0.26        0.08        0.08        0.08        0.08        0.01         XXX
                                                 bones.
70160...........  .............  A............  X-ray exam of nasal         0.17        0.71        0.64          NA          NA        0.03         XXX
                                                 bones.
70160...........  TC...........  A............  X-ray exam of nasal         0.00        0.65        0.58          NA          NA        0.02         XXX
                                                 bones.
70160...........  26...........  A............  X-ray exam of nasal         0.17        0.06        0.06        0.06        0.06        0.01         XXX
                                                 bones.
70170...........  .............  C............  X-ray exam of tear          0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 duct.
70170...........  TC...........  C............  X-ray exam of tear          0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 duct.
70170...........  26...........  A............  X-ray exam of tear          0.30        0.10        0.10        0.10        0.10        0.01         XXX
                                                 duct.
70190...........  .............  A............  X-ray exam of eye           0.21        0.72        0.70          NA          NA        0.05         XXX
                                                 sockets.
70190...........  TC...........  A............  X-ray exam of eye           0.00        0.65        0.63          NA          NA        0.04         XXX
                                                 sockets.
70190...........  26...........  A............  X-ray exam of eye           0.21        0.07        0.07        0.07        0.07        0.01         XXX
                                                 sockets.
70200...........  .............  A............  X-ray exam of eye           0.28        0.87        0.87          NA          NA        0.06         XXX
                                                 sockets.
70200...........  TC...........  A............  X-ray exam of eye           0.00        0.78        0.78          NA          NA        0.05         XXX
                                                 sockets.
70200...........  26...........  A............  X-ray exam of eye           0.28        0.09        0.09        0.09        0.09        0.01         XXX
                                                 sockets.
70210...........  .............  A............  X-ray exam of               0.17        0.58        0.62          NA          NA        0.05         XXX
                                                 sinuses.
70210...........  TC...........  A............  X-ray exam of               0.00        0.53        0.57          NA          NA        0.04         XXX
                                                 sinuses.
70210...........  26...........  A............  X-ray exam of               0.17        0.05        0.05        0.05        0.05        0.01         XXX
                                                 sinuses.
70220...........  .............  A............  X-ray exam of               0.25        0.73        0.80          NA          NA        0.06         XXX
                                                 sinuses.
70220...........  TC...........  A............  X-ray exam of               0.00        0.65        0.72          NA          NA        0.05         XXX
                                                 sinuses.
70220...........  26...........  A............  X-ray exam of               0.25        0.08        0.08        0.08        0.08        0.01         XXX
                                                 sinuses.
70240...........  .............  A............  X-ray exam,                 0.19        0.61        0.54          NA          NA        0.03         XXX
                                                 pituitary saddle.

[[Page 66489]]

 
70240...........  TC...........  A............  X-ray exam,                 0.00        0.55        0.48          NA          NA        0.02         XXX
                                                 pituitary saddle.
70240...........  26...........  A............  X-ray exam,                 0.19        0.06        0.06        0.06        0.06        0.01         XXX
                                                 pituitary saddle.
70250...........  .............  A............  X-ray exam of skull.        0.24        0.70        0.69          NA          NA        0.05         XXX
70250...........  TC...........  A............  X-ray exam of skull.        0.00        0.63        0.62          NA          NA        0.04         XXX
70250...........  26...........  A............  X-ray exam of skull.        0.24        0.07        0.07        0.07        0.07        0.01         XXX
70260...........  .............  A............  X-ray exam of skull.        0.34        0.88        0.94          NA          NA        0.08         XXX
70260...........  TC...........  A............  X-ray exam of skull.        0.00        0.78        0.83          NA          NA        0.06         XXX
70260...........  26...........  A............  X-ray exam of skull.        0.34        0.10        0.11        0.10        0.11        0.02         XXX
70300...........  .............  A............  X-ray exam of teeth.        0.10        0.24        0.27          NA          NA        0.03         XXX
70300...........  TC...........  A............  X-ray exam of teeth.        0.00        0.21        0.23          NA          NA        0.02         XXX
70300...........  26...........  A............  X-ray exam of teeth.        0.10        0.03        0.04        0.03        0.04        0.01         XXX
70310...........  .............  A............  X-ray exam of teeth.        0.16        0.82        0.65          NA          NA        0.03         XXX
70310...........  TC...........  A............  X-ray exam of teeth.        0.00        0.77        0.59          NA          NA        0.02         XXX
70310...........  26...........  A............  X-ray exam of teeth.        0.16        0.05        0.06        0.05        0.06        0.01         XXX
70320...........  .............  A............  Full mouth x-ray of         0.22        1.06        0.96          NA          NA        0.06         XXX
                                                 teeth.
70320...........  TC...........  A............  Full mouth x-ray of         0.00        0.99        0.89          NA          NA        0.05         XXX
                                                 teeth.
70320...........  26...........  A............  Full mouth x-ray of         0.22        0.07        0.07        0.07        0.07        0.01         XXX
                                                 teeth.
70328...........  .............  A............  X-ray exam of jaw           0.18        0.63        0.59          NA          NA        0.03         XXX
                                                 joint.
70328...........  TC...........  A............  X-ray exam of jaw           0.00        0.57        0.53          NA          NA        0.02         XXX
                                                 joint.
70328...........  26...........  A............  X-ray exam of jaw           0.18        0.06        0.06        0.06        0.06        0.01         XXX
                                                 joint.
70330...........  .............  A............  X-ray exam of jaw           0.24        1.01        0.96          NA          NA        0.06         XXX
                                                 joints.
70330...........  TC...........  A............  X-ray exam of jaw           0.00        0.93        0.88          NA          NA        0.05         XXX
                                                 joints.
70330...........  26...........  A............  X-ray exam of jaw           0.24        0.08        0.08        0.08        0.08        0.01         XXX
                                                 joints.
70332...........  .............  A............  X-ray exam of jaw           0.54        1.45        1.88          NA          NA        0.14         XXX
                                                 joint.
70332...........  TC...........  A............  X-ray exam of jaw           0.00        1.29        1.70          NA          NA        0.12         XXX
                                                 joint.
70332...........  26...........  A............  X-ray exam of jaw           0.54        0.16        0.18        0.16        0.18        0.02         XXX
                                                 joint.
70336...........  .............  A............  Magnetic image, jaw         1.48       12.15       11.91          NA          NA        0.66         XXX
                                                 joint.
70336...........  TC...........  A............  Magnetic image, jaw         0.00       11.65       11.42          NA          NA        0.59         XXX
                                                 joint.
70336...........  26...........  A............  Magnetic image, jaw         1.48        0.50        0.49        0.50        0.49        0.07         XXX
                                                 joint.
70350...........  .............  A............  X-ray head for              0.17        0.32        0.39          NA          NA        0.03         XXX
                                                 orthodontia.
70350...........  TC...........  A............  X-ray head for              0.00        0.27        0.33          NA          NA        0.02         XXX
                                                 orthodontia.
70350...........  26...........  A............  X-ray head for              0.17        0.05        0.06        0.05        0.06        0.01         XXX
                                                 orthodontia.
70355...........  .............  A............  Panoramic x-ray of          0.20        0.30        0.47          NA          NA        0.05         XXX
                                                 jaws.
70355...........  TC...........  A............  Panoramic x-ray of          0.00        0.23        0.40          NA          NA        0.04         XXX
                                                 jaws.
70355...........  26...........  A............  Panoramic x-ray of          0.20        0.07        0.07        0.07        0.07        0.01         XXX
                                                 jaws.
70360...........  .............  A............  X-ray exam of neck..        0.17        0.56        0.52          NA          NA        0.03         XXX
70360...........  TC...........  A............  X-ray exam of neck..        0.00        0.51        0.46          NA          NA        0.02         XXX
70360...........  26...........  A............  X-ray exam of neck..        0.17        0.05        0.06        0.05        0.06        0.01         XXX
70370...........  .............  A............  Throat x-ray &              0.32        1.65        1.53          NA          NA        0.08         XXX
                                                 fluoroscopy.
70370...........  TC...........  A............  Throat x-ray &              0.00        1.55        1.43          NA          NA        0.07         XXX
                                                 fluoroscopy.
70370...........  26...........  A............  Throat x-ray &              0.32        0.10        0.10        0.10        0.10        0.01         XXX
                                                 fluoroscopy.
70371...........  .............  A............  Speech evaluation,          0.84        1.47        1.93          NA          NA        0.16         XXX
                                                 complex.
70371...........  TC...........  A............  Speech evaluation,          0.00        1.21        1.66          NA          NA        0.12         XXX
                                                 complex.
70371...........  26...........  A............  Speech evaluation,          0.84        0.26        0.27        0.26        0.27        0.04         XXX
                                                 complex.
70373...........  .............  A............  Contrast x-ray of           0.44        1.58        1.75          NA          NA        0.13         XXX
                                                 larynx.
70373...........  TC...........  A............  Contrast x-ray of           0.00        1.47        1.62          NA          NA        0.11         XXX
                                                 larynx.
70373...........  26...........  A............  Contrast x-ray of           0.44        0.11        0.13        0.11        0.13        0.02         XXX
                                                 larynx.
70380...........  .............  A............  X-ray exam of               0.17        0.82        0.78          NA          NA        0.05         XXX
                                                 salivary gland.
70380...........  TC...........  A............  X-ray exam of               0.00        0.76        0.72          NA          NA        0.04         XXX
                                                 salivary gland.
70380...........  26...........  A............  X-ray exam of               0.17        0.06        0.06        0.06        0.06        0.01         XXX
                                                 salivary gland.
70390...........  .............  A............  X-ray exam of               0.38        2.33        2.12          NA          NA        0.13         XXX
                                                 salivary duct.
70390...........  TC...........  A............  X-ray exam of               0.00        2.20        1.99          NA          NA        0.11         XXX
                                                 salivary duct.
70390...........  26...........  A............  X-ray exam of               0.38        0.13        0.13        0.13        0.13        0.02         XXX
                                                 salivary duct.
70450...........  .............  A............  Ct head/brain w/o           0.85        4.91        4.95          NA          NA        0.29         XXX
                                                 dye.
70450...........  TC...........  A............  Ct head/brain w/o           0.00        4.61        4.66          NA          NA        0.25         XXX
                                                 dye.
70450...........  26...........  A............  Ct head/brain w/o           0.85        0.30        0.29        0.30        0.29        0.04         XXX
                                                 dye.
70460...........  .............  A............  Ct head/brain w/dye.        1.13        6.51        6.27          NA          NA        0.35         XXX
70460...........  TC...........  A............  Ct head/brain w/dye.        0.00        6.11        5.88          NA          NA        0.30         XXX
70460...........  26...........  A............  Ct head/brain w/dye.        1.13        0.40        0.39        0.40        0.39        0.05         XXX
70470...........  .............  A............  Ct head/brain w/o &         1.27        7.93        7.70          NA          NA        0.43         XXX
                                                 w/dye.
70470...........  TC...........  A............  Ct head/brain w/o &         0.00        7.48        7.27          NA          NA        0.37         XXX
                                                 w/dye.
70470...........  26...........  A............  Ct head/brain w/o &         1.27        0.45        0.43        0.45        0.43        0.06         XXX
                                                 w/dye.
70480...........  .............  A............  Ct orbit/ear/fossa w/       1.28        8.48        6.80          NA          NA        0.31         XXX
                                                 o dye.
70480...........  TC...........  A............  Ct orbit/ear/fossa w/       0.00        8.03        6.37          NA          NA        0.25         XXX
                                                 o dye.
70480...........  26...........  A............  Ct orbit/ear/fossa w/       1.28        0.45        0.43        0.45        0.43        0.06         XXX
                                                 o dye.
70481...........  .............  A............  Ct orbit/ear/fossa w/       1.38        9.97        8.04          NA          NA        0.36         XXX
                                                 dye.
70481...........  TC...........  A............  Ct orbit/ear/fossa w/       0.00        9.48        7.57          NA          NA        0.30         XXX
                                                 dye.
70481...........  26...........  A............  Ct orbit/ear/fossa w/       1.38        0.49        0.47        0.49        0.47        0.06         XXX
                                                 dye.
70482...........  .............  A............  Ct orbit/ear/fossa w/       1.45       11.40        9.47          NA          NA        0.43         XXX
                                                 o&w/dye.
70482...........  TC...........  A............  Ct orbit/ear/fossa w/       0.00       10.89        8.98          NA          NA        0.37         XXX
                                                 o&w/dye.
70482...........  26...........  A............  Ct orbit/ear/fossa w/       1.45        0.51        0.49        0.51        0.49        0.06         XXX
                                                 o&w/dye.
70486...........  .............  A............  Ct maxillofacial w/o        1.14        6.78        5.93          NA          NA        0.30         XXX
                                                 dye.

[[Page 66490]]

 
70486...........  TC...........  A............  Ct maxillofacial w/o        0.00        6.39        5.55          NA          NA        0.25         XXX
                                                 dye.
70486...........  26...........  A............  Ct maxillofacial w/o        1.14        0.39        0.38        0.39        0.38        0.05         XXX
                                                 dye.
70487...........  .............  A............  Ct maxillofacial w/         1.30        8.34        7.21          NA          NA        0.36         XXX
                                                 dye.
70487...........  TC...........  A............  Ct maxillofacial w/         0.00        7.88        6.77          NA          NA        0.30         XXX
                                                 dye.
70487...........  26...........  A............  Ct maxillofacial w/         1.30        0.46        0.44        0.46        0.44        0.06         XXX
                                                 dye.
70488...........  .............  A............  Ct maxillofacial w/o        1.42       10.39        8.96          NA          NA        0.43         XXX
                                                 & w/dye.
70488...........  TC...........  A............  Ct maxillofacial w/o        0.00        9.90        8.48          NA          NA        0.37         XXX
                                                 & w/dye.
70488...........  26...........  A............  Ct maxillofacial w/o        1.42        0.49        0.48        0.49        0.48        0.06         XXX
                                                 & w/dye.
70490...........  .............  A............  Ct soft tissue neck         1.28        6.48        5.81          NA          NA        0.31         XXX
                                                 w/o dye.
70490...........  TC...........  A............  Ct soft tissue neck         0.00        6.03        5.37          NA          NA        0.25         XXX
                                                 w/o dye.
70490...........  26...........  A............  Ct soft tissue neck         1.28        0.45        0.44        0.45        0.44        0.06         XXX
                                                 w/o dye.
70491...........  .............  A............  Ct soft tissue neck         1.38        8.03        7.07          NA          NA        0.36         XXX
                                                 w/dye.
70491...........  TC...........  A............  Ct soft tissue neck         0.00        7.54        6.60          NA          NA        0.30         XXX
                                                 w/dye.
70491...........  26...........  A............  Ct soft tissue neck         1.38        0.49        0.47        0.49        0.47        0.06         XXX
                                                 w/dye.
70492...........  .............  A............  Ct sft tsue nck w/o         1.45       10.03        8.78          NA          NA        0.43         XXX
                                                 & w/dye.
70492...........  TC...........  A............  Ct sft tsue nck w/o         0.00        9.52        8.29          NA          NA        0.37         XXX
                                                 & w/dye.
70492...........  26...........  A............  Ct sft tsue nck w/o         1.45        0.51        0.49        0.51        0.49        0.06         XXX
                                                 & w/dye.
70496...........  .............  A............  Ct angiography, head        1.75       17.08       14.12          NA          NA        0.66         XXX
70496...........  TC...........  A............  Ct angiography, head        0.00       16.45       13.52          NA          NA        0.58         XXX
70496...........  26...........  A............  Ct angiography, head        1.75        0.63        0.60        0.63        0.60        0.08         XXX
70498...........  .............  A............  Ct angiography, neck        1.75       17.22       14.19          NA          NA        0.66         XXX
70498...........  TC...........  A............  Ct angiography, neck        0.00       16.57       13.58          NA          NA        0.58         XXX
70498...........  26...........  A............  Ct angiography, neck        1.75        0.65        0.61        0.65        0.61        0.08         XXX
70540...........  .............  A............  Mri orbit/face/neck         1.35       14.16       12.90          NA          NA        0.45         XXX
                                                 w/o dye.
70540...........  TC...........  A............  Mri orbit/face/neck         0.00       13.70       12.45          NA          NA        0.39         XXX
                                                 w/o dye.
70540...........  26...........  A............  Mri orbit/face/neck         1.35        0.46        0.45        0.46        0.45        0.06         XXX
                                                 w/o dye.
70542...........  .............  A............  Mri orbit/face/neck         1.62       15.28       14.61          NA          NA        0.54         XXX
                                                 w/dye.
70542...........  TC...........  A............  Mri orbit/face/neck         0.00       14.72       14.07          NA          NA        0.47         XXX
                                                 w/dye.
70542...........  26...........  A............  Mri orbit/face/neck         1.62        0.56        0.54        0.56        0.54        0.07         XXX
                                                 w/dye.
70543...........  .............  A............  Mri orbt/fac/nck w/o        2.15       18.75       22.16          NA          NA        0.94         XXX
                                                 & w/dye.
70543...........  TC...........  A............  Mri orbt/fac/nck w/o        0.00       18.01       21.44          NA          NA        0.84         XXX
                                                 & w/dye.
70543...........  26...........  A............  Mri orbt/fac/nck w/o        2.15        0.74        0.72        0.74        0.72        0.10         XXX
                                                 & w/dye.
70544...........  .............  A............  Mr angiography head         1.20       15.84       13.72          NA          NA        0.64         XXX
                                                 w/o dye.
70544...........  TC...........  A............  Mr angiography head         0.00       15.42       13.31          NA          NA        0.59         XXX
                                                 w/o dye.
70544...........  26...........  A............  Mr angiography head         1.20        0.42        0.41        0.42        0.41        0.05         XXX
                                                 w/o dye.
70545...........  .............  A............  Mr angiography head         1.20       15.73       13.65          NA          NA        0.64         XXX
                                                 w/dye.
70545...........  TC...........  A............  Mr angiography head         0.00       15.31       13.25          NA          NA        0.59         XXX
                                                 w/dye.
70545...........  26...........  A............  Mr angiography head         1.20        0.42        0.40        0.42        0.40        0.05         XXX
                                                 w/dye.
70546...........  .............  A............  Mr angiograph head w/       1.80       24.00       23.50          NA          NA        0.67         XXX
                                                 o&w/dye.
70546...........  TC...........  A............  Mr angiograph head w/       0.00       23.38       22.89          NA          NA        0.59         XXX
                                                 o&w/dye.
70546...........  26...........  A............  Mr angiograph head w/       1.80        0.62        0.61        0.62        0.61        0.08         XXX
                                                 o&w/dye.
70547...........  .............  A............  Mr angiography neck         1.20       15.77       13.68          NA          NA        0.64         XXX
                                                 w/o dye.
70547...........  TC...........  A............  Mr angiography neck         0.00       15.36       13.28          NA          NA        0.59         XXX
                                                 w/o dye.
70547...........  26...........  A............  Mr angiography neck         1.20        0.41        0.40        0.41        0.40        0.05         XXX
                                                 w/o dye.
70548...........  .............  A............  Mr angiography neck         1.20       16.63       14.11          NA          NA        0.64         XXX
                                                 w/dye.
70548...........  TC...........  A............  Mr angiography neck         0.00       16.21       13.70          NA          NA        0.59         XXX
                                                 w/dye.
70548...........  26...........  A............  Mr angiography neck         1.20        0.42        0.41        0.42        0.41        0.05         XXX
                                                 w/dye.
70549...........  .............  A............  Mr angiograph neck w/       1.80       24.02       23.50          NA          NA        0.67         XXX
                                                 o&w/dye.
70549...........  TC...........  A............  Mr angiograph neck w/       0.00       23.39       22.89          NA          NA        0.59         XXX
                                                 o&w/dye.
70549...........  26...........  A............  Mr angiograph neck w/       1.80        0.63        0.61        0.63        0.61        0.08         XXX
                                                 o&w/dye.
70551...........  .............  A............  Mri brain w/o dye...        1.48       14.42       13.05          NA          NA        0.66         XXX
70551...........  TC...........  A............  Mri brain w/o dye...        0.00       13.91       12.55          NA          NA        0.59         XXX
70551...........  26...........  A............  Mri brain w/o dye...        1.48        0.51        0.50        0.51        0.50        0.07         XXX
70552...........  .............  A............  Mri brain w/dye.....        1.78       15.58       14.79          NA          NA        0.78         XXX
70552...........  TC...........  A............  Mri brain w/dye.....        0.00       14.96       14.19          NA          NA        0.70         XXX
70552...........  26...........  A............  Mri brain w/dye.....        1.78        0.62        0.60        0.62        0.60        0.08         XXX
70553...........  .............  A............  Mri brain w/o & w/          2.36       18.06       21.86          NA          NA        1.41         XXX
                                                 dye.
70553...........  TC...........  A............  Mri brain w/o & w/          0.00       17.24       21.06          NA          NA        1.31         XXX
                                                 dye.
70553...........  26...........  A............  Mri brain w/o & w/          2.36        0.82        0.80        0.82        0.80        0.10         XXX
                                                 dye.
70554...........  .............  A............  Fmri brain by tech..        2.11       15.40       15.40          NA          NA        0.92         XXX
70554...........  TC...........  A............  Fmri brain by tech..        0.00       14.71       14.71          NA          NA        0.82         XXX
70554...........  26...........  A............  Fmri brain by tech..        2.11        0.69        0.69        0.69        0.69        0.10         XXX
70555...........  .............  C............  Fmri brain by phys/         0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 psych.
70555...........  TC...........  C............  Fmri brain by phys/         0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 psych.
70555...........  26...........  A............  Fmri brain by phys/         2.54        0.90        0.90        0.90        0.90        0.11         XXX
                                                 psych.
70557...........  .............  C............  Mri brain w/o dye...        0.00        0.00        0.00          NA          NA        0.00         XXX
70557...........  TC...........  C............  Mri brain w/o dye...        0.00        0.00        0.00          NA          NA        0.00         XXX
70557...........  26...........  A............  Mri brain w/o dye...        2.90        1.03        1.08        1.03        1.08        0.08         XXX
70558...........  .............  C............  Mri brain w/dye.....        0.00        0.00        0.00          NA          NA        0.00         XXX
70558...........  TC...........  C............  Mri brain w/dye.....        0.00        0.00        0.00          NA          NA        0.00         XXX
70558...........  26...........  A............  Mri brain w/dye.....        3.20        1.09        1.16        1.09        1.16        0.10         XXX
70559...........  .............  C............  Mri brain w/o & w/          0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 dye.

[[Page 66491]]

 
70559...........  TC...........  C............  Mri brain w/o & w/          0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 dye.
70559...........  26...........  A............  Mri brain w/o & w/          3.20        1.14        1.19        1.14        1.19        0.12         XXX
                                                 dye.
71010...........  .............  A............  Chest x-ray.........        0.18        0.43        0.48          NA          NA        0.03         XXX
71010...........  TC...........  A............  Chest x-ray.........        0.00        0.37        0.42          NA          NA        0.02         XXX
71010...........  26...........  A............  Chest x-ray.........        0.18        0.06        0.06        0.06        0.06        0.01         XXX
71015...........  .............  A............  Chest x-ray.........        0.21        0.58        0.58          NA          NA        0.03         XXX
71015...........  TC...........  A............  Chest x-ray.........        0.00        0.51        0.51          NA          NA        0.02         XXX
71015...........  26...........  A............  Chest x-ray.........        0.21        0.07        0.07        0.07        0.07        0.01         XXX
71020...........  .............  A............  Chest x-ray.........        0.22        0.57        0.63          NA          NA        0.05         XXX
71020...........  TC...........  A............  Chest x-ray.........        0.00        0.50        0.56          NA          NA        0.04         XXX
71020...........  26...........  A............  Chest x-ray.........        0.22        0.07        0.07        0.07        0.07        0.01         XXX
71021...........  .............  A............  Chest x-ray.........        0.27        0.71        0.76          NA          NA        0.06         XXX
71021...........  TC...........  A............  Chest x-ray.........        0.00        0.62        0.67          NA          NA        0.05         XXX
71021...........  26...........  A............  Chest x-ray.........        0.27        0.09        0.09        0.09        0.09        0.01         XXX
71022...........  .............  A............  Chest x-ray.........        0.31        0.90        0.86          NA          NA        0.06         XXX
71022...........  TC...........  A............  Chest x-ray.........        0.00        0.80        0.76          NA          NA        0.05         XXX
71022...........  26...........  A............  Chest x-ray.........        0.31        0.10        0.10        0.10        0.10        0.01         XXX
71023...........  .............  A............  Chest x-ray and             0.38        1.54        1.23          NA          NA        0.06         XXX
                                                 fluoroscopy.
71023...........  TC...........  A............  Chest x-ray and             0.00        1.40        1.09          NA          NA        0.05         XXX
                                                 fluoroscopy.
71023...........  26...........  A............  Chest x-ray and             0.38        0.14        0.14        0.14        0.14        0.01         XXX
                                                 fluoroscopy.
71030...........  .............  A............  Chest x-ray.........        0.31        0.92        0.90          NA          NA        0.06         XXX
71030...........  TC...........  A............  Chest x-ray.........        0.00        0.82        0.80          NA          NA        0.05         XXX
71030...........  26...........  A............  Chest x-ray.........        0.31        0.10        0.10        0.10        0.10        0.01         XXX
71034...........  .............  A............  Chest x-ray and             0.46        2.11        1.85          NA          NA        0.10         XXX
                                                 fluoroscopy.
71034...........  TC...........  A............  Chest x-ray and             0.00        1.90        1.67          NA          NA        0.08         XXX
                                                 fluoroscopy.
71034...........  26...........  A............  Chest x-ray and             0.46        0.21        0.18        0.21        0.18        0.02         XXX
                                                 fluoroscopy.
71035...........  .............  A............  Chest x-ray.........        0.18        0.78        0.68          NA          NA        0.03         XXX
71035...........  TC...........  A............  Chest x-ray.........        0.00        0.72        0.62          NA          NA        0.02         XXX
71035...........  26...........  A............  Chest x-ray.........        0.18        0.06        0.06        0.06        0.06        0.01         XXX
71040...........  .............  A............  Contrast x-ray of           0.58        2.06        1.85          NA          NA        0.11         XXX
                                                 bronchi.
71040...........  TC...........  A............  Contrast x-ray of           0.00        1.88        1.67          NA          NA        0.08         XXX
                                                 bronchi.
71040...........  26...........  A............  Contrast x-ray of           0.58        0.18        0.18        0.18        0.18        0.03         XXX
                                                 bronchi.
71060...........  .............  A............  Contrast x-ray of           0.74        3.11        2.77          NA          NA        0.16         XXX
                                                 bronchi.
71060...........  TC...........  A............  Contrast x-ray of           0.00        2.85        2.52          NA          NA        0.13         XXX
                                                 bronchi.
71060...........  26...........  A............  Contrast x-ray of           0.74        0.26        0.25        0.26        0.25        0.03         XXX
                                                 bronchi.
71090...........  .............  C............  X-ray & pacemaker           0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 insertion.
71090...........  TC...........  C............  X-ray & pacemaker           0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 insertion.
71090...........  26...........  A............  X-ray & pacemaker           0.54        0.28        0.24        0.28        0.24        0.02         XXX
                                                 insertion.
71100...........  .............  A............  X-ray exam of ribs..        0.22        0.62        0.63          NA          NA        0.05         XXX
71100...........  TC...........  A............  X-ray exam of ribs..        0.00        0.55        0.56          NA          NA        0.04         XXX
71100...........  26...........  A............  X-ray exam of ribs..        0.22        0.07        0.07        0.07        0.07        0.01         XXX
71101...........  .............  A............  X-ray exam of ribs/         0.27        0.77        0.76          NA          NA        0.05         XXX
                                                 chest.
71101...........  TC...........  A............  X-ray exam of ribs/         0.00        0.68        0.67          NA          NA        0.04         XXX
                                                 chest.
71101...........  26...........  A............  X-ray exam of ribs/         0.27        0.09        0.09        0.09        0.09        0.01         XXX
                                                 chest.
71110...........  .............  A............  X-ray exam of ribs..        0.27        0.77        0.82          NA          NA        0.06         XXX
71110...........  TC...........  A............  X-ray exam of ribs..        0.00        0.69        0.73          NA          NA        0.05         XXX
71110...........  26...........  A............  X-ray exam of ribs..        0.27        0.08        0.09        0.08        0.09        0.01         XXX
71111...........  .............  A............  X-ray exam of ribs/         0.32        1.06        1.02          NA          NA        0.07         XXX
                                                 chest.
71111...........  TC...........  A............  X-ray exam of ribs/         0.00        0.96        0.92          NA          NA        0.06         XXX
                                                 chest.
71111...........  26...........  A............  X-ray exam of ribs/         0.32        0.10        0.10        0.10        0.10        0.01         XXX
                                                 chest.
71120...........  .............  A............  X-ray exam of               0.20        0.63        0.67          NA          NA        0.05         XXX
                                                 breastbone.
71120...........  TC...........  A............  X-ray exam of               0.00        0.56        0.60          NA          NA        0.04         XXX
                                                 breastbone.
71120...........  26...........  A............  X-ray exam of               0.20        0.07        0.07        0.07        0.07        0.01         XXX
                                                 breastbone.
71130...........  .............  A............  X-ray exam of               0.22        0.76        0.76          NA          NA        0.05         XXX
                                                 breastbone.
71130...........  TC...........  A............  X-ray exam of               0.00        0.68        0.69          NA          NA        0.04         XXX
                                                 breastbone.
71130...........  26...........  A............  X-ray exam of               0.22        0.08        0.07        0.08        0.07        0.01         XXX
                                                 breastbone.
71250...........  .............  A............  Ct thorax w/o dye...        1.16        6.45        6.36          NA          NA        0.36         XXX
71250...........  TC...........  A............  Ct thorax w/o dye...        0.00        6.04        5.97          NA          NA        0.31         XXX
71250...........  26...........  A............  Ct thorax w/o dye...        1.16        0.41        0.39        0.41        0.39        0.05         XXX
71260...........  .............  A............  Ct thorax w/dye.....        1.24        7.99        7.73          NA          NA        0.42         XXX
71260...........  TC...........  A............  Ct thorax w/dye.....        0.00        7.55        7.31          NA          NA        0.37         XXX
71260...........  26...........  A............  Ct thorax w/dye.....        1.24        0.44        0.42        0.44        0.42        0.05         XXX
71270...........  .............  A............  Ct thorax w/o & w/          1.38       10.03        9.67          NA          NA        0.52         XXX
                                                 dye.
71270...........  TC...........  A............  Ct thorax w/o & w/          0.00        9.55        9.20          NA          NA        0.46         XXX
                                                 dye.
71270...........  26...........  A............  Ct thorax w/o & w/          1.38        0.48        0.47        0.48        0.47        0.06         XXX
                                                 dye.
71275...........  .............  A............  Ct angiography,             1.92       11.75       12.38          NA          NA        0.48         XXX
                                                 chest.
71275...........  TC...........  A............  Ct angiography,             0.00       11.06       11.72          NA          NA        0.39         XXX
                                                 chest.
71275...........  26...........  A............  Ct angiography,             1.92        0.69        0.66        0.69        0.66        0.09         XXX
                                                 chest.
71550...........  .............  A............  Mri chest w/o dye...        1.46       16.35       14.01          NA          NA        0.51         XXX
71550...........  TC...........  A............  Mri chest w/o dye...        0.00       15.85       13.52          NA          NA        0.45         XXX
71550...........  26...........  A............  Mri chest w/o dye...        1.46        0.50        0.49        0.50        0.49        0.06         XXX
71551...........  .............  A............  Mri chest w/dye.....        1.73       17.92       15.96          NA          NA        0.60         XXX

[[Page 66492]]

 
71551...........  TC...........  A............  Mri chest w/dye.....        0.00       17.32       15.38          NA          NA        0.52         XXX
71551...........  26...........  A............  Mri chest w/dye.....        1.73        0.60        0.58        0.60        0.58        0.08         XXX
71552...........  .............  A............  Mri chest w/o & w/          2.26       22.55       24.08          NA          NA        0.78         XXX
                                                 dye.
71552...........  TC...........  A............  Mri chest w/o & w/          0.00       21.75       23.31          NA          NA        0.68         XXX
                                                 dye.
71552...........  26...........  A............  Mri chest w/o & w/          2.26        0.80        0.77        0.80        0.77        0.10         XXX
                                                 dye.
71555...........  .............  R............  Mri angio chest w or        1.81       15.30       13.54          NA          NA        0.67         XXX
                                                 w/o dye.
71555...........  TC...........  R............  Mri angio chest w or        0.00       14.64       12.91          NA          NA        0.59         XXX
                                                 w/o dye.
71555...........  26...........  R............  Mri angio chest w or        1.81        0.66        0.63        0.66        0.63        0.08         XXX
                                                 w/o dye.
72010...........  .............  A............  X-ray exam of spine.        0.45        1.43        1.30          NA          NA        0.08         XXX
72010...........  TC...........  A............  X-ray exam of spine.        0.00        1.30        1.16          NA          NA        0.06         XXX
72010...........  26...........  A............  X-ray exam of spine.        0.45        0.13        0.14        0.13        0.14        0.02         XXX
72020...........  .............  A............  X-ray exam of spine.        0.15        0.47        0.47          NA          NA        0.03         XXX
72020...........  TC...........  A............  X-ray exam of spine.        0.00        0.42        0.42          NA          NA        0.02         XXX
72020...........  26...........  A............  X-ray exam of spine.        0.15        0.05        0.05        0.05        0.05        0.01         XXX
72040...........  .............  A............  X-ray exam of neck          0.22        0.76        0.72          NA          NA        0.05         XXX
                                                 spine.
72040...........  TC...........  A............  X-ray exam of neck          0.00        0.69        0.65          NA          NA        0.04         XXX
                                                 spine.
72040...........  26...........  A............  X-ray exam of neck          0.22        0.07        0.07        0.07        0.07        0.01         XXX
                                                 spine.
72050...........  .............  A............  X-ray exam of neck          0.31        1.08        1.03          NA          NA        0.07         XXX
                                                 spine.
72050...........  TC...........  A............  X-ray exam of neck          0.00        0.97        0.93          NA          NA        0.06         XXX
                                                 spine.
72050...........  26...........  A............  X-ray exam of neck          0.31        0.11        0.10        0.11        0.10        0.01         XXX
                                                 spine.
72052...........  .............  A............  X-ray exam of neck          0.36        1.39        1.32          NA          NA        0.08         XXX
                                                 spine.
72052...........  TC...........  A............  X-ray exam of neck          0.00        1.27        1.20          NA          NA        0.06         XXX
                                                 spine.
72052...........  26...........  A............  X-ray exam of neck          0.36        0.12        0.12        0.12        0.12        0.02         XXX
                                                 spine.
72069...........  .............  A............  X-ray exam of trunk         0.22        0.76        0.66          NA          NA        0.03         XXX
                                                 spine.
72069...........  TC...........  A............  X-ray exam of trunk         0.00        0.68        0.58          NA          NA        0.02         XXX
                                                 spine.
72069...........  26...........  A............  X-ray exam of trunk         0.22        0.08        0.08        0.08        0.08        0.01         XXX
                                                 spine.
72070...........  .............  A............  X-ray exam of               0.22        0.64        0.68          NA          NA        0.05         XXX
                                                 thoracic spine.
72070...........  TC...........  A............  X-ray exam of               0.00        0.57        0.61          NA          NA        0.04         XXX
                                                 thoracic spine.
72070...........  26...........  A............  X-ray exam of               0.22        0.07        0.07        0.07        0.07        0.01         XXX
                                                 thoracic spine.
72072...........  .............  A............  X-ray exam of               0.22        0.77        0.78          NA          NA        0.06         XXX
                                                 thoracic spine.
72072...........  TC...........  A............  X-ray exam of               0.00        0.70        0.71          NA          NA        0.05         XXX
                                                 thoracic spine.
72072...........  26...........  A............  X-ray exam of               0.22        0.07        0.07        0.07        0.07        0.01         XXX
                                                 thoracic spine.
72074...........  .............  A............  X-ray exam of               0.22        0.94        0.96          NA          NA        0.07         XXX
                                                 thoracic spine.
72074...........  TC...........  A............  X-ray exam of               0.00        0.87        0.89          NA          NA        0.06         XXX
                                                 thoracic spine.
72074...........  26...........  A............  X-ray exam of               0.22        0.07        0.07        0.07        0.07        0.01         XXX
                                                 thoracic spine.
72080...........  .............  A............  X-ray exam of trunk         0.22        0.70        0.71          NA          NA        0.05         XXX
                                                 spine.
72080...........  TC...........  A............  X-ray exam of trunk         0.00        0.62        0.64          NA          NA        0.04         XXX
                                                 spine.
72080...........  26...........  A............  X-ray exam of trunk         0.22        0.08        0.07        0.08        0.07        0.01         XXX
                                                 spine.
72090...........  .............  A............  X-ray exam of trunk         0.28        1.00        0.88          NA          NA        0.05         XXX
                                                 spine.
72090...........  TC...........  A............  X-ray exam of trunk         0.00        0.90        0.78          NA          NA        0.04         XXX
                                                 spine.
72090...........  26...........  A............  X-ray exam of trunk         0.28        0.10        0.10        0.10        0.10        0.01         XXX
                                                 spine.
72100...........  .............  A............  X-ray exam of lower         0.22        0.81        0.77          NA          NA        0.05         XXX
                                                 spine.
72100...........  TC...........  A............  X-ray exam of lower         0.00        0.74        0.70          NA          NA        0.04         XXX
                                                 spine.
72100...........  26...........  A............  X-ray exam of lower         0.22        0.07        0.07        0.07        0.07        0.01         XXX
                                                 spine.
72110...........  .............  A............  X-ray exam of lower         0.31        1.15        1.07          NA          NA        0.07         XXX
                                                 spine.
72110...........  TC...........  A............  X-ray exam of lower         0.00        1.04        0.97          NA          NA        0.06         XXX
                                                 spine.
72110...........  26...........  A............  X-ray exam of lower         0.31        0.11        0.10        0.11        0.10        0.01         XXX
                                                 spine.
72114...........  .............  A............  X-ray exam of lower         0.36        1.57        1.43          NA          NA        0.08         XXX
                                                 spine.
72114...........  TC...........  A............  X-ray exam of lower         0.00        1.44        1.31          NA          NA        0.06         XXX
                                                 spine.
72114...........  26...........  A............  X-ray exam of lower         0.36        0.13        0.12        0.13        0.12        0.02         XXX
                                                 spine.
72120...........  .............  A............  X-ray exam of lower         0.22        1.08        1.01          NA          NA        0.07         XXX
                                                 spine.
72120...........  TC...........  A............  X-ray exam of lower         0.00        1.00        0.94          NA          NA        0.06         XXX
                                                 spine.
72120...........  26...........  A............  X-ray exam of lower         0.22        0.08        0.07        0.08        0.07        0.01         XXX
                                                 spine.
72125...........  .............  A............  Ct neck spine w/o           1.16        6.46        6.37          NA          NA        0.36         XXX
                                                 dye.
72125...........  TC...........  A............  Ct neck spine w/o           0.00        6.05        5.98          NA          NA        0.31         XXX
                                                 dye.
72125...........  26...........  A............  Ct neck spine w/o           1.16        0.41        0.39        0.41        0.39        0.05         XXX
                                                 dye.
72126...........  .............  A............  Ct neck spine w/dye.        1.22        7.99        7.72          NA          NA        0.42         XXX
72126...........  TC...........  A............  Ct neck spine w/dye.        0.00        7.56        7.31          NA          NA        0.37         XXX
72126...........  26...........  A............  Ct neck spine w/dye.        1.22        0.43        0.41        0.43        0.41        0.05         XXX
72127...........  .............  A............  Ct neck spine w/o &         1.27       10.03        9.65          NA          NA        0.52         XXX
                                                 w/dye.
72127...........  TC...........  A............  Ct neck spine w/o &         0.00        9.59        9.22          NA          NA        0.46         XXX
                                                 w/dye.
72127...........  26...........  A............  Ct neck spine w/o &         1.27        0.44        0.43        0.44        0.43        0.06         XXX
                                                 w/dye.
72128...........  .............  A............  Ct chest spine w/o          1.16        6.45        6.36          NA          NA        0.36         XXX
                                                 dye.
72128...........  TC...........  A............  Ct chest spine w/o          0.00        6.04        5.97          NA          NA        0.31         XXX
                                                 dye.
72128...........  26...........  A............  Ct chest spine w/o          1.16        0.41        0.39        0.41        0.39        0.05         XXX
                                                 dye.
72129...........  .............  A............  Ct chest spine w/dye        1.22        7.99        7.72          NA          NA        0.42         XXX
72129...........  TC...........  A............  Ct chest spine w/dye        0.00        7.56        7.31          NA          NA        0.37         XXX
72129...........  26...........  A............  Ct chest spine w/dye        1.22        0.43        0.41        0.43        0.41        0.05         XXX
72130...........  .............  A............  Ct chest spine w/o &        1.27        9.97        9.62          NA          NA        0.52         XXX
                                                 w/dye.
72130...........  TC...........  A............  Ct chest spine w/o &        0.00        9.53        9.19          NA          NA        0.46         XXX
                                                 w/dye.
72130...........  26...........  A............  Ct chest spine w/o &        1.27        0.44        0.43        0.44        0.43        0.06         XXX
                                                 w/dye.
72131...........  .............  A............  Ct lumbar spine w/o         1.16        6.42        6.36          NA          NA        0.36         XXX
                                                 dye.

[[Page 66493]]

 
72131...........  TC...........  A............  Ct lumbar spine w/o         0.00        6.02        5.97          NA          NA        0.31         XXX
                                                 dye.
72131...........  26...........  A............  Ct lumbar spine w/o         1.16        0.40        0.39        0.40        0.39        0.05         XXX
                                                 dye.
72132...........  .............  A............  Ct lumbar spine w/          1.22        7.97        7.71          NA          NA        0.42         XXX
                                                 dye.
72132...........  TC...........  A............  Ct lumbar spine w/          0.00        7.54        7.30          NA          NA        0.37         XXX
                                                 dye.
72132...........  26...........  A............  Ct lumbar spine w/          1.22        0.43        0.41        0.43        0.41        0.05         XXX
                                                 dye.
72133...........  .............  A............  Ct lumbar spine w/o         1.27       10.01        9.64          NA          NA        0.52         XXX
                                                 & w/dye.
72133...........  TC...........  A............  Ct lumbar spine w/o         0.00        9.57        9.21          NA          NA        0.46         XXX
                                                 & w/dye.
72133...........  26...........  A............  Ct lumbar spine w/o         1.27        0.44        0.43        0.44        0.43        0.06         XXX
                                                 & w/dye.
72141...........  .............  A............  Mri neck spine w/o          1.60       12.45       12.09          NA          NA        0.66         XXX
                                                 dye.
72141...........  TC...........  A............  Mri neck spine w/o          0.00       11.90       11.55          NA          NA        0.59         XXX
                                                 dye.
72141...........  26...........  A............  Mri neck spine w/o          1.60        0.55        0.54        0.55        0.54        0.07         XXX
                                                 dye.
72142...........  .............  A............  Mri neck spine w/dye        1.92       15.60       14.84          NA          NA        0.79         XXX
72142...........  TC...........  A............  Mri neck spine w/dye        0.00       14.94       14.19          NA          NA        0.70         XXX
72142...........  26...........  A............  Mri neck spine w/dye        1.92        0.66        0.65        0.66        0.65        0.09         XXX
72146...........  .............  A............  Mri chest spine w/o         1.60       12.47       12.72          NA          NA        0.71         XXX
                                                 dye.
72146...........  TC...........  A............  Mri chest spine w/o         0.00       11.92       12.18          NA          NA        0.64         XXX
                                                 dye.
72146...........  26...........  A............  Mri chest spine w/o         1.60        0.55        0.54        0.55        0.54        0.07         XXX
                                                 dye.
72147...........  .............  A............  Mri chest spine w/          1.92       13.56       13.81          NA          NA        0.79         XXX
                                                 dye.
72147...........  TC...........  A............  Mri chest spine w/          0.00       12.89       13.16          NA          NA        0.70         XXX
                                                 dye.
72147...........  26...........  A............  Mri chest spine w/          1.92        0.67        0.65        0.67        0.65        0.09         XXX
                                                 dye.
72148...........  .............  A............  Mri lumbar spine w/o        1.48       12.41       12.67          NA          NA        0.71         XXX
                                                 dye.
72148...........  TC...........  A............  Mri lumbar spine w/o        0.00       11.90       12.17          NA          NA        0.64         XXX
                                                 dye.
72148...........  26...........  A............  Mri lumbar spine w/o        1.48        0.51        0.50        0.51        0.50        0.07         XXX
                                                 dye.
72149...........  .............  A............  Mri lumbar spine w/         1.78       15.51       14.77          NA          NA        0.78         XXX
                                                 dye.
72149...........  TC...........  A............  Mri lumbar spine w/         0.00       14.89       14.16          NA          NA        0.70         XXX
                                                 dye.
72149...........  26...........  A............  Mri lumbar spine w/         1.78        0.62        0.61        0.62        0.61        0.08         XXX
                                                 dye.
72156...........  .............  A............  Mri neck spine w/o &        2.57       17.76       21.74          NA          NA        1.42         XXX
                                                 w/dye.
72156...........  TC...........  A............  Mri neck spine w/o &        0.00       16.88       20.87          NA          NA        1.31         XXX
                                                 w/dye.
72156...........  26...........  A............  Mri neck spine w/o &        2.57        0.88        0.87        0.88        0.87        0.11         XXX
                                                 w/dye.
72157...........  .............  A............  Mri chest spine w/o         2.57       16.20       20.95          NA          NA        1.42         XXX
                                                 & w/dye.
72157...........  TC...........  A............  Mri chest spine w/o         0.00       15.30       20.08          NA          NA        1.31         XXX
                                                 & w/dye.
72157...........  26...........  A............  Mri chest spine w/o         2.57        0.90        0.87        0.90        0.87        0.11         XXX
                                                 & w/dye.
72158...........  .............  A............  Mri lumbar spine w/o        2.36       17.68       21.66          NA          NA        1.41         XXX
                                                 & w/dye.
72158...........  TC...........  A............  Mri lumbar spine w/o        0.00       16.86       20.86          NA          NA        1.31         XXX
                                                 & w/dye.
72158...........  26...........  A............  Mri lumbar spine w/o        2.36        0.82        0.80        0.82        0.80        0.10         XXX
                                                 & w/dye.
72159...........  .............  N............  Mr angio spine w/o&w/       1.80       14.65       13.78          NA          NA        0.74         XXX
                                                 dye.
72159...........  TC...........  N............  Mr angio spine w/o&w/       0.00       14.24       13.23          NA          NA        0.64         XXX
                                                 dye.
72159...........  26...........  N............  Mr angio spine w/o&w/       1.80        0.41        0.55        0.41        0.55        0.10         XXX
                                                 dye.
72170...........  .............  A............  X-ray exam of pelvis        0.17        0.50        0.54          NA          NA        0.03         XXX
72170...........  TC...........  A............  X-ray exam of pelvis        0.00        0.44        0.48          NA          NA        0.02         XXX
72170...........  26...........  A............  X-ray exam of pelvis        0.17        0.06        0.06        0.06        0.06        0.01         XXX
72190...........  .............  A............  X-ray exam of pelvis        0.21        0.84        0.79          NA          NA        0.05         XXX
72190...........  TC...........  A............  X-ray exam of pelvis        0.00        0.77        0.72          NA          NA        0.04         XXX
72190...........  26...........  A............  X-ray exam of pelvis        0.21        0.07        0.07        0.07        0.07        0.01         XXX
72191...........  .............  A............  Ct angiograph pelv w/       1.81       11.32       11.97          NA          NA        0.47         XXX
                                                 o&w/dye.
72191...........  TC...........  A............  Ct angiograph pelv w/       0.00       10.67       11.35          NA          NA        0.39         XXX
                                                 o&w/dye.
72191...........  26...........  A............  Ct angiograph pelv w/       1.81        0.65        0.62        0.65        0.62        0.08         XXX
                                                 o&w/dye.
72192...........  .............  A............  Ct pelvis w/o dye...        1.09        6.03        6.15          NA          NA        0.36         XXX
72192...........  TC...........  A............  Ct pelvis w/o dye...        0.00        5.64        5.78          NA          NA        0.31         XXX
72192...........  26...........  A............  Ct pelvis w/o dye...        1.09        0.39        0.37        0.39        0.37        0.05         XXX
72193...........  .............  A............  Ct pelvis w/dye.....        1.16        7.54        7.37          NA          NA        0.41         XXX
72193...........  TC...........  A............  Ct pelvis w/dye.....        0.00        7.13        6.98          NA          NA        0.36         XXX
72193...........  26...........  A............  Ct pelvis w/dye.....        1.16        0.41        0.39        0.41        0.39        0.05         XXX
72194...........  .............  A............  Ct pelvis w/o & w/          1.22       10.12        9.49          NA          NA        0.48         XXX
                                                 dye.
72194...........  TC...........  A............  Ct pelvis w/o & w/          0.00        9.69        9.08          NA          NA        0.43         XXX
                                                 dye.
72194...........  26...........  A............  Ct pelvis w/o & w/          1.22        0.43        0.41        0.43        0.41        0.05         XXX
                                                 dye.
72195...........  .............  A............  Mri pelvis w/o dye..        1.46       14.43       13.04          NA          NA        0.51         XXX
72195...........  TC...........  A............  Mri pelvis w/o dye..        0.00       13.92       12.55          NA          NA        0.45         XXX
72195...........  26...........  A............  Mri pelvis w/o dye..        1.46        0.51        0.49        0.51        0.49        0.06         XXX
72196...........  .............  A............  Mri pelvis w/dye....        1.73       15.52       14.76          NA          NA        0.60         XXX
72196...........  TC...........  A............  Mri pelvis w/dye....        0.00       14.91       14.17          NA          NA        0.52         XXX
72196...........  26...........  A............  Mri pelvis w/dye....        1.73        0.61        0.59        0.61        0.59        0.08         XXX
72197...........  .............  A............  Mri pelvis w/o & w/         2.26       18.95       22.27          NA          NA        1.02         XXX
                                                 dye.
72197...........  TC...........  A............  Mri pelvis w/o & w/         0.00       18.16       21.51          NA          NA        0.92         XXX
                                                 dye.
72197...........  26...........  A............  Mri pelvis w/o & w/         2.26        0.79        0.76        0.79        0.76        0.10         XXX
                                                 dye.
72198...........  .............  A............  Mr angio pelvis w/o         1.80       15.08       13.42          NA          NA        0.67         XXX
                                                 & w/dye.
72198...........  TC...........  A............  Mr angio pelvis w/o         0.00       14.44       12.81          NA          NA        0.59         XXX
                                                 & w/dye.
72198...........  26...........  A............  Mr angio pelvis w/o         1.80        0.64        0.61        0.64        0.61        0.08         XXX
                                                 & w/dye.
72200...........  .............  A............  X-ray exam                  0.17        0.59        0.59          NA          NA        0.03         XXX
                                                 sacroiliac joints.
72200...........  TC...........  A............  X-ray exam                  0.00        0.54        0.53          NA          NA        0.02         XXX
                                                 sacroiliac joints.
72200...........  26...........  A............  X-ray exam                  0.17        0.05        0.06        0.05        0.06        0.01         XXX
                                                 sacroiliac joints.
72202...........  .............  A............  X-ray exam                  0.19        0.74        0.71          NA          NA        0.05         XXX
                                                 sacroiliac joints.

[[Page 66494]]

 
72202...........  TC...........  A............  X-ray exam                  0.00        0.67        0.65          NA          NA        0.04         XXX
                                                 sacroiliac joints.
72202...........  26...........  A............  X-ray exam                  0.19        0.07        0.06        0.07        0.06        0.01         XXX
                                                 sacroiliac joints.
72220...........  .............  A............  X-ray exam of               0.17        0.57        0.61          NA          NA        0.05         XXX
                                                 tailbone.
72220...........  TC...........  A............  X-ray exam of               0.00        0.52        0.55          NA          NA        0.04         XXX
                                                 tailbone.
72220...........  26...........  A............  X-ray exam of               0.17        0.05        0.06        0.05        0.06        0.01         XXX
                                                 tailbone.
72240...........  .............  A............  Contrast x-ray of           0.91        2.58        3.80          NA          NA        0.29         XXX
                                                 neck spine.
72240...........  TC...........  A............  Contrast x-ray of           0.00        2.26        3.50          NA          NA        0.25         XXX
                                                 neck spine.
72240...........  26...........  A............  Contrast x-ray of           0.91        0.32        0.30        0.32        0.30        0.04         XXX
                                                 neck spine.
72255...........  .............  A............  Contrast x-ray,             0.91        2.24        3.42          NA          NA        0.26         XXX
                                                 thorax spine.
72255...........  TC...........  A............  Contrast x-ray,             0.00        1.96        3.14          NA          NA        0.22         XXX
                                                 thorax spine.
72255...........  26...........  A............  Contrast x-ray,             0.91        0.28        0.28        0.28        0.28        0.04         XXX
                                                 thorax spine.
72265...........  .............  A............  Contrast x-ray,             0.83        2.53        3.43          NA          NA        0.26         XXX
                                                 lower spine.
72265...........  TC...........  A............  Contrast x-ray,             0.00        2.24        3.16          NA          NA        0.22         XXX
                                                 lower spine.
72265...........  26...........  A............  Contrast x-ray,             0.83        0.29        0.27        0.29        0.27        0.04         XXX
                                                 lower spine.
72270...........  .............  A............  Contrast x-ray,             1.33        3.99        5.26          NA          NA        0.39         XXX
                                                 spine.
72270...........  TC...........  A............  Contrast x-ray,             0.00        3.52        4.81          NA          NA        0.33         XXX
                                                 spine.
72270...........  26...........  A............  Contrast x-ray,             1.33        0.47        0.45        0.47        0.45        0.06         XXX
                                                 spine.
72275...........  .............  A............  Epidurography.......        0.76        1.73        2.02          NA          NA        0.26         XXX
72275...........  TC...........  A............  Epidurography.......        0.00        1.53        1.82          NA          NA        0.22         XXX
72275...........  26...........  A............  Epidurography.......        0.76        0.20        0.20        0.20        0.20        0.04         XXX
72285...........  .............  A............  X-ray c/t spine disk        1.16        1.44        5.08          NA          NA        0.50         XXX
72285...........  TC...........  A............  X-ray c/t spine disk        0.00        1.14        4.75          NA          NA        0.43         XXX
72285...........  26...........  A............  X-ray c/t spine disk        1.16        0.30        0.33        0.30        0.33        0.07         XXX
72291...........  .............  C............  Perq vertebroplasty,        0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 fluor.
72291...........  TC...........  C............  Perq vertebroplasty,        0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 fluor.
72291...........  26...........  A............  Perq vertebroplasty,        1.31        0.47        0.47        0.47        0.47        0.10         XXX
                                                 fluor.
72292...........  .............  C............  Perq vertebroplasty,        0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 ct.
72292...........  TC...........  C............  Perq vertebroplasty,        0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 ct.
72292...........  26...........  A............  Perq vertebroplasty,        1.38        0.50        0.49        0.50        0.49        0.07         XXX
                                                 ct.
72295...........  .............  A............  X-ray of lower spine        0.83        1.45        4.79          NA          NA        0.46         XXX
                                                 disk.
72295...........  TC...........  A............  X-ray of lower spine        0.00        1.21        4.53          NA          NA        0.40         XXX
                                                 disk.
72295...........  26...........  A............  X-ray of lower spine        0.83        0.24        0.26        0.24        0.26        0.06         XXX
                                                 disk.
73000...........  .............  A............  X-ray exam of collar        0.16        0.55        0.56          NA          NA        0.03         XXX
                                                 bone.
73000...........  TC...........  A............  X-ray exam of collar        0.00        0.50        0.51          NA          NA        0.02         XXX
                                                 bone.
73000...........  26...........  A............  X-ray exam of collar        0.16        0.05        0.05        0.05        0.05        0.01         XXX
                                                 bone.
73010...........  .............  A............  X-ray exam of               0.17        0.58        0.58          NA          NA        0.03         XXX
                                                 shoulder blade.
73010...........  TC...........  A............  X-ray exam of               0.00        0.52        0.52          NA          NA        0.02         XXX
                                                 shoulder blade.
73010...........  26...........  A............  X-ray exam of               0.17        0.06        0.06        0.06        0.06        0.01         XXX
                                                 shoulder blade.
73020...........  .............  A............  X-ray exam of               0.15        0.44        0.48          NA          NA        0.03         XXX
                                                 shoulder.
73020...........  TC...........  A............  X-ray exam of               0.00        0.39        0.43          NA          NA        0.02         XXX
                                                 shoulder.
73020...........  26...........  A............  X-ray exam of               0.15        0.05        0.05        0.05        0.05        0.01         XXX
                                                 shoulder.
73030...........  .............  A............  X-ray exam of               0.18        0.57        0.60          NA          NA        0.05         XXX
                                                 shoulder.
73030...........  TC...........  A............  X-ray exam of               0.00        0.51        0.54          NA          NA        0.04         XXX
                                                 shoulder.
73030...........  26...........  A............  X-ray exam of               0.18        0.06        0.06        0.06        0.06        0.01         XXX
                                                 shoulder.
73040...........  .............  A............  Contrast x-ray of           0.54        2.24        2.26          NA          NA        0.14         XXX
                                                 shoulder.
73040...........  TC...........  A............  Contrast x-ray of           0.00        2.05        2.08          NA          NA        0.12         XXX
                                                 shoulder.
73040...........  26...........  A............  Contrast x-ray of           0.54        0.19        0.18        0.19        0.18        0.02         XXX
                                                 shoulder.
73050...........  .............  A............  X-ray exam of               0.20        0.74        0.73          NA          NA        0.05         XXX
                                                 shoulders.
73050...........  TC...........  A............  X-ray exam of               0.00        0.66        0.66          NA          NA        0.04         XXX
                                                 shoulders.
73050...........  26...........  A............  X-ray exam of               0.20        0.08        0.07        0.08        0.07        0.01         XXX
                                                 shoulders.
73060...........  .............  A............  X-ray exam of               0.17        0.58        0.60          NA          NA        0.05         XXX
                                                 humerus.
73060...........  TC...........  A............  X-ray exam of               0.00        0.52        0.54          NA          NA        0.04         XXX
                                                 humerus.
73060...........  26...........  A............  X-ray exam of               0.17        0.06        0.06        0.06        0.06        0.01         XXX
                                                 humerus.
73070...........  .............  A............  X-ray exam of elbow.        0.15        0.55        0.56          NA          NA        0.03         XXX
73070...........  TC...........  A............  X-ray exam of elbow.        0.00        0.50        0.51          NA          NA        0.02         XXX
73070...........  26...........  A............  X-ray exam of elbow.        0.15        0.05        0.05        0.05        0.05        0.01         XXX
73080...........  .............  A............  X-ray exam of elbow.        0.17        0.76        0.69          NA          NA        0.05         XXX
73080...........  TC...........  A............  X-ray exam of elbow.        0.00        0.70        0.63          NA          NA        0.04         XXX
73080...........  26...........  A............  X-ray exam of elbow.        0.17        0.06        0.06        0.06        0.06        0.01         XXX
73085...........  .............  A............  Contrast x-ray of           0.54        1.83        2.07          NA          NA        0.14         XXX
                                                 elbow.
73085...........  TC...........  A............  Contrast x-ray of           0.00        1.65        1.88          NA          NA        0.12         XXX
                                                 elbow.
73085...........  26...........  A............  Contrast x-ray of           0.54        0.18        0.19        0.18        0.19        0.02         XXX
                                                 elbow.
73090...........  .............  A............  X-ray exam of               0.16        0.55        0.56          NA          NA        0.03         XXX
                                                 forearm.
73090...........  TC...........  A............  X-ray exam of               0.00        0.50        0.51          NA          NA        0.02         XXX
                                                 forearm.
73090...........  26...........  A............  X-ray exam of               0.16        0.05        0.05        0.05        0.05        0.01         XXX
                                                 forearm.
73092...........  .............  A............  X-ray exam of arm,          0.16        0.58        0.56          NA          NA        0.03         XXX
                                                 infant.
73092...........  TC...........  A............  X-ray exam of arm,          0.00        0.53        0.51          NA          NA        0.02         XXX
                                                 infant.
73092...........  26...........  A............  X-ray exam of arm,          0.16        0.05        0.05        0.05        0.05        0.01         XXX
                                                 infant.
73100...........  .............  A............  X-ray exam of wrist.        0.16        0.61        0.57          NA          NA        0.03         XXX
73100...........  TC...........  A............  X-ray exam of wrist.        0.00        0.55        0.52          NA          NA        0.02         XXX
73100...........  26...........  A............  X-ray exam of wrist.        0.16        0.06        0.05        0.06        0.05        0.01         XXX
73110...........  .............  A............  X-ray exam of wrist.        0.17        0.78        0.68          NA          NA        0.03         XXX

[[Page 66495]]

 
73110...........  TC...........  A............  X-ray exam of wrist.        0.00        0.72        0.62          NA          NA        0.02         XXX
73110...........  26...........  A............  X-ray exam of wrist.        0.17        0.06        0.06        0.06        0.06        0.01         XXX
73115...........  .............  A............  Contrast x-ray of           0.54        2.33        2.04          NA          NA        0.12         XXX
                                                 wrist.
73115...........  TC...........  A............  Contrast x-ray of           0.00        2.14        1.86          NA          NA        0.10         XXX
                                                 wrist.
73115...........  26...........  A............  Contrast x-ray of           0.54        0.19        0.18        0.19        0.18        0.02         XXX
                                                 wrist.
73120...........  .............  A............  X-ray exam of hand..        0.16        0.56        0.55          NA          NA        0.03         XXX
73120...........  TC...........  A............  X-ray exam of hand..        0.00        0.51        0.50          NA          NA        0.02         XXX
73120...........  26...........  A............  X-ray exam of hand..        0.16        0.05        0.05        0.05        0.05        0.01         XXX
73130...........  .............  A............  X-ray exam of hand..        0.17        0.66        0.62          NA          NA        0.03         XXX
73130...........  TC...........  A............  X-ray exam of hand..        0.00        0.60        0.56          NA          NA        0.02         XXX
73130...........  26...........  A............  X-ray exam of hand..        0.17        0.06        0.06        0.06        0.06        0.01         XXX
73140...........  .............  A............  X-ray exam of               0.13        0.67        0.57          NA          NA        0.03         XXX
                                                 finger(s).
73140...........  TC...........  A............  X-ray exam of               0.00        0.63        0.53          NA          NA        0.02         XXX
                                                 finger(s).
73140...........  26...........  A............  X-ray exam of               0.13        0.04        0.04        0.04        0.04        0.01         XXX
                                                 finger(s).
73200...........  .............  A............  Ct upper extremity w/       1.09        6.39        5.85          NA          NA        0.30         XXX
                                                 o dye.
73200...........  TC...........  A............  Ct upper extremity w/       0.00        6.01        5.48          NA          NA        0.25         XXX
                                                 o dye.
73200...........  26...........  A............  Ct upper extremity w/       1.09        0.38        0.37        0.38        0.37        0.05         XXX
                                                 o dye.
73201...........  .............  A............  Ct upper extremity w/       1.16        7.91        7.09          NA          NA        0.36         XXX
                                                 dye.
73201...........  TC...........  A............  Ct upper extremity w/       0.00        7.50        6.70          NA          NA        0.31         XXX
                                                 dye.
73201...........  26...........  A............  Ct upper extremity w/       1.16        0.41        0.39        0.41        0.39        0.05         XXX
                                                 dye.
73202...........  .............  A............  Ct uppr extremity w/        1.22       10.54        9.18          NA          NA        0.44         XXX
                                                 o&w/dye.
73202...........  TC...........  A............  Ct uppr extremity w/        0.00       10.12        8.77          NA          NA        0.39         XXX
                                                 o&w/dye.
73202...........  26...........  A............  Ct uppr extremity w/        1.22        0.42        0.41        0.42        0.41        0.05         XXX
                                                 o&w/dye.
73206...........  .............  A............  Ct angio upr extrm w/       1.81       10.91       11.23          NA          NA        0.47         XXX
                                                 o&w/dye.
73206...........  TC...........  A............  Ct angio upr extrm w/       0.00       10.24       10.60          NA          NA        0.39         XXX
                                                 o&w/dye.
73206...........  26...........  A............  Ct angio upr extrm w/       1.81        0.67        0.63        0.67        0.63        0.08         XXX
                                                 o&w/dye.
73218...........  .............  A............  Mri upper extremity         1.35       14.63       13.13          NA          NA        0.45         XXX
                                                 w/o dye.
73218...........  TC...........  A............  Mri upper extremity         0.00       14.17       12.68          NA          NA        0.39         XXX
                                                 w/o dye.
73218...........  26...........  A............  Mri upper extremity         1.35        0.46        0.45        0.46        0.45        0.06         XXX
                                                 w/o dye.
73219...........  .............  A............  Mri upper extremity         1.62       15.39       14.68          NA          NA        0.54         XXX
                                                 w/dye.
73219...........  TC...........  A............  Mri upper extremity         0.00       14.83       14.13          NA          NA        0.47         XXX
                                                 w/dye.
73219...........  26...........  A............  Mri upper extremity         1.62        0.56        0.55        0.56        0.55        0.07         XXX
                                                 w/dye.
73220...........  .............  A............  Mri uppr extremity w/       2.15       19.03       22.31          NA          NA        0.94         XXX
                                                 o&w/dye.
73220...........  TC...........  A............  Mri uppr extremity w/       0.00       18.29       21.58          NA          NA        0.84         XXX
                                                 o&w/dye.
73220...........  26...........  A............  Mri uppr extremity w/       2.15        0.74        0.73        0.74        0.73        0.10         XXX
                                                 o&w/dye.
73221...........  .............  A............  Mri joint upr extrem        1.35       13.55       12.59          NA          NA        0.45         XXX
                                                 w/o dye.
73221...........  TC...........  A............  Mri joint upr extrem        0.00       13.08       12.14          NA          NA        0.39         XXX
                                                 w/o dye.
73221...........  26...........  A............  Mri joint upr extrem        1.35        0.47        0.45        0.47        0.45        0.06         XXX
                                                 w/o dye.
73222...........  .............  A............  Mri joint upr extrem        1.62       14.29       14.12          NA          NA        0.54         XXX
                                                 w/dye.
73222...........  TC...........  A............  Mri joint upr extrem        0.00       13.73       13.58          NA          NA        0.47         XXX
                                                 w/dye.
73222...........  26...........  A............  Mri joint upr extrem        1.62        0.56        0.54        0.56        0.54        0.07         XXX
                                                 w/dye.
73223...........  .............  A............  Mri joint upr extr w/       2.15       17.56       21.56          NA          NA        0.94         XXX
                                                 o&w/dye.
73223...........  TC...........  A............  Mri joint upr extr w/       0.00       16.82       20.84          NA          NA        0.84         XXX
                                                 o&w/dye.
73223...........  26...........  A............  Mri joint upr extr w/       2.15        0.74        0.72        0.74        0.72        0.10         XXX
                                                 o&w/dye.
73225...........  .............  N............  Mr angio upr extr w/        1.73       14.64       13.15          NA          NA        0.69         XXX
                                                 o&w/dye.
73225...........  TC...........  N............  Mr angio upr extr w/        0.00       14.24       12.62          NA          NA        0.59         XXX
                                                 o&w/dye.
73225...........  26...........  N............  Mr angio upr extr w/        1.73        0.40        0.53        0.40        0.53        0.10         XXX
                                                 o&w/dye.
73500...........  .............  A............  X-ray exam of hip...        0.17        0.49        0.51          NA          NA        0.03         XXX
73500...........  TC...........  A............  X-ray exam of hip...        0.00        0.43        0.45          NA          NA        0.02         XXX
73500...........  26...........  A............  X-ray exam of hip...        0.17        0.06        0.06        0.06        0.06        0.01         XXX
73510...........  .............  A............  X-ray exam of hip...        0.21        0.77        0.71          NA          NA        0.05         XXX
73510...........  TC...........  A............  X-ray exam of hip...        0.00        0.70        0.64          NA          NA        0.04         XXX
73510...........  26...........  A............  X-ray exam of hip...        0.21        0.07        0.07        0.07        0.07        0.01         XXX
73520...........  .............  A............  X-ray exam of hips..        0.26        0.79        0.77          NA          NA        0.05         XXX
73520...........  TC...........  A............  X-ray exam of hips..        0.00        0.70        0.68          NA          NA        0.04         XXX
73520...........  26...........  A............  X-ray exam of hips..        0.26        0.09        0.09        0.09        0.09        0.01         XXX
73525...........  .............  A............  Contrast x-ray of           0.54        1.82        2.05          NA          NA        0.15         XXX
                                                 hip.
73525...........  TC...........  A............  Contrast x-ray of           0.00        1.64        1.87          NA          NA        0.12         XXX
                                                 hip.
73525...........  26...........  A............  Contrast x-ray of           0.54        0.18        0.18        0.18        0.18        0.03         XXX
                                                 hip.
73530...........  .............  C............  X-ray exam of hip...        0.00        0.00        0.00          NA          NA        0.00         XXX
73530...........  TC...........  C............  X-ray exam of hip...        0.00        0.00        0.00          NA          NA        0.00         XXX
73530...........  26...........  A............  X-ray exam of hip...        0.29        0.11        0.10        0.11        0.10        0.01         XXX
73540...........  .............  A............  X-ray exam of pelvis        0.20        0.81        0.72          NA          NA        0.05         XXX
                                                 & hips.
73540...........  TC...........  A............  X-ray exam of pelvis        0.00        0.74        0.65          NA          NA        0.04         XXX
                                                 & hips.
73540...........  26...........  A............  X-ray exam of pelvis        0.20        0.07        0.07        0.07        0.07        0.01         XXX
                                                 & hips.
73542...........  .............  A............  X-ray exam,                 0.59        1.12        1.69          NA          NA        0.15         XXX
                                                 sacroiliac joint.
73542...........  TC...........  A............  X-ray exam,                 0.00        0.98        1.54          NA          NA        0.12         XXX
                                                 sacroiliac joint.
73542...........  26...........  A............  X-ray exam,                 0.59        0.14        0.15        0.14        0.15        0.03         XXX
                                                 sacroiliac joint.
73550...........  .............  A............  X-ray exam of thigh.        0.17        0.55        0.59          NA          NA        0.05         XXX
73550...........  TC...........  A............  X-ray exam of thigh.        0.00        0.49        0.53          NA          NA        0.04         XXX
73550...........  26...........  A............  X-ray exam of thigh.        0.17        0.06        0.06        0.06        0.06        0.01         XXX
73560...........  .............  A............  X-ray exam of knee,         0.17        0.58        0.58          NA          NA        0.03         XXX
                                                 1 or 2.

[[Page 66496]]

 
73560...........  TC...........  A............  X-ray exam of knee,         0.00        0.52        0.52          NA          NA        0.02         XXX
                                                 1 or 2.
73560...........  26...........  A............  X-ray exam of knee,         0.17        0.06        0.06        0.06        0.06        0.01         XXX
                                                 1 or 2.
73562...........  .............  A............  X-ray exam of knee,         0.18        0.73        0.68          NA          NA        0.05         XXX
                                                 3.
73562...........  TC...........  A............  X-ray exam of knee,         0.00        0.66        0.62          NA          NA        0.04         XXX
                                                 3.
73562...........  26...........  A............  X-ray exam of knee,         0.18        0.07        0.06        0.07        0.06        0.01         XXX
                                                 3.
73564...........  .............  A............  X-ray exam, knee, 4         0.22        0.86        0.77          NA          NA        0.05         XXX
                                                 or more.
73564...........  TC...........  A............  X-ray exam, knee, 4         0.00        0.78        0.70          NA          NA        0.04         XXX
                                                 or more.
73564...........  26...........  A............  X-ray exam, knee, 4         0.22        0.08        0.07        0.08        0.07        0.01         XXX
                                                 or more.
73565...........  .............  A............  X-ray exam of knees.        0.17        0.65        0.60          NA          NA        0.03         XXX
73565...........  TC...........  A............  X-ray exam of knees.        0.00        0.59        0.54          NA          NA        0.02         XXX
73565...........  26...........  A............  X-ray exam of knees.        0.17        0.06        0.06        0.06        0.06        0.01         XXX
73580...........  .............  A............  Contrast x-ray of           0.54        2.55        2.67          NA          NA        0.17         XXX
                                                 knee joint.
73580...........  TC...........  A............  Contrast x-ray of           0.00        2.36        2.49          NA          NA        0.14         XXX
                                                 knee joint.
73580...........  26...........  A............  Contrast x-ray of           0.54        0.19        0.18        0.19        0.18        0.03         XXX
                                                 knee joint.
73590...........  .............  A............  X-ray exam of lower         0.17        0.54        0.56          NA          NA        0.03         XXX
                                                 leg.
73590...........  TC...........  A............  X-ray exam of lower         0.00        0.48        0.50          NA          NA        0.02         XXX
                                                 leg.
73590...........  26...........  A............  X-ray exam of lower         0.17        0.06        0.06        0.06        0.06        0.01         XXX
                                                 leg.
73592...........  .............  A............  X-ray exam of leg,          0.16        0.58        0.56          NA          NA        0.03         XXX
                                                 infant.
73592...........  TC...........  A............  X-ray exam of leg,          0.00        0.53        0.51          NA          NA        0.02         XXX
                                                 infant.
73592...........  26...........  A............  X-ray exam of leg,          0.16        0.05        0.05        0.05        0.05        0.01         XXX
                                                 infant.
73600...........  .............  A............  X-ray exam of ankle.        0.16        0.56        0.55          NA          NA        0.03         XXX
73600...........  TC...........  A............  X-ray exam of ankle.        0.00        0.51        0.50          NA          NA        0.02         XXX
73600...........  26...........  A............  X-ray exam of ankle.        0.16        0.05        0.05        0.05        0.05        0.01         XXX
73610...........  .............  A............  X-ray exam of ankle.        0.17        0.68        0.63          NA          NA        0.03         XXX
73610...........  TC...........  A............  X-ray exam of ankle.        0.00        0.62        0.57          NA          NA        0.02         XXX
73610...........  26...........  A............  X-ray exam of ankle.        0.17        0.06        0.06        0.06        0.06        0.01         XXX
73615...........  .............  A............  Contrast x-ray of           0.54        2.00        2.14          NA          NA        0.15         XXX
                                                 ankle.
73615...........  TC...........  A............  Contrast x-ray of           0.00        1.82        1.96          NA          NA        0.12         XXX
                                                 ankle.
73615...........  26...........  A............  Contrast x-ray of           0.54        0.18        0.18        0.18        0.18        0.03         XXX
                                                 ankle.
73620...........  .............  A............  X-ray exam of foot..        0.16        0.52        0.54          NA          NA        0.03         XXX
73620...........  TC...........  A............  X-ray exam of foot..        0.00        0.48        0.49          NA          NA        0.02         XXX
73620...........  26...........  A............  X-ray exam of foot..        0.16        0.04        0.05        0.04        0.05        0.01         XXX
73630...........  .............  A............  X-ray exam of foot..        0.17        0.65        0.62          NA          NA        0.03         XXX
73630...........  TC...........  A............  X-ray exam of foot..        0.00        0.60        0.56          NA          NA        0.02         XXX
73630...........  26...........  A............  X-ray exam of foot..        0.17        0.05        0.06        0.05        0.06        0.01         XXX
73650...........  .............  A............  X-ray exam of heel..        0.16        0.55        0.53          NA          NA        0.03         XXX
73650...........  TC...........  A............  X-ray exam of heel..        0.00        0.50        0.48          NA          NA        0.02         XXX
73650...........  26...........  A............  X-ray exam of heel..        0.16        0.05        0.05        0.05        0.05        0.01         XXX
73660...........  .............  A............  X-ray exam of toe(s)        0.13        0.64        0.55          NA          NA        0.03         XXX
73660...........  TC...........  A............  X-ray exam of toe(s)        0.00        0.60        0.51          NA          NA        0.02         XXX
73660...........  26...........  A............  X-ray exam of toe(s)        0.13        0.04        0.04        0.04        0.04        0.01         XXX
73700...........  .............  A............  Ct lower extremity w/       1.09        6.40        5.86          NA          NA        0.30         XXX
                                                 o dye.
73700...........  TC...........  A............  Ct lower extremity w/       0.00        6.02        5.49          NA          NA        0.25         XXX
                                                 o dye.
73700...........  26...........  A............  Ct lower extremity w/       1.09        0.38        0.37        0.38        0.37        0.05         XXX
                                                 o dye.
73701...........  .............  A............  Ct lower extremity w/       1.16        7.97        7.13          NA          NA        0.36         XXX
                                                 dye.
73701...........  TC...........  A............  Ct lower extremity w/       0.00        7.56        6.73          NA          NA        0.31         XXX
                                                 dye.
73701...........  26...........  A............  Ct lower extremity w/       1.16        0.41        0.40        0.41        0.40        0.05         XXX
                                                 dye.
73702...........  .............  A............  Ct lwr extremity w/         1.22       10.72        9.27          NA          NA        0.44         XXX
                                                 o&w/dye.
73702...........  TC...........  A............  Ct lwr extremity w/         0.00       10.28        8.85          NA          NA        0.39         XXX
                                                 o&w/dye.
73702...........  26...........  A............  Ct lwr extremity w/         1.22        0.44        0.42        0.44        0.42        0.05         XXX
                                                 o&w/dye.
73706...........  .............  A............  Ct angio lwr extr w/        1.90       12.34       11.96          NA          NA        0.47         XXX
                                                 o&w/dye.
73706...........  TC...........  A............  Ct angio lwr extr w/        0.00       11.62       11.29          NA          NA        0.39         XXX
                                                 o&w/dye.
73706...........  26...........  A............  Ct angio lwr extr w/        1.90        0.72        0.67        0.72        0.67        0.08         XXX
                                                 o&w/dye.
73718...........  .............  A............  Mri lower extremity         1.35       14.25       12.94          NA          NA        0.45         XXX
                                                 w/o dye.
73718...........  TC...........  A............  Mri lower extremity         0.00       13.79       12.49          NA          NA        0.39         XXX
                                                 w/o dye.
73718...........  26...........  A............  Mri lower extremity         1.35        0.46        0.45        0.46        0.45        0.06         XXX
                                                 w/o dye.
73719...........  .............  A............  Mri lower extremity         1.62       15.39       14.68          NA          NA        0.54         XXX
                                                 w/dye.
73719...........  TC...........  A............  Mri lower extremity         0.00       14.82       14.13          NA          NA        0.47         XXX
                                                 w/dye.
73719...........  26...........  A............  Mri lower extremity         1.62        0.57        0.55        0.57        0.55        0.07         XXX
                                                 w/dye.
73720...........  .............  A............  Mri lwr extremity w/        2.15       18.98       22.27          NA          NA        0.94         XXX
                                                 o&w/dye.
73720...........  TC...........  A............  Mri lwr extremity w/        0.00       18.23       21.55          NA          NA        0.84         XXX
                                                 o&w/dye.
73720...........  26...........  A............  Mri lwr extremity w/        2.15        0.75        0.72        0.75        0.72        0.10         XXX
                                                 o&w/dye.
73721...........  .............  A............  Mri jnt of lwr extre        1.35       13.86       12.74          NA          NA        0.45         XXX
                                                 w/o dye.
73721...........  TC...........  A............  Mri jnt of lwr extre        0.00       13.39       12.29          NA          NA        0.39         XXX
                                                 w/o dye.
73721...........  26...........  A............  Mri jnt of lwr extre        1.35        0.47        0.45        0.47        0.45        0.06         XXX
                                                 w/o dye.
73722...........  .............  A............  Mri joint of lwr            1.62       14.48       14.22          NA          NA        0.54         XXX
                                                 extr w/dye.
73722...........  TC...........  A............  Mri joint of lwr            0.00       13.91       13.67          NA          NA        0.47         XXX
                                                 extr w/dye.
73722...........  26...........  A............  Mri joint of lwr            1.62        0.57        0.55        0.57        0.55        0.07         XXX
                                                 extr w/dye.
73723...........  .............  A............  Mri joint lwr extr w/       2.15       17.54       21.55          NA          NA        0.94         XXX
                                                 o&w/dye.
73723...........  TC...........  A............  Mri joint lwr extr w/       0.00       16.80       20.83          NA          NA        0.84         XXX
                                                 o&w/dye.
73723...........  26...........  A............  Mri joint lwr extr w/       2.15        0.74        0.72        0.74        0.72        0.10         XXX
                                                 o&w/dye.
73725...........  .............  R............  Mr ang lwr ext w or         1.82       15.11       13.45          NA          NA        0.67         XXX
                                                 w/o dye.

[[Page 66497]]

 
73725...........  TC...........  R............  Mr ang lwr ext w or         0.00       14.47       12.83          NA          NA        0.59         XXX
                                                 w/o dye.
73725...........  26...........  R............  Mr ang lwr ext w or         1.82        0.64        0.62        0.64        0.62        0.08         XXX
                                                 w/o dye.
74000...........  .............  A............  X-ray exam of               0.18        0.46        0.52          NA          NA        0.03         XXX
                                                 abdomen.
74000...........  TC...........  A............  X-ray exam of               0.00        0.40        0.46          NA          NA        0.02         XXX
                                                 abdomen.
74000...........  26...........  A............  X-ray exam of               0.18        0.06        0.06        0.06        0.06        0.01         XXX
                                                 abdomen.
74010...........  .............  A............  X-ray exam of               0.23        0.79        0.72          NA          NA        0.05         XXX
                                                 abdomen.
74010...........  TC...........  A............  X-ray exam of               0.00        0.71        0.64          NA          NA        0.04         XXX
                                                 abdomen.
74010...........  26...........  A............  X-ray exam of               0.23        0.08        0.08        0.08        0.08        0.01         XXX
                                                 abdomen.
74020...........  .............  A............  X-ray exam of               0.27        0.81        0.76          NA          NA        0.05         XXX
                                                 abdomen.
74020...........  TC...........  A............  X-ray exam of               0.00        0.72        0.67          NA          NA        0.04         XXX
                                                 abdomen.
74020...........  26...........  A............  X-ray exam of               0.27        0.09        0.09        0.09        0.09        0.01         XXX
                                                 abdomen.
74022...........  .............  A............  X-ray exam series,          0.32        0.98        0.91          NA          NA        0.06         XXX
                                                 abdomen.
74022...........  TC...........  A............  X-ray exam series,          0.00        0.87        0.80          NA          NA        0.05         XXX
                                                 abdomen.
74022...........  26...........  A............  X-ray exam series,          0.32        0.11        0.11        0.11        0.11        0.01         XXX
                                                 abdomen.
74150...........  .............  A............  Ct abdomen w/o dye..        1.19        6.06        6.06          NA          NA        0.35         XXX
74150...........  TC...........  A............  Ct abdomen w/o dye..        0.00        5.64        5.65          NA          NA        0.30         XXX
74150...........  26...........  A............  Ct abdomen w/o dye..        1.19        0.42        0.41        0.42        0.41        0.05         XXX
74160...........  .............  A............  Ct abdomen w/dye....        1.27        8.81        8.03          NA          NA        0.42         XXX
74160...........  TC...........  A............  Ct abdomen w/dye....        0.00        8.36        7.60          NA          NA        0.36         XXX
74160...........  26...........  A............  Ct abdomen w/dye....        1.27        0.45        0.43        0.45        0.43        0.06         XXX
74170...........  .............  A............  Ct abdomen w/o & w/         1.40       12.17       10.56          NA          NA        0.49         XXX
                                                 dye.
74170...........  TC...........  A............  Ct abdomen w/o & w/         0.00       11.68       10.08          NA          NA        0.43         XXX
                                                 dye.
74170...........  26...........  A............  Ct abdomen w/o & w/         1.40        0.49        0.48        0.49        0.48        0.06         XXX
                                                 dye.
74175...........  .............  A............  Ct angio abdom w/o &        1.90       12.27       12.45          NA          NA        0.47         XXX
                                                 w/dye.
74175...........  TC...........  A............  Ct angio abdom w/o &        0.00       11.58       11.80          NA          NA        0.39         XXX
                                                 w/dye.
74175...........  26...........  A............  Ct angio abdom w/o &        1.90        0.69        0.65        0.69        0.65        0.08         XXX
                                                 w/dye.
74181...........  .............  A............  Mri abdomen w/o dye.        1.46       12.44       12.06          NA          NA        0.51         XXX
74181...........  TC...........  A............  Mri abdomen w/o dye.        0.00       11.93       11.56          NA          NA        0.45         XXX
74181...........  26...........  A............  Mri abdomen w/o dye.        1.46        0.51        0.50        0.51        0.50        0.06         XXX
74182...........  .............  A............  Mri abdomen w/dye...        1.73       17.42       15.72          NA          NA        0.60         XXX
74182...........  TC...........  A............  Mri abdomen w/dye...        0.00       16.82       15.13          NA          NA        0.52         XXX
74182...........  26...........  A............  Mri abdomen w/dye...        1.73        0.60        0.59        0.60        0.59        0.08         XXX
74183...........  .............  A............  Mri abdomen w/o & w/        2.26       18.98       22.29          NA          NA        1.02         XXX
                                                 dye.
74183...........  TC...........  A............  Mri abdomen w/o & w/        0.00       18.19       21.53          NA          NA        0.92         XXX
                                                 dye.
74183...........  26...........  A............  Mri abdomen w/o & w/        2.26        0.79        0.76        0.79        0.76        0.10         XXX
                                                 dye.
74185...........  .............  R............  Mri angio, abdom w          1.80       15.07       13.42          NA          NA        0.67         XXX
                                                 orw/o dye.
74185...........  TC...........  R............  Mri angio, abdom w          0.00       14.43       12.81          NA          NA        0.59         XXX
                                                 orw/o dye.
74185...........  26...........  R............  Mri angio, abdom w          1.80        0.64        0.61        0.64        0.61        0.08         XXX
                                                 orw/o dye.
74190...........  .............  C............  X-ray exam of               0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 peritoneum.
74190...........  TC...........  C............  X-ray exam of               0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 peritoneum.
74190...........  26...........  A............  X-ray exam of               0.48        0.17        0.16        0.17        0.16        0.02         XXX
                                                 peritoneum.
74210...........  .............  A............  Contrst x-ray exam          0.36        1.77        1.53          NA          NA        0.08         XXX
                                                 of throat.
74210...........  TC...........  A............  Contrst x-ray exam          0.00        1.64        1.41          NA          NA        0.06         XXX
                                                 of throat.
74210...........  26...........  A............  Contrst x-ray exam          0.36        0.13        0.12        0.13        0.12        0.02         XXX
                                                 of throat.
74220...........  .............  A............  Contrast x-ray,             0.46        2.01        1.68          NA          NA        0.08         XXX
                                                 esophagus.
74220...........  TC...........  A............  Contrast x-ray,             0.00        1.85        1.52          NA          NA        0.06         XXX
                                                 esophagus.
74220...........  26...........  A............  Contrast x-ray,             0.46        0.16        0.16        0.16        0.16        0.02         XXX
                                                 esophagus.
74230...........  .............  A............  Cine/vid x-ray,             0.53        1.95        1.71          NA          NA        0.09         XXX
                                                 throat/esoph.
74230...........  TC...........  A............  Cine/vid x-ray,             0.00        1.76        1.53          NA          NA        0.07         XXX
                                                 throat/esoph.
74230...........  26...........  A............  Cine/vid x-ray,             0.53        0.19        0.18        0.19        0.18        0.02         XXX
                                                 throat/esoph.
74235...........  .............  C............  Remove esophagus            0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 obstruction.
74235...........  TC...........  C............  Remove esophagus            0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 obstruction.
74235...........  26...........  A............  Remove esophagus            1.19        0.47        0.43        0.47        0.43        0.05         XXX
                                                 obstruction.
74240...........  .............  A............  X-ray exam, upper gi        0.69        2.30        2.00          NA          NA        0.11         XXX
                                                 tract.
74240...........  TC...........  A............  X-ray exam, upper gi        0.00        2.06        1.76          NA          NA        0.08         XXX
                                                 tract.
74240...........  26...........  A............  X-ray exam, upper gi        0.69        0.24        0.24        0.24        0.24        0.03         XXX
                                                 tract.
74241...........  .............  A............  X-ray exam, upper gi        0.69        2.56        2.13          NA          NA        0.11         XXX
                                                 tract.
74241...........  TC...........  A............  X-ray exam, upper gi        0.00        2.32        1.90          NA          NA        0.08         XXX
                                                 tract.
74241...........  26...........  A............  X-ray exam, upper gi        0.69        0.24        0.23        0.24        0.23        0.03         XXX
                                                 tract.
74245...........  .............  A............  X-ray exam, upper gi        0.91        3.96        3.32          NA          NA        0.17         XXX
                                                 tract.
74245...........  TC...........  A............  X-ray exam, upper gi        0.00        3.64        3.01          NA          NA        0.13         XXX
                                                 tract.
74245...........  26...........  A............  X-ray exam, upper gi        0.91        0.32        0.31        0.32        0.31        0.04         XXX
                                                 tract.
74246...........  .............  A............  Contrst x-ray uppr          0.69        2.80        2.33          NA          NA        0.13         XXX
                                                 gi tract.
74246...........  TC...........  A............  Contrst x-ray uppr          0.00        2.55        2.09          NA          NA        0.10         XXX
                                                 gi tract.
74246...........  26...........  A............  Contrst x-ray uppr          0.69        0.25        0.24        0.25        0.24        0.03         XXX
                                                 gi tract.
74247...........  .............  A............  Contrst x-ray uppr          0.69        3.21        2.56          NA          NA        0.14         XXX
                                                 gi tract.
74247...........  TC...........  A............  Contrst x-ray uppr          0.00        2.97        2.32          NA          NA        0.11         XXX
                                                 gi tract.
74247...........  26...........  A............  Contrst x-ray uppr          0.69        0.24        0.24        0.24        0.24        0.03         XXX
                                                 gi tract.
74249...........  .............  A............  Contrst x-ray uppr          0.91        4.35        3.61          NA          NA        0.18         XXX
                                                 gi tract.
74249...........  TC...........  A............  Contrst x-ray uppr          0.00        4.03        3.30          NA          NA        0.14         XXX
                                                 gi tract.
74249...........  26...........  A............  Contrst x-ray uppr          0.91        0.32        0.31        0.32        0.31        0.04         XXX
                                                 gi tract.
74250...........  .............  A............  X-ray exam of small         0.47        2.48        1.97          NA          NA        0.09         XXX
                                                 bowel.

[[Page 66498]]

 
74250...........  TC...........  A............  X-ray exam of small         0.00        2.32        1.81          NA          NA        0.07         XXX
                                                 bowel.
74250...........  26...........  A............  X-ray exam of small         0.47        0.16        0.16        0.16        0.16        0.02         XXX
                                                 bowel.
74251...........  .............  A............  X-ray exam of small         0.69       10.01        5.77          NA          NA        0.10         XXX
                                                 bowel.
74251...........  TC...........  A............  X-ray exam of small         0.00        9.76        5.53          NA          NA        0.07         XXX
                                                 bowel.
74251...........  26...........  A............  X-ray exam of small         0.69        0.25        0.24        0.25        0.24        0.03         XXX
                                                 bowel.
74260...........  .............  A............  X-ray exam of small         0.50        8.30        4.97          NA          NA        0.10         XXX
                                                 bowel.
74260...........  TC...........  A............  X-ray exam of small         0.00        8.12        4.80          NA          NA        0.08         XXX
                                                 bowel.
74260...........  26...........  A............  X-ray exam of small         0.50        0.18        0.17        0.18        0.17        0.02         XXX
                                                 bowel.
74270...........  .............  A............  Contrast x-ray exam         0.69        3.59        2.76          NA          NA        0.14         XXX
                                                 of colon.
74270...........  TC...........  A............  Contrast x-ray exam         0.00        3.34        2.52          NA          NA        0.11         XXX
                                                 of colon.
74270...........  26...........  A............  Contrast x-ray exam         0.69        0.25        0.24        0.25        0.24        0.03         XXX
                                                 of colon.
74280...........  .............  A............  Contrast x-ray exam         0.99        4.94        3.74          NA          NA        0.17         XXX
                                                 of colon.
74280...........  TC...........  A............  Contrast x-ray exam         0.00        4.59        3.41          NA          NA        0.13         XXX
                                                 of colon.
74280...........  26...........  A............  Contrast x-ray exam         0.99        0.35        0.33        0.35        0.33        0.04         XXX
                                                 of colon.
74283...........  .............  A............  Contrast x-ray exam         2.02        3.49        3.35          NA          NA        0.23         XXX
                                                 of colon.
74283...........  TC...........  A............  Contrast x-ray exam         0.00        2.80        2.68          NA          NA        0.14         XXX
                                                 of colon.
74283...........  26...........  A............  Contrast x-ray exam         2.02        0.69        0.67        0.69        0.67        0.09         XXX
                                                 of colon.
74290...........  .............  A............  Contrast x-ray,             0.32        1.58        1.21          NA          NA        0.06         XXX
                                                 gallbladder.
74290...........  TC...........  A............  Contrast x-ray,             0.00        1.47        1.10          NA          NA        0.05         XXX
                                                 gallbladder.
74290...........  26...........  A............  Contrast x-ray,             0.32        0.11        0.11        0.11        0.11        0.01         XXX
                                                 gallbladder.
74291...........  .............  A............  Contrast x-rays,            0.20        1.55        1.02          NA          NA        0.03         XXX
                                                 gallbladder.
74291...........  TC...........  A............  Contrast x-rays,            0.00        1.48        0.95          NA          NA        0.02         XXX
                                                 gallbladder.
74291...........  26...........  A............  Contrast x-rays,            0.20        0.07        0.07        0.07        0.07        0.01         XXX
                                                 gallbladder.
74300...........  .............  C............  X-ray bile ducts/           0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 pancreas.
74300...........  TC...........  C............  X-ray bile ducts/           0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 pancreas.
74300...........  26...........  A............  X-ray bile ducts/           0.36        0.13        0.12        0.13        0.12        0.02         XXX
                                                 pancreas.
74301...........  .............  C............  X-rays at surgery           0.00        0.00        0.00          NA          NA        0.00         ZZZ
                                                 add-on.
74301...........  TC...........  C............  X-rays at surgery           0.00        0.00        0.00          NA          NA        0.00         ZZZ
                                                 add-on.
74301...........  26...........  A............  X-rays at surgery           0.21        0.07        0.07        0.07        0.07        0.01         ZZZ
                                                 add-on.
74305...........  .............  C............  X-ray bile ducts/           0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 pancreas.
74305...........  TC...........  C............  X-ray bile ducts/           0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 pancreas.
74305...........  26...........  A............  X-ray bile ducts/           0.42        0.15        0.15        0.15        0.15        0.02         XXX
                                                 pancreas.
74320...........  .............  A............  Contrast x-ray of           0.54        2.13        2.73          NA          NA        0.19         XXX
                                                 bile ducts.
74320...........  TC...........  A............  Contrast x-ray of           0.00        1.93        2.54          NA          NA        0.17         XXX
                                                 bile ducts.
74320...........  26...........  A............  Contrast x-ray of           0.54        0.20        0.19        0.20        0.19        0.02         XXX
                                                 bile ducts.
74327...........  .............  A............  X-ray bile stone            0.70        2.97        2.48          NA          NA        0.14         XXX
                                                 removal.
74327...........  TC...........  A............  X-ray bile stone            0.00        2.72        2.24          NA          NA        0.11         XXX
                                                 removal.
74327...........  26...........  A............  X-ray bile stone            0.70        0.25        0.24        0.25        0.24        0.03         XXX
                                                 removal.
74328...........  .............  C............  X-ray bile duct             0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 endoscopy.
74328...........  TC...........  C............  X-ray bile duct             0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 endoscopy.
74328...........  26...........  A............  X-ray bile duct             0.70        0.26        0.25        0.26        0.25        0.03         XXX
                                                 endoscopy.
74329...........  .............  C............  X-ray for pancreas          0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 endoscopy.
74329...........  TC...........  C............  X-ray for pancreas          0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 endoscopy.
74329...........  26...........  A............  X-ray for pancreas          0.70        0.27        0.25        0.27        0.25        0.03         XXX
                                                 endoscopy.
74330...........  .............  C............  X-ray bile/panc             0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 endoscopy.
74330...........  TC...........  C............  X-ray bile/panc             0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 endoscopy.
74330...........  26...........  A............  X-ray bile/panc             0.90        0.33        0.31        0.33        0.31        0.04         XXX
                                                 endoscopy.
74340...........  .............  C............  X-ray guide for GI          0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 tube.
74340...........  TC...........  C............  X-ray guide for GI          0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 tube.
74340...........  26...........  A............  X-ray guide for GI          0.54        0.19        0.19        0.19        0.19        0.02         XXX
                                                 tube.
74355...........  .............  C............  X-ray guide,                0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 intestinal tube.
74355...........  TC...........  C............  X-ray guide,                0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 intestinal tube.
74355...........  26...........  A............  X-ray guide,                0.76        0.28        0.26        0.28        0.26        0.03         XXX
                                                 intestinal tube.
74360...........  .............  C............  X-ray guide, GI             0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 dilation.
74360...........  TC...........  C............  X-ray guide, GI             0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 dilation.
74360...........  26...........  A............  X-ray guide, GI             0.54        0.24        0.21        0.24        0.21        0.02         XXX
                                                 dilation.
74363...........  .............  C............  X-ray, bile duct            0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 dilation.
74363...........  TC...........  C............  X-ray, bile duct            0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 dilation.
74363...........  26...........  A............  X-ray, bile duct            0.88        0.32        0.30        0.32        0.30        0.04         XXX
                                                 dilation.
74400...........  .............  A............  Contrst x-ray,              0.49        2.60        2.22          NA          NA        0.13         XXX
                                                 urinary tract.
74400...........  TC...........  A............  Contrst x-ray,              0.00        2.43        2.05          NA          NA        0.11         XXX
                                                 urinary tract.
74400...........  26...........  A............  Contrst x-ray,              0.49        0.17        0.17        0.17        0.17        0.02         XXX
                                                 urinary tract.
74410...........  .............  A............  Contrst x-ray,              0.49        2.69        2.40          NA          NA        0.13         XXX
                                                 urinary tract.
74410...........  TC...........  A............  Contrst x-ray,              0.00        2.51        2.23          NA          NA        0.11         XXX
                                                 urinary tract.
74410...........  26...........  A............  Contrst x-ray,              0.49        0.18        0.17        0.18        0.17        0.02         XXX
                                                 urinary tract.
74415...........  .............  A............  Contrst x-ray,              0.49        3.27        2.78          NA          NA        0.14         XXX
                                                 urinary tract.
74415...........  TC...........  A............  Contrst x-ray,              0.00        3.10        2.61          NA          NA        0.12         XXX
                                                 urinary tract.
74415...........  26...........  A............  Contrst x-ray,              0.49        0.17        0.17        0.17        0.17        0.02         XXX
                                                 urinary tract.
74420...........  .............  C............  Contrst x-ray,              0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 urinary tract.
74420...........  TC...........  C............  Contrst x-ray,              0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 urinary tract.
74420...........  26...........  A............  Contrst x-ray,              0.36        0.14        0.13        0.14        0.13        0.02         XXX
                                                 urinary tract.
74425...........  .............  C............  Contrst x-ray,              0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 urinary tract.

[[Page 66499]]

 
74425...........  TC...........  C............  Contrst x-ray,              0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 urinary tract.
74425...........  26...........  A............  Contrst x-ray,              0.36        0.13        0.13        0.13        0.13        0.02         XXX
                                                 urinary tract.
74430...........  .............  A............  Contrast x-ray,             0.32        1.96        1.55          NA          NA        0.08         XXX
                                                 bladder.
74430...........  TC...........  A............  Contrast x-ray,             0.00        1.84        1.44          NA          NA        0.06         XXX
                                                 bladder.
74430...........  26...........  A............  Contrast x-ray,             0.32        0.12        0.11        0.12        0.11        0.02         XXX
                                                 bladder.
74440...........  .............  A............  X-ray, male genital         0.38        2.11        1.68          NA          NA        0.08         XXX
                                                 tract.
74440...........  TC...........  A............  X-ray, male genital         0.00        1.97        1.55          NA          NA        0.06         XXX
                                                 tract.
74440...........  26...........  A............  X-ray, male genital         0.38        0.14        0.13        0.14        0.13        0.02         XXX
                                                 tract.
74445...........  .............  C............  X-ray exam of penis.        0.00        0.00        0.00          NA          NA        0.00         XXX
74445...........  TC...........  C............  X-ray exam of penis.        0.00        0.00        0.00          NA          NA        0.00         XXX
74445...........  26...........  A............  X-ray exam of penis.        1.14        0.45        0.41        0.45        0.41        0.07         XXX
74450...........  .............  C............  X-ray, urethra/             0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 bladder.
74450...........  TC...........  C............  X-ray, urethra/             0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 bladder.
74450...........  26...........  A............  X-ray, urethra/             0.33        0.12        0.12        0.12        0.12        0.02         XXX
                                                 bladder.
74455...........  .............  A............  X-ray, urethra/             0.33        2.18        1.94          NA          NA        0.12         XXX
                                                 bladder.
74455...........  TC...........  A............  X-ray, urethra/             0.00        2.06        1.82          NA          NA        0.10         XXX
                                                 bladder.
74455...........  26...........  A............  X-ray, urethra/             0.33        0.12        0.12        0.12        0.12        0.02         XXX
                                                 bladder.
74470...........  .............  C............  X-ray exam of kidney        0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 lesion.
74470...........  TC...........  C............  X-ray exam of kidney        0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 lesion.
74470...........  26...........  A............  X-ray exam of kidney        0.54        0.17        0.18        0.17        0.18        0.02         XXX
                                                 lesion.
74475...........  .............  A............  X-ray control, cath         0.54        2.12        3.18          NA          NA        0.24         XXX
                                                 insert.
74475...........  TC...........  A............  X-ray control, cath         0.00        1.92        2.99          NA          NA        0.22         XXX
                                                 insert.
74475...........  26...........  A............  X-ray control, cath         0.54        0.20        0.19        0.20        0.19        0.02         XXX
                                                 insert.
74480...........  .............  A............  X-ray control, cath         0.54        2.13        3.19          NA          NA        0.24         XXX
                                                 insert.
74480...........  TC...........  A............  X-ray control, cath         0.00        1.93        3.00          NA          NA        0.22         XXX
                                                 insert.
74480...........  26...........  A............  X-ray control, cath         0.54        0.20        0.19        0.20        0.19        0.02         XXX
                                                 insert.
74485...........  .............  A............  X-ray guide, GU             0.54        2.27        2.80          NA          NA        0.20         XXX
                                                 dilation.
74485...........  TC...........  A............  X-ray guide, GU             0.00        2.07        2.61          NA          NA        0.17         XXX
                                                 dilation.
74485...........  26...........  A............  X-ray guide, GU             0.54        0.20        0.19        0.20        0.19        0.03         XXX
                                                 dilation.
74710...........  .............  A............  X-ray measurement of        0.34        0.64        0.90          NA          NA        0.08         XXX
                                                 pelvis.
74710...........  TC...........  A............  X-ray measurement of        0.00        0.53        0.79          NA          NA        0.06         XXX
                                                 pelvis.
74710...........  26...........  A............  X-ray measurement of        0.34        0.11        0.11        0.11        0.11        0.02         XXX
                                                 pelvis.
74740...........  .............  A............  X-ray, female               0.38        1.76        1.60          NA          NA        0.09         XXX
                                                 genital tract.
74740...........  TC...........  A............  X-ray, female               0.00        1.63        1.47          NA          NA        0.07         XXX
                                                 genital tract.
74740...........  26...........  A............  X-ray, female               0.38        0.13        0.13        0.13        0.13        0.02         XXX
                                                 genital tract.
74742...........  .............  C............  X-ray, fallopian            0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 tube.
74742...........  TC...........  C............  X-ray, fallopian            0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 tube.
74742...........  26...........  A............  X-ray, fallopian            0.61        0.19        0.20        0.19        0.20        0.03         XXX
                                                 tube.
74775...........  .............  C............  X-ray exam of               0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 perineum.
74775...........  TC...........  C............  X-ray exam of               0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 perineum.
74775...........  26...........  A............  X-ray exam of               0.62        0.22        0.21        0.22        0.21        0.03         XXX
                                                 perineum.
75557...........  .............  A............  Cardiac mri for             2.35       11.25       11.25          NA          NA        0.97         XXX
                                                 morph.
75557...........  TC...........  A............  Cardiac mri for             0.00       10.31       10.31          NA          NA        0.87         XXX
                                                 morph.
75557...........  26...........  A............  Cardiac mri for             2.35        0.94        0.94        0.94        0.94        0.10         XXX
                                                 morph.
75558...........  .............  N............  Cardiac mri flow/           2.60       12.38       12.38          NA          NA        1.07         XXX
                                                 velocity.
75558...........  TC...........  N............  Cardiac mri flow/           0.00       11.78       11.78          NA          NA        0.96         XXX
                                                 velocity.
75558...........  26...........  N............  Cardiac mri flow/           2.60        0.60        0.60        0.60        0.60        0.11         XXX
                                                 velocity.
75559...........  .............  A............  Cardiac mri w/stress        2.95       17.24       17.24          NA          NA        0.97         XXX
                                                 img.
75559...........  TC...........  A............  Cardiac mri w/stress        0.00       15.97       15.97          NA          NA        0.87         XXX
                                                 img.
75559...........  26...........  A............  Cardiac mri w/stress        2.95        1.27        1.27        1.27        1.27        0.10         XXX
                                                 img.
75560...........  .............  N............  Cardiac mri flow/vel/       3.00       16.82       16.82          NA          NA        1.00         XXX
                                                 stress.
75560...........  TC...........  N............  Cardiac mri flow/vel/       0.00       16.13       16.13          NA          NA        0.89         XXX
                                                 stress.
75560...........  26...........  N............  Cardiac mri flow/vel/       3.00        0.69        0.69        0.69        0.69        0.11         XXX
                                                 stress.
75561...........  .............  A............  Cardiac mri for             2.60       15.95       15.95          NA          NA        1.07         XXX
                                                 morph w/dye.
75561...........  TC...........  A............  Cardiac mri for             0.00       14.92       14.92          NA          NA        0.96         XXX
                                                 morph w/dye.
75561...........  26...........  A............  Cardiac mri for             2.60        1.03        1.03        1.03        1.03        0.11         XXX
                                                 morph w/dye.
75562...........  .............  N............  Card mri flow/vel w/        2.86       16.75       16.75          NA          NA        1.03         XXX
                                                 dye.
75562...........  TC...........  N............  Card mri flow/vel w/        0.00       16.09       16.09          NA          NA        0.92         XXX
                                                 dye.
75562...........  26...........  N............  Card mri flow/vel w/        2.86        0.66        0.66        0.66        0.66        0.11         XXX
                                                 dye.
75563...........  .............  A............  Card mri w/stress           3.00       20.20       20.20          NA          NA        1.08         XXX
                                                 img & dye.
75563...........  TC...........  A............  Card mri w/stress           0.00       18.82       18.82          NA          NA        0.97         XXX
                                                 img & dye.
75563...........  26...........  A............  Card mri w/stress           3.00        1.38        1.38        1.38        1.38        0.11         XXX
                                                 img & dye.
75564...........  .............  N............  Ht mri w/flo/vel/           3.35       19.71       19.71          NA          NA        1.21         XXX
                                                 strs & dye.
75564...........  TC...........  N............  Ht mri w/flo/vel/           0.00       18.94       18.94          NA          NA        1.08         XXX
                                                 strs & dye.
75564...........  26...........  N............  Ht mri w/flo/vel/           3.35        0.77        0.77        0.77        0.77        0.13         XXX
                                                 strs & dye.
75600...........  .............  A............  Contrast x-ray exam         0.49        6.42        9.61          NA          NA        0.67         XXX
                                                 of aorta.
75600...........  TC...........  A............  Contrast x-ray exam         0.00        6.18        9.39          NA          NA        0.65         XXX
                                                 of aorta.
75600...........  26...........  A............  Contrast x-ray exam         0.49        0.24        0.22        0.24        0.22        0.02         XXX
                                                 of aorta.
75605...........  .............  A............  Contrast x-ray exam         1.14        3.55        8.27          NA          NA        0.70         XXX
                                                 of aorta.
75605...........  TC...........  A............  Contrast x-ray exam         0.00        3.06        7.83          NA          NA        0.65         XXX
                                                 of aorta.
75605...........  26...........  A............  Contrast x-ray exam         1.14        0.49        0.44        0.49        0.44        0.05         XXX
                                                 of aorta.
75625...........  .............  A............  Contrast x-ray exam         1.14        3.35        8.16          NA          NA        0.71         XXX
                                                 of aorta.

[[Page 66500]]

 
75625...........  TC...........  A............  Contrast x-ray exam         0.00        2.93        7.76          NA          NA        0.65         XXX
                                                 of aorta.
75625...........  26...........  A............  Contrast x-ray exam         1.14        0.42        0.40        0.42        0.40        0.06         XXX
                                                 of aorta.
75630...........  .............  A............  X-ray aorta, leg            1.79        3.76        8.75          NA          NA        0.80         XXX
                                                 arteries.
75630...........  TC...........  A............  X-ray aorta, leg            0.00        3.05        8.09          NA          NA        0.69         XXX
                                                 arteries.
75630...........  26...........  A............  X-ray aorta, leg            1.79        0.71        0.66        0.71        0.66        0.11         XXX
                                                 arteries.
75635...........  .............  A............  Ct angio abdominal          2.40       12.92       14.80          NA          NA        0.50         XXX
                                                 arteries.
75635...........  TC...........  A............  Ct angio abdominal          0.00       12.00       13.95          NA          NA        0.39         XXX
                                                 arteries.
75635...........  26...........  A............  Ct angio abdominal          2.40        0.92        0.85        0.92        0.85        0.11         XXX
                                                 arteries.
75650...........  .............  A............  Artery x-rays, head         1.49        3.52        8.30          NA          NA        0.72         XXX
                                                 & neck.
75650...........  TC...........  A............  Artery x-rays, head         0.00        2.95        7.77          NA          NA        0.65         XXX
                                                 & neck.
75650...........  26...........  A............  Artery x-rays, head         1.49        0.57        0.53        0.57        0.53        0.07         XXX
                                                 & neck.
75658...........  .............  A............  Artery x-rays, arm..        1.31        3.72        8.40          NA          NA        0.72         XXX
75658...........  TC...........  A............  Artery x-rays, arm..        0.00        3.28        7.94          NA          NA        0.65         XXX
75658...........  26...........  A............  Artery x-rays, arm..        1.31        0.44        0.46        0.44        0.46        0.07         XXX
75660...........  .............  A............  Artery x-rays, head         1.31        3.88        8.46          NA          NA        0.71         XXX
                                                 & neck.
75660...........  TC...........  A............  Artery x-rays, head         0.00        3.39        7.99          NA          NA        0.65         XXX
                                                 & neck.
75660...........  26...........  A............  Artery x-rays, head         1.31        0.49        0.47        0.49        0.47        0.06         XXX
                                                 & neck.
75662...........  .............  A............  Artery x-rays, head         1.66        5.01        9.09          NA          NA        0.71         XXX
                                                 & neck.
75662...........  TC...........  A............  Artery x-rays, head         0.00        4.31        8.45          NA          NA        0.65         XXX
                                                 & neck.
75662...........  26...........  A............  Artery x-rays, head         1.66        0.70        0.64        0.70        0.64        0.06         XXX
                                                 & neck.
75665...........  .............  A............  Artery x-rays, head         1.31        4.09        8.57          NA          NA        0.74         XXX
                                                 & neck.
75665...........  TC...........  A............  Artery x-rays, head         0.00        3.61        8.11          NA          NA        0.65         XXX
                                                 & neck.
75665...........  26...........  A............  Artery x-rays, head         1.31        0.48        0.46        0.48        0.46        0.09         XXX
                                                 & neck.
75671...........  .............  A............  Artery x-rays, head         1.66        5.10        9.12          NA          NA        0.72         XXX
                                                 & neck.
75671...........  TC...........  A............  Artery x-rays, head         0.00        4.46        8.53          NA          NA        0.65         XXX
                                                 & neck.
75671...........  26...........  A............  Artery x-rays, head         1.66        0.64        0.59        0.64        0.59        0.07         XXX
                                                 & neck.
75676...........  .............  A............  Artery x-rays, neck.        1.31        3.86        8.45          NA          NA        0.72         XXX
75676...........  TC...........  A............  Artery x-rays, neck.        0.00        3.38        7.99          NA          NA        0.65         XXX
75676...........  26...........  A............  Artery x-rays, neck.        1.31        0.48        0.46        0.48        0.46        0.07         XXX
75680...........  .............  A............  Artery x-rays, neck.        1.66        4.61        8.87          NA          NA        0.72         XXX
75680...........  TC...........  A............  Artery x-rays, neck.        0.00        3.95        8.27          NA          NA        0.65         XXX
75680...........  26...........  A............  Artery x-rays, neck.        1.66        0.66        0.60        0.66        0.60        0.07         XXX
75685...........  .............  A............  Artery x-rays, spine        1.31        3.88        8.46          NA          NA        0.71         XXX
75685...........  TC...........  A............  Artery x-rays, spine        0.00        3.38        7.99          NA          NA        0.65         XXX
75685...........  26...........  A............  Artery x-rays, spine        1.31        0.50        0.47        0.50        0.47        0.06         XXX
75705...........  .............  A............  Artery x-rays, spine        2.18        4.17        8.74          NA          NA        0.78         XXX
75705...........  TC...........  A............  Artery x-rays, spine        0.00        3.37        7.98          NA          NA        0.65         XXX
75705...........  26...........  A............  Artery x-rays, spine        2.18        0.80        0.76        0.80        0.76        0.13         XXX
75710...........  .............  A............  Artery x-rays, arm/         1.14        3.94        8.47          NA          NA        0.72         XXX
                                                 leg.
75710...........  TC...........  A............  Artery x-rays, arm/         0.00        3.52        8.06          NA          NA        0.65         XXX
                                                 leg.
75710...........  26...........  A............  Artery x-rays, arm/         1.14        0.42        0.41        0.42        0.41        0.07         XXX
                                                 leg.
75716...........  .............  A............  Artery x-rays, arms/        1.31        4.92        8.97          NA          NA        0.72         XXX
                                                 legs.
75716...........  TC...........  A............  Artery x-rays, arms/        0.00        4.42        8.51          NA          NA        0.65         XXX
                                                 legs.
75716...........  26...........  A............  Artery x-rays, arms/        1.31        0.50        0.46        0.50        0.46        0.07         XXX
                                                 legs.
75722...........  .............  A............  Artery x-rays,              1.14        3.84        8.42          NA          NA        0.70         XXX
                                                 kidney.
75722...........  TC...........  A............  Artery x-rays,              0.00        3.37        7.98          NA          NA        0.65         XXX
                                                 kidney.
75722...........  26...........  A............  Artery x-rays,              1.14        0.47        0.44        0.47        0.44        0.05         XXX
                                                 kidney.
75724...........  .............  A............  Artery x-rays,              1.49        5.12        9.14          NA          NA        0.70         XXX
                                                 kidneys.
75724...........  TC...........  A............  Artery x-rays,              0.00        4.38        8.49          NA          NA        0.65         XXX
                                                 kidneys.
75724...........  26...........  A............  Artery x-rays,              1.49        0.74        0.65        0.74        0.65        0.05         XXX
                                                 kidneys.
75726...........  .............  A............  Artery x-rays,              1.14        3.76        8.36          NA          NA        0.70         XXX
                                                 abdomen.
75726...........  TC...........  A............  Artery x-rays,              0.00        3.34        7.97          NA          NA        0.65         XXX
                                                 abdomen.
75726...........  26...........  A............  Artery x-rays,              1.14        0.42        0.39        0.42        0.39        0.05         XXX
                                                 abdomen.
75731...........  .............  A............  Artery x-rays,              1.14        4.09        8.54          NA          NA        0.71         XXX
                                                 adrenal gland.
75731...........  TC...........  A............  Artery x-rays,              0.00        3.59        8.10          NA          NA        0.65         XXX
                                                 adrenal gland.
75731...........  26...........  A............  Artery x-rays,              1.14        0.50        0.44        0.50        0.44        0.06         XXX
                                                 adrenal gland.
75733...........  .............  A............  Artery x-rays,              1.31        5.45        9.25          NA          NA        0.71         XXX
                                                 adrenals.
75733...........  TC...........  A............  Artery x-rays,              0.00        4.80        8.70          NA          NA        0.65         XXX
                                                 adrenals.
75733...........  26...........  A............  Artery x-rays,              1.31        0.65        0.55        0.65        0.55        0.06         XXX
                                                 adrenals.
75736...........  .............  A............  Artery x-rays,              1.14        3.87        8.42          NA          NA        0.71         XXX
                                                 pelvis.
75736...........  TC...........  A............  Artery x-rays,              0.00        3.44        8.02          NA          NA        0.65         XXX
                                                 pelvis.
75736...........  26...........  A............  Artery x-rays,              1.14        0.43        0.40        0.43        0.40        0.06         XXX
                                                 pelvis.
75741...........  .............  A............  Artery x-rays, lung.        1.31        3.18        8.10          NA          NA        0.71         XXX
75741...........  TC...........  A............  Artery x-rays, lung.        0.00        2.69        7.64          NA          NA        0.65         XXX
75741...........  26...........  A............  Artery x-rays, lung.        1.31        0.49        0.46        0.49        0.46        0.06         XXX
75743...........  .............  A............  Artery x-rays, lungs        1.66        3.56        8.35          NA          NA        0.72         XXX
75743...........  TC...........  A............  Artery x-rays, lungs        0.00        2.94        7.77          NA          NA        0.65         XXX
75743...........  26...........  A............  Artery x-rays, lungs        1.66        0.62        0.58        0.62        0.58        0.07         XXX
75746...........  .............  A............  Artery x-rays, lung.        1.14        3.52        8.25          NA          NA        0.70         XXX
75746...........  TC...........  A............  Artery x-rays, lung.        0.00        3.12        7.86          NA          NA        0.65         XXX
75746...........  26...........  A............  Artery x-rays, lung.        1.14        0.40        0.39        0.40        0.39        0.05         XXX
75756...........  .............  A............  Artery x-rays, chest        1.14        4.34        8.69          NA          NA        0.69         XXX

[[Page 66501]]

 
75756...........  TC...........  A............  Artery x-rays, chest        0.00        3.76        8.18          NA          NA        0.65         XXX
75756...........  26...........  A............  Artery x-rays, chest        1.14        0.58        0.51        0.58        0.51        0.04         XXX
75774...........  .............  A............  Artery x-ray, each          0.36        2.50        7.61          NA          NA        0.67         ZZZ
                                                 vessel.
75774...........  TC...........  A............  Artery x-ray, each          0.00        2.36        7.48          NA          NA        0.65         ZZZ
                                                 vessel.
75774...........  26...........  A............  Artery x-ray, each          0.36        0.14        0.13        0.14        0.13        0.02         ZZZ
                                                 vessel.
75790...........  .............  A............  Visualize A-V shunt.        1.84        3.12        2.53          NA          NA        0.17         XXX
75790...........  TC...........  A............  Visualize A-V shunt.        0.00        2.52        1.93          NA          NA        0.08         XXX
75790...........  26...........  A............  Visualize A-V shunt.        1.84        0.60        0.60        0.60        0.60        0.09         XXX
75801...........  .............  C............  Lymph vessel x-ray,         0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 arm/leg.
75801...........  TC...........  C............  Lymph vessel x-ray,         0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 arm/leg.
75801...........  26...........  A............  Lymph vessel x-ray,         0.81        0.22        0.25        0.22        0.25        0.08         XXX
                                                 arm/leg.
75803...........  .............  C............  Lymph vessel x-             0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 ray,arms/legs.
75803...........  TC...........  C............  Lymph vessel x-             0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 ray,arms/legs.
75803...........  26...........  A............  Lymph vessel x-             1.17        0.40        0.39        0.40        0.39        0.05         XXX
                                                 ray,arms/legs.
75805...........  .............  C............  Lymph vessel x-ray,         0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 trunk.
75805...........  TC...........  C............  Lymph vessel x-ray,         0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 trunk.
75805...........  26...........  A............  Lymph vessel x-ray,         0.81        0.27        0.27        0.27        0.27        0.05         XXX
                                                 trunk.
75807...........  .............  C............  Lymph vessel x-ray,         0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 trunk.
75807...........  TC...........  C............  Lymph vessel x-ray,         0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 trunk.
75807...........  26...........  A............  Lymph vessel x-ray,         1.17        0.39        0.39        0.39        0.39        0.05         XXX
                                                 trunk.
75809...........  .............  A............  Nonvascular shunt, x-       0.47        2.17        1.54          NA          NA        0.07         XXX
                                                 ray.
75809...........  TC...........  A............  Nonvascular shunt, x-       0.00        2.01        1.39          NA          NA        0.05         XXX
                                                 ray.
75809...........  26...........  A............  Nonvascular shunt, x-       0.47        0.16        0.15        0.16        0.15        0.02         XXX
                                                 ray.
75810...........  .............  C............  Vein x-ray, spleen/         0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 liver.
75810...........  TC...........  C............  Vein x-ray, spleen/         0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 liver.
75810...........  26...........  A............  Vein x-ray, spleen/         1.14        0.39        0.38        0.39        0.38        0.05         XXX
                                                 liver.
75820...........  .............  A............  Vein x-ray, arm/leg.        0.70        3.01        2.09          NA          NA        0.09         XXX
75820...........  TC...........  A............  Vein x-ray, arm/leg.        0.00        2.72        1.83          NA          NA        0.06         XXX
75820...........  26...........  A............  Vein x-ray, arm/leg.        0.70        0.29        0.26        0.29        0.26        0.03         XXX
75822...........  .............  A............  Vein x-ray, arms/           1.06        3.17        2.50          NA          NA        0.13         XXX
                                                 legs.
75822...........  TC...........  A............  Vein x-ray, arms/           0.00        2.80        2.14          NA          NA        0.08         XXX
                                                 legs.
75822...........  26...........  A............  Vein x-ray, arms/           1.06        0.37        0.36        0.37        0.36        0.05         XXX
                                                 legs.
75825...........  .............  A............  Vein x-ray, trunk...        1.14        2.92        7.95          NA          NA        0.72         XXX
75825...........  TC...........  A............  Vein x-ray, trunk...        0.00        2.54        7.57          NA          NA        0.65         XXX
75825...........  26...........  A............  Vein x-ray, trunk...        1.14        0.38        0.38        0.38        0.38        0.07         XXX
75827...........  .............  A............  Vein x-ray, chest...        1.14        2.95        7.96          NA          NA        0.70         XXX
75827...........  TC...........  A............  Vein x-ray, chest...        0.00        2.58        7.59          NA          NA        0.65         XXX
75827...........  26...........  A............  Vein x-ray, chest...        1.14        0.37        0.37        0.37        0.37        0.05         XXX
75831...........  .............  A............  Vein x-ray, kidney..        1.14        3.05        8.00          NA          NA        0.71         XXX
75831...........  TC...........  A............  Vein x-ray, kidney..        0.00        2.67        7.63          NA          NA        0.65         XXX
75831...........  26...........  A............  Vein x-ray, kidney..        1.14        0.38        0.37        0.38        0.37        0.06         XXX
75833...........  .............  A............  Vein x-ray, kidneys.        1.49        3.67        8.38          NA          NA        0.74         XXX
75833...........  TC...........  A............  Vein x-ray, kidneys.        0.00        3.17        7.88          NA          NA        0.65         XXX
75833...........  26...........  A............  Vein x-ray, kidneys.        1.49        0.50        0.50        0.50        0.50        0.09         XXX
75840...........  .............  A............  Vein x-ray, adrenal         1.14        2.96        7.97          NA          NA        0.72         XXX
                                                 gland.
75840...........  TC...........  A............  Vein x-ray, adrenal         0.00        2.60        7.60          NA          NA        0.65         XXX
                                                 gland.
75840...........  26...........  A............  Vein x-ray, adrenal         1.14        0.36        0.37        0.36        0.37        0.07         XXX
                                                 gland.
75842...........  .............  A............  Vein x-ray, adrenal         1.49        3.75        8.41          NA          NA        0.72         XXX
                                                 glands.
75842...........  TC...........  A............  Vein x-ray, adrenal         0.00        3.20        7.90          NA          NA        0.65         XXX
                                                 glands.
75842...........  26...........  A............  Vein x-ray, adrenal         1.49        0.55        0.51        0.55        0.51        0.07         XXX
                                                 glands.
75860...........  .............  A............  Vein x-ray, neck....        1.14        3.39        8.19          NA          NA        0.69         XXX
75860...........  TC...........  A............  Vein x-ray, neck....        0.00        2.90        7.75          NA          NA        0.65         XXX
75860...........  26...........  A............  Vein x-ray, neck....        1.14        0.49        0.44        0.49        0.44        0.04         XXX
75870...........  .............  A............  Vein x-ray, skull...        1.14        3.29        8.14          NA          NA        0.70         XXX
75870...........  TC...........  A............  Vein x-ray, skull...        0.00        2.89        7.74          NA          NA        0.65         XXX
75870...........  26...........  A............  Vein x-ray, skull...        1.14        0.40        0.40        0.40        0.40        0.05         XXX
75872...........  .............  A............  Vein x-ray, skull...        1.14        4.04        8.51          NA          NA        0.79         XXX
75872...........  TC...........  A............  Vein x-ray, skull...        0.00        3.60        8.10          NA          NA        0.65         XXX
75872...........  26...........  A............  Vein x-ray, skull...        1.14        0.44        0.41        0.44        0.41        0.14         XXX
75880...........  .............  A............  Vein x-ray, eye             0.70        3.21        2.19          NA          NA        0.09         XXX
                                                 socket.
75880...........  TC...........  A............  Vein x-ray, eye             0.00        2.94        1.94          NA          NA        0.06         XXX
                                                 socket.
75880...........  26...........  A............  Vein x-ray, eye             0.70        0.27        0.25        0.27        0.25        0.03         XXX
                                                 socket.
75885...........  .............  A............  Vein x-ray, liver...        1.44        3.18        8.12          NA          NA        0.71         XXX
75885...........  TC...........  A............  Vein x-ray, liver...        0.00        2.66        7.63          NA          NA        0.65         XXX
75885...........  26...........  A............  Vein x-ray, liver...        1.44        0.52        0.49        0.52        0.49        0.06         XXX
75887...........  .............  A............  Vein x-ray, liver...        1.44        3.42        8.24          NA          NA        0.71         XXX
75887...........  TC...........  A............  Vein x-ray, liver...        0.00        2.85        7.72          NA          NA        0.65         XXX
75887...........  26...........  A............  Vein x-ray, liver...        1.44        0.57        0.52        0.57        0.52        0.06         XXX
75889...........  .............  A............  Vein x-ray, liver...        1.14        3.07        8.02          NA          NA        0.70         XXX
75889...........  TC...........  A............  Vein x-ray, liver...        0.00        2.66        7.63          NA          NA        0.65         XXX
75889...........  26...........  A............  Vein x-ray, liver...        1.14        0.41        0.39        0.41        0.39        0.05         XXX
75891...........  .............  A............  Vein x-ray, liver...        1.14        3.06        8.01          NA          NA        0.70         XXX

[[Page 66502]]

 
75891...........  TC...........  A............  Vein x-ray, liver...        0.00        2.65        7.62          NA          NA        0.65         XXX
75891...........  26...........  A............  Vein x-ray, liver...        1.14        0.41        0.39        0.41        0.39        0.05         XXX
75893...........  .............  A............  Venous sampling by          0.54        2.86        7.82          NA          NA        0.67         XXX
                                                 catheter.
75893...........  TC...........  A............  Venous sampling by          0.00        2.66        7.63          NA          NA        0.65         XXX
                                                 catheter.
75893...........  26...........  A............  Venous sampling by          0.54        0.20        0.19        0.20        0.19        0.02         XXX
                                                 catheter.
75894...........  .............  C............  X-rays, transcath           0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 therapy.
75894...........  TC...........  C............  X-rays, transcath           0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 therapy.
75894...........  26...........  A............  X-rays, transcath           1.31        0.46        0.44        0.46        0.44        0.08         XXX
                                                 therapy.
75896...........  .............  C............  X-rays, transcath           0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 therapy.
75896...........  TC...........  C............  X-rays, transcath           0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 therapy.
75896...........  26...........  A............  X-rays, transcath           1.31        0.52        0.48        0.52        0.48        0.05         XXX
                                                 therapy.
75898...........  .............  C............  Follow-up                   0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 angiography.
75898...........  TC...........  C............  Follow-up                   0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 angiography.
75898...........  26...........  A............  Follow-up                   1.65        0.63        0.59        0.63        0.59        0.07         XXX
                                                 angiography.
75900...........  .............  C............  Intravascular cath          0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 exchange.
75900...........  TC...........  C............  Intravascular cath          0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 exchange.
75900...........  26...........  A............  Intravascular cath          0.49        0.17        0.16        0.17        0.16        0.03         XXX
                                                 exchange.
75901...........  .............  A............  Remove cva device           0.49        4.15        2.80          NA          NA        0.85         XXX
                                                 obstruct.
75901...........  TC...........  A............  Remove cva device           0.00        3.98        2.64          NA          NA        0.83         XXX
                                                 obstruct.
75901...........  26...........  A............  Remove cva device           0.49        0.17        0.16        0.17        0.16        0.02         XXX
                                                 obstruct.
75902...........  .............  A............  Remove cva lumen            0.39        1.63        1.53          NA          NA        0.85         XXX
                                                 obstruct.
75902...........  TC...........  A............  Remove cva lumen            0.00        1.50        1.40          NA          NA        0.83         XXX
                                                 obstruct.
75902...........  26...........  A............  Remove cva lumen            0.39        0.13        0.13        0.13        0.13        0.02         XXX
                                                 obstruct.
75940...........  .............  C............  X-ray placement,            0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 vein filter.
75940...........  TC...........  C............  X-ray placement,            0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 vein filter.
75940...........  26...........  A............  X-ray placement,            0.54        0.18        0.18        0.18        0.18        0.04         XXX
                                                 vein filter.
75945...........  .............  C............  Intravascular us....        0.00        0.00        0.00          NA          NA        0.00         XXX
75945...........  TC...........  C............  Intravascular us....        0.00        0.00        0.00          NA          NA        0.00         XXX
75945...........  26...........  A............  Intravascular us....        0.40        0.14        0.14        0.14        0.14        0.04         XXX
75946...........  .............  C............  Intravascular us add-       0.00        0.00        0.00          NA          NA        0.00         ZZZ
                                                 on.
75946...........  TC...........  C............  Intravascular us add-       0.00        0.00        0.00          NA          NA        0.00         ZZZ
                                                 on.
75946...........  26...........  A............  Intravascular us add-       0.40        0.12        0.13        0.12        0.13        0.05         ZZZ
                                                 on.
75952...........  .............  C............  Endovasc repair             0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 abdom aorta.
75952...........  TC...........  C............  Endovasc repair             0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 abdom aorta.
75952...........  26...........  A............  Endovasc repair             4.49        1.30        1.39        1.30        1.39        0.43         XXX
                                                 abdom aorta.
75953...........  .............  C............  Abdom aneurysm              0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 endovas rpr.
75953...........  TC...........  C............  Abdom aneurysm              0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 endovas rpr.
75953...........  26...........  A............  Abdom aneurysm              1.36        0.40        0.42        0.40        0.42        0.13         XXX
                                                 endovas rpr.
75954...........  .............  C............  Iliac aneurysm              0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 endovas rpr.
75954...........  TC...........  C............  Iliac aneurysm              0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 endovas rpr.
75954...........  26...........  A............  Iliac aneurysm              2.25        0.63        0.70        0.63        0.70        0.15         XXX
                                                 endovas rpr.
75956...........  .............  C............  Xray, endovasc thor         0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 ao repr.
75956...........  TC...........  C............  Xray, endovasc thor         0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 ao repr.
75956...........  26...........  A............  Xray, endovasc thor         7.00        1.88        2.29        1.88        2.29        0.69         XXX
                                                 ao repr.
75957...........  .............  C............  Xray, endovasc thor         0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 ao repr.
75957...........  TC...........  C............  Xray, endovasc thor         0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 ao repr.
75957...........  26...........  A............  Xray, endovasc thor         6.00        1.63        1.97        1.63        1.97        0.59         XXX
                                                 ao repr.
75958...........  .............  C............  Xray, place prox ext        0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 thor ao.
75958...........  TC...........  C............  Xray, place prox ext        0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 thor ao.
75958...........  26...........  A............  Xray, place prox ext        4.00        1.04        1.29        1.04        1.29        0.39         XXX
                                                 thor ao.
75959...........  .............  C............  Xray, place dist ext        0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 thor ao.
75959...........  TC...........  C............  Xray, place dist ext        0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 thor ao.
75959...........  26...........  A............  Xray, place dist ext        3.50        0.92        1.14        0.92        1.14        0.34         XXX
                                                 thor ao.
75960...........  .............  A............  Transcath iv stent          0.82        2.71        8.94          NA          NA        0.82         XXX
                                                 rs&i.
75960...........  TC...........  A............  Transcath iv stent          0.00        2.39        8.64          NA          NA        0.77         XXX
                                                 rs&i.
75960...........  26...........  A............  Transcath iv stent          0.82        0.32        0.30        0.32        0.30        0.05         XXX
                                                 rs&i.
75961...........  .............  A............  Retrieval, broken           4.24        4.66        8.28          NA          NA        0.73         XXX
                                                 catheter.
75961...........  TC...........  A............  Retrieval, broken           0.00        3.18        6.84          NA          NA        0.55         XXX
                                                 catheter.
75961...........  26...........  A............  Retrieval, broken           4.24        1.48        1.44        1.48        1.44        0.18         XXX
                                                 catheter.
75962...........  .............  A............  Repair arterial             0.54        3.50        9.71          NA          NA        0.86         XXX
                                                 blockage.
75962...........  TC...........  A............  Repair arterial             0.00        3.30        9.52          NA          NA        0.83         XXX
                                                 blockage.
75962...........  26...........  A............  Repair arterial             0.54        0.20        0.19        0.20        0.19        0.03         XXX
                                                 blockage.
75964...........  .............  A............  Repair artery               0.36        2.35        5.42          NA          NA        0.46         ZZZ
                                                 blockage, each.
75964...........  TC...........  A............  Repair artery               0.00        2.22        5.30          NA          NA        0.43         ZZZ
                                                 blockage, each.
75964...........  26...........  A............  Repair artery               0.36        0.13        0.12        0.13        0.12        0.03         ZZZ
                                                 blockage, each.
75966...........  .............  A............  Repair arterial             1.31        4.16       10.17          NA          NA        0.89         XXX
                                                 blockage.
75966...........  TC...........  A............  Repair arterial             0.00        3.59        9.66          NA          NA        0.83         XXX
                                                 blockage.
75966...........  26...........  A............  Repair arterial             1.31        0.57        0.51        0.57        0.51        0.06         XXX
                                                 blockage.
75968...........  .............  A............  Repair artery               0.36        2.41        5.46          NA          NA        0.45         ZZZ
                                                 blockage, each.
75968...........  TC...........  A............  Repair artery               0.00        2.25        5.32          NA          NA        0.43         ZZZ
                                                 blockage, each.
75968...........  26...........  A............  Repair artery               0.36        0.16        0.14        0.16        0.14        0.02         ZZZ
                                                 blockage, each.
75970...........  .............  C............  Vascular biopsy.....        0.00        0.00        0.00          NA          NA        0.00         XXX

[[Page 66503]]

 
75970...........  TC...........  C............  Vascular biopsy.....        0.00        0.00        0.00          NA          NA        0.00         XXX
75970...........  26...........  A............  Vascular biopsy.....        0.83        0.31        0.29        0.31        0.29        0.04         XXX
75978...........  .............  A............  Repair venous               0.54        3.26        9.59          NA          NA        0.85         XXX
                                                 blockage.
75978...........  TC...........  A............  Repair venous               0.00        3.08        9.41          NA          NA        0.83         XXX
                                                 blockage.
75978...........  26...........  A............  Repair venous               0.54        0.18        0.18        0.18        0.18        0.02         XXX
                                                 blockage.
75980...........  .............  C............  Contrast xray exam          0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 bile duct.
75980...........  TC...........  C............  Contrast xray exam          0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 bile duct.
75980...........  26...........  A............  Contrast xray exam          1.44        0.52        0.49        0.52        0.49        0.06         XXX
                                                 bile duct.
75982...........  .............  C............  Contrast xray exam          0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 bile duct.
75982...........  TC...........  C............  Contrast xray exam          0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 bile duct.
75982...........  26...........  A............  Contrast xray exam          1.44        0.52        0.50        0.52        0.50        0.06         XXX
                                                 bile duct.
75984...........  .............  A............  Xray control                0.72        2.31        2.24          NA          NA        0.14         XXX
                                                 catheter change.
75984...........  TC...........  A............  Xray control                0.00        2.05        2.00          NA          NA        0.11         XXX
                                                 catheter change.
75984...........  26...........  A............  Xray control                0.72        0.26        0.24        0.26        0.24        0.03         XXX
                                                 catheter change.
75989...........  .............  A............  Abscess drainage            1.19        2.24        2.89          NA          NA        0.22         XXX
                                                 under x-ray.
75989...........  TC...........  A............  Abscess drainage            0.00        1.82        2.48          NA          NA        0.17         XXX
                                                 under x-ray.
75989...........  26...........  A............  Abscess drainage            1.19        0.42        0.41        0.42        0.41        0.05         XXX
                                                 under x-ray.
75992...........  .............  C............  Atherectomy, x-ray          0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 exam.
75992...........  TC...........  C............  Atherectomy, x-ray          0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 exam.
75992...........  26...........  A............  Atherectomy, x-ray          0.54        0.22        0.21        0.22        0.21        0.03         XXX
                                                 exam.
75993...........  .............  C............  Atherectomy, x-ray          0.00        0.00        0.00          NA          NA        0.00         ZZZ
                                                 exam.
75993...........  TC...........  C............  Atherectomy, x-ray          0.00        0.00        0.00          NA          NA        0.00         ZZZ
                                                 exam.
75993...........  26...........  A............  Atherectomy, x-ray          0.36        0.14        0.13        0.14        0.13        0.02         ZZZ
                                                 exam.
75994...........  .............  C............  Atherectomy, x-ray          0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 exam.
75994...........  TC...........  C............  Atherectomy, x-ray          0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 exam.
75994...........  26...........  A............  Atherectomy, x-ray          1.31        0.54        0.50        0.54        0.50        0.07         XXX
                                                 exam.
75995...........  .............  C............  Atherectomy, x-ray          0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 exam.
75995...........  TC...........  C............  Atherectomy, x-ray          0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 exam.
75995...........  26...........  A............  Atherectomy, x-ray          1.31        0.48        0.47        0.48        0.47        0.05         XXX
                                                 exam.
75996...........  .............  C............  Atherectomy, x-ray          0.00        0.00        0.00          NA          NA        0.00         ZZZ
                                                 exam.
75996...........  TC...........  C............  Atherectomy, x-ray          0.00        0.00        0.00          NA          NA        0.00         ZZZ
                                                 exam.
75996...........  26...........  A............  Atherectomy, x-ray          0.36        0.12        0.12        0.12        0.12        0.02         ZZZ
                                                 exam.
76000...........  .............  A............  Fluoroscope                 0.17        2.77        2.06          NA          NA        0.08         XXX
                                                 examination.
76000...........  TC...........  A............  Fluoroscope                 0.00        2.71        2.01          NA          NA        0.07         XXX
                                                 examination.
76000...........  26...........  A............  Fluoroscope                 0.17        0.06        0.05        0.06        0.05        0.01         XXX
                                                 examination.
76001...........  .............  C............  Fluoroscope exam,           0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 extensive.
76001...........  TC...........  C............  Fluoroscope exam,           0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 extensive.
76001...........  26...........  A............  Fluoroscope exam,           0.67        0.24        0.23        0.24        0.23        0.05         XXX
                                                 extensive.
76010...........  .............  A............  X-ray, nose to              0.18        0.54        0.56          NA          NA        0.03         XXX
                                                 rectum.
76010...........  TC...........  A............  X-ray, nose to              0.00        0.48        0.50          NA          NA        0.02         XXX
                                                 rectum.
76010...........  26...........  A............  X-ray, nose to              0.18        0.06        0.06        0.06        0.06        0.01         XXX
                                                 rectum.
76080...........  .............  A............  X-ray exam of               0.54        1.10        1.16          NA          NA        0.08         XXX
                                                 fistula.
76080...........  TC...........  A............  X-ray exam of               0.00        0.90        0.97          NA          NA        0.06         XXX
                                                 fistula.
76080...........  26...........  A............  X-ray exam of               0.54        0.20        0.19        0.20        0.19        0.02         XXX
                                                 fistula.
76098...........  .............  A............  X-ray exam, breast          0.16        0.32        0.39          NA          NA        0.03         XXX
                                                 specimen.
76098...........  TC...........  A............  X-ray exam, breast          0.00        0.27        0.34          NA          NA        0.02         XXX
                                                 specimen.
76098...........  26...........  A............  X-ray exam, breast          0.16        0.05        0.05        0.05        0.05        0.01         XXX
                                                 specimen.
76100...........  .............  A............  X-ray exam of body          0.58        3.55        2.50          NA          NA        0.10         XXX
                                                 section.
76100...........  TC...........  A............  X-ray exam of body          0.00        3.35        2.30          NA          NA        0.07         XXX
                                                 section.
76100...........  26...........  A............  X-ray exam of body          0.58        0.20        0.20        0.20        0.20        0.03         XXX
                                                 section.
76101...........  .............  A............  Complex body section        0.58        5.45        3.53          NA          NA        0.11         XXX
                                                 x-ray.
76101...........  TC...........  A............  Complex body section        0.00        5.27        3.34          NA          NA        0.08         XXX
                                                 x-ray.
76101...........  26...........  A............  Complex body section        0.58        0.18        0.19        0.18        0.19        0.03         XXX
                                                 x-ray.
76102...........  .............  A............  Complex body section        0.58        7.64        4.78          NA          NA        0.14         XXX
                                                 x-rays.
76102...........  TC...........  A............  Complex body section        0.00        7.46        4.60          NA          NA        0.11         XXX
                                                 x-rays.
76102...........  26...........  A............  Complex body section        0.58        0.18        0.18        0.18        0.18        0.03         XXX
                                                 x-rays.
76120...........  .............  A............  Cine/video x-rays...        0.38        1.87        1.52          NA          NA        0.08         XXX
76120...........  TC...........  A............  Cine/video x-rays...        0.00        1.74        1.39          NA          NA        0.06         XXX
76120...........  26...........  A............  Cine/video x-rays...        0.38        0.13        0.13        0.13        0.13        0.02         XXX
76125...........  .............  C............  Cine/video x-rays           0.00        0.00        0.00          NA          NA        0.00         ZZZ
                                                 add-on.
76125...........  TC...........  C............  Cine/video x-rays           0.00        0.00        0.00          NA          NA        0.00         ZZZ
                                                 add-on.
76125...........  26...........  A............  Cine/video x-rays           0.27        0.12        0.11        0.12        0.11        0.01         ZZZ
                                                 add-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        0.68        0.55          NA          NA        0.02         XXX
                                                 process.
76350...........  .............  C............  Special x-ray               0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 contrast study.
76376...........  .............  A............  3d render w/o               0.20        1.40        2.45          NA          NA        0.10         XXX
                                                 postprocess.
76376...........  TC...........  A............  3d render w/o               0.00        1.33        2.38          NA          NA        0.08         XXX
                                                 postprocess.
76376...........  26...........  A............  3d render w/o               0.20        0.07        0.07        0.07        0.07        0.02         XXX
                                                 postprocess.
76377...........  .............  A............  3d rendering w/             0.79        1.40        2.54          NA          NA        0.39         XXX
                                                 postprocess.
76377...........  TC...........  A............  3d rendering w/             0.00        1.12        2.27          NA          NA        0.31         XXX
                                                 postprocess.
76377...........  26...........  A............  3d rendering w/             0.79        0.28        0.27        0.28        0.27        0.08         XXX
                                                 postprocess.
76380...........  .............  A............  CAT scan follow-up          0.98        4.71        4.26          NA          NA        0.22         XXX
                                                 study.

[[Page 66504]]

 
76380...........  TC...........  A............  CAT scan follow-up          0.00        4.37        3.93          NA          NA        0.18         XXX
                                                 study.
76380...........  26...........  A............  CAT scan follow-up          0.98        0.34        0.33        0.34        0.33        0.04         XXX
                                                 study.
76390...........  .............  N............  Mr spectroscopy.....        1.40        9.42       10.44          NA          NA        0.66         XXX
76390...........  TC...........  N............  Mr spectroscopy.....        0.00        9.10       10.05          NA          NA        0.59         XXX
76390...........  26...........  N............  Mr spectroscopy.....        1.40        0.32        0.39        0.32        0.39        0.07         XXX
76496...........  .............  C............  Fluoroscopic                0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 procedure.
76496...........  TC...........  C............  Fluoroscopic                0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 procedure.
76496...........  26...........  C............  Fluoroscopic                0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 procedure.
76497...........  .............  C............  Ct procedure........        0.00        0.00        0.00          NA          NA        0.00         XXX
76497...........  TC...........  C............  Ct procedure........        0.00        0.00        0.00          NA          NA        0.00         XXX
76497...........  26...........  C............  Ct procedure........        0.00        0.00        0.00        0.00        0.00        0.00         XXX
76498...........  .............  C............  Mri procedure.......        0.00        0.00        0.00          NA          NA        0.00         XXX
76498...........  TC...........  C............  Mri procedure.......        0.00        0.00        0.00          NA          NA        0.00         XXX
76498...........  26...........  C............  Mri procedure.......        0.00        0.00        0.00        0.00        0.00        0.00         XXX
76499...........  .............  C............  Radiographic                0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 procedure.
76499...........  TC...........  C............  Radiographic                0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 procedure.
76499...........  26...........  C............  Radiographic                0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 procedure.
76506...........  .............  A............  Echo exam of head...        0.63        2.76        2.21          NA          NA        0.14         XXX
76506...........  TC...........  A............  Echo exam of head...        0.00        2.56        1.99          NA          NA        0.08         XXX
76506...........  26...........  A............  Echo exam of head...        0.63        0.20        0.22        0.20        0.22        0.06         XXX
76510...........  .............  A............  Ophth us, b & quant         1.55        2.25        2.55          NA          NA        0.10         XXX
                                                 a.
76510...........  TC...........  A............  Ophth us, b & quant         0.00        1.70        1.94          NA          NA        0.07         XXX
                                                 a.
76510...........  26...........  A............  Ophth us, b & quant         1.55        0.55        0.61        0.55        0.61        0.03         XXX
                                                 a.
76511...........  .............  A............  Ophth us, quant a           0.94        1.35        1.88          NA          NA        0.10         XXX
                                                 only.
76511...........  TC...........  A............  Ophth us, quant a           0.00        1.02        1.52          NA          NA        0.07         XXX
                                                 only.
76511...........  26...........  A............  Ophth us, quant a           0.94        0.33        0.36        0.33        0.36        0.03         XXX
                                                 only.
76512...........  .............  A............  Ophth us, b w/non-          0.94        1.16        1.69          NA          NA        0.12         XXX
                                                 quant a.
76512...........  TC...........  A............  Ophth us, b w/non-          0.00        0.83        1.32          NA          NA        0.10         XXX
                                                 quant a.
76512...........  26...........  A............  Ophth us, b w/non-          0.94        0.33        0.37        0.33        0.37        0.02         XXX
                                                 quant a.
76513...........  .............  A............  Echo exam of eye,           0.66        1.52        1.66          NA          NA        0.12         XXX
                                                 water bath.
76513...........  TC...........  A............  Echo exam of eye,           0.00        1.29        1.40          NA          NA        0.10         XXX
                                                 water bath.
76513...........  26...........  A............  Echo exam of eye,           0.66        0.23        0.26        0.23        0.26        0.02         XXX
                                                 water bath.
76514...........  .............  A............  Echo exam of eye,           0.17        0.16        0.15          NA          NA        0.02         XXX
                                                 thickness.
76514...........  TC...........  A............  Echo exam of eye,           0.00        0.10        0.08          NA          NA        0.01         XXX
                                                 thickness.
76514...........  26...........  A............  Echo exam of eye,           0.17        0.06        0.07        0.06        0.07        0.01         XXX
                                                 thickness.
76516...........  .............  A............  Echo exam of eye....        0.54        1.15        1.30          NA          NA        0.08         XXX
76516...........  TC...........  A............  Echo exam of eye....        0.00        0.97        1.09          NA          NA        0.07         XXX
76516...........  26...........  A............  Echo exam of eye....        0.54        0.18        0.21        0.18        0.21        0.01         XXX
76519...........  .............  A............  Echo exam of eye....        0.54        1.28        1.42          NA          NA        0.08         XXX
76519...........  TC...........  A............  Echo exam of eye....        0.00        1.09        1.20          NA          NA        0.07         XXX
76519...........  26...........  A............  Echo exam of eye....        0.54        0.19        0.22        0.19        0.22        0.01         XXX
76529...........  .............  A............  Echo exam of eye....        0.57        1.15        1.26          NA          NA        0.10         XXX
76529...........  TC...........  A............  Echo exam of eye....        0.00        0.95        1.04          NA          NA        0.08         XXX
76529...........  26...........  A............  Echo exam of eye....        0.57        0.20        0.22        0.20        0.22        0.02         XXX
76536...........  .............  A............  Us exam of head and         0.56        2.67        2.13          NA          NA        0.10         XXX
                                                 neck.
76536...........  TC...........  A............  Us exam of head and         0.00        2.49        1.95          NA          NA        0.08         XXX
                                                 neck.
76536...........  26...........  A............  Us exam of head and         0.56        0.18        0.18        0.18        0.18        0.02         XXX
                                                 neck.
76604...........  .............  A............  Us exam, chest......        0.55        1.83        1.66          NA          NA        0.09         XXX
76604...........  TC...........  A............  Us exam, chest......        0.00        1.64        1.47          NA          NA        0.07         XXX
76604...........  26...........  A............  Us exam, chest......        0.55        0.19        0.19        0.19        0.19        0.02         XXX
76645...........  .............  A............  Us exam, breast(s)..        0.54        2.12        1.67          NA          NA        0.08         XXX
76645...........  TC...........  A............  Us exam, breast(s)..        0.00        1.93        1.49          NA          NA        0.06         XXX
76645...........  26...........  A............  Us exam, breast(s)..        0.54        0.19        0.18        0.19        0.18        0.02         XXX
76700...........  .............  A............  Us exam, abdom,             0.81        3.02        2.63          NA          NA        0.15         XXX
                                                 complete.
76700...........  TC...........  A............  Us exam, abdom,             0.00        2.75        2.36          NA          NA        0.11         XXX
                                                 complete.
76700...........  26...........  A............  Us exam, abdom,             0.81        0.27        0.27        0.27        0.27        0.04         XXX
                                                 complete.
76705...........  .............  A............  Echo exam of abdomen        0.59        2.35        1.98          NA          NA        0.11         XXX
76705...........  TC...........  A............  Echo exam of abdomen        0.00        2.14        1.78          NA          NA        0.08         XXX
76705...........  26...........  A............  Echo exam of abdomen        0.59        0.21        0.20        0.21        0.20        0.03         XXX
76770...........  .............  A............  Us exam abdo back           0.74        2.93        2.57          NA          NA        0.14         XXX
                                                 wall, comp.
76770...........  TC...........  A............  Us exam abdo back           0.00        2.67        2.32          NA          NA        0.11         XXX
                                                 wall, comp.
76770...........  26...........  A............  Us exam abdo back           0.74        0.26        0.25        0.26        0.25        0.03         XXX
                                                 wall, comp.
76775...........  .............  A............  Us exam abdo back           0.58        2.42        2.01          NA          NA        0.11         XXX
                                                 wall, lim.
76775...........  TC...........  A............  Us exam abdo back           0.00        2.21        1.81          NA          NA        0.08         XXX
                                                 wall, lim.
76775...........  26...........  A............  Us exam abdo back           0.58        0.21        0.20        0.21        0.20        0.03         XXX
                                                 wall, lim.
76776...........  .............  A............  Us exam k transpl w/        0.76        3.43        2.82          NA          NA        0.14         XXX
                                                 doppler.
76776...........  TC...........  A............  Us exam k transpl w/        0.00        3.16        2.57          NA          NA        0.11         XXX
                                                 doppler.
76776...........  26...........  A............  Us exam k transpl w/        0.76        0.27        0.25        0.27        0.25        0.03         XXX
                                                 doppler.
76800...........  .............  A............  Us exam, spinal             1.13        2.31        2.03          NA          NA        0.13         XXX
                                                 canal.
76800...........  TC...........  A............  Us exam, spinal             0.00        2.03        1.72          NA          NA        0.08         XXX
                                                 canal.
76800...........  26...........  A............  Us exam, spinal             1.13        0.28        0.31        0.28        0.31        0.05         XXX
                                                 canal.
76801...........  .............  A............  Ob us < 14 wks,             0.99        2.46        2.45          NA          NA        0.16         XXX
                                                 single fetus.

[[Page 66505]]

 
76801...........  TC...........  A............  Ob us < 14 wks,             0.00        2.16        2.13          NA          NA        0.12         XXX
                                                 single fetus.
76801...........  26...........  A............  Ob us < 14 wks,             0.99        0.30        0.32        0.30        0.32        0.04         XXX
                                                 single fetus.
76802...........  .............  A............  Ob us < 14 wks,             0.83        0.97        1.16          NA          NA        0.16         ZZZ
                                                 add'l fetus.
76802...........  TC...........  A............  Ob us < 14 wks,             0.00        0.71        0.88          NA          NA        0.12         ZZZ
                                                 add'l fetus.
76802...........  26...........  A............  Ob us < 14 wks,             0.83        0.26        0.28        0.26        0.28        0.04         ZZZ
                                                 add'l fetus.
76805...........  .............  A............  Ob us >/= 14 wks,           0.99        3.04        2.74          NA          NA        0.16         XXX
                                                 sngl fetus.
76805...........  TC...........  A............  Ob us >/= 14 wks,           0.00        2.73        2.42          NA          NA        0.12         XXX
                                                 sngl fetus.
76805...........  26...........  A............  Ob us >/= 14 wks,           0.99        0.31        0.32        0.31        0.32        0.04         XXX
                                                 sngl fetus.
76810...........  .............  A............  Ob us >/= 14 wks,           0.98        1.65        1.52          NA          NA        0.26         ZZZ
                                                 addl fetus.
76810...........  TC...........  A............  Ob us >/= 14 wks,           0.00        1.35        1.20          NA          NA        0.22         ZZZ
                                                 addl fetus.
76810...........  26...........  A............  Ob us >/= 14 wks,           0.98        0.30        0.32        0.30        0.32        0.04         ZZZ
                                                 addl fetus.
76811...........  .............  A............  Ob us, detailed,            1.90        3.05        3.64          NA          NA        0.52         XXX
                                                 sngl fetus.
76811...........  TC...........  A............  Ob us, detailed,            0.00        2.51        3.02          NA          NA        0.43         XXX
                                                 sngl fetus.
76811...........  26...........  A............  Ob us, detailed,            1.90        0.54        0.62        0.54        0.62        0.09         XXX
                                                 sngl fetus.
76812...........  .............  A............  Ob us, detailed,            1.78        3.98        2.84          NA          NA        0.49         ZZZ
                                                 addl fetus.
76812...........  TC...........  A............  Ob us, detailed,            0.00        3.48        2.26          NA          NA        0.41         ZZZ
                                                 addl fetus.
76812...........  26...........  A............  Ob us, detailed,            1.78        0.50        0.58        0.50        0.58        0.08         ZZZ
                                                 addl fetus.
76813...........  .............  A............  Ob us nuchal meas, 1        1.18        2.21        2.21          NA          NA        0.19         XXX
                                                 gest.
76813...........  TC...........  A............  Ob us nuchal meas, 1        0.00        1.81        1.81          NA          NA        0.14         XXX
                                                 gest.
76813...........  26...........  A............  Ob us nuchal meas, 1        1.18        0.40        0.40        0.40        0.40        0.05         XXX
                                                 gest.
76814...........  .............  A............  Ob us nuchal meas,          0.99        1.15        1.15          NA          NA        0.19         XXX
                                                 add-on.
76814...........  TC...........  A............  Ob us nuchal meas,          0.00        0.86        0.86          NA          NA        0.14         XXX
                                                 add-on.
76814...........  26...........  A............  Ob us nuchal meas,          0.99        0.29        0.29        0.29        0.29        0.05         XXX
                                                 add-on.
76815...........  .............  A............  Ob us, limited,             0.65        1.80        1.72          NA          NA        0.11         XXX
                                                 fetus(s).
76815...........  TC...........  A............  Ob us, limited,             0.00        1.60        1.51          NA          NA        0.08         XXX
                                                 fetus(s).
76815...........  26...........  A............  Ob us, limited,             0.65        0.20        0.21        0.20        0.21        0.03         XXX
                                                 fetus(s).
76816...........  .............  A............  Ob us, follow-up,           0.85        2.38        1.90          NA          NA        0.10         XXX
                                                 per fetus.
76816...........  TC...........  A............  Ob us, follow-up,           0.00        2.13        1.62          NA          NA        0.06         XXX
                                                 per fetus.
76816...........  26...........  A............  Ob us, follow-up,           0.85        0.25        0.28        0.25        0.28        0.04         XXX
                                                 per fetus.
76817...........  .............  A............  Transvaginal us,            0.75        2.02        1.89          NA          NA        0.09         XXX
                                                 obstetric.
76817...........  TC...........  A............  Transvaginal us,            0.00        1.79        1.65          NA          NA        0.06         XXX
                                                 obstetric.
76817...........  26...........  A............  Transvaginal us,            0.75        0.23        0.24        0.23        0.24        0.03         XXX
                                                 obstetric.
76818...........  .............  A............  Fetal biophys               1.05        2.21        2.11          NA          NA        0.15         XXX
                                                 profile w/nst.
76818...........  TC...........  A............  Fetal biophys               0.00        1.91        1.76          NA          NA        0.10         XXX
                                                 profile w/nst.
76818...........  26...........  A............  Fetal biophys               1.05        0.30        0.35        0.30        0.35        0.05         XXX
                                                 profile w/nst.
76819...........  .............  A............  Fetal biophys profil        0.77        1.63        1.75          NA          NA        0.13         XXX
                                                 w/o nst.
76819...........  TC...........  A............  Fetal biophys profil        0.00        1.40        1.50          NA          NA        0.10         XXX
                                                 w/o nst.
76819...........  26...........  A............  Fetal biophys profil        0.77        0.23        0.25        0.23        0.25        0.03         XXX
                                                 w/o nst.
76820...........  .............  A............  Umbilical artery            0.50        0.56        1.18          NA          NA        0.15         XXX
                                                 echo.
76820...........  TC...........  A............  Umbilical artery            0.00        0.42        1.01          NA          NA        0.12         XXX
                                                 echo.
76820...........  26...........  A............  Umbilical artery            0.50        0.14        0.17        0.14        0.17        0.03         XXX
                                                 echo.
76821...........  .............  A............  Middle cerebral             0.70        1.86        1.87          NA          NA        0.15         XXX
                                                 artery echo.
76821...........  TC...........  A............  Middle cerebral             0.00        1.66        1.63          NA          NA        0.12         XXX
                                                 artery echo.
76821...........  26...........  A............  Middle cerebral             0.70        0.20        0.24        0.20        0.24        0.03         XXX
                                                 artery echo.
76825...........  .............  A............  Echo exam of fetal          1.67        4.37        3.47          NA          NA        0.18         XXX
                                                 heart.
76825...........  TC...........  A............  Echo exam of fetal          0.00        3.87        2.92          NA          NA        0.11         XXX
                                                 heart.
76825...........  26...........  A............  Echo exam of fetal          1.67        0.50        0.55        0.50        0.55        0.07         XXX
                                                 heart.
76826...........  .............  A............  Echo exam of fetal          0.83        2.76        1.88          NA          NA        0.08         XXX
                                                 heart.
76826...........  TC...........  A............  Echo exam of fetal          0.00        2.52        1.61          NA          NA        0.05         XXX
                                                 heart.
76826...........  26...........  A............  Echo exam of fetal          0.83        0.24        0.27        0.24        0.27        0.03         XXX
                                                 heart.
76827...........  .............  A............  Echo exam of fetal          0.58        1.07        1.50          NA          NA        0.14         XXX
                                                 heart.
76827...........  TC...........  A............  Echo exam of fetal          0.00        0.90        1.31          NA          NA        0.12         XXX
                                                 heart.
76827...........  26...........  A............  Echo exam of fetal          0.58        0.17        0.19        0.17        0.19        0.02         XXX
                                                 heart.
76828...........  .............  A............  Echo exam of fetal          0.56        0.63        0.98          NA          NA        0.11         XXX
                                                 heart.
76828...........  TC...........  A............  Echo exam of fetal          0.00        0.48        0.79          NA          NA        0.08         XXX
                                                 heart.
76828...........  26...........  A............  Echo exam of fetal          0.56        0.15        0.19        0.15        0.19        0.03         XXX
                                                 heart.
76830...........  .............  A............  Transvaginal us, non-       0.69        2.76        2.26          NA          NA        0.13         XXX
                                                 ob.
76830...........  TC...........  A............  Transvaginal us, non-       0.00        2.54        2.03          NA          NA        0.10         XXX
                                                 ob.
76830...........  26...........  A............  Transvaginal us, non-       0.69        0.22        0.23        0.22        0.23        0.03         XXX
                                                 ob.
76831...........  .............  A............  Echo exam, uterus...        0.72        2.73        2.25          NA          NA        0.13         XXX
76831...........  TC...........  A............  Echo exam, uterus...        0.00        2.52        2.02          NA          NA        0.10         XXX
76831...........  26...........  A............  Echo exam, uterus...        0.72        0.21        0.23        0.21        0.23        0.03         XXX
76856...........  .............  A............  Us exam, pelvic,            0.69        2.79        2.26          NA          NA        0.13         XXX
                                                 complete.
76856...........  TC...........  A............  Us exam, pelvic,            0.00        2.55        2.03          NA          NA        0.10         XXX
                                                 complete.
76856...........  26...........  A............  Us exam, pelvic,            0.69        0.24        0.23        0.24        0.23        0.03         XXX
                                                 complete.
76857...........  .............  A............  Us exam, pelvic,            0.38        2.48        2.15          NA          NA        0.08         XXX
                                                 limited.
76857...........  TC...........  A............  Us exam, pelvic,            0.00        2.34        2.02          NA          NA        0.06         XXX
                                                 limited.
76857...........  26...........  A............  Us exam, pelvic,            0.38        0.14        0.13        0.14        0.13        0.02         XXX
                                                 limited.
76870...........  .............  A............  Us exam, scrotum....        0.64        2.83        2.28          NA          NA        0.13         XXX
76870...........  TC...........  A............  Us exam, scrotum....        0.00        2.60        2.06          NA          NA        0.10         XXX
76870...........  26...........  A............  Us exam, scrotum....        0.64        0.23        0.22        0.23        0.22        0.03         XXX
76872...........  .............  A............  Us, transrectal.....        0.69        3.40        2.82          NA          NA        0.14         XXX

[[Page 66506]]

 
76872...........  TC...........  A............  Us, transrectal.....        0.00        3.13        2.58          NA          NA        0.10         XXX
76872...........  26...........  A............  Us, transrectal.....        0.69        0.27        0.24        0.27        0.24        0.04         XXX
76873...........  .............  A............  Echograp trans r,           1.55        3.40        2.99          NA          NA        0.25         XXX
                                                 pros study.
76873...........  TC...........  A............  Echograp trans r,           0.00        2.85        2.47          NA          NA        0.16         XXX
                                                 pros study.
76873...........  26...........  A............  Echograp trans r,           1.55        0.55        0.52        0.55        0.52        0.09         XXX
                                                 pros study.
76880...........  .............  A............  Us exam, extremity..        0.59        3.18        2.40          NA          NA        0.11         XXX
76880...........  TC...........  A............  Us exam, extremity..        0.00        3.00        2.21          NA          NA        0.08         XXX
76880...........  26...........  A............  Us exam, extremity..        0.59        0.18        0.19        0.18        0.19        0.03         XXX
76885...........  .............  A............  Us exam infant hips,        0.74        3.26        2.50          NA          NA        0.13         XXX
                                                 dynamic.
76885...........  TC...........  A............  Us exam infant hips,        0.00        3.01        2.26          NA          NA        0.10         XXX
                                                 dynamic.
76885...........  26...........  A............  Us exam infant hips,        0.74        0.25        0.24        0.25        0.24        0.03         XXX
                                                 dynamic.
76886...........  .............  A............  Us exam infant hips,        0.62        2.27        1.94          NA          NA        0.11         XXX
                                                 static.
76886...........  TC...........  A............  Us exam infant hips,        0.00        2.05        1.73          NA          NA        0.08         XXX
                                                 static.
76886...........  26...........  A............  Us exam infant hips,        0.62        0.22        0.21        0.22        0.21        0.03         XXX
                                                 static.
76930...........  .............  A............  Echo guide,                 0.67        2.08        1.92          NA          NA        0.12         XXX
                                                 cardiocentesis.
76930...........  TC...........  A............  Echo guide,                 0.00        1.74        1.63          NA          NA        0.10         XXX
                                                 cardiocentesis.
76930...........  26...........  A............  Echo guide,                 0.67        0.34        0.29        0.34        0.29        0.02         XXX
                                                 cardiocentesis.
76932...........  .............  C............  Echo guide for heart        0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 biopsy.
76932...........  TC...........  C............  Echo guide for heart        0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 biopsy.
76932...........  26...........  A............  Echo guide for heart        0.67        0.35        0.30        0.35        0.30        0.02         XXX
                                                 biopsy.
76936...........  .............  A............  Echo guide for              1.99        6.12        6.54          NA          NA        0.47         XXX
                                                 artery repair.
76936...........  TC...........  A............  Echo guide for              0.00        5.41        5.85          NA          NA        0.34         XXX
                                                 artery repair.
76936...........  26...........  A............  Echo guide for              1.99        0.71        0.69        0.71        0.69        0.13         XXX
                                                 artery repair.
76937...........  .............  A............  Us guide, vascular          0.30        0.62        0.55          NA          NA        0.13         ZZZ
                                                 access.
76937...........  TC...........  A............  Us guide, vascular          0.00        0.52        0.45          NA          NA        0.10         ZZZ
                                                 access.
76937...........  26...........  A............  Us guide, vascular          0.30        0.10        0.10        0.10        0.10        0.03         ZZZ
                                                 access.
76940...........  .............  C............  Us guide, tissue            0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 ablation.
76940...........  TC...........  C............  Us guide, tissue            0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 ablation.
76940...........  26...........  A............  Us guide, tissue            2.00        0.65        0.65        0.65        0.65        0.31         XXX
                                                 ablation.
76941...........  .............  C............  Echo guide for              0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 transfusion.
76941...........  TC...........  C............  Echo guide for              0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 transfusion.
76941...........  26...........  A............  Echo guide for              1.34        0.38        0.42        0.38        0.42        0.07         XXX
                                                 transfusion.
76942...........  .............  A............  Echo guide for              0.67        4.79        3.91          NA          NA        0.13         XXX
                                                 biopsy.
76942...........  TC...........  A............  Echo guide for              0.00        4.55        3.68          NA          NA        0.10         XXX
                                                 biopsy.
76942...........  26...........  A............  Echo guide for              0.67        0.24        0.23        0.24        0.23        0.03         XXX
                                                 biopsy.
76945...........  .............  C............  Echo guide, villus          0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 sampling.
76945...........  TC...........  C............  Echo guide, villus          0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 sampling.
76945...........  26...........  A............  Echo guide, villus          0.67        0.21        0.21        0.21        0.21        0.03         XXX
                                                 sampling.
76946...........  .............  A............  Echo guide for              0.38        0.45        1.05          NA          NA        0.12         XXX
                                                 amniocentesis.
76946...........  TC...........  A............  Echo guide for              0.00        0.34        0.93          NA          NA        0.10         XXX
                                                 amniocentesis.
76946...........  26...........  A............  Echo guide for              0.38        0.11        0.12        0.11        0.12        0.02         XXX
                                                 amniocentesis.
76948...........  .............  A............  Echo guide, ova             0.38        0.45        1.04          NA          NA        0.12         XXX
                                                 aspiration.
76948...........  TC...........  A............  Echo guide, ova             0.00        0.35        0.93          NA          NA        0.10         XXX
                                                 aspiration.
76948...........  26...........  A............  Echo guide, ova             0.38        0.10        0.11        0.10        0.11        0.02         XXX
                                                 aspiration.
76950...........  .............  A............  Echo guidance               0.58        1.21        1.35          NA          NA        0.10         XXX
                                                 radiotherapy.
76950...........  TC...........  A............  Echo guidance               0.00        1.02        1.16          NA          NA        0.07         XXX
                                                 radiotherapy.
76950...........  26...........  A............  Echo guidance               0.58        0.19        0.19        0.19        0.19        0.03         XXX
                                                 radiotherapy.
76965...........  .............  A............  Echo guidance               1.34        1.20        3.60          NA          NA        0.37         XXX
                                                 radiotherapy.
76965...........  TC...........  A............  Echo guidance               0.00        0.70        3.14          NA          NA        0.29         XXX
                                                 radiotherapy.
76965...........  26...........  A............  Echo guidance               1.34        0.50        0.46        0.50        0.46        0.08         XXX
                                                 radiotherapy.
76970...........  .............  A............  Ultrasound exam             0.40        1.98        1.58          NA          NA        0.08         XXX
                                                 follow-up.
76970...........  TC...........  A............  Ultrasound exam             0.00        1.87        1.46          NA          NA        0.06         XXX
                                                 follow-up.
76970...........  26...........  A............  Ultrasound exam             0.40        0.11        0.12        0.11        0.12        0.02         XXX
                                                 follow-up.
76975...........  .............  C............  GI endoscopic               0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 ultrasound.
76975...........  TC...........  C............  GI endoscopic               0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 ultrasound.
76975...........  26...........  A............  GI endoscopic               0.81        0.30        0.29        0.30        0.29        0.04         XXX
                                                 ultrasound.
76977...........  .............  A............  Us bone density             0.05        0.10        0.48          NA          NA        0.06         XXX
                                                 measure.
76977...........  TC...........  A............  Us bone density             0.00        0.09        0.46          NA          NA        0.05         XXX
                                                 measure.
76977...........  26...........  A............  Us bone density             0.05        0.01        0.02        0.01        0.02        0.01         XXX
                                                 measure.
76998...........  .............  C............  Us guide, intraop...        0.00        0.00        0.00          NA          NA        0.00         XXX
76998...........  TC...........  C............  Us guide, intraop...        0.00        0.00        0.00          NA          NA        0.00         XXX
76998...........  26...........  A............  Us guide, intraop...        1.20        0.35        0.37        0.35        0.37        0.13         XXX
76999...........  .............  C............  Echo examination            0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 procedure.
76999...........  TC...........  C............  Echo examination            0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 procedure.
76999...........  26...........  C............  Echo examination            0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 procedure.
77001...........  .............  A............  Fluoroguide for vein        0.38        2.72        2.08          NA          NA        0.11         ZZZ
                                                 device.
77001...........  TC...........  A............  Fluoroguide for vein        0.00        2.59        1.95          NA          NA        0.10         ZZZ
                                                 device.
77001...........  26...........  A............  Fluoroguide for vein        0.38        0.13        0.13        0.13        0.13        0.01         ZZZ
                                                 device.
77002...........  .............  A............  Needle localization         0.54        1.23        1.35          NA          NA        0.09         XXX
                                                 by xray.
77002...........  TC...........  A............  Needle localization         0.00        1.07        1.19          NA          NA        0.07         XXX
                                                 by xray.
77002...........  26...........  A............  Needle localization         0.54        0.16        0.16        0.16        0.16        0.02         XXX
                                                 by xray.
77003...........  .............  A............  Fluoroguide for             0.60        0.76        1.11          NA          NA        0.10         XXX
                                                 spine inject.

[[Page 66507]]

 
77003...........  TC...........  A............  Fluoroguide for             0.00        0.62        0.96          NA          NA        0.07         XXX
                                                 spine inject.
77003...........  26...........  A............  Fluoroguide for             0.60        0.14        0.15        0.14        0.15        0.03         XXX
                                                 spine inject.
77011...........  .............  A............  Ct scan for                 1.21       20.26       14.45          NA          NA        0.47         XXX
                                                 localization.
77011...........  TC...........  A............  Ct scan for                 0.00       19.86       14.05          NA          NA        0.42         XXX
                                                 localization.
77011...........  26...........  A............  Ct scan for                 1.21        0.40        0.40        0.40        0.40        0.05         XXX
                                                 localization.
77012...........  .............  A............  Ct scan for needle          1.16        2.33        5.47          NA          NA        0.47         XXX
                                                 biopsy.
77012...........  TC...........  A............  Ct scan for needle          0.00        1.92        5.08          NA          NA        0.42         XXX
                                                 biopsy.
77012...........  26...........  A............  Ct scan for needle          1.16        0.41        0.39        0.41        0.39        0.05         XXX
                                                 biopsy.
77013...........  .............  C............  Ct guide for tissue         0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 ablation.
77013...........  TC...........  C............  Ct guide for tissue         0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 ablation.
77013...........  26...........  A............  Ct guide for tissue         3.99        1.43        1.36        1.43        1.36        0.18         XXX
                                                 ablation.
77014...........  .............  A............  Ct scan for therapy         0.85        4.47        3.85          NA          NA        0.20         XXX
                                                 guide.
77014...........  TC...........  A............  Ct scan for therapy         0.00        4.19        3.57          NA          NA        0.16         XXX
                                                 guide.
77014...........  26...........  A............  Ct scan for therapy         0.85        0.28        0.28        0.28        0.28        0.04         XXX
                                                 guide.
77021...........  .............  A............  Mr guidance for             1.50        9.70       10.70          NA          NA        0.64         XXX
                                                 needle place.
77021...........  TC...........  A............  Mr guidance for             0.00        9.18       10.19          NA          NA        0.55         XXX
                                                 needle place.
77021...........  26...........  A............  Mr guidance for             1.50        0.52        0.51        0.52        0.51        0.09         XXX
                                                 needle place.
77022...........  .............  C............  Mri for tissue              0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 ablation.
77022...........  TC...........  C............  Mri for tissue              0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 ablation.
77022...........  26...........  A............  Mri for tissue              4.24        1.52        1.45        1.52        1.45        0.24         XXX
                                                 ablation.
77031...........  .............  A............  Stereotact guide for        1.59        1.87        4.77          NA          NA        0.46         XXX
                                                 brst bx.
77031...........  TC...........  A............  Stereotact guide for        0.00        1.34        4.25          NA          NA        0.37         XXX
                                                 brst bx.
77031...........  26...........  A............  Stereotact guide for        1.59        0.53        0.52        0.53        0.52        0.09         XXX
                                                 brst bx.
77032...........  .............  A............  Guidance for needle,        0.56        0.84        1.16          NA          NA        0.09         XXX
                                                 breast.
77032...........  TC...........  A............  Guidance for needle,        0.00        0.64        0.97          NA          NA        0.07         XXX
                                                 breast.
77032...........  26...........  A............  Guidance for needle,        0.56        0.20        0.19        0.20        0.19        0.02         XXX
                                                 breast.
77051...........  .............  A............  Computer dx                 0.06        0.20        0.32          NA          NA        0.02         ZZZ
                                                 mammogram add-on.
77051...........  TC...........  A............  Computer dx                 0.00        0.18        0.30          NA          NA        0.01         ZZZ
                                                 mammogram add-on.
77051...........  26...........  A............  Computer dx                 0.06        0.02        0.02        0.02        0.02        0.01         ZZZ
                                                 mammogram add-on.
77052...........  .............  A............  Comp screen                 0.06        0.20        0.32          NA          NA        0.02         ZZZ
                                                 mammogram add-on.
77052...........  TC...........  A............  Comp screen                 0.00        0.18        0.30          NA          NA        0.01         ZZZ
                                                 mammogram add-on.
77052...........  26...........  A............  Comp screen                 0.06        0.02        0.02        0.02        0.02        0.01         ZZZ
                                                 mammogram add-on.
77053...........  .............  A............  X-ray of mammary            0.36        1.24        1.98          NA          NA        0.16         XXX
                                                 duct.
77053...........  TC...........  A............  X-ray of mammary            0.00        1.11        1.86          NA          NA        0.14         XXX
                                                 duct.
77053...........  26...........  A............  X-ray of mammary            0.36        0.13        0.12        0.13        0.12        0.02         XXX
                                                 duct.
77054...........  .............  A............  X-ray of mammary            0.45        1.68        2.74          NA          NA        0.21         XXX
                                                 ducts.
77054...........  TC...........  A............  X-ray of mammary            0.00        1.52        2.59          NA          NA        0.19         XXX
                                                 ducts.
77054...........  26...........  A............  X-ray of mammary            0.45        0.16        0.15        0.16        0.15        0.02         XXX
                                                 ducts.
77055...........  .............  A............  Mammogram, one              0.70        1.65        1.46          NA          NA        0.09         XXX
                                                 breast.
77055...........  TC...........  A............  Mammogram, one              0.00        1.40        1.22          NA          NA        0.06         XXX
                                                 breast.
77055...........  26...........  A............  Mammogram, one              0.70        0.25        0.24        0.25        0.24        0.03         XXX
                                                 breast.
77056...........  .............  A............  Mammogram, both             0.87        2.15        1.86          NA          NA        0.11         XXX
                                                 breasts.
77056...........  TC...........  A............  Mammogram, both             0.00        1.84        1.57          NA          NA        0.07         XXX
                                                 breasts.
77056...........  26...........  A............  Mammogram, both             0.87        0.31        0.29        0.31        0.29        0.04         XXX
                                                 breasts.
77057...........  .............  A............  Mammogram, screening        0.70        1.44        1.45          NA          NA        0.10         XXX
77057...........  TC...........  A............  Mammogram, screening        0.00        1.20        1.21          NA          NA        0.07         XXX
77057...........  26...........  A............  Mammogram, screening        0.70        0.24        0.24        0.24        0.24        0.03         XXX
77058...........  .............  A............  Mri, one breast.....        1.63       21.62       19.89          NA          NA        0.99         XXX
77058...........  TC...........  A............  Mri, one breast.....        0.00       21.06       19.34          NA          NA        0.92         XXX
77058...........  26...........  A............  Mri, one breast.....        1.63        0.56        0.55        0.56        0.55        0.07         XXX
77059...........  .............  A............  Mri, both breasts...        1.63       21.56       22.99          NA          NA        1.31         XXX
77059...........  TC...........  A............  Mri, both breasts...        0.00       20.99       22.44          NA          NA        1.24         XXX
77059...........  26...........  A............  Mri, both breasts...        1.63        0.57        0.55        0.57        0.55        0.07         XXX
77071...........  .............  A............  X-ray stress view...        0.41        0.77        0.47        0.77        0.47        0.06         XXX
77072...........  .............  A............  X-rays for bone age.        0.19        0.42        0.42          NA          NA        0.03         XXX
77072...........  TC...........  A............  X-rays for bone age.        0.00        0.36        0.36          NA          NA        0.02         XXX
77072...........  26...........  A............  X-rays for bone age.        0.19        0.06        0.06        0.06        0.06        0.01         XXX
77073...........  .............  A............  X-rays, bone length         0.27        0.67        0.77          NA          NA        0.06         XXX
                                                 studies.
77073...........  TC...........  A............  X-rays, bone length         0.00        0.57        0.67          NA          NA        0.05         XXX
                                                 studies.
77073...........  26...........  A............  X-rays, bone length         0.27        0.10        0.10        0.10        0.10        0.01         XXX
                                                 studies.
77074...........  .............  A............  X-rays, bone survey,        0.45        1.44        1.30          NA          NA        0.08         XXX
                                                 limited.
77074...........  TC...........  A............  X-rays, bone survey,        0.00        1.28        1.14          NA          NA        0.06         XXX
                                                 limited.
77074...........  26...........  A............  X-rays, bone survey,        0.45        0.16        0.16        0.16        0.16        0.02         XXX
                                                 limited.
77075...........  .............  A............  X-rays, bone survey         0.54        2.29        1.96          NA          NA        0.10         XXX
                                                 complete.
77075...........  TC...........  A............  X-rays, bone survey         0.00        2.10        1.77          NA          NA        0.08         XXX
                                                 complete.
77075...........  26...........  A............  X-rays, bone survey         0.54        0.19        0.19        0.19        0.19        0.02         XXX
                                                 complete.
77076...........  .............  A............  X-rays, bone survey,        0.70        2.13        1.54          NA          NA        0.08         XXX
                                                 infant.
77076...........  TC...........  A............  X-rays, bone survey,        0.00        1.90        1.31          NA          NA        0.05         XXX
                                                 infant.
77076...........  26...........  A............  X-rays, bone survey,        0.70        0.23        0.23        0.23        0.23        0.03         XXX
                                                 infant.
77077...........  .............  A............  Joint survey, single        0.31        0.66        0.93          NA          NA        0.08         XXX
                                                 view.
77077...........  TC...........  A............  Joint survey, single        0.00        0.55        0.83          NA          NA        0.06         XXX
                                                 view.
77077...........  26...........  A............  Joint survey, single        0.31        0.11        0.10        0.11        0.10        0.02         XXX
                                                 view.

[[Page 66508]]

 
77078...........  .............  A............  Ct bone density,            0.25        4.74        3.88          NA          NA        0.17         XXX
                                                 axial.
77078...........  TC...........  A............  Ct bone density,            0.00        4.65        3.80          NA          NA        0.16         XXX
                                                 axial.
77078...........  26...........  A............  Ct bone density,            0.25        0.09        0.08        0.09        0.08        0.01         XXX
                                                 axial.
77079...........  .............  A............  Ct bone density,            0.22        0.83        1.92          NA          NA        0.06         XXX
                                                 peripheral.
77079...........  TC...........  A............  Ct bone density,            0.00        0.75        1.85          NA          NA        0.05         XXX
                                                 peripheral.
77079...........  26...........  A............  Ct bone density,            0.22        0.08        0.07        0.08        0.07        0.01         XXX
                                                 peripheral.
77080...........  .............  A............  Dxa bone density,           0.20        1.10        2.15          NA          NA        0.18         XXX
                                                 axial.
77080...........  TC...........  A............  Dxa bone density,           0.00        1.04        2.07          NA          NA        0.17         XXX
                                                 axial.
77080...........  26...........  A............  Dxa bone density,           0.20        0.06        0.08        0.06        0.08        0.01         XXX
                                                 axial.
77081...........  .............  A............  Dxa bone density/           0.22        0.47        0.65          NA          NA        0.06         XXX
                                                 peripheral.
77081...........  TC...........  A............  Dxa bone density/           0.00        0.41        0.58          NA          NA        0.05         XXX
                                                 peripheral.
77081...........  26...........  A............  Dxa bone density/           0.22        0.06        0.07        0.06        0.07        0.01         XXX
                                                 peripheral.
77082...........  .............  A............  Dxa bone density,           0.17        0.53        0.66          NA          NA        0.06         XXX
                                                 vert fx.
77082...........  TC...........  A............  Dxa bone density,           0.00        0.48        0.61          NA          NA        0.05         XXX
                                                 vert fx.
77082...........  26...........  A............  Dxa bone density,           0.17        0.05        0.05        0.05        0.05        0.01         XXX
                                                 vert fx.
77083...........  .............  A............  Radiographic                0.20        0.37        0.59          NA          NA        0.06         XXX
                                                 absorptiometry.
77083...........  TC...........  A............  Radiographic                0.00        0.32        0.53          NA          NA        0.05         XXX
                                                 absorptiometry.
77083...........  26...........  A............  Radiographic                0.20        0.05        0.06        0.05        0.06        0.01         XXX
                                                 absorptiometry.
77084...........  .............  A............  Magnetic image, bone        1.60       13.55       12.63          NA          NA        0.66         XXX
                                                 marrow.
77084...........  TC...........  A............  Magnetic image, bone        0.00       13.03       12.11          NA          NA        0.59         XXX
                                                 marrow.
77084...........  26...........  A............  Magnetic image, bone        1.60        0.52        0.52        0.52        0.52        0.07         XXX
                                                 marrow.
77261...........  .............  A............  Radiation therapy           1.39        0.48        0.49        0.48        0.49        0.07         XXX
                                                 planning.
77262...........  .............  A............  Radiation therapy           2.11        0.69        0.72        0.69        0.72        0.11         XXX
                                                 planning.
77263...........  .............  A............  Radiation therapy           3.14        1.03        1.07        1.03        1.07        0.16         XXX
                                                 planning.
77280...........  .............  A............  Set radiation               0.70        4.43        4.05          NA          NA        0.22         XXX
                                                 therapy field.
77280...........  TC...........  A............  Set radiation               0.00        4.20        3.83          NA          NA        0.18         XXX
                                                 therapy field.
77280...........  26...........  A............  Set radiation               0.70        0.23        0.22        0.23        0.22        0.04         XXX
                                                 therapy field.
77285...........  .............  A............  Set radiation               1.05        8.01        6.96          NA          NA        0.35         XXX
                                                 therapy field.
77285...........  TC...........  A............  Set radiation               0.00        7.67        6.62          NA          NA        0.30         XXX
                                                 therapy field.
77285...........  26...........  A............  Set radiation               1.05        0.34        0.34        0.34        0.34        0.05         XXX
                                                 therapy field.
77290...........  .............  A............  Set radiation               1.56       13.41       10.21          NA          NA        0.43         XXX
                                                 therapy field.
77290...........  TC...........  A............  Set radiation               0.00       12.90        9.71          NA          NA        0.35         XXX
                                                 therapy field.
77290...........  26...........  A............  Set radiation               1.56        0.51        0.50        0.51        0.50        0.08         XXX
                                                 therapy field.
77295...........  .............  A............  Set radiation               4.56        7.45       18.41          NA          NA        1.71         XXX
                                                 therapy field.
77295...........  TC...........  A............  Set radiation               0.00        5.95       16.93          NA          NA        1.48         XXX
                                                 therapy field.
77295...........  26...........  A............  Set radiation               4.56        1.50        1.48        1.50        1.48        0.23         XXX
                                                 therapy field.
77299...........  .............  C............  Radiation therapy           0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 planning.
77299...........  TC...........  C............  Radiation therapy           0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 planning.
77299...........  26...........  C............  Radiation therapy           0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 planning.
77300...........  .............  A............  Radiation therapy           0.62        1.18        1.36          NA          NA        0.10         XXX
                                                 dose plan.
77300...........  TC...........  A............  Radiation therapy           0.00        0.98        1.16          NA          NA        0.07         XXX
                                                 dose plan.
77300...........  26...........  A............  Radiation therapy           0.62        0.20        0.20        0.20        0.20        0.03         XXX
                                                 dose plan.
77301...........  .............  A............  Radiotherapy dose           7.99       57.41       43.94          NA          NA        1.88         XXX
                                                 plan, imrt.
77301...........  TC...........  A............  Radiotherapy dose           0.00       54.79       41.35          NA          NA        1.48         XXX
                                                 plan, imrt.
77301...........  26...........  A............  Radiotherapy dose           7.99        2.62        2.59        2.62        2.59        0.40         XXX
                                                 plan, imrt.
77305...........  .............  A............  Teletx isodose plan         0.70        0.90        1.50          NA          NA        0.15         XXX
                                                 simple.
77305...........  TC...........  A............  Teletx isodose plan         0.00        0.67        1.27          NA          NA        0.11         XXX
                                                 simple.
77305...........  26...........  A............  Teletx isodose plan         0.70        0.23        0.23        0.23        0.23        0.04         XXX
                                                 simple.
77310...........  .............  A............  Teletx isodose plan         1.05        1.24        1.96          NA          NA        0.18         XXX
                                                 intermed.
77310...........  TC...........  A............  Teletx isodose plan         0.00        0.90        1.62          NA          NA        0.13         XXX
                                                 intermed.
77310...........  26...........  A............  Teletx isodose plan         1.05        0.34        0.34        0.34        0.34        0.05         XXX
                                                 intermed.
77315...........  .............  A............  Teletx isodose plan         1.56        2.08        2.62          NA          NA        0.22         XXX
                                                 complex.
77315...........  TC...........  A............  Teletx isodose plan         0.00        1.57        2.12          NA          NA        0.14         XXX
                                                 complex.
77315...........  26...........  A............  Teletx isodose plan         1.56        0.51        0.50        0.51        0.50        0.08         XXX
                                                 complex.
77321...........  .............  A............  Special teletx port         0.95        1.51        2.93          NA          NA        0.26         XXX
                                                 plan.
77321...........  TC...........  A............  Special teletx port         0.00        1.20        2.62          NA          NA        0.21         XXX
                                                 plan.
77321...........  26...........  A............  Special teletx port         0.95        0.31        0.31        0.31        0.31        0.05         XXX
                                                 plan.
77326...........  .............  A............  Brachytx isodose            0.93        2.98        2.82          NA          NA        0.18         XXX
                                                 calc simp.
77326...........  TC...........  A............  Brachytx isodose            0.00        2.68        2.52          NA          NA        0.13         XXX
                                                 calc simp.
77326...........  26...........  A............  Brachytx isodose            0.93        0.30        0.30        0.30        0.30        0.05         XXX
                                                 calc simp.
77327...........  .............  A............  Brachytx isodose            1.39        4.09        4.00          NA          NA        0.25         XXX
                                                 calc interm.
77327...........  TC...........  A............  Brachytx isodose            0.00        3.64        3.55          NA          NA        0.18         XXX
                                                 calc interm.
77327...........  26...........  A............  Brachytx isodose            1.39        0.45        0.45        0.45        0.45        0.07         XXX
                                                 calc interm.
77328...........  .............  A............  Brachytx isodose            2.09        5.25        5.44          NA          NA        0.36         XXX
                                                 plan compl.
77328...........  TC...........  A............  Brachytx isodose            0.00        4.56        4.76          NA          NA        0.25         XXX
                                                 plan compl.
77328...........  26...........  A............  Brachytx isodose            2.09        0.69        0.68        0.69        0.68        0.11         XXX
                                                 plan compl.
77331...........  .............  A............  Special radiation           0.87        0.81        0.79          NA          NA        0.06         XXX
                                                 dosimetry.
77331...........  TC...........  A............  Special radiation           0.00        0.52        0.51          NA          NA        0.02         XXX
                                                 dosimetry.
77331...........  26...........  A............  Special radiation           0.87        0.29        0.28        0.29        0.28        0.04         XXX
                                                 dosimetry.
77332...........  .............  A............  Radiation treatment         0.54        1.55        1.52          NA          NA        0.10         XXX
                                                 aid(s).
77332...........  TC...........  A............  Radiation treatment         0.00        1.37        1.35          NA          NA        0.07         XXX
                                                 aid(s).
77332...........  26...........  A............  Radiation treatment         0.54        0.18        0.17        0.18        0.17        0.03         XXX
                                                 aid(s).

[[Page 66509]]

 
77333...........  .............  A............  Radiation treatment         0.84        0.52        1.34          NA          NA        0.15         XXX
                                                 aid(s).
77333...........  TC...........  A............  Radiation treatment         0.00        0.24        1.07          NA          NA        0.11         XXX
                                                 aid(s).
77333...........  26...........  A............  Radiation treatment         0.84        0.28        0.27        0.28        0.27        0.04         XXX
                                                 aid(s).
77334...........  .............  A............  Radiation treatment         1.24        2.71        3.18          NA          NA        0.23         XXX
                                                 aid(s).
77334...........  TC...........  A............  Radiation treatment         0.00        2.31        2.78          NA          NA        0.17         XXX
                                                 aid(s).
77334...........  26...........  A............  Radiation treatment         1.24        0.40        0.40        0.40        0.40        0.06         XXX
                                                 aid(s).
77336...........  .............  A............  Radiation physics           0.00        1.14        2.06          NA          NA        0.16         XXX
                                                 consult.
77370...........  .............  A............  Radiation physics           0.00        3.04        3.27          NA          NA        0.18         XXX
                                                 consult.
77371...........  .............  A............  Srs, multisource....        0.00       30.07       30.07          NA          NA        0.13         XXX
77372...........  .............  A............  Srs, linear based...        0.00       22.80       22.80          NA          NA        0.13         XXX
77373...........  .............  A............  Sbrt delivery.......        0.00       42.62       42.62          NA          NA        0.13         XXX
77399...........  .............  C............  External radiation          0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 dosimetry.
77399...........  TC...........  C............  External radiation          0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 dosimetry.
77399...........  26...........  C............  External radiation          0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 dosimetry.
77401...........  .............  A............  Radiation treatment         0.00        0.47        1.12          NA          NA        0.11         XXX
                                                 delivery.
77402...........  .............  A............  Radiation treatment         0.00        4.34        3.06          NA          NA        0.11         XXX
                                                 delivery.
77403...........  .............  A............  Radiation treatment         0.00        3.75        2.76          NA          NA        0.11         XXX
                                                 delivery.
77404...........  .............  A............  Radiation treatment         0.00        4.20        2.99          NA          NA        0.11         XXX
                                                 delivery.
77406...........  .............  A............  Radiation treatment         0.00        4.23        3.00          NA          NA        0.11         XXX
                                                 delivery.
77407...........  .............  A............  Radiation treatment         0.00        5.78        3.93          NA          NA        0.12         XXX
                                                 delivery.
77408...........  .............  A............  Radiation treatment         0.00        5.19        3.64          NA          NA        0.12         XXX
                                                 delivery.
77409...........  .............  A............  Radiation treatment         0.00        5.76        3.93          NA          NA        0.12         XXX
                                                 delivery.
77411...........  .............  A............  Radiation treatment         0.00        5.73        3.91          NA          NA        0.12         XXX
                                                 delivery.
77412...........  .............  A............  Radiation treatment         0.00        6.78        4.56          NA          NA        0.13         XXX
                                                 delivery.
77413...........  .............  A............  Radiation treatment         0.00        6.85        4.59          NA          NA        0.13         XXX
                                                 delivery.
77414...........  .............  A............  Radiation treatment         0.00        7.71        5.02          NA          NA        0.13         XXX
                                                 delivery.
77416...........  .............  A............  Radiation treatment         0.00        7.72        5.02          NA          NA        0.13         XXX
                                                 delivery.
77417...........  .............  A............  Radiology port              0.00        0.36        0.48          NA          NA        0.04         XXX
                                                 film(s).
77418...........  .............  A............  Radiation tx                0.00       13.15       15.58          NA          NA        0.13         XXX
                                                 delivery, imrt.
77421...........  .............  A............  Stereoscopic x-ray          0.39        2.38        2.93          NA          NA        0.12         XXX
                                                 guidance.
77421...........  TC...........  A............  Stereoscopic x-ray          0.00        2.25        2.80          NA          NA        0.10         XXX
                                                 guidance.
77421...........  26...........  A............  Stereoscopic x-ray          0.39        0.13        0.13        0.13        0.13        0.02         XXX
                                                 guidance.
77422...........  .............  A............  Neutron beam tx,            0.00        5.35        3.53          NA          NA        0.13         XXX
                                                 simple.
77423...........  .............  A............  Neutron beam tx,            0.00        7.46        4.86          NA          NA        0.13         XXX
                                                 complex.
77427...........  .............  A............  Radiation tx                3.70        1.39        1.22        1.39        1.22        0.17         XXX
                                                 management, x5.
77431...........  .............  A............  Radiation therapy           1.81        0.77        0.73        0.77        0.73        0.09         XXX
                                                 management.
77432...........  .............  A............  Stereotactic                7.92        2.59        2.75        2.59        2.75        0.41         XXX
                                                 radiation trmt.
77435...........  .............  A............  Sbrt management.....       13.00        4.75        4.75          NA          NA        0.67         XXX
77470...........  .............  A............  Special radiation           2.09        1.92        6.87          NA          NA        0.70         XXX
                                                 treatment.
77470...........  TC...........  A............  Special radiation           0.00        1.24        6.19          NA          NA        0.59         XXX
                                                 treatment.
77470...........  26...........  A............  Special radiation           2.09        0.68        0.68        0.68        0.68        0.11         XXX
                                                 treatment.
77499...........  .............  C............  Radiation therapy           0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 management.
77499...........  TC...........  C............  Radiation therapy           0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 management.
77499...........  26...........  C............  Radiation therapy           0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 management.
77520...........  .............  C............  Proton trmt, simple         0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 w/o comp.
77522...........  .............  C............  Proton trmt, simple         0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 w/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...........  .............  R............  Hyperthermia                1.56       10.23        6.89          NA          NA        0.24         XXX
                                                 treatment.
77600...........  TC...........  R............  Hyperthermia                0.00        9.73        6.39          NA          NA        0.16         XXX
                                                 treatment.
77600...........  26...........  R............  Hyperthermia                1.56        0.50        0.50        0.50        0.50        0.08         XXX
                                                 treatment.
77605...........  .............  R............  Hyperthermia                2.09       18.46       11.58          NA          NA        0.38         XXX
                                                 treatment.
77605...........  TC...........  R............  Hyperthermia                0.00       17.91       10.98          NA          NA        0.22         XXX
                                                 treatment.
77605...........  26...........  R............  Hyperthermia                2.09        0.55        0.60        0.55        0.60        0.16         XXX
                                                 treatment.
77610...........  .............  R............  Hyperthermia                1.56       17.92       10.74          NA          NA        0.24         XXX
                                                 treatment.
77610...........  TC...........  R............  Hyperthermia                0.00       17.56       10.31          NA          NA        0.16         XXX
                                                 treatment.
77610...........  26...........  R............  Hyperthermia                1.56        0.36        0.43        0.36        0.43        0.08         XXX
                                                 treatment.
77615...........  .............  R............  Hyperthermia                2.09       25.90       15.31          NA          NA        0.33         XXX
                                                 treatment.
77615...........  TC...........  R............  Hyperthermia                0.00       25.26       14.66          NA          NA        0.22         XXX
                                                 treatment.
77615...........  26...........  R............  Hyperthermia                2.09        0.64        0.65        0.64        0.65        0.11         XXX
                                                 treatment.
77620...........  .............  R............  Hyperthermia                1.56       10.49        7.03          NA          NA        0.36         XXX
                                                 treatment.
77620...........  TC...........  R............  Hyperthermia                0.00       10.09        6.57          NA          NA        0.16         XXX
                                                 treatment.
77620...........  26...........  R............  Hyperthermia                1.56        0.40        0.46        0.40        0.46        0.20         XXX
                                                 treatment.
77750...........  .............  A............  Infuse radioactive          4.94        4.55        3.73          NA          NA        0.32         090
                                                 materials.
77750...........  TC...........  A............  Infuse radioactive          0.00        2.93        2.13          NA          NA        0.07         090
                                                 materials.
77750...........  26...........  A............  Infuse radioactive          4.94        1.62        1.60        1.62        1.60        0.25         090
                                                 materials.
77761...........  .............  A............  Apply intrcav radiat        3.82        6.34        4.96          NA          NA        0.33         090
                                                 simple.
77761...........  TC...........  A............  Apply intrcav radiat        0.00        5.10        3.80          NA          NA        0.14         090
                                                 simple.
77761...........  26...........  A............  Apply intrcav radiat        3.82        1.24        1.16        1.24        1.16        0.19         090
                                                 simple.
77762...........  .............  A............  Apply intrcav radiat        5.73        7.62        6.53          NA          NA        0.48         090
                                                 interm.
77762...........  TC...........  A............  Apply intrcav radiat        0.00        5.75        4.68          NA          NA        0.19         090
                                                 interm.
77762...........  26...........  A............  Apply intrcav radiat        5.73        1.87        1.85        1.87        1.85        0.29         090
                                                 interm.

[[Page 66510]]

 
77763...........  .............  A............  Apply intrcav radiat        8.60       10.33        8.78          NA          NA        0.66         090
                                                 compl.
77763...........  TC...........  A............  Apply intrcav radiat        0.00        7.52        6.00          NA          NA        0.23         090
                                                 compl.
77763...........  26...........  A............  Apply intrcav radiat        8.60        2.81        2.78        2.81        2.78        0.43         090
                                                 compl.
77776...........  .............  A............  Apply interstit             4.67        7.46        5.29          NA          NA        0.57         090
                                                 radiat simpl.
77776...........  TC...........  A............  Apply interstit             0.00        5.79        3.98          NA          NA        0.13         090
                                                 radiat simpl.
77776...........  26...........  A............  Apply interstit             4.67        1.67        1.31        1.67        1.31        0.44         090
                                                 radiat simpl.
77777...........  .............  A............  Apply interstit             7.49        7.92        7.26          NA          NA        0.61         090
                                                 radiat inter.
77777...........  TC...........  A............  Apply interstit             0.00        5.47        4.85          NA          NA        0.22         090
                                                 radiat inter.
77777...........  26...........  A............  Apply interstit             7.49        2.45        2.41        2.45        2.41        0.39         090
                                                 radiat inter.
77778...........  .............  A............  Apply interstit            11.23       11.31       10.00          NA          NA        0.84         090
                                                 radiat compl.
77778...........  TC...........  A............  Apply interstit             0.00        7.62        6.37          NA          NA        0.27         090
                                                 radiat compl.
77778...........  26...........  A............  Apply interstit            11.23        3.69        3.63        3.69        3.63        0.57         090
                                                 radiat compl.
77781...........  .............  A............  High intensity              1.21        4.41       12.61          NA          NA        1.14         XXX
                                                 brachytherapy.
77781...........  TC...........  A............  High intensity              0.00        4.01       12.15          NA          NA        1.06         XXX
                                                 brachytherapy.
77781...........  26...........  A............  High intensity              1.21        0.40        0.46        0.40        0.46        0.08         XXX
                                                 brachytherapy.
77782...........  .............  A............  High intensity              2.04       12.41       16.74          NA          NA        1.19         XXX
                                                 brachytherapy.
77782...........  TC...........  A............  High intensity              0.00       11.74       16.01          NA          NA        1.06         XXX
                                                 brachytherapy.
77782...........  26...........  A............  High intensity              2.04        0.67        0.73        0.67        0.73        0.13         XXX
                                                 brachytherapy.
77783...........  .............  A............  High intensity              3.27       24.19       22.83          NA          NA        1.25         XXX
                                                 brachytherapy.
77783...........  TC...........  A............  High intensity              0.00       23.12       21.70          NA          NA        1.06         XXX
                                                 brachytherapy.
77783...........  26...........  A............  High intensity              3.27        1.07        1.13        1.07        1.13        0.19         XXX
                                                 brachytherapy.
77784...........  .............  A............  High intensity              5.15       45.65       33.87          NA          NA        1.35         XXX
                                                 brachytherapy.
77784...........  TC...........  A............  High intensity              0.00       43.97       32.13          NA          NA        1.06         XXX
                                                 brachytherapy.
77784...........  26...........  A............  High intensity              5.15        1.68        1.74        1.68        1.74        0.29         XXX
                                                 brachytherapy.
77789...........  .............  A............  Apply surface               1.14        2.02        1.42          NA          NA        0.08         000
                                                 radiation.
77789...........  TC...........  A............  Apply surface               0.00        1.64        1.04          NA          NA        0.02         000
                                                 radiation.
77789...........  26...........  A............  Apply surface               1.14        0.38        0.38        0.38        0.38        0.06         000
                                                 radiation.
77790...........  .............  A............  Radiation handling..        1.05        1.46        1.15          NA          NA        0.07         XXX
77790...........  TC...........  A............  Radiation handling..        0.00        1.12        0.81          NA          NA        0.02         XXX
77790...........  26...........  A............  Radiation handling..        1.05        0.34        0.34        0.34        0.34        0.05         XXX
77799...........  .............  C............  Radium/radioisotope         0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 therapy.
77799...........  TC...........  C............  Radium/radioisotope         0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 therapy.
77799...........  26...........  C............  Radium/radioisotope         0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 therapy.
78000...........  .............  A............  Thyroid, single             0.19        1.85        1.44          NA          NA        0.07         XXX
                                                 uptake.
78000...........  TC...........  A............  Thyroid, single             0.00        1.79        1.38          NA          NA        0.06         XXX
                                                 uptake.
78000...........  26...........  A............  Thyroid, single             0.19        0.06        0.06        0.06        0.06        0.01         XXX
                                                 uptake.
78001...........  .............  A............  Thyroid, multiple           0.26        2.30        1.85          NA          NA        0.08         XXX
                                                 uptakes.
78001...........  TC...........  A............  Thyroid, multiple           0.00        2.21        1.76          NA          NA        0.07         XXX
                                                 uptakes.
78001...........  26...........  A............  Thyroid, multiple           0.26        0.09        0.09        0.09        0.09        0.01         XXX
                                                 uptakes.
78003...........  .............  A............  Thyroid suppress/           0.33        1.94        1.50          NA          NA        0.07         XXX
                                                 stimul.
78003...........  TC...........  A............  Thyroid suppress/           0.00        1.82        1.39          NA          NA        0.06         XXX
                                                 stimul.
78003...........  26...........  A............  Thyroid suppress/           0.33        0.12        0.11        0.12        0.11        0.01         XXX
                                                 stimul.
78006...........  .............  A............  Thyroid imaging with        0.49        6.22        4.38          NA          NA        0.15         XXX
                                                 uptake.
78006...........  TC...........  A............  Thyroid imaging with        0.00        6.05        4.22          NA          NA        0.13         XXX
                                                 uptake.
78006...........  26...........  A............  Thyroid imaging with        0.49        0.17        0.16        0.17        0.16        0.02         XXX
                                                 uptake.
78007...........  .............  A............  Thyroid image, mult         0.50        3.05        2.90          NA          NA        0.16         XXX
                                                 uptakes.
78007...........  TC...........  A............  Thyroid image, mult         0.00        2.88        2.73          NA          NA        0.14         XXX
                                                 uptakes.
78007...........  26...........  A............  Thyroid image, mult         0.50        0.17        0.17        0.17        0.17        0.02         XXX
                                                 uptakes.
78010...........  .............  A............  Thyroid imaging.....        0.39        4.18        3.07          NA          NA        0.13         XXX
78010...........  TC...........  A............  Thyroid imaging.....        0.00        4.05        2.94          NA          NA        0.11         XXX
78010...........  26...........  A............  Thyroid imaging.....        0.39        0.13        0.13        0.13        0.13        0.02         XXX
78011...........  .............  A............  Thyroid imaging with        0.45        4.54        3.55          NA          NA        0.15         XXX
                                                 flow.
78011...........  TC...........  A............  Thyroid imaging with        0.00        4.38        3.40          NA          NA        0.13         XXX
                                                 flow.
78011...........  26...........  A............  Thyroid imaging with        0.45        0.16        0.15        0.16        0.15        0.02         XXX
                                                 flow.
78015...........  .............  A............  Thyroid met imaging.        0.67        5.34        4.07          NA          NA        0.17         XXX
78015...........  TC...........  A............  Thyroid met imaging.        0.00        5.12        3.84          NA          NA        0.14         XXX
78015...........  26...........  A............  Thyroid met imaging.        0.67        0.22        0.23        0.22        0.23        0.03         XXX
78016...........  .............  A............  Thyroid met imaging/        0.82        8.52        6.14          NA          NA        0.21         XXX
                                                 studies.
78016...........  TC...........  A............  Thyroid met imaging/        0.00        8.25        5.86          NA          NA        0.18         XXX
                                                 studies.
78016...........  26...........  A............  Thyroid met imaging/        0.82        0.27        0.28        0.27        0.28        0.03         XXX
                                                 studies.
78018...........  .............  A............  Thyroid met imaging,        0.86        7.93        6.82          NA          NA        0.33         XXX
                                                 body.
78018...........  TC...........  A............  Thyroid met imaging,        0.00        7.63        6.52          NA          NA        0.29         XXX
                                                 body.
78018...........  26...........  A............  Thyroid met imaging,        0.86        0.30        0.30        0.30        0.30        0.04         XXX
                                                 body.
78020...........  .............  A............  Thyroid met uptake..        0.60        1.80        1.66          NA          NA        0.16         ZZZ
78020...........  TC...........  A............  Thyroid met uptake..        0.00        1.60        1.45          NA          NA        0.14         ZZZ
78020...........  26...........  A............  Thyroid met uptake..        0.60        0.20        0.21        0.20        0.21        0.02         ZZZ
78070...........  .............  A............  Parathyroid nuclear         0.82        3.48        4.01          NA          NA        0.15         XXX
                                                 imaging.
78070...........  TC...........  A............  Parathyroid nuclear         0.00        3.20        3.73          NA          NA        0.11         XXX
                                                 imaging.
78070...........  26...........  A............  Parathyroid nuclear         0.82        0.28        0.28        0.28        0.28        0.04         XXX
                                                 imaging.
78075...........  .............  A............  Adrenal nuclear             0.74       11.61        8.64          NA          NA        0.32         XXX
                                                 imaging.
78075...........  TC...........  A............  Adrenal nuclear             0.00       11.36        8.39          NA          NA        0.29         XXX
                                                 imaging.
78075...........  26...........  A............  Adrenal nuclear             0.74        0.25        0.25        0.25        0.25        0.03         XXX
                                                 imaging.

[[Page 66511]]

 
78099...........  .............  C............  Endocrine nuclear           0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 procedure.
78099...........  TC...........  C............  Endocrine nuclear           0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 procedure.
78099...........  26...........  C............  Endocrine nuclear           0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 procedure.
78102...........  .............  A............  Bone marrow imaging,        0.55        4.18        3.20          NA          NA        0.14         XXX
                                                 ltd.
78102...........  TC...........  A............  Bone marrow imaging,        0.00        3.99        3.01          NA          NA        0.12         XXX
                                                 ltd.
78102...........  26...........  A............  Bone marrow imaging,        0.55        0.19        0.19        0.19        0.19        0.02         XXX
                                                 ltd.
78103...........  .............  A............  Bone marrow imaging,        0.75        5.43        4.43          NA          NA        0.20         XXX
                                                 mult.
78103...........  TC...........  A............  Bone marrow imaging,        0.00        5.17        4.17          NA          NA        0.17         XXX
                                                 mult.
78103...........  26...........  A............  Bone marrow imaging,        0.75        0.26        0.26        0.26        0.26        0.03         XXX
                                                 mult.
78104...........  .............  A............  Bone marrow imaging,        0.80        6.23        5.28          NA          NA        0.25         XXX
                                                 body.
78104...........  TC...........  A............  Bone marrow imaging,        0.00        5.94        5.00          NA          NA        0.22         XXX
                                                 body.
78104...........  26...........  A............  Bone marrow imaging,        0.80        0.29        0.28        0.29        0.28        0.03         XXX
                                                 body.
78110...........  .............  A............  Plasma volume,              0.19        2.13        1.57          NA          NA        0.07         XXX
                                                 single.
78110...........  TC...........  A............  Plasma volume,              0.00        2.06        1.50          NA          NA        0.06         XXX
                                                 single.
78110...........  26...........  A............  Plasma volume,              0.19        0.07        0.07        0.07        0.07        0.01         XXX
                                                 single.
78111...........  .............  A............  Plasma volume,              0.22        2.14        2.40          NA          NA        0.15         XXX
                                                 multiple.
78111...........  TC...........  A............  Plasma volume,              0.00        2.07        2.32          NA          NA        0.14         XXX
                                                 multiple.
78111...........  26...........  A............  Plasma volume,              0.22        0.07        0.08        0.07        0.08        0.01         XXX
                                                 multiple.
78120...........  .............  A............  Red cell mass,              0.23        2.10        1.96          NA          NA        0.12         XXX
                                                 single.
78120...........  TC...........  A............  Red cell mass,              0.00        2.02        1.88          NA          NA        0.11         XXX
                                                 single.
78120...........  26...........  A............  Red cell mass,              0.23        0.08        0.08        0.08        0.08        0.01         XXX
                                                 single.
78121...........  .............  A............  Red cell mass,              0.32        2.20        2.61          NA          NA        0.15         XXX
                                                 multiple.
78121...........  TC...........  A............  Red cell mass,              0.00        2.10        2.50          NA          NA        0.14         XXX
                                                 multiple.
78121...........  26...........  A............  Red cell mass,              0.32        0.10        0.11        0.10        0.11        0.01         XXX
                                                 multiple.
78122...........  .............  A............  Blood volume........        0.45        2.25        3.51          NA          NA        0.26         XXX
78122...........  TC...........  A............  Blood volume........        0.00        2.10        3.35          NA          NA        0.24         XXX
78122...........  26...........  A............  Blood volume........        0.45        0.15        0.16        0.15        0.16        0.02         XXX
78130...........  .............  A............  Red cell survival           0.61        3.50        3.28          NA          NA        0.17         XXX
                                                 study.
78130...........  TC...........  A............  Red cell survival           0.00        3.29        3.07          NA          NA        0.14         XXX
                                                 study.
78130...........  26...........  A............  Red cell survival           0.61        0.21        0.21        0.21        0.21        0.03         XXX
                                                 study.
78135...........  .............  A............  Red cell survival           0.64        8.67        6.88          NA          NA        0.28         XXX
                                                 kinetics.
78135...........  TC...........  A............  Red cell survival           0.00        8.45        6.66          NA          NA        0.25         XXX
                                                 kinetics.
78135...........  26...........  A............  Red cell survival           0.64        0.22        0.22        0.22        0.22        0.03         XXX
                                                 kinetics.
78140...........  .............  A............  Red cell                    0.61        2.94        3.53          NA          NA        0.24         XXX
                                                 sequestration.
78140...........  TC...........  A............  Red cell                    0.00        2.72        3.32          NA          NA        0.21         XXX
                                                 sequestration.
78140...........  26...........  A............  Red cell                    0.61        0.22        0.21        0.22        0.21        0.03         XXX
                                                 sequestration.
78185...........  .............  A............  Spleen imaging......        0.40        5.19        3.85          NA          NA        0.15         XXX
78185...........  TC...........  A............  Spleen imaging......        0.00        5.05        3.71          NA          NA        0.13         XXX
78185...........  26...........  A............  Spleen imaging......        0.40        0.14        0.14        0.14        0.14        0.02         XXX
78190...........  .............  A............  Platelet survival,          1.09        8.37        7.24          NA          NA        0.38         XXX
                                                 kinetics.
78190...........  TC...........  A............  Platelet survival,          0.00        8.12        6.92          NA          NA        0.30         XXX
                                                 kinetics.
78190...........  26...........  A............  Platelet survival,          1.09        0.25        0.32        0.25        0.32        0.08         XXX
                                                 kinetics.
78191...........  .............  A............  Platelet survival...        0.61        3.51        5.53          NA          NA        0.40         XXX
78191...........  TC...........  A............  Platelet survival...        0.00        3.30        5.32          NA          NA        0.37         XXX
78191...........  26...........  A............  Platelet survival...        0.61        0.21        0.21        0.21        0.21        0.03         XXX
78195...........  .............  A............  Lymph system imaging        1.20        8.68        6.58          NA          NA        0.28         XXX
78195...........  TC...........  A............  Lymph system imaging        0.00        8.27        6.17          NA          NA        0.22         XXX
78195...........  26...........  A............  Lymph system imaging        1.20        0.41        0.41        0.41        0.41        0.06         XXX
78199...........  .............  C............  Blood/lymph nuclear         0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 exam.
78199...........  TC...........  C............  Blood/lymph nuclear         0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 exam.
78199...........  26...........  C............  Blood/lymph nuclear         0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 exam.
78201...........  .............  A............  Liver imaging.......        0.44        4.59        3.55          NA          NA        0.15         XXX
78201...........  TC...........  A............  Liver imaging.......        0.00        4.46        3.41          NA          NA        0.13         XXX
78201...........  26...........  A............  Liver imaging.......        0.44        0.13        0.14        0.13        0.14        0.02         XXX
78202...........  .............  A............  Liver imaging with          0.51        5.34        4.20          NA          NA        0.16         XXX
                                                 flow.
78202...........  TC...........  A............  Liver imaging with          0.00        5.17        4.03          NA          NA        0.14         XXX
                                                 flow.
78202...........  26...........  A............  Liver imaging with          0.51        0.17        0.17        0.17        0.17        0.02         XXX
                                                 flow.
78205...........  .............  A............  Liver imaging (3D)..        0.71        5.27        5.70          NA          NA        0.34         XXX
78205...........  TC...........  A............  Liver imaging (3D)..        0.00        5.02        5.46          NA          NA        0.31         XXX
78205...........  26...........  A............  Liver imaging (3D)..        0.71        0.25        0.24        0.25        0.24        0.03         XXX
78206...........  .............  A............  Liver image (3d)            0.96        8.60        7.41          NA          NA        0.15         XXX
                                                 with flow.
78206...........  TC...........  A............  Liver image (3d)            0.00        8.26        7.08          NA          NA        0.11         XXX
                                                 with flow.
78206...........  26...........  A............  Liver image (3d)            0.96        0.34        0.33        0.34        0.33        0.04         XXX
                                                 with flow.
78215...........  .............  A............  Liver and spleen            0.49        4.82        3.96          NA          NA        0.16         XXX
                                                 imaging.
78215...........  TC...........  A............  Liver and spleen            0.00        4.65        3.79          NA          NA        0.14         XXX
                                                 imaging.
78215...........  26...........  A............  Liver and spleen            0.49        0.17        0.17        0.17        0.17        0.02         XXX
                                                 imaging.
78216...........  .............  A............  Liver & spleen image/       0.57        2.84        3.26          NA          NA        0.20         XXX
                                                 flow.
78216...........  TC...........  A............  Liver & spleen image/       0.00        2.65        3.07          NA          NA        0.18         XXX
                                                 flow.
78216...........  26...........  A............  Liver & spleen image/       0.57        0.19        0.19        0.19        0.19        0.02         XXX
                                                 flow.
78220...........  .............  A............  Liver function study        0.49        3.08        3.47          NA          NA        0.21         XXX
78220...........  TC...........  A............  Liver function study        0.00        2.91        3.31          NA          NA        0.19         XXX
78220...........  26...........  A............  Liver function study        0.49        0.17        0.16        0.17        0.16        0.02         XXX

[[Page 66512]]

 
78223...........  .............  A............  Hepatobiliary               0.84        8.50        6.22          NA          NA        0.23         XXX
                                                 imaging.
78223...........  TC...........  A............  Hepatobiliary               0.00        8.21        5.93          NA          NA        0.19         XXX
                                                 imaging.
78223...........  26...........  A............  Hepatobiliary               0.84        0.29        0.29        0.29        0.29        0.04         XXX
                                                 imaging.
78230...........  .............  A............  Salivary gland              0.45        4.17        3.25          NA          NA        0.15         XXX
                                                 imaging.
78230...........  TC...........  A............  Salivary gland              0.00        4.01        3.10          NA          NA        0.13         XXX
                                                 imaging.
78230...........  26...........  A............  Salivary gland              0.45        0.16        0.15        0.16        0.15        0.02         XXX
                                                 imaging.
78231...........  .............  A............  Serial salivary             0.52        2.80        3.07          NA          NA        0.19         XXX
                                                 imaging.
78231...........  TC...........  A............  Serial salivary             0.00        2.63        2.90          NA          NA        0.17         XXX
                                                 imaging.
78231...........  26...........  A............  Serial salivary             0.52        0.17        0.17        0.17        0.17        0.02         XXX
                                                 imaging.
78232...........  .............  A............  Salivary gland              0.47        2.77        3.24          NA          NA        0.20         XXX
                                                 function exam.
78232...........  TC...........  A............  Salivary gland              0.00        2.62        3.08          NA          NA        0.18         XXX
                                                 function exam.
78232...........  26...........  A............  Salivary gland              0.47        0.15        0.16        0.15        0.16        0.02         XXX
                                                 function exam.
78258...........  .............  A............  Esophageal motility         0.74        5.52        4.32          NA          NA        0.17         XXX
                                                 study.
78258...........  TC...........  A............  Esophageal motility         0.00        5.25        4.06          NA          NA        0.14         XXX
                                                 study.
78258...........  26...........  A............  Esophageal motility         0.74        0.27        0.26        0.27        0.26        0.03         XXX
                                                 study.
78261...........  .............  A............  Gastric mucosa              0.69        6.00        5.17          NA          NA        0.25         XXX
                                                 imaging.
78261...........  TC...........  A............  Gastric mucosa              0.00        5.76        4.93          NA          NA        0.22         XXX
                                                 imaging.
78261...........  26...........  A............  Gastric mucosa              0.69        0.24        0.24        0.24        0.24        0.03         XXX
                                                 imaging.
78262...........  .............  A............  Gastroesophageal            0.68        5.95        5.21          NA          NA        0.25         XXX
                                                 reflux exam.
78262...........  TC...........  A............  Gastroesophageal            0.00        5.73        4.99          NA          NA        0.22         XXX
                                                 reflux exam.
78262...........  26...........  A............  Gastroesophageal            0.68        0.22        0.22        0.22        0.22        0.03         XXX
                                                 reflux exam.
78264...........  .............  A............  Gastric emptying            0.78        7.16        5.78          NA          NA        0.25         XXX
                                                 study.
78264...........  TC...........  A............  Gastric emptying            0.00        6.89        5.51          NA          NA        0.22         XXX
                                                 study.
78264...........  26...........  A............  Gastric emptying            0.78        0.27        0.27        0.27        0.27        0.03         XXX
                                                 study.
78267...........  .............  X............  Breath tst attain/          0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 anal c-14.
78268...........  .............  X............  Breath test                 0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 analysis, c-14.
78270...........  .............  A............  Vit B-12 absorption         0.20        1.95        1.78          NA          NA        0.11         XXX
                                                 exam.
78270...........  TC...........  A............  Vit B-12 absorption         0.00        1.88        1.71          NA          NA        0.10         XXX
                                                 exam.
78270...........  26...........  A............  Vit B-12 absorption         0.20        0.07        0.07        0.07        0.07        0.01         XXX
                                                 exam.
78271...........  .............  A............  Vit b-12 absrp exam,        0.20        1.88        1.79          NA          NA        0.11         XXX
                                                 int fac.
78271...........  TC...........  A............  Vit b-12 absrp exam,        0.00        1.83        1.73          NA          NA        0.10         XXX
                                                 int fac.
78271...........  26...........  A............  Vit b-12 absrp exam,        0.20        0.05        0.06        0.05        0.06        0.01         XXX
                                                 int fac.
78272...........  .............  A............  Vit B-12 absorp,            0.27        2.06        2.23          NA          NA        0.14         XXX
                                                 combined.
78272...........  TC...........  A............  Vit B-12 absorp,            0.00        1.99        2.15          NA          NA        0.13         XXX
                                                 combined.
78272...........  26...........  A............  Vit B-12 absorp,            0.27        0.07        0.08        0.07        0.08        0.01         XXX
                                                 combined.
78278...........  .............  A............  Acute GI blood loss         0.99        8.60        6.90          NA          NA        0.29         XXX
                                                 imaging.
78278...........  TC...........  A............  Acute GI blood loss         0.00        8.25        6.56          NA          NA        0.25         XXX
                                                 imaging.
78278...........  26...........  A............  Acute GI blood loss         0.99        0.35        0.34        0.35        0.34        0.04         XXX
                                                 imaging.
78282...........  .............  C............  GI protein loss exam        0.00        0.00        0.00          NA          NA        0.00         XXX
78282...........  TC...........  C............  GI protein loss exam        0.00        0.00        0.00          NA          NA        0.00         XXX
78282...........  26...........  A............  GI protein loss exam        0.38        0.13        0.13        0.13        0.13        0.02         XXX
78290...........  .............  A............  Meckel's divert exam        0.68        8.51        5.89          NA          NA        0.19         XXX
78290...........  TC...........  A............  Meckel's divert exam        0.00        8.27        5.66          NA          NA        0.16         XXX
78290...........  26...........  A............  Meckel's divert exam        0.68        0.24        0.23        0.24        0.23        0.03         XXX
78291...........  .............  A............  Leveen/shunt patency        0.88        6.14        4.75          NA          NA        0.20         XXX
                                                 exam.
78291...........  TC...........  A............  Leveen/shunt patency        0.00        5.84        4.45          NA          NA        0.16         XXX
                                                 exam.
78291...........  26...........  A............  Leveen/shunt patency        0.88        0.30        0.30        0.30        0.30        0.04         XXX
                                                 exam.
78299...........  .............  C............  GI nuclear procedure        0.00        0.00        0.00          NA          NA        0.00         XXX
78299...........  TC...........  C............  GI nuclear procedure        0.00        0.00        0.00          NA          NA        0.00         XXX
78299...........  26...........  C............  GI nuclear procedure        0.00        0.00        0.00        0.00        0.00        0.00         XXX
78300...........  .............  A............  Bone imaging,               0.62        4.23        3.46          NA          NA        0.17         XXX
                                                 limited area.
78300...........  TC...........  A............  Bone imaging,               0.00        4.01        3.25          NA          NA        0.14         XXX
                                                 limited area.
78300...........  26...........  A............  Bone imaging,               0.62        0.22        0.21        0.22        0.21        0.03         XXX
                                                 limited area.
78305...........  .............  A............  Bone imaging,               0.83        5.47        4.70          NA          NA        0.23         XXX
                                                 multiple areas.
78305...........  TC...........  A............  Bone imaging,               0.00        5.19        4.42          NA          NA        0.19         XXX
                                                 multiple areas.
78305...........  26...........  A............  Bone imaging,               0.83        0.28        0.28        0.28        0.28        0.04         XXX
                                                 multiple areas.
78306...........  .............  A............  Bone imaging, whole         0.86        6.06        5.31          NA          NA        0.26         XXX
                                                 body.
78306...........  TC...........  A............  Bone imaging, whole         0.00        5.76        5.01          NA          NA        0.22         XXX
                                                 body.
78306...........  26...........  A............  Bone imaging, whole         0.86        0.30        0.30        0.30        0.30        0.04         XXX
                                                 body.
78315...........  .............  A............  Bone imaging, 3             1.02        8.59        6.85          NA          NA        0.29         XXX
                                                 phase.
78315...........  TC...........  A............  Bone imaging, 3             0.00        8.23        6.50          NA          NA        0.25         XXX
                                                 phase.
78315...........  26...........  A............  Bone imaging, 3             1.02        0.36        0.35        0.36        0.35        0.04         XXX
                                                 phase.
78320...........  .............  A............  Bone imaging (3D)...        1.04        5.35        5.81          NA          NA        0.35         XXX
78320...........  TC...........  A............  Bone imaging (3D)...        0.00        4.99        5.45          NA          NA        0.31         XXX
78320...........  26...........  A............  Bone imaging (3D)...        1.04        0.36        0.36        0.36        0.36        0.04         XXX
78350...........  .............  N............  Bone mineral, single        0.22        0.51        0.67          NA          NA        0.06         XXX
                                                 photon.
78350...........  TC...........  N............  Bone mineral, single        0.00        0.46        0.61          NA          NA        0.05         XXX
                                                 photon.
78350...........  26...........  N............  Bone mineral, single        0.22        0.05        0.06        0.05        0.06        0.01         XXX
                                                 photon.
78351...........  .............  N............  Bone mineral, dual          0.30          NA          NA        0.07        0.09        0.01         XXX
                                                 photon.
78399...........  .............  C............  Musculoskeletal             0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 nuclear exam.
78399...........  TC...........  C............  Musculoskeletal             0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 nuclear exam.
78399...........  26...........  C............  Musculoskeletal             0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 nuclear exam.

[[Page 66513]]

 
78414...........  .............  C............  Non-imaging heart           0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 function.
78414...........  TC...........  C............  Non-imaging heart           0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 function.
78414...........  26...........  A............  Non-imaging heart           0.45        0.17        0.17        0.17        0.17        0.02         XXX
                                                 function.
78428...........  .............  A............  Cardiac shunt               0.78        5.26        3.90          NA          NA        0.16         XXX
                                                 imaging.
78428...........  TC...........  A............  Cardiac shunt               0.00        4.90        3.58          NA          NA        0.13         XXX
                                                 imaging.
78428...........  26...........  A............  Cardiac shunt               0.78        0.36        0.32        0.36        0.32        0.03         XXX
                                                 imaging.
78445...........  .............  A............  Vascular flow               0.49        4.48        3.26          NA          NA        0.13         XXX
                                                 imaging.
78445...........  TC...........  A............  Vascular flow               0.00        4.31        3.09          NA          NA        0.11         XXX
                                                 imaging.
78445...........  26...........  A............  Vascular flow               0.49        0.17        0.17        0.17        0.17        0.02         XXX
                                                 imaging.
78456...........  .............  A............  Acute venous                1.00        8.80        6.56          NA          NA        0.33         XXX
                                                 thrombus image.
78456...........  TC...........  A............  Acute venous                0.00        8.43        6.20          NA          NA        0.29         XXX
                                                 thrombus image.
78456...........  26...........  A............  Acute venous                1.00        0.37        0.36        0.37        0.36        0.04         XXX
                                                 thrombus image.
78457...........  .............  A............  Venous thrombosis           0.77        4.65        3.78          NA          NA        0.17         XXX
                                                 imaging.
78457...........  TC...........  A............  Venous thrombosis           0.00        4.41        3.53          NA          NA        0.14         XXX
                                                 imaging.
78457...........  26...........  A............  Venous thrombosis           0.77        0.24        0.25        0.24        0.25        0.03         XXX
                                                 imaging.
78458...........  .............  A............  Ven thrombosis              0.90        4.51        4.43          NA          NA        0.25         XXX
                                                 images, bilat.
78458...........  TC...........  A............  Ven thrombosis              0.00        4.22        4.12          NA          NA        0.21         XXX
                                                 images, bilat.
78458...........  26...........  A............  Ven thrombosis              0.90        0.29        0.31        0.29        0.31        0.04         XXX
                                                 images, bilat.
78459...........  .............  C............  Heart muscle imaging        0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 (PET).
78459...........  TC...........  C............  Heart muscle imaging        0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 (PET).
78459...........  26...........  A............  Heart muscle imaging        1.50        0.60        0.59        0.60        0.59        0.05         XXX
                                                 (PET).
78460...........  .............  A............  Heart muscle blood,         0.86        4.66        3.65          NA          NA        0.17         XXX
                                                 single.
78460...........  TC...........  A............  Heart muscle blood,         0.00        4.34        3.35          NA          NA        0.13         XXX
                                                 single.
78460...........  26...........  A............  Heart muscle blood,         0.86        0.32        0.30        0.32        0.30        0.04         XXX
                                                 single.
78461...........  .............  A............  Heart muscle blood,         1.23        4.07        4.60          NA          NA        0.30         XXX
                                                 multiple.
78461...........  TC...........  A............  Heart muscle blood,         0.00        3.61        4.16          NA          NA        0.25         XXX
                                                 multiple.
78461...........  26...........  A............  Heart muscle blood,         1.23        0.46        0.44        0.46        0.44        0.05         XXX
                                                 multiple.
78464...........  .............  A............  Heart image (3d),           1.09        5.86        6.65          NA          NA        0.41         XXX
                                                 single.
78464...........  TC...........  A............  Heart image (3d),           0.00        5.36        6.21          NA          NA        0.37         XXX
                                                 single.
78464...........  26...........  A............  Heart image (3d),           1.09        0.50        0.44        0.50        0.44        0.04         XXX
                                                 single.
78465...........  .............  A............  Heart image (3d),           1.46       11.44       11.87          NA          NA        0.67         XXX
                                                 multiple.
78465...........  TC...........  A............  Heart image (3d),           0.00       10.73       11.26          NA          NA        0.62         XXX
                                                 multiple.
78465...........  26...........  A............  Heart image (3d),           1.46        0.71        0.61        0.71        0.61        0.05         XXX
                                                 multiple.
78466...........  .............  A............  Heart infarct image.        0.69        4.57        3.71          NA          NA        0.17         XXX
78466...........  TC...........  A............  Heart infarct image.        0.00        4.28        3.45          NA          NA        0.14         XXX
78466...........  26...........  A............  Heart infarct image.        0.69        0.29        0.26        0.29        0.26        0.03         XXX
78468...........  .............  A............  Heart infarct image         0.80        5.86        4.89          NA          NA        0.22         XXX
                                                 (ef).
78468...........  TC...........  A............  Heart infarct image         0.00        5.47        4.56          NA          NA        0.19         XXX
                                                 (ef).
78468...........  26...........  A............  Heart infarct image         0.80        0.39        0.33        0.39        0.33        0.03         XXX
                                                 (ef).
78469...........  .............  A............  Heart infarct image         0.92        6.28        5.90          NA          NA        0.31         XXX
                                                 (3D).
78469...........  TC...........  A............  Heart infarct image         0.00        5.84        5.53          NA          NA        0.28         XXX
                                                 (3D).
78469...........  26...........  A............  Heart infarct image         0.92        0.44        0.37        0.44        0.37        0.03         XXX
                                                 (3D).
78472...........  .............  A............  Gated heart, planar,        0.98        6.03        5.93          NA          NA        0.34         XXX
                                                 single.
78472...........  TC...........  A............  Gated heart, planar,        0.00        5.62        5.56          NA          NA        0.30         XXX
                                                 single.
78472...........  26...........  A............  Gated heart, planar,        0.98        0.41        0.37        0.41        0.37        0.04         XXX
                                                 single.
78473...........  .............  A............  Gated heart,                1.47        7.76        8.25          NA          NA        0.48         XXX
                                                 multiple.
78473...........  TC...........  A............  Gated heart,                0.00        7.12        7.68          NA          NA        0.42         XXX
                                                 multiple.
78473...........  26...........  A............  Gated heart,                1.47        0.64        0.57        0.64        0.57        0.06         XXX
                                                 multiple.
78478...........  .............  A............  Heart wall motion           0.50        0.80        1.30          NA          NA        0.12         XXX
                                                 add-on.
78478...........  TC...........  A............  Heart wall motion           0.00        0.56        1.06          NA          NA        0.10         XXX
                                                 add-on.
78478...........  26...........  A............  Heart wall motion           0.50        0.24        0.24        0.24        0.24        0.02         XXX
                                                 add-on.
78480...........  .............  A............  Heart function add-         0.30        0.70        1.24          NA          NA        0.12         XXX
                                                 on.
78480...........  TC...........  A............  Heart function add-         0.00        0.56        1.06          NA          NA        0.10         XXX
                                                 on.
78480...........  26...........  A............  Heart function add-         0.30        0.14        0.18        0.14        0.18        0.02         XXX
                                                 on.
78481...........  .............  A............  Heart first pass,           0.98        5.07        5.33          NA          NA        0.31         XXX
                                                 single.
78481...........  TC...........  A............  Heart first pass,           0.00        4.58        4.90          NA          NA        0.28         XXX
                                                 single.
78481...........  26...........  A............  Heart first pass,           0.98        0.49        0.43        0.49        0.43        0.03         XXX
                                                 single.
78483...........  .............  A............  Heart first pass,           1.47        6.87        7.63          NA          NA        0.46         XXX
                                                 multiple.
78483...........  TC...........  A............  Heart first pass,           0.00        6.09        6.97          NA          NA        0.41         XXX
                                                 multiple.
78483...........  26...........  A............  Heart first pass,           1.47        0.78        0.66        0.78        0.66        0.05         XXX
                                                 multiple.
78491...........  .............  C............  Heart image (pet),          0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 single.
78491...........  TC...........  C............  Heart image (pet),          0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 single.
78491...........  26...........  A............  Heart image (pet),          1.50        0.63        0.61        0.63        0.61        0.06         XXX
                                                 single.
78492...........  .............  C............  Heart image (pet),          0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 multiple.
78492...........  TC...........  C............  Heart image (pet),          0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 multiple.
78492...........  26...........  A............  Heart image (pet),          1.87        0.91        0.82        0.91        0.82        0.07         XXX
                                                 multiple.
78494...........  .............  A............  Heart image, spect..        1.19        6.22        6.85          NA          NA        0.35         XXX
78494...........  TC...........  A............  Heart image, spect..        0.00        5.68        6.37          NA          NA        0.30         XXX
78494...........  26...........  A............  Heart image, spect..        1.19        0.54        0.48        0.54        0.48        0.05         XXX
78496...........  .............  A............  Heart first pass add-       0.50        0.88        4.06          NA          NA        0.32         ZZZ
                                                 on.
78496...........  TC...........  A............  Heart first pass add-       0.00        0.65        3.86          NA          NA        0.30         ZZZ
                                                 on.
78496...........  26...........  A............  Heart first pass add-       0.50        0.23        0.20        0.23        0.20        0.02         ZZZ
                                                 on.

[[Page 66514]]

 
78499...........  .............  C............  Cardiovascular              0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 nuclear exam.
78499...........  TC...........  C............  Cardiovascular              0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 nuclear exam.
78499...........  26...........  C............  Cardiovascular              0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 nuclear exam.
78580...........  .............  A............  Lung perfusion              0.74        5.13        4.41          NA          NA        0.21         XXX
                                                 imaging.
78580...........  TC...........  A............  Lung perfusion              0.00        4.87        4.15          NA          NA        0.18         XXX
                                                 imaging.
78580...........  26...........  A............  Lung perfusion              0.74        0.26        0.26        0.26        0.26        0.03         XXX
                                                 imaging.
78584...........  .............  A............  Lung V/Q image              0.99        3.02        3.27          NA          NA        0.21         XXX
                                                 single breath.
78584...........  TC...........  A............  Lung V/Q image              0.00        2.67        2.93          NA          NA        0.17         XXX
                                                 single breath.
78584...........  26...........  A............  Lung V/Q image              0.99        0.35        0.34        0.35        0.34        0.04         XXX
                                                 single breath.
78585...........  .............  A............  Lung V/Q imaging....        1.09        8.62        7.31          NA          NA        0.35         XXX
78585...........  TC...........  A............  Lung V/Q imaging....        0.00        8.24        6.94          NA          NA        0.30         XXX
78585...........  26...........  A............  Lung V/Q imaging....        1.09        0.38        0.37        0.38        0.37        0.05         XXX
78586...........  .............  A............  Aerosol lung image,         0.40        4.17        3.44          NA          NA        0.16         XXX
                                                 single.
78586...........  TC...........  A............  Aerosol lung image,         0.00        4.03        3.31          NA          NA        0.14         XXX
                                                 single.
78586...........  26...........  A............  Aerosol lung image,         0.40        0.14        0.13        0.14        0.13        0.02         XXX
                                                 single.
78587...........  .............  A............  Aerosol lung image,         0.49        5.43        4.20          NA          NA        0.16         XXX
                                                 multiple.
78587...........  TC...........  A............  Aerosol lung image,         0.00        5.26        4.03          NA          NA        0.14         XXX
                                                 multiple.
78587...........  26...........  A............  Aerosol lung image,         0.49        0.17        0.17        0.17        0.17        0.02         XXX
                                                 multiple.
78588...........  .............  A............  Perfusion lung image        1.09        8.65        6.11          NA          NA        0.23         XXX
78588...........  TC...........  A............  Perfusion lung image        0.00        8.27        5.74          NA          NA        0.18         XXX
78588...........  26...........  A............  Perfusion lung image        1.09        0.38        0.37        0.38        0.37        0.05         XXX
78591...........  .............  A............  Vent image, 1               0.40        4.17        3.57          NA          NA        0.16         XXX
                                                 breath, 1 proj.
78591...........  TC...........  A............  Vent image, 1               0.00        4.03        3.44          NA          NA        0.14         XXX
                                                 breath, 1 proj.
78591...........  26...........  A............  Vent image, 1               0.40        0.14        0.13        0.14        0.13        0.02         XXX
                                                 breath, 1 proj.
78593...........  .............  A............  Vent image, 1 proj,         0.49        4.82        4.21          NA          NA        0.20         XXX
                                                 gas.
78593...........  TC...........  A............  Vent image, 1 proj,         0.00        4.65        4.05          NA          NA        0.18         XXX
                                                 gas.
78593...........  26...........  A............  Vent image, 1 proj,         0.49        0.17        0.16        0.17        0.16        0.02         XXX
                                                 gas.
78594...........  .............  A............  Vent image, mult            0.53        5.29        5.22          NA          NA        0.27         XXX
                                                 proj, gas.
78594...........  TC...........  A............  Vent image, mult            0.00        5.11        5.04          NA          NA        0.25         XXX
                                                 proj, gas.
78594...........  26...........  A............  Vent image, mult            0.53        0.18        0.18        0.18        0.18        0.02         XXX
                                                 proj, gas.
78596...........  .............  A............  Lung differential           1.27        8.67        8.08          NA          NA        0.42         XXX
                                                 function.
78596...........  TC...........  A............  Lung differential           0.00        8.28        7.67          NA          NA        0.37         XXX
                                                 function.
78596...........  26...........  A............  Lung differential           1.27        0.39        0.41        0.39        0.41        0.05         XXX
                                                 function.
78599...........  .............  C............  Respiratory nuclear         0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 exam.
78599...........  TC...........  C............  Respiratory nuclear         0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 exam.
78599...........  26...........  C............  Respiratory nuclear         0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 exam.
78600...........  .............  A............  Brain image < 4             0.44        4.39        3.71          NA          NA        0.16         XXX
                                                 views.
78600...........  TC...........  A............  Brain image < 4             0.00        4.24        3.56          NA          NA        0.14         XXX
                                                 views.
78600...........  26...........  A............  Brain image < 4             0.44        0.15        0.15        0.15        0.15        0.02         XXX
                                                 views.
78601...........  .............  A............  Brain image w/flow <        0.51        5.38        4.47          NA          NA        0.20         XXX
                                                 4 views.
78601...........  TC...........  A............  Brain image w/flow <        0.00        5.20        4.30          NA          NA        0.18         XXX
                                                 4 views.
78601...........  26...........  A............  Brain image w/flow <        0.51        0.18        0.17        0.18        0.17        0.02         XXX
                                                 4 views.
78605...........  .............  A............  Brain image 4+ views        0.53        4.84        4.22          NA          NA        0.20         XXX
78605...........  TC...........  A............  Brain image 4+ views        0.00        4.65        4.03          NA          NA        0.18         XXX
78605...........  26...........  A............  Brain image 4+ views        0.53        0.19        0.19        0.19        0.19        0.02         XXX
78606...........  .............  A............  Brain image w/flow 4        0.64        8.53        6.30          NA          NA        0.24         XXX
                                                 + views.
78606...........  TC...........  A............  Brain image w/flow 4        0.00        8.31        6.09          NA          NA        0.21         XXX
                                                 + views.
78606...........  26...........  A............  Brain image w/flow 4        0.64        0.22        0.21        0.22        0.21        0.03         XXX
                                                 + views.
78607...........  .............  A............  Brain imaging (3D)..        1.23        8.63        7.80          NA          NA        0.40         XXX
78607...........  TC...........  A............  Brain imaging (3D)..        0.00        8.22        7.38          NA          NA        0.35         XXX
78607...........  26...........  A............  Brain imaging (3D)..        1.23        0.41        0.42        0.41        0.42        0.05         XXX
78608...........  .............  C............  Brain imaging (PET).        0.00        0.00        0.00          NA          NA        0.00         XXX
78608...........  TC...........  C............  Brain imaging (PET).        0.00        0.00        0.00          NA          NA        0.00         XXX
78608...........  26...........  A............  Brain imaging (PET).        1.50        0.49        0.50        0.49        0.50        0.06         XXX
78609...........  .............  N............  Brain imaging (PET).        1.50        0.00        0.49          NA          NA        0.06         XXX
78609...........  TC...........  N............  Brain imaging (PET).        0.00        0.00        0.00          NA          NA        0.00         XXX
78609...........  26...........  N............  Brain imaging (PET).        1.50        0.00        0.49        0.00        0.49        0.06         XXX
78610...........  .............  A............  Brain flow imaging          0.30        4.45        4.23          NA          NA        0.11         XXX
                                                 only.
78610...........  TC...........  A............  Brain flow imaging          0.00        4.35        4.10          NA          NA        0.10         XXX
                                                 only.
78610...........  26...........  A............  Brain flow imaging          0.30        0.10        0.13        0.10        0.13        0.01         XXX
                                                 only.
78630...........  .............  A............  Cerebrospinal fluid         0.68        8.65        6.95          NA          NA        0.30         XXX
                                                 scan.
78630...........  TC...........  A............  Cerebrospinal fluid         0.00        8.41        6.72          NA          NA        0.27         XXX
                                                 scan.
78630...........  26...........  A............  Cerebrospinal fluid         0.68        0.24        0.23        0.24        0.23        0.03         XXX
                                                 scan.
78635...........  .............  A............  CSF ventriculography        0.61        8.79        5.78          NA          NA        0.16         XXX
78635...........  TC...........  A............  CSF ventriculography        0.00        8.58        5.56          NA          NA        0.14         XXX
78635...........  26...........  A............  CSF ventriculography        0.61        0.21        0.22        0.21        0.22        0.02         XXX
78645...........  .............  A............  CSF shunt evaluation        0.57        8.48        6.04          NA          NA        0.20         XXX
78645...........  TC...........  A............  CSF shunt evaluation        0.00        8.28        5.85          NA          NA        0.18         XXX
78645...........  26...........  A............  CSF shunt evaluation        0.57        0.20        0.19        0.20        0.19        0.02         XXX
78647...........  .............  A............  Cerebrospinal fluid         0.90        8.52        7.37          NA          NA        0.35         XXX
                                                 scan.
78647...........  TC...........  A............  Cerebrospinal fluid         0.00        8.23        7.07          NA          NA        0.31         XXX
                                                 scan.
78647...........  26...........  A............  Cerebrospinal fluid         0.90        0.29        0.30        0.29        0.30        0.04         XXX
                                                 scan.

[[Page 66515]]

 
78650...........  .............  A............  CSF leakage imaging.        0.61        8.56        6.70          NA          NA        0.27         XXX
78650...........  TC...........  A............  CSF leakage imaging.        0.00        8.35        6.49          NA          NA        0.24         XXX
78650...........  26...........  A............  CSF leakage imaging.        0.61        0.21        0.21        0.21        0.21        0.03         XXX
78660...........  .............  A............  Nuclear exam of tear        0.53        4.26        3.28          NA          NA        0.14         XXX
                                                 flow.
78660...........  TC...........  A............  Nuclear exam of tear        0.00        4.07        3.10          NA          NA        0.12         XXX
                                                 flow.
78660...........  26...........  A............  Nuclear exam of tear        0.53        0.19        0.18        0.19        0.18        0.02         XXX
                                                 flow.
78699...........  .............  C............  Nervous system              0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 nuclear exam.
78699...........  TC...........  C............  Nervous system              0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 nuclear exam.
78699...........  26...........  C............  Nervous system              0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 nuclear exam.
78700...........  .............  A............  Kidney imaging,             0.45        4.38        3.80          NA          NA        0.18         XXX
                                                 morphol.
78700...........  TC...........  A............  Kidney imaging,             0.00        4.22        3.64          NA          NA        0.16         XXX
                                                 morphol.
78700...........  26...........  A............  Kidney imaging,             0.45        0.16        0.16        0.16        0.16        0.02         XXX
                                                 morphol.
78701...........  .............  A............  Kidney imaging with         0.49        5.38        4.55          NA          NA        0.20         XXX
                                                 flow.
78701...........  TC...........  A............  Kidney imaging with         0.00        5.21        4.38          NA          NA        0.18         XXX
                                                 flow.
78701...........  26...........  A............  Kidney imaging with         0.49        0.17        0.17        0.17        0.17        0.02         XXX
                                                 flow.
78707...........  .............  A............  K flow/funct image w/       0.96        5.49        5.14          NA          NA        0.27         XXX
                                                 o drug.
78707...........  TC...........  A............  K flow/funct image w/       0.00        5.15        4.81          NA          NA        0.23         XXX
                                                 o drug.
78707...........  26...........  A............  K flow/funct image w/       0.96        0.34        0.33        0.34        0.33        0.04         XXX
                                                 o drug.
78708...........  .............  A............  K flow/funct image w/       1.21        3.48        4.18          NA          NA        0.28         XXX
                                                 drug.
78708...........  TC...........  A............  K flow/funct image w/       0.00        3.05        3.76          NA          NA        0.23         XXX
                                                 drug.
78708...........  26...........  A............  K flow/funct image w/       1.21        0.43        0.42        0.43        0.42        0.05         XXX
                                                 drug.
78709...........  .............  A............  K flow/funct image,         1.41        8.88        6.91          NA          NA        0.29         XXX
                                                 multiple.
78709...........  TC...........  A............  K flow/funct image,         0.00        8.39        6.43          NA          NA        0.23         XXX
                                                 multiple.
78709...........  26...........  A............  K flow/funct image,         1.41        0.49        0.48        0.49        0.48        0.06         XXX
                                                 multiple.
78710...........  .............  A............  Kidney imaging (3D).        0.66        5.28        5.70          NA          NA        0.34         XXX
78710...........  TC...........  A............  Kidney imaging (3D).        0.00        5.06        5.48          NA          NA        0.31         XXX
78710...........  26...........  A............  Kidney imaging (3D).        0.66        0.22        0.22        0.22        0.22        0.03         XXX
78725...........  .............  A............  Kidney function             0.38        2.35        2.14          NA          NA        0.13         XXX
                                                 study.
78725...........  TC...........  A............  Kidney function             0.00        2.23        2.01          NA          NA        0.11         XXX
                                                 study.
78725...........  26...........  A............  Kidney function             0.38        0.12        0.13        0.12        0.13        0.02         XXX
                                                 study.
78730...........  .............  A............  Urinary bladder             0.15        1.98        1.78          NA          NA        0.10         ZZZ
                                                 retention.
78730...........  TC...........  A............  Urinary bladder             0.00        1.92        1.69          NA          NA        0.08         ZZZ
                                                 retention.
78730...........  26...........  A............  Urinary bladder             0.15        0.06        0.09        0.06        0.09        0.02         ZZZ
                                                 retention.
78740...........  .............  A............  Ureteral reflux             0.57        5.65        3.98          NA          NA        0.15         XXX
                                                 study.
78740...........  TC...........  A............  Ureteral reflux             0.00        5.46        3.79          NA          NA        0.12         XXX
                                                 study.
78740...........  26...........  A............  Ureteral reflux             0.57        0.19        0.19        0.19        0.19        0.03         XXX
                                                 study.
78761...........  .............  A............  Testicular imaging w/       0.71        5.05        4.24          NA          NA        0.20         XXX
                                                 flow.
78761...........  TC...........  A............  Testicular imaging w/       0.00        4.80        4.00          NA          NA        0.17         XXX
                                                 flow.
78761...........  26...........  A............  Testicular imaging w/       0.71        0.25        0.24        0.25        0.24        0.03         XXX
                                                 flow.
78799...........  .............  C............  Genitourinary               0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 nuclear exam.
78799...........  TC...........  C............  Genitourinary               0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 nuclear exam.
78799...........  26...........  C............  Genitourinary               0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 nuclear exam.
78800...........  .............  A............  Tumor imaging,              0.66        4.33        3.98          NA          NA        0.22         XXX
                                                 limited area.
78800...........  TC...........  A............  Tumor imaging,              0.00        4.12        3.76          NA          NA        0.18         XXX
                                                 limited area.
78800...........  26...........  A............  Tumor imaging,              0.66        0.21        0.22        0.21        0.22        0.04         XXX
                                                 limited area.
78801...........  .............  A............  Tumor imaging, mult         0.79        6.04        5.27          NA          NA        0.27         XXX
                                                 areas.
78801...........  TC...........  A............  Tumor imaging, mult         0.00        5.78        5.00          NA          NA        0.22         XXX
                                                 areas.
78801...........  26...........  A............  Tumor imaging, mult         0.79        0.26        0.27        0.26        0.27        0.05         XXX
                                                 areas.
78802...........  .............  A............  Tumor imaging, whole        0.86        8.14        6.98          NA          NA        0.34         XXX
                                                 body.
78802...........  TC...........  A............  Tumor imaging, whole        0.00        7.84        6.69          NA          NA        0.30         XXX
                                                 body.
78802...........  26...........  A............  Tumor imaging, whole        0.86        0.30        0.29        0.30        0.29        0.04         XXX
                                                 body.
78803...........  .............  A............  Tumor imaging (3D)..        1.09        8.53        7.74          NA          NA        0.40         XXX
78803...........  TC...........  A............  Tumor imaging (3D)..        0.00        8.16        7.36          NA          NA        0.35         XXX
78803...........  26...........  A............  Tumor imaging (3D)..        1.09        0.37        0.38        0.37        0.38        0.05         XXX
78804...........  .............  A............  Tumor imaging, whole        1.07       14.83       13.13          NA          NA        0.34         XXX
                                                 body.
78804...........  TC...........  A............  Tumor imaging, whole        0.00       14.46       12.76          NA          NA        0.30         XXX
                                                 body.
78804...........  26...........  A............  Tumor imaging, whole        1.07        0.37        0.37        0.37        0.37        0.04         XXX
                                                 body.
78805...........  .............  A............  Abscess imaging, ltd        0.73        4.22        3.94          NA          NA        0.21         XXX
                                                 area.
78805...........  TC...........  A............  Abscess imaging, ltd        0.00        3.97        3.69          NA          NA        0.18         XXX
                                                 area.
78805...........  26...........  A............  Abscess imaging, ltd        0.73        0.25        0.25        0.25        0.25        0.03         XXX
                                                 area.
78806...........  .............  A............  Abscess imaging,            0.86        8.35        7.53          NA          NA        0.39         XXX
                                                 whole body.
78806...........  TC...........  A............  Abscess imaging,            0.00        8.05        7.24          NA          NA        0.35         XXX
                                                 whole body.
78806...........  26...........  A............  Abscess imaging,            0.86        0.30        0.29        0.30        0.29        0.04         XXX
                                                 whole body.
78807...........  .............  A............  Nuclear localization/       1.09        8.51        7.73          NA          NA        0.39         XXX
                                                 abscess.
78807...........  TC...........  A............  Nuclear localization/       0.00        8.14        7.35          NA          NA        0.35         XXX
                                                 abscess.
78807...........  26...........  A............  Nuclear localization/       1.09        0.37        0.38        0.37        0.38        0.04         XXX
                                                 abscess.
78811...........  .............  C............  Pet image, ltd area.        0.00        0.00        0.00          NA          NA        0.00         XXX
78811...........  TC...........  C............  Pet image, ltd area.        0.00        0.00        0.00          NA          NA        0.00         XXX
78811...........  26...........  A............  Pet image, ltd area.        1.54        0.54        0.53        0.54        0.53        0.11         XXX
78812...........  .............  C............  Pet image, skull-           0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 thigh.
78812...........  TC...........  C............  Pet image, skull-           0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 thigh.
78812...........  26...........  A............  Pet image, skull-           1.93        0.67        0.66        0.67        0.66        0.11         XXX
                                                 thigh.

[[Page 66516]]

 
78813...........  .............  C............  Pet image, full body        0.00        0.00        0.00          NA          NA        0.00         XXX
78813...........  TC...........  C............  Pet image, full body        0.00        0.00        0.00          NA          NA        0.00         XXX
78813...........  26...........  A............  Pet image, full body        2.00        0.68        0.68        0.68        0.68        0.11         XXX
78814...........  .............  C............  Pet image w/ct, lmtd        0.00        0.00        0.00          NA          NA        0.00         XXX
78814...........  TC...........  C............  Pet image w/ct, lmtd        0.00        0.00        0.00          NA          NA        0.00         XXX
78814...........  26...........  A............  Pet image w/ct, lmtd        2.20        0.74        0.75        0.74        0.75        0.11         XXX
78815...........  .............  C............  Pet image w/ct,             0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 skull-thigh.
78815...........  TC...........  C............  Pet image w/ct,             0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 skull-thigh.
78815...........  26...........  A............  Pet image w/ct,             2.44        0.84        0.84        0.84        0.84        0.11         XXX
                                                 skull-thigh.
78816...........  .............  C............  Pet image w/ct, full        0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 body.
78816...........  TC...........  C............  Pet image w/ct, full        0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 body.
78816...........  26...........  A............  Pet image w/ct, full        2.50        0.85        0.85        0.85        0.85        0.11         XXX
                                                 body.
78890...........  .............  B............  Nuclear medicine            0.05        0.39        0.86          NA          NA        0.07         XXX
                                                 data proc.
78890...........  TC...........  B............  Nuclear medicine            0.00        0.38        0.84          NA          NA        0.06         XXX
                                                 data proc.
78890...........  26...........  B............  Nuclear medicine            0.05        0.01        0.02        0.01        0.02        0.01         XXX
                                                 data proc.
78891...........  .............  B............  Nuclear med data            0.10        0.88        1.77          NA          NA        0.14         XXX
                                                 proc.
78891...........  TC...........  B............  Nuclear med data            0.00        0.86        1.74          NA          NA        0.13         XXX
                                                 proc.
78891...........  26...........  B............  Nuclear med data            0.10        0.02        0.03        0.02        0.03        0.01         XXX
                                                 proc.
78999...........  .............  C............  Nuclear diagnostic          0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 exam.
78999...........  TC...........  C............  Nuclear diagnostic          0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 exam.
78999...........  26...........  C............  Nuclear diagnostic          0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 exam.
79005...........  .............  A............  Nuclear rx, oral            1.80        1.85        2.53          NA          NA        0.22         XXX
                                                 admin.
79005...........  TC...........  A............  Nuclear rx, oral            0.00        1.27        1.94          NA          NA        0.14         XXX
                                                 admin.
79005...........  26...........  A............  Nuclear rx, oral            1.80        0.58        0.59        0.58        0.59        0.08         XXX
                                                 admin.
79101...........  .............  A............  Nuclear rx, iv admin        1.96        2.17        2.72          NA          NA        0.22         XXX
79101...........  TC...........  A............  Nuclear rx, iv admin        0.00        1.43        2.02          NA          NA        0.14         XXX
79101...........  26...........  A............  Nuclear rx, iv admin        1.96        0.74        0.70        0.74        0.70        0.08         XXX
79200...........  .............  A............  Nuclear rx, intracav        1.99        2.22        2.77          NA          NA        0.23         XXX
                                                 admin.
79200...........  TC...........  A............  Nuclear rx, intracav        0.00        1.57        2.10          NA          NA        0.14         XXX
                                                 admin.
79200...........  26...........  A............  Nuclear rx, intracav        1.99        0.65        0.67        0.65        0.67        0.09         XXX
                                                 admin.
79300...........  .............  C............  Nuclr rx, interstit         0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 colloid.
79300...........  TC...........  C............  Nuclr rx, interstit         0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 colloid.
79300...........  26...........  A............  Nuclr rx, interstit         1.60        0.54        0.55        0.54        0.55        0.13         XXX
                                                 colloid.
79403...........  .............  A............  Hematopoietic               2.25        2.92        4.04          NA          NA        0.24         XXX
                                                 nuclear tx.
79403...........  TC...........  A............  Hematopoietic               0.00        2.17        3.22          NA          NA        0.14         XXX
                                                 nuclear tx.
79403...........  26...........  A............  Hematopoietic               2.25        0.75        0.82        0.75        0.82        0.10         XXX
                                                 nuclear tx.
79440...........  .............  A............  Nuclear rx, intra-          1.99        1.84        2.59          NA          NA        0.22         XXX
                                                 articular.
79440...........  TC...........  A............  Nuclear rx, intra-          0.00        1.16        1.89          NA          NA        0.14         XXX
                                                 articular.
79440...........  26...........  A............  Nuclear rx, intra-          1.99        0.68        0.70        0.68        0.70        0.08         XXX
                                                 articular.
79445...........  .............  C............  Nuclear rx, intra-          0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 arterial.
79445...........  TC...........  C............  Nuclear rx, intra-          0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 arterial.
79445...........  26...........  A............  Nuclear rx, intra-          2.40        0.85        0.83        0.85        0.83        0.12         XXX
                                                 arterial.
79999...........  .............  C............  Nuclear medicine            0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 therapy.
79999...........  TC...........  C............  Nuclear medicine            0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 therapy.
79999...........  26...........  C............  Nuclear medicine            0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 therapy.
80500...........  .............  A............  Lab pathology               0.37        0.20        0.20        0.11        0.14        0.01         XXX
                                                 consultation.
80502...........  .............  A............  Lab pathology               1.33        0.31        0.43        0.25        0.40        0.04         XXX
                                                 consultation.
83020...........  26...........  A............  Hemoglobin                  0.37        0.12        0.13        0.12        0.13        0.01         XXX
                                                 electrophoresis.
83912...........  26...........  A............  Genetic examination.        0.37        0.11        0.12        0.11        0.12        0.01         XXX
84165...........  26...........  A............  Protein e-phoresis,         0.37        0.12        0.13        0.12        0.13        0.01         XXX
                                                 serum.
84166...........  26...........  A............  Protein e-phoresis/         0.37        0.12        0.13        0.12        0.13        0.01         XXX
                                                 urine/csf.
84181...........  26...........  A............  Western blot test...        0.37        0.12        0.13        0.12        0.13        0.01         XXX
84182...........  26...........  A............  Protein, western            0.37        0.12        0.14        0.12        0.14        0.02         XXX
                                                 blot test.
85060...........  .............  A............  Blood smear                 0.45        0.14        0.16        0.14        0.16        0.02         XXX
                                                 interpretation.
85097...........  .............  A............  Bone marrow                 0.94        1.25        1.58        0.27        0.34        0.04         XXX
                                                 interpretation.
85390...........  26...........  A............  Fibrinolysins screen        0.37        0.13        0.13        0.13        0.13        0.01         XXX
85396...........  .............  A............  Clotting assay,             0.37          NA          NA        0.10        0.13        0.04         XXX
                                                 whole blood.
85576...........  26...........  A............  Blood platelet              0.37        0.12        0.14        0.12        0.14        0.01         XXX
                                                 aggregation.
86077...........  .............  A............  Physician blood bank        0.94        0.38        0.39        0.30        0.34        0.03         XXX
                                                 service.
86078...........  .............  A............  Physician blood bank        0.94        0.38        0.42        0.30        0.35        0.03         XXX
                                                 service.
86079...........  .............  A............  Physician blood bank        0.94        0.39        0.42        0.30        0.36        0.03         XXX
                                                 service.
86255...........  26...........  A............  Fluorescent                 0.37        0.12        0.13        0.12        0.13        0.01         XXX
                                                 antibody, screen.
86256...........  26...........  A............  Fluorescent                 0.37        0.12        0.13        0.12        0.13        0.01         XXX
                                                 antibody, titer.
86320...........  26...........  A............  Serum                       0.37        0.12        0.14        0.12        0.14        0.01         XXX
                                                 immunoelectrophores
                                                 is.
86325...........  26...........  A............  Other                       0.37        0.12        0.13        0.12        0.13        0.01         XXX
                                                 immunoelectrophores
                                                 is.
86327...........  26...........  A............  Immunoelectrophoresi        0.42        0.12        0.15        0.12        0.15        0.02         XXX
                                                 s assay.
86334...........  26...........  A............  Immunofix e-                0.37        0.12        0.13        0.12        0.13        0.01         XXX
                                                 phoresis, serum.
86335...........  26...........  A............  Immunfix e-phorsis/         0.37        0.12        0.13        0.12        0.13        0.01         XXX
                                                 urine/csf.
86485...........  .............  C............  Skin test, candida..        0.00        0.00        0.00        0.00        0.00        0.00         XXX
86486...........  .............  A............  Skin test, nos              0.00        0.13        0.13          NA          NA        0.02         XXX
                                                 antigen.
86490...........  .............  A............  Coccidioidomycosis          0.00        0.13        0.21          NA          NA        0.02         XXX
                                                 skin test.
86510...........  .............  A............  Histoplasmosis skin         0.00        0.13        0.22          NA          NA        0.02         XXX
                                                 test.

[[Page 66517]]

 
86580...........  .............  A............  TB intradermal test.        0.00        0.16        0.20          NA          NA        0.02         XXX
87164...........  26...........  A............  Dark field                  0.37        0.12        0.12        0.12        0.12        0.01         XXX
                                                 examination.
87207...........  26...........  A............  Smear, special stain        0.37        0.12        0.14        0.12        0.14        0.01         XXX
88104...........  .............  A............  Cytopath fl nongyn,         0.56        1.19        1.02          NA          NA        0.04         XXX
                                                 smears.
88104...........  TC...........  A............  Cytopath fl nongyn,         0.00        1.03        0.82          NA          NA        0.02         XXX
                                                 smears.
88104...........  26...........  A............  Cytopath fl nongyn,         0.56        0.16        0.20        0.16        0.20        0.02         XXX
                                                 smears.
88106...........  .............  A............  Cytopath fl nongyn,         0.56        1.52        1.44          NA          NA        0.04         XXX
                                                 filter.
88106...........  TC...........  A............  Cytopath fl nongyn,         0.00        1.37        1.24          NA          NA        0.02         XXX
                                                 filter.
88106...........  26...........  A............  Cytopath fl nongyn,         0.56        0.15        0.20        0.15        0.20        0.02         XXX
                                                 filter.
88107...........  .............  A............  Cytopath fl nongyn,         0.76        2.00        1.77          NA          NA        0.05         XXX
                                                 sm/fltr.
88107...........  TC...........  A............  Cytopath fl nongyn,         0.00        1.77        1.49          NA          NA        0.02         XXX
                                                 sm/fltr.
88107...........  26...........  A............  Cytopath fl nongyn,         0.76        0.23        0.28        0.23        0.28        0.03         XXX
                                                 sm/fltr.
88108...........  .............  A............  Cytopath,                   0.56        1.47        1.34          NA          NA        0.04         XXX
                                                 concentrate tech.
88108...........  TC...........  A............  Cytopath,                   0.00        1.32        1.14          NA          NA        0.02         XXX
                                                 concentrate tech.
88108...........  26...........  A............  Cytopath,                   0.56        0.15        0.20        0.15        0.20        0.02         XXX
                                                 concentrate tech.
88112...........  .............  A............  Cytopath, cell              1.18        1.47        1.72          NA          NA        0.04         XXX
                                                 enhance tech.
88112...........  TC...........  A............  Cytopath, cell              0.00        1.18        1.32          NA          NA        0.02         XXX
                                                 enhance tech.
88112...........  26...........  A............  Cytopath, cell              1.18        0.29        0.40        0.29        0.40        0.02         XXX
                                                 enhance tech.
88125...........  .............  A............  Forensic                    0.26        0.21        0.24          NA          NA        0.02         XXX
                                                 cytopathology.
88125...........  TC...........  A............  Forensic                    0.00        0.16        0.16          NA          NA        0.01         XXX
                                                 cytopathology.
88125...........  26...........  A............  Forensic                    0.26        0.05        0.08        0.05        0.08        0.01         XXX
                                                 cytopathology.
88141...........  .............  A............  Cytopath, c/v,              0.42        0.38        0.26        0.38        0.26        0.02         XXX
                                                 interpret.
88160...........  .............  A............  Cytopath smear,             0.50        0.91        0.87          NA          NA        0.04         XXX
                                                 other source.
88160...........  TC...........  A............  Cytopath smear,             0.00        0.78        0.70          NA          NA        0.02         XXX
                                                 other source.
88160...........  26...........  A............  Cytopath smear,             0.50        0.13        0.17        0.13        0.17        0.02         XXX
                                                 other source.
88161...........  .............  A............  Cytopath smear,             0.50        1.06        1.00          NA          NA        0.04         XXX
                                                 other source.
88161...........  TC...........  A............  Cytopath smear,             0.00        0.92        0.82          NA          NA        0.02         XXX
                                                 other source.
88161...........  26...........  A............  Cytopath smear,             0.50        0.14        0.18        0.14        0.18        0.02         XXX
                                                 other source.
88162...........  .............  A............  Cytopath smear,             0.76        1.58        1.30          NA          NA        0.05         XXX
                                                 other source.
88162...........  TC...........  A............  Cytopath smear,             0.00        1.35        1.02          NA          NA        0.02         XXX
                                                 other source.
88162...........  26...........  A............  Cytopath smear,             0.76        0.23        0.28        0.23        0.28        0.03         XXX
                                                 other source.
88172...........  .............  A............  Cytopathology eval          0.60        0.81        0.77          NA          NA        0.04         XXX
                                                 of fna.
88172...........  TC...........  A............  Cytopathology eval          0.00        0.64        0.55          NA          NA        0.02         XXX
                                                 of fna.
88172...........  26...........  A............  Cytopathology eval          0.60        0.17        0.22        0.17        0.22        0.02         XXX
                                                 of fna.
88173...........  .............  A............  Cytopath eval, fna,         1.39        2.20        2.16          NA          NA        0.07         XXX
                                                 report.
88173...........  TC...........  A............  Cytopath eval, fna,         0.00        1.82        1.68          NA          NA        0.02         XXX
                                                 report.
88173...........  26...........  A............  Cytopath eval, fna,         1.39        0.38        0.48        0.38        0.48        0.05         XXX
                                                 report.
88182...........  .............  A............  Cell marker study...        0.77        2.02        1.99          NA          NA        0.07         XXX
88182...........  TC...........  A............  Cell marker study...        0.00        1.88        1.76          NA          NA        0.04         XXX
88182...........  26...........  A............  Cell marker study...        0.77        0.14        0.23        0.14        0.23        0.03         XXX
88184...........  .............  A............  Flowcytometry/ tc, 1        0.00        2.46        1.89          NA          NA        0.02         XXX
                                                 marker.
88185...........  .............  A............  Flowcytometry/tc,           0.00        1.50        1.07          NA          NA        0.02         ZZZ
                                                 add-on.
88187...........  .............  A............  Flowcytometry/read,         1.36        0.39        0.42        0.39        0.42        0.01         XXX
                                                 2-8.
88188...........  .............  A............  Flowcytometry/read,         1.69        0.44        0.50        0.44        0.50        0.01         XXX
                                                 9-15.
88189...........  .............  A............  Flowcytometry/read,         2.23        0.47        0.61        0.47        0.61        0.01         XXX
                                                 16 & >.
88199...........  .............  C............  Cytopathology               0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 procedure.
88199...........  TC...........  C............  Cytopathology               0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 procedure.
88199...........  26...........  C............  Cytopathology               0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 procedure.
88291...........  .............  A............  Cyto/molecular              0.52        0.27        0.22        0.27        0.22        0.02         XXX
                                                 report.
88299...........  .............  C............  Cytogenetic study...        0.00        0.00        0.00        0.00        0.00        0.00         XXX
88300...........  .............  A............  Surgical path, gross        0.08        0.56        0.51          NA          NA        0.02         XXX
88300...........  TC...........  A............  Surgical path, gross        0.00        0.54        0.48          NA          NA        0.01         XXX
88300...........  26...........  A............  Surgical path, gross        0.08        0.02        0.03        0.02        0.03        0.01         XXX
88302...........  .............  A............  Tissue exam by              0.13        1.29        1.16          NA          NA        0.03         XXX
                                                 pathologist.
88302...........  TC...........  A............  Tissue exam by              0.00        1.25        1.11          NA          NA        0.02         XXX
                                                 pathologist.
88302...........  26...........  A............  Tissue exam by              0.13        0.04        0.05        0.04        0.05        0.01         XXX
                                                 pathologist.
88304...........  .............  A............  Tissue exam by              0.22        1.47        1.39          NA          NA        0.03         XXX
                                                 pathologist.
88304...........  TC...........  A............  Tissue exam by              0.00        1.41        1.32          NA          NA        0.02         XXX
                                                 pathologist.
88304...........  26...........  A............  Tissue exam by              0.22        0.06        0.07        0.06        0.07        0.01         XXX
                                                 pathologist.
88305...........  .............  A............  Tissue exam by              0.75        2.04        1.97          NA          NA        0.07         XXX
                                                 pathologist.
88305...........  TC...........  A............  Tissue exam by              0.00        1.84        1.71          NA          NA        0.04         XXX
                                                 pathologist.
88305...........  26...........  A............  Tissue exam by              0.75        0.20        0.26        0.20        0.26        0.03         XXX
                                                 pathologist.
88307...........  .............  A............  Tissue exam by              1.59        4.41        3.78          NA          NA        0.12         XXX
                                                 pathologist.
88307...........  TC...........  A............  Tissue exam by              0.00        3.94        3.20          NA          NA        0.06         XXX
                                                 pathologist.
88307...........  26...........  A............  Tissue exam by              1.59        0.47        0.58        0.47        0.58        0.06         XXX
                                                 pathologist.
88309...........  .............  A............  Tissue exam by              2.80        6.16        5.28          NA          NA        0.14         XXX
                                                 pathologist.
88309...........  TC...........  A............  Tissue exam by              0.00        5.34        4.38          NA          NA        0.06         XXX
                                                 pathologist.
88309...........  26...........  A............  Tissue exam by              2.80        0.82        0.90        0.82        0.90        0.08         XXX
                                                 pathologist.
88311...........  .............  A............  Decalcify tissue....        0.24        0.24        0.23          NA          NA        0.02         XXX
88311...........  TC...........  A............  Decalcify tissue....        0.00        0.17        0.15          NA          NA        0.01         XXX
88311...........  26...........  A............  Decalcify tissue....        0.24        0.07        0.08        0.07        0.08        0.01         XXX
88312...........  .............  A............  Special stains......        0.54        2.29        1.90          NA          NA        0.03         XXX

[[Page 66518]]

 
88312...........  TC...........  A............  Special stains......        0.00        2.15        1.72          NA          NA        0.01         XXX
88312...........  26...........  A............  Special stains......        0.54        0.14        0.18        0.14        0.18        0.02         XXX
88313...........  .............  A............  Special stains......        0.24        1.94        1.59          NA          NA        0.02         XXX
88313...........  TC...........  A............  Special stains......        0.00        1.88        1.51          NA          NA        0.01         XXX
88313...........  26...........  A............  Special stains......        0.24        0.06        0.08        0.06        0.08        0.01         XXX
88314...........  .............  A............  Histochemical stain.        0.45        1.96        2.00          NA          NA        0.04         XXX
88314...........  TC...........  A............  Histochemical stain.        0.00        1.82        1.84          NA          NA        0.02         XXX
88314...........  26...........  A............  Histochemical stain.        0.45        0.14        0.16        0.14        0.16        0.02         XXX
88318...........  .............  A............  Chemical                    0.42        2.94        2.29          NA          NA        0.03         XXX
                                                 histochemistry.
88318...........  TC...........  A............  Chemical                    0.00        2.82        2.14          NA          NA        0.01         XXX
                                                 histochemistry.
88318...........  26...........  A............  Chemical                    0.42        0.12        0.15        0.12        0.15        0.02         XXX
                                                 histochemistry.
88319...........  .............  A............  Enzyme                      0.53        3.22        3.32          NA          NA        0.04         XXX
                                                 histochemistry.
88319...........  TC...........  A............  Enzyme                      0.00        3.07        3.13          NA          NA        0.02         XXX
                                                 histochemistry.
88319...........  26...........  A............  Enzyme                      0.53        0.15        0.19        0.15        0.19        0.02         XXX
                                                 histochemistry.
88321...........  .............  A............  Microslide                  1.63        0.71        0.75        0.46        0.51        0.05         XXX
                                                 consultation.
88323...........  .............  A............  Microslide                  1.83        2.21        1.99          NA          NA        0.07         XXX
                                                 consultation.
88323...........  TC...........  A............  Microslide                  0.00        1.75        1.48          NA          NA        0.02         XXX
                                                 consultation.
88323...........  26...........  A............  Microslide                  1.83        0.46        0.51        0.46        0.51        0.05         XXX
                                                 consultation.
88325...........  .............  A............  Comprehensive review        2.50        2.40        2.66        0.69        0.82        0.07         XXX
                                                 of data.
88329...........  .............  A............  Path consult introp.        0.67        0.66        0.66        0.20        0.24        0.02         XXX
88331...........  .............  A............  Path consult                1.19        1.21        1.15          NA          NA        0.08         XXX
                                                 intraop, 1 bloc.
88331...........  TC...........  A............  Path consult                0.00        0.84        0.71          NA          NA        0.04         XXX
                                                 intraop, 1 bloc.
88331...........  26...........  A............  Path consult                1.19        0.37        0.44        0.37        0.44        0.04         XXX
                                                 intraop, 1 bloc.
88332...........  .............  A............  Path consult                0.59        0.48        0.46          NA          NA        0.04         XXX
                                                 intraop, add'l.
88332...........  TC...........  A............  Path consult                0.00        0.30        0.25          NA          NA        0.02         XXX
                                                 intraop, add'l.
88332...........  26...........  A............  Path consult                0.59        0.18        0.21        0.18        0.21        0.02         XXX
                                                 intraop, add'l.
88333...........  .............  A............  Intraop cyto path           1.20        1.32        1.20          NA          NA        0.08         XXX
                                                 consult, 1.
88333...........  TC...........  A............  Intraop cyto path           0.00        0.95        0.75          NA          NA        0.04         XXX
                                                 consult, 1.
88333...........  26...........  A............  Intraop cyto path           1.20        0.37        0.45        0.37        0.45        0.04         XXX
                                                 consult, 1.
88334...........  .............  A............  Intraop cyto path           0.73        0.78        0.69          NA          NA        0.04         XXX
                                                 consult, 2.
88334...........  TC...........  A............  Intraop cyto path           0.00        0.56        0.45          NA          NA        0.02         XXX
                                                 consult, 2.
88334...........  26...........  A............  Intraop cyto path           0.73        0.22        0.24        0.22        0.24        0.02         XXX
                                                 consult, 2.
88342...........  .............  A............  Immunohistochemistry        0.85        1.99        1.72          NA          NA        0.05         XXX
88342...........  TC...........  A............  Immunohistochemistry        0.00        1.77        1.43          NA          NA        0.02         XXX
88342...........  26...........  A............  Immunohistochemistry        0.85        0.22        0.29        0.22        0.29        0.03         XXX
88346...........  .............  A............  Immunofluorescent           0.86        1.91        1.73          NA          NA        0.05         XXX
                                                 study.
88346...........  TC...........  A............  Immunofluorescent           0.00        1.68        1.44          NA          NA        0.02         XXX
                                                 study.
88346...........  26...........  A............  Immunofluorescent           0.86        0.23        0.29        0.23        0.29        0.03         XXX
                                                 study.
88347...........  .............  A............  Immunofluorescent           0.86        1.31        1.29          NA          NA        0.05         XXX
                                                 study.
88347...........  TC...........  A............  Immunofluorescent           0.00        1.13        1.02          NA          NA        0.02         XXX
                                                 study.
88347...........  26...........  A............  Immunofluorescent           0.86        0.18        0.27        0.18        0.27        0.03         XXX
                                                 study.
88348...........  .............  A............  Electron microscopy.        1.51       18.24       13.79          NA          NA        0.13         XXX
88348...........  TC...........  A............  Electron microscopy.        0.00       17.82       13.26          NA          NA        0.07         XXX
88348...........  26...........  A............  Electron microscopy.        1.51        0.42        0.53        0.42        0.53        0.06         XXX
88349...........  .............  A............  Scanning electron           0.76        9.39        6.47          NA          NA        0.09         XXX
                                                 microscopy.
88349...........  TC...........  A............  Scanning electron           0.00        9.16        6.19          NA          NA        0.06         XXX
                                                 microscopy.
88349...........  26...........  A............  Scanning electron           0.76        0.23        0.28        0.23        0.28        0.03         XXX
                                                 microscopy.
88355...........  .............  A............  Analysis, skeletal          1.85        3.22        5.99          NA          NA        0.13         XXX
                                                 muscle.
88355...........  TC...........  A............  Analysis, skeletal          0.00        2.85        5.41          NA          NA        0.06         XXX
                                                 muscle.
88355...........  26...........  A............  Analysis, skeletal          1.85        0.37        0.58        0.37        0.58        0.07         XXX
                                                 muscle.
88356...........  .............  A............  Analysis, nerve.....        3.02        5.35        4.77          NA          NA        0.19         XXX
88356...........  TC...........  A............  Analysis, nerve.....        0.00        4.77        3.85          NA          NA        0.07         XXX
88356...........  26...........  A............  Analysis, nerve.....        3.02        0.58        0.92        0.58        0.92        0.12         XXX
88358...........  .............  A............  Analysis, tumor.....        0.95        1.10        0.97          NA          NA        0.17         XXX
88358...........  TC...........  A............  Analysis, tumor.....        0.00        0.94        0.69          NA          NA        0.07         XXX
88358...........  26...........  A............  Analysis, tumor.....        0.95        0.16        0.28        0.16        0.28        0.10         XXX
88360...........  .............  A............  Tumor                       1.10        2.22        1.97          NA          NA        0.08         XXX
                                                 immunohistochem/
                                                 manual.
88360...........  TC...........  A............  Tumor                       0.00        1.95        1.60          NA          NA        0.02         XXX
                                                 immunohistochem/
                                                 manual.
88360...........  26...........  A............  Tumor                       1.10        0.27        0.37        0.27        0.37        0.06         XXX
                                                 immunohistochem/
                                                 manual.
88361...........  .............  A............  Tumor                       1.18        2.79        2.91          NA          NA        0.17         XXX
                                                 immunohistochem/
                                                 comput.
88361...........  TC...........  A............  Tumor                       0.00        2.52        2.53          NA          NA        0.07         XXX
                                                 immunohistochem/
                                                 comput.
88361...........  26...........  A............  Tumor                       1.18        0.27        0.38        0.27        0.38        0.10         XXX
                                                 immunohistochem/
                                                 comput.
88362...........  .............  A............  Nerve teasing               2.17        4.99        4.84          NA          NA        0.15         XXX
                                                 preparations.
88362...........  TC...........  A............  Nerve teasing               0.00        4.42        4.09          NA          NA        0.06         XXX
                                                 preparations.
88362...........  26...........  A............  Nerve teasing               2.17        0.57        0.75        0.57        0.75        0.09         XXX
                                                 preparations.
88365...........  .............  A............  Insitu hybridization        1.20        3.34        2.73          NA          NA        0.05         XXX
                                                 (fish).
88365...........  TC...........  A............  Insitu hybridization        0.00        3.04        2.33          NA          NA        0.02         XXX
                                                 (fish).
88365...........  26...........  A............  Insitu hybridization        1.20        0.30        0.40        0.30        0.40        0.03         XXX
                                                 (fish).
88367...........  .............  A............  Insitu                      1.30        5.15        4.59          NA          NA        0.12         XXX
                                                 hybridization, auto.
88367...........  TC...........  A............  Insitu                      0.00        4.93        4.21          NA          NA        0.06         XXX
                                                 hybridization, auto.
88367...........  26...........  A............  Insitu                      1.30        0.22        0.38        0.22        0.38        0.06         XXX
                                                 hybridization, auto.
88368...........  .............  A............  Insitu                      1.40        4.97        3.69          NA          NA        0.12         XXX
                                                 hybridization,
                                                 manual.

[[Page 66519]]

 
88368...........  TC...........  A............  Insitu                      0.00        4.72        3.26          NA          NA        0.06         XXX
                                                 hybridization,
                                                 manual.
88368...........  26...........  A............  Insitu                      1.40        0.25        0.43        0.25        0.43        0.06         XXX
                                                 hybridization,
                                                 manual.
88371...........  26...........  A............  Protein, western            0.37        0.10        0.12        0.10        0.12        0.01         XXX
                                                 blot tissue.
88372...........  26...........  A............  Protein analysis w/         0.37        0.12        0.14        0.12        0.14        0.01         XXX
                                                 probe.
88380...........  .............  A............  Microdissection,            1.56        2.65        2.65          NA          NA        0.14         XXX
                                                 laser.
88380...........  TC...........  A............  Microdissection,            0.00        2.22        2.22          NA          NA        0.07         XXX
                                                 laser.
88380...........  26...........  A............  Microdissection,            1.56        0.43        0.43        0.43        0.43        0.07         XXX
                                                 laser.
88381...........  .............  A............  Microdissection,            1.18        4.47        4.47          NA          NA        0.08         XXX
                                                 manual.
88381...........  TC...........  A............  Microdissection,            0.00        4.15        4.15          NA          NA        0.02         XXX
                                                 manual.
88381...........  26...........  A............  Microdissection,            1.18        0.32        0.32        0.32        0.32        0.06         XXX
                                                 manual.
88384...........  .............  C............  Eval molecular              0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 probes, 11-50.
88384...........  TC...........  C............  Eval molecular              0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 probes, 11-50.
88384...........  26...........  C............  Eval molecular              0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 probes, 11-50.
88385...........  .............  A............  Eval molecul probes,        1.50       15.53       11.31          NA          NA        0.12         XXX
                                                 51-250.
88385...........  TC...........  A............  Eval molecul probes,        0.00       15.26       10.85          NA          NA        0.06         XXX
                                                 51-250.
88385...........  26...........  A............  Eval molecul probes,        1.50        0.27        0.46        0.27        0.46        0.06         XXX
                                                 51-250.
88386...........  .............  A............  Eval molecul probes,        1.88       15.44       11.24          NA          NA        0.16         XXX
                                                 251-500.
88386...........  TC...........  A............  Eval molecul probes,        0.00       15.10       10.66          NA          NA        0.08         XXX
                                                 251-500.
88386...........  26...........  A............  Eval molecul probes,        1.88        0.34        0.58        0.34        0.58        0.08         XXX
                                                 251-500.
88399...........  .............  C............  Surgical pathology          0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 procedure.
88399...........  TC...........  C............  Surgical pathology          0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 procedure.
88399...........  26...........  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        3.55        0.19        0.23        0.06         XXX
                                                 hyperthermia.
89060...........  26...........  A............  Exam,synovial fluid         0.37        0.12        0.14        0.12        0.14        0.01         XXX
                                                 crystals.
89100...........  .............  A............  Sample intestinal           0.60        7.89        4.86        0.54        0.37        0.03         XXX
                                                 contents.
89105...........  .............  A............  Sample intestinal           0.50        7.84        5.03        0.46        0.31        0.02         XXX
                                                 contents.
89130...........  .............  A............  Sample stomach              0.45        6.54        4.14        0.38        0.25        0.02         XXX
                                                 contents.
89132...........  .............  A............  Sample stomach              0.19        8.38        4.96        0.39        0.22        0.01         XXX
                                                 contents.
89135...........  .............  A............  Sample stomach              0.79        8.82        5.36        0.67        0.46        0.04         XXX
                                                 contents.
89136...........  .............  A............  Sample stomach              0.21        5.94        3.84        0.26        0.18        0.01         XXX
                                                 contents.
89140...........  .............  A............  Sample stomach              0.94        6.22        4.15        0.43        0.35        0.04         XXX
                                                 contents.
89141...........  .............  A............  Sample stomach              0.85        6.36        4.57        0.49        0.41        0.03         XXX
                                                 contents.
89220...........  .............  A............  Sputum specimen             0.00        0.37        0.40          NA          NA        0.02         XXX
                                                 collection.
89230...........  .............  A............  Collect sweat for           0.00        0.07        0.09          NA          NA        0.02         XXX
                                                 test.
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
90284...........  .............  X............  Human ig, sc........        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        0.44        0.38          NA          NA        0.01         XXX
                                                 < 8 yrs.
90466...........  .............  A............  Immune admin addl           0.15        0.12        0.12        0.04        0.08        0.01         ZZZ
                                                 inj, < 8 y.
90467...........  .............  R............  Immune admin o or n,        0.17        0.17        0.17        0.07        0.08        0.01         XXX
                                                 < 8 yrs.
90468...........  .............  R............  Immune admin o/n,           0.15        0.11        0.11        0.04        0.05        0.01         ZZZ
                                                 addl < 8 y.
90471...........  .............  A............  Immunization admin..        0.17        0.44        0.38          NA          NA        0.01         XXX
90472...........  .............  A............  Immunization admin,         0.15        0.12        0.13        0.04        0.08        0.01         ZZZ
                                                 each add.
90473...........  .............  R............  Immune admin oral/          0.17        0.17        0.18        0.04        0.06        0.01         XXX
                                                 nasal.
90474...........  .............  R............  Immune admin oral/          0.15        0.08        0.09        0.04        0.05        0.01         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/            0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 adol, 2 dose.
90634...........  .............  E............  Hep a vacc, ped/            0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 adol, 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,          0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 im.

[[Page 66520]]

 
90646...........  .............  E............  Hib vaccine, prp-d,         0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 im.
90647...........  .............  E............  Hib vaccine, prp-           0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 omp, im.
90648...........  .............  E............  Hib vaccine, prp-t,         0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 im.
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              0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 preserv 6-35m.
90656...........  .............  X............  Flu vaccine no              0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 preserv 3 & >.
90657...........  .............  X............  Flu vaccine, 3 yrs,         0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 im.
90658...........  .............  X............  Flu vaccine, 3 yrs &        0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 >, im.
90660...........  .............  X............  Flu vaccine, nasal..        0.00        0.00        0.00        0.00        0.00        0.00         XXX
90661...........  .............  X............  Flu vacc cell cult          0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 prsv free.
90662...........  .............  X............  Flu vacc prsv free          0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 inc antig.
90663...........  .............  X............  Flu vacc pandemic...        0.00        0.00        0.00        0.00        0.00        0.00         XXX
90665...........  .............  E............  Lyme disease                0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 vaccine, im.
90669...........  .............  X............  Pneumococcal vacc,          0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 ped <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            0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 dose, oral.
90690...........  .............  E............  Typhoid vaccine,            0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 oral.
90691...........  .............  E............  Typhoid vaccine, im.        0.00        0.00        0.00        0.00        0.00        0.00         XXX
90692...........  .............  E............  Typhoid vaccine, h-         0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 p, sc/id.
90693...........  .............  E............  Typhoid vaccine,            0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 akd, 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           0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 yrs, 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/        0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 im.
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                0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 vaccine, sc.
90718...........  .............  E............  Td vaccine > 7, im..        0.00        0.00        0.00        0.00        0.00        0.00         XXX
90719...........  .............  E............  Diphtheria vaccine,         0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 im.
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               0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 vaccine, sc.
90734...........  .............  E............  Meningococcal               0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 vaccine, im.
90735...........  .............  E............  Encephalitis                0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 vaccine, 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,              0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 adult, 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,          0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 im.
90749...........  .............  E............  Vaccine toxoid......        0.00        0.00        0.00        0.00        0.00        0.00         XXX
90760...........  .............  A............  Hydration iv                0.17        1.32        1.37          NA          NA        0.07         XXX
                                                 infusion, init.
90761...........  .............  A............  Hydrate iv infusion,        0.09        0.32        0.36          NA          NA        0.04         ZZZ
                                                 add-on.
90765...........  .............  A............  Ther/proph/diag iv          0.21        1.62        1.69          NA          NA        0.07         XXX
                                                 inf, init.
90766...........  .............  A............  Ther/proph/dg iv            0.18        0.37        0.42          NA          NA        0.04         ZZZ
                                                 inf, add-on.
90767...........  .............  A............  Tx/proph/dg addl seq        0.19        0.69        0.79          NA          NA        0.04         ZZZ
                                                 iv inf.
90768...........  .............  A............  Ther/diag concurrent        0.17        0.33        0.39          NA          NA        0.04         ZZZ
                                                 inf.
90769...........  .............  A............  Sc ther infusion, up        0.21        3.92        3.92          NA          NA        0.06         XXX
                                                 to 1 hr.
90770...........  .............  A............  Sc ther infusion,           0.18        0.22        0.22          NA          NA        0.04         ZZZ
                                                 addl hr.
90771...........  .............  A............  Sc ther infusion,           0.00        1.86        1.86          NA          NA        0.01         ZZZ
                                                 reset pump.
90772...........  .............  A............  Ther/proph/diag inj,        0.17        0.44        0.38          NA          NA        0.01         XXX
                                                 sc/im.
90773...........  .............  A............  Ther/proph/diag inj,        0.17        0.30        0.31          NA          NA        0.02         XXX
                                                 ia.
90774...........  .............  A............  Ther/proph/diag inj,        0.18        1.33        1.31          NA          NA        0.04         XXX
                                                 iv push.
90775...........  .............  A............  Tx/pro/dx inj new           0.10        0.51        0.54          NA          NA        0.04         ZZZ
                                                 drug addon.
90776...........  .............  X............  Tx/pro/dx inj same          0.00        0.00        0.00        0.00        0.00        0.00         ZZZ
                                                 drug adon.
90779...........  .............  C............  Ther/prop/diag inj/         0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 inf proc.

[[Page 66521]]

 
90801...........  .............  A............  Psy dx interview....        2.80        1.49        1.33        0.60        0.76        0.06         XXX
90802...........  .............  A............  Intac psy dx                3.01        1.54        1.37        0.68        0.83        0.07         XXX
                                                 interview.
90804...........  .............  A............  Psytx, office, 20-30        1.21        0.56        0.52        0.21        0.30        0.03         XXX
                                                 min.
90805...........  .............  A............  Psytx, off, 20-30           1.37        0.60        0.55        0.24        0.33        0.03         XXX
                                                 min w/e&m.
90806...........  .............  A............  Psytx, off, 45-50           1.86        0.53        0.61        0.33        0.46        0.04         XXX
                                                 min.
90807...........  .............  A............  Psytx, off, 45-50           2.02        0.70        0.70        0.35        0.49        0.05         XXX
                                                 min w/e&m.
90808...........  .............  A............  Psytx, office, 75-80        2.79        0.69        0.86        0.49        0.69        0.06         XXX
                                                 min.
90809...........  .............  A............  Psytx, off, 75-80, w/       2.95        0.86        0.93        0.52        0.72        0.07         XXX
                                                 e&m.
90810...........  .............  A............  Intac psytx, off, 20-       1.32        0.54        0.52        0.23        0.33        0.04         XXX
                                                 30 min.
90811...........  .............  A............  Intac psytx, 20-30,         1.48        0.72        0.64        0.26        0.36        0.04         XXX
                                                 w/e&m.
90812...........  .............  A............  Intac psytx, off, 45-       1.97        0.65        0.72        0.34        0.49        0.04         XXX
                                                 50 min.
90813...........  .............  A............  Intac psytx, 45-50          2.13        0.83        0.80        0.37        0.52        0.05         XXX
                                                 min w/e&m.
90814...........  .............  A............  Intac psytx, off, 75-       2.90        0.81        0.95        0.53        0.75        0.06         XXX
                                                 80 min.
90815...........  .............  A............  Intac psytx, 75-80 w/       3.06        0.99        1.02        0.53        0.74        0.07         XXX
                                                 e&m.
90816...........  .............  A............  Psytx, hosp, 20-30          1.25          NA          NA        0.32        0.39        0.03         XXX
                                                 min.
90817...........  .............  A............  Psytx, hosp, 20-30          1.41          NA          NA        0.35        0.40        0.03         XXX
                                                 min w/e&m.
90818...........  .............  A............  Psytx, hosp, 45-50          1.89          NA          NA        0.44        0.56        0.04         XXX
                                                 min.
90819...........  .............  A............  Psytx, hosp, 45-50          2.05          NA          NA        0.46        0.55        0.05         XXX
                                                 min w/e&m.
90821...........  .............  A............  Psytx, hosp, 75-80          2.83          NA          NA        0.60        0.80        0.06         XXX
                                                 min.
90822...........  .............  A............  Psytx, hosp, 75-80          2.99          NA          NA        0.62        0.79        0.08         XXX
                                                 min w/e&m.
90823...........  .............  A............  Intac psytx, hosp,          1.36          NA          NA        0.35        0.41        0.03         XXX
                                                 20-30 min.
90824...........  .............  A............  Intac psytx, hsp 20-        1.52          NA          NA        0.37        0.43        0.04         XXX
                                                 30 w/e&m.
90826...........  .............  A............  Intac psytx, hosp,          2.01          NA          NA        0.46        0.59        0.05         XXX
                                                 45-50 min.
90827...........  .............  A............  Intac psytx, hsp 45-        2.16          NA          NA        0.48        0.58        0.05         XXX
                                                 50 w/e&m.
90828...........  .............  A............  Intac psytx, hosp,          2.94          NA          NA        0.62        0.84        0.06         XXX
                                                 75-80 min.
90829...........  .............  A............  Intac psytx, hsp 75-        3.10          NA          NA        0.64        0.81        0.07         XXX
                                                 80 w/e&m.
90845...........  .............  A............  Psychoanalysis......        1.79        0.39        0.48        0.32        0.43        0.04         XXX
90846...........  .............  R............  Family psytx w/o            1.83        0.51        0.58        0.42        0.54        0.04         XXX
                                                 patient.
90847...........  .............  R............  Family psytx w/             2.21        0.74        0.78        0.49        0.63        0.05         XXX
                                                 patient.
90849...........  .............  R............  Multiple family             0.59        0.33        0.30        0.21        0.22        0.02         XXX
                                                 group psytx.
90853...........  .............  A............  Group psychotherapy.        0.59        0.26        0.26        0.20        0.21        0.01         XXX
90857...........  .............  A............  Intac group psytx...        0.63        0.38        0.33        0.21        0.23        0.01         XXX
90862...........  .............  A............  Medication                  0.95        0.62        0.51        0.27        0.29        0.02         XXX
                                                 management.
90865...........  .............  A............  Narcosynthesis......        2.84        1.16        1.26        0.63        0.77        0.12         XXX
90870...........  .............  A............  Electroconvulsive           1.88        1.92        1.93        0.38        0.48        0.04         000
                                                 therapy.
90875...........  .............  N............  Psychophysiological         1.20        0.53        0.71        0.28        0.37        0.04         XXX
                                                 therapy.
90876...........  .............  N............  Psychophysiological         1.90        0.67        0.91        0.44        0.58        0.05         XXX
                                                 therapy.
90880...........  .............  A............  Hypnotherapy........        2.19        0.57        0.81        0.39        0.54        0.05         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        0.22        0.30        0.22        0.30        0.02         XXX
                                                 records.
90887...........  .............  B............  Consultation with           1.48        0.61        0.71        0.34        0.45        0.04         XXX
                                                 family.
90889...........  .............  B............  Preparation of              0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 report.
90899...........  .............  C............  Psychiatric service/        0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 therapy.
90901...........  .............  A............  Biofeedback train,          0.41        0.46        0.56        0.10        0.12        0.02         000
                                                 any meth.
90911...........  .............  A............  Biofeedback peri/uro/       0.89        1.37        1.46        0.30        0.30        0.06         000
                                                 rectal.
90918...........  .............  I............  ESRD related               11.16        4.70        5.40        3.74        4.92        0.36         XXX
                                                 services, month.
90919...........  .............  I............  ESRD related                8.53        3.03        3.51        2.55        3.27        0.29         XXX
                                                 services, month.
90920...........  .............  I............  ESRD related                7.26        2.73        3.24        2.26        3.01        0.23         XXX
                                                 services, month.
90921...........  .............  I............  ESRD related                4.46        1.71        2.07        1.61        2.03        0.14         XXX
                                                 services, month.
90922...........  .............  I............  ESRD related                0.37        0.16        0.18        0.13        0.17        0.01         XXX
                                                 services, day.
90923...........  .............  I............  Esrd related                0.28        0.10        0.11        0.08        0.11        0.01         XXX
                                                 services, day.
90924...........  .............  I............  Esrd related                0.24        0.09        0.10        0.07        0.10        0.01         XXX
                                                 services, day.
90925...........  .............  I............  Esrd related                0.15        0.05        0.07        0.05        0.07        0.01         XXX
                                                 services, day.
90935...........  .............  A............  Hemodialysis, one           1.22          NA          NA        0.53        0.60        0.04         000
                                                 evaluation.
90937...........  .............  A............  Hemodialysis,               2.11          NA          NA        0.77        0.87        0.07         000
                                                 repeated 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          NA        0.55        0.62        0.04         000
                                                 evaluation.
90947...........  .............  A............  Dialysis, repeated          2.16          NA          NA        0.79        0.89        0.07         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          NA        0.50        0.58        0.06         000
90999...........  .............  C............  Dialysis procedure..        0.00        0.00        0.00        0.00        0.00        0.00         XXX
91000...........  .............  A............  Esophageal                  0.73        2.13        1.23          NA          NA        0.04         000
                                                 intubation.
91000...........  TC...........  A............  Esophageal                  0.00        1.91        0.99          NA          NA        0.01         000
                                                 intubation.
91000...........  26...........  A............  Esophageal                  0.73        0.22        0.24        0.22        0.24        0.03         000
                                                 intubation.
91010...........  .............  A............  Esophagus motility          1.25        3.67        4.03          NA          NA        0.12         000
                                                 study.
91010...........  TC...........  A............  Esophagus motility          0.00        3.12        3.54          NA          NA        0.06         000
                                                 study.
91010...........  26...........  A............  Esophagus motility          1.25        0.55        0.49        0.55        0.49        0.06         000
                                                 study.
91011...........  .............  A............  Esophagus motility          1.50        5.37        5.29          NA          NA        0.13         000
                                                 study.
91011...........  TC...........  A............  Esophagus motility          0.00        4.65        4.67          NA          NA        0.06         000
                                                 study.
91011...........  26...........  A............  Esophagus motility          1.50        0.72        0.62        0.72        0.62        0.07         000
                                                 study.
91012...........  .............  A............  Esophagus motility          1.46        5.44        5.60          NA          NA        0.13         000
                                                 study.

[[Page 66522]]

 
91012...........  TC...........  A............  Esophagus motility          0.00        4.76        5.00          NA          NA        0.07         000
                                                 study.
91012...........  26...........  A............  Esophagus motility          1.46        0.68        0.60        0.68        0.60        0.06         000
                                                 study.
91020...........  .............  A............  Gastric motility            1.44        4.81        4.66          NA          NA        0.13         000
                                                 studies.
91020...........  TC...........  A............  Gastric motility            0.00        4.20        4.11          NA          NA        0.06         000
                                                 studies.
91020...........  26...........  A............  Gastric motility            1.44        0.61        0.55        0.61        0.55        0.07         000
                                                 studies.
91022...........  .............  A............  Duodenal motility           1.44        3.13        3.76          NA          NA        0.13         000
                                                 study.
91022...........  TC...........  A............  Duodenal motility           0.00        2.51        3.20          NA          NA        0.06         000
                                                 study.
91022...........  26...........  A............  Duodenal motility           1.44        0.62        0.56        0.62        0.56        0.07         000
                                                 study.
91030...........  .............  A............  Acid perfusion of           0.91        2.90        2.66          NA          NA        0.06         000
                                                 esophagus.
91030...........  TC...........  A............  Acid perfusion of           0.00        2.48        2.29          NA          NA        0.02         000
                                                 esophagus.
91030...........  26...........  A............  Acid perfusion of           0.91        0.42        0.37        0.42        0.37        0.04         000
                                                 esophagus.
91034...........  .............  A............  Gastroesophageal            0.97        4.15        4.69          NA          NA        0.12         000
                                                 reflux test.
91034...........  TC...........  A............  Gastroesophageal            0.00        3.73        4.31          NA          NA        0.06         000
                                                 reflux test.
91034...........  26...........  A............  Gastroesophageal            0.97        0.42        0.38        0.42        0.38        0.06         000
                                                 reflux test.
91035...........  .............  A............  G-esoph reflx tst w/        1.59       11.37       11.08          NA          NA        0.12         000
                                                 electrod.
91035...........  TC...........  A............  G-esoph reflx tst w/        0.00       10.67       10.45          NA          NA        0.06         000
                                                 electrod.
91035...........  26...........  A............  G-esoph reflx tst w/        1.59        0.70        0.63        0.70        0.63        0.06         000
                                                 electrod.
91037...........  .............  A............  Esoph imped function        0.97        3.47        3.20          NA          NA        0.12         000
                                                 test.
91037...........  TC...........  A............  Esoph imped function        0.00        3.03        2.81          NA          NA        0.06         000
                                                 test.
91037...........  26...........  A............  Esoph imped function        0.97        0.44        0.39        0.44        0.39        0.06         000
                                                 test.
91038...........  .............  A............  Esoph imped funct           1.10        2.80        2.52          NA          NA        0.12         000
                                                 test > 1h.
91038...........  TC...........  A............  Esoph imped funct           0.00        2.30        2.07          NA          NA        0.06         000
                                                 test > 1h.
91038...........  26...........  A............  Esoph imped funct           1.10        0.50        0.45        0.50        0.45        0.06         000
                                                 test > 1h.
91040...........  .............  A............  Esoph balloon               0.97        7.72        9.42          NA          NA        0.12         000
                                                 distension tst.
91040...........  TC...........  A............  Esoph balloon               0.00        7.44        9.11          NA          NA        0.06         000
                                                 distension tst.
91040...........  26...........  A............  Esoph balloon               0.97        0.28        0.31        0.28        0.31        0.06         000
                                                 distension tst.
91052...........  .............  A............  Gastric analysis            0.79        2.92        2.68          NA          NA        0.05         000
                                                 test.
91052...........  TC...........  A............  Gastric analysis            0.00        2.55        2.36          NA          NA        0.02         000
                                                 test.
91052...........  26...........  A............  Gastric analysis            0.79        0.37        0.32        0.37        0.32        0.03         000
                                                 test.
91055...........  .............  A............  Gastric intubation          0.94        2.57        2.76          NA          NA        0.07         000
                                                 for smear.
91055...........  TC...........  A............  Gastric intubation          0.00        2.28        2.48          NA          NA        0.02         000
                                                 for smear.
91055...........  26...........  A............  Gastric intubation          0.94        0.29        0.28        0.29        0.28        0.05         000
                                                 for smear.
91065...........  .............  A............  Breath hydrogen test        0.20        1.33        1.40          NA          NA        0.03         000
91065...........  TC...........  A............  Breath hydrogen test        0.00        1.27        1.33          NA          NA        0.02         000
91065...........  26...........  A............  Breath hydrogen test        0.20        0.06        0.07        0.06        0.07        0.01         000
91100...........  .............  A............  Pass intestine              1.08        2.14        2.46        0.32        0.30        0.07         000
                                                 bleeding tube.
91105...........  .............  A............  Gastric intubation          0.37        1.67        1.89        0.07        0.08        0.03         000
                                                 treatment.
91110...........  .............  A............  Gi tract capsule            3.64       20.63       21.40          NA          NA        0.16         XXX
                                                 endoscopy.
91110...........  TC...........  A............  Gi tract capsule            0.00       18.97       19.93          NA          NA        0.07         XXX
                                                 endoscopy.
91110...........  26...........  A............  Gi tract capsule            3.64        1.66        1.47        1.66        1.47        0.09         XXX
                                                 endoscopy.
91111...........  .............  A............  Esophageal capsule          1.00       18.82       18.82          NA          NA        0.05         XXX
                                                 endoscopy.
91111...........  TC...........  A............  Esophageal capsule          0.00       18.37       18.37          NA          NA        0.02         XXX
                                                 endoscopy.
91111...........  26...........  A............  Esophageal capsule          1.00        0.45        0.45        0.45        0.45        0.03         XXX
                                                 endoscopy.
91120...........  .............  A............  Rectal sensation            0.97        8.88        9.92          NA          NA        0.11         XXX
                                                 test.
91120...........  TC...........  A............  Rectal sensation            0.00        8.61        9.62          NA          NA        0.04         XXX
                                                 test.
91120...........  26...........  A............  Rectal sensation            0.97        0.27        0.30        0.27        0.30        0.07         XXX
                                                 test.
91122...........  .............  A............  Anal pressure record        1.77        4.30        4.70          NA          NA        0.21         000
91122...........  TC...........  A............  Anal pressure record        0.00        3.68        4.09          NA          NA        0.08         000
91122...........  26...........  A............  Anal pressure record        1.77        0.62        0.61        0.62        0.61        0.13         000
91123...........  .............  B............  Irrigate fecal              0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 impaction.
91132...........  .............  C............  Electrogastrography.        0.00        0.00        0.00          NA          NA        0.00         XXX
91132...........  TC...........  C............  Electrogastrography.        0.00        0.00        0.00          NA          NA        0.00         XXX
91132...........  26...........  A............  Electrogastrography.        0.52        0.25        0.22        0.25        0.22        0.02         XXX
91133...........  .............  C............  Electrogastrography         0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 w/test.
91133...........  TC...........  C............  Electrogastrography         0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 w/test.
91133...........  26...........  A............  Electrogastrography         0.66        0.32        0.28        0.32        0.28        0.03         XXX
                                                 w/test.
91299...........  .............  C............  Gastroenterology            0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 procedure.
91299...........  TC...........  C............  Gastroenterology            0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 procedure.
91299...........  26...........  C............  Gastroenterology            0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 procedure.
92002...........  .............  A............  Eye exam, new               0.88        0.93        0.95        0.25        0.30        0.02         XXX
                                                 patient.
92004...........  .............  A............  Eye exam, new               1.82        1.57        1.63        0.55        0.62        0.04         XXX
                                                 patient.
92012...........  .............  A............  Eye exam established        0.92        0.99        1.01        0.31        0.30        0.02         XXX
                                                 pat.
92014...........  .............  A............  Eye exam & treatment        1.42        1.37        1.39        0.46        0.46        0.03         XXX
92015...........  .............  N............  Refraction..........        0.38        0.10        0.79        0.09        0.12        0.01         XXX
92018...........  .............  A............  New eye exam &              2.50          NA          NA        0.86        0.96        0.07         XXX
                                                 treatment.
92019...........  .............  A............  Eye exam & treatment        1.31          NA          NA        0.35        0.46        0.03         XXX
92020...........  .............  A............  Special eye                 0.37        0.25        0.29        0.13        0.14        0.01         XXX
                                                 evaluation.
92025...........  .............  A............  Corneal topography..        0.35        0.49        0.49          NA          NA        0.02         XXX
92025...........  TC...........  A............  Corneal topography..        0.00        0.37        0.37          NA          NA        0.01         XXX
92025...........  26...........  A............  Corneal topography..        0.35        0.12        0.12        0.12        0.12        0.01         XXX
92060...........  .............  A............  Special eye                 0.69        0.76        0.75          NA          NA        0.03         XXX
                                                 evaluation.
92060...........  TC...........  A............  Special eye                 0.00        0.54        0.49          NA          NA        0.01         XXX
                                                 evaluation.

[[Page 66523]]

 
92060...........  26...........  A............  Special eye                 0.69        0.22        0.26        0.22        0.26        0.02         XXX
                                                 evaluation.
92065...........  .............  A............  Orthoptic/pleoptic          0.37        0.86        0.69          NA          NA        0.02         XXX
                                                 training.
92065...........  TC...........  A............  Orthoptic/pleoptic          0.00        0.77        0.57          NA          NA        0.01         XXX
                                                 training.
92065...........  26...........  A............  Orthoptic/pleoptic          0.37        0.09        0.12        0.09        0.12        0.01         XXX
                                                 training.
92070...........  .............  A............  Fitting of contact          0.70        0.90        0.98        0.22        0.27        0.02         XXX
                                                 lens.
92081...........  .............  A............  Visual field                0.36        0.95        0.94          NA          NA        0.02         XXX
                                                 examination(s).
92081...........  TC...........  A............  Visual field                0.00        0.84        0.81          NA          NA        0.01         XXX
                                                 examination(s).
92081...........  26...........  A............  Visual field                0.36        0.11        0.13        0.11        0.13        0.01         XXX
                                                 examination(s).
92082...........  .............  A............  Visual field                0.44        1.32        1.27          NA          NA        0.02         XXX
                                                 examination(s).
92082...........  TC...........  A............  Visual field                0.00        1.18        1.11          NA          NA        0.01         XXX
                                                 examination(s).
92082...........  26...........  A............  Visual field                0.44        0.14        0.16        0.14        0.16        0.01         XXX
                                                 examination(s).
92083...........  .............  A............  Visual field                0.50        1.51        1.47          NA          NA        0.02         XXX
                                                 examination(s).
92083...........  TC...........  A............  Visual field                0.00        1.35        1.28          NA          NA        0.01         XXX
                                                 examination(s).
92083...........  26...........  A............  Visual field                0.50        0.16        0.19        0.16        0.19        0.01         XXX
                                                 examination(s).
92100...........  .............  A............  Serial tonometry            0.92        1.24        1.29        0.27        0.32        0.02         XXX
                                                 exam(s).
92120...........  .............  A............  Tonography & eye            0.81        0.97        1.02        0.25        0.28        0.02         XXX
                                                 evaluation.
92130...........  .............  A............  Water provocation           0.81        1.18        1.23        0.27        0.32        0.02         XXX
                                                 tonography.
92135...........  .............  A............  Ophth dx imaging            0.35        0.79        0.78          NA          NA        0.02         XXX
                                                 post seg.
92135...........  TC...........  A............  Ophth dx imaging            0.00        0.67        0.65          NA          NA        0.01         XXX
                                                 post seg.
92135...........  26...........  A............  Ophth dx imaging            0.35        0.12        0.13        0.12        0.13        0.01         XXX
                                                 post seg.
92136...........  .............  A............  Ophthalmic biometry.        0.54        1.42        1.54          NA          NA        0.08         XXX
92136...........  TC...........  A............  Ophthalmic biometry.        0.00        1.23        1.32          NA          NA        0.07         XXX
92136...........  26...........  A............  Ophthalmic biometry.        0.54        0.19        0.22        0.19        0.22        0.01         XXX
92140...........  .............  A............  Glaucoma provocative        0.50        0.89        0.94        0.14        0.18        0.01         XXX
                                                 tests.
92225...........  .............  A............  Special eye exam,           0.38        0.24        0.23        0.12        0.14        0.01         XXX
                                                 initial.
92226...........  .............  A............  Special eye exam,           0.33        0.23        0.22        0.11        0.13        0.01         XXX
                                                 subsequent.
92230...........  .............  A............  Eye exam with photos        0.60        0.68        1.10        0.19        0.19        0.02         XXX
92235...........  .............  A............  Eye exam with photos        0.81        2.26        2.44          NA          NA        0.08         XXX
92235...........  TC...........  A............  Eye exam with photos        0.00        1.97        2.11          NA          NA        0.06         XXX
92235...........  26...........  A............  Eye exam with photos        0.81        0.29        0.33        0.29        0.33        0.02         XXX
92240...........  .............  A............  Icg angiography.....        1.10        4.38        5.23          NA          NA        0.09         XXX
92240...........  TC...........  A............  Icg angiography.....        0.00        3.99        4.79          NA          NA        0.06         XXX
92240...........  26...........  A............  Icg angiography.....        1.10        0.39        0.44        0.39        0.44        0.03         XXX
92250...........  .............  A............  Eye exam with photos        0.44        1.30        1.41          NA          NA        0.02         XXX
92250...........  TC...........  A............  Eye exam with photos        0.00        1.16        1.25          NA          NA        0.01         XXX
92250...........  26...........  A............  Eye exam with photos        0.44        0.14        0.16        0.14        0.16        0.01         XXX
92260...........  .............  A............  Ophthalmoscopy/             0.20        0.23        0.24        0.07        0.08        0.01         XXX
                                                 dynamometry.
92265...........  .............  A............  Eye muscle                  0.81        1.00        1.24          NA          NA        0.06         XXX
                                                 evaluation.
92265...........  TC...........  A............  Eye muscle                  0.00        0.76        0.98          NA          NA        0.02         XXX
                                                 evaluation.
92265...........  26...........  A............  Eye muscle                  0.81        0.24        0.26        0.24        0.26        0.04         XXX
                                                 evaluation.
92270...........  .............  A............  Electro-oculography.        0.81        1.32        1.42          NA          NA        0.05         XXX
92270...........  TC...........  A............  Electro-oculography.        0.00        1.09        1.14          NA          NA        0.02         XXX
92270...........  26...........  A............  Electro-oculography.        0.81        0.23        0.28        0.23        0.28        0.03         XXX
92275...........  .............  A............  Electroretinography.        1.01        2.42        2.18          NA          NA        0.05         XXX
92275...........  TC...........  A............  Electroretinography.        0.00        2.07        1.79          NA          NA        0.02         XXX
92275...........  26...........  A............  Electroretinography.        1.01        0.35        0.39        0.35        0.39        0.03         XXX
92283...........  .............  A............  Color vision                0.17        0.99        0.91          NA          NA        0.02         XXX
                                                 examination.
92283...........  TC...........  A............  Color vision                0.00        0.94        0.85          NA          NA        0.01         XXX
                                                 examination.
92283...........  26...........  A............  Color vision                0.17        0.05        0.06        0.05        0.06        0.01         XXX
                                                 examination.
92284...........  .............  A............  Dark adaptation eye         0.24        1.13        1.50          NA          NA        0.02         XXX
                                                 exam.
92284...........  TC...........  A............  Dark adaptation eye         0.00        1.06        1.43          NA          NA        0.01         XXX
                                                 exam.
92284...........  26...........  A............  Dark adaptation eye         0.24        0.07        0.07        0.07        0.07        0.01         XXX
                                                 exam.
92285...........  .............  A............  Eye photography.....        0.20        0.80        0.89          NA          NA        0.02         XXX
92285...........  TC...........  A............  Eye photography.....        0.00        0.73        0.81          NA          NA        0.01         XXX
92285...........  26...........  A............  Eye photography.....        0.20        0.07        0.08        0.07        0.08        0.01         XXX
92286...........  .............  A............  Internal eye                0.66        2.08        2.56          NA          NA        0.04         XXX
                                                 photography.
92286...........  TC...........  A............  Internal eye                0.00        1.86        2.31          NA          NA        0.02         XXX
                                                 photography.
92286...........  26...........  A............  Internal eye                0.66        0.22        0.25        0.22        0.25        0.02         XXX
                                                 photography.
92287...........  .............  A............  Internal eye                0.81        1.90        2.14        0.27        0.29        0.02         XXX
                                                 photography.
92310...........  .............  N............  Contact lens fitting        1.17        1.06        1.09        0.27        0.36        0.04         XXX
92311...........  .............  A............  Contact lens fitting        1.08        1.27        1.18        0.30        0.33        0.03         XXX
92312...........  .............  A............  Contact lens fitting        1.26        1.45        1.26        0.33        0.41        0.03         XXX
92313...........  .............  A............  Contact lens fitting        0.92        1.42        1.24        0.31        0.30        0.02         XXX
92314...........  .............  N............  Prescription of             0.69        1.14        1.04        0.16        0.21        0.01         XXX
                                                 contact lens.
92315...........  .............  A............  Prescription of             0.45        1.31        1.08        0.13        0.14        0.01         XXX
                                                 contact lens.
92316...........  .............  A............  Prescription of             0.68        1.63        1.27        0.22        0.26        0.02         XXX
                                                 contact lens.
92317...........  .............  A............  Prescription of             0.45        1.31        1.12        0.11        0.13        0.01         XXX
                                                 contact lens.
92325...........  .............  A............  Modification of             0.00        0.83        0.62          NA          NA        0.01         XXX
                                                 contact lens.
92326...........  .............  A............  Replacement of              0.00        0.73        1.18          NA          NA        0.06         XXX
                                                 contact lens.
92340...........  .............  N............  Fitting of                  0.37        0.44        0.57        0.09        0.11        0.01         XXX
                                                 spectacles.
92341...........  .............  N............  Fitting of                  0.47        0.46        0.60        0.11        0.14        0.01         XXX
                                                 spectacles.
92342...........  .............  N............  Fitting of                  0.53        0.48        0.62        0.12        0.17        0.01         XXX
                                                 spectacles.

[[Page 66524]]

 
92352...........  .............  B............  Special spectacles          0.37        0.56        0.62        0.09        0.11        0.01         XXX
                                                 fitting.
92353...........  .............  B............  Special spectacles          0.50        0.59        0.66        0.11        0.15        0.02         XXX
                                                 fitting.
92354...........  .............  B............  Special spectacles          0.00        0.28        4.57          NA          NA        0.10         XXX
                                                 fitting.
92355...........  .............  B............  Special spectacles          0.00        0.44        2.38          NA          NA        0.01         XXX
                                                 fitting.
92358...........  .............  B............  Eye prosthesis              0.00        0.24        0.60          NA          NA        0.05         XXX
                                                 service.
92370...........  .............  N............  Repair & adjust             0.32        0.39        0.47        0.07        0.10        0.02         XXX
                                                 spectacles.
92371...........  .............  B............  Repair & adjust             0.00        0.24        0.43          NA          NA        0.02         XXX
                                                 spectacles.
92499...........  .............  C............  Eye service or              0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 procedure.
92499...........  TC...........  C............  Eye service or              0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 procedure.
92499...........  26...........  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          NA        0.90        1.00        0.05         000
                                                 examination.
92504...........  .............  A............  Ear microscopy              0.18        0.60        0.55        0.06        0.07        0.01         XXX
                                                 examination.
92506...........  .............  A............  Speech/hearing              0.86        3.49        3.04        0.28        0.34        0.03         XXX
                                                 evaluation.
92507...........  .............  A............  Speech/hearing              0.52        1.23        1.17        0.16        0.19        0.02         XXX
                                                 therapy.
92508...........  .............  A............  Speech/hearing              0.26        0.55        0.53        0.09        0.11        0.01         XXX
                                                 therapy.
92511...........  .............  A............  Nasopharyngoscopy...        0.84        3.12        3.21        0.67        0.72        0.03         000
92512...........  .............  A............  Nasal function              0.55        1.00        1.07        0.17        0.18        0.02         XXX
                                                 studies.
92516...........  .............  A............  Facial nerve                0.43        1.23        1.21        0.14        0.18        0.01         XXX
                                                 function test.
92520...........  .............  A............  Laryngeal function          0.75        0.93        0.72        0.24        0.31        0.03         XXX
                                                 studies.
92526...........  .............  A............  Oral function               0.55        1.70        1.67        0.16        0.18        0.02         XXX
                                                 therapy.
92531...........  .............  B............  Spontaneous                 0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 nystagmus 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                 0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 nystagmus test.
92541...........  .............  A............  Spontaneous                 0.40        1.14        1.09          NA          NA        0.04         XXX
                                                 nystagmus test.
92541...........  TC...........  A............  Spontaneous                 0.00        1.03        0.94          NA          NA        0.02         XXX
                                                 nystagmus test.
92541...........  26...........  A............  Spontaneous                 0.40        0.11        0.15        0.11        0.15        0.02         XXX
                                                 nystagmus test.
92542...........  .............  A............  Positional nystagmus        0.33        1.29        1.22          NA          NA        0.03         XXX
                                                 test.
92542...........  TC...........  A............  Positional nystagmus        0.00        1.20        1.09          NA          NA        0.02         XXX
                                                 test.
92542...........  26...........  A............  Positional nystagmus        0.33        0.09        0.13        0.09        0.13        0.01         XXX
                                                 test.
92543...........  .............  A............  Caloric vestibular          0.10        0.65        0.61          NA          NA        0.02         XXX
                                                 test.
92543...........  TC...........  A............  Caloric vestibular          0.00        0.62        0.57          NA          NA        0.01         XXX
                                                 test.
92543...........  26...........  A............  Caloric vestibular          0.10        0.03        0.04        0.03        0.04        0.01         XXX
                                                 test.
92544...........  .............  A............  Optokinetic                 0.26        1.03        0.97          NA          NA        0.03         XXX
                                                 nystagmus test.
92544...........  TC...........  A............  Optokinetic                 0.00        0.96        0.87          NA          NA        0.02         XXX
                                                 nystagmus test.
92544...........  26...........  A............  Optokinetic                 0.26        0.07        0.10        0.07        0.10        0.01         XXX
                                                 nystagmus test.
92545...........  .............  A............  Oscillating tracking        0.23        1.00        0.90          NA          NA        0.03         XXX
                                                 test.
92545...........  TC...........  A............  Oscillating tracking        0.00        0.94        0.81          NA          NA        0.02         XXX
                                                 test.
92545...........  26...........  A............  Oscillating tracking        0.23        0.06        0.09        0.06        0.09        0.01         XXX
                                                 test.
92546...........  .............  A............  Sinusoidal                  0.29        1.81        1.89          NA          NA        0.03         XXX
                                                 rotational test.
92546...........  TC...........  A............  Sinusoidal                  0.00        1.73        1.79          NA          NA        0.02         XXX
                                                 rotational test.
92546...........  26...........  A............  Sinusoidal                  0.29        0.08        0.10        0.08        0.10        0.01         XXX
                                                 rotational test.
92547...........  .............  A............  Supplemental                0.00        0.11        0.09        0.11        0.09        0.06         ZZZ
                                                 electrical test.
92548...........  .............  A............  Posturography.......        0.50        1.70        1.98          NA          NA        0.15         XXX
92548...........  TC...........  A............  Posturography.......        0.00        1.56        1.78          NA          NA        0.13         XXX
92548...........  26...........  A............  Posturography.......        0.50        0.14        0.20        0.14        0.20        0.02         XXX
92551...........  .............  N............  Pure tone hearing           0.00        0.25        0.25          NA          NA        0.01         XXX
                                                 test, air.
92552...........  .............  A............  Pure tone                   0.00        0.61        0.52          NA          NA        0.04         XXX
                                                 audiometry, air.
92553...........  .............  A............  Audiometry, air &           0.00        0.77        0.71          NA          NA        0.06         XXX
                                                 bone.
92555...........  .............  A............  Speech threshold            0.00        0.41        0.40          NA          NA        0.04         XXX
                                                 audiometry.
92556...........  .............  A............  Speech audiometry,          0.00        0.51        0.54          NA          NA        0.06         XXX
                                                 complete.
92557...........  .............  A............  Comprehensive               0.60        0.29        0.74        0.20        0.69        0.12         XXX
                                                 hearing 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        0.70        0.71          NA          NA        0.06         XXX
                                                 diagnosis.
92562...........  .............  A............  Loudness balance            0.00        0.62        0.51          NA          NA        0.04         XXX
                                                 test.
92563...........  .............  A............  Tone decay hearing          0.00        0.55        0.46          NA          NA        0.04         XXX
                                                 test.
92564...........  .............  A............  Sisi hearing test...        0.00        0.48        0.47          NA          NA        0.05         XXX
92565...........  .............  A............  Stenger test, pure          0.00        0.25        0.33          NA          NA        0.04         XXX
                                                 tone.
92567...........  .............  A............  Tympanometry........        0.20        0.13        0.33        0.07        0.29        0.06         XXX
92568...........  .............  A............  Acoustic refl               0.29        0.10        0.24        0.09        0.24        0.04         XXX
                                                 threshold tst.
92569...........  .............  A............  Acoustic reflex             0.20        0.07        0.24        0.07        0.24        0.04         XXX
                                                 decay test.
92571...........  .............  A............  Filtered speech             0.00        0.44        0.41          NA          NA        0.04         XXX
                                                 hearing test.
92572...........  .............  A............  Staggered spondaic          0.00        0.59        0.34          NA          NA        0.01         XXX
                                                 word test.
92575...........  .............  A............  Sensorineural acuity        0.00        1.15        0.72          NA          NA        0.02         XXX
                                                 test.
92576...........  .............  A............  Synthetic sentence          0.00        0.58        0.51          NA          NA        0.05         XXX
                                                 test.
92577...........  .............  A............  Stenger test, speech        0.00        0.26        0.49          NA          NA        0.07         XXX
92579...........  .............  A............  Visual audiometry           0.70        0.35        0.54        0.23        0.48        0.06         XXX
                                                 (vra).
92582...........  .............  A............  Conditioning play           0.00        1.17        0.95          NA          NA        0.06         XXX
                                                 audiometry.
92583...........  .............  A............  Select picture              0.00        0.73        0.81          NA          NA        0.08         XXX
                                                 audiometry.
92584...........  .............  A............  Electrocochleography        0.00        1.36        1.91          NA          NA        0.21         XXX
92585...........  .............  A............  Auditor evoke               0.50        2.10        2.08          NA          NA        0.17         XXX
                                                 potent, compre.

[[Page 66525]]

 
92585...........  TC...........  A............  Auditor evoke               0.00        1.95        1.90          NA          NA        0.14         XXX
                                                 potent, compre.
92585...........  26...........  A............  Auditor evoke               0.50        0.15        0.18        0.15        0.18        0.03         XXX
                                                 potent, compre.
92586...........  .............  A............  Auditor evoke               0.00        1.41        1.63          NA          NA        0.14         XXX
                                                 potent, limit.
92587...........  .............  A............  Evoked auditory test        0.13        0.65        1.01          NA          NA        0.12         XXX
92587...........  TC...........  A............  Evoked auditory test        0.00        0.61        0.96          NA          NA        0.11         XXX
92587...........  26...........  A............  Evoked auditory test        0.13        0.04        0.05        0.04        0.05        0.01         XXX
92588...........  .............  A............  Evoked auditory test        0.36        1.11        1.37          NA          NA        0.14         XXX
92588...........  TC...........  A............  Evoked auditory test        0.00        1.00        1.23          NA          NA        0.13         XXX
92588...........  26...........  A............  Evoked auditory test        0.36        0.11        0.14        0.11        0.14        0.01         XXX
92590...........  .............  N............  Hearing aid exam,           0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 one ear.
92591...........  .............  N............  Hearing aid exam,           0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 both ears.
92592...........  .............  N............  Hearing aid check,          0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 one 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        1.02        0.80          NA          NA        0.06         XXX
                                                 evaluation.
92597...........  .............  A............  Oral speech device          0.86        1.99        1.84        0.28        0.37        0.03         XXX
                                                 eval.
92601...........  .............  A............  Cochlear implt f/up         2.30        1.08        2.29        0.64        2.07        0.07         XXX
                                                 exam < 7.
92602...........  .............  A............  Reprogram cochlear          1.30        0.84        1.61        0.40        1.39        0.07         XXX
                                                 implt < 7.
92603...........  .............  A............  Cochlear implt f/up         2.25        1.19        1.66        0.73        1.44        0.07         XXX
                                                 exam 7 >.
92604...........  .............  A............  Reprogram cochlear          1.25        0.78        1.06        0.41        0.88        0.07         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        4.63        3.85          NA          NA        0.05         XXX
                                                 rx, 1hr.
92608...........  .............  A............  Ex for speech device        0.00        0.88        0.72          NA          NA        0.05         XXX
                                                 rx addl.
92609...........  .............  A............  Use of speech device        0.00        2.45        2.02          NA          NA        0.04         XXX
                                                 service.
92610...........  .............  A............  Evaluate swallowing         0.00        1.70        2.56          NA          NA        0.08         XXX
                                                 function.
92611...........  .............  A............  Motion fluoroscopy/         0.00        1.95        2.69          NA          NA        0.08         XXX
                                                 swallow.
92612...........  .............  A............  Endoscopy swallow           1.27        2.97        2.85        0.42        0.54        0.04         XXX
                                                 tst (fees).
92613...........  .............  A............  Endoscopy swallow           0.71        0.24        0.32        0.23        0.31        0.05         XXX
                                                 tst (fees).
92614...........  .............  A............  Laryngoscopic               1.27        2.42        2.46        0.42        0.54        0.04         XXX
                                                 sensory test.
92615...........  .............  A............  Eval laryngoscopy           0.63        0.21        0.28        0.20        0.28        0.05         XXX
                                                 sense tst.
92616...........  .............  A............  Fees w/laryngeal            1.88        3.16        3.27        0.60        0.80        0.06         XXX
                                                 sense test.
92617...........  .............  A............  Interprt fees/              0.79        0.26        0.35        0.26        0.35        0.05         XXX
                                                 laryngeal test.
92620...........  .............  A............  Auditory function,          0.00        1.93        1.53          NA          NA        0.06         XXX
                                                 60 min.
92621...........  .............  A............  Auditory function, +        0.00        0.44        0.34          NA          NA        0.06         ZZZ
                                                 15 min.
92625...........  .............  A............  Tinnitus assessment.        0.00        1.94        1.53        1.94        1.53        0.06         XXX
92626...........  .............  A............  Eval aud rehab              0.00        2.00        2.10          NA          NA        0.06         XXX
                                                 status.
92627...........  .............  A............  Eval aud status             0.00        0.46        0.50        0.46        0.50        0.02         ZZZ
                                                 rehab 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.
92640...........  .............  A............  Aud brainstem implt         0.00        1.34        1.34        1.34        1.34        0.01         XXX
                                                 programg.
92700...........  .............  C............  Ent procedure/              0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 service.
92950...........  .............  A............  Heart/lung                  3.79        3.24        3.72        0.77        0.87        0.28         000
                                                 resuscitation cpr.
92953...........  .............  A............  Temporary external          0.23          NA          NA        0.07        0.07        0.02         000
                                                 pacing.
92960...........  .............  A............  Cardioversion               2.25        4.37        5.34        1.45        1.31        0.07         000
                                                 electric, ext.
92961...........  .............  A............  Cardioversion,              4.59          NA          NA        2.43        2.26        0.29         000
                                                 electric, int.
92970...........  .............  A............  Cardioassist,               3.51          NA          NA        1.46        1.26        0.16         000
                                                 internal.
92971...........  .............  A............  Cardioassist,               1.77          NA          NA        1.09        0.97        0.06         000
                                                 external.
92973...........  .............  A............  Percut coronary             3.28          NA          NA        1.76        1.52        0.23         ZZZ
                                                 thrombectomy.
92974...........  .............  A............  Cath place, cardio          3.00          NA          NA        1.62        1.40        0.21         ZZZ
                                                 brachytx.
92975...........  .............  A............  Dissolve clot, heart        7.24          NA          NA        3.83        3.32        0.50         000
                                                 vessel.
92977...........  .............  A............  Dissolve clot, heart        0.00        1.73        4.88          NA          NA        0.46         XXX
                                                 vessel.
92978...........  .............  C............  Intravasc us, heart         0.00        0.00        0.00          NA          NA        0.00         ZZZ
                                                 add-on.
92978...........  TC...........  C............  Intravasc us, heart         0.00        0.00        0.00          NA          NA        0.00         ZZZ
                                                 add-on.
92978...........  26...........  A............  Intravasc us, heart         1.80        0.96        0.83        0.96        0.83        0.06         ZZZ
                                                 add-on.
92979...........  .............  C............  Intravasc us, heart         0.00        0.00        0.00          NA          NA        0.00         ZZZ
                                                 add-on.
92979...........  TC...........  C............  Intravasc us, heart         0.00        0.00        0.00          NA          NA        0.00         ZZZ
                                                 add-on.
92979...........  26...........  A............  Intravasc us, heart         1.44        0.77        0.67        0.77        0.67        0.06         ZZZ
                                                 add-on.
92980...........  .............  A............  Insert intracoronary       14.82          NA          NA        8.12        7.08        1.03         000
                                                 stent.
92981...........  .............  A............  Insert intracoronary        4.16          NA          NA        2.22        1.92        0.29         ZZZ
                                                 stent.
92982...........  .............  A............  Coronary artery            10.96          NA          NA        6.05        5.29        0.76         000
                                                 dilation.
92984...........  .............  A............  Coronary artery             2.97          NA          NA        1.58        1.37        0.21         ZZZ
                                                 dilation.
92986...........  .............  A............  Revision of aortic         22.70          NA          NA       15.32       13.57        1.51         090
                                                 valve.
92987...........  .............  A............  Revision of mitral         23.48          NA          NA       15.94       14.07        1.59         090
                                                 valve.
92990...........  .............  A............  Revision of                18.12          NA          NA       11.33       10.56        1.20         090
                                                 pulmonary 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          NA        6.64        5.80        0.84         000
92996...........  .............  A............  Coronary atherectomy        3.26          NA          NA        1.76        1.51        0.10         ZZZ
                                                 add-on.
92997...........  .............  A............  Pul art balloon            11.98          NA          NA        5.61        5.21        0.40         000
                                                 repr, percut.
92998...........  .............  A............  Pul art balloon             5.99          NA          NA        3.00        2.60        0.28         ZZZ
                                                 repr, percut.

[[Page 66526]]

 
93000...........  .............  A............  Electrocardiogram,          0.17        0.35        0.42          NA          NA        0.03         XXX
                                                 complete.
93005...........  .............  A............  Electrocardiogram,          0.00        0.28        0.36          NA          NA        0.02         XXX
                                                 tracing.
93010...........  .............  A............  Electrocardiogram           0.17        0.07        0.06        0.07        0.06        0.01         XXX
                                                 report.
93012...........  .............  A............  Transmission of ecg.        0.00        4.16        5.09          NA          NA        0.18         XXX
93014...........  .............  A............  Report on                   0.52        0.22        0.21        0.22        0.21        0.02         XXX
                                                 transmitted ecg.
93015...........  .............  A............  Cardiovascular              0.75        1.90        1.93          NA          NA        0.14         XXX
                                                 stress test.
93016...........  .............  A............  Cardiovascular              0.45        0.22        0.20        0.22        0.20        0.02         XXX
                                                 stress test.
93017...........  .............  A............  Cardiovascular              0.00        1.53        1.60          NA          NA        0.11         XXX
                                                 stress test.
93018...........  .............  A............  Cardiovascular              0.30        0.15        0.13        0.15        0.13        0.01         XXX
                                                 stress test.
93024...........  .............  A............  Cardiac drug stress         1.17        2.40        1.98          NA          NA        0.12         XXX
                                                 test.
93024...........  TC...........  A............  Cardiac drug stress         0.00        1.82        1.47          NA          NA        0.08         XXX
                                                 test.
93024...........  26...........  A............  Cardiac drug stress         1.17        0.58        0.51        0.58        0.51        0.04         XXX
                                                 test.
93025...........  .............  A............  Microvolt t-wave            0.75        3.93        5.76          NA          NA        0.14         XXX
                                                 assess.
93025...........  TC...........  A............  Microvolt t-wave            0.00        3.55        5.42          NA          NA        0.11         XXX
                                                 assess.
93025...........  26...........  A............  Microvolt t-wave            0.75        0.38        0.34        0.38        0.34        0.03         XXX
                                                 assess.
93040...........  .............  A............  Rhythm ECG with             0.16        0.19        0.20          NA          NA        0.02         XXX
                                                 report.
93041...........  .............  A............  Rhythm ECG, tracing.        0.00        0.14        0.15          NA          NA        0.01         XXX
93042...........  .............  A............  Rhythm ECG, report..        0.16        0.05        0.05        0.05        0.05        0.01         XXX
93224...........  .............  A............  ECG monitor/report,         0.52        2.31        2.96          NA          NA        0.24         XXX
                                                 24 hrs.
93225...........  .............  A............  ECG monitor/record,         0.00        0.85        1.04          NA          NA        0.08         XXX
                                                 24 hrs.
93226...........  .............  A............  ECG monitor/report,         0.00        1.19        1.69          NA          NA        0.14         XXX
                                                 24 hrs.
93227...........  .............  A............  ECG monitor/review,         0.52        0.27        0.23        0.27        0.23        0.02         XXX
                                                 24 hrs.
93230...........  .............  A............  ECG monitor/report,         0.52        2.30        3.09          NA          NA        0.26         XXX
                                                 24 hrs.
93231...........  .............  A............  Ecg monitor/record,         0.00        0.72        1.12          NA          NA        0.11         XXX
                                                 24 hrs.
93232...........  .............  A............  ECG monitor/report,         0.00        1.35        1.76          NA          NA        0.13         XXX
                                                 24 hrs.
93233...........  .............  A............  ECG monitor/review,         0.52        0.23        0.21        0.23        0.21        0.02         XXX
                                                 24 hrs.
93235...........  .............  C............  ECG monitor/report,         0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 24 hrs.
93236...........  .............  C............  ECG monitor/report,         0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 24 hrs.
93237...........  .............  A............  ECG monitor/review,         0.45        0.22        0.19        0.22        0.19        0.02         XXX
                                                 24 hrs.
93268...........  .............  A............  ECG record/review...        0.52        5.78        6.60          NA          NA        0.28         XXX
93270...........  .............  A............  ECG recording.......        0.00        0.29        0.76          NA          NA        0.08         XXX
93271...........  .............  A............  Ecg/monitoring and          0.00        5.27        5.64          NA          NA        0.18         XXX
                                                 analysis.
93272...........  .............  A............  Ecg/review,                 0.52        0.22        0.20        0.22        0.20        0.02         XXX
                                                 interpret only.
93278...........  .............  A............  ECG/signal-averaged.        0.25        0.62        0.93          NA          NA        0.12         XXX
93278...........  TC...........  A............  ECG/signal-averaged.        0.00        0.52        0.83          NA          NA        0.11         XXX
93278...........  26...........  A............  ECG/signal-averaged.        0.25        0.10        0.10        0.10        0.10        0.01         XXX
93303...........  .............  A............  Echo transthoracic..        1.30        4.49        4.41          NA          NA        0.27         XXX
93303...........  TC...........  A............  Echo transthoracic..        0.00        3.96        3.91          NA          NA        0.23         XXX
93303...........  26...........  A............  Echo transthoracic..        1.30        0.53        0.50        0.53        0.50        0.04         XXX
93304...........  .............  A............  Echo transthoracic..        0.75        3.10        2.66          NA          NA        0.15         XXX
93304...........  TC...........  A............  Echo transthoracic..        0.00        2.80        2.37          NA          NA        0.13         XXX
93304...........  26...........  A............  Echo transthoracic..        0.75        0.30        0.29        0.30        0.29        0.02         XXX
93307...........  .............  A............  Echo exam of heart..        0.92        3.73        3.97          NA          NA        0.26         XXX
93307...........  TC...........  A............  Echo exam of heart..        0.00        3.28        3.57          NA          NA        0.23         XXX
93307...........  26...........  A............  Echo exam of heart..        0.92        0.45        0.40        0.45        0.40        0.03         XXX
93308...........  .............  A............  Echo exam of heart..        0.53        2.62        2.38          NA          NA        0.15         XXX
93308...........  TC...........  A............  Echo exam of heart..        0.00        2.35        2.15          NA          NA        0.13         XXX
93308...........  26...........  A............  Echo exam of heart..        0.53        0.27        0.23        0.27        0.23        0.02         XXX
93312...........  .............  A............  Echo transesophageal        2.20        7.39        5.98          NA          NA        0.37         XXX
93312...........  TC...........  A............  Echo transesophageal        0.00        6.42        5.10          NA          NA        0.29         XXX
93312...........  26...........  A............  Echo transesophageal        2.20        0.97        0.88        0.97        0.88        0.08         XXX
93313...........  .............  A............  Echo transesophageal        0.95          NA          NA        0.12        0.17        0.06         XXX
93314...........  .............  A............  Echo transesophageal        1.25        7.21        5.73          NA          NA        0.33         XXX
93314...........  TC...........  A............  Echo transesophageal        0.00        6.65        5.22          NA          NA        0.29         XXX
93314...........  26...........  A............  Echo transesophageal        1.25        0.56        0.51        0.56        0.51        0.04         XXX
93315...........  .............  C............  Echo transesophageal        0.00        0.00        0.00          NA          NA        0.00         XXX
93315...........  TC...........  C............  Echo transesophageal        0.00        0.00        0.00          NA          NA        0.00         XXX
93315...........  26...........  A............  Echo transesophageal        2.78        1.30        1.16        1.30        1.16        0.09         XXX
93316...........  .............  A............  Echo transesophageal        0.95          NA          NA        0.26        0.25        0.05         XXX
93317...........  .............  C............  Echo transesophageal        0.00        0.00        0.00          NA          NA        0.00         XXX
93317...........  TC...........  C............  Echo transesophageal        0.00        0.00        0.00          NA          NA        0.00         XXX
93317...........  26...........  A............  Echo transesophageal        1.83        0.55        0.61        0.55        0.61        0.08         XXX
93318...........  .............  C............  Echo transesophageal        0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 intraop.
93318...........  TC...........  C............  Echo transesophageal        0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 intraop.
93318...........  26...........  A............  Echo transesophageal        2.20        0.85        0.67        0.85        0.67        0.14         XXX
                                                 intraop.
93320...........  .............  A............  Doppler echo exam,          0.38        1.67        1.77          NA          NA        0.13         ZZZ
                                                 heart.
93320...........  TC...........  A............  Doppler echo exam,          0.00        1.49        1.60          NA          NA        0.12         ZZZ
                                                 heart.
93320...........  26...........  A............  Doppler echo exam,          0.38        0.18        0.17        0.18        0.17        0.01         ZZZ
                                                 heart.
93321...........  .............  A............  Doppler echo exam,          0.15        0.61        0.89          NA          NA        0.09         ZZZ
                                                 heart.
93321...........  TC...........  A............  Doppler echo exam,          0.00        0.54        0.82          NA          NA        0.08         ZZZ
                                                 heart.
93321...........  26...........  A............  Doppler echo exam,          0.15        0.07        0.07        0.07        0.07        0.01         ZZZ
                                                 heart.
93325...........  .............  A............  Doppler color flow          0.07        0.66        1.80          NA          NA        0.22         ZZZ
                                                 add-on.

[[Page 66527]]

 
93325...........  TC...........  A............  Doppler color flow          0.00        0.63        1.77          NA          NA        0.21         ZZZ
                                                 add-on.
93325...........  26...........  A............  Doppler color flow          0.07        0.03        0.03        0.03        0.03        0.01         ZZZ
                                                 add-on.
93350...........  .............  A............  Echo transthoracic..        1.48        5.09        3.71          NA          NA        0.18         XXX
93350...........  TC...........  A............  Echo transthoracic..        0.00        4.33        3.05          NA          NA        0.13         XXX
93350...........  26...........  A............  Echo transthoracic..        1.48        0.76        0.66        0.76        0.66        0.05         XXX
93501...........  .............  A............  Right heart                 3.02       18.69       18.37          NA          NA        1.27         000
                                                 catheterization.
93501...........  TC...........  A............  Right heart                 0.00       17.12       17.01          NA          NA        1.06         000
                                                 catheterization.
93501...........  26...........  A............  Right heart                 3.02        1.57        1.36        1.57        1.36        0.21         000
                                                 catheterization.
93503...........  .............  C............  Insert/place heart          0.00          NA          NA          NA          NA        0.00         000
                                                 catheter.
93505...........  .............  A............  Biopsy of heart             4.37       20.90       12.28          NA          NA        0.46         000
                                                 lining.
93505...........  TC...........  A............  Biopsy of heart             0.00       18.62       10.30          NA          NA        0.16         000
                                                 lining.
93505...........  26...........  A............  Biopsy of heart             4.37        2.28        1.98        2.28        1.98        0.30         000
                                                 lining.
93508...........  .............  A............  Cath placement,             4.09       28.82       21.75          NA          NA        0.93         000
                                                 angiography.
93508...........  TC...........  A............  Cath placement,             0.00       26.65       19.62          NA          NA        0.65         000
                                                 angiography.
93508...........  26...........  A............  Cath placement,             4.09        2.17        2.13        2.17        2.13        0.28         000
                                                 angiography.
93510...........  .............  A............  Left heart                  4.32       28.12       33.61          NA          NA        2.61         000
                                                 catheterization.
93510...........  TC...........  A............  Left heart                  0.00       25.84       31.39          NA          NA        2.31         000
                                                 catheterization.
93510...........  26...........  A............  Left heart                  4.32        2.28        2.22        2.28        2.22        0.30         000
                                                 catheterization.
93511...........  .............  C............  Left heart                  0.00          NA          NA          NA          NA        0.00         000
                                                 catheterization.
93511...........  TC...........  C............  Left heart                  0.00          NA          NA          NA          NA        0.00         000
                                                 catheterization.
93511...........  26...........  A............  Left heart                  5.02        2.65        2.54        2.65        2.54        0.35         000
                                                 catheterization.
93514...........  .............  C............  Left heart                  0.00          NA          NA          NA          NA        0.00         000
                                                 catheterization.
93514...........  TC...........  C............  Left heart                  0.00          NA          NA          NA          NA        0.00         000
                                                 catheterization.
93514...........  26...........  A............  Left heart                  7.04        2.95        3.03        2.95        3.03        0.49         000
                                                 catheterization.
93524...........  .............  C............  Left heart                  0.00          NA          NA          NA          NA        0.00         000
                                                 catheterization.
93524...........  TC...........  C............  Left heart                  0.00          NA          NA          NA          NA        0.00         000
                                                 catheterization.
93524...........  26...........  A............  Left heart                  6.94        3.77        3.47        3.77        3.47        0.48         000
                                                 catheterization.
93526...........  .............  A............  Rt & Lt heart               5.98       35.09       42.99          NA          NA        3.46         000
                                                 catheters.
93526...........  TC...........  A............  Rt & Lt heart               0.00       31.93       40.00          NA          NA        3.04         000
                                                 catheters.
93526...........  26...........  A............  Rt & Lt heart               5.98        3.16        2.99        3.16        2.99        0.42         000
                                                 catheters.
93527...........  .............  C............  Rt & Lt heart               0.00          NA          NA          NA          NA        0.00         000
                                                 catheters.
93527...........  TC...........  C............  Rt & Lt heart               0.00          NA          NA          NA          NA        0.00         000
                                                 catheters.
93527...........  26...........  A............  Rt & Lt heart               7.27        3.85        3.58        3.85        3.58        0.51         000
                                                 catheters.
93528...........  .............  C............  Rt & Lt heart               0.00          NA          NA          NA          NA        0.00         000
                                                 catheters.
93528...........  TC...........  C............  Rt & Lt heart               0.00          NA          NA          NA          NA        0.00         000
                                                 catheters.
93528...........  26...........  A............  Rt & Lt heart               8.99        4.43        4.23        4.43        4.23        0.62         000
                                                 catheters.
93529...........  .............  C............  Rt, lt heart                0.00          NA          NA          NA          NA        0.00         000
                                                 catheterization.
93529...........  TC...........  C............  Rt, lt heart                0.00          NA          NA          NA          NA        0.00         000
                                                 catheterization.
93529...........  26...........  A............  Rt, lt heart                4.79        2.58        2.43        2.58        2.43        0.33         000
                                                 catheterization.
93530...........  .............  C............  Rt heart cath,              0.00          NA          NA          NA          NA        0.00         000
                                                 congenital.
93530...........  TC...........  C............  Rt heart cath,              0.00          NA          NA          NA          NA        0.00         000
                                                 congenital.
93530...........  26...........  A............  Rt heart cath,              4.22        1.84        1.89        1.84        1.89        0.29         000
                                                 congenital.
93531...........  .............  C............  R & l heart cath,           0.00          NA          NA          NA          NA        0.00         000
                                                 congenital.
93531...........  TC...........  C............  R & l heart cath,           0.00          NA          NA          NA          NA        0.00         000
                                                 congenital.
93531...........  26...........  A............  R & l heart cath,           8.34        3.57        3.57        3.57        3.57        0.58         000
                                                 congenital.
93532...........  .............  C............  R & l heart cath,           0.00          NA          NA          NA          NA        0.00         000
                                                 congenital.
93532...........  TC...........  C............  R & l heart cath,           0.00          NA          NA          NA          NA        0.00         000
                                                 congenital.
93532...........  26...........  A............  R & l heart cath,           9.99        3.65        3.95        3.65        3.95        0.69         000
                                                 congenital.
93533...........  .............  C............  R & l heart cath,           0.00          NA          NA          NA          NA        0.00         000
                                                 congenital.
93533...........  TC...........  C............  R & l heart cath,           0.00          NA          NA          NA          NA        0.00         000
                                                 congenital.
93533...........  26...........  A............  R & l heart cath,           6.69        3.15        2.97        3.15        2.97        0.47         000
                                                 congenital.
93539...........  .............  A............  Injection, cardiac          0.40        2.46       11.72        0.21        0.19        0.01         000
                                                 cath.
93540...........  .............  A............  Injection, cardiac          0.43        8.61       15.53        0.23        0.20        0.01         000
                                                 cath.
93541...........  .............  A............  Injection for lung          0.29        0.15        7.60        0.15        0.13        0.01         000
                                                 angiogram.
93542...........  .............  A............  Injection for heart         0.29        5.18       10.07        0.15        0.13        0.01         000
                                                 x-rays.
93543...........  .............  A............  Injection for heart         0.29        2.62        8.86        0.16        0.13        0.01         000
                                                 x-rays.
93544...........  .............  A............  Injection for               0.25        1.84        7.41        0.13        0.12        0.01         000
                                                 aortography.
93545...........  .............  A............  Inject for coronary         0.40        5.86       13.42        0.21        0.19        0.01         000
                                                 x-rays.
93555...........  .............  A............  Imaging, cardiac            0.81        0.59        3.59          NA          NA        0.37         XXX
                                                 cath.
93555...........  TC...........  A............  Imaging, cardiac            0.00        0.17        3.22          NA          NA        0.34         XXX
                                                 cath.
93555...........  26...........  A............  Imaging, cardiac            0.81        0.42        0.37        0.42        0.37        0.03         XXX
                                                 cath.
93556...........  .............  A............  Imaging, cardiac            0.83        0.88        5.54          NA          NA        0.54         XXX
                                                 cath.
93556...........  TC...........  A............  Imaging, cardiac            0.00        0.44        5.16          NA          NA        0.51         XXX
                                                 cath.
93556...........  26...........  A............  Imaging, cardiac            0.83        0.44        0.38        0.44        0.38        0.03         XXX
                                                 cath.
93561...........  .............  C............  Cardiac output              0.00          NA          NA          NA          NA        0.00         000
                                                 measurement.
93561...........  TC...........  C............  Cardiac output              0.00          NA          NA          NA          NA        0.00         000
                                                 measurement.
93561...........  26...........  A............  Cardiac output              0.50        0.14        0.15        0.14        0.15        0.02         000
                                                 measurement.
93562...........  .............  C............  Cardiac output              0.00          NA          NA          NA          NA        0.00         000
                                                 measurement.
93562...........  TC...........  C............  Cardiac output              0.00          NA          NA          NA          NA        0.00         000
                                                 measurement.
93562...........  26...........  A............  Cardiac output              0.16        0.03        0.04        0.03        0.04        0.01         000
                                                 measurement.
93571...........  .............  C............  Heart flow reserve          0.00          NA          NA          NA          NA        0.00         ZZZ
                                                 measure.
93571...........  TC...........  C............  Heart flow reserve          0.00          NA          NA          NA          NA        0.00         ZZZ
                                                 measure.

[[Page 66528]]

 
93571...........  26...........  A............  Heart flow reserve          1.80        0.95        0.82        0.95        0.82        0.06         ZZZ
                                                 measure.
93572...........  .............  C............  Heart flow reserve          0.00          NA          NA          NA          NA        0.00         ZZZ
                                                 measure.
93572...........  TC...........  C............  Heart flow reserve          0.00          NA          NA          NA          NA        0.00         ZZZ
                                                 measure.
93572...........  26...........  A............  Heart flow reserve          1.44        0.74        0.62        0.74        0.62        0.04         ZZZ
                                                 measure.
93580...........  .............  A............  Transcath closure of       17.97          NA          NA        9.40        8.39        1.25         000
                                                 asd.
93581...........  .............  A............  Transcath closure of       24.39          NA          NA       11.55       10.47        1.72         000
                                                 vsd.
93600...........  .............  C............  Bundle of His               0.00        0.00        0.00          NA          NA        0.00         000
                                                 recording.
93600...........  TC...........  C............  Bundle of His               0.00        0.00        0.00          NA          NA        0.00         000
                                                 recording.
93600...........  26...........  A............  Bundle of His               2.12        1.09        0.96        1.09        0.96        0.16         000
                                                 recording.
93602...........  .............  C............  Intra-atrial                0.00        0.00        0.00          NA          NA        0.00         000
                                                 recording.
93602...........  TC...........  C............  Intra-atrial                0.00        0.00        0.00          NA          NA        0.00         000
                                                 recording.
93602...........  26...........  A............  Intra-atrial                2.12        1.04        0.93        1.04        0.93        0.17         000
                                                 recording.
93603...........  .............  C............  Right ventricular           0.00        0.00        0.00          NA          NA        0.00         000
                                                 recording.
93603...........  TC...........  C............  Right ventricular           0.00        0.00        0.00          NA          NA        0.00         000
                                                 recording.
93603...........  26...........  A............  Right ventricular           2.12        1.04        0.92        1.04        0.92        0.18         000
                                                 recording.
93609...........  .............  C............  Map tachycardia, add-       0.00        0.00        0.00          NA          NA        0.00         ZZZ
                                                 on.
93609...........  TC...........  C............  Map tachycardia, add-       0.00        0.00        0.00          NA          NA        0.00         ZZZ
                                                 on.
93609...........  26...........  A............  Map tachycardia, add-       4.99        2.61        2.28        2.61        2.28        0.35         ZZZ
                                                 on.
93610...........  .............  C............  Intra-atrial pacing.        0.00        0.00        0.00          NA          NA        0.00         000
93610...........  TC...........  C............  Intra-atrial pacing.        0.00        0.00        0.00          NA          NA        0.00         000
93610...........  26...........  A............  Intra-atrial pacing.        3.02        1.47        1.31        1.47        1.31        0.24         000
93612...........  .............  C............  Intraventricular            0.00        0.00        0.00          NA          NA        0.00         000
                                                 pacing.
93612...........  TC...........  C............  Intraventricular            0.00        0.00        0.00          NA          NA        0.00         000
                                                 pacing.
93612...........  26...........  A............  Intraventricular            3.02        1.42        1.29        1.42        1.29        0.25         000
                                                 pacing.
93613...........  .............  A............  Electrophys map 3d,         6.99          NA          NA        3.69        3.22        0.49         ZZZ
                                                 add-on.
93615...........  .............  C............  Esophageal recording        0.00        0.00        0.00          NA          NA        0.00         000
93615...........  TC...........  C............  Esophageal recording        0.00        0.00        0.00          NA          NA        0.00         000
93615...........  26...........  A............  Esophageal recording        0.99        0.54        0.40        0.54        0.40        0.03         000
93616...........  .............  C............  Esophageal recording        0.00        0.00        0.00          NA          NA        0.00         000
93616...........  TC...........  C............  Esophageal recording        0.00        0.00        0.00          NA          NA        0.00         000
93616...........  26...........  A............  Esophageal recording        1.49        0.26        0.35        0.26        0.35        0.09         000
93618...........  .............  C............  Heart rhythm pacing.        0.00        0.00        0.00          NA          NA        0.00         000
93618...........  TC...........  C............  Heart rhythm pacing.        0.00        0.00        0.00          NA          NA        0.00         000
93618...........  26...........  A............  Heart rhythm pacing.        4.25        2.28        1.97        2.28        1.97        0.30         000
93619...........  .............  C............  Electrophysiology           0.00        0.00        0.00          NA          NA        0.00         000
                                                 evaluation.
93619...........  TC...........  C............  Electrophysiology           0.00        0.00        0.00          NA          NA        0.00         000
                                                 evaluation.
93619...........  26...........  A............  Electrophysiology           7.31        3.87        3.52        3.87        3.52        0.51         000
                                                 evaluation.
93620...........  .............  C............  Electrophysiology           0.00        0.00        0.00          NA          NA        0.00         000
                                                 evaluation.
93620...........  TC...........  C............  Electrophysiology           0.00        0.00        0.00          NA          NA        0.00         000
                                                 evaluation.
93620...........  26...........  A............  Electrophysiology          11.57        6.08        5.46        6.08        5.46        0.80         000
                                                 evaluation.
93621...........  .............  C............  Electrophysiology           0.00        0.00        0.00          NA          NA        0.00         ZZZ
                                                 evaluation.
93621...........  TC...........  C............  Electrophysiology           0.00        0.00        0.00          NA          NA        0.00         ZZZ
                                                 evaluation.
93621...........  26...........  A............  Electrophysiology           2.10        1.10        0.96        1.10        0.96        0.15         ZZZ
                                                 evaluation.
93622...........  .............  C............  Electrophysiology           0.00        0.00        0.00          NA          NA        0.00         ZZZ
                                                 evaluation.
93622...........  TC...........  C............  Electrophysiology           0.00        0.00        0.00          NA          NA        0.00         ZZZ
                                                 evaluation.
93622...........  26...........  A............  Electrophysiology           3.10        1.56        1.39        1.56        1.39        0.22         ZZZ
                                                 evaluation.
93623...........  .............  C............  Stimulation, pacing         0.00        0.00        0.00          NA          NA        0.00         ZZZ
                                                 heart.
93623...........  TC...........  C............  Stimulation, pacing         0.00        0.00        0.00          NA          NA        0.00         ZZZ
                                                 heart.
93623...........  26...........  A............  Stimulation, pacing         2.85        1.49        1.30        1.49        1.30        0.20         ZZZ
                                                 heart.
93624...........  .............  C............  Electrophysiologic          0.00        0.00        0.00          NA          NA        0.00         000
                                                 study.
93624...........  TC...........  C............  Electrophysiologic          0.00        0.00        0.00          NA          NA        0.00         000
                                                 study.
93624...........  26...........  A............  Electrophysiologic          4.80        2.60        2.39        2.60        2.39        0.33         000
                                                 study.
93631...........  .............  C............  Heart pacing,               0.00        0.00        0.00          NA          NA        0.00         000
                                                 mapping.
93631...........  TC...........  C............  Heart pacing,               0.00        0.00        0.00          NA          NA        0.00         000
                                                 mapping.
93631...........  26...........  A............  Heart pacing,               7.59        2.75        2.76        2.75        2.76        0.97         000
                                                 mapping.
93640...........  .............  C............  Evaluation heart            0.00        0.00        0.00          NA          NA        0.00         000
                                                 device.
93640...........  TC...........  C............  Evaluation heart            0.00        0.00        0.00          NA          NA        0.00         000
                                                 device.
93640...........  26...........  A............  Evaluation heart            3.51        1.81        1.58        1.81        1.58        0.24         000
                                                 device.
93641...........  .............  C............  Electrophysiology           0.00        0.00        0.00          NA          NA        0.00         000
                                                 evaluation.
93641...........  TC...........  C............  Electrophysiology           0.00        0.00        0.00          NA          NA        0.00         000
                                                 evaluation.
93641...........  26...........  A............  Electrophysiology           5.92        3.10        2.71        3.10        2.71        0.41         000
                                                 evaluation.
93642...........  .............  C............  Electrophysiology           0.00        0.00        0.00          NA          NA        0.00         000
                                                 evaluation.
93642...........  TC...........  A............  Electrophysiology           0.00        4.76        5.97          NA          NA        0.42         000
                                                 evaluation.
93642...........  26...........  A............  Electrophysiology           4.88        2.60        2.40        2.60        2.40        0.15         000
                                                 evaluation.
93650...........  .............  A............  Ablate heart               10.49          NA          NA        5.80        5.11        0.73         000
                                                 dysrhythm focus.
93651...........  .............  A............  Ablate heart               16.23          NA          NA        8.52        7.42        1.13         000
                                                 dysrhythm focus.
93652...........  .............  A............  Ablate heart               17.65          NA          NA        9.34        8.11        1.23         000
                                                 dysrhythm focus.
93660...........  .............  A............  Tilt table                  1.89        3.01        2.71          NA          NA        0.08         000
                                                 evaluation.
93660...........  TC...........  A............  Tilt table                  0.00        2.04        1.86          NA          NA        0.02         000
                                                 evaluation.
93660...........  26...........  A............  Tilt table                  1.89        0.97        0.85        0.97        0.85        0.06         000
                                                 evaluation.
93662...........  .............  C............  Intracardiac ecg            0.00        0.00        0.00          NA          NA        0.00         ZZZ
                                                 (ice).
93662...........  TC...........  C............  Intracardiac ecg            0.00        0.00        0.00          NA          NA        0.00         ZZZ
                                                 (ice).

[[Page 66529]]

 
93662...........  26...........  A............  Intracardiac ecg            2.80        1.47        1.29        1.47        1.29        0.09         ZZZ
                                                 (ice).
93668...........  .............  N............  Peripheral vascular         0.00        0.41        0.41          NA          NA        0.01         XXX
                                                 rehab.
93701...........  .............  A............  Bioimpedance,               0.17        0.70        0.84          NA          NA        0.02         XXX
                                                 thoracic.
93701...........  TC...........  A............  Bioimpedance,               0.00        0.64        0.77          NA          NA        0.01         XXX
                                                 thoracic.
93701...........  26...........  A............  Bioimpedance,               0.17        0.06        0.07        0.06        0.07        0.01         XXX
                                                 thoracic.
93720...........  .............  A............  Total body                  0.17        1.17        0.97          NA          NA        0.07         XXX
                                                 plethysmography.
93721...........  .............  A............  Plethysmography             0.00        1.13        0.92          NA          NA        0.06         XXX
                                                 tracing.
93722...........  .............  A............  Plethysmography             0.17        0.04        0.05        0.04        0.05        0.01         XXX
                                                 report.
93724...........  .............  A............  Analyze pacemaker           4.88        3.22        4.55          NA          NA        0.39         000
                                                 system.
93724...........  TC...........  A............  Analyze pacemaker           0.00        0.87        2.42          NA          NA        0.24         000
                                                 system.
93724...........  26...........  A............  Analyze pacemaker           4.88        2.35        2.13        2.35        2.13        0.15         000
                                                 system.
93727...........  .............  A............  Analyze ilr system..        0.52        0.63        0.42        0.63        0.42        0.02         XXX
93731...........  .............  A............  Analyze pacemaker           0.45        0.79        0.72          NA          NA        0.05         XXX
                                                 system.
93731...........  TC...........  A............  Analyze pacemaker           0.00        0.55        0.52          NA          NA        0.04         XXX
                                                 system.
93731...........  26...........  A............  Analyze pacemaker           0.45        0.24        0.20        0.24        0.20        0.01         XXX
                                                 system.
93732...........  .............  A............  Analyze pacemaker           0.92        1.15        1.00          NA          NA        0.07         XXX
                                                 system.
93732...........  TC...........  A............  Analyze pacemaker           0.00        0.67        0.59          NA          NA        0.04         XXX
                                                 system.
93732...........  26...........  A............  Analyze pacemaker           0.92        0.48        0.41        0.48        0.41        0.03         XXX
                                                 system.
93733...........  .............  A............  Telephone analy,            0.17        0.93        0.86          NA          NA        0.07         XXX
                                                 pacemaker.
93733...........  TC...........  A............  Telephone analy,            0.00        0.85        0.79          NA          NA        0.06         XXX
                                                 pacemaker.
93733...........  26...........  A............  Telephone analy,            0.17        0.08        0.07        0.08        0.07        0.01         XXX
                                                 pacemaker.
93734...........  .............  A............  Analyze pacemaker           0.38        0.69        0.59          NA          NA        0.03         XXX
                                                 system.
93734...........  TC...........  A............  Analyze pacemaker           0.00        0.50        0.42          NA          NA        0.02         XXX
                                                 system.
93734...........  26...........  A............  Analyze pacemaker           0.38        0.19        0.17        0.19        0.17        0.01         XXX
                                                 system.
93735...........  .............  A............  Analyze pacemaker           0.74        0.96        0.84          NA          NA        0.06         XXX
                                                 system.
93735...........  TC...........  A............  Analyze pacemaker           0.00        0.57        0.51          NA          NA        0.04         XXX
                                                 system.
93735...........  26...........  A............  Analyze pacemaker           0.74        0.39        0.33        0.39        0.33        0.02         XXX
                                                 system.
93736...........  .............  A............  Telephonic analy,           0.15        0.91        0.79          NA          NA        0.07         XXX
                                                 pacemaker.
93736...........  TC...........  A............  Telephonic analy,           0.00        0.84        0.73          NA          NA        0.06         XXX
                                                 pacemaker.
93736...........  26...........  A............  Telephonic analy,           0.15        0.07        0.06        0.07        0.06        0.01         XXX
                                                 pacemaker.
93740...........  .............  B............  Temperature gradient        0.16        0.04        0.11          NA          NA        0.02         XXX
                                                 studies.
93740...........  TC...........  B............  Temperature gradient        0.00        0.00        0.07          NA          NA        0.01         XXX
                                                 studies.
93740...........  26...........  B............  Temperature gradient        0.16        0.04        0.04        0.04        0.04        0.01         XXX
                                                 studies.
93741...........  .............  A............  Analyze ht pace             0.80        1.01        0.99          NA          NA        0.07         XXX
                                                 device sngl.
93741...........  TC...........  A............  Analyze ht pace             0.00        0.59        0.63          NA          NA        0.04         XXX
                                                 device sngl.
93741...........  26...........  A............  Analyze ht pace             0.80        0.42        0.36        0.42        0.36        0.03         XXX
                                                 device sngl.
93742...........  .............  A............  Analyze ht pace             0.91        1.15        1.09          NA          NA        0.07         XXX
                                                 device sngl.
93742...........  TC...........  A............  Analyze ht pace             0.00        0.67        0.67          NA          NA        0.04         XXX
                                                 device sngl.
93742...........  26...........  A............  Analyze ht pace             0.91        0.48        0.42        0.48        0.42        0.03         XXX
                                                 device sngl.
93743...........  .............  A............  Analyze ht pace             1.03        1.19        1.16          NA          NA        0.07         XXX
                                                 device dual.
93743...........  TC...........  A............  Analyze ht pace             0.00        0.64        0.69          NA          NA        0.04         XXX
                                                 device dual.
93743...........  26...........  A............  Analyze ht pace             1.03        0.55        0.47        0.55        0.47        0.03         XXX
                                                 device dual.
93744...........  .............  A............  Analyze ht pace             1.18        1.35        1.23          NA          NA        0.08         XXX
                                                 device dual.
93744...........  TC...........  A............  Analyze ht pace             0.00        0.72        0.69          NA          NA        0.04         XXX
                                                 device dual.
93744...........  26...........  A............  Analyze ht pace             1.18        0.63        0.54        0.63        0.54        0.04         XXX
                                                 device dual.
93745...........  .............  C............  Set-up cardiovert-          0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 defibrill.
93745...........  TC...........  C............  Set-up cardiovert-          0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 defibrill.
93745...........  26...........  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                  0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 thermogram.
93770...........  .............  B............  Measure venous              0.16        0.04        0.05          NA          NA        0.02         XXX
                                                 pressure.
93770...........  TC...........  B............  Measure venous              0.00        0.00        0.01          NA          NA        0.01         XXX
                                                 pressure.
93770...........  26...........  B............  Measure venous              0.16        0.04        0.04        0.04        0.04        0.01         XXX
                                                 pressure.
93784...........  .............  A............  Ambulatory BP               0.38        1.39        1.47          NA          NA        0.03         XXX
                                                 monitoring.
93786...........  .............  A............  Ambulatory BP               0.00        0.81        0.86          NA          NA        0.01         XXX
                                                 recording.
93788...........  .............  A............  Ambulatory BP               0.00        0.45        0.48          NA          NA        0.01         XXX
                                                 analysis.
93790...........  .............  A............  Review/report BP            0.38        0.13        0.13        0.13        0.13        0.01         XXX
                                                 recording.
93797...........  .............  A............  Cardiac rehab.......        0.18        0.32        0.31        0.09        0.08        0.01         000
93798...........  .............  A............  Cardiac rehab/              0.28        0.44        0.45        0.13        0.12        0.01         000
                                                 monitor.
93799...........  .............  C............  Cardiovascular              0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 procedure.
93799...........  TC...........  C............  Cardiovascular              0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 procedure.
93799...........  26...........  C............  Cardiovascular              0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 procedure.
93875...........  .............  A............  Extracranial study..        0.22        2.54        2.43          NA          NA        0.12         XXX
93875...........  TC...........  A............  Extracranial study..        0.00        2.47        2.36          NA          NA        0.11         XXX
93875...........  26...........  A............  Extracranial study..        0.22        0.07        0.07        0.07        0.07        0.01         XXX
93880...........  .............  A............  Extracranial study..        0.60        6.15        5.85          NA          NA        0.39         XXX
93880...........  TC...........  A............  Extracranial study..        0.00        5.94        5.65          NA          NA        0.35         XXX
93880...........  26...........  A............  Extracranial study..        0.60        0.21        0.20        0.21        0.20        0.04         XXX
93882...........  .............  A............  Extracranial study..        0.40        4.11        3.81          NA          NA        0.26         XXX
93882...........  TC...........  A............  Extracranial study..        0.00        4.00        3.68          NA          NA        0.22         XXX
93882...........  26...........  A............  Extracranial study..        0.40        0.11        0.13        0.11        0.13        0.04         XXX
93886...........  .............  A............  Intracranial study..        0.94        7.02        6.87          NA          NA        0.45         XXX

[[Page 66530]]

 
93886...........  TC...........  A............  Intracranial study..        0.00        6.74        6.55          NA          NA        0.39         XXX
93886...........  26...........  A............  Intracranial study..        0.94        0.28        0.32        0.28        0.32        0.06         XXX
93888...........  .............  A............  Intracranial study..        0.62        4.91        4.57          NA          NA        0.32         XXX
93888...........  TC...........  A............  Intracranial study..        0.00        4.71        4.36          NA          NA        0.27         XXX
93888...........  26...........  A............  Intracranial study..        0.62        0.20        0.21        0.20        0.21        0.05         XXX
93890...........  .............  A............  Tcd, vasoreactivity         1.00        6.44        5.67          NA          NA        0.45         XXX
                                                 study.
93890...........  TC...........  A............  Tcd, vasoreactivity         0.00        6.13        5.31          NA          NA        0.39         XXX
                                                 study.
93890...........  26...........  A............  Tcd, vasoreactivity         1.00        0.31        0.36        0.31        0.36        0.06         XXX
                                                 study.
93892...........  .............  A............  Tcd, emboli detect w/       1.15        6.84        6.00          NA          NA        0.45         XXX
                                                 o inj.
93892...........  TC...........  A............  Tcd, emboli detect w/       0.00        6.52        5.61          NA          NA        0.39         XXX
                                                 o inj.
93892...........  26...........  A............  Tcd, emboli detect w/       1.15        0.32        0.39        0.32        0.39        0.06         XXX
                                                 o inj.
93893...........  .............  A............  Tcd, emboli detect w/       1.15        6.99        6.00          NA          NA        0.45         XXX
                                                 inj.
93893...........  TC...........  A............  Tcd, emboli detect w/       0.00        6.66        5.61          NA          NA        0.39         XXX
                                                 inj.
93893...........  26...........  A............  Tcd, emboli detect w/       1.15        0.33        0.39        0.33        0.39        0.06         XXX
                                                 inj.
93922...........  .............  A............  Extremity study.....        0.25        3.10        2.89          NA          NA        0.15         XXX
93922...........  TC...........  A............  Extremity study.....        0.00        3.02        2.81          NA          NA        0.13         XXX
93922...........  26...........  A............  Extremity study.....        0.25        0.08        0.08        0.08        0.08        0.02         XXX
93923...........  .............  A............  Extremity study.....        0.45        4.68        4.35          NA          NA        0.26         XXX
93923...........  TC...........  A............  Extremity study.....        0.00        4.54        4.21          NA          NA        0.22         XXX
93923...........  26...........  A............  Extremity study.....        0.45        0.14        0.14        0.14        0.14        0.04         XXX
93924...........  .............  A............  Extremity study.....        0.50        5.93        5.36          NA          NA        0.30         XXX
93924...........  TC...........  A............  Extremity study.....        0.00        5.76        5.19          NA          NA        0.25         XXX
93924...........  26...........  A............  Extremity study.....        0.50        0.17        0.17        0.17        0.17        0.05         XXX
93925...........  .............  A............  Lower extremity             0.58        8.01        7.39          NA          NA        0.39         XXX
                                                 study.
93925...........  TC...........  A............  Lower extremity             0.00        7.82        7.20          NA          NA        0.35         XXX
                                                 study.
93925...........  26...........  A............  Lower extremity             0.58        0.19        0.19        0.19        0.19        0.04         XXX
                                                 study.
93926...........  .............  A............  Lower extremity             0.39        5.14        4.59          NA          NA        0.27         XXX
                                                 study.
93926...........  TC...........  A............  Lower extremity             0.00        5.03        4.47          NA          NA        0.23         XXX
                                                 study.
93926...........  26...........  A............  Lower extremity             0.39        0.11        0.12        0.11        0.12        0.04         XXX
                                                 study.
93930...........  .............  A............  Upper extremity             0.46        6.24        5.79          NA          NA        0.41         XXX
                                                 study.
93930...........  TC...........  A............  Upper extremity             0.00        6.09        5.64          NA          NA        0.37         XXX
                                                 study.
93930...........  26...........  A............  Upper extremity             0.46        0.15        0.15        0.15        0.15        0.04         XXX
                                                 study.
93931...........  .............  A............  Upper extremity             0.31        4.18        3.83          NA          NA        0.27         XXX
                                                 study.
93931...........  TC...........  A............  Upper extremity             0.00        4.08        3.73          NA          NA        0.24         XXX
                                                 study.
93931...........  26...........  A............  Upper extremity             0.31        0.10        0.10        0.10        0.10        0.03         XXX
                                                 study.
93965...........  .............  A............  Extremity study.....        0.35        3.00        2.89          NA          NA        0.14         XXX
93965...........  TC...........  A............  Extremity study.....        0.00        2.89        2.78          NA          NA        0.12         XXX
93965...........  26...........  A............  Extremity study.....        0.35        0.11        0.11        0.11        0.11        0.02         XXX
93970...........  .............  A............  Extremity study.....        0.68        6.20        5.72          NA          NA        0.46         XXX
93970...........  TC...........  A............  Extremity study.....        0.00        5.99        5.50          NA          NA        0.40         XXX
93970...........  26...........  A............  Extremity study.....        0.68        0.21        0.22        0.21        0.22        0.06         XXX
93971...........  .............  A............  Extremity study.....        0.45        4.07        3.83          NA          NA        0.30         XXX
93971...........  TC...........  A............  Extremity study.....        0.00        3.92        3.68          NA          NA        0.27         XXX
93971...........  26...........  A............  Extremity study.....        0.45        0.15        0.15        0.15        0.15        0.03         XXX
93975...........  .............  A............  Vascular study......        1.80        8.45        8.03          NA          NA        0.56         XXX
93975...........  TC...........  A............  Vascular study......        0.00        7.82        7.42          NA          NA        0.43         XXX
93975...........  26...........  A............  Vascular study......        1.80        0.63        0.61        0.63        0.61        0.13         XXX
93976...........  .............  A............  Vascular study......        1.21        4.57        4.45          NA          NA        0.35         XXX
93976...........  TC...........  A............  Vascular study......        0.00        4.15        4.04          NA          NA        0.30         XXX
93976...........  26...........  A............  Vascular study......        1.21        0.42        0.41        0.42        0.41        0.05         XXX
93978...........  .............  A............  Vascular study......        0.65        6.02        5.27          NA          NA        0.43         XXX
93978...........  TC...........  A............  Vascular study......        0.00        5.81        5.05          NA          NA        0.37         XXX
93978...........  26...........  A............  Vascular study......        0.65        0.21        0.22        0.21        0.22        0.06         XXX
93979...........  .............  A............  Vascular study......        0.44        4.16        3.69          NA          NA        0.27         XXX
93979...........  TC...........  A............  Vascular study......        0.00        4.02        3.54          NA          NA        0.24         XXX
93979...........  26...........  A............  Vascular study......        0.44        0.14        0.15        0.14        0.15        0.03         XXX
93980...........  .............  A............  Penile vascular             1.25        3.48        3.16          NA          NA        0.42         XXX
                                                 study.
93980...........  TC...........  A............  Penile vascular             0.00        3.02        2.73          NA          NA        0.34         XXX
                                                 study.
93980...........  26...........  A............  Penile vascular             1.25        0.46        0.43        0.46        0.43        0.08         XXX
                                                 study.
93981...........  .............  A............  Penile vascular             0.44        2.84        2.85          NA          NA        0.33         XXX
                                                 study.
93981...........  TC...........  A............  Penile vascular             0.00        2.68        2.70          NA          NA        0.31         XXX
                                                 study.
93981...........  26...........  A............  Penile vascular             0.44        0.16        0.15        0.16        0.15        0.02         XXX
                                                 study.
93982...........  .............  R............  Aneurysm pressure           0.30        0.80        0.80          NA          NA        0.01         XXX
                                                 sens study.
93990...........  .............  A............  Doppler flow testing        0.25        5.21        4.61          NA          NA        0.26         XXX
93990...........  TC...........  A............  Doppler flow testing        0.00        5.15        4.53          NA          NA        0.23         XXX
93990...........  26...........  A............  Doppler flow testing        0.25        0.06        0.08        0.06        0.08        0.03         XXX
94002...........  .............  A............  Vent mgmt inpat,            1.99          NA          NA        0.35        0.34        0.09         XXX
                                                 init day.
94003...........  .............  A............  Vent mgmt inpat,            1.37          NA          NA        0.32        0.32        0.06         XXX
                                                 subq day.
94004...........  .............  A............  Vent mgmt nf per day        1.00          NA          NA        0.23        0.23        0.04         XXX
94005...........  .............  B............  Home vent mgmt              1.50        0.70        0.70          NA          NA        0.06         XXX
                                                 supervision.
94010...........  .............  A............  Breathing capacity          0.17        0.74        0.71          NA          NA        0.03         XXX
                                                 test.
94010...........  TC...........  A............  Breathing capacity          0.00        0.70        0.66          NA          NA        0.02         XXX
                                                 test.

[[Page 66531]]

 
94010...........  26...........  A............  Breathing capacity          0.17        0.04        0.05        0.04        0.05        0.01         XXX
                                                 test.
94014...........  .............  A............  Patient recorded            0.52        0.81        0.78          NA          NA        0.03         XXX
                                                 spirometry.
94015...........  .............  A............  Patient recorded            0.00        0.67        0.63          NA          NA        0.01         XXX
                                                 spirometry.
94016...........  .............  A............  Review patient              0.52        0.14        0.15        0.14        0.15        0.02         XXX
                                                 spirometry.
94060...........  .............  A............  Evaluation of               0.31        1.32        1.19          NA          NA        0.07         XXX
                                                 wheezing.
94060...........  TC...........  A............  Evaluation of               0.00        1.24        1.11          NA          NA        0.06         XXX
                                                 wheezing.
94060...........  26...........  A............  Evaluation of               0.31        0.08        0.08        0.08        0.08        0.01         XXX
                                                 wheezing.
94070...........  .............  A............  Evaluation of               0.60        1.00        0.90          NA          NA        0.13         XXX
                                                 wheezing.
94070...........  TC...........  A............  Evaluation of               0.00        0.85        0.74          NA          NA        0.10         XXX
                                                 wheezing.
94070...........  26...........  A............  Evaluation of               0.60        0.15        0.16        0.15        0.16        0.03         XXX
                                                 wheezing.
94150...........  .............  B............  Vital capacity test.        0.07        0.48        0.47          NA          NA        0.02         XXX
94150...........  TC...........  B............  Vital capacity test.        0.00        0.46        0.45          NA          NA        0.01         XXX
94150...........  26...........  B............  Vital capacity test.        0.07        0.02        0.02        0.02        0.02        0.01         XXX
94200...........  .............  A............  Lung function test          0.11        0.50        0.47          NA          NA        0.03         XXX
                                                 (MBC/MVV).
94200...........  TC...........  A............  Lung function test          0.00        0.47        0.44          NA          NA        0.02         XXX
                                                 (MBC/MVV).
94200...........  26...........  A............  Lung function test          0.11        0.03        0.03        0.03        0.03        0.01         XXX
                                                 (MBC/MVV).
94240...........  .............  A............  Residual lung               0.26        0.81        0.74          NA          NA        0.06         XXX
                                                 capacity.
94240...........  TC...........  A............  Residual lung               0.00        0.75        0.67          NA          NA        0.05         XXX
                                                 capacity.
94240...........  26...........  A............  Residual lung               0.26        0.06        0.07        0.06        0.07        0.01         XXX
                                                 capacity.
94250...........  .............  A............  Expired gas                 0.11        0.51        0.58          NA          NA        0.02         XXX
                                                 collection.
94250...........  TC...........  A............  Expired gas                 0.00        0.48        0.55          NA          NA        0.01         XXX
                                                 collection.
94250...........  26...........  A............  Expired gas                 0.11        0.03        0.03        0.03        0.03        0.01         XXX
                                                 collection.
94260...........  .............  A............  Thoracic gas volume.        0.13        0.75        0.66          NA          NA        0.05         XXX
94260...........  TC...........  A............  Thoracic gas volume.        0.00        0.72        0.63          NA          NA        0.04         XXX
94260...........  26...........  A............  Thoracic gas volume.        0.13        0.03        0.03        0.03        0.03        0.01         XXX
94350...........  .............  A............  Lung nitrogen               0.26        0.61        0.69          NA          NA        0.05         XXX
                                                 washout curve.
94350...........  TC...........  A............  Lung nitrogen               0.00        0.55        0.62          NA          NA        0.04         XXX
                                                 washout curve.
94350...........  26...........  A............  Lung nitrogen               0.26        0.06        0.07        0.06        0.07        0.01         XXX
                                                 washout curve.
94360...........  .............  A............  Measure airflow             0.26        0.95        0.82          NA          NA        0.07         XXX
                                                 resistance.
94360...........  TC...........  A............  Measure airflow             0.00        0.89        0.75          NA          NA        0.06         XXX
                                                 resistance.
94360...........  26...........  A............  Measure airflow             0.26        0.06        0.07        0.06        0.07        0.01         XXX
                                                 resistance.
94370...........  .............  A............  Breath airway               0.26        0.60        0.66          NA          NA        0.03         XXX
                                                 closing volume.
94370...........  TC...........  A............  Breath airway               0.00        0.53        0.59          NA          NA        0.02         XXX
                                                 closing volume.
94370...........  26...........  A............  Breath airway               0.26        0.07        0.07        0.07        0.07        0.01         XXX
                                                 closing volume.
94375...........  .............  A............  Respiratory flow            0.31        0.73        0.66          NA          NA        0.03         XXX
                                                 volume loop.
94375...........  TC...........  A............  Respiratory flow            0.00        0.65        0.58          NA          NA        0.02         XXX
                                                 volume loop.
94375...........  26...........  A............  Respiratory flow            0.31        0.08        0.08        0.08        0.08        0.01         XXX
                                                 volume loop.
94400...........  .............  A............  CO2 breathing               0.40        1.03        0.93          NA          NA        0.09         XXX
                                                 response curve.
94400...........  TC...........  A............  CO2 breathing               0.00        0.93        0.82          NA          NA        0.06         XXX
                                                 response curve.
94400...........  26...........  A............  CO2 breathing               0.40        0.10        0.11        0.10        0.11        0.03         XXX
                                                 response curve.
94450...........  .............  A............  Hypoxia response            0.40        1.01        0.92          NA          NA        0.04         XXX
                                                 curve.
94450...........  TC...........  A............  Hypoxia response            0.00        0.92        0.82          NA          NA        0.02         XXX
                                                 curve.
94450...........  26...........  A............  Hypoxia response            0.40        0.09        0.10        0.09        0.10        0.02         XXX
                                                 curve.
94452...........  .............  A............  Hast w/report.......        0.31        1.27        1.14          NA          NA        0.04         XXX
94452...........  TC...........  A............  Hast w/report.......        0.00        1.20        1.06          NA          NA        0.02         XXX
94452...........  26...........  A............  Hast w/report.......        0.31        0.07        0.08        0.07        0.08        0.02         XXX
94453...........  .............  A............  Hast w/oxygen               0.40        1.69        1.60          NA          NA        0.04         XXX
                                                 titrate.
94453...........  TC...........  A............  Hast w/oxygen               0.00        1.59        1.49          NA          NA        0.02         XXX
                                                 titrate.
94453...........  26...........  A............  Hast w/oxygen               0.40        0.10        0.11        0.10        0.11        0.02         XXX
                                                 titrate.
94610...........  .............  A............  Surfactant admin            1.16        0.34        0.34        0.34        0.34        0.26         XXX
                                                 thru tube.
94620...........  .............  A............  Pulmonary stress            0.64        0.79        1.64          NA          NA        0.13         XXX
                                                 test/simple.
94620...........  TC...........  A............  Pulmonary stress            0.00        0.63        1.46          NA          NA        0.10         XXX
                                                 test/simple.
94620...........  26...........  A............  Pulmonary stress            0.64        0.16        0.18        0.16        0.18        0.03         XXX
                                                 test/simple.
94621...........  .............  A............  Pulm stress test/           1.42        3.18        2.69          NA          NA        0.16         XXX
                                                 complex.
94621...........  TC...........  A............  Pulm stress test/           0.00        2.73        2.25          NA          NA        0.10         XXX
                                                 complex.
94621...........  26...........  A............  Pulm stress test/           1.42        0.45        0.44        0.45        0.44        0.06         XXX
                                                 complex.
94640...........  .............  A............  Airway inhalation           0.00        0.38        0.34          NA          NA        0.02         XXX
                                                 treatment.
94642...........  .............  C............  Aerosol inhalation          0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 treatment.
94644...........  .............  A............  Cbt, 1st hour.......        0.00        0.96        0.96          NA          NA        0.02         XXX
94645...........  .............  A............  Cbt, each addl hour.        0.00        0.35        0.35          NA          NA        0.02         XXX
94660...........  .............  A............  Pos airway pressure,        0.76        0.81        0.73        0.19        0.21        0.04         XXX
                                                 CPAP.
94662...........  .............  A............  Neg press                   0.76          NA          NA        0.20        0.21        0.03         XXX
                                                 ventilation, cnp.
94664...........  .............  A............  Evaluate pt use of          0.00        0.40        0.35          NA          NA        0.04         XXX
                                                 inhaler.
94667...........  .............  A............  Chest wall                  0.00        0.53        0.53          NA          NA        0.05         XXX
                                                 manipulation.
94668...........  .............  A............  Chest wall                  0.00        0.50        0.48          NA          NA        0.02         XXX
                                                 manipulation.
94680...........  .............  A............  Exhaled air                 0.26        1.06        1.46          NA          NA        0.07         XXX
                                                 analysis, o2.
94680...........  TC...........  A............  Exhaled air                 0.00        1.00        1.39          NA          NA        0.06         XXX
                                                 analysis, o2.
94680...........  26...........  A............  Exhaled air                 0.26        0.06        0.07        0.06        0.07        0.01         XXX
                                                 analysis, o2.
94681...........  .............  A............  Exhaled air                 0.20        1.07        1.79          NA          NA        0.13         XXX
                                                 analysis, o2/co2.
94681...........  TC...........  A............  Exhaled air                 0.00        1.02        1.74          NA          NA        0.12         XXX
                                                 analysis, o2/co2.
94681...........  26...........  A............  Exhaled air                 0.20        0.05        0.05        0.05        0.05        0.01         XXX
                                                 analysis, o2/co2.
94690...........  .............  A............  Exhaled air analysis        0.07        1.04        1.52          NA          NA        0.05         XXX

[[Page 66532]]

 
94690...........  TC...........  A............  Exhaled air analysis        0.00        1.02        1.50          NA          NA        0.04         XXX
94690...........  26...........  A............  Exhaled air analysis        0.07        0.02        0.02        0.02        0.02        0.01         XXX
94720...........  .............  A............  Monoxide diffusing          0.26        1.15        1.08          NA          NA        0.07         XXX
                                                 capacity.
94720...........  TC...........  A............  Monoxide diffusing          0.00        1.09        1.01          NA          NA        0.06         XXX
                                                 capacity.
94720...........  26...........  A............  Monoxide diffusing          0.26        0.06        0.07        0.06        0.07        0.01         XXX
                                                 capacity.
94725...........  .............  A............  Membrane diffusion          0.26        0.98        1.94          NA          NA        0.13         XXX
                                                 capacity.
94725...........  TC...........  A............  Membrane diffusion          0.00        0.91        1.87          NA          NA        0.12         XXX
                                                 capacity.
94725...........  26...........  A............  Membrane diffusion          0.26        0.07        0.07        0.07        0.07        0.01         XXX
                                                 capacity.
94750...........  .............  A............  Pulmonary compliance        0.23        1.77        1.55          NA          NA        0.05         XXX
                                                 study.
94750...........  TC...........  A............  Pulmonary compliance        0.00        1.71        1.49          NA          NA        0.04         XXX
                                                 study.
94750...........  26...........  A............  Pulmonary compliance        0.23        0.06        0.06        0.06        0.06        0.01         XXX
                                                 study.
94760...........  .............  T............  Measure blood oxygen        0.00        0.06        0.05          NA          NA        0.02         XXX
                                                 level.
94761...........  .............  T............  Measure blood oxygen        0.00        0.11        0.09          NA          NA        0.06         XXX
                                                 level.
94762...........  .............  A............  Measure blood oxygen        0.00        0.84        0.66          NA          NA        0.10         XXX
                                                 level.
94770...........  .............  A............  Exhaled carbon              0.15        0.81        0.78          NA          NA        0.08         XXX
                                                 dioxide test.
94770...........  TC...........  A............  Exhaled carbon              0.00        0.77        0.74          NA          NA        0.07         XXX
                                                 dioxide test.
94770...........  26...........  A............  Exhaled carbon              0.15        0.04        0.04        0.04        0.04        0.01         XXX
                                                 dioxide test.
94772...........  .............  C............  Breath recording,           0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 infant.
94772...........  TC...........  C............  Breath recording,           0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 infant.
94772...........  26...........  C............  Breath recording,           0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 infant.
94774...........  .............  C............  Ped home apnea rec,         0.00        0.00        0.00        0.00        0.00        0.00         YYY
                                                 compl.
94775...........  .............  C............  Ped home apnea rec,         0.00        0.00        0.00        0.00        0.00        0.00         YYY
                                                 hk-up.
94776...........  .............  C............  Ped home apnea rec,         0.00        0.00        0.00        0.00        0.00        0.00         YYY
                                                 downld.
94777...........  .............  C............  Ped home apnea rec,         0.00        0.00        0.00        0.00        0.00        0.00         YYY
                                                 report.
94799...........  .............  C............  Pulmonary service/          0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 procedure.
94799...........  TC...........  C............  Pulmonary service/          0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 procedure.
94799...........  26...........  C............  Pulmonary service/          0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 procedure.
95004...........  .............  A............  Percut allergy skin         0.01        0.15        0.13          NA          NA        0.01         XXX
                                                 tests.
95010...........  .............  A............  Percut allergy              0.15        0.31        0.31          NA          NA        0.01         XXX
                                                 titrate test.
95012...........  .............  A............  Exhaled nitric oxide        0.00        0.49        0.49          NA          NA        0.01         XXX
                                                 meas.
95015...........  .............  A............  Id allergy titrate-         0.15        0.21        0.18          NA          NA        0.01         XXX
                                                 drug/bug.
95024...........  .............  A............  Id allergy test,            0.01        0.17        0.16          NA          NA        0.01         XXX
                                                 drug/bug.
95027...........  .............  A............  Id allergy titrate-         0.01        0.10        0.12          NA          NA        0.01         XXX
                                                 airborne.
95028...........  .............  A............  Id allergy test-            0.00        0.31        0.27          NA          NA        0.01         XXX
                                                 delayed type.
95044...........  .............  A............  Allergy patch tests.        0.00        0.15        0.18          NA          NA        0.01         XXX
95052...........  .............  A............  Photo patch test....        0.00        0.16        0.20          NA          NA        0.01         XXX
95056...........  .............  A............  Photosensitivity            0.00        1.25        0.71          NA          NA        0.01         XXX
                                                 tests.
95060...........  .............  A............  Eye allergy tests...        0.00        0.73        0.54        0.73        0.54        0.02         XXX
95065...........  .............  A............  Nose allergy test...        0.00        0.70        0.45        0.70        0.45        0.01         XXX
95070...........  .............  A............  Bronchial allergy           0.00        0.81        1.55          NA          NA        0.02         XXX
                                                 tests.
95071...........  .............  A............  Bronchial allergy           0.00        0.98        1.95          NA          NA        0.02         XXX
                                                 tests.
95075...........  .............  A............  Ingestion challenge         0.95        0.68        0.75        0.26        0.32        0.03         XXX
                                                 test.
95115...........  .............  A............  Immunotherapy, one          0.00        0.23        0.31          NA          NA        0.02         XXX
                                                 injection.
95117...........  .............  A............  Immunotherapy               0.00        0.28        0.39          NA          NA        0.02         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,              0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 insect venom.
95131...........  .............  I............  Immunotherapy,              0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 insect venoms.
95132...........  .............  I............  Immunotherapy,              0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 insect venoms.
95133...........  .............  I............  Immunotherapy,              0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 insect venoms.
95134...........  .............  I............  Immunotherapy,              0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 insect venoms.
95144...........  .............  A............  Antigen therapy             0.06        0.27        0.23        0.02        0.02        0.01         XXX
                                                 services.
95145...........  .............  A............  Antigen therapy             0.06        0.36        0.34        0.02        0.02        0.01         XXX
                                                 services.
95146...........  .............  A............  Antigen therapy             0.06        0.68        0.56        0.02        0.02        0.01         XXX
                                                 services.
95147...........  .............  A............  Antigen therapy             0.06        0.66        0.54        0.02        0.02        0.01         XXX
                                                 services.
95148...........  .............  A............  Antigen therapy             0.06        0.98        0.78        0.02        0.02        0.01         XXX
                                                 services.
95149...........  .............  A............  Antigen therapy             0.06        1.30        1.05        0.02        0.02        0.01         XXX
                                                 services.
95165...........  .............  A............  Antigen therapy             0.06        0.26        0.23        0.02        0.02        0.01         XXX
                                                 services.
95170...........  .............  A............  Antigen therapy             0.06        0.20        0.17        0.02        0.02        0.01         XXX
                                                 services.
95180...........  .............  A............  Rapid                       2.01        1.66        1.85        0.77        0.85        0.04         XXX
                                                 desensitization.
95199...........  .............  C............  Allergy immunology          0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 services.
95250...........  .............  A............  Glucose monitoring,         0.00        3.49        3.80          NA          NA        0.01         XXX
                                                 cont.
95251...........  .............  A............  Gluc monitor, cont,         0.85        0.26        0.22        0.26        0.22        0.02         XXX
                                                 phys i&r.
95805...........  .............  A............  Multiple sleep              1.88        7.01       12.13          NA          NA        0.43         XXX
                                                 latency test.
95805...........  TC...........  A............  Multiple sleep              0.00        6.50       11.55          NA          NA        0.34         XXX
                                                 latency test.
95805...........  26...........  A............  Multiple sleep              1.88        0.51        0.58        0.51        0.58        0.09         XXX
                                                 latency test.
95806...........  .............  A............  Sleep study,                1.66        3.92        3.62          NA          NA        0.39         XXX
                                                 unattended.
95806...........  TC...........  A............  Sleep study,                0.00        3.45        3.12          NA          NA        0.31         XXX
                                                 unattended.
95806...........  26...........  A............  Sleep study,                1.66        0.47        0.50        0.47        0.50        0.08         XXX
                                                 unattended.
95807...........  .............  A............  Sleep study,                1.66       12.29       12.07          NA          NA        0.50         XXX
                                                 attended.
95807...........  TC...........  A............  Sleep study,                0.00       11.88       11.60          NA          NA        0.42         XXX
                                                 attended.
95807...........  26...........  A............  Sleep study,                1.66        0.41        0.47        0.41        0.47        0.08         XXX
                                                 attended.

[[Page 66533]]

 
95808...........  .............  A............  Polysomnography, 1-3        2.65       15.74       14.46          NA          NA        0.55         XXX
95808...........  TC...........  A............  Polysomnography, 1-3        0.00       15.04       13.65          NA          NA        0.42         XXX
95808...........  26...........  A............  Polysomnography, 1-3        2.65        0.70        0.81        0.70        0.81        0.13         XXX
95810...........  .............  A............  Polysomnography, 4          3.52       17.68       17.58          NA          NA        0.59         XXX
                                                 or more.
95810...........  TC...........  A............  Polysomnography, 4          0.00       16.78       16.54          NA          NA        0.42         XXX
                                                 or more.
95810...........  26...........  A............  Polysomnography, 4          3.52        0.90        1.04        0.90        1.04        0.17         XXX
                                                 or more.
95811...........  .............  A............  Polysomnography w/          3.79       19.68       19.42          NA          NA        0.61         XXX
                                                 cpap.
95811...........  TC...........  A............  Polysomnography w/          0.00       18.72       18.31          NA          NA        0.43         XXX
                                                 cpap.
95811...........  26...........  A............  Polysomnography w/          3.79        0.96        1.11        0.96        1.11        0.18         XXX
                                                 cpap.
95812...........  .............  A............  Eeg, 41-60 minutes..        1.08        5.89        4.96          NA          NA        0.17         XXX
95812...........  TC...........  A............  Eeg, 41-60 minutes..        0.00        5.59        4.58          NA          NA        0.11         XXX
95812...........  26...........  A............  Eeg, 41-60 minutes..        1.08        0.30        0.38        0.30        0.38        0.06         XXX
95813...........  .............  A............  Eeg, over 1 hour....        1.73        6.51        5.76          NA          NA        0.20         XXX
95813...........  TC...........  A............  Eeg, over 1 hour....        0.00        6.03        5.17          NA          NA        0.11         XXX
95813...........  26...........  A............  Eeg, over 1 hour....        1.73        0.48        0.59        0.48        0.59        0.09         XXX
95816...........  .............  A............  Eeg, awake and              1.08        5.27        4.49          NA          NA        0.16         XXX
                                                 drowsy.
95816...........  TC...........  A............  Eeg, awake and              0.00        4.97        4.11          NA          NA        0.10         XXX
                                                 drowsy.
95816...........  26...........  A............  Eeg, awake and              1.08        0.30        0.38        0.30        0.38        0.06         XXX
                                                 drowsy.
95819...........  .............  A............  Eeg, awake and              1.08        6.13        4.55          NA          NA        0.16         XXX
                                                 asleep.
95819...........  TC...........  A............  Eeg, awake and              0.00        5.83        4.17          NA          NA        0.10         XXX
                                                 asleep.
95819...........  26...........  A............  Eeg, awake and              1.08        0.30        0.38        0.30        0.38        0.06         XXX
                                                 asleep.
95822...........  .............  A............  Eeg, coma or sleep          1.08        5.51        5.05          NA          NA        0.19         XXX
                                                 only.
95822...........  TC...........  A............  Eeg, coma or sleep          0.00        5.21        4.67          NA          NA        0.13         XXX
                                                 only.
95822...........  26...........  A............  Eeg, coma or sleep          1.08        0.30        0.38        0.30        0.38        0.06         XXX
                                                 only.
95824...........  .............  C............  Eeg, cerebral death         0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 only.
95824...........  TC...........  C............  Eeg, cerebral death         0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 only.
95824...........  26...........  A............  Eeg, cerebral death         0.74        0.21        0.26        0.21        0.26        0.04         XXX
                                                 only.
95827...........  .............  A............  Eeg, all night              1.08       11.52        7.11          NA          NA        0.19         XXX
                                                 recording.
95827...........  TC...........  A............  Eeg, all night              0.00       11.22        6.76          NA          NA        0.14         XXX
                                                 recording.
95827...........  26...........  A............  Eeg, all night              1.08        0.30        0.35        0.30        0.35        0.05         XXX
                                                 recording.
95829...........  .............  A............  Surgery                     6.20       24.75       27.87          NA          NA        0.50         XXX
                                                 electrocorticogram.
95829...........  TC...........  A............  Surgery                     0.00       22.99       25.83          NA          NA        0.02         XXX
                                                 electrocorticogram.
95829...........  26...........  A............  Surgery                     6.20        1.76        2.04        1.76        2.04        0.48         XXX
                                                 electrocorticogram.
95830...........  .............  A............  Insert electrodes           1.70        2.96        3.13        0.41        0.57        0.11         XXX
                                                 for EEG.
95831...........  .............  A............  Limb muscle testing,        0.28        0.40        0.43        0.09        0.11        0.01         XXX
                                                 manual.
95832...........  .............  A............  Hand muscle testing,        0.29        0.37        0.35        0.10        0.11        0.02         XXX
                                                 manual.
95833...........  .............  A............  Body muscle testing,        0.47        0.49        0.54        0.14        0.18        0.02         XXX
                                                 manual.
95834...........  .............  A............  Body muscle testing,        0.60        0.54        0.58        0.17        0.23        0.03         XXX
                                                 manual.
95851...........  .............  A............  Range of motion             0.16        0.26        0.31        0.04        0.06        0.01         XXX
                                                 measurements.
95852...........  .............  A............  Range of motion             0.11        0.24        0.25        0.04        0.04        0.01         XXX
                                                 measurements.
95857...........  .............  A............  Tensilon test.......        0.53        0.58        0.59        0.16        0.19        0.02         XXX
95860...........  .............  A............  Muscle test, one            0.96        1.16        1.29          NA          NA        0.07         XXX
                                                 limb.
95860...........  TC...........  A............  Muscle test, one            0.00        0.84        0.92          NA          NA        0.02         XXX
                                                 limb.
95860...........  26...........  A............  Muscle test, one            0.96        0.32        0.37        0.32        0.37        0.05         XXX
                                                 limb.
95861...........  .............  A............  Muscle test, 2 limbs        1.54        1.66        1.53          NA          NA        0.13         XXX
95861...........  TC...........  A............  Muscle test, 2 limbs        0.00        1.15        0.94          NA          NA        0.06         XXX
95861...........  26...........  A............  Muscle test, 2 limbs        1.54        0.51        0.59        0.51        0.59        0.07         XXX
95863...........  .............  A............  Muscle test, 3 limbs        1.87        1.92        1.82          NA          NA        0.15         XXX
95863...........  TC...........  A............  Muscle test, 3 limbs        0.00        1.35        1.14          NA          NA        0.06         XXX
95863...........  26...........  A............  Muscle test, 3 limbs        1.87        0.57        0.68        0.57        0.68        0.09         XXX
95864...........  .............  A............  Muscle test, 4 limbs        1.99        2.14        2.40          NA          NA        0.21         XXX
95864...........  TC...........  A............  Muscle test, 4 limbs        0.00        1.53        1.66          NA          NA        0.12         XXX
95864...........  26...........  A............  Muscle test, 4 limbs        1.99        0.61        0.74        0.61        0.74        0.09         XXX
95865...........  .............  A............  Muscle test, larynx.        1.57        1.39        1.42          NA          NA        0.11         XXX
95865...........  TC...........  A............  Muscle test, larynx.        0.00        0.90        0.79          NA          NA        0.03         XXX
95865...........  26...........  A............  Muscle test, larynx.        1.57        0.49        0.63        0.49        0.63        0.08         XXX
95866...........  .............  A............  Muscle test,                1.25        1.32        1.03          NA          NA        0.10         XXX
                                                 hemidiaphragm.
95866...........  TC...........  A............  Muscle test,                0.00        0.93        0.56          NA          NA        0.03         XXX
                                                 hemidiaphragm.
95866...........  26...........  A............  Muscle test,                1.25        0.39        0.47        0.39        0.47        0.07         XXX
                                                 hemidiaphragm.
95867...........  .............  A............  Muscle test cran            0.79        1.15        1.03          NA          NA        0.07         XXX
                                                 nerv unilat.
95867...........  TC...........  A............  Muscle test cran            0.00        0.91        0.74          NA          NA        0.04         XXX
                                                 nerv unilat.
95867...........  26...........  A............  Muscle test cran            0.79        0.24        0.29        0.24        0.29        0.03         XXX
                                                 nerv unilat.
95868...........  .............  A............  Muscle test cran            1.18        1.47        1.34          NA          NA        0.10         XXX
                                                 nerve bilat.
95868...........  TC...........  A............  Muscle test cran            0.00        1.11        0.90          NA          NA        0.05         XXX
                                                 nerve bilat.
95868...........  26...........  A............  Muscle test cran            1.18        0.36        0.44        0.36        0.44        0.05         XXX
                                                 nerve bilat.
95869...........  .............  A............  Muscle test, thor           0.37        1.03        0.70          NA          NA        0.04         XXX
                                                 paraspinal.
95869...........  TC...........  A............  Muscle test, thor           0.00        0.91        0.56          NA          NA        0.02         XXX
                                                 paraspinal.
95869...........  26...........  A............  Muscle test, thor           0.37        0.12        0.14        0.12        0.14        0.02         XXX
                                                 paraspinal.
95870...........  .............  A............  Muscle test,                0.37        0.99        0.68          NA          NA        0.04         XXX
                                                 nonparaspinal.
95870...........  TC...........  A............  Muscle test,                0.00        0.87        0.54          NA          NA        0.02         XXX
                                                 nonparaspinal.
95870...........  26...........  A............  Muscle test,                0.37        0.12        0.14        0.12        0.14        0.02         XXX
                                                 nonparaspinal.
95872...........  .............  A............  Muscle test, one            2.88        1.63        1.43          NA          NA        0.13         XXX
                                                 fiber.

[[Page 66534]]

 
95872...........  TC...........  A............  Muscle test, one            0.00        0.76        0.68          NA          NA        0.05         XXX
                                                 fiber.
95872...........  26...........  A............  Muscle test, one            2.88        0.87        0.75        0.87        0.75        0.08         XXX
                                                 fiber.
95873...........  .............  A............  Guide nerv destr,           0.37        1.02        0.69          NA          NA        0.04         ZZZ
                                                 elec stim.
95873...........  TC...........  A............  Guide nerv destr,           0.00        0.88        0.54          NA          NA        0.02         ZZZ
                                                 elec stim.
95873...........  26...........  A............  Guide nerv destr,           0.37        0.14        0.15        0.14        0.15        0.02         ZZZ
                                                 elec stim.
95874...........  .............  A............  Guide nerv destr,           0.37        0.95        0.67          NA          NA        0.04         ZZZ
                                                 needle emg.
95874...........  TC...........  A............  Guide nerv destr,           0.00        0.83        0.52          NA          NA        0.02         ZZZ
                                                 needle emg.
95874...........  26...........  A............  Guide nerv destr,           0.37        0.12        0.15        0.12        0.15        0.02         ZZZ
                                                 needle emg.
95875...........  .............  A............  Limb exercise test..        1.10        1.46        1.46          NA          NA        0.11         XXX
95875...........  TC...........  A............  Limb exercise test..        0.00        1.08        1.03          NA          NA        0.06         XXX
95875...........  26...........  A............  Limb exercise test..        1.10        0.38        0.43        0.38        0.43        0.05         XXX
95900...........  .............  A............  Motor nerve                 0.42        0.92        1.09          NA          NA        0.04         XXX
                                                 conduction test.
95900...........  TC...........  A............  Motor nerve                 0.00        0.78        0.93          NA          NA        0.02         XXX
                                                 conduction test.
95900...........  26...........  A............  Motor nerve                 0.42        0.14        0.16        0.14        0.16        0.02         XXX
                                                 conduction test.
95903...........  .............  A............  Motor nerve                 0.60        0.99        1.09          NA          NA        0.05         XXX
                                                 conduction test.
95903...........  TC...........  A............  Motor nerve                 0.00        0.82        0.88          NA          NA        0.02         XXX
                                                 conduction test.
95903...........  26...........  A............  Motor nerve                 0.60        0.17        0.21        0.17        0.21        0.03         XXX
                                                 conduction test.
95904...........  .............  A............  Sense nerve                 0.34        0.84        0.97          NA          NA        0.04         XXX
                                                 conduction test.
95904...........  TC...........  A............  Sense nerve                 0.00        0.74        0.84          NA          NA        0.02         XXX
                                                 conduction test.
95904...........  26...........  A............  Sense nerve                 0.34        0.10        0.13        0.10        0.13        0.02         XXX
                                                 conduction test.
95920...........  .............  A............  Intraop nerve test          2.11        1.72        1.97          NA          NA        0.23         ZZZ
                                                 add-on.
95920...........  TC...........  A............  Intraop nerve test          0.00        1.10        1.20          NA          NA        0.07         ZZZ
                                                 add-on.
95920...........  26...........  A............  Intraop nerve test          2.11        0.62        0.77        0.62        0.77        0.16         ZZZ
                                                 add-on.
95921...........  .............  A............  Autonomic nerv              0.90        1.16        0.93          NA          NA        0.06         XXX
                                                 function test.
95921...........  TC...........  A............  Autonomic nerv              0.00        0.91        0.64          NA          NA        0.02         XXX
                                                 function test.
95921...........  26...........  A............  Autonomic nerv              0.90        0.25        0.29        0.25        0.29        0.04         XXX
                                                 function test.
95922...........  .............  A............  Autonomic nerv              0.96        1.61        1.19          NA          NA        0.07         XXX
                                                 function test.
95922...........  TC...........  A............  Autonomic nerv              0.00        1.35        0.86          NA          NA        0.02         XXX
                                                 function test.
95922...........  26...........  A............  Autonomic nerv              0.96        0.26        0.33        0.26        0.33        0.05         XXX
                                                 function test.
95923...........  .............  A............  Autonomic nerv              0.90        2.33        2.14          NA          NA        0.07         XXX
                                                 function test.
95923...........  TC...........  A............  Autonomic nerv              0.00        2.08        1.82          NA          NA        0.02         XXX
                                                 function test.
95923...........  26...........  A............  Autonomic nerv              0.90        0.25        0.32        0.25        0.32        0.05         XXX
                                                 function test.
95925...........  .............  A............  Somatosensory               0.54        3.07        2.10          NA          NA        0.10         XXX
                                                 testing.
95925...........  TC...........  A............  Somatosensory               0.00        2.92        1.91          NA          NA        0.06         XXX
                                                 testing.
95925...........  26...........  A............  Somatosensory               0.54        0.15        0.19        0.15        0.19        0.04         XXX
                                                 testing.
95926...........  .............  A............  Somatosensory               0.54        3.00        2.07          NA          NA        0.09         XXX
                                                 testing.
95926...........  TC...........  A............  Somatosensory               0.00        2.85        1.88          NA          NA        0.06         XXX
                                                 testing.
95926...........  26...........  A............  Somatosensory               0.54        0.15        0.19        0.15        0.19        0.03         XXX
                                                 testing.
95927...........  .............  A............  Somatosensory               0.54        3.12        2.14          NA          NA        0.10         XXX
                                                 testing.
95927...........  TC...........  A............  Somatosensory               0.00        2.96        1.93          NA          NA        0.06         XXX
                                                 testing.
95927...........  26...........  A............  Somatosensory               0.54        0.16        0.21        0.16        0.21        0.04         XXX
                                                 testing.
95928...........  .............  A............  C motor evoked, uppr        1.50        3.94        3.47          NA          NA        0.09         XXX
                                                 limbs.
95928...........  TC...........  A............  C motor evoked, uppr        0.00        3.50        2.93          NA          NA        0.03         XXX
                                                 limbs.
95928...........  26...........  A............  C motor evoked, uppr        1.50        0.44        0.54        0.44        0.54        0.06         XXX
                                                 limbs.
95929...........  .............  A............  C motor evoked, lwr         1.50        4.25        3.74          NA          NA        0.09         XXX
                                                 limbs.
95929...........  TC...........  A............  C motor evoked, lwr         0.00        3.81        3.19          NA          NA        0.03         XXX
                                                 limbs.
95929...........  26...........  A............  C motor evoked, lwr         1.50        0.44        0.55        0.44        0.55        0.06         XXX
                                                 limbs.
95930...........  .............  A............  Visual evoked               0.35        2.63        2.44          NA          NA        0.03         XXX
                                                 potential test.
95930...........  TC...........  A............  Visual evoked               0.00        2.53        2.31          NA          NA        0.01         XXX
                                                 potential test.
95930...........  26...........  A............  Visual evoked               0.35        0.10        0.13        0.10        0.13        0.02         XXX
                                                 potential test.
95933...........  .............  A............  Blink reflex test...        0.59        1.11        1.07          NA          NA        0.10         XXX
95933...........  TC...........  A............  Blink reflex test...        0.00        0.94        0.86          NA          NA        0.06         XXX
95933...........  26...........  A............  Blink reflex test...        0.59        0.17        0.21        0.17        0.21        0.04         XXX
95934...........  .............  A............  H-reflex test.......        0.51        0.85        0.64          NA          NA        0.04         XXX
95934...........  TC...........  A............  H-reflex test.......        0.00        0.70        0.45          NA          NA        0.02         XXX
95934...........  26...........  A............  H-reflex test.......        0.51        0.15        0.19        0.15        0.19        0.02         XXX
95936...........  .............  A............  H-reflex test.......        0.55        0.59        0.52          NA          NA        0.05         XXX
95936...........  TC...........  A............  H-reflex test.......        0.00        0.43        0.32          NA          NA        0.02         XXX
95936...........  26...........  A............  H-reflex test.......        0.55        0.16        0.20        0.16        0.20        0.03         XXX
95937...........  .............  A............  Neuromuscular               0.65        0.92        0.76          NA          NA        0.10         XXX
                                                 junction test.
95937...........  TC...........  A............  Neuromuscular               0.00        0.72        0.53          NA          NA        0.02         XXX
                                                 junction test.
95937...........  26...........  A............  Neuromuscular               0.65        0.20        0.23        0.20        0.23        0.08         XXX
                                                 junction test.
95950...........  .............  A............  Ambulatory eeg              1.51        4.92        4.42          NA          NA        0.51         XXX
                                                 monitoring.
95950...........  TC...........  A............  Ambulatory eeg              0.00        4.50        3.89          NA          NA        0.43         XXX
                                                 monitoring.
95950...........  26...........  A............  Ambulatory eeg              1.51        0.42        0.53        0.42        0.53        0.08         XXX
                                                 monitoring.
95951...........  .............  C............  EEG monitoring/             0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 videorecord.
95951...........  TC...........  C............  EEG monitoring/             0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 videorecord.
95951...........  26...........  A............  EEG monitoring/             5.99        1.68        2.12        1.68        2.12        0.32         XXX
                                                 videorecord.
95953...........  .............  A............  EEG monitoring/             3.30        7.21        7.42          NA          NA        0.60         XXX
                                                 computer.
95953...........  TC...........  A............  EEG monitoring/             0.00        6.29        6.31          NA          NA        0.43         XXX
                                                 computer.
95953...........  26...........  A............  EEG monitoring/             3.30        0.92        1.11        0.92        1.11        0.17         XXX
                                                 computer.
95954...........  .............  A............  EEG monitoring/             2.45        4.37        4.30          NA          NA        0.19         XXX
                                                 giving drugs.

[[Page 66535]]

 
95954...........  TC...........  A............  EEG monitoring/             0.00        3.95        3.57          NA          NA        0.06         XXX
                                                 giving drugs.
95954...........  26...........  A............  EEG monitoring/             2.45        0.42        0.73        0.42        0.73        0.13         XXX
                                                 giving drugs.
95955...........  .............  A............  EEG during surgery..        1.01        2.75        2.54          NA          NA        0.22         XXX
95955...........  TC...........  A............  EEG during surgery..        0.00        2.47        2.22          NA          NA        0.17         XXX
95955...........  26...........  A............  EEG during surgery..        1.01        0.28        0.32        0.28        0.32        0.05         XXX
95956...........  .............  A............  Eeg monitoring,             3.08       16.28       15.84          NA          NA        0.59         XXX
                                                 cable/radio.
95956...........  TC...........  A............  Eeg monitoring,             0.00       15.42       14.76          NA          NA        0.43         XXX
                                                 cable/radio.
95956...........  26...........  A............  Eeg monitoring,             3.08        0.86        1.08        0.86        1.08        0.16         XXX
                                                 cable/radio.
95957...........  .............  A............  EEG digital analysis        1.98        5.84        4.19          NA          NA        0.23         XXX
95957...........  TC...........  A............  EEG digital analysis        0.00        5.29        3.49          NA          NA        0.12         XXX
95957...........  26...........  A............  EEG digital analysis        1.98        0.55        0.70        0.55        0.70        0.11         XXX
95958...........  .............  A............  EEG monitoring/             4.24        6.70        5.09          NA          NA        0.34         XXX
                                                 function test.
95958...........  TC...........  A............  EEG monitoring/             0.00        5.47        3.60          NA          NA        0.13         XXX
                                                 function test.
95958...........  26...........  A............  EEG monitoring/             4.24        1.23        1.49        1.23        1.49        0.21         XXX
                                                 function test.
95961...........  .............  A............  Electrode                   2.97        3.05        2.83          NA          NA        0.55         XXX
                                                 stimulation, brain.
95961...........  TC...........  A............  Electrode                   0.00        2.18        1.74          NA          NA        0.07         XXX
                                                 stimulation, brain.
95961...........  26...........  A............  Electrode                   2.97        0.87        1.09        0.87        1.09        0.48         XXX
                                                 stimulation, brain.
95962...........  .............  A............  Electrode stim,             3.21        2.21        2.45          NA          NA        0.39         ZZZ
                                                 brain add-on.
95962...........  TC...........  A............  Electrode stim,             0.00        1.30        1.30          NA          NA        0.07         ZZZ
                                                 brain add-on.
95962...........  26...........  A............  Electrode stim,             3.21        0.91        1.15        0.91        1.15        0.32         ZZZ
                                                 brain add-on.
95965...........  .............  C............  Meg, spontaneous....        0.00        0.00        0.00          NA          NA        0.00         XXX
95965...........  TC...........  C............  Meg, spontaneous....        0.00        0.00        0.00          NA          NA        0.00         XXX
95965...........  26...........  A............  Meg, spontaneous....        7.99        2.39        2.90        2.39        2.90        0.46         XXX
95966...........  .............  C............  Meg, evoked, single.        0.00        0.00        0.00          NA          NA        0.00         XXX
95966...........  TC...........  C............  Meg, evoked, single.        0.00        0.00        0.00          NA          NA        0.00         XXX
95966...........  26...........  A............  Meg, evoked, single.        3.99        1.19        1.45        1.19        1.45        0.19         XXX
95967...........  .............  C............  Meg, evoked, each           0.00        0.00        0.00          NA          NA        0.00         ZZZ
                                                 add'l.
95967...........  TC...........  C............  Meg, evoked, each           0.00        0.00        0.00          NA          NA        0.00         ZZZ
                                                 add'l.
95967...........  26...........  A............  Meg, evoked, each           3.49        1.01        1.09        1.01        1.09        0.16         ZZZ
                                                 add'l.
95970...........  .............  A............  Analyze neurostim,          0.45        0.90        0.87        0.13        0.13        0.03         XXX
                                                 no prog.
95971...........  .............  A............  Analyze neurostim,          0.78        0.58        0.63        0.18        0.20        0.07         XXX
                                                 simple.
95972...........  .............  A............  Analyze neurostim,          1.50        1.14        1.18        0.44        0.46        0.14         XXX
                                                 complex.
95973...........  .............  A............  Analyze neurostim,          0.92        0.49        0.55        0.21        0.28        0.07         ZZZ
                                                 complex.
95974...........  .............  A............  Cranial neurostim,          3.00        1.44        1.57        0.78        1.04        0.16         XXX
                                                 complex.
95975...........  .............  A............  Cranial neurostim,          1.70        0.73        0.81        0.47        0.60        0.12         ZZZ
                                                 complex.
95978...........  .............  A............  Analyze neurostim           3.50        1.85        1.89        1.02        1.16        0.18         XXX
                                                 brain/1h.
95979...........  .............  A............  Analyz neurostim            1.64        0.72        0.79        0.46        0.57        0.08         ZZZ
                                                 brain addon.
95980...........  .............  A............  Io anal gast n-stim         0.80          NA          NA        0.25        0.25        0.07         XXX
                                                 init.
95981...........  .............  A............  Io anal gast n-stim         0.30        0.44        0.44        0.12        0.12        0.02         XXX
                                                 subsq.
95982...........  .............  A............  Io ga n-stim subsq w/       0.65        0.47        0.47        0.18        0.18        0.05         XXX
                                                 reprog.
95990...........  .............  A............  Spin/brain pump             0.00        1.62        1.56          NA          NA        0.06         XXX
                                                 refil & main.
95991...........  .............  A............  Spin/brain pump             0.77        1.61        1.55        0.17        0.17        0.06         XXX
                                                 refil & main.
95999...........  .............  C............  Neurological                0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 procedure.
96000...........  .............  A............  Motion analysis,            1.80          NA          NA        0.44        0.48        0.11         XXX
                                                 video/3d.
96001...........  .............  A............  Motion test w/ft            2.15          NA          NA        0.56        0.61        0.10         XXX
                                                 press meas.
96002...........  .............  A............  Dynamic surface emg.        0.41          NA          NA        0.10        0.13        0.02         XXX
96003...........  .............  A............  Dynamic fine wire           0.37          NA          NA        0.09        0.10        0.02         XXX
                                                 emg.
96004...........  .............  A............  Phys review of              2.14        0.65        0.79        0.65        0.79        0.11         XXX
                                                 motion tests.
96020...........  .............  C............  Functional brain            0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 mapping.
96020...........  TC...........  C............  Functional brain            0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 mapping.
96020...........  26...........  A............  Functional brain            3.43        1.07        1.07        1.07        1.07        0.17         XXX
                                                 mapping.
96040...........  .............  B............  Genetic counseling,         0.00        0.98        0.98          NA          NA        0.01         XXX
                                                 30 min.
96101...........  .............  A............  Psycho testing by           1.86        0.35        0.50        0.33        0.48        0.05         XXX
                                                 psych/phys.
96102...........  .............  A............  Psycho testing by           0.50        1.10        0.88        0.09        0.13        0.01         XXX
                                                 technician.
96103...........  .............  A............  Psycho testing admin        0.51        0.92        0.56        0.10        0.14        0.02         XXX
                                                 by comp.
96105...........  .............  A............  Assessment of               0.00        1.66        1.71          NA          NA        0.18         XXX
                                                 aphasia.
96110...........  .............  A............  Developmental test,         0.00        0.19        0.18          NA          NA        0.18         XXX
                                                 lim.
96111...........  .............  A............  Developmental test,         2.60        0.69        0.87        0.58        0.81        0.18         XXX
                                                 extend.
96116...........  .............  A............  Neurobehavioral             1.86        0.52        0.68        0.40        0.52        0.18         XXX
                                                 status exam.
96118...........  .............  A............  Neuropsych tst by           1.86        0.84        1.11        0.33        0.48        0.18         XXX
                                                 psych/phys.
96119...........  .............  A............  Neuropsych testing          0.55        1.53        1.27        0.10        0.14        0.18         XXX
                                                 by tec.
96120...........  .............  A............  Neuropsych tst admin        0.51        1.69        1.21        0.10        0.13        0.02         XXX
                                                 w/comp.
96125...........  .............  A............  Cognitive test by hc        1.70        0.76        0.76        0.37        0.37        0.16         XXX
                                                 pro.
96150...........  .............  A............  Assess hlth/behave,         0.50        0.10        0.14        0.09        0.13        0.01         XXX
                                                 init.
96151...........  .............  A............  Assess hlth/behave,         0.48        0.10        0.14        0.09        0.13        0.01         XXX
                                                 subseq.
96152...........  .............  A............  Intervene hlth/             0.46        0.09        0.13        0.08        0.12        0.01         XXX
                                                 behave, indiv.
96153...........  .............  A............  Intervene hlth/             0.10        0.02        0.03        0.02        0.02        0.01         XXX
                                                 behave, group.
96154...........  .............  A............  Interv hlth/behav,          0.45        0.09        0.13        0.08        0.12        0.01         XXX
                                                 fam w/pt.
96155...........  .............  N............  Interv hlth/behav           0.44        0.10        0.14        0.10        0.14        0.02         XXX
                                                 fam no pt.
96401...........  .............  A............  Chemo, anti-neopl,          0.21        1.86        1.51          NA          NA        0.01         XXX
                                                 sq/im.
96402...........  .............  A............  Chemo hormon                0.19        0.77        0.89          NA          NA        0.01         XXX
                                                 antineopl sq/im.
96405...........  .............  A............  Chemo intralesional,        0.52        3.69        3.06        0.24        0.24        0.03         000
                                                 up to 7.

[[Page 66536]]

 
96406...........  .............  A............  Chemo intralesional         0.80        3.61        3.31        0.32        0.31        0.03         000
                                                 over 7.
96409...........  .............  A............  Chemo, iv push, sngl        0.24        2.79        2.86          NA          NA        0.06         XXX
                                                 drug.
96411...........  .............  A............  Chemo, iv push, addl        0.20        1.50        1.55          NA          NA        0.06         ZZZ
                                                 drug.
96413...........  .............  A............  Chemo, iv infusion,         0.28        3.63        3.91          NA          NA        0.08         XXX
                                                 1 hr.
96415...........  .............  A............  Chemo, iv infusion,         0.19        0.66        0.71          NA          NA        0.07         ZZZ
                                                 addl hr.
96416...........  .............  A............  Chemo prolong infuse        0.21        4.08        4.34          NA          NA        0.08         XXX
                                                 w/pump.
96417...........  .............  A............  Chemo iv infus each         0.21        1.73        1.83          NA          NA        0.07         ZZZ
                                                 addl seq.
96420...........  .............  A............  Chemo, ia, push             0.17        2.78        2.72          NA          NA        0.08         XXX
                                                 tecnique.
96422...........  .............  A............  Chemo ia infusion up        0.17        4.49        4.66          NA          NA        0.08         XXX
                                                 to 1 hr.
96423...........  .............  A............  Chemo ia infuse each        0.17        1.99        1.94          NA          NA        0.02         ZZZ
                                                 addl hr.
96425...........  .............  A............  Chemotherapy,infusio        0.17        4.67        4.57          NA          NA        0.08         XXX
                                                 n method.
96440...........  .............  A............  Chemotherapy,               2.37        5.55        6.84        0.98        1.10        0.17         000
                                                 intracavitary.
96445...........  .............  A............  Chemotherapy,               2.20        5.41        6.72        0.96        1.07        0.14         000
                                                 intracavitary.
96450...........  .............  A............  Chemotherapy, into          1.53        4.99        5.97        0.83        1.06        0.09         000
                                                 CNS.
96521...........  .............  A............  Refill/maint,               0.21        3.15        3.45          NA          NA        0.06         XXX
                                                 portable pump.
96522...........  .............  A............  Refill/maint pump/          0.21        2.78        2.71          NA          NA        0.06         XXX
                                                 resvr syst.
96523...........  .............  T............  Irrig drug delivery         0.04        0.64        0.66          NA          NA        0.01         XXX
                                                 device.
96542...........  .............  A............  Chemotherapy                0.75        3.55        3.90        0.32        0.49        0.07         XXX
                                                 injection.
96549...........  .............  C............  Chemotherapy,               0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 unspecified.
96567...........  .............  A............  Photodynamic tx,            0.00        3.74        2.84          NA          NA        0.04         XXX
                                                 skin.
96570...........  .............  A............  Photodynamic tx, 30         1.10        0.40        0.38        0.40        0.38        0.11         ZZZ
                                                 min.
96571...........  .............  A............  Photodynamic tx,            0.55        0.19        0.19        0.19        0.19        0.03         ZZZ
                                                 addl 15 min.
96900...........  .............  A............  Ultraviolet light           0.00        0.57        0.50          NA          NA        0.02         XXX
                                                 therapy.
96902...........  .............  B............  Trichogram..........        0.41        0.11        0.15        0.09        0.13        0.01         XXX
96904...........  .............  R............  Whole body                  0.00        1.90        1.90          NA          NA        0.01         XXX
                                                 photography.
96910...........  .............  A............  Photochemotherapy           0.00        2.01        1.50          NA          NA        0.04         XXX
                                                 with UV-B.
96912...........  .............  A............  Photochemotherapy           0.00        2.58        1.92          NA          NA        0.05         XXX
                                                 with UV-A.
96913...........  .............  A............  Photochemotherapy,          0.00        3.47        2.57          NA          NA        0.10         XXX
                                                 UV-A or B.
96920...........  .............  A............  Laser tx, skin < 250        1.15        3.58        3.05        0.56        0.56        0.02         000
                                                 sq cm.
96921...........  .............  A............  Laser tx, skin 250-         1.17        3.32        2.96        0.51        0.54        0.03         000
                                                 500 sq cm.
96922...........  .............  A............  Laser tx, skin > 500        2.10        4.63        4.06        1.04        0.83        0.04         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        0.65        0.70          NA          NA        0.05         XXX
97002...........  .............  A............  Pt re-evaluation....        0.60        0.41        0.42          NA          NA        0.02         XXX
97003...........  .............  A............  Ot evaluation.......        1.20        0.76        0.82          NA          NA        0.06         XXX
97004...........  .............  A............  Ot re-evaluation....        0.60        0.54        0.60          NA          NA        0.02         XXX
97005...........  .............  I............  Athletic train eval.        0.00        0.00        0.00        0.00        0.00        0.00         XXX
97006...........  .............  I............  Athletic train              0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 reeval.
97010...........  .............  B............  Hot or cold packs           0.06        0.07        0.06          NA          NA        0.01         XXX
                                                 therapy.
97012...........  .............  A............  Mechanical traction         0.25        0.14        0.13          NA          NA        0.01         XXX
                                                 therapy.
97014...........  .............  I............  Electric stimulation        0.18        0.18        0.18          NA          NA        0.01         XXX
                                                 therapy.
97016...........  .............  A............  Vasopneumatic device        0.18        0.24        0.21          NA          NA        0.01         XXX
                                                 therapy.
97018...........  .............  A............  Paraffin bath               0.06        0.17        0.13          NA          NA        0.01         XXX
                                                 therapy.
97022...........  .............  A............  Whirlpool therapy...        0.17        0.33        0.27          NA          NA        0.01         XXX
97024...........  .............  A............  Diathermy eg,               0.06        0.08        0.07          NA          NA        0.01         XXX
                                                 microwave.
97026...........  .............  A............  Infrared therapy....        0.06        0.07        0.06          NA          NA        0.01         XXX
97028...........  .............  A............  Ultraviolet therapy.        0.08        0.08        0.08          NA          NA        0.01         XXX
97032...........  .............  A............  Electrical                  0.25        0.20        0.18          NA          NA        0.01         XXX
                                                 stimulation.
97033...........  .............  A............  Electric current            0.26        0.44        0.36          NA          NA        0.01         XXX
                                                 therapy.
97034...........  .............  A............  Contrast bath               0.21        0.20        0.17          NA          NA        0.01         XXX
                                                 therapy.
97035...........  .............  A............  Ultrasound therapy..        0.21        0.10        0.10          NA          NA        0.01         XXX
97036...........  .............  A............  Hydrotherapy........        0.28        0.44        0.38          NA          NA        0.01         XXX
97039...........  .............  C............  Physical therapy            0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 treatment.
97110...........  .............  A............  Therapeutic                 0.45        0.32        0.29          NA          NA        0.02         XXX
                                                 exercises.
97112...........  .............  A............  Neuromuscular               0.45        0.34        0.33          NA          NA        0.01         XXX
                                                 reeducation.
97113...........  .............  A............  Aquatic therapy/            0.44        0.53        0.46          NA          NA        0.01         XXX
                                                 exercises.
97116...........  .............  A............  Gait training               0.40        0.27        0.26          NA          NA        0.01         XXX
                                                 therapy.
97124...........  .............  A............  Massage therapy.....        0.35        0.27        0.25          NA          NA        0.01         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        0.29        0.27          NA          NA        0.01         XXX
97150...........  .............  A............  Group therapeutic           0.27        0.22        0.20          NA          NA        0.01         XXX
                                                 procedures.
97530...........  .............  A............  Therapeutic                 0.44        0.38        0.35          NA          NA        0.01         XXX
                                                 activities.
97532...........  .............  A............  Cognitive skills            0.44        0.22        0.21          NA          NA        0.01         XXX
                                                 development.
97533...........  .............  A............  Sensory integration.        0.44        0.27        0.25          NA          NA        0.01         XXX
97535...........  .............  A............  Self care mngment           0.45        0.37        0.35          NA          NA        0.01         XXX
                                                 training.
97537...........  .............  A............  Community/work              0.45        0.28        0.27          NA          NA        0.01         XXX
                                                 reintegration.
97542...........  .............  A............  Wheelchair mngment          0.45        0.29        0.28          NA          NA        0.01         XXX
                                                 training.
97545...........  .............  R............  Work hardening......        0.00        0.00        0.00        0.00        0.00        0.00         XXX
97546...........  .............  R............  Work hardening add-         0.00        0.00        0.00        0.00        0.00        0.00         ZZZ
                                                 on.
97597...........  .............  A............  Active wound care/20        0.58        1.09        0.88        0.12        0.39        0.05         XXX
                                                 cm or <.
97598...........  .............  A............  Active wound care >         0.80        1.27        1.03        0.17        0.48        0.05         XXX
                                                 20 cm.
97602...........  .............  B............  Wound(s) care non-          0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 selective.

[[Page 66537]]

 
97605...........  .............  A............  Neg press wound tx,         0.55        0.40        0.37        0.11        0.17        0.02         XXX
                                                 < 50 cm.
97606...........  .............  A............  Neg press wound tx,         0.60        0.41        0.38        0.13        0.18        0.03         XXX
                                                 > 50 cm.
97750...........  .............  A............  Physical performance        0.45        0.33        0.32          NA          NA        0.02         XXX
                                                 test.
97755...........  .............  A............  Assistive technology        0.62        0.27        0.28          NA          NA        0.02         XXX
                                                 assess.
97760...........  .............  A............  Orthotic mgmt and           0.45        0.42        0.38          NA          NA        0.03         XXX
                                                 training.
97761...........  .............  A............  Prosthetic training.        0.45        0.33        0.30          NA          NA        0.02         XXX
97762...........  .............  A............  C/o for orthotic/           0.25        0.73        0.57          NA          NA        0.02         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,          0.45        0.14        0.30        0.11        0.29        0.01         XXX
                                                 indiv, in.
97803...........  .............  A............  Med nutrition,              0.37        0.12        0.29        0.09        0.28        0.01         XXX
                                                 indiv, subseq.
97804...........  .............  A............  Medical nutrition,          0.25        0.08        0.13        0.07        0.12        0.01         XXX
                                                 group.
97810...........  .............  N............  Acupunct w/o stimul         0.60        0.26        0.32        0.14        0.18        0.03         XXX
                                                 15 min.
97811...........  .............  N............  Acupunct w/o stimul         0.50        0.15        0.20        0.11        0.15        0.03         ZZZ
                                                 addl 15m.
97813...........  .............  N............  Acupunct w/stimul 15        0.65        0.27        0.33        0.15        0.20        0.03         XXX
                                                 min.
97814...........  .............  N............  Acupunct w/stimul           0.55        0.19        0.24        0.13        0.17        0.03         ZZZ
                                                 addl 15m.
98925...........  .............  A............  Osteopathic                 0.45        0.29        0.30        0.12        0.13        0.02         000
                                                 manipulation.
98926...........  .............  A............  Osteopathic                 0.65        0.37        0.39        0.17        0.21        0.03         000
                                                 manipulation.
98927...........  .............  A............  Osteopathic                 0.87        0.45        0.47        0.22        0.26        0.03         000
                                                 manipulation.
98928...........  .............  A............  Osteopathic                 1.03        0.51        0.55        0.26        0.30        0.04         000
                                                 manipulation.
98929...........  .............  A............  Osteopathic                 1.19        0.57        0.62        0.30        0.33        0.05         000
                                                 manipulation.
98940...........  .............  A............  Chiropractic                0.45        0.21        0.22        0.12        0.12        0.01         000
                                                 manipulation.
98941...........  .............  A............  Chiropractic                0.65        0.27        0.29        0.17        0.17        0.01         000
                                                 manipulation.
98942...........  .............  A............  Chiropractic                0.87        0.33        0.35        0.24        0.23        0.02         000
                                                 manipulation.
98943...........  .............  N............  Chiropractic                0.40        0.17        0.21        0.09        0.13        0.01         XXX
                                                 manipulation.
98960...........  .............  B............  Self-mgmt educ &            0.00        0.58        0.58          NA          NA        0.01         XXX
                                                 train, 1 pt.
98961...........  .............  B............  Self-mgmt educ/             0.00        0.28        0.28          NA          NA        0.01         XXX
                                                 train, 2-4 pt.
98962...........  .............  B............  Self-mgmt educ/             0.00        0.20        0.20          NA          NA        0.01         XXX
                                                 train, 5-8 pt.
98966...........  .............  N............  Hc pro phone call 5-        0.25        0.09        0.09        0.06        0.06        0.01         XXX
                                                 10 min.
98967...........  .............  N............  Hc pro phone call 11-       0.50        0.14        0.14        0.11        0.11        0.02         XXX
                                                 20 min.
98968...........  .............  N............  Hc pro phone call 21-       0.75        0.20        0.20        0.17        0.17        0.03         XXX
                                                 30 min.
98969...........  .............  N............  Online service by hc        0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 pro.
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            0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 visit.
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            0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 after 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,          0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 24 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            0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 care.
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                0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 education.
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               0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 analysis.
99091...........  .............  B............  Collect/review data         1.10        0.25        0.25          NA          NA        0.04         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,        0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 5 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          0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 yrs +.
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,            1.75        1.83        1.80        0.61        0.58        0.08         000
                                                 child.
99172...........  .............  N............  Ocular function             0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 screen.
99173...........  .............  N............  Visual acuity screen        0.00        0.06        0.06          NA          NA        0.01         XXX
99174...........  .............  N............  Ocular                      0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 photoscreening.
99175...........  .............  A............  Induction of                0.00        0.36        0.87          NA          NA        0.10         XXX
                                                 vomiting.
99183...........  .............  A............  Hyperbaric oxygen           2.34        2.60        2.92        0.57        0.65        0.16         XXX
                                                 therapy.
99185...........  .............  A............  Regional hypothermia        0.00        1.67        1.15          NA          NA        0.04         XXX
99186...........  .............  A............  Total body                  0.00        1.63        1.70          NA          NA        0.45         XXX
                                                 hypothermia.
99190...........  .............  X............  Special pump                0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 services.
99191...........  .............  X............  Special pump                0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 services.
99192...........  .............  X............  Special pump                0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 services.

[[Page 66538]]

 
99195...........  .............  A............  Phlebotomy..........        0.00        2.56        1.50          NA          NA        0.02         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        0.55        0.52        0.16        0.15        0.03         XXX
                                                 visit, new.
99202...........  .............  A............  Office/outpatient           0.88        0.84        0.81        0.29        0.30        0.05         XXX
                                                 visit, new.
99203...........  .............  A............  Office/outpatient           1.34        1.11        1.12        0.43        0.45        0.09         XXX
                                                 visit, new.
99204...........  .............  A............  Office/outpatient           2.30        1.49        1.49        0.71        0.71        0.12         XXX
                                                 visit, new.
99205...........  .............  A............  Office/outpatient           3.00        1.78        1.78        0.91        0.93        0.15         XXX
                                                 visit, new.
99211...........  .............  A............  Office/outpatient           0.17        0.32        0.36        0.06        0.06        0.01         XXX
                                                 visit, est.
99212...........  .............  A............  Office/outpatient           0.45        0.55        0.55        0.15        0.15        0.03         XXX
                                                 visit, est.
99213...........  .............  A............  Office/outpatient           0.92        0.76        0.72        0.28        0.26        0.03         XXX
                                                 visit, est.
99214...........  .............  A............  Office/outpatient           1.42        1.10        1.06        0.44        0.42        0.05         XXX
                                                 visit, est.
99215...........  .............  A............  Office/outpatient           2.00        1.38        1.35        0.61        0.63        0.08         XXX
                                                 visit, est.
99217...........  .............  A............  Observation care            1.28          NA          NA        0.50        0.51        0.06         XXX
                                                 discharge.
99218...........  .............  A............  Observation care....        1.28          NA          NA        0.38        0.41        0.06         XXX
99219...........  .............  A............  Observation care....        2.14          NA          NA        0.59        0.65        0.10         XXX
99220...........  .............  A............  Observation care....        2.99          NA          NA        0.84        0.93        0.14         XXX
99221...........  .............  A............  Initial hospital            1.88          NA          NA        0.54        0.50        0.07         XXX
                                                 care.
99222...........  .............  A............  Initial hospital            2.56          NA          NA        0.71        0.72        0.10         XXX
                                                 care.
99223...........  .............  A............  Initial hospital            3.78          NA          NA        1.07        1.05        0.13         XXX
                                                 care.
99231...........  .............  A............  Subsequent hospital         0.76          NA          NA        0.24        0.23        0.03         XXX
                                                 care.
99232...........  .............  A............  Subsequent hospital         1.39          NA          NA        0.42        0.40        0.04         XXX
                                                 care.
99233...........  .............  A............  Subsequent hospital         2.00          NA          NA        0.59        0.56        0.06         XXX
                                                 care.
99234...........  .............  A............  Observ/hosp same            2.56          NA          NA        0.78        0.83        0.13         XXX
                                                 date.
99235...........  .............  A............  Observ/hosp same            3.41          NA          NA        0.98        1.06        0.16         XXX
                                                 date.
99236...........  .............  A............  Observ/hosp same            4.26          NA          NA        1.21        1.32        0.19         XXX
                                                 date.
99238...........  .............  A............  Hospital discharge          1.28          NA          NA        0.49        0.52        0.05         XXX
                                                 day.
99239...........  .............  A............  Hospital discharge          1.90          NA          NA        0.67        0.70        0.07         XXX
                                                 day.
99241...........  .............  A............  Office consultation.        0.64        0.66        0.65        0.22        0.22        0.05         XXX
99242...........  .............  A............  Office consultation.        1.34        1.08        1.06        0.48        0.47        0.10         XXX
99243...........  .............  A............  Office consultation.        1.88        1.45        1.42        0.67        0.65        0.13         XXX
99244...........  .............  A............  Office consultation.        3.02        1.93        1.88        1.08        1.00        0.16         XXX
99245...........  .............  A............  Office consultation.        3.77        2.26        2.27        1.31        1.27        0.21         XXX
99251...........  .............  A............  Inpatient                   1.00          NA          NA        0.31        0.27        0.05         XXX
                                                 consultation.
99252...........  .............  A............  Inpatient                   1.50          NA          NA        0.49        0.49        0.09         XXX
                                                 consultation.
99253...........  .............  A............  Inpatient                   2.27          NA          NA        0.80        0.74        0.11         XXX
                                                 consultation.
99254...........  .............  A............  Inpatient                   3.29          NA          NA        1.18        1.08        0.13         XXX
                                                 consultation.
99255...........  .............  A............  Inpatient                   4.00          NA          NA        1.38        1.36        0.18         XXX
                                                 consultation.
99281...........  .............  A............  Emergency dept visit        0.45          NA          NA        0.09        0.09        0.02         XXX
99282...........  .............  A............  Emergency dept visit        0.88          NA          NA        0.17        0.15        0.04         XXX
99283...........  .............  A............  Emergency dept visit        1.34          NA          NA        0.25        0.28        0.09         XXX
99284...........  .............  A............  Emergency dept visit        2.56          NA          NA        0.46        0.47        0.14         XXX
99285...........  .............  A............  Emergency dept visit        3.80          NA          NA        0.67        0.69        0.23         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          NA        1.08        1.26        0.24         XXX
                                                 transport.
99290...........  .............  A............  Ped crit care               2.40          NA          NA        0.89        0.85        0.12         ZZZ
                                                 transport addl.
99291...........  .............  A............  Critical care, first        4.50        2.26        2.41        1.10        1.19        0.21         XXX
                                                 hour.
99292...........  .............  A............  Critical care, add'l        2.25        0.80        0.85        0.56        0.60        0.11         ZZZ
                                                 30 min.
99293...........  .............  A............  Ped critical care,         15.98          NA          NA        3.78        4.26        1.12         XXX
                                                 initial.
99294...........  .............  A............  Ped critical care,          7.99          NA          NA        1.65        2.03        0.45         XXX
                                                 subseq.
99295...........  .............  A............  Neonate crit care,         18.46          NA          NA        4.56        4.97        1.16         XXX
                                                 initial.
99296...........  .............  A............  Neonate critical            7.99          NA          NA        2.06        2.30        0.32         XXX
                                                 care subseq.
99298...........  .............  A............  Ic for lbw infant <         2.75          NA          NA        0.68        0.80        0.17         XXX
                                                 1500 gm.
99299...........  .............  A............  Ic, lbw infant 1500-        2.50          NA          NA        0.58        0.72        0.16         XXX
                                                 2500 gm.
99300...........  .............  A............  Ic, infant pbw 2501-        2.40          NA          NA        0.71        0.77        0.15         XXX
                                                 5000 gm.
99304...........  .............  A............  Nursing facility            1.61        0.57        0.53        0.57        0.53        0.05         XXX
                                                 care, init.
99305...........  .............  A............  Nursing facility            2.30        0.74        0.68        0.74        0.68        0.07         XXX
                                                 care, init.
99306...........  .............  A............  Nursing facility            3.00        0.90        0.83        0.90        0.83        0.09         XXX
                                                 care, init.
99307...........  .............  A............  Nursing fac care,           0.76        0.31        0.29        0.31        0.29        0.03         XXX
                                                 subseq.
99308...........  .............  A............  Nursing fac care,           1.16        0.47        0.46        0.47        0.46        0.04         XXX
                                                 subseq.
99309...........  .............  A............  Nursing fac care,           1.55        0.61        0.61        0.61        0.61        0.06         XXX
                                                 subseq.
99310...........  .............  A............  Nursing fac care,           2.35        0.87        0.82        0.87        0.82        0.08         XXX
                                                 subseq.
99315...........  .............  A............  Nursing fac                 1.13        0.41        0.43        0.41        0.43        0.05         XXX
                                                 discharge day.
99316...........  .............  A............  Nursing fac                 1.50        0.50        0.55        0.50        0.55        0.06         XXX
                                                 discharge day.
99318...........  .............  A............  Annual nursing fac          1.71        0.56        0.53        0.56        0.53        0.05         XXX
                                                 assessmnt.
99324...........  .............  A............  Domicil/r-home visit        1.01        0.43        0.46          NA          NA        0.05         XXX
                                                 new pat.
99325...........  .............  A............  Domicil/r-home visit        1.52        0.55        0.62          NA          NA        0.07         XXX
                                                 new pat.
99326...........  .............  A............  Domicil/r-home visit        2.63        0.82        0.87          NA          NA        0.10         XXX
                                                 new pat.
99327...........  .............  A............  Domicil/r-home visit        3.46        1.02        1.09          NA          NA        0.13         XXX
                                                 new pat.
99328...........  .............  A............  Domicil/r-home visit        4.09        1.16        1.29          NA          NA        0.16         XXX
                                                 new pat.
99334...........  .............  A............  Domicil/r-home visit        1.07        0.43        0.41          NA          NA        0.04         XXX
                                                 est pat.
99335...........  .............  A............  Domicil/r-home visit        1.72        0.59        0.58          NA          NA        0.06         XXX
                                                 est pat.
99336...........  .............  A............  Domicil/r-home visit        2.46        0.77        0.79          NA          NA        0.09         XXX
                                                 est pat.

[[Page 66539]]

 
99337...........  .............  A............  Domicil/r-home visit        3.58        1.03        1.09          NA          NA        0.13         XXX
                                                 est pat.
99339...........  .............  B............  Domicil/r-home care         1.25        0.58        0.58          NA          NA        0.06         XXX
                                                 supervis.
99340...........  .............  B............  Domicil/r-home care         1.80        0.77        0.77          NA          NA        0.07         XXX
                                                 supervis.
99341...........  .............  A............  Home visit, new             1.01        0.43        0.45          NA          NA        0.05         XXX
                                                 patient.
99342...........  .............  A............  Home visit, new             1.52        0.56        0.62          NA          NA        0.07         XXX
                                                 patient.
99343...........  .............  A............  Home visit, new             2.53        0.82        0.88          NA          NA        0.10         XXX
                                                 patient.
99344...........  .............  A............  Home visit, new             3.38        1.00        1.09          NA          NA        0.13         XXX
                                                 patient.
99345...........  .............  A............  Home visit, new             4.09        1.15        1.29          NA          NA        0.16         XXX
                                                 patient.
99347...........  .............  A............  Home visit, est             1.00        0.42        0.41          NA          NA        0.04         XXX
                                                 patient.
99348...........  .............  A............  Home visit, est             1.56        0.56        0.57          NA          NA        0.06         XXX
                                                 patient.
99349...........  .............  A............  Home visit, est             2.33        0.73        0.78          NA          NA        0.09         XXX
                                                 patient.
99350...........  .............  A............  Home visit, est             3.28        0.96        1.07          NA          NA        0.13         XXX
                                                 patient.
99354...........  .............  A............  Prolonged service,          1.77        0.65        0.71        0.50        0.58        0.08         ZZZ
                                                 office.
99355...........  .............  A............  Prolonged service,          1.77        0.62        0.68        0.47        0.54        0.07         ZZZ
                                                 office.
99356...........  .............  A............  Prolonged service,          1.71          NA          NA        0.50        0.56        0.07         ZZZ
                                                 inpatient.
99357...........  .............  A............  Prolonged service,          1.71          NA          NA        0.50        0.56        0.08         ZZZ
                                                 inpatient.
99358...........  .............  B............  Prolonged serv, w/o         2.10        0.51        0.51        0.51        0.51        0.09         ZZZ
                                                 contact.
99359...........  .............  B............  Prolonged serv, w/o         1.00        0.26        0.26        0.26        0.26        0.04         ZZZ
                                                 contact.
99360...........  .............  X............  Physician standby           1.20        0.28        0.28        0.28        0.28        0.05         XXX
                                                 services.
99363...........  .............  B............  Anticoag mgmt, init.        1.65        1.30        1.30        0.38        0.38        0.07         XXX
99364...........  .............  B............  Anticoag mgmt,              0.63        0.38        0.38        0.14        0.14        0.04         XXX
                                                 subseq.
99366...........  .............  B............  Team conf w/pat by          0.82        0.20        0.20        0.19        0.19        0.06         XXX
                                                 hc pro.
99367...........  .............  B............  Team conf w/o pat by        1.10        0.25        0.25        0.25        0.25        0.05         XXX
                                                 phys.
99368...........  .............  B............  Team conf w/o pat by        0.72        0.16        0.16        0.16        0.16        0.03         XXX
                                                 hc pro.
99374...........  .............  B............  Home health care            1.10        0.55        0.62        0.25        0.34        0.05         XXX
                                                 supervision.
99375...........  .............  I............  Home health care            1.73        0.75        1.15        0.40        0.97        0.07         XXX
                                                 supervision.
99377...........  .............  B............  Hospice care                1.10        0.55        0.62        0.25        0.34        0.05         XXX
                                                 supervision.
99378...........  .............  I............  Hospice care                1.73        0.75        1.35        0.40        1.17        0.07         XXX
                                                 supervision.
99379...........  .............  B............  Nursing fac care            1.10        0.55        0.62        0.25        0.34        0.04         XXX
                                                 supervision.
99380...........  .............  B............  Nursing fac care            1.73        0.75        0.87        0.40        0.53        0.06         XXX
                                                 supervision.
99381...........  .............  N............  Init pm e/m, new            1.19        1.00        1.25        0.27        0.36        0.05         XXX
                                                 pat, inf.
99382...........  .............  N............  Init pm e/m, new pat        1.36        1.04        1.29        0.31        0.42        0.05         XXX
                                                 1-4 yrs.
99383...........  .............  N............  Prev visit, new, age        1.36        1.03        1.25        0.31        0.42        0.05         XXX
                                                 5-11.
99384...........  .............  N............  Prev visit, new, age        1.53        1.07        1.31        0.35        0.47        0.06         XXX
                                                 12-17.
99385...........  .............  N............  Prev visit, new, age        1.53        1.07        1.31        0.35        0.47        0.06         XXX
                                                 18-39.
99386...........  .............  N............  Prev visit, new, age        1.88        1.15        1.45        0.43        0.58        0.07         XXX
                                                 40-64.
99387...........  .............  N............  Init pm e/m, new pat        2.06        1.28        1.58        0.47        0.63        0.07         XXX
                                                 65+ yrs.
99391...........  .............  N............  Per pm reeval, est          1.02        0.86        0.94        0.23        0.31        0.04         XXX
                                                 pat, inf.
99392...........  .............  N............  Prev visit, est, age        1.19        0.90        0.99        0.27        0.36        0.05         XXX
                                                 1-4.
99393...........  .............  N............  Prev visit, est, age        1.19        0.89        0.98        0.27        0.36        0.05         XXX
                                                 5-11.
99394...........  .............  N............  Prev visit, est, age        1.36        0.93        1.03        0.31        0.42        0.05         XXX
                                                 12-17.
99395...........  .............  N............  Prev visit, est, age        1.36        0.94        1.05        0.31        0.42        0.05         XXX
                                                 18-39.
99396...........  .............  N............  Prev visit, est, age        1.53        0.98        1.11        0.35        0.47        0.06         XXX
                                                 40-64.
99397...........  .............  N............  Per pm reeval est           1.71        1.12        1.24        0.39        0.53        0.06         XXX
                                                 pat 65+ yr.
99401...........  .............  N............  Preventive                  0.48        0.36        0.49        0.11        0.15        0.01         XXX
                                                 counseling, indiv.
99402...........  .............  N............  Preventive                  0.98        0.48        0.67        0.22        0.30        0.02         XXX
                                                 counseling, indiv.
99403...........  .............  N............  Preventive                  1.46        0.59        0.84        0.34        0.45        0.04         XXX
                                                 counseling, indiv.
99404...........  .............  N............  Preventive                  1.95        0.70        1.01        0.45        0.60        0.05         XXX
                                                 counseling, indiv.
99406...........  .............  A............  Behav chng smoking 3-       0.24        0.11        0.10        0.07        0.08        0.01         XXX
                                                 10 min.
99407...........  .............  A............  Behav chng smoking <        0.50        0.18        0.18        0.13        0.15        0.01         XXX
                                                 10 min.
99408...........  .............  N............  Audit/dast, 15-30           0.65        0.19        0.19        0.15        0.15        0.01         XXX
                                                 min.
99409...........  .............  N............  Audit/dast, over 30         1.30        0.34        0.34        0.30        0.30        0.03         XXX
                                                 min.
99411...........  .............  N............  Preventive                  0.15        0.22        0.20        0.03        0.05        0.01         XXX
                                                 counseling, group.
99412...........  .............  N............  Preventive                  0.25        0.24        0.25        0.06        0.08        0.01         XXX
                                                 counseling, group.
99420...........  .............  N............  Health risk                 0.00        0.22        0.22          NA          NA        0.01         XXX
                                                 assessment 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          NA        0.27        0.32        0.05         XXX
                                                 newborn.
99432...........  .............  A............  Newborn care, not in        1.26        1.01        0.97        0.29        0.34        0.07         XXX
                                                 hosp.
99433...........  .............  A............  Normal newborn care/        0.62          NA          NA        0.17        0.19        0.02         XXX
                                                 hospital.
99435...........  .............  A............  Newborn discharge           1.50          NA          NA        0.50        0.54        0.06         XXX
                                                 day hosp.
99436...........  .............  A............  Attendance, birth...        1.50          NA          NA        0.33        0.40        0.06         XXX
99440...........  .............  A............  Newborn                     2.93          NA          NA        0.67        0.80        0.12         XXX
                                                 resuscitation.
99441...........  .............  N............  Phone e/m by phys 5-        0.25        0.09        0.09        0.06        0.06        0.02         XXX
                                                 10 min.
99442...........  .............  N............  Phone e/m by phys 11-       0.50        0.14        0.14        0.11        0.11        0.02         XXX
                                                 20 min.
99443...........  .............  N............  Phone e/m by phys 21-       0.75        0.20        0.20        0.17        0.17        0.03         XXX
                                                 30 min.
99444...........  .............  N............  Online e/m by phys..        0.00        0.00        0.00        0.00        0.00        0.00         XXX
99450...........  .............  N............  Basic life                  0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 disability exam.
99455...........  .............  R............  Work related                0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 disability exam.
99456...........  .............  R............  Disability                  0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 examination.
99477...........  .............  A............  Init day hosp               7.00        1.98        1.98        1.98        1.98        0.32         XXX
                                                 neonate care.
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

[[Page 66540]]

 
99501...........  .............  I............  Home visit,                 0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 postnatal.
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           0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 care.
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/         0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 fam 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,        0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 2 hrs.
99602...........  .............  I............  Home infusion, each         0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 addtl hr.
99605...........  .............  X............  Mtms by pharm, np,          0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 15 min.
99606...........  .............  X............  Mtms by pharm, est,         0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 15 min.
99607...........  .............  X............  Mtms by pharm, addl         0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 15 min.
A4890...........  .............  R............  Repair/maint cont           0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 hemo equip.
G0008...........  .............  X............  Admin influenza             0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 virus 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        0.48        0.50          NA          NA        0.02         XXX
                                                 breast exam.
G0102...........  .............  A............  Prostate ca                 0.17        0.32        0.36        0.06        0.06        0.01         XXX
                                                 screening; dre.
G0103...........  .............  X............  PSA screening.......        0.00        0.00        0.00        0.00        0.00        0.00         XXX
G0104...........  .............  A............  CA screen;flexi             0.96        2.52        2.40        0.62        0.56        0.08         000
                                                 sigmoidscope.
G0105...........  .............  A............  Colorectal scrn; hi         3.69        6.38        6.26        1.82        1.64        0.30         000
                                                 risk ind.
G0105...........  53...........  A............  Colorectal scrn; hi         0.96        2.52        2.40        0.62        0.56        0.08         000
                                                 risk ind.
G0106...........  .............  A............  Colon CA                    0.99        4.94        3.74          NA          NA        0.17         XXX
                                                 screen;barium enema.
G0106...........  TC...........  A............  Colon CA                    0.00        4.59        3.41          NA          NA        0.13         XXX
                                                 screen;barium enema.
G0106...........  26...........  A............  Colon CA                    0.99        0.35        0.33        0.35        0.33        0.04         XXX
                                                 screen;barium enema.
G0108...........  .............  A............  Diab manage trn per         0.00        0.59        0.71          NA          NA        0.01         XXX
                                                 indiv.
G0109...........  .............  A............  Diab manage trn ind/        0.00        0.31        0.40          NA          NA        0.01         XXX
                                                 group.
G0117...........  .............  T............  Glaucoma scrn hgh           0.45        0.76        0.74          NA          NA        0.01         XXX
                                                 risk direc.
G0118...........  .............  T............  Glaucoma scrn hgh           0.17        0.71        0.62          NA          NA        0.01         XXX
                                                 risk direc.
G0120...........  .............  A............  Colon ca scrn;              0.99        4.94        3.74          NA          NA        0.17         XXX
                                                 barium enema.
G0120...........  TC...........  A............  Colon ca scrn;              0.00        4.59        3.41          NA          NA        0.13         XXX
                                                 barium enema.
G0120...........  26...........  A............  Colon ca scrn;              0.99        0.35        0.33        0.35        0.33        0.04         XXX
                                                 barium enema.
G0121...........  .............  A............  Colon ca scrn not hi        3.69        6.38        6.26        1.82        1.64        0.30         000
                                                 rsk ind.
G0121...........  53...........  A............  Colon ca scrn not hi        0.96        2.52        2.40        0.62        0.56        0.08         000
                                                 rsk ind.
G0122...........  .............  N............  Colon ca scrn;              0.99        5.64        4.10          NA          NA        0.18         XXX
                                                 barium enema.
G0122...........  TC...........  N............  Colon ca scrn;              0.00        5.41        3.80          NA          NA        0.13         XXX
                                                 barium enema.
G0122...........  26...........  N............  Colon ca scrn;              0.99        0.23        0.30        0.23        0.30        0.05         XXX
                                                 barium 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             0.42        0.38        0.26        0.38        0.26        0.02         XXX
                                                 layer by MD.
G0127...........  .............  R............  Trim nail(s)........        0.17        0.38        0.32        0.04        0.06        0.01         000
G0128...........  .............  R............  CORF skilled nursing        0.08        0.02        0.02        0.02        0.02        0.01         XXX
                                                 service.
G0130...........  .............  A............  Single energy x-ray         0.22        0.55        0.71          NA          NA        0.06         XXX
                                                 study.
G0130...........  TC...........  A............  Single energy x-ray         0.00        0.49        0.64          NA          NA        0.05         XXX
                                                 study.
G0130...........  26...........  A............  Single energy x-ray         0.22        0.06        0.07        0.06        0.07        0.01         XXX
                                                 study.
G0141...........  .............  A............  Scr c/v cyto,autosys        0.42        0.38        0.26        0.38        0.26        0.02         XXX
                                                 and md.
G0143...........  .............  X............  Scr c/v                     0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 cyto,thinlayer,resc
                                                 r.
G0144...........  .............  X............  Scr c/v                     0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 cyto,thinlayer,resc
                                                 r.
G0145...........  .............  X............  Scr c/v                     0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 cyto,thinlayer,resc
                                                 r.
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,               0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 autosys, rescr.
G0166...........  .............  A............  Extrnl counterpulse,        0.07        4.50        4.03          NA          NA        0.01         XXX
                                                 per tx.
G0168...........  .............  A............  Wound closure by            0.45        1.58        1.76        0.21        0.21        0.03         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 &           0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 educ serv.
G0179...........  .............  A............  MD recertification          0.45        0.48        0.75          NA          NA        0.02         XXX
                                                 HHA PT.
G0180...........  .............  A............  MD certification HHA        0.67        0.56        0.91          NA          NA        0.03         XXX
                                                 patient.
G0181...........  .............  A............  Home health care            1.73        0.80        1.14          NA          NA        0.07         XXX
                                                 supervision.
G0182...........  .............  A............  Hospice care                1.73        0.82        1.24          NA          NA        0.07         XXX
                                                 supervision.
G0186...........  .............  C............  Dstry eye lesn,fdr          0.00        0.00        0.00        0.00        0.00        0.00         YYY
                                                 vssl tech.
G0202...........  .............  A............  Screeningmammography        0.70        2.80        2.78          NA          NA        0.10         XXX
                                                 digital.
G0202...........  TC...........  A............  Screeningmammography        0.00        2.56        2.55          NA          NA        0.07         XXX
                                                 digital.
G0202...........  26...........  A............  Screeningmammography        0.70        0.24        0.23        0.24        0.23        0.03         XXX
                                                 digital.
G0204...........  .............  A............  Diagnosticmammograph        0.87        3.40        3.09          NA          NA        0.11         XXX
                                                 ydigital.
G0204...........  TC...........  A............  Diagnosticmammograph        0.00        3.10        2.80          NA          NA        0.07         XXX
                                                 ydigital.

[[Page 66541]]

 
G0204...........  26...........  A............  Diagnosticmammograph        0.87        0.30        0.29        0.30        0.29        0.04         XXX
                                                 ydigital.
G0206...........  .............  A............  Diagnosticmammograph        0.70        2.66        2.45          NA          NA        0.09         XXX
                                                 ydigital.
G0206...........  TC...........  A............  Diagnosticmammograph        0.00        2.42        2.22          NA          NA        0.06         XXX
                                                 ydigital.
G0206...........  26...........  A............  Diagnosticmammograph        0.70        0.24        0.23        0.24        0.23        0.03         XXX
                                                 ydigital.
G0219...........  .............  N............  PET img wholbod             0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 melano nonco.
G0219...........  TC...........  N............  PET img wholbod             0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 melano nonco.
G0219...........  26...........  N............  PET img wholbod             0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 melano nonco.
G0235...........  .............  N............  PET not otherwise           0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 specified.
G0235...........  TC...........  N............  PET not otherwise           0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 specified.
G0235...........  26...........  N............  PET not otherwise           0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 specified.
G0237...........  .............  A............  Therapeutic procd           0.00        0.21        0.34          NA          NA        0.02         XXX
                                                 strg endur.
G0238...........  .............  A............  Oth resp proc, indiv        0.00        0.23        0.36          NA          NA        0.02         XXX
G0239...........  .............  A............  Oth resp proc, group        0.00        0.31        0.32          NA          NA        0.02         XXX
G0245...........  .............  R............  Initial foot exam pt        0.88        0.84        0.81        0.29        0.30        0.04         XXX
                                                 lops.
G0246...........  .............  R............  Followup eval of            0.45        0.55        0.55        0.15        0.15        0.02         XXX
                                                 foot pt lop.
G0247...........  .............  R............  Routine footcare pt         0.50        0.68        0.60        0.16        0.18        0.02         ZZZ
                                                 w lops.
G0248...........  .............  R............  Demonstrate use home        0.00        3.40        5.00          NA          NA        0.01         XXX
                                                 inr mon.
G0249...........  .............  R............  Provide test                0.00        3.40        3.68          NA          NA        0.01         XXX
                                                 material,equipm.
G0250...........  .............  R............  MD review interpret         0.18        0.08        0.07          NA          NA        0.01         XXX
                                                 of test.
G0251...........  .............  E............  Linear acc based            0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 stero radio.
G0252...........  .............  N............  PET imaging initial         0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 dx.
G0252...........  TC...........  N............  PET imaging initial         0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 dx.
G0252...........  26...........  N............  PET imaging initial         1.50        0.00        0.60        0.00        0.60        0.04         XXX
                                                 dx.
G0255...........  .............  N............  Current percep              0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 threshold tst.
G0255...........  TC...........  N............  Current percep              0.00        0.00        0.00          NA          NA        0.00         XXX
                                                 threshold tst.
G0255...........  26...........  N............  Current percep              0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 threshold tst.
G0257...........  .............  E............  Unsched dialysis            0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 ESRD pt hos.
G0259...........  .............  E............  Inject for                  0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 sacroiliac joint.
G0260...........  .............  E............  Inj for sacroiliac          0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 jt anesth.
G0268...........  .............  A............  Removal of impacted         0.61        0.66        0.65        0.20        0.22        0.02         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             0.37        0.12        0.29        0.09        0.28        0.01         XXX
                                                 change dx.
G0271...........  .............  A............  Group MNT 2 or more         0.25        0.08        0.13        0.07        0.12        0.01         XXX
                                                 30 mins.
G0275...........  .............  A............  Renal angio, cardiac        0.25          NA          NA        0.13        0.12        0.01         ZZZ
                                                 cath.
G0278...........  .............  A............  Iliac art                   0.25          NA          NA        0.13        0.12        0.01         ZZZ
                                                 angio,cardiac cath.
G0281...........  .............  A............  Elec stim unattend          0.18        0.14        0.12          NA          NA        0.01         XXX
                                                 for press.
G0282...........  .............  N............  Elect stim wound            0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 care not pd.
G0283...........  .............  A............  Elec stim other than        0.18        0.14        0.12          NA          NA        0.01         XXX
                                                 wound.
G0288...........  .............  A............  Recon, CTA for surg         0.00        1.03        5.82          NA          NA        0.18         XXX
                                                 plan.
G0289...........  .............  A............  Arthro, loose body +        1.48          NA          NA        0.58        0.69        0.26         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                0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 proc,clin trial.
G0294...........  .............  E............  Non-cov proc,               0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 clinical trial.
G0295...........  .............  N............  Electromagnetic             0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 therapy onc.
G0297...........  .............  X............  Insert single               0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 chamber/cd.
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         0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 10-15dos.
G0304...........  .............  X............  Pre-op service LVRS         0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 1-9 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           12.74        5.57        7.05        5.57        7.05        0.42         XXX
                                                 4+mo < 2yrs.
G0309...........  .............  A............  ESRD related svc 2-        10.61        4.16        5.63        4.16        5.63        0.36         XXX
                                                 3mo <2yrs.
G0310...........  .............  A............  ESRD related svc 1          8.49        2.78        4.23        2.78        4.23        0.28         XXX
                                                 vst <2yrs.
G0311...........  .............  A............  ESRD related svs            9.73        3.54        4.13        3.54        4.13        0.34         XXX
                                                 4+mo 2-11yr.
G0312...........  .............  A............  ESRD relate svs 2-3         8.11        2.70        3.31        2.70        3.31        0.29         XXX
                                                 mo 2-11y.
G0313...........  .............  A............  ESRD related svs 1          6.49        1.83        2.49        1.83        2.49        0.22         XXX
                                                 mon 2-11y.
G0314...........  .............  A............  ESRD related svs 4+         8.28        3.39        3.90        3.39        3.90        0.27         XXX
                                                 mo 12-19.
G0315...........  .............  A............  ESRD related svs 2-         6.90        2.56        3.11        2.56        3.11        0.23         XXX
                                                 3mo/12-19.
G0316...........  .............  A............  ESRD related svs            5.52        1.66        2.30        1.66        2.30        0.17         XXX
                                                 1vis/12-19y.
G0317...........  .............  A............  ESRD related svs            5.09        2.25        2.55        2.25        2.55        0.17         XXX
                                                 4+mo 20+yrs.
G0318...........  .............  A............  ESRD related svs 2-3        4.24        1.69        2.04        1.69        2.04        0.14         XXX
                                                 mo 20+y.
G0319...........  .............  A............  ESRD related svs            3.39        1.13        1.52        1.13        1.52        0.11         XXX
                                                 1visit 20+y.
G0320...........  .............  A............  ESD related svs home       10.61        2.68        4.89        2.68        4.89        0.36         XXX
                                                 undr 2.
G0321...........  .............  A............  ESRDrelatedsvs home         8.11        1.99        2.95        1.99        2.95        0.29         XXX
                                                 mo 2-11y.
G0322...........  .............  A............  ESRD related svs hom        6.90        1.71        2.69        1.71        2.69        0.23         XXX
                                                 mo12-19.
G0323...........  .............  A............  ESRD related svs            4.24        1.14        1.76        1.14        1.76        0.14         XXX
                                                 home mo 20+.
G0324...........  .............  A............  ESRD relate svs home/       0.35        0.16        0.20        0.16        0.20        0.01         XXX
                                                 dy <2yr.
G0325...........  .............  A............  ESRD relate home/day/       0.23        0.09        0.10        0.09        0.10        0.01         XXX
                                                  2-11yr.
G0326...........  .............  A............  ESRD relate home/dy         0.27        0.10        0.11        0.10        0.11        0.01         XXX
                                                 12-19yr.

[[Page 66542]]

 
G0327...........  .............  A............  ESRD relate home/dy         0.14        0.06        0.07        0.06        0.07        0.01         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           0.06        0.15        0.14          NA          NA        0.01         XXX
                                                 for ulcers.
G0332...........  .............  A............  Preadmin IV                 0.00        0.00        1.97          NA          NA        0.00         XXX
                                                 immunoglobulin.
G0333...........  .............  X............  Dispense fee initial        0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 30 day.
G0337...........  .............  X............  Hospice evaluation          1.34        0.31        0.41        0.31        0.41        0.09         XXX
                                                 preelecti.
G0339...........  .............  C............  Robot lin-radsurg           0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 com, 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          NA          NA        2.35        2.47        0.48         000
                                                 celltrans.
G0342...........  .............  A............  Laparoscopy islet          11.92          NA          NA        5.06        5.18        1.46         090
                                                 cell trans.
G0343...........  .............  A............  Laparotomy islet           19.85          NA          NA        8.54        8.65        2.07         090
                                                 cell transp.
G0344...........  .............  A............  Initial preventive          1.34        1.11        1.12        0.43        0.45        0.10         XXX
                                                 exam.
G0364...........  .............  A............  Bone marrow aspirate        0.16        0.16        0.15        0.07        0.06        0.04         ZZZ
                                                 &biopsy.
G0365...........  .............  A............  Vessel mapping hemo         0.25        5.21        4.61          NA          NA        0.25         XXX
                                                 access.
G0365...........  TC...........  A............  Vessel mapping hemo         0.00        5.15        4.53          NA          NA        0.23         XXX
                                                 access.
G0365...........  26...........  A............  Vessel mapping hemo         0.25        0.06        0.08        0.06        0.08        0.02         XXX
                                                 access.
G0366...........  .............  A............  EKG for initial             0.17        0.35        0.42          NA          NA        0.03         XXX
                                                 prevent exam.
G0367...........  .............  A............  EKG tracing for             0.00        0.28        0.36          NA          NA        0.02         XXX
                                                 initial prev.
G0368...........  .............  A............  EKG interpret &             0.17        0.07        0.06        0.07        0.06        0.01         XXX
                                                 report preve.
G0372...........  .............  A............  MD service required         0.17        0.04        0.22        0.04        0.05        0.01         XXX
                                                 for PMD.
G0377...........  .............  X............  Administra Part D           0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 vaccine.
G0378...........  .............  X............  Hospital observation        0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 per hr.
G0379...........  .............  X............  Direct admit                0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 hospital observ.
G0389...........  .............  A............  Ultrasound exam AAA         0.58        2.41        2.41          NA          NA        0.11         XXX
                                                 screen.
G0389...........  TC...........  A............  Ultrasound exam AAA         0.00        2.21        2.21          NA          NA        0.08         XXX
                                                 screen.
G0389...........  26...........  A............  Ultrasound exam AAA         0.58        0.20        0.20        0.20        0.20        0.03         XXX
                                                 screen.
G0392...........  .............  A............  AV fistula or graft         9.48       48.63       48.63          NA          NA        0.62         000
                                                 arterial.
G0393...........  .............  A............  AV fistula or graft         6.03       37.11       37.11          NA          NA        0.34         000
                                                 venous.
G0394...........  .............  X............  Blood occult                0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 test,colorectal.
G0396...........  .............  A............  Alcohol/subs interv         0.65        0.19        0.19        0.15        0.15        0.01         XXX
                                                 15-30mn.
G0397...........  .............  A............  Alcohol/subs interv         1.30        0.34        0.34        0.29        0.29        0.03         XXX
                                                 >30 min.
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            0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 rate.
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                  0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 monitoring.
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,             0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 level 3.
G9010...........  .............  X............  MCCD, risk adj,             0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 level 4.
G9011...........  .............  X............  MCCD, risk adj,             0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 level 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            0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 level I.
G9014...........  .............  N............  ESRD demo bundle-           0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 level II.
G9016...........  .............  N............  Demo-smoking                0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 cessation 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                 0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 phosphate 75mg.
G9020...........  .............  X............  Rimantadine HCL             0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 100mg oral.
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,            0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 brand.
G9041...........  .............  A............  Low vision rehab            0.44        0.10        0.20        0.10        0.20        0.01         XXX
                                                 occupationa.
G9042...........  .............  A............  Low vision rehab            0.10        0.02        0.16        0.02        0.16        0.01         XXX
                                                 orient/mobi.
G9043...........  .............  A............  Low vision lowvision        0.10        0.02        0.16        0.02        0.16        0.01         XXX
                                                 therapi.
G9044...........  .............  A............  Low vision                  0.10        0.02        0.13        0.02        0.13        0.01         XXX
                                                 rehabilate teache.
G9140...........  .............  X............  Frontier extended           0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 stay demo.
M0064...........  .............  A............  Visit for drug              0.37        0.91        0.62        0.07        0.09        0.01         XXX
                                                 monitoring.
P3001...........  .............  A............  Screening pap smear         0.42        0.38        0.26        0.38        0.26        0.02         XXX
                                                 by phys.
Q0035...........  .............  A............  Cardiokymography....        0.17        0.30        0.37          NA          NA        0.03         XXX
Q0035...........  TC...........  A............  Cardiokymography....        0.00        0.25        0.32          NA          NA        0.02         XXX
Q0035...........  26...........  A............  Cardiokymography....        0.17        0.05        0.05        0.05        0.05        0.01         XXX
Q0091...........  .............  A............  Obtaining screen pap        0.37        0.75        0.71        0.10        0.12        0.02         XXX
                                                 smear.
Q0092...........  .............  A............  Set up port xray            0.00        0.47        0.40        0.47        0.40        0.01         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          0.00        0.00        0.00        0.00        0.00        0.00         XXX
                                                 EKG.

[[Page 66543]]

 
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 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.
\2\ If values are reflected for codes not payable by Medicare, please note that these values have been established as a courteesy to the general public
  and are not used for Medicare payment.
 






Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / 
Rules and Regulations


                                                          Addendum C.--Codes With Interim RVUs
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                              Fully     Year 2008     Fully     Year 2008
                                                                             imple-      transi-     imple-      transi-
                                                                Physician  mented non- tional non-   mented      tional    Malpractice
 CPT \1\/HCPCS     Mod        Status          Description       work RVUs   facility    facility    facility    facility     RVUs \2\        Global
                                                                   \2\       PE RVUs     PE RVUs     PE RVUs     PE RVUs
                                                                               \2\         \2\         \2\         \2\
--------------------------------------------------------------------------------------------------------------------------------------------------------
20555..........  .......  A............  Place ndl musc/tis          6.00          NA          NA        2.18        2.18         0.43  000
                                          for rt.
20660..........  .......  A............  Apply, rem fixation         4.00        2.27        2.27        1.55        1.55         0.59  000
                                          device.
20690..........  .......  A............  Apply bone fixation         8.65          NA          NA        3.71        3.71         0.59  090
                                          device.
20692..........  .......  A............  Apply bone fixation        16.00          NA          NA        6.78        6.78         1.05  090
                                          device.
20985..........  .......  A............  Cptr-asst dir ms px.        2.50        0.99        0.99        0.99        0.99         0.48  ZZZ
20986..........  .......  C............  Cptr-asst dir ms px         0.00        0.00        0.00        0.00        0.00         0.00  ZZZ
                                          io img.
20987..........  .......  C............  Cptr-asst dir ms px         0.00        0.00        0.00        0.00        0.00         0.00  ZZZ
                                          pre img.
21073..........  .......  A............  Mnpj of tmj w/anesth        3.33        5.50        5.50        2.31        2.31         0.43  090
22206..........  .......  A............  Cut spine 3 col,           37.00          NA          NA       17.71       17.71         6.23  090
                                          thor.
22207..........  .......  A............  Cut spine 3 col,           36.50          NA          NA       17.59       17.59         6.07  090
                                          lumb.
22208..........  .......  A............  Cut spine 3 col,            9.66        3.72        3.72        3.72        3.72         2.07  ZZZ
                                          addl seg.
23515..........  .......  A............  Treat clavicle              9.53          NA          NA        6.77        6.77         1.28  090
                                          fracture.
23585..........  .......  A............  Treat scapula              14.07          NA          NA        8.07        8.07         1.54  090
                                          fracture.
23615..........  .......  A............  Treat humerus              12.12          NA          NA        8.44        8.44         1.62  090
                                          fracture.
23616..........  .......  A............  Treat humerus              18.19          NA          NA       12.29       12.29         3.70  090
                                          fracture.
23630..........  .......  A............  Treat humerus              10.39          NA          NA        7.00        7.00         1.27  090
                                          fracture.
23670..........  .......  A............  Treat dislocation/         12.12          NA          NA        7.37        7.37         1.36  090
                                          fracture.
23680..........  .......  A............  Treat dislocation/         12.99          NA          NA        8.16        8.16         1.76  090
                                          fracture.
24357..........  .......  A............  Repair elbow, perc..        5.32          NA          NA        5.15        5.15         0.87  090
24358..........  .......  A............  Repair elbow w/deb,         6.54          NA          NA        5.73        5.73         1.07  090
                                          open.
24359..........  .......  A............  Repair elbow deb/           8.86          NA          NA        6.19        6.19         1.41  090
                                          attch open.
24545..........  .......  A............  Treat humerus              12.99          NA          NA        8.36        8.36         1.83  090
                                          fracture.
24546..........  .......  A............  Treat humerus              14.73          NA          NA       10.20       10.20         2.74  090
                                          fracture.
24575..........  .......  A............  Treat humerus               9.53          NA          NA        7.68        7.68         1.87  090
                                          fracture.
24579..........  .......  A............  Treat humerus              11.26          NA          NA        8.28        8.28         2.03  090
                                          fracture.
24635..........  .......  A............  Treat elbow fracture        8.64          NA          NA       10.29       10.29         2.29  090
24685..........  .......  A............  Treat ulnar fracture        8.21          NA          NA        7.01        7.01         1.52  090
25515..........  .......  A............  Treat fracture of           8.64          NA          NA        6.96        6.96         1.59  090
                                          radius.
25525..........  .......  A............  Treat fracture of          10.37          NA          NA        8.70        8.70         2.13  090
                                          radius.
25526..........  .......  A............  Treat fracture of          12.96          NA          NA       11.09       11.09         2.20  090
                                          radius.
25545..........  .......  A............  Treat fracture of           7.78          NA          NA        6.94        6.94         1.53  090
                                          ulna.
25574..........  .......  A............  Treat fracture              8.64          NA          NA        6.87        6.87         1.21  090
                                          radius & ulna.
25575..........  .......  A............  Treat fracture             12.10          NA          NA        8.93        8.93         1.82  090
                                          radius/ulna.
25628..........  .......  A............  Treat wrist bone            9.51          NA          NA        7.33        7.33         1.37  090
                                          fracture.
26615..........  .......  A............  Treat metacarpal            6.91          NA          NA        5.66        5.66         0.86  090
                                          fracture.
26650..........  .......  A............  Treat thumb fracture        5.19          NA          NA        5.78        5.78         0.94  090
26665..........  .......  A............  Treat thumb fracture        7.78          NA          NA        6.46        6.46         0.90  090
26685..........  .......  A............  Treat hand                  6.91          NA          NA        6.05        6.05         1.09  090
                                          dislocation.
26715..........  .......  A............  Treat knuckle               6.87          NA          NA        5.75        5.75         0.91  090
                                          dislocation.
26735..........  .......  A............  Treat finger                7.26          NA          NA        5.84        5.84         0.95  090
                                          fracture, each.
26746..........  .......  A............  Treat finger                9.59          NA          NA        6.38        6.38         0.91  090
                                          fracture, each.
26765..........  .......  A............  Treat finger                5.70          NA          NA        4.93        4.93         0.66  090
                                          fracture, each.
26785..........  .......  A............  Treat finger                6.44          NA          NA        5.15        5.15         0.68  090
                                          dislocation.
27248..........  .......  A............  Treat thigh fracture       10.64          NA          NA        7.29        7.29         1.82  090
27267..........  .......  A............  Cltx thigh fx.......        5.38          NA          NA        4.39        4.39         0.89  090
27268..........  .......  A............  Cltx thigh fx w/mnpj        7.00          NA          NA        5.02        5.02         1.16  090
27269..........  .......  A............  Optx thigh fx.......       18.75          NA          NA        9.88        9.88         2.93  090
27416..........  .......  A............  Osteochondral knee         14.00          NA          NA        8.38        8.38         2.32  090
                                          autograft.
27511..........  .......  A............  Treatment of thigh         14.97          NA          NA        9.65        9.65         2.38  090
                                          fracture.
27513..........  .......  A............  Treatment of thigh         19.11          NA          NA       11.81       11.81         3.13  090
                                          fracture.
27514..........  .......  A............  Treatment of thigh         14.46          NA          NA       10.61       10.61         3.01  090
                                          fracture.
27519..........  .......  A............  Treat thigh fx             13.11          NA          NA        9.48        9.48         2.56  090
                                          growth plate.
27535..........  .......  A............  Treat knee fracture.       13.27          NA          NA        8.77        8.77         2.01  090
27540..........  .......  A............  Treat knee fracture.       11.16          NA          NA        8.44        8.44         2.28  090
27556..........  .......  A............  Treat knee                 12.86          NA          NA        9.45        9.45         2.51  090
                                          dislocation.
27557..........  .......  A............  Treat knee                 15.76          NA          NA       10.78       10.78         2.98  090
                                          dislocation.
27558..........  .......  A............  Treat knee                 18.25          NA          NA       11.16       11.16         3.09  090
                                          dislocation.
27726..........  .......  A............  Repair fibula              14.20          NA          NA        7.67        7.67         1.43  090
                                          nonunion.
27766..........  .......  A............  Optx medial ankle fx        7.73          NA          NA        6.67        6.67         1.44  090
27767..........  .......  A............  Cltx post ankle fx..        2.50        3.62        3.62        3.65        3.65         0.30  090

[[Page 66544]]

 
27768..........  .......  A............  Cltx post ankle fx w/       5.00          NA          NA        4.29        4.29         0.79  090
                                          mnpj.
27769..........  .......  A............  Optx post ankle fx..       10.00          NA          NA        6.07        6.07         1.45  090
27784..........  .......  A............  Treatment of fibula         9.51          NA          NA        6.65        6.65         1.23  090
                                          fracture.
27792..........  .......  A............  Treatment of ankle          9.55          NA          NA        6.88        6.88         1.32  090
                                          fracture.
27814..........  .......  A............  Treatment of ankle         10.46          NA          NA        7.89        7.89         1.86  090
                                          fracture.
27822..........  .......  A............  Treatment of ankle         11.03          NA          NA        9.42        9.42         1.92  090
                                          fracture.
27823..........  .......  A............  Treatment of ankle         12.98          NA          NA       10.19       10.19         2.26  090
                                          fracture.
27826..........  .......  A............  Treat lower leg            10.92          NA          NA        8.51        8.51         1.47  090
                                          fracture.
27827..........  .......  A............  Treat lower leg            14.56          NA          NA       11.47       11.47         2.44  090
                                          fracture.
27828..........  .......  A............  Treat lower leg            18.20          NA          NA       12.74       12.74         2.82  090
                                          fracture.
27829..........  .......  A............  Treat lower leg             8.64          NA          NA        6.87        6.87         0.95  090
                                          joint.
27832..........  .......  A............  Treat lower leg            10.01          NA          NA        6.50        6.50         1.03  090
                                          dislocation.
28415..........  .......  A............  Treat heel fracture.       15.96          NA          NA       11.75       11.75         2.67  090
28420..........  .......  A............  Treat/graft heel           17.29          NA          NA       11.59       11.59         2.81  090
                                          fracture.
28445..........  .......  A............  Treat ankle fracture       15.53          NA          NA       10.25       10.25         2.59  090
28446..........  .......  A............  Osteochondral talus        17.50          NA          NA       10.34       10.34         2.45  090
                                          autogrft.
28465..........  .......  A............  Treat midfoot               8.64          NA          NA        6.18        6.18         1.10  090
                                          fracture, each.
28485..........  .......  A............  Treat metatarsal            7.28          NA          NA        5.50        5.50         0.83  090
                                          fracture.
28505..........  .......  A............  Treat big toe               7.28        8.27        8.27        4.36        4.36         0.56  090
                                          fracture.
28525..........  .......  A............  Treat toe fracture..        5.46        7.81        7.81        3.87        3.87         0.49  090
28555..........  .......  A............  Repair foot                 9.49       10.35       10.35        5.98        5.98         1.04  090
                                          dislocation.
28585..........  .......  A............  Repair foot                10.92        9.44        9.44        6.40        6.40         1.25  090
                                          dislocation.
28615..........  .......  A............  Repair foot                10.46          NA          NA        8.08        8.08         1.30  090
                                          dislocation.
28645..........  .......  A............  Repair toe                  7.28        6.64        6.64        3.94        3.94         0.57  090
                                          dislocation.
28675..........  .......  A............  Repair of toe               5.46        7.68        7.68        3.90        3.90         0.45  090
                                          dislocation.
29828..........  .......  A............  Arthroscopy biceps         13.00          NA          NA        8.17        8.17         2.17  090
                                          tenodesis.
29904..........  .......  A............  Subtalar arthro w/fb        8.50          NA          NA        5.89        5.89         1.25  090
                                          rmvl.
29905..........  .......  A............  Subtalar arthro w/          9.00          NA          NA        6.51        6.51         1.32  090
                                          exc.
29906..........  .......  A............  Subtalar arthro w/          9.47          NA          NA        6.87        6.87         1.39  090
                                          deb.
29907..........  .......  A............  Subtalar arthro w/         12.00          NA          NA        7.86        7.86         1.90  090
                                          fusion.
31500..........  .......  A............  Insert emergency            2.33          NA          NA        0.48        0.48         0.17  000
                                          airway.
33257..........  .......  A............  Ablate atria, lmtd,         9.63          NA          NA        5.46        5.46         0.89  ZZZ
                                          add-on.
33258..........  .......  A............  Ablate atria, x10sv,       11.00          NA          NA        5.98        5.98         1.09  ZZZ
                                          add-on.
33259..........  .......  A............  Ablate atria w/            14.14          NA          NA        7.79        7.79         1.78  ZZZ
                                          bypass add-on.
33864..........  .......  A............  Ascending aortic           60.00          NA          NA       20.09       20.09         6.73  090
                                          graft.
34806..........  .......  A............  Aneurysm press              2.06        0.51        0.51        0.51        0.51         0.30  ZZZ
                                          sensor add-on.
35523..........  .......  A............  Artery bypass graft.       24.00          NA          NA        9.20        9.20         2.14  090
36591..........  .......  T............  Draw blood off              0.00        0.54        0.54          NA          NA         0.01  XXX
                                          venous device.
36592..........  .......  T............  Collect blood from          0.00        0.67        0.67          NA          NA         0.01  XXX
                                          picc.
36593..........  .......  A............  Declot vascular             0.00        0.60        0.60          NA          NA         0.37  XXX
                                          device.
36620..........  .......  A............  Insertion catheter,         1.15          NA          NA        0.19        0.19         0.07  000
                                          artery.
41019..........  .......  A............  Place needles h&n           8.84          NA          NA        3.28        3.28         0.59  000
                                          for rt.
43760..........  .......  A............  Change gastrostomy          0.90        4.03        4.03        0.39        0.39         0.09  000
                                          tube.
49203..........  .......  A............  Exc abd tum 5 cm or        20.00          NA          NA        7.65        7.65         2.27  090
                                          less.
49204..........  .......  A............  Exc abd tum over 5         26.00          NA          NA        9.26        9.26         2.94  090
                                          cm.
49205..........  .......  A............  Exc abd tum over 10        30.00          NA          NA       10.34       10.34         3.40  090
                                          cm.
49440..........  .......  A............  Place gastrostomy           4.18       25.03       25.03        1.81        1.81         0.49  010
                                          tube perc.
49441..........  .......  A............  Place duod/jej tube         4.77       30.10       30.10        2.00        2.00         0.29  010
                                          perc.
49442..........  .......  A............  Place cecostomy tube        4.00       24.43       24.43        1.63        1.63         0.24  010
                                          perc.
49446..........  .......  A............  Change g-tube to g-j        3.31       25.74       25.74        1.15        1.15         0.18  000
                                          perc.
49450..........  .......  A............  Replace g/c tube            1.36       18.94       18.94        0.44        0.44         0.08  000
                                          perc.
49451..........  .......  A............  Replace duod/jej            1.84       19.69       19.69        0.64        0.64         0.11  000
                                          tube perc.
49452..........  .......  A............  Replace g-j tube            2.86       23.48       23.48        1.00        1.00         0.18  000
                                          perc.
49460..........  .......  A............  Fix g/colon tube w/         0.96       20.56       20.56        0.31        0.31         0.05  000
                                          device.
49465..........  .......  A............  Fluoro exam of g/           0.62        3.88        3.88        0.22        0.22         0.03  000
                                          colon tube.
50385..........  .......  A............  Change stent via            4.44       30.61       30.61        2.05        2.05         0.27  000
                                          transureth.
50386..........  .......  A............  Remove stent via            3.30       19.36       19.36        1.60        1.60         0.20  000
                                          transureth.
50593..........  .......  A............  Perc cryo ablate            9.08      114.48      114.48        3.44        3.44         0.58  010
                                          renal tum.
51797..........       26  A............  Intraabdominal              0.80        0.41        0.41        0.41        0.41         0.12  ZZZ
                                          pressure test.
52649..........  .......  A............  2Prostate laser            17.16          NA          NA        9.31        9.31         1.11  090
                                          enucleation.
55920..........  .......  A............  Place needles pelvic        8.31          NA          NA        3.13        3.13         0.58  000
                                          for rt.
57284..........  .......  A............  Repair paravag             14.25          NA          NA        6.56        6.56         1.41  090
                                          defect, open.
57285..........  .......  A............  Repair paravag             11.52          NA          NA        5.16        5.16         0.63  090
                                          defect, vag.
57423..........  .......  A............  Repair paravag             16.00          NA          NA        6.51        6.51         1.65  090
                                          defect, lap.
58570..........  .......  A............  Tlh, uterus 250 g or       15.75          NA          NA        6.45        6.45         1.82  090
                                          less.
58571..........  .......  A............  Tlh w/t/o 250 g or         17.56          NA          NA        6.94        6.94         1.81  090
                                          less.
58572..........  .......  A............  Tlh, uterus over 250       19.96          NA          NA        7.59        7.59         2.31  090
                                          g.
58573..........  .......  A............  Tlh w/t/o uterus           22.98          NA          NA        8.41        8.41         2.28  090
                                          over 250 g.
67041..........  .......  A............  Vit for macular            19.00          NA          NA       10.36       10.36         0.86  090
                                          pucker.
67042..........  .......  A............  Vit for macular hole       22.13          NA          NA       11.48       11.48         1.00  090
67043..........  .......  A............  Vit for membrane           22.94          NA          NA       12.34       12.34         1.04  090
                                          dissect.
67113..........  .......  A............  Repair retinal             22.49          NA          NA       12.75       12.75         1.13  090
                                          detach, cplx.
67229..........  .......  A............  Tr retinal les             16.00          NA          NA        9.51        9.51         0.71  090
                                          preterm inf.
68816..........  .......  A............  Probe nl duct w/            3.00       12.73       12.73        2.51        2.51         0.16  010
                                          balloon.
75557..........       26  A............  Cardiac mri for             2.35        0.94        0.94        0.94        0.94         0.10  XXX
                                          morph.
75558..........       26  N............  Cardiac mri flow/           2.60        0.60        0.60        0.60        0.60         0.11  XXX
                                          velocity.
75559..........       26  A............  Cardiac mri w/stress        2.95        1.27        1.27        1.27        1.27         0.10  XXX
                                          img.
75560..........       26  N............  Cardiac mri flow/vel/       3.00        0.69        0.69        0.69        0.69         0.11  XXX
                                          stress.

[[Page 66545]]

 
75561..........       26  A............  Cardiac mri for             2.60        1.03        1.03        1.03        1.03         0.11  XXX
                                          morph w/dye.
75562..........       26  N............  Card mri flow/vel w/        2.86        0.66        0.66        0.66        0.66         0.11  XXX
                                          dye.
75563..........       26  A............  Card mri w/stress           3.00        1.38        1.38        1.38        1.38         0.11  XXX
                                          img & dye.
75564..........       26  N............  Ht mri w/flo/vel/           3.35        0.77        0.77        0.77        0.77         0.13  XXX
                                          strs & dye.
78811..........       26  A............  Pet image, ltd area.        1.54        0.53        0.53        0.53        0.53         0.11  XXX
78812..........       26  A............  Pet image, skull-           1.93        0.66        0.66        0.66        0.66         0.11  XXX
                                          thigh.
78813..........       26  A............  Pet image, full body        2.00        0.68        0.68        0.68        0.68         0.11  XXX
78814..........       26  A............  Pet image w/ct, lmtd        2.20        0.75        0.75        0.75        0.75         0.11  XXX
78815..........       26  A............  Pet image w/ct,             2.44        0.84        0.84        0.84        0.84         0.11  XXX
                                          skull-thigh.
78816..........       26  A............  Pet image w/ct, full        2.50        0.85        0.85        0.85        0.85         0.11  XXX
                                          body.
86486..........  .......  A............  Skin test, nos              0.00        0.13        0.13          NA          NA         0.02  XXX
                                          antigen.
88380..........       26  A............  Microdissection,            1.56        0.43        0.43        0.43        0.43         0.07  XXX
                                          laser.
88381..........       26  A............  Microdissection,            1.18        0.32        0.32        0.32        0.32         0.06  XXX
                                          manual.
90769..........  .......  A............  Sc ther infusion, up        0.21        3.92        3.92          NA          NA         0.06  XXX
                                          to 1 hr.
90770..........  .......  A............  Sc ther infusion,           0.18        0.22        0.22          NA          NA         0.04  ZZZ
                                          addl hr.
90771..........  .......  A............  Sc ther infusion,           0.00        1.86        1.86          NA          NA         0.01  ZZZ
                                          reset pump.
93503..........  .......  C............  Insert/place heart          0.00          NA          NA          NA          NA         0.00  000
                                          catheter.
93982..........  .......  R............  Aneurysm pressure           0.30        0.80        0.80          NA          NA         0.01  XXX
                                          sens study.
95004..........  .......  A............  Percut allergy skin         0.01        0.13        0.13          NA          NA         0.01  XXX
                                          tests.
95024..........  .......  A............  Id allergy test,            0.01        0.16        0.16          NA          NA         0.01  XXX
                                          drug/bug.
95027..........  .......  A............  Id allergy titrate-         0.01        0.12        0.12          NA          NA         0.01  XXX
                                          airborne.
95980..........  .......  A............  Io anal gast n-stim         0.80          NA          NA        0.25        0.25         0.07  XXX
                                          init.
95981..........  .......  A............  Io anal gast n-stim         0.30        0.44        0.44        0.12        0.12         0.02  XXX
                                          subsq.
95982..........  .......  A............  Io ga n-stim subsq w/       0.65        0.47        0.47        0.18        0.18         0.05  XXX
                                          reprog.
96125..........  .......  A............  Cognitive test by hc        1.70        0.76        0.76        0.37        0.37         0.16  XXX
                                          pro.
98966..........  .......  N............  Hc pro phone call 5-        0.25        0.09        0.09        0.06        0.06         0.01  XXX
                                          10 min.
98967..........  .......  N............  Hc pro phone call 11-       0.50        0.14        0.14        0.11        0.11         0.02  XXX
                                          20 min.
98968..........  .......  N............  Hc pro phone call 21-       0.75        0.20        0.20        0.17        0.17         0.03  XXX
                                          30 min.
98969..........  .......  N............  Online service by hc        0.00        0.00        0.00        0.00        0.00         0.00  XXX
                                          pro.
99174..........  .......  N............  Ocular                      0.00        0.00        0.00        0.00        0.00         0.00  XXX
                                          photoscreening.
99366..........  .......  B............  Team conf w/pat by          0.82        0.20        0.20        0.19        0.19         0.06  XXX
                                          hc pro.
99367..........  .......  B............  Team conf w/o pat by        1.10        0.25        0.25        0.25        0.25         0.05  XXX
                                          phys.
99368..........  .......  B............  Team conf w/o pat by        0.72        0.16        0.16        0.16        0.16         0.03  XXX
                                          hc pro.
99406..........  .......  A............  Behav chng smoking 3-       0.24        0.10        0.10        0.08        0.08         0.01  XXX
                                          10 min.
99407..........  .......  A............  Behav chng smoking <        0.50        0.18        0.18        0.15        0.15         0.01  XXX
                                          10 min.
99408..........  .......  N............  Audit/dast, 15-30           0.65        0.19        0.19        0.15        0.15         0.01  XXX
                                          min.
99409..........  .......  N............  Audit/dast, over 30         1.30        0.34        0.34        0.30        0.30         0.03  XXX
                                          min.
99441..........  .......  N............  Phone e/m by phys 5-        0.25        0.09        0.09        0.06        0.06         0.02  XXX
                                          10 min.
99442..........  .......  N............  Phone e/m by phys 11-       0.50        0.14        0.14        0.11        0.11         0.02  XXX
                                          20 min.
99443..........  .......  N............  Phone e/m by phys 21-       0.75        0.20        0.20        0.17        0.17         0.03  XXX
                                          30 min.
99444..........  .......  N............  Online e/m by phys..        0.00        0.00        0.00        0.00        0.00         0.00  XXX
99477..........  .......  A............  Init day hosp               7.00        1.98        1.98        1.98        1.98         0.32  XXX
                                          neonate care.
G0396..........  .......  A............  Alcohol/subs interv         0.65        0.19        0.19        0.15        0.15         0.01  XXX
                                          15-30 min.
G0397..........  .......  A............  Alcohol/subs interv         1.30        0.34        0.34        0.29        0.29         0.03  XXX
                                          >30 min.
--------------------------------------------------------------------------------------------------------------------------------------------------------
\1\ CPT codes and descriptions only are copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.
\2\ If values are reflected for codes not payable by Medicare, please note that these values have been established as a courtesy to the general public
  and are not used for Medicare payment.


         Addendum D.--2008 Geographic Adjustment Factors (GAFs)
------------------------------------------------------------------------
       Carrier             Locality           Locality name        GAF
------------------------------------------------------------------------
31140...............  06...............  San Mateo, CA.........    1.232
31140...............  05...............  San Francisco, CA.....    1.229
31140...............  09...............  Santa Clara, CA.......    1.207
00803...............  01...............  Manhattan, NY.........    1.174
00803...............  02...............  NYC Suburbs/Long I.,      1.171
                                          NY.
31140...............  07...............  Oakland/Berkley, CA...    1.154
31143...............  01...............  Metropolitan Boston...    1.143
14330...............  04...............  Queens, NY............    1.137
31140...............  03...............  Marin/Napa/Solano, CA.    1.133
00805...............  01...............  Northern NJ...........    1.130
00903...............  01...............  DC + MD/VA Suburbs....    1.127
31146...............  26...............  Anaheim/Santa Ana, CA.    1.124
31146...............  17...............  Ventura, CA...........    1.102
31146...............  18...............  Los Angeles, CA.......    1.100
00591...............  00...............  Connecticut...........    1.096
00952...............  16...............  Chicago, IL...........    1.093
00590...............  04...............  Miami, FL.............    1.092
00953...............  01...............  Detroit, MI...........    1.091
00805...............  99...............  Rest of New Jersey....    1.078
00952...............  15...............  Suburban Chicago, IL..    1.074
00865...............  01...............  Metropolitan              1.072
                                          Philadelphia, PA.
00836...............  02...............  Seattle (King Cnty),      1.046
                                          WA.

[[Page 66546]]

 
00831...............  01...............  Alaska................    1.045
00833...............  01...............  Hawaii/Guam...........    1.044
31143...............  99...............  Rest of Massachusetts.    1.042
00803...............  03...............  Poughkpsie/N NYC          1.040
                                          Suburbs, NY.
00901...............  01...............  Baltimore/Surr. Cntys,    1.037
                                          MD.
00590...............  03...............  Fort Lauderdale, FL...    1.033
00524...............  01...............  Rhode Island..........    1.030
00511...............  01...............  Atlanta, GA...........    1.024
00900...............  11...............  Dallas, TX............    1.022
00900...............  18...............  Houston, TX...........    1.021
00834...............  00...............  Nevada................    1.019
31140...............  99...............  Rest of California *..    1.015
31146...............  99...............  Rest of California *..    1.015
00902...............  01...............  Delaware..............    1.012
00900...............  31...............  Austin, TX............    1.001
00835...............  01...............  Portland, OR..........    0.997
00900...............  09...............  Brazoria, TX..........    0.995
00528...............  01...............  New Orleans, LA.......    0.993
31144...............  40...............  New Hampshire.........    0.993
00952...............  15...............  East St. Louis, IL....    0.992
00900...............  28...............  Fort Worth, TX........    0.990
00973...............  50...............  Virgin Islands........    0.989
00900...............  15...............  Galveston, TX.........    0.985
00824...............  01...............  Colorado..............    0.983
00901...............  99...............  Rest of Maryland......    0.981
31142...............  03...............  Southern Maine........    0.981
03102...............  00...............  Arizona...............    0.980
00523...............  01...............  Metropolitan Kansas       0.980
                                          City, MO.
00590...............  99...............  Rest of Florida.......    0.977
00953...............  99...............  Rest of Michigan......    0.976
00836...............  99...............  Rest of Washington....    0.973
00740...............  02...............  Metropolitan St.          0.971
                                          Louis, MO.
00883...............  00...............  Ohio..................    0.969
00954...............  00...............  Minnesota.............    0.967
00865...............  99...............  Rest of Pennsylvania..    0.956
31145...............  50...............  Vermont...............    0.953
00904...............  00...............  Virginia..............    0.950
03502...............  09...............  Utah..................    0.948
00900...............  20...............  Beaumont, TX..........    0.946
00801...............  99...............  Rest of New York......    0.946
00951...............  00...............  Wisconsin.............    0.942
00952...............  99...............  Rest of Illinois......    0.940
05535...............  00...............  North Carolina........    0.937
00521...............  05...............  New Mexico............    0.936
00630...............  00...............  Indiana...............    0.935
00511...............  99...............  Rest of Georgia.......    0.932
00900...............  99...............  Rest of Texas.........    0.931
00835...............  99...............  Rest of Oregon........    0.930
00884...............  16...............  West Virginia.........    0.926
00528...............  99...............  Rest of Louisiana.....    0.923
05440...............  35...............  Tennessee.............    0.923
00880...............  01...............  South Carolina........    0.921
00650...............  00...............  Kansas *..............    0.917
00740...............  04...............  Kansas *..............    0.917
31142...............  99...............  Rest of Maine.........    0.915
00660...............  00...............  Kentucky..............    0.912
00510...............  00...............  Alabama...............    0.910
05130...............  00...............  Idaho.................    0.909
03602...............  21...............  Wyoming...............    0.907
00826...............  00...............  Iowa..................    0.906
00512...............  00...............  Mississippi...........    0.903
00655...............  00...............  Nebraska..............    0.902
03202...............  01...............  Montana...............    0.898
00522...............  00...............  Oklahoma..............    0.898
00740...............  99...............  Rest of Missouri *....    0.890
03402...............  02...............  South Dakota..........    0.890
00523...............  99...............  Rest of Missouri *....    0.889
03302...............  01...............  North Dakota..........    0.888
00520...............  13...............  Arkansas..............    0.888
00973...............  20...............  Puerto Rico...........    0.789
------------------------------------------------------------------------


[[Page 66547]]


   Addendum E.--2008 *** Geographic Practice Cost Indices by State and
                            Medicare Locality
------------------------------------------------------------------------
                                               2008 budget neutral GPCIs
    Carrier       Locality     Locality name  --------------------------
                                                 Work      PE       MP
------------------------------------------------------------------------
00510.........  00.........  Alabama.........    0.982    0.850    0.617
00831.........  01.........  Alaska..........    1.018    1.097    0.828
03102.........  00.........  Arizona.........    0.987    0.975    0.936
00520.........  13.........  Arkansas........    0.961    0.839    0.439
31146.........  26.........  Anaheim/Santa       1.034    1.254    0.875
                              Ana, CA.
31146.........  18.........  Los Angeles, CA.    1.041    1.192    0.871
31140.........  03.........  Marin/Napa/         1.035    1.304    0.535
                              Solano, CA.
31140.........  07.........  Oakland/Berkley,    1.054    1.330    0.532
                              CA.
31140.........  05.........  San Francisco,      1.060    1.494    0.526
                              CA.
31140.........  06.........  San Mateo, CA...    1.073    1.486    0.511
31140.........  09.........  Santa Clara, CA.    1.083    1.419    0.485
31146.........  17.........  Ventura, CA.....    1.028    1.223    0.749
31140.........  99.........  Rest of             1.008    1.056    0.634
                              California *.
31146.........  99.........  Rest of              .008    1.056    0.634
                              California *.
00824.........  01.........  Colorado........    0.986    1.003    0.715
00591.........  00.........  Connecticut.....    1.038    1.179    0.934
00903.........  01.........  DC + MD/VA          1.048    1.235    0.972
                              Suburbs.
00902.........  01.........  Delaware........    1.012    1.033    0.777
00590.........  03.........  Fort Lauderdale,    0.988    1.004    1.965
                              FL.
00590.........  04.........  Miami, FL.......    1.001    1.058    2.705
00590.........  99.........  Rest of Florida.    0.973    0.937    1.490
00511.........  01.........  Atlanta, GA.....    1.010    1.052    0.893
00511.........  99.........  Rest of Georgia.    0.979    0.879    0.889
00833.........  01.........  Hawaii/Guam.....    0.990    1.137    0.726
05130.........  00.........  Idaho...........    0.967    0.876    0.499
00952.........  16.........  Chicago, IL.....    1.025    1.104    1.889
00952.........  12.........  East St. Louis,     0.988    0.929    1.758
                              IL.
00952.........  15.........  Suburban            1.018    1.092    1.628
                              Chicago, IL.
00952.........  99.........  Rest of Illinois    0.974    0.877    1.197
00630.........  00.........  Indiana.........    0.985    0.913    0.515
00826.........  00.........  Iowa............    0.966    0.870    0.506
00650.........  00.........  Kansas *........    0.968    0.881    0.633
00740.........  04.........  Kansas *........    0.968    0.881    0.633
00660.........  00.........  Kentucky........    0.969    0.858    0.755
00528.........  01.........  New Orleans, LA.    0.986    0.995    1.066
00528.........  99.........  Rest of             0.970    0.863    0.966
                              Louisiana.
31142.........  03.........  Southern Maine..    0.980    1.019    0.558
31142.........  99.........  Rest of Maine...    0.962    0.890    0.558
00901.........  01.........  Baltimore/Surr.     1.013    1.068    1.010
                              Cntys, MD.
00901.........  99.........  Rest of Maryland    0.993    0.981    0.812
31143.........  01.........  Metropolitan        1.030    1.311    0.787
                              Boston.
31143.........  99.........  Rest of             1.008    1.105    0.787
                              Massachusetts.
00953.........  01.........  Detroit, MI.....    1.037    1.048    2.300
00953.........  99.........  Rest of Michigan    0.998    0.922    1.287
00954.........  00.........  Minnesota.......    0.991    0.994    0.324
00512.........  00.........  Mississippi.....    0.959    0.848    0.760
00523.........  01.........  Metropolitan        0.989    0.961    1.061
                              Kansas City, MO.
00740.........  02.........  Metropolitan St.    0.992    0.943    1.001
                              Louis, MO.
00523.........  99.........  Rest of Missouri    0.950    0.812    0.938
                              *.
00740.........  99.........  Rest of Missouri    0.951    0.812    0.938
                              *.
03202.........  01.........  Montana.........    0.950    0.846    0.781
00655.........  00.........  Nebraska........    0.959    0.883    0.345
00834.........  00.........  Nevada..........    1.003    1.035    1.067
31144.........  40.........  New Hampshire...    0.981    1.034    0.693
00805.........  01.........  Northern NJ.....    1.058    1.225    1.038
00805.........  99.........  Rest of New         1.043    1.124    1.038
                              Jersey.
00521.........  05.........  New Mexico......    0.972    0.889    0.989
00803.........  01.........  Manhattan, NY...    1.065    1.299    1.243
00803.........  02.........  NYC Suburbs/Long    1.052    1.286    1.494
                              I., NY.
00803.........  03.........  Poughkpsie/N NYC    1.015    1.076    0.984
                              Suburbs, NY.
14330.........  04.........  Queens, NY......    1.032    1.235    1.450
00801.........  99.........  Rest of New York    0.997    0.920    0.544
05535.........  00.........  North Carolina..    0.971    0.923    0.632
03302.........  01.........  North Dakota....    0.946    0.853    0.489
00883.........  00.........  Ohio............    0.992    0.930    1.097
00522.........  00.........  Oklahoma........    0.964    0.853    0.503
00835.........  01.........  Portland, OR....    1.003    1.037    0.453
00835.........  99.........  Rest of Oregon..    0.968    0.927    0.453
00865.........  01.........  Metropolitan        1.017    1.101    1.492
                              Philadelphia,
                              PA.

[[Page 66548]]

 
00865.........  99.........  Rest of             0.992    0.914    0.938
                              Pennsylvania.
00973.........  20.........  Puerto Rico.....    0.905    0.697    0.253
00524.........  01.........  Rhode Island....    1.029    1.039    0.946
00880.........  01.........  South Carolina..    0.975    0.900    0.418
03402.........  02.........  South Dakota....    0.942    0.871    0.390
05440.........  35.........  Tennessee.......    0.977    0.885    0.614
00900.........  31.........  Austin, TX......    0.991    1.015    0.970
00900.........  20.........  Beaumont, TX....    0.983    0.869    1.312
00900.........  09.........  Brazoria, TX....    1.020    0.942    1.250
00900.........  11.........  Dallas, TX......    1.010    1.032    1.078
00900.........  28.........  Fort Worth, TX..    0.998    0.972    1.078
00900.........  15.........  Galveston, TX...    0.990    0.956    1.250
00900.........  18.........  Houston, TX.....    1,017    1.000    1.311
00900.........  99.........  Rest of Texas...    0.968    0.873    1.092
03502.........  09.........  Utah............    0.977    0.922    0.841
31145.........  50.........  Vermont.........    0.968    0.976    0.497
00904.........  00.........  Virginia........    0.981    0.942    0.613
00973.........  50.........  Virgin Islands..    0.982    0.996    0.998
00836.........  02.........  Seattle (King       1.015    1.109    0.755
                              Cnty), WA.
00836.........  99.........  Rest of             0.987    0.977    0.749
                              Washington.
00884.........  16.........  West Virginia...    0.973    0.824    1.437
00951.........  00.........  Wisconsin.......    0.987    0.920    0.592
03602.........  21.........  Wyoming.........    0.956    0.849   0.905
------------------------------------------------------------------------
* Indicates multiple carriers.
** Transition value for work GPCI does not reflect the 2007 1.000 floor.
*** 2008 GPCIs are the first year of the update transition.


       Addendum F.--CPT/HCPCS Imaging Codes Defined by DRA 5102(b)
------------------------------------------------------------------------
                HCPCS/CPT *                       Short descriptor
------------------------------------------------------------------------
31620.....................................  Endobronchial us add-on.
37250.....................................  Iv us first vessel add-on.
37251.....................................  Iv us each add vessel add-
                                             on.
51798.....................................  Us urine capacity measure.
70010.....................................  Contrast x-ray of brain.
70015.....................................  Contrast x-ray of brain.
70030.....................................  X-ray eye for foreign body.
70100.....................................  X-ray exam of jaw.
70110.....................................  X-ray exam of jaw.
70120.....................................  X-ray exam of mastoids.
70130.....................................  X-ray exam of mastoids.
70134.....................................  X-ray exam of middle ear.
70140.....................................  X-ray exam of facial bones.
70150.....................................  X-ray exam of facial bones.
70160.....................................  X-ray exam of nasal bones.
70170.....................................  X-ray exam of tear duct.
70190.....................................  X-ray exam of eye sockets.
70200.....................................  X-ray exam of eye sockets.
70210.....................................  X-ray exam of sinuses.
70220.....................................  X-ray exam of sinuses.
70240.....................................  X-ray exam, pituitary
                                             saddle.
70250.....................................  X-ray exam of skull.
70260.....................................  X-ray exam of skull.
70300.....................................  X-ray exam of teeth.
70310.....................................  X-ray exam of teeth.
70320.....................................  Full mouth x-ray of teeth.
70328.....................................  X-ray exam of jaw joint.
70330.....................................  X-ray exam of jaw joints.
70332.....................................  X-ray exam of jaw joint.
70336.....................................  Magnetic image, jaw joint.
70350.....................................  X-ray head for orthodontia.
70355.....................................  Panoramic x-ray of jaws.
70360.....................................  X-ray exam of neck.
70370.....................................  Throat x-ray & fluoroscopy.
70371.....................................  Speech evaluation, complex.
70373.....................................  Contrast x-ray of larynx.
70380.....................................  X-ray exam of salivary
                                             gland.
70390.....................................  X-ray exam of salivary duct.
70450.....................................  Ct head/brain w/o dye.
70460.....................................  Ct head/brain w/dye.
70470.....................................  Ct head/brain w/o & w/dye.
70480.....................................  Ct orbit/ear/fossa w/o dye.
70481.....................................  Ct orbit/ear/fossa w/dye.
70482.....................................  Ct orbit/ear/fossa w/o & w/
                                             dye.
70486.....................................  Ct maxillofacial w/o dye.
70487.....................................  Ct maxillofacial w/dye.
70488.....................................  Ct maxillofacial w/o & w/
                                             dye.
70490.....................................  Ct soft tissue neck w/o dye.
70491.....................................  Ct soft tissue neck w/dye.
70492.....................................  Ct sft tsue nck w/o & w/dye.
70496.....................................  Ct angiography, head.
70498.....................................  Ct angiography, neck.
70540.....................................  Mri orbit/face/neck w/o dye.
70542.....................................  Mri orbit/face/neck w/dye.
70543.....................................  Mri orbt/fac/nck w/o & w/
                                             dye.
70544.....................................  Mr angiography head w/o dye.
70545.....................................  Mr angiography head w/dye.
70546.....................................  Mr angiograph head w/o & w/
                                             dye.
70547.....................................  Mr angiography neck w/o dye.
70548.....................................  Mr angiography neck w/dye.
70549.....................................  Mr angiograph neck w/o & w/
                                             dye.
70551.....................................  Mri brain w/o dye.
70552.....................................  Mri brain w/dye.
70553.....................................  Mri brain w/o & w/dye.
70557.....................................  Mri brain w/o dye.
70558.....................................  Mri brain w/dye.
70559.....................................  Mri brain w/o & w/dye.
71010.....................................  Chest x-ray.
71015.....................................  Chest x-ray.
71020.....................................  Chest x-ray.
71021.....................................  Chest x-ray.
71022.....................................  Chest x-ray.
71023.....................................  Chest x-ray and fluoroscopy.
71030.....................................  Chest x-ray.
71034.....................................  Chest x-ray and fluoroscopy.
71035.....................................  Chest x-ray.
71040.....................................  Contrast x-ray of bronchi.
71060.....................................  Contrast x-ray of bronchi.
71090.....................................  X-ray & pacemaker insertion.
71100.....................................  X-ray exam of ribs.
71101.....................................  X-ray exam of ribs/chest.
71110.....................................  X-ray exam of ribs.
71111.....................................  X-ray exam of ribs/chest.
71120.....................................  X-ray exam of breastbone.
71130.....................................  X-ray exam of breastbone.
71250.....................................  Ct thorax w/o dye.
71260.....................................  Ct thorax w/dye.
71270.....................................  Ct thorax w/o & w/dye.
71275.....................................  Ct angiography, chest.
71550.....................................  Mri chest w/o dye.
71551.....................................  Mri chest w/dye.
71552.....................................  Mri chest w/o & w/dye.
71555.....................................  Mri angio chest w/ or w/o
                                             dye.
72010.....................................  X-ray exam of spine.
72020.....................................  X-ray exam of spine.
72040.....................................  X-ray exam of neck spine.
72050.....................................  X-ray exam of neck spine.
72052.....................................  X-ray exam of neck spine.
72069.....................................  X-ray exam of trunk spine.
72070.....................................  X-ray exam of thoracic
                                             spine.
72072.....................................  X-ray exam of thoracic
                                             spine.
72074.....................................  X-ray exam of thoracic
                                             spine.

[[Page 66549]]

 
72080.....................................  X-ray exam of trunk spine.
72090.....................................  X-ray exam of trunk spine.
72100.....................................  X-ray exam of lower spine.
72110.....................................  X-ray exam of lower spine.
72114.....................................  X-ray exam of lower spine.
72120.....................................  X-ray exam of lower spine.
72125.....................................  Ct neck spine w/o dye.
72126.....................................  Ct neck spine w/dye.
72127.....................................  Ct neck spine w/o & w/dye.
72128.....................................  Ct chest spine w/o dye.
72129.....................................  Ct chest spine w/dye.
72130.....................................  Ct chest spine w/o & w/dye.
72131.....................................  Ct lumbar spine w/o dye.
72132.....................................  Ct lumbar spine w/dye.
72133.....................................  Ct lumbar spine w/o & w/dye.
72141.....................................  Mri neck spine w/o dye.
72142.....................................  Mri neck spine w/dye.
72146.....................................  Mri chest spine w/o dye.
72147.....................................  Mri chest spine w/dye.
72148.....................................  Mri lumbar spine w/o dye.
72149.....................................  Mri lumbar spine w/dye.
72156.....................................  Mri neck spine w/o & w/dye.
72157.....................................  Mri chest spine w/o & w/dye.
72158.....................................  Mri lumbar spine w/o & w/
                                             dye.
72159.....................................  Mr angio spine w/o & w/dye.
72170.....................................  X-ray exam of pelvis.
72190.....................................  X-ray exam of pelvis.
72191.....................................  Ct angiograph pelv w/o & w/
                                             dye.
72192.....................................  Ct pelvis w/o dye.
72193.....................................  Ct pelvis w/dye.
72194.....................................  Ct pelvis w/o & w/dye.
72195.....................................  Mri pelvis w/o dye.
72196.....................................  Mri pelvis w/dye.
72197.....................................  Mri pelvis w/o & w/dye.
72198.....................................  Mr angio pelvis w/o & w/dye.
72200.....................................  X-ray exam sacroiliac
                                             joints.
72202.....................................  X-ray exam sacroiliac
                                             joints.
72220.....................................  X-ray exam of tailbone.
72240.....................................  Contrast x-ray of neck
                                             spine.
72255.....................................  Contrast x-ray, thorax
                                             spine.
72265.....................................  Contrast x-ray, lower spine.
72270.....................................  Contrast x-ray, spine.
72275.....................................  Epidurography.
72285.....................................  X-ray c/t spine disk.
72291.....................................  Percut vertebroplasty fluor.
72293.....................................  Percut vertebroplasty, ct.
72295.....................................  X-ray of lower spine disk.
73000.....................................  X-ray exam of collar bone.
73010.....................................  X-ray exam of shoulder
                                             blade.
73020.....................................  X-ray exam of shoulder.
73030.....................................  X-ray exam of shoulder.
73040.....................................  Contrast x-ray of shoulder.
73050.....................................  X-ray exam of shoulders.
73060.....................................  X-ray exam of humerus.
73070.....................................  X-ray exam of elbow.
73080.....................................  X-ray exam of elbow.
73085.....................................  Contrast x-ray of elbow.
73090.....................................  X-ray exam of forearm.
73092.....................................  X-ray exam of arm, infant.
73100.....................................  X-ray exam of wrist.
73110.....................................  X-ray exam of wrist.
73115.....................................  Contrast x-ray of wrist.
73120.....................................  X-ray exam of hand.
73130.....................................  X-ray exam of hand.
73140.....................................  X-ray exam of finger(s).
73200.....................................  Ct upper extremity w/o dye.
73201.....................................  Ct upper extremity w/dye.
73202.....................................  Ct uppr extremity w/o & w/
                                             dye.
73206.....................................  Ct angio upr extrm w/o & w/
                                             dye.
73218.....................................  Mri upper extremity w/o dye.
73219.....................................  Mri upper extremity w/dye.
73220.....................................  Mri uppr extremity w/o & w/
                                             dye.
73221.....................................  Mri joint upr extrem w/o
                                             dye.
73222.....................................  Mri joint upr extrem w/dye.
73223.....................................  Mri joint upr extr w/o & w/
                                             dye.
73225.....................................  Mr angio upr extr w/o & w/
                                             dye.
73500.....................................  X-ray exam of hip.
73510.....................................  X-ray exam of hip.
73520.....................................  X-ray exam of hips.
73525.....................................  Contrast x-ray of hip.
73530.....................................  X-ray exam of hip.
73540.....................................  X-ray exam of pelvis & hips.
73542.....................................  X-ray exam, sacroiliac
                                             joint.
73550.....................................  X-ray exam of thigh.
73560.....................................  X-ray exam of knee, 1 or 2.
73562.....................................  X-ray exam of knee, 3.
73564.....................................  X-ray exam, knee, 4 or more.
73565.....................................  X-ray exam of knees.
73580.....................................  Contrast x-ray of knee
                                             joint.
73590.....................................  X-ray exam of lower leg.
73592.....................................  X-ray exam of leg, infant.
73600.....................................  X-ray exam of ankle.
73610.....................................  X-ray exam of ankle.
73615.....................................  Contrast x-ray of ankle.
73620.....................................  X-ray exam of foot.
73630.....................................  X-ray exam of foot.
73650.....................................  X-ray exam of heel.
73660.....................................  X-ray exam of toe(s).
73700.....................................  Ct lower extremity w/o dye.
73701.....................................  Ct lower extremity w/dye.
73702.....................................  Ct lwr extremity w/o & w/
                                             dye.
73706.....................................  Ct angio lwr extr w/o & w/
                                             dye.
73718.....................................  Mri lower extremity w/o dye.
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/ or w/o
                                             dye.
74190.....................................  X-ray exam of peritoneum.
74210.....................................  Contrast x-ray exam of
                                             throat.
74220.....................................  Contrast x-ray, esophagus.
74230.....................................  Cine/vid x-ray, throat/
                                             esoph.
74235.....................................  Remove esophagus
                                             obstruction.
74240.....................................  X-ray exam, upper gi tract.
74241.....................................  X-ray exam, upper gi tract.
74245.....................................  X-ray exam, upper gi tract.
74246.....................................  Contrast x-ray uppr gi
                                             tract.
74247.....................................  Contrast x-ray uppr gi
                                             tract.
74249.....................................  Contrast x-ray uppr gi
                                             tract.
74250.....................................  X-ray exam of small bowel.
74251.....................................  X-ray exam of small bowel.
74260.....................................  X-ray exam of small bowel.
74270.....................................  Contrast x-ray exam of
                                             colon.
74280.....................................  Contrast x-ray exam of
                                             colon.
74283.....................................  Contrast x-ray exam of
                                             colon.
74290.....................................  Contrast x-ray, gallbladder.
74291.....................................  Contrast x-rays,
                                             gallbladder.
74300.....................................  X-ray bile ducts/pancreas.
74301.....................................  X-rays at surgery add-on.
74305.....................................  X-ray bile ducts/pancreas.
74320.....................................  Contrast x-ray of bile
                                             ducts.
74327.....................................  X-ray bile stone removal.
74328.....................................  X-ray bile duct endoscopy.
74329.....................................  X-ray for pancreas
                                             endoscopy.
74330.....................................  X-ray bile/panc endoscopy.
74340.....................................  X-ray guide for GI tube.
74355.....................................  X-ray guide, intestinal
                                             tube.
74360.....................................  X-ray guide, GI dilation.
74363.....................................  X-ray, bile duct dilation.
74400.....................................  Contrast x-ray, urinary
                                             tract.
74410.....................................  Contrast x-ray, urinary
                                             tract.
74415.....................................  Contrast x-ray, urinary
                                             tract.
74420.....................................  Contrast x-ray, urinary
                                             tract.
74425.....................................  Contrast x-ray, urinary
                                             tract.
74430.....................................  Contrast x-ray, bladder.
74440.....................................  X-ray, male genital tract.
74445.....................................  X-ray exam of penis.
74450.....................................  X-ray, urethra/bladder.
74455.....................................  X-ray, urethra/bladder.
74470.....................................  X-ray exam of kidney lesion.
74475.....................................  X-ray control, cath insert.
74480.....................................  X-ray control, cath insert.
74485.....................................  X-ray guide, GU dilation.
74710.....................................  X-ray measurement of pelvis.
74740.....................................  X-ray, female genital tract.
74742.....................................  X-ray, fallopian tube.
74775.....................................  X-ray exam of perineum.
75557.....................................  Cardiac MRI w/o contrast.
75558.....................................  Cardiac MRI w/flow/velocity.
75559.....................................  Cardiac MRI w/stress
                                             imaging.
75560.....................................  Cardiac MRI w/flow/velocity/
                                             stress.
75561.....................................  Cardiac MRI w/ & w/o
                                             contrast.
75562.....................................  Cardiac MRI w/flow velocity.
75563.....................................  Cardiac MRI w/stress
                                             imaging.
75564.....................................  Cardiac MRI w/flow/velocity/
                                             stress.
75600.....................................  Contrast x-ray exam of
                                             aorta.
75605.....................................  Contrast x-ray exam of
                                             aorta.
75625.....................................  Contrast x-ray exam of
                                             aorta.
75630.....................................  X-ray aorta, leg arteries.
75635.....................................  Ct angio abdominal arteries.
75650.....................................  Artery x-rays, head & neck.
75658.....................................  Artery x-rays, arm.
75660.....................................  Artery x-rays, head & neck.
75662.....................................  Artery x-rays, head & neck.
75665.....................................  Artery x-rays, head & neck.
75671.....................................  Artery x-rays, head & neck.
75676.....................................  Artery x-rays, neck.
75680.....................................  Artery x-rays, neck.
75685.....................................  Artery x-rays, spine.
75705.....................................  Artery x-rays, spine.
75710.....................................  Artery x-rays, arm/leg.
75716.....................................  Artery x-rays, arms/legs.
75722.....................................  Artery x-rays, kidney.
75724.....................................  Artery x-rays, kidneys.
75726.....................................  Artery x-rays, abdomen.
75731.....................................  Artery x-rays, adrenal
                                             gland.
75733.....................................  Artery x-rays, adrenals.
75736.....................................  Artery x-rays, pelvis.

[[Page 66550]]

 
75741.....................................  Artery x-rays, lung.
75743.....................................  Artery x-rays, lungs.
75746.....................................  Artery x-rays, lung.
75756.....................................  Artery x-rays, chest.
75774.....................................  Artery x-ray, each vessel.
75790.....................................  Visualize A-V shunt.
75801.....................................  Lymph vessel x-ray, arm/leg.
75803.....................................  Lymph vessel x-ray, arms/
                                             legs.
75805.....................................  Lymph vessel x-ray, trunk.
75807.....................................  Lymph vessel x-ray, trunk.
75809.....................................  Nonvascular shunt, x-ray.
75810.....................................  Vein x-ray, spleen/liver.
75820.....................................  Vein x-ray, arm/leg.
75822.....................................  Vein x-ray, arms/legs.
75825.....................................  Vein x-ray, trunk.
75827.....................................  Vein x-ray, chest.
75831.....................................  Vein x-ray, kidney.
75833.....................................  Vein x-ray, kidneys.
75840.....................................  Vein x-ray, adrenal gland.
75842.....................................  Vein x-ray, adrenal glands.
75860.....................................  Vein x-ray, neck.
75870.....................................  Vein x-ray, skull.
75872.....................................  Vein x-ray, skull.
75880.....................................  Vein x-ray, eye socket.
75885.....................................  Vein x-ray, liver.
75887.....................................  Vein x-ray, liver.
75889.....................................  Vein x-ray, liver.
75891.....................................  Vein x-ray, liver.
75893.....................................  Venous sampling by catheter.
75894.....................................  X-rays, transcath therapy.
75896.....................................  X-rays, transcath therapy.
75898.....................................  Follow-up angiography.
75900.....................................  Intravascular cath exchange.
75901.....................................  Remove cva device obstruct.
75902.....................................  Remove cva lumen obstruct.
75940.....................................  X-ray placement, vein
                                             filter.
75945.....................................  Intravascular us.
75946.....................................  Intravascular us add-on.
75953.....................................  Abdom aneurysm endovas rpr.
75956.....................................  X-ray, endovasc thor ao
                                             repr.
75957.....................................  X-ray, endovasc thor ao
                                             repr.
75958.....................................  X-ray, place prox ext thor
                                             ao.
75959.....................................  X-ray, place dist ext thor
                                             ao.
75960.....................................  Transcath iv stent rs&i.
75961.....................................  Retrieval, broken catheter.
75962.....................................  Repair arterial blockage.
75964.....................................  Repair artery blockage,
                                             each.
75966.....................................  Repair arterial blockage.
75968.....................................  Repair artery blockage,
                                             each.
75970.....................................  Vascular biopsy.
75978.....................................  Repair venous blockage.
75980.....................................  Contrast x-ray exam bile
                                             duct.
75982.....................................  Contrast x-ray exam bile
                                             duct.
75984.....................................  X-ray control catheter
                                             change.
75989.....................................  Abscess drainage under x-
                                             ray.
75992.....................................  Atherectomy, x-ray exam.
76000.....................................  Fluoroscope examination.
76001.....................................  Fluoroscope exam, extensive.
76010.....................................  X-ray, nose to rectum.
76080.....................................  X-ray exam of fistula.
76098.....................................  X-ray exam, breast specimen.
76100.....................................  X-ray exam of body section.
76101.....................................  Complex body section x-ray.
76102.....................................  Complex body section x-rays.
76120.....................................  Cine/video x-rays.
76125.....................................  Cine/video x-rays add-on.
76140.....................................  X-ray consultation.
76150.....................................  X-ray exam, dry process.
76350.....................................  Special x-ray contrast
                                             study.
76376.....................................  3d render w/o postprocess.
76377.....................................  3d rendering w/postprocess.
76380.....................................  CAT scan follow-up study.
76390.....................................  Mr spectroscopy.
76496.....................................  Fluoroscopic procedure.
76497.....................................  Ct procedure.
76498.....................................  Mri procedure.
76506.....................................  Echo exam of head.
76510.....................................  Ophth us, b & quant a.
76511.....................................  Ophth us, quant a only.
76512.....................................  Ophth us, b w/non-quant a.
76513.....................................  Echo exam of eye, water
                                             bath.
76514.....................................  Echo exam of eye, thickness.
76516.....................................  Echo exam of eye.
76519.....................................  Echo exam of eye.
76529.....................................  Echo exam of eye.
76536.....................................  Us exam of head and neck.
76604.....................................  Us exam, chest, b-scan.
76645.....................................  Us exam, breast(s).
76700.....................................  Us exam, abdom, complete.
76705.....................................  Echo exam of abdomen.
76770.....................................  Us exam abdo back wall,
                                             comp.
76775.....................................  Us exam abdo back wall, lim.
76778.....................................  Us exam kidney transplant.
76800.....................................  Us exam, spinal canal.
76801.....................................  Ob us < 14 wks, single
                                             fetus.
76802.....................................  Ob us < 14 wks, addl fetus.
76805.....................................  Ob us > 14 wks, sngl fetus.
76810.....................................  Ob us > 14 wks, addl fetus.
76811.....................................  Ob us, detailed, sngl fetus.
76812.....................................  Ob us, detailed, addl fetus.
76815.....................................  Ob us, limited, fetus(s).
76816.....................................  Ob us, follow-up, per fetus.
76817.....................................  Transvaginal us, obstetric.
76818.....................................  Fetal biophys profile w/nst.
76819.....................................  Fetal biophys profil w/o
                                             nst.
76820.....................................  Umbilical artery echo.
76821.....................................  Middle cerebral artery echo.
76825.....................................  Echo exam of fetal heart.
76826.....................................  Echo exam of fetal heart.
76827.....................................  Echo exam of fetal heart.
76828.....................................  Echo exam of fetal heart.
76830.....................................  Transvaginal us, non-ob.
76831.....................................  Echo exam, uterus.
76856.....................................  Us exam, pelvic, complete.
76857.....................................  Us exam, pelvic, limited.
76870.....................................  Us exam, scrotum.
76872.....................................  Us, transrectal.
76873.....................................  Echograp trans r, pros
                                             study.
76880.....................................  Us exam, extremity.
76885.....................................  Us exam infant hips,
                                             dynamic.
76886.....................................  Us exam infant hips, static.
76930.....................................  Echo guide, cardiocentesis.
76932.....................................  Echo guide for heart biopsy.
76936.....................................  Echo guide for artery
                                             repair.
76937.....................................  Us guide, vascular access.
76940.....................................  Us guide, tissue ablation.
76941.....................................  Echo guide for transfusion.
76942.....................................  Echo guide for biopsy.
76945.....................................  Echo guide, villus sampling.
76946.....................................  Echo guide for
                                             amniocentesis.
76948.....................................  Echo guide, ova aspiration.
76950.....................................  Echo guidance radiotherapy.
76965.....................................  Echo guidance radiotherapy.
76970.....................................  Ultrasound exam follow-up.
76975.....................................  GI endoscopic ultrasound.
76977.....................................  Us bone density measure.
76998.....................................  Ultrasound guide intraoper.
77001.....................................  Fluoroguide for vein device.
77002.....................................  Needle localization by x-
                                             ray.
77003.....................................  Fluoroguide for spine
                                             inject.
77011.....................................  Ct scan for localization.
77012.....................................  Ct scan for needle biopsy.
77013.....................................  Ct guide for tissue
                                             ablation.
77014.....................................  Ct scan for therapy guide.
77021.....................................  Mr guidance for needle
                                             place.
77022.....................................  Mri for tissue ablation.
77031.....................................  Stereotactic breast biopsy.
77032.....................................  X-ray of needle wire,
                                             breast.
77053.....................................  X-ray of mammary duct.
77054.....................................  X-ray of mammary ducts.
77058.....................................  Magnetic image, breast.
77059.....................................  Magnetic image, both
                                             breasts.
77071.....................................  X-ray stress view.
77072.....................................  X-rays for bone age.
77073.....................................  X-rays, bone evaluation.
77074.....................................  X-rays, bone survey.
77075.....................................  X-rays, bone survey.
77076.....................................  X-rays, bone evaluation.
77077.....................................  Joint survey, single view.
77078.....................................  Ct bone density, axial.
77079.....................................  Ct bone density, peripheral.
77080.....................................  Dxa bone density, axial.
77081.....................................  Dxa bone density/peripheral.
77082.....................................  Dxa bone density/v-fracture.
77083.....................................  Radiographic absorptiometry.
77084.....................................  Magnetic image, bone marrow.
77417.....................................  Radiology port film(s).
77421.....................................  Stereoscopic x-ray guidance.
78006.....................................  Thyroid imaging with uptake.
78007.....................................  Thyroid image, mult uptakes.
78010.....................................  Thyroid imaging.
78011.....................................  Thyroid imaging with flow.
78015.....................................  Thyroid met imaging.
78016.....................................  Thyroid met imaging/studies.
78018.....................................  Thyroid met imaging, body.
78020.....................................  Thyroid met uptake.
78070.....................................  Parathyroid nuclear imaging.
78075.....................................  Adrenal nuclear imaging.
78102.....................................  Bone marrow imaging, ltd.
78103.....................................  Bone marrow imaging, mult.
78104.....................................  Bone marrow imaging, body.
78135.....................................  Red cell survival kinetics.
78140.....................................  Red cell sequestration.
78185.....................................  Spleen imaging.
78190.....................................  Platelet survival, kinetics.
78195.....................................  Lymph system imaging.
78201.....................................  Liver imaging.
78202.....................................  Liver imaging with flow.
78205.....................................  Liver imaging (3D).
78206.....................................  Liver image (3d) with flow.
78215.....................................  Liver and spleen imaging.
78216.....................................  Liver & spleen image/flow.
78220.....................................  Liver function study.
78223.....................................  Hepatobiliary imaging.
78230.....................................  Salivary gland imaging.
78231.....................................  Serial salivary imaging.
78232.....................................  Salivary gland function
                                             exam.
78258.....................................  Esophageal motility study.
78261.....................................  Gastric mucosa imaging.
78262.....................................  Gastroesophageal reflux
                                             exam.
78264.....................................  Gastric emptying study.
78278.....................................  Acute GI blood loss imaging.
78282.....................................  GI protein loss exam.
78290.....................................  Meckels divert exam.
78291.....................................  Leveen/shunt patency exam.
78300.....................................  Bone imaging, limited area.

[[Page 66551]]

 
78305.....................................  Bone imaging, multiple
                                             areas.
78306.....................................  Bone imaging, whole body.
78315.....................................  Bone imaging, 3 phase.
78320.....................................  Bone imaging (3D).
78350.....................................  Bone mineral, single photon.
78351.....................................  Bone mineral, dual photon.
78428.....................................  Cardiac shunt imaging.
78445.....................................  Vascular flow imaging.
78456.....................................  Acute venous thrombus image.
78457.....................................  Venous thrombosis imaging.
78458.....................................  Ven thrombosis images,
                                             bilat.
78459.....................................  Heart muscle imaging (PET).
78460.....................................  Heart muscle blood, single.
78461.....................................  Heart muscle blood,
                                             multiple.
78464.....................................  Heart image (3d), single.
78465.....................................  Heart image (3d), multiple.
78466.....................................  Heart infarct image.
78468.....................................  Heart infarct image (ef).
78469.....................................  Heart infarct image (3D).
78472.....................................  Gated heart, planar, single.
78473.....................................  Gated heart, multiple.
78478.....................................  Heart wall motion add-on.
78480.....................................  Heart function add-on.
78481.....................................  Heart first pass, single.
78483.....................................  Heart first pass, multiple.
78491.....................................  Heart image (pet), single.
78492.....................................  Heart image (pet), multiple.
78494.....................................  Heart image, spect.
78496.....................................  Heart first pass add-on.
78580.....................................  Lung perfusion imaging.
78584.....................................  Lung V/Q image single
                                             breath.
78585.....................................  Lung V/Q imaging.
78586.....................................  Aerosol lung image, single.
78587.....................................  Aerosol lung image,
                                             multiple.
78588.....................................  Perfusion lung image.
78591.....................................  Vent image, 1 breath, 1
                                             proj.
78593.....................................  Vent image, 1 proj, gas.
78594.....................................  Vent image, mult proj, gas.
78596.....................................  Lung differential function.
78600.....................................  Brain imaging, ltd static.
78601.....................................  Brain imaging, ltd w/flow.
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.
78630.....................................  Cerebrospinal fluid scan.
78635.....................................  CSF ventriculography.
78645.....................................  CSF shunt evaluation.
78647.....................................  Cerebrospinal fluid scan.
78650.....................................  CSF leakage imaging.
78660.....................................  Nuclear exam of tear flow.
78700.....................................  Kidney imaging, static.
78701.....................................  Kidney imaging with flow.
78704.....................................  Imaging renogram.
78707.....................................  Kidney flow/function image.
78708.....................................  Kidney flow/function image.
78709.....................................  Kidney flow/function image.
78710.....................................  Kidney imaging (3D).
78715.....................................  Renal vascular flow exam.
78730.....................................  Urinary bladder retention.
78740.....................................  Ureteral reflux study.
78760.....................................  Testicular imaging.
78761.....................................  Testicular imaging/flow.
78800.....................................  Tumor imaging, limited area.
78801.....................................  Tumor imaging, mult areas.
78802.....................................  Tumor imaging, whole body.
78803.....................................  Tumor imaging (3D).
78804.....................................  Tumor imaging, whole body.
78805.....................................  Abscess imaging, ltd area.
78806.....................................  Abscess imaging, whole body.
78807.....................................  Nuclear localization/
                                             abscess.
78811.....................................  Tumor imaging (pet),
                                             limited.
78812.....................................  Tumor image (pet)/skul-
                                             thigh.
78813.....................................  Tumor image (pet) full body.
78814.....................................  Tumor image pet/ct, limited.
78815.....................................  Tumorimage pet/ct skul-
                                             thigh.
78816.....................................  Tumor image pet/ct full
                                             body.
78890.....................................  Nuclear medicine data proc.
78891.....................................  Nuclear med data proc.
92135.....................................  Scanning computer
                                             ophthalmic.
92235.....................................  Fluorscein angioscopy.
92240.....................................  IDC green angiography.
92250.....................................  Fundus photography.
92285.....................................  External ocular photography.
92286.....................................  Anterior segment
                                             photography.
93303.....................................  Echo transthoracic.
93304.....................................  Echo transthoracic.
93307.....................................  Echo exam of heart.
93308.....................................  Echo exam of heart.
93312.....................................  Echo transesophageal.
93313.....................................  Echo transesophageal.
93314.....................................  Echo transesophageal.
93315.....................................  Echo transesophageal.
93316.....................................  Echo transesophageal.
93317.....................................  Echo transesophageal.
93318.....................................  Echo transesophageal
                                             intraop.
93320.....................................  Doppler echo exam, heart.
93321.....................................  Doppler echo exam, heart.
93325.....................................  Doppler color flow add-on.
93350.....................................  Echo transthoracic.
93555.....................................  Imaging, cardiac cath.
93556.....................................  Imaging, cardiac cath.
93571.....................................  Heart flow reserve measure.
93572.....................................  Heart flow reserve measure.
93880.....................................  Extracranial study.
93882.....................................  Extracranial study.
93886.....................................  Intracranial study.
93888.....................................  Intracranial study.
93890.....................................  Tcd, vasoreactivity study.
93892.....................................  Tcd, emboli detect w/o inj.
93893.....................................  Tcd, emboli detect w/inj.
93925.....................................  Lower extremity study.
93926.....................................  Lower extremity study.
93930.....................................  Upper extremity study.
93931.....................................  Upper extremity study.
93970.....................................  Extremity study.
93971.....................................  Extremity study.
93975.....................................  Vascular study.
93976.....................................  Vascular study.
93978.....................................  Vascular study.
93979.....................................  Vascular study.
93980.....................................  Penile vascular study.
93981.....................................  Penile vascular study.
93990.....................................  Doppler flow testing.
0028T.....................................  Dexa body composition study.
0042T.....................................  Ct perfusion w/contrast,
                                             cbf.
0066T.....................................  Ct colonography; screen.
0067T.....................................  Ct colonography; dx.
0080T.....................................  Endovasc aort repr rad s&i.
0081T.....................................  Endovasc visc extnsn s&i.
0144T.....................................  CT heart wo dye; qual calc.
0145T.....................................  CT heart w/wo dye funct.
0146T.....................................  CCTA w/wo dye.
0147T.....................................  CCTA w/wo, quan calcium.
0148T.....................................  CCTA w/wo, strxr.
0149T.....................................  CCTA w/wo, strxr quan calc.
0150T.....................................  CCTA w/wo, disease strxr.
0151T.....................................  CT heart funct add-on.
0152T.....................................  Computer chest add-on.
G0120.....................................  Colon ca scrn; barium enema.
G0122.....................................  Colon ca scrn; barium enema.
G0130.....................................  Single energy x-ray study.
G0219.....................................  PET img wholbod melano
                                             nonco.
G0235.....................................  PET not otherwise specified.
G0275.....................................  Renal angio, cardiac cath.
G0278.....................................  Iliac art angio, cardiac
                                             cath.
G0288.....................................  Recon, CTA for surg plan.
G0365.....................................  Vessel mapping hemo access.
------------------------------------------------------------------------
* CPT codes are descriptors only are copyright 2007 American Medical
  Association.
All rights reserved.
Applicable FARS/DFARS apply.


[[Page 66552]]


Addendum G.--CY 2008 ESRD Wage Index for Urban Areas Based on CBSA Labor
                              Market Areas
------------------------------------------------------------------------
                                                                   Wage
    CBSA code            Urban area (constituent counties)        index
------------------------------------------------------------------------
10180............  Abilene, TX.................................   0.8398
                    Callahan County, TX........................
                    Jones County, TX...........................
                    Taylor County, TX..........................
10380............  Aguadilla-Isabela-San Sebasti[aacute]n, PR..   0.7916
                    Aguada Municipio, PR.......................
                    Aguadilla Municipio, PR....................
                    A[ntilde]asco Municipio, PR................
                    Isabela Municipio, PR......................
                    Lares Municipio, PR........................
                    Moca Municipio, PR.........................
                    Rinc[oacute]n Municipio, PR................
                    San Sebasti[aacute]n Municipio, PR.........
10420............  Akron, OH...................................   0.9282
                    Portage County, OH.........................
                    Summit County, OH..........................
10500............  Albany, GA..................................   0.8986
                    Baker County, GA...........................
                    Dougherty County, GA.......................
                    Lee County, GA.............................
                    Terrell County, GA.........................
                    Worth County, GA...........................
10580............  Albany-Schenectady-Troy, NY.................   0.9064
                    Albany County, NY..........................
                    Rensselaer County, NY......................
                    Saratoga County, NY........................
                    Schenectady County, NY.....................
                    Schoharie County, NY.......................
10740............  Albuquerque, NM.............................   1.0084
                    Bernalillo County, NM......................
                    Sandoval County, NM........................
                    Torrance County, NM........................
                    Valencia County, NM........................
10780............  Alexandria, LA..............................   0.8422
                    Grant Parish, LA...........................
                    Rapides Parish, LA.........................
10900............  Allentown-Bethlehem-Easton, PA-NJ...........   1.0412
                    Warren County, NJ..........................
                    Carbon County, PA..........................
                    Lehigh County, PA..........................
                    Northampton County, PA.....................
11020............  Altoona, PA.................................   0.9096
                    Blair County, PA...........................
11100............  Amarillo, TX................................   0.9622
                    Armstrong County, TX.......................
                    Carson County, TX..........................
                    Potter County, TX..........................
                    Randall County, TX.........................
11180............  Ames, IA....................................   1.0603
                    Story County, IA...........................
11260............  Anchorage, AK...............................   1.2574
                    Anchorage Municipality, AK.................
                    Matanuska-Susitna Borough, AK..............
11300............  Anderson, IN................................   0.9317
                    Madison County, IN.........................
11340............  Anderson, SC................................   0.9590
                    Anderson County, SC........................
11460............  Ann Arbor, MI...............................   1.1124
                    Washtenaw County, MI.......................
11500............  Anniston-Oxford, AL.........................   0.8366
                    Calhoun County, AL.........................
11540............  Appleton, WI................................   1.0130
                    Calumet County, WI.........................
                    Outagamie County, WI.......................
11700............  Asheville, NC...............................   0.9695
                    Buncombe County, NC........................
                    Haywood County, NC.........................
                    Henderson County, NC.......................
                    Madison County, NC.........................
12020............  Athens-Clarke County, GA....................   1.1100
                    Clarke County, GA..........................

[[Page 66553]]

 
                    Madison County, GA.........................
                    Oconee County, GA..........................
                    Oglethorpe County, GA......................
12060............  Atlanta-Sandy Springs-Marietta, GA..........   1.0373
                    Barrow County, GA..........................
                    Bartow County, GA..........................
                    Butts County, GA...........................
                    Carroll County, GA.........................
                    Cherokee County, GA........................
                    Clayton County, GA.........................
                    Cobb County, GA............................
                    Coweta County, GA..........................
                    Dawson County, GA..........................
                    DeKalb County, GA..........................
                    Douglas County, GA.........................
                    Fayette County, GA.........................
                    Forsyth County, GA.........................
                    Fulton County, GA..........................
                    Gwinnett County, GA........................
                    Haralson County, GA........................
                    Heard County, GA...........................
                    Henry County, GA...........................
                    Jasper County, GA..........................
                    Lamar County, GA...........................
                    Meriwether County, GA......................
                    Newton County, GA..........................
                    Paulding County, GA........................
                    Pickens County, GA.........................
                    Pike County, GA............................
                    Rockdale County, GA........................
                    Spalding County, GA........................
                    Walton County, GA..........................
12100............  Atlantic City, NJ...........................   1.2875
                    Atlantic County, NJ........................
12220............  Auburn-Opelika, AL..........................   0.8539
                    Lee County, AL.............................
12260............  Augusta-Richmond County, GA-SC..............   1.0180
                    Burke County, GA...........................
                    Columbia County, GA........................
                    McDuffie County, GA........................
                    Richmond County, GA........................
                    Aiken County, SC...........................
                    Edgefield County, SC.......................
12420............  Austin-Round Rock, TX.......................   1.0073
                    Bastrop County, TX.........................
                    Caldwell County, TX........................
                    Hays County, TX............................
                    Travis County, TX..........................
                    Williamson County, TX......................
12540............  Bakersfield, CA.............................   1.1664
                    Kern County, CA............................
12580............  Baltimore-Towson, MD........................   1.0696
                    Anne Arundel County, MD....................
                    Baltimore County, MD.......................
                    Carroll County, MD.........................
                    Harford County, MD.........................
                    Howard County, MD..........................
                    Queen Anne's County, MD....................
                    Baltimore City, MD.........................
12620............  Bangor, ME..................................   1.0532
                    Penobscot County, ME.......................
12700............  Barnstable Town, MA.........................   1.3302
                    Barnstable County, MA......................
12940............  Baton Rouge, LA.............................   0.8480
                    Ascension Parish, LA.......................
                    East Baton Rouge Parish, LA................
                    East Feliciana Parish, LA..................
                    Iberville Parish, LA.......................
                    Livingston Parish, LA......................
                    Pointe Coupee Parish, LA...................
                    St. Helena Parish, LA......................

[[Page 66554]]

 
                    West Baton Rouge Parish, LA................
                    West Feliciana Parish, LA..................
12980............  Battle Creek, MI............................   1.0744
                    Calhoun County, MI.........................
13020............  Bay City, MI................................   0.9391
                    Bay County, MI.............................
13140............  Beaumont-Port Arthur, TX....................   0.9004
                    Hardin County, TX..........................
                    Jefferson County, TX.......................
                    Orange County, TX..........................
13380............  Bellingham, WA..............................   1.2110
                    Whatcom County, WA.........................
13460............  Bend, OR....................................   1.1549
                    Deschutes County, OR.......................
13644............  Bethesda-Frederick-Gaithersburg, MD.........   1.1094
                    Frederick County, MD.......................
                    Montgomery County, MD......................
13740............  Billings, MT................................   0.9147
                    Carbon County, MT..........................
                    Yellowstone County, MT.....................
13780............  Binghamton, NY..............................   0.9445
                    Broome County, NY..........................
                    Tioga County, NY...........................
13820............  Birmingham-Hoover, AL.......................   0.9392
                    Bibb County, AL............................
                    Blount County, AL..........................
                    Chilton County, AL.........................
                    Jefferson County, AL.......................
                    St. Clair County, AL.......................
                    Shelby County, AL..........................
                    Walker County, AL..........................
13900............  Bismarck, ND................................   0.7916
                    Burleigh County, ND........................
                    Morton County, ND..........................
13980............  Blacksburg-Christiansburg-Radford, VA.......   0.8646
                    Giles County, VA...........................
                    Montgomery County, VA......................
                    Pulaski County, VA.........................
                    Radford City, VA...........................
14020............  Bloomington, IN.............................   0.9410
                    Greene County, IN..........................
                    Monroe County, IN..........................
                    Owen County, IN............................
14060............  Bloomington-Normal, IL......................   0.9842
                    McLean County, IL..........................
14260............  Boise City-Nampa, ID........................   0.9990
                    Ada County, ID.............................
                    Boise County, ID...........................
                    Canyon County, ID..........................
                    Gem County, ID.............................
                    Owyhee County, ID..........................
14484............  Boston-Quincy, MA...........................   1.2285
                    Norfolk County, MA.........................
                    Plymouth County, MA........................
                    Suffolk County, MA.........................
14500............  Boulder, CO.................................   1.1004
                    Boulder County, CO.........................
14540............  Bowling Green, KY...........................   0.8612
                    Edmonson County, KY........................
                    Warren County, KY..........................
14740............  Bremerton-Silverdale, WA....................   1.1509
                    Kitsap County, WA..........................
14860............  Bridgeport-Stamford-Norwalk, CT.............   1.3441
                    Fairfield County, CT.......................
15180............  Brownsville-Harlingen, TX...................   0.9408
                    Cameron County, TX.........................
15260............  Brunswick, GA...............................   1.0001
                    Brantley County, GA........................
                    Glynn County, GA...........................
                    McIntosh County, GA........................
15380............  Buffalo-Niagara Falls, NY...................   1.0099

[[Page 66555]]

 
                    Erie County, NY............................
                    Niagara County, NY.........................
15500............  Burlington, NC..............................   0.9232
                    Alamance County, NC........................
15540............  Burlington-South Burlington, VT.............   1.0196
                    Chittenden County, VT......................
                    Franklin County, VT........................
                    Grand Isle County, VT......................
15764............  Cambridge-Newton-Framingham, MA.............   1.1837
                    Middlesex County, MA.......................
15804............  Camden, NJ..................................   1.0989
                    Burlington County, NJ......................
                    Camden County, NJ..........................
                    Gloucester County, NJ......................
15940............  Canton-Massillon, OH........................   0.9431
                    Carroll County, OH.........................
                    Stark County, OH...........................
15980............  Cape Coral-Fort Myers, FL...................   0.9917
                    Lee County, FL.............................
16180............  Carson City, NV.............................   1.0558
                    Carson City, NV............................
16220............  Casper, WY..................................   0.9906
                    Natrona County, WY.........................
16300............  Cedar Rapids, IA............................   0.9343
                    Benton County, IA..........................
                    Jones County, IA...........................
                    Linn County, IA............................
16580............  Champaign-Urbana, IL........................   0.9913
                    Champaign County, IL.......................
                    Ford County, IL............................
                    Piatt County, IL...........................
16620............  Charleston, WV..............................   0.8749
                    Boone County, WV...........................
                    Clay County, WV............................
                    Kanawha County, WV.........................
                    Lincoln County, WV.........................
                    Putnam County, WV..........................
16700............  Charleston-North Charleston, SC.............   0.9630
                    Berkeley County, SC........................
                    Charleston County, SC......................
                    Dorchester County, SC......................
16740............  Charlotte-Gastonia-Concord, NC SC...........   1.0048
                    Anson County, NC...........................
                    Cabarrus County, NC........................
                    Gaston County, NC..........................
                    Mecklenburg County, NC.....................
                    Union County, NC...........................
                    York County, SC............................
16820............  Charlottesville, VA.........................   0.9792
                    Albemarle County, VA.......................
                    Fluvanna County, VA........................
                    Greene County, VA..........................
                    Nelson County, VA..........................
                    Charlottesville City, VA...................
16860............  Chattanooga, TN-GA..........................   0.9493
                    Catoosa County, GA.........................
                    Dade County, GA............................
                    Walker County, GA..........................
                    Hamilton County, TN........................
                    Marion County, TN..........................
                    Sequatchie County, TN......................
16940............  Cheyenne, WY................................   0.9824
                    Laramie County, WY.........................
16974............  Chicago-Naperville-Joliet, IL...............   1.1331
                    Cook County, IL............................
                    DeKalb County, IL..........................
                    DuPage County, IL..........................
                    Grundy County, IL..........................
                    Kane County, IL............................
                    Kendall County, IL.........................
                    McHenry County, IL.........................

[[Page 66556]]

 
                    Will County, IL............................
17020............  Chico, CA...................................   1.1916
                    Butte County, CA...........................
17140............  Cincinnati-Middletown, OH-KY-IN.............   1.0327
                    Dearborn County, IN........................
                    Franklin County, IN........................
                    Ohio County, IN............................
                    Boone County, KY...........................
                    Bracken County, KY.........................
                    Campbell County, KY........................
                    Gallatin County, KY........................
                    Grant County, KY...........................
                    Kenton County, KY..........................
                    Pendleton County, KY.......................
                    Brown County, OH...........................
                    Butler County, OH..........................
                    Clermont County, OH........................
                    Hamilton County, OH........................
                    Warren County, OH..........................
17300............  Clarksville, TN-KY..........................   0.8709
                    Christian County, KY.......................
                    Trigg County, KY...........................
                    Montgomery County, TN......................
                    Stewart County, TN.........................
17420............  Cleveland, TN...............................   0.8499
                    Bradley County, TN.........................
                    Polk County, TN............................
17460............  Cleveland-Elyria-Mentor, OH.................   0.9857
                    Cuyahoga County, OH........................
                    Geauga County, OH..........................
                    Lake County, OH............................
                    Lorain County, OH..........................
                    Medina County, OH..........................
17660............  Coeur d'Alene, ID...........................   1.0061
                    Kootenai County, ID........................
17780............  College Station-Bryan, TX...................   0.9877
                    Brazos County, TX..........................
                    Burleson County, TX........................
                    Robertson County, TX.......................
17820............  Colorado Springs, CO........................   1.0258
                    El Paso County, CO.........................
                    Teller County, CO..........................
17860............  Columbia, MO................................   0.9138
                    Boone County, MO...........................
                    Howard County, MO..........................
17900............  Columbia, SC................................   0.9288
                    Calhoun County, SC.........................
                    Fairfield County, SC.......................
                    Kershaw County, SC.........................
                    Lexington County, SC.......................
                    Richland County, SC........................
                    Saluda County, SC..........................
17980............  Columbus, GA-AL.............................   0.9213
                    Russell County, AL.........................
                    Chattahoochee County, GA...................
                    Harris County, GA..........................
                    Marion County, GA..........................
                    Muscogee County, GA........................
18020............  Columbus, IN................................   1.0066
                    Bartholomew County, IN.....................
18140............  Columbus, OH................................   1.0644
                    Delaware County, OH........................
                    Fairfield County, OH.......................
                    Franklin County, OH........................
                    Licking County, OH.........................
                    Madison County, OH.........................
                    Morrow County, OH..........................
                    Pickaway County, OH........................
                    Union County, OH...........................
18580............  Corpus Christi, TX..........................   0.9064
                    Aransas County, TX.........................

[[Page 66557]]

 
                    Nueces County, TX..........................
                    San Patricio County, TX....................
18700............  Corvallis, OR...............................   1.1567
                    Benton County, OR..........................
19060............  Cumberland, MD-WV...........................   0.8754
                    Allegany County, MD........................
                    Mineral County, WV.........................
19124............  Dallas-Plano-Irving, TX.....................   1.0465
                    Collin County, TX..........................
                    Dallas County, TX..........................
                    Delta County, TX...........................
                    Denton County, TX..........................
                    Ellis County, TX...........................
                    Hunt County, TX............................
                    Kaufman County, TX.........................
                    Rockwall County, TX........................
19140............  Dalton, GA..................................   0.9246
                    Murray County, GA..........................
                    Whitfield County, GA.......................
19180............  Danville, IL................................   0.9454
                    Vermilion County, IL.......................
19260............  Danville, VA................................   0.8697
                    Pittsylvania County, VA....................
                    Danville City, VA..........................
19340............  Davenport-Moline-Rock Island, IA-IL.........   0.9320
                    Henry County, IL...........................
                    Mercer County, IL..........................
                    Rock Island County, IL.....................
                    Scott County, IA...........................
19380............  Dayton, OH..................................   0.9700
                    Greene County, OH..........................
                    Miami County, OH...........................
                    Montgomery County, OH......................
                    Preble County, OH..........................
19460............  Decatur, AL.................................   0.8322
                    Lawrence County, AL........................
                    Morgan County, AL..........................
19500............  Decatur, IL.................................   0.8522
                    Macon County, IL...........................
19660............  Deltona-Daytona Beach-Ormond Beach, FL......   0.9532
                    Volusia County, FL.........................
19740............  Denver-Aurora, CO...........................   1.1313
                    Adams County, CO...........................
                    Arapahoe County, CO........................
                    Broomfield County, CO......................
                    Clear Creek County, CO.....................
                    Denver County, CO..........................
                    Douglas County, CO.........................
                    Elbert County, CO..........................
                    Gilpin County, CO..........................
                    Jefferson County, CO.......................
                    Park County, CO............................
19780............  Des Moines-West Des Moines, IA..............   0.9738
                    Dallas County, IA..........................
                    Guthrie County, IA.........................
                    Madison County, IA.........................
                    Polk County, IA............................
                    Warren County, IA..........................
19804............  Detroit-Livonia-Dearborn, MI................   1.0554
                    Wayne County, MI...........................
20020............  Dothan, AL..................................   0.7916
                    Geneva County, AL..........................
                    Henry County, AL...........................
                    Houston County, AL.........................
20100............  Dover, DE...................................   1.0659
                    Kent County, DE............................
20220............  Dubuque, IA.................................   0.9560
                    Dubuque County, IA.........................
20260............  Duluth, MN-WI...............................   1.0528
                    Carlton County, MN.........................
                    St. Louis County, MN.......................

[[Page 66558]]

 
                    Douglas County, WI.........................
20500............  Durham, NC..................................   1.0361
                    Chatham County, NC.........................
                    Durham County, NC..........................
                    Orange County, NC..........................
                    Person County, NC..........................
20740............  Eau Claire, WI..............................   1.0001
                    Chippewa County, WI........................
                    Eau Claire County, WI......................
20764............  Edison, NJ..................................   1.1801
                    Middlesex County, NJ.......................
                    Monmouth County, NJ........................
                    Ocean County, NJ...........................
                    Somerset County, NJ........................
20940............  El Centro, CA...............................   0.9408
                    Imperial County, CA........................
21060............  Elizabethtown, KY...........................   0.9194
                    Hardin County, KY..........................
                    Larue County, KY...........................
21140............  Elkhart-Goshen, IN..........................   1.0144
                    Elkhart County, IN.........................
21300............  Elmira, NY..................................   0.8722
                    Chemung County, NY.........................
21340............  El Paso, TX.................................   0.9488
                    El Paso County, TX.........................
21500............  Erie, PA....................................   0.8966
                    Erie County, PA............................
21660............  Eugene-Springfield, OR......................   1.1538
                    Lane County, OR............................
21780............  Evansville, IN-KY...........................   0.9143
                    Gibson County, IN..........................
                    Posey County, IN...........................
                    Vanderburgh County, IN.....................
                    Warrick County, IN.........................
                    Henderson County, KY.......................
                    Webster County, KY.........................
21820............  Fairbanks, AK...............................   1.1663
                    Fairbanks North Star Borough, AK...........
21940............  Fajardo, PR.................................   0.7916
                    Ceiba Municipio, PR........................
                    Fajardo Municipio, PR......................
                    Luquillo Municipio, PR.....................
22020............  Fargo, ND-MN................................   0.8488
                    Cass County, ND............................
                    Clay County, MN............................
22140............  Farmington, NM..............................   1.0119
                    San Juan County, NM........................
22180............  Fayetteville, NC............................   0.9888
                    Cumberland County, NC......................
                    Hoke County, NC............................
22220............  Fayetteville-Springdale-Rogers, AR-MO.......   0.9227
                    Benton County, AR..........................
                    Madison County, AR.........................
                    Washington County, AR......................
                    McDonald County, MO........................
22380............  Flagstaff, AZ...............................   1.2335
                    Coconino County, AZ........................
22420............  Flint, MI...................................   1.1842
                    Genesee County, MI.........................
22500............  Florence, SC................................   0.8707
                    Darlington County, SC......................
                    Florence County, SC........................
22520............  Florence-Muscle Shoals, AL..................   0.8106
                    Colbert County, AL.........................
                    Lauderdale County, AL......................
22540............  Fond du Lac, WI.............................   1.0203
                    Fond du Lac County, WI.....................
22660............  Fort Collins-Loveland, CO...................   1.0446
                    Larimer County, CO.........................
22744............  Fort Lauderdale-Pompano Beach-Deerfield        1.0796
                    Beach, FL.
                    Broward County, FL.........................

[[Page 66559]]

 
22900............  Fort Smith, AR-OK...........................   0.8373
                    Crawford County, AR........................
                    Franklin County, AR........................
                    Sebastian County, AR.......................
                    Le Flore County, OK........................
                    Sequoyah County, OK........................
23020............  Fort Walton Beach-Crestview-Destin, FL......   0.9228
                    Okaloosa County, FL........................
23060............  Fort Wayne, IN..............................   0.9799
                    Allen County, IN...........................
                    Wells County, IN...........................
                    Whitley County, IN.........................
23104............  Fort Worth-Arlington, TX....................   1.0231
                    Johnson County, TX.........................
                    Parker County, TX..........................
                    Tarrant County, TX.........................
                    Wise County, TX............................
23420............  Fresno, CA..................................   1.1603
                    Fresno County, CA..........................
23460............  Gadsden, AL.................................   0.8612
                    Etowah County, AL..........................
23540............  Gainesville, FL.............................   0.9706
                    Alachua County, FL.........................
                    Gilchrist County, FL.......................
23580............  Gainesville, GA.............................   0.9727
                    Hall County, GA............................
23844............  Gary, IN....................................   0.9736
                    Jasper County, IN..........................
                    Lake County, IN............................
                    Newton County, IN..........................
                    Porter County, IN..........................
24020............  Glens Falls, NY.............................   0.8714
                    Warren County, NY..........................
                    Washington County, NY......................
24140............  Goldsboro, NC...............................   0.9803
                    Wayne County, NC...........................
24220............  Grand Forks, ND-MN..........................   0.8318
                    Polk County, MN............................
                    Grand Forks County, ND.....................
24300............  Grand Junction, CO..........................   1.0411
                    Mesa County, CO............................
24340............  Grand Rapids-Wyoming, MI....................   0.9832
                    Barry County, MI...........................
                    Ionia County, MI...........................
                    Kent County, MI............................
                    Newaygo County, MI.........................
24500............  Great Falls, MT.............................   0.9156
                    Cascade County, MT.........................
24540............  Greeley, CO.................................   1.0194
                    Weld County, CO............................
24580............  Green Bay, WI...............................   1.0267
                    Brown County, WI...........................
                    Kewaunee County, WI........................
                    Oconto County, WI..........................
24660............  Greensboro-High Point, NC...................   0.9510
                    Guilford County, NC........................
                    Randolph County, NC........................
                    Rockingham County, NC......................
24780............  Greenville, NC..............................   0.9924
                    Greene County, NC..........................
                    Pitt County, NC............................
24860............  Greenville-Maudlin-Easley, SC...............   1.0407
                    Greenville County, SC......................
                    Laurens County, SC.........................
                    Pickens County, SC.........................
25020............  Guayama, PR.................................   0.7916
                    Arroyo Municipio, PR.......................
                    Guayama Municipio, PR......................
                    Patillas Municipio, PR.....................
25060............  Gulfport-Biloxi, MS.........................   0.9260
                    Hancock County, MS.........................

[[Page 66560]]

 
                    Harrison County, MS........................
                    Stone County, MS...........................
25180............  Hagerstown-Martinsburg, MD-WV...............   0.9513
                    Washington County, MD......................
                    Berkeley County, WV........................
                    Morgan County, WV..........................
25260............  Hanford-Corcoran, CA........................   1.1081
                    Kings County, CA...........................
25420............  Harrisburg-Carlisle, PA.....................   0.9795
                    Cumberland County, PA......................
                    Dauphin County, PA.........................
                    Perry County, PA...........................
25500............  Harrisonburg, VA............................   0.9359
                    Rockingham County, VA......................
                    Harrisonburg City, VA......................
25540............  Hartford-West Hartford-East Hartford, CT....   1.1536
                    Hartford County, CT........................
                    Litchfield County, CT......................
                    Middlesex County, CT.......................
                    Tolland County, CT.........................
25620............  Hattiesburg, MS.............................   0.7916
                    Forrest County, MS.........................
                    Lamar County, MS...........................
                    Perry County, MS...........................
25860............  Hickory-Lenoir-Morganton, NC................   0.9529
                    Alexander County, NC.......................
                    Burke County, NC...........................
                    Caldwell County, NC........................
                    Catawba County, NC.........................
25980............  Hinesville-Fort Stewart, GA \3\.............   0.9697
                    Liberty County, GA.........................
                    Long County, GA............................
26100............  Holland-Grand Haven, MI.....................   0.9506
                    Ottawa County, MI..........................
26180............  Honolulu, HI................................   1.2197
                    Honolulu County, HI........................
26300............  Hot Springs, AR.............................   0.9614
                    Garland County, AR.........................
26380............  Houma-Bayou Cane-Thibodaux, LA..............   0.8330
                    Lafourche Parish, LA.......................
                    Terrebonne Parish, LA......................
26420............  Houston-Sugar Land-Baytown, TX..............   1.0490
                    Austin County, TX..........................
                    Brazoria County, TX........................
                    Chambers County, TX........................
                    Fort Bend County, TX.......................
                    Galveston County, TX.......................
                    Harris County, TX..........................
                    Liberty County, TX.........................
                    Montgomery County, TX......................
                    San Jacinto County, TX.....................
                    Waller County, TX..........................
26580............  Huntington-Ashland, WV-KY-OH................   0.9543
                    Boyd County, KY............................
                    Greenup County, KY.........................
                    Lawrence County, OH........................
                    Cabell County, WV..........................
                    Wayne County, WV...........................
26620............  Huntsville, AL..............................   0.9653
                    Limestone County, AL.......................
                    Madison County, AL.........................
26820............  Idaho Falls, ID.............................   0.9778
                    Bonneville County, ID......................
                    Jefferson County, ID.......................
26900............  Indianapolis-Carmel, IN.....................   1.0390
                    Boone County, IN...........................
                    Brown County, IN...........................
                    Hamilton County, IN........................
                    Hancock County, IN.........................
                    Hendricks County, IN.......................
                    Johnson County, IN.........................

[[Page 66561]]

 
                    Marion County, IN..........................
                    Morgan County, IN..........................
                    Putnam County, IN..........................
                    Shelby County, IN..........................
26980............  Iowa City, IA...............................   1.0099
                    Johnson County, IA.........................
                    Washington County, IA......................
27060............  Ithaca, NY..................................   1.0164
                    Tompkins County, NY........................
27100............  Jackson, MI.................................   0.9847
                    Jackson County, MI.........................
27140............  Jackson, MS.................................   0.8455
                    Copiah County, MS..........................
                    Hinds County, MS...........................
                    Madison County, MS.........................
                    Rankin County, MS..........................
                    Simpson County, MS.........................
27180............  Jackson, TN.................................   0.9157
                    Chester County, TN.........................
                    Madison County, TN.........................
27260............  Jacksonville, FL............................   0.9521
                    Baker County, FL...........................
                    Clay County, FL............................
                    Duval County, FL...........................
                    Nassau County, FL..........................
                    St. Johns County, FL.......................
27340............  Jacksonville, NC............................   0.8527
                    Onslow County, NC..........................
27500............  Janesville, WI..............................   1.0240
                    Rock County, WI............................
27620............  Jefferson City, MO..........................   0.8948
                    Callaway County, MO........................
                    Cole County, MO............................
                    Moniteau County, MO........................
                    Osage County, MO...........................
27740............  Johnson City, TN............................   0.8103
                    Carter County, TN..........................
                    Unicoi County, TN..........................
                    Washington County, TN......................
27780............  Johnstown, PA...............................   0.7961
                    Cambria County, PA.........................
27860............  Jonesboro, AR...............................   0.8222
                    Craighead County, AR.......................
                    Poinsett County, AR........................
27900............  Joplin, MO..................................   0.9448
                    Jasper County, MO..........................
                    Newton County, MO..........................
28020............  Kalamazoo-Portage, MI.......................   1.1012
                    Kalamazoo County, MI.......................
                    Van Buren County, MI.......................
28100............  Kankakee-Bradley, IL........................   1.0806
                    Kankakee County, IL........................
28140............  Kansas City, MO-KS..........................   1.0031
                    Franklin County, KS........................
                    Johnson County, KS.........................
                    Leavenworth County, KS.....................
                    Linn County, KS............................
                    Miami County, KS...........................
                    Wyandotte County, KS.......................
                    Bates County, MO...........................
                    Caldwell County, MO........................
                    Cass County, MO............................
                    Clay County, MO............................
                    Clinton County, MO.........................
                    Jackson County, MO.........................
                    Lafayette County, MO.......................
                    Platte County, MO..........................
                    Ray County, MO.............................
28420............  Kennewick-Richland-Pasco, WA................   1.0634
                    Benton County, WA..........................
                    Franklin County, WA........................

[[Page 66562]]

 
28660............  Killeen-Temple-Fort Hood, TX................   0.8707
                    Bell County, TX............................
                    Coryell County, TX.........................
                    Lampasas County, TX........................
28700............  Kingsport-Bristol-Bristol, TN-VA............   0.8083
                    Hawkins County, TN.........................
                    Sullivan County, TN........................
                    Bristol City, VA...........................
                    Scott County, VA...........................
                    Washington County, VA......................
28740............  Kingston, NY................................   1.0086
                    Ulster County, NY..........................
28940............  Knoxville, TN...............................   0.8482
                    Anderson County, TN........................
                    Blount County, TN..........................
                    Knox County, TN............................
                    Loudon County, TN..........................
                    Union County, TN...........................
29020............  Kokomo, IN..................................   1.0123
                    Howard County, IN..........................
                    Tipton County, IN..........................
29100............  La Crosse, WI-MN............................   1.0222
                    Houston County, MN.........................
                    La Crosse County, WI.......................
29140............  Lafayette, IN...............................   0.9361
                    Benton County, IN..........................
                    Carroll County, IN.........................
                    Tippecanoe County, IN......................
29180............  Lafayette, LA...............................   0.8704
                    Lafayette Parish, LA.......................
                    St. Martin Parish, LA......................
29340............  Lake Charles, LA............................   0.8208
                    Calcasieu Parish, LA.......................
                    Cameron Parish, LA.........................
29404............  Lake County-Kenosha County, IL-WI...........   1.0887
                    Lake County, IL............................
                    Kenosha County, WI.........................
29420............  Lake Havasu City--Kingman, AZ...............   0.9851
                    Mohave, County, AZ.........................
29460............  Lakeland, FL................................   0.9141
                    Polk County, FL............................
29540............  Lancaster, PA...............................   0.9765
                    Lancaster County, PA.......................
29620............  Lansing-East Lansing, MI....................   1.0680
                    Clinton County, MI.........................
                    Eaton County, MI...........................
                    Ingham County, MI..........................
29700............  Laredo, TX..................................   0.8542
                    Webb County, TX............................
29740............  Las Cruces, NM..............................   0.9157
                    Dona Ana County, NM........................
29820............  Las Vegas-Paradise, NV......................   1.2454
                    Clark County, NV...........................
29940............  Lawrence, KS................................   0.8683
                    Douglas County, KS.........................
30020............  Lawton, OK..................................   0.8470
                    Comanche County, OK........................
30140............  Lebanon, PA.................................   0.8646
                    Lebanon County, PA.........................
30300............  Lewiston, ID-WA.............................   0.9978
                    Nez Perce County, ID.......................
                    Asotin County, WA..........................
30340............  Lewiston-Auburn, ME.........................   0.9703
                    Androscoggin County, ME....................
30460............  Lexington-Fayette, KY.......................   0.9701
                    Bourbon County, KY.........................
                    Clark County, KY...........................
                    Fayette County, KY.........................
                    Jessamine County, KY.......................
                    Scott County, KY...........................
                    Woodford County, KY........................

[[Page 66563]]

 
30620............  Lima, OH....................................   0.9947
                    Allen County, OH...........................
30700............  Lincoln, NE.................................   1.0609
                    Lancaster County, NE.......................
                    Seward County, NE..........................
30780............  Little Rock-North Little Rock-Conway, AR....   0.9355
                    Faulkner County, AR........................
                    Grant County, AR...........................
                    Lonoke County, AR..........................
                    Perry County, AR...........................
                    Pulaski County, AR.........................
                    Saline County, AR..........................
30860............  Logan, UT-ID................................   0.9692
                    Franklin County, ID........................
                    Cache County, UT...........................
30980............  Longview, TX................................   0.9201
                    Gregg County, TX...........................
                    Rusk County, TX............................
                    Upshur County, TX..........................
31020............  Longview, WA................................   1.1428
                    Cowlitz County, WA.........................
31084............  Los Angeles-Long Beach-Glendale, CA.........   1.2424
                    Los Angeles County, CA.....................
31140............  Louisville-Jefferson County, KY-IN..........   0.9568
                    Clark County, IN...........................
                    Floyd County, IN...........................
                    Harrison County, IN........................
                    Washington County, IN......................
                    Bullitt County, KY.........................
                    Henry County, KY...........................
                    Jefferson County, KY.......................
                    Meade County, KY...........................
                    Nelson County, KY..........................
                    Oldham County, KY..........................
                    Shelby County, KY..........................
                    Spencer County, KY.........................
                    Trimble County, KY.........................
31180............  Lubbock, TX.................................   0.9162
                    Crosby County, TX..........................
                    Lubbock County, TX.........................
31340............  Lynchburg, VA...............................   0.9216
                    Amherst County, VA.........................
                    Appomattox County, VA......................
                    Bedford County, VA.........................
                    Campbell County, VA........................
                    Bedford City, VA...........................
                    Lynchburg City, VA.........................
31420............  Macon, GA...................................   1.0070
                    Bibb County, GA............................
                    Crawford County, GA........................
                    Jones County, GA...........................
                    Monroe County, GA..........................
                    Twiggs County, GA..........................
31460............  Madera, CA..................................   0.8517
                    Madera County, CA..........................
31540............  Madison, WI.................................   1.1542
                    Columbia County, WI........................
                    Dane County, WI............................
                    Iowa County, WI............................
31700............  Manchester-Nashua, NH.......................   1.0621
                    Hillsborough County, NH....................
                    Merrimack County, NH.......................
31900............  Mansfield, OH \1\...........................   0.9785
                    Richland County, OH........................
32420............  Mayag[uuml]ez, PR...........................   0.7916
                    Hormigueros Municipio, PR..................
                    Mayag[uuml]ez Municipio, PR................
32580............  McAllen-Edinburg-Mission, TX................   0.9629
                    Hidalgo County, TX.........................
32780............  Medford, OR.................................   1.0890
                    Jackson County, OR.........................

[[Page 66564]]

 
32820............  Memphis, TN-MS-AR...........................   0.9763
                    Crittenden County, AR......................
                    DeSoto County, MS..........................
                    Marshall County, MS........................
                    Tate County, MS............................
                    Tunica County, MS..........................
                    Fayette County, TN.........................
                    Shelby County, TN..........................
                    Tipton County, TN..........................
32900............  Merced, CA..................................   1.2792
                    Merced County, CA..........................
33124............  Miami-Miami Beach-Kendall, FL...............   1.0557
                    Miami-Dade County, FL......................
33140............  Michigan City-La Porte, IN..................   0.9408
                    LaPorte County, IN.........................
33260............  Midland, TX.................................   1.0573
                    Midland County, TX.........................
33340............  Milwaukee-Waukesha-West Allis, WI...........   1.0781
                    Milwaukee County, WI.......................
                    Ozaukee County, WI.........................
                    Washington County, WI......................
                    Waukesha County, WI........................
33460............  Minneapolis-St. Paul-Bloomington, MN-WI.....   1.1708
                    Anoka County, MN...........................
                    Carver County, MN..........................
                    Chisago County, MN.........................
                    Dakota County, MN..........................
                    Hennepin County, MN........................
                    Isanti County, MN..........................
                    Ramsey County, MN..........................
                    Scott County, MN...........................
                    Sherburne County, MN.......................
                    Washington County, MN......................
                    Wright County, MN..........................
                    Pierce County, WI..........................
                    St. Croix County, WI.......................
33540............  Missoula, MT................................   0.9450
                    Missoula County, MT........................
33660............  Mobile, AL..................................   0.8479
                    Mobile County, AL..........................
33700............  Modesto, CA.................................   1.2626
                    Stanislaus County, CA......................
33740............  Monroe, LA..................................   0.8266
                    Ouachita Parish, LA........................
                    Union Parish, LA...........................
33780............  Monroe, MI..................................   0.9936
                    Monroe County, MI..........................
33860............  Montgomery, AL..............................   0.8537
                    Autauga County, AL.........................
                    Elmore County, AL..........................
                    Lowndes County, AL.........................
                    Montgomery County, AL......................
34060............  Morgantown, WV..............................   0.8783
                    Monongalia County, WV......................
                    Preston County, WV.........................
34100............  Morristown, TN..............................   0.7916
                    Grainger County, TN........................
                    Hamblen County, TN.........................
                    Jefferson County, TN.......................
34580............  Mount Vernon-Anacortes, WA..................   1.1113
                    Skagit County, WA..........................
34620............  Muncie, IN..................................   0.8670
                    Delaware County, IN........................
34740............  Muskegon-Norton Shores, MI..................   1.0382
                    Muskegon County, MI........................
34820............  Myrtle Beach-Conway-North Myrtle Beach, SC..   0.9113
                    Horry County, SC...........................
34900............  Napa, CA....................................   1.5279
                    Napa County, CA............................
34940............  Naples-Marco Island, FL.....................   1.0013
                    Collier County, FL.........................

[[Page 66565]]

 
34980............  Nashville-Davidson-Murfreesboro, TN.........   1.0226
                    Cannon County, TN..........................
                    Cheatham County, TN........................
                    Davidson County, TN........................
                    Dickson County, TN.........................
                    Hickman County, TN.........................
                    Macon County, TN...........................
                    Robertson County, TN.......................
                    Rutherford County, TN......................
                    Smith County, TN...........................
                    Sumner County, TN..........................
                    Trousdale County, TN.......................
                    Williamson County, TN......................
                    Wilson County, TN..........................
35004............  Nassau-Suffolk, NY..........................   1.3341
                    Nassau County, NY..........................
                    Suffolk County, NY.........................
35084............  Newark-Union, NJ-PA.........................   1.2520
                    Essex County, NJ...........................
                    Hunterdon County, NJ.......................
                    Morris County, NJ..........................
                    Sussex County, NJ..........................
                    Union County, NJ...........................
                    Pike County, PA............................
35300............  New Haven-Milford, CT.......................   1.2530
                    New Haven County, CT.......................
35380............  New Orleans-Metairie-Kenner, LA.............   0.9391
                    Jefferson Parish, LA.......................
                    Orleans Parish, LA.........................
                    Plaquemines Parish, LA.....................
                    St. Bernard Parish, LA.....................
                    St. Charles Parish, LA.....................
                    St. John the Baptist Parish, LA............
                    St. Tammany Parish, LA.....................
35644............  New York-Wayne-White Plains, NY-NJ..........   1.3843
                    Bergen County, NJ..........................
                    Hudson County, NJ..........................
                    Passaic County, NJ.........................
                    Bronx County, NY...........................
                    Kings County, NY...........................
                    New York County, NY........................
                    Putnam County, NY..........................
                    Queens County, NY..........................
                    Richmond County, NY........................
                    Rockland County, NY........................
                    Westchester County, NY.....................
35660............  Niles-Benton Harbor, MI.....................   0.9648
                    Berrien County, MI.........................
35980............  Norwich-New London, CT......................   1.2066
                    New London County, CT......................
36084............  Oakland-Fremont-Hayward, CA.................   1.6555
                    Alameda County, CA.........................
                    Contra Costa County, CA....................
36100............  Ocala, FL...................................   0.9106
                    Marion County, FL..........................
36140............  Ocean City, NJ..............................   1.1598
                    Cape May County, NJ........................
36220............  Odessa, TX..................................   1.0599
                    Ector County, TX...........................
36260............  Ogden-Clearfield, UT........................   0.9499
                    Davis County, UT...........................
                    Morgan County, UT..........................
                    Weber County, UT...........................
36420............  Oklahoma City, OK...........................   0.9304
                    Canadian County, OK........................
                    Cleveland County, OK.......................
                    Grady County, OK...........................
                    Lincoln County, OK.........................
                    Logan County, OK...........................
                    McClain County, OK.........................
                    Oklahoma County, OK........................

[[Page 66566]]

 
36500............  Olympia, WA.................................   1.2151
                    Thurston County, WA........................
36540............  Omaha-Council Bluffs, NE-IA.................   1.0091
                    Harrison County, IA........................
                    Mills County, IA...........................
                    Pottawattamie County, IA...................
                    Cass County, NE............................
                    Douglas County, NE.........................
                    Sarpy County, NE...........................
                    Saunders County, NE........................
                    Washington County, NE......................
36740............  Orlando-Kissimmee, FL.......................   0.9738
                    Lake County, FL............................
                    Orange County, FL..........................
                    Osceola County, FL.........................
                    Seminole County, FL........................
36780............  Oshkosh-Neenah, WI..........................   1.0081
                    Winnebago County, WI.......................
36980............  Owensboro, KY...............................   0.9132
                    Daviess County, KY.........................
                    Hancock County, KY.........................
                    McLean County, KY..........................
37100............  Oxnard-Thousand Oaks-Ventura, CA............   1.2509
                    Ventura County, CA.........................
37340............  Palm Bay-Melbourne-Titusville, FL...........   0.9842
                    Brevard County, FL.........................
37380............  Palm Coast, FL..............................   0.9441
                    Flagler County, FL.........................
37460............  Panama City-Lynn Haven, FL..................   0.8774
                    Bay County, FL.............................
37620............  Parkersburg-Marietta-Vienna, WV-OH..........   0.8555
                    Washington County, OH......................
                    Pleasants County, WV.......................
                    Wirt County, WV............................
                    Wood County, WV............................
37700............  Pascagoula, MS..............................   0.9127
                    George County, MS..........................
                    Jackson County, MS.........................
37764............  Peabody, MA.................................   1.1241
                    Essex County, MA...........................
37860............  Pensacola-Ferry Pass-Brent, FL..............   0.8740
                    Escambia County, FL........................
                    Santa Rosa County, FL......................
37900............  Peoria, IL..................................   0.9815
                    Marshall County, IL........................
                    Peoria County, IL..........................
                    Stark County, IL...........................
                    Tazewell County, IL........................
                    Woodford County, IL........................
37964............  Philadelphia, PA............................   1.1531
                    Bucks County, PA...........................
                    Chester County, PA.........................
                    Delaware County, PA........................
                    Montgomery County, PA......................
                    Philadelphia County, PA....................
38060............  Phoenix-Mesa-Scottsdale, AZ.................   1.0833
                    Maricopa County, AZ........................
                    Pinal County, AZ...........................
38220............  Pine Bluff, AR..............................   0.8274
                    Cleveland County, AR.......................
                    Jefferson County, AR.......................
                    Lincoln County, AR.........................
38300............  Pittsburgh, PA..............................   0.8998
                    Allegheny County, PA.......................
                    Armstrong County, PA.......................
                    Beaver County, PA..........................
                    Butler County, PA..........................
                    Fayette County, PA.........................
                    Washington County, PA......................
                    Westmoreland County, PA....................
38340............  Pittsfield, MA..............................   1.0651

[[Page 66567]]

 
                    Berkshire County, MA.......................
38540............  Pocatello, ID...............................   0.9990
                    Bannock County, ID.........................
                    Power County, ID...........................
38660............  Ponce, PR...................................   0.7916
                    Juana D[iacute]az Municipio, PR............
                    Ponce Municipio, PR........................
                    Villalba Municipio, PR.....................
38860............  Portland-South Portland-Biddeford, ME.......   1.0599
                    Cumberland County, ME......................
                    Sagadahoc County, ME.......................
                    York County, ME............................
38900............  Portland-Vancouver-Beaverton, OR-WA.........   1.2136
                    Clackamas County, OR.......................
                    Columbia County, OR........................
                    Multnomah County, OR.......................
                    Washington County, OR......................
                    Yamhill County, OR.........................
                    Clark County, WA...........................
                    Skamania County, WA........................
38940............  Port St. Lucie, FL..........................   1.0572
                    Martin County, FL..........................
                    St. Lucie County, FL.......................
39100............  Poughkeepsie-Newburgh-Middletown, NY........   1.1591
                    Dutchess County, NY........................
                    Orange County, NY..........................
39140............  Prescott, AZ................................   1.0576
                    Yavapai County, AZ.........................
39300............  Providence-New Bedford-Fall River, RI-MA....   1.1278
                    Bristol County, MA.........................
                    Bristol County, RI.........................
                    Kent County, RI............................
                    Newport County, RI.........................
                    Providence County, RI......................
                    Washington County, RI......................
39340............  Provo-Orem, UT..............................   1.0087
                    Juab County, UT............................
                    Utah County, UT............................
39380............  Pueblo, CO..................................   0.9342
                    Pueblo County, CO..........................
39460............  Punta Gorda, FL.............................   0.9767
                    Charlotte County, FL.......................
39540............  Racine, WI..................................   1.0025
                    Racine County, WI..........................
39580............  Raleigh-Cary, NC............................   1.0385
                    Franklin County, NC........................
                    Johnston County, NC........................
                    Wake County, NC............................
39660............  Rapid City, SD..............................   0.9300
                    Meade County, SD...........................
                    Pennington County, SD......................
39740............  Reading, PA.................................   0.9875
                    Berks County, PA...........................
39820............  Redding, CA.................................   1.4292
                    Shasta County, CA..........................
39900............  Reno-Sparks, NV.............................   1.1309
                    Storey County, NV..........................
                    Washoe County, NV..........................
40060............  Richmond, VA................................   0.9948
                    Amelia County, VA..........................
                    Caroline County, VA........................
                    Charles City County, VA....................
                    Chesterfield County, VA....................
                    Cumberland County, VA......................
                    Dinwiddie County, VA.......................
                    Goochland County, VA.......................
                    Hanover County, VA.........................
                    Henrico County, VA.........................
                    King and Queen County, VA..................
                    King William County, VA....................
                    Louisa County, VA..........................

[[Page 66568]]

 
                    New Kent County, VA........................
                    Powhatan County, VA........................
                    Prince George County, VA...................
                    Sussex County, VA..........................
                    Colonial Heights City, VA..................
                    Hopewell City, VA..........................
                    Petersburg City, VA........................
                    Richmond City, VA..........................
40140............  Riverside-San Bernardino-Ontario, CA........   1.1716
                    Riverside County, CA.......................
                    San Bernardino County, CA..................
40220............  Roanoke, VA.................................   0.9173
                    Botetourt County, VA.......................
                    Craig County, VA...........................
                    Franklin County, VA........................
                    Roanoke County, VA.........................
                    Roanoke City, VA...........................
                    Salem City, VA.............................
40340............  Rochester, MN...............................   1.1352
                    Dodge County, MN...........................
                    Olmsted County, MN.........................
                    Wabasha County, MN.........................
40380............  Rochester, NY...............................   0.9349
                    Livingston County, NY......................
                    Monroe County, NY..........................
                    Ontario County, NY.........................
                    Orleans County, NY.........................
                    Wayne County, NY...........................
40420............  Rockford, IL................................   1.0358
                    Boone County, IL...........................
                    Winnebago County, IL.......................
40484............  Rockingham County-Strafford County, NH......   1.0672
                    Rockingham County, NH......................
                    Strafford County, NH.......................
40580............  Rocky Mount, NC.............................   0.9500
                    Edgecombe County, NC.......................
                    Nash County, NC............................
40660............  Rome, GA....................................   0.9544
                    Floyd County, GA...........................
40900............  Sacramento-Arden-Arcade-Roseville, CA.......   1.4254
                    El Dorado County, CA.......................
                    Placer County, CA..........................
                    Sacramento County, CA......................
                    Yolo County, CA............................
40980............  Saginaw-Saginaw Township North, MI..........   0.9301
                    Saginaw County, MI.........................
41060............  St. Cloud, MN...............................   1.1134
                    Benton County, MN..........................
                    Stearns County, MN.........................
41100............  St. George, UT..............................   0.9877
                    Washington County, UT......................
41140............  St. Joseph, MO-KS...........................   0.9248
                    Doniphan County, KS........................
                    Andrew County, MO..........................
                    Buchanan County, MO........................
                    DeKalb County, MO..........................
41180............  St. Louis, MO-IL............................   0.9525
                    Bond County, IL............................
                    Calhoun County, IL.........................
                    Clinton County, IL.........................
                    Jersey County, IL..........................
                    Macoupin County, IL........................
                    Madison County, IL.........................
                    Monroe County, IL..........................
                    St. Clair County, IL.......................
                    Crawford County, MO........................
                    Franklin County, MO........................
                    Jefferson County, MO.......................
                    Lincoln County, MO.........................
                    St. Charles County, MO.....................
                    St. Louis County, MO.......................

[[Page 66569]]

 
                    Warren County, MO..........................
                    Washington County, MO......................
                    St. Louis City, MO.........................
41420............  Salem, OR...................................   1.1158
                    Marion County, OR..........................
                    Polk County, OR............................
41500............  Salinas, CA.................................   1.5595
                    Monterey County, CA........................
41540............  Salisbury, MD...............................   0.9493
                    Somerset County, MD........................
                    Wicomico County, MD........................
41620............  Salt Lake City, UT..........................   0.9920
                    Salt Lake County, UT.......................
                    Summit County, UT..........................
                    Tooele County, UT..........................
41660............  San Angelo, TX..............................   0.9055
                    Irion County, TX...........................
                    Tom Green County, TX.......................
41700............  San Antonio, TX.............................   0.9324
                    Atascosa County, TX........................
                    Bandera County, TX.........................
                    Bexar County, TX...........................
                    Comal County, TX...........................
                    Guadalupe County, TX.......................
                    Kendall County, TX.........................
                    Medina County, TX..........................
                    Wilson County, TX..........................
41740............  San Diego-Carlsbad-San Marcos, CA...........   1.2129
                    San Diego County, CA.......................
41780............  Sandusky, OH................................   0.9311
                    Erie County, OH............................
41884............  San Francisco-San Mateo-Redwood City, CA....   1.6038
                    Marin County, CA...........................
                    San Francisco County, CA...................
                    San Mateo County, CA.......................
41900............  San Germ[aacute]n-Cabo Rojo, PR.............   0.7916
                    Cabo Rojo Municipio, PR....................
                    Lajas Municipio, PR........................
                    Sabana Grande Municipio, PR................
                    San Germ[aacute]n Municipio, PR............
41940............  San Jose-Sunnyvale-Santa Clara, CA..........   1.6608
                    San Benito County, CA......................
                    Santa Clara County, CA.....................
41980............  San Juan-Caguas-Guaynabo, PR................   0.7916
                    Aguas Buenas Municipio, PR.................
                    Aibonito Municipio, PR.....................
                    Arecibo Municipio, PR......................
                    Barceloneta Municipio, PR..................
                    Barranquitas Municipio, PR.................
                    Bayam[oacute]n Municipio, PR...............
                    Caguas Municipio, PR.......................
                    Camuy Municipio, PR........................
                    Can[oacute]vanas Municipio, PR.............
                    Carolina Municipio, PR.....................
                    Cata[ntilde]o Municipio, PR................
                    Cayey Municipio, PR........................
                    Ciales Municipio, PR.......................
                    Cidra Municipio, PR........................
                    Comer[iacute]o Municipio, PR...............
                    Corozal Municipio, PR......................
                    Dorado Municipio, PR.......................
                    Florida Municipio, PR......................
                    Guaynabo Municipio, PR.....................
                    Gurabo Municipio, PR.......................
                    Hatillo Municipio, PR......................
                    Humacao Municipio, PR......................
                    Juncos Municipio, PR.......................
                    Las Piedras Municipio, PR..................
                    Lo[iacute]za Municipio, PR.................
                    Manat[iacute] Municipio, PR................
                    Maunabo Municipio, PR......................

[[Page 66570]]

 
                    Morovis Municipio, PR......................
                    Naguabo Municipio, PR......................
                    Naranjito Municipio, PR....................
                    Orocovis Municipio, PR.....................
                    Quebradillas Municipio, PR.................
                    R[iacute]o Grande Municipio, PR............
                    San Juan Municipio, PR.....................
                    San Lorenzo Municipio, PR..................
                    Toa Alta Municipio, PR.....................
                    Toa Baja Municipio, PR.....................
                    Trujillo Alto Municipio, PR................
                    Vega Alta Municipio, PR....................
                    Vega Baja Municipio, PR....................
                    Yabucoa Municipio, PR......................
42020............  San Luis Obispo-Paso Robles, CA.............   1.3181
                    San Luis Obispo County, CA.................
42044............  Santa Ana-Anaheim-Irvine, CA................   1.2419
                    Orange County, CA..........................
42060............  Santa Barbara-Santa Maria-Goleta, CA........   1.2364
                    Santa Barbara County, CA...................
42100............  Santa Cruz-Watsonville, CA..................   1.7016
                    Santa Cruz County, CA......................
42140............  Santa Fe, NM................................   1.1329
                    Santa Fe County, NM........................
42220............  Santa Rosa-Petaluma, CA.....................   1.5511
                    Sonoma County, CA..........................
42260............  Sarasota-Bradenton-Venice, FL...............   1.0484
                    Manatee County, FL.........................
                    Sarasota County, FL........................
42340............  Savannah, GA................................   0.9638
                    Bryan County, GA...........................
                    Chatham County, GA.........................
                    Effingham County, GA.......................
42540............  Scranton-Wilkes-Barre, PA...................   0.8926
                    Lackawanna County, PA......................
                    Luzerne County, PA.........................
                    Wyoming County, PA.........................
42644............  Seattle-Bellevue-Everett, WA................   1.2214
                    King County, WA............................
                    Snohomish County, WA.......................
42680............  Sebastian-Vero Beach, FL....................   0.9934
                    Indian River County, FL....................
43100............  Sheboygan, WI...............................   0.9473
                    Sheboygan County, WI.......................
43300............  Sherman-Denison, TX.........................   0.8782
                    Grayson County, TX.........................
43340............  Shreveport-Bossier City, LA.................   0.8946
                    Bossier Parish, LA.........................
                    Caddo Parish, LA...........................
                    De Soto Parish, LA.........................
43580............  Sioux City, IA-NE-SD........................   0.9764
                    Woodbury County, IA........................
                    Dakota County, NE..........................
                    Dixon County, NE...........................
                    Union County, SD...........................
43620............  Sioux Falls, SD.............................   1.0093
                    Lincoln County, SD.........................
                    McCook County, SD..........................
                    Minnehaha County, SD.......................
                    Turner County, SD..........................
43780............  South Bend-Mishawaka, IN-MI.................   1.0150
                    St. Joseph County, IN......................
                    Cass County, MI............................
43900............  Spartanburg, SC.............................   0.9945
                    Spartanburg County, SC.....................
44060............  Spokane, WA.................................   1.1035
                    Spokane County, WA.........................
44100............  Springfield, IL.............................   0.9440
                    Menard County, IL..........................
                    Sangamon County, IL........................
44140............  Springfield, MA.............................   1.0941

[[Page 66571]]

 
                    Franklin County, MA........................
                    Hampden County, MA.........................
                    Hampshire County, MA.......................
44180............  Springfield, MO.............................   0.9177
                    Christian County, MO.......................
                    Dallas County, MO..........................
                    Greene County, MO..........................
                    Polk County, MO............................
                    Webster County, MO.........................
44220............  Springfield, OH.............................   0.9176
                    Clark County, OH...........................
44300............  State College, PA...........................   0.9254
                    Centre County, PA..........................
44700............  Stockton, CA................................   1.2513
                    San Joaquin County, CA.....................
44940............  Sumter, SC..................................   0.9076
                    Sumter County, SC..........................
45060............  Syracuse, NY................................   1.0460
                    Madison County, NY.........................
                    Onondaga County, NY........................
                    Oswego County, NY..........................
45104............  Tacoma, WA..................................   1.1668
                    Pierce County, WA..........................
45220............  Tallahassee, FL.............................   0.9526
                    Gadsden County, FL.........................
                    Jefferson County, FL.......................
                    Leon County, FL............................
                    Wakulla County, FL.........................
45300............  Tampa-St. Petersburg-Clearwater, FL.........   0.9520
                    Hernando County, FL........................
                    Hillsborough County, FL....................
                    Pasco County, FL...........................
                    Pinellas County, FL........................
45460............  Terre Haute, IN.............................   0.9293
                    Clay County, IN............................
                    Sullivan County, IN........................
                    Vermillion County, IN......................
                    Vigo County, IN............................
45500............  Texarkana, TX-Texarkana, AR.................   0.8201
                    Miller County, AR..........................
                    Bowie County, TX...........................
45780............  Toledo, OH..................................   0.9954
                    Fulton County, OH..........................
                    Lucas County, OH...........................
                    Ottawa County, OH..........................
                    Wood County, OH............................
45820............  Topeka, KS..................................   0.9012
                    Jackson County, KS.........................
                    Jefferson County, KS.......................
                    Osage County, KS...........................
                    Shawnee County, KS.........................
                    Wabaunsee County, KS.......................
45940............  Trenton-Ewing, NJ...........................   1.1293
                    Mercer County, NJ..........................
46060............  Tucson, AZ..................................   0.9758
                    Pima County, AZ............................
46140............  Tulsa, OK...................................   0.8803
                    Creek County, OK...........................
                    Okmulgee County, OK........................
                    Osage County, OK...........................
                    Pawnee County, OK..........................
                    Rogers County, OK..........................
                    Tulsa County, OK...........................
                    Wagoner County, OK.........................
46220............  Tuscaloosa, AL..............................   0.8764
                    Greene County, AL..........................
                    Hale County, AL............................
                    Tuscaloosa County, AL......................
46340............  Tyler, TX...................................   0.9620
                    Smith County, TX...........................
46540............  Utica-Rome, NY..............................   0.8957

[[Page 66572]]

 
                    Herkimer County, NY........................
                    Oneida County, NY..........................
46660............  Valdosta, GA................................   0.8547
                    Brooks County, GA..........................
                    Echols County, GA..........................
                    Lanier County, GA..........................
                    Lowndes County, GA.........................
46700............  Vallejo-Fairfield, CA.......................   1.5480
                    Solano County, CA..........................
47020............  Victoria, TX................................   0.8763
                    Calhoun County, TX.........................
                    Goliad County, TX..........................
                    Victoria County, TX........................
47220............  Vineland-Millville-Bridgeton, NJ............   1.0695
                    Cumberland County, NJ......................
47260............  Virginia Beach-Norfolk-Newport News, VA-NC..   0.9307
                    Currituck County, NC.......................
                    Gloucester County, VA......................
                    Isle of Wight County, VA...................
                    James City County, VA......................
                    Mathews County, VA.........................
                    Surry County, VA...........................
                    York County, VA............................
                    Chesapeake City, VA........................
                    Hampton City, VA...........................
                    Newport News City, VA......................
                    Norfolk City, VA...........................
                    Poquoson City, VA..........................
                    Portsmouth City, VA........................
                    Suffolk City, VA...........................
                    Virginia Beach City, VA....................
                    Williamsburg City, VA......................
47300............  Visalia-Porterville, CA.....................   1.0651
                    Tulare County, CA..........................
47380............  Waco, TX....................................   0.8991
                    McLennan County, TX........................
47580............  Warner Robins, GA...........................   0.9634
                    Houston County, GA.........................
47644............  Warren-Troy-Farmington Hills, MI............   1.0556
                    Lapeer County, MI..........................
                    Livingston County, MI......................
                    Macomb County, MI..........................
                    Oakland County, MI.........................
                    St. Clair County, MI.......................
47894............  Washington-Arlington-Alexandria, DC-VA-MD-WV   1.1457
                    District of Columbia, DC...................
                    Calvert County, MD.........................
                    Charles County, MD.........................
                    Prince George's County, MD.................
                    Arlington County, VA.......................
                    Clarke County, VA..........................
                    Fairfax County, VA.........................
                    Fauquier County, VA........................
                    Loudoun County, VA.........................
                    Prince William County, VA..................
                    Spotsylvania County, VA....................
                    Stafford County, VA........................
                    Warren County, VA..........................
                    Alexandria City, VA........................
                    Fairfax City, VA...........................
                    Falls Church City, VA......................
                    Fredericksburg City, VA....................
                    Manassas City, VA..........................
                    Manassas Park City, VA.....................
                    Jefferson County, WV.......................
47940............  Waterloo-Cedar Falls, IA....................   0.8992
                    Black Hawk County, IA......................
                    Bremer County, IA..........................
                    Grundy County, IA..........................
48140............  Wausau, WI..................................   1.0216
                    Marathon County, WI........................

[[Page 66573]]

 
48260............  Weirton-Steubenville, WV-OH.................   0.8364
                    Jefferson County, OH.......................
                    Brooke County, WV..........................
                    Hancock County, WV.........................
48300............  Wenatchee, WA...............................   1.2105
                    Chelan County, WA..........................
                    Douglas County, WA.........................
48424............  West Palm Beach-Boca Raton-Boynton Beach, FL   1.0268
                    Palm Beach County, FL......................
48540............  Wheeling, WV-OH.............................   0.7916
                    Belmont County, OH.........................
                    Marshall County, WV........................
                    Ohio County, WV............................
48620............  Wichita, KS.................................   0.9565
                    Butler County, KS..........................
                    Harvey County, KS..........................
                    Sedgwick County, KS........................
                    Sumner County, KS..........................
48660............  Wichita Falls, TX...........................   0.8359
                    Archer County, TX..........................
                    Clay County, TX............................
                    Wichita County, TX.........................
48700............  Williamsport, PA............................   0.8489
                    Lycoming County, PA........................
48864............  Wilmington, DE-MD-NJ........................   1.1424
                    New Castle County, DE......................
                    Cecil County, MD...........................
                    Salem County, NJ...........................
48900............  Wilmington, NC..............................   0.9932
                    Brunswick County, NC.......................
                    New Hanover County, NC.....................
                    Pender County, NC..........................
49020............  Winchester, VA-WV...........................   1.0463
                    Frederick County, VA.......................
                    Winchester City, VA........................
                    Hampshire County, WV.......................
49180............  Winston-Salem, NC...........................   0.9624
                    Davie County, NC...........................
                    Forsyth County, NC.........................
                    Stokes County, NC..........................
                    Yadkin County, NC..........................
49340............  Worcester, MA...............................   1.1913
                    Worcester County, MA.......................
49420............  Yakima, WA..................................   1.0837
                    Yakima County, WA..........................
49500............  Yauco, PR...................................   0.7916
                    Gu[aacute]nica Municipio, PR...............
                    Guayanilla Municipio, PR...................
                    Penuelas Municipio, PR.....................
                    Yauco Municipio, PR........................
49620............  York-Hanover, PA............................   0.9878
                    York County, PA............................
49660............  Youngstown-Warren-Boardman, OH-PA...........   0.9501
                    Mahoning County, OH........................
                    Trumbull County, OH........................
                    Mercer County, PA..........................
49700............  Yuba City, CA...............................   1.1353
                    Sutter County, CA..........................
                    Yuba County, CA............................
49740............  Yuma, AZ....................................   1.0014
                    Yuma County, AZ............................
------------------------------------------------------------------------
\1\ At this time, there are no hospitals located in this urban area on
  which to base a wage index.


[[Page 66574]]


  Addendum H.--CY 2008 ESRD Wage Index Based on CBSA Labor Market Areas
                             for Rural Areas
------------------------------------------------------------------------
                                                                  Wage
              CBSA code                    Nonurban area         index
------------------------------------------------------------------------
1...................................  Alabama................     0.7951
2...................................  Alaska.................     1.2781
3...................................  Arizona................     0.8949
4...................................  Arkansas...............     0.7916
5...................................  California.............     1.2690
6...................................  Colorado...............     1.0242
7...................................  Connecticut............     1.2361
8...................................  Delaware...............     1.0267
10..................................  Florida................     0.8935
11..................................  Georgia................     0.8084
12..................................  Hawaii.................     1.1201
13..................................  Idaho..................     0.8359
14..................................  Illinois...............     0.8797
15..................................  Indiana................     0.9052
16..................................  Iowa...................     0.9041
17..................................  Kansas.................     0.8424
18..................................  Kentucky...............     0.8225
19..................................  Louisiana..............     0.7916
20..................................  Maine..................     0.8946
21..................................  Maryland...............     0.9535
22..................................  Massachusetts \1\......     1.2290
23..................................  Michigan...............     0.9450
24..................................  Minnesota..............     0.9583
25..................................  Mississippi............     0.8127
26..................................  Missouri...............     0.8370
27..................................  Montana................     0.8844
28..................................  Nebraska...............     0.9340
29..................................  Nevada.................     0.9786
30..................................  New Hampshire..........     1.1466
31..................................  New Jersey \1\.........  .........
32..................................  New Mexico.............     0.9436
33..................................  New York...............     0.8727
34..................................  North Carolina.........     0.9080
35..................................  North Dakota...........     0.7916
36..................................  Ohio...................     0.9197
37..................................  Oklahoma...............     0.7916
38..................................  Oregon.................     1.0456
39..................................  Pennsylvania...........     0.8850
40..................................  Puerto Rico \1\........     0.7916
41..................................  Rhode Island \1\.......  .........
42..................................  South Carolina.........     0.9136
43..................................  South Dakota...........     0.9023
44..................................  Tennessee..............     0.8151
45..................................  Texas..................     0.8410
46..................................  Utah...................     0.8566
47..................................  Vermont................     1.0469
48..................................  Virgin Islands.........     0.7916
49..................................  Virginia...............     0.8334
50..................................  Washington.............     1.0828
51..................................  West Virginia..........     0.7916
52..................................  Wisconsin..............     1.0203
53..................................  Wyoming................    0.9802
------------------------------------------------------------------------
\1\ All counties within the State are classified as urban, with the
  exception of Massachusetts and Puerto Rico. Massachusetts and Puerto
  Rico have areas designated as rural; however, no short-term, acute
  care hospitals are located in the area(s) for FY 2008.


    Addendum I.--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: January 1, 2008]
------------------------------------------------------------------------
 
------------------------------------------------------------------------
                      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.
86960.................................  Vol reduction of blood/prod.
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.
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.
78191.................................  Platelet survival.
78267.................................  Breath tst attain/anal c-14.
78268.................................  Breath test analysis c-14.
78270.................................  Vit B-12 absorption exam.
78271.................................  Vit B-12 absrp exam, int fac.
78272.................................  Vit B-12 absorp, combined.
78725.................................  Kidney function study.
G0027.................................  Semen analysis.
G0103.................................  Psa, total screening.
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.
G0394.................................  Blood occult test colorectal.
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
                                SERVICES
 
INCLUDE the following CPT and HCPCS codes for 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.
96125.................................  Cognitive test by HC pro.
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.

[[Page 66575]]

 
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.
0144T.................................  Ct heart wo dye; qual calc.
0145T.................................  Ct heart w/wo dye funct.
0146T.................................  Ccta w/wo dye 0147T Ccta w/wo,
                                         quan calcium.
0148T.................................  Ccta w/wo, strxr.
0149T.................................  Ccta w/wo, strxr quan calc.
0150T.................................  Ccta w/wo, disease strxr.
0151T.................................  Ct heart funct add-on.
0159T.................................  Cad breast mri.
0174T.................................  Cad cxr with interp.
0175T.................................  Cad cxr remote.
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.
70554.................................  Fmri brain by tech.
70555.................................  Fmri brain by phys/psych.
71010.................................  Chest x-ray 71015 Chest x-ray.
71020.................................  Chest x-ray.
71021.................................  Chest x-ray.
71022.................................  Chest x-ray.
71023.................................  Chest x-ray and fluoroscopy.
71030.................................  Chest x-ray.
71034.................................  Chest x-ray and fluoroscopy.
71035.................................  Chest x-ray.
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.

[[Page 66576]]

 
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.
75557.................................  Cardiac MRI for morph.
75558.................................  Cardiac MRI flow/velocity.
75559.................................  Cardiac MRI w/stress img.
75560.................................  Cardiac MRI flo/vel/stress.
75561.................................  Cardiac MRI for morph w/dye.
75562.................................  Card MRI flow/vel w/dye.
75563.................................  Card MRI w/stress img & dye.
75564.................................  Ht MRI w/flo/vel/strs & dye.
75635.................................  Ct angio abdominal arteries.
76000.................................  Fluoroscope examination.
76010.................................  X-ray, nose to rectum.
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.
76376.................................  3d render w/o postprocess.
76377.................................  3d rendering w/postprocess.
76380.................................  CAT scan follow-up study.
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.
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.
76776.................................  Us exam k transpl w/Doppler.
76800.................................  Us exam, spinal canal.
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.
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.
77014.................................  Ct scan for therapy guide.
77051.................................  Computer dx mammogram add-on.
77052.................................  Comp screen mammogram add-on.
77055.................................  Mammogram, one breast.
77056.................................  Mammogram, both breasts.
77057.................................  Mammogram, screening.
77058.................................  Mri, one breast.
77059.................................  Mri, both breasts.
77071.................................  X-ray stress view.
77072.................................  X-rays for bone age.
77073.................................  X-rays, bone length studies.
77074.................................  X-rays, bone survey, limited.
77075.................................  X-rays, bone survey complete.
77076.................................  X-rays, bone survey, infant.
77077.................................  Joint survey, single view.
77078.................................  Ct bone density, axial.
77079.................................  Ct bone density, peripheral.
77080.................................  Dxa bone density, axial.
77081.................................  Dxa bone density/peripheral.
77082.................................  Dxa bone density, vert fx.
77083.................................  Radiographic absorptiometry.
77084.................................  Magnetic image, bone marrow.
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.
78135.................................  Red cell survival kinetics.
78140.................................  Red cell sequestration.
78185.................................  Spleen imaging.
78190.................................  Platelet survival, kinetics.
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.
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).
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 image < 4 views.
78601.................................  Brain image w/flow < 4 views.
78605.................................  Brain image 4+ views.
78606.................................  Brain image w/flow 4 + views.
78607.................................  Brain imaging (3D).
78608.................................  Brain imaging (PET).
78610.................................  Brain flow imaging only.
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, morphol.
78701.................................  Kidney imaging with flow.
78707.................................  K flow/funct image w/o drug.
78708.................................  K flow/funct image w/drug.
78709.................................  K flow/funct image, multiple.
78710.................................  Kidney imaging (3D).
78730.................................  Urinary bladder retention.
78740.................................  Ureteral reflux study.
78761.................................  Testicular imaging w/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.................................  PET image, ltd area.
78812.................................  PET image, skull-thigh.
78813.................................  PET image, full body.
78814.................................  PET image w/ct, lmtd.
78815.................................  PET image w/ct, skull-thigh.
78816.................................  PET image w/ct, full body.
78890.................................  Nuclear medicine data proc.

[[Page 66577]]

 
78891.................................  Nuclear med data proc.
78999.................................  Nuclear diagnostic exam.
91110.................................  Gi tract capsule endoscopy.
91111.................................  Esophageal 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.................................  Radiopharm dx agent noc.
A4642.................................  In111 satumomab.
A9500.................................  Tc99m sestamibi.
A9501.................................  Technitium TC-99m teboroxime.
A9502.................................  Tc99m tetrofosmin.
A9503.................................  Tc99m medronate.
A9504.................................  Tc99m apcitide.
A9505.................................  TL201 thallium.
A9507.................................  In111 capromab.
A9508.................................  I131 iodobenguate, dx.
A9509.................................  Iodine I-123 sod iodide mil.
A9510.................................  Tc99m disofenin.
A9512.................................  Tc99m pertechnetate.
A9516.................................  Iodine I-123 sod iodide mic.
A9521.................................  Tc99m exametazime.
A9524.................................  I131 serum albumin, dx.
A9526.................................  Nitrogen N-13 ammonia.
A9528.................................  Iodine I-131 iodide cap, dx.
A9529.................................  I131 iodide sol, dx.
A9531.................................  I131 max 100uCi.
A9532.................................  I125 serum albumin, dx.
A9536.................................  TC99m depreotide.
A9537.................................  Tc99m mebrofenin.
A9538.................................  Tc99m pyrophosphate.
A9539.................................  Tc99m pentetate.
A9540.................................  Tc99m MAA.
A9541.................................  Tc99m sulfur colloid.
A9542.................................  In111 ibritumomab, dx.
A9544.................................  I131 tositumomab, dx.
A9546.................................  CO57/58.
A9547.................................  In111 oxyquinoline.
A9548.................................  In111 pentetate.
A9550.................................  Tc99m gluceptate.
A9551.................................  Tc99m succimer.
A9552.................................  F18 fdg.
A9553.................................  Cr51 chromate.
A9554.................................  I125 iothalamate, dx.
A9555.................................  Rb82 rubidium.
A9556.................................  Ga67 gallium.
A9557.................................  Tc99m bicisate.
A9558.................................  Xe133 xenon 10mci.
A9559.................................  Co57 cyano.
A9560.................................  Tc99m labeled rbc.
A9561.................................  Tc99m oxidronate.
A9562.................................  Tc99m mertiatide.
A9566.................................  Tc99m fanolesomab.
A9567.................................  Technetium TC-99m aerosol.
A9568.................................  Technetium tc99m arcitumomab.
A9569.................................  Technetium TC-99m auto WBC.
A9570.................................  Indium In-111 auto WBC.
A9571.................................  Indium In-111 auto platelet.
A9572.................................  Indium In-111 pentetreotide.
A9576.................................  Inj prohance multipack.
A9577.................................  Inj multihance.
A9578.................................  Inj multihance multipack.
A9579.................................  Gad-base MR contrast NOS,1ml.
A9700.................................  Echocardiography contrast.
G0130.................................  Single energy x-ray study.
G0202.................................  Screeningmammographydigital.
G0204.................................  Diagnosticmammographydigital.
G0206.................................  Diagnosticmammographydigital.
G0288.................................  Recon, CTA for surg plan.
G0389.................................  Ultrasound exam AAA screen.
Q0092.................................  Set up port xray equipment.
Q9951.................................  LOCM>=400 mg/ml iodine,1ml.
Q9953.................................  Inj Fe-base MR contrast,1ml.
Q9954.................................  Oral MR contrast, 100ml.
Q9955.................................  Inj perflexane lip micros,ml.
Q9956.................................  Inj octafluoropropane mic,ml.
Q9957.................................  Inj perflutren lip micros,ml.
Q9958.................................  HOCM <=149 mg/ml iodine, 1ml.
Q9959.................................  HOCM 150-199mg/ml iodine,1ml.
Q9960.................................  HOCM 200-249mg/ml iodine,1ml.
Q9961.................................  HOCM 250-299mg/ml iodine,1ml.
Q9962.................................  HOCM 300-349mg/ml iodine,1ml.
Q9963.................................  HOCM 350-399mg/ml iodine,1ml.
Q9964.................................  HOCM>= 400mg/ml iodine, 1ml.
Q9965.................................  LOCM 100-199mg/ml iodine,1ml.
Q9966.................................  LOCM 200-299mg/ml iodine,1ml.
Q9967.................................  LOCM 300-399mg/ml iodine,1ml.
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.
0182T.................................  HDR elect brachytherapy.
19296.................................  Place po breast cath for rad.
19297.................................  Place breast cath for rad.
19298.................................  Place breast rad tube/caths.
20555.................................  Place ndl musc/tis for rt.
31643.................................  Diag bronchoscope/catheter.
41019.................................  Place needles h&n for rt.
55875.................................  Transperi needle place, pros.
55876.................................  Place rt device/marker, pros.
55920.................................  Place needles pelvic for rt.
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.
77371.................................  Srs, multisource.
77372.................................  Srs, linear based.
77373.................................  Sbrt delivery.
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, simple.
77423.................................  Neutron beam tx, complex.
77427.................................  Radiation tx management, x5.
77431.................................  Radiation therapy management.
77432.................................  Stereotactic radiation trmt.
77435.................................  Sbrt management.
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.

[[Page 66578]]

 
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.................................  I131 iodide cap, rx.
A9527.................................  Iodine I-125 sodium iodide.
A9530.................................  I131 iodide sol, rx.
A9543.................................  Y90 ibritumomab, rx.
A9545.................................  I131 tositumomab, rx.
A9563.................................  P32 Na phosphate.
A9564.................................  P32 chromic phosphate.
A9600.................................  Sr89 strontium.
A9605.................................  Sm 153 lexidronm.
A9699.................................  Radiopharm rx agent noc.
C1716.................................  Brachytx source, Gold 198.
C1717.................................  Brachytx source, HDR Ir-192.
C1719.................................  Brachytx sour, Non-HDR Ir-192.
C2616.................................  Brachytx source, Yttrium-9.
C2634.................................  Brachytx source, HA, I-125.
C2635.................................  Brachytx source, HA, P-13.
C2636.................................  Brachytx linear source, P-13.
C2637.................................  Brachytx, Ytterbium-169.
C2638.................................  Brachytx, stranded, I-125.
C2639.................................  Brachytx,non-stranded, I-125.
C2640.................................  Brachytx, stranded, P-13.
C2641.................................  Brachytx, non-stranded, P-13.
C2642.................................  Brachytx, stranded, C-131.
C2643.................................  Brachytx, non-stranded, C-131.
C2698.................................  Brachytx, stranded, NOS.
C2699.................................  Brachytx, non-stranded, NOS.
G0173.................................  Linear acc stereo radsur com.
G0251.................................  Linear acc based stero radio.
G0339.................................  Robot lin-radsurg com, first.
G0340.................................  Robt lin-radsurg fractx 2-5.
Q3001.................................  Brachytherapy Radioelements.
 
                  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.
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.
Q4081.................................  Epoetin alfa, 100 units ESRD.
 
         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): .
77052.................................  Comp screen mammogram add-on.
77057.................................  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].
82270.................................  Occult blood, feces.
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.
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.
G0202.................................  Screeningmammographydigital.
G0328.................................  Fecal blood scrn immunoassay.
G0389.................................  Ultrasound exam AAA screen.
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, 3 yrs, im.
90658.................................  Flu vaccine 3 yrs & >, im.
90660.................................  Flu vaccine, nasal.
90669.................................  Pneumococcal vacc, ped <5.
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 2007 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 Sec.
  411.351. For more information, refer to the CMS Web site at http://www.cms.hhs.gov/PhysicianSelfReferral/.

[FR Doc. 07-5506 Filed 11-1-07; 4:00 pm]
BILLING CODE 4120-01-P


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