Medicare Program; Medicare Program; Changes to the Hospital Outpatient Prospective Payment System and Calendar Year 2004 Payment Rates; Final Rule; Correction

Federal RegisterDec 31, 2003

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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

42 CFR Parts 410 and 419

[CMS-1471-CN]

RIN 0938-AL19

Medicare Program; Medicare Program; Changes to the Hospital Outpatient Prospective Payment System and Calendar Year 2004 Payment Rates; Final Rule; Correction

AGENCY:

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

ACTION:

Correction of final rule with comment period.

SUMMARY:

This document corrects errors in the final rule with comment period that appeared in the

Federal Register

on November 7, 2003, entitled “Medicare Program; Changes to the Hospital Outpatient Prospective Payment System

and Calendar Year 2004 Payment Rates; Final Rule.” This notice is a supplement to the November 7, 2003 final rule and is completely separate from any notice that promulgates new policy that results from enactment of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003.

EFFECTIVE DATE:

January 1, 2004.

FOR FURTHER INFORMATION CONTACT:

Dana Burley, (410) 786-0378.

SUPPLEMENTARY INFORMATION:

I. Background

In FR Doc. 03-27791 of November 7, 2003 (68 FR 63398), there were several technical errors as well as a number of public comments that were received timely, but that we inadvertently failed to address. The errors include incorrect or potentially misleading responses, and in Addenda A and B, omissions and typographical errors. In addition, we are adding information to the addenda that was not available when we published the final rule. This additional information does not affect payment under the hospital outpatient prospective payment system (OPPS). We ordinarily provide a 30-day delay in the effective date of the provisions of a notice. Section 553(d) of the Administrative Procedure Act (5 U.S.C. 553(d)) ordinarily requires a 30-day delay in the effective date of final rules after the date of their publication in the

Federal Register

. This 30-day delay in effective date can be waived, however, if an agency finds good cause that the delay is impracticable, unnecessary, or contrary to the public interest, and the agency incorporates a statement of the finding and its reasons in the notice issued. In addition, section 1871(e)(1) of the Social Security Act, as amended by section 903(b)(1) of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (DIMA), also requires that a substantive change in a regulation shall not become effective before the end of the 30-day period that begins on the date that the Secretary has issued or published the substantive change. Section 1871(e)(1) of the Social Security Act, as amended by section 903(b)(1) of DIMA, provides an exception to that requirement if the Secretary finds that the waiver of such 30-day period is necessary to comply with statutory requirements or that the application of such 30-day period is contrary to the public interest. We find good cause to waive the 30-day delay in effective date for this correction notice as set forth in section III, “Waiver of 30-Day Delay in Effective Date,” below.

II. Correction of Errors

A. Correction of Inaccurate Information

On page 63423, first column, fifth sentence, we stated: “The case of APC 0108, we used the external device cost data that was used to set the median for the 2003 OPPS because we received no outside data for the 2004 OPPS for this APC and because the proposed median of $28,685.30 set forth in the proposed rule was considerably higher than the final rule data median of $23,944.80, which resulted when additional claims were used to calculate the median cost.”

We subsequently determined that external data that met our preferred criteria for use in setting payment rates had been furnished as part of a timely, properly submitted comment for APC 0108. Therefore, we have revised the median cost and payment rate ($23,641.27) that was in the final rule for this APC using the data submitted in the comment. The new payment rate is $24,699.74. See Table 1 below for the complete revised values information.

To correct this error, we remove the fifth sentence in column 1 on page 63423 and replace it with the following: “In the case of APC 0108, we used external device cost data submitted in a comment on the proposed rule to set the median for the 2004 OPPS. The proposed median of $28,685.30 set forth in the proposed rule was considerably higher than the median calculated for the final rule, $23,944.80, which resulted when additional claims were used to calculate the median cost. The use of this external data raised the payment rate to a level we believe is more appropriate.”

B. Responses to Comments Not Included in the Final Rule

Bone Marrow Harvesting

Comment:

A commenter asserted that the claims data for Physicians' Current Procedural Terminology (CPT) codes 38230 (bone marrow harvesting), 38240 (bone marrow/stem cell transplantation, allogenic), and 38241 (bone marrow/stem cell transplantation, autologous) are seriously flawed. For instance, the median cost for CPT code 38230 (using data for 35 claims) was $74.81. The commenter stated that CPT code 38230 involves a 60-90 minute operating room procedure performed under general anesthesia, with costs more closely approaching the payment rate for APC 0111 (paying $718.67) than APC 0123 (paying $288.53), its current APC placement. The commenter expressed similar concern over the claims data for CPT codes 38240 and 38241, asserting that their placement in APC 0123 results in inadequate payment to cover the costs of bone marrow and stem cell transplantation.

The commenter urged us to move CPT codes 38230, 38240, and 38241 from APC 0123 (bone marrow harvesting/stem cell transplant, paying $288.53) to APC 0111 (blood product exchange, paying $718.67).

Response:

We agree with the commenter that the claims data for CPT code 38230 appear to be based on flawed claims. We believe that the costs involved in performing CPT code 38230 (bone marrow harvesting) are more similar to the costs involved in performing CPT codes 38205 and 38206 (stem cell harvesting, placed in APC 0111); therefore, we will move CPT code 38230 from APC 0123 to APC 0111. We will maintain the payment rate for APC 0111 at $718.67 as stated in the November 7, 2003 final rule, since we believe the claims for CPT code 38230 represent aberrant data and should not be used to recalculate the payment rate for APC 0111.

In contrast, we do not believe that the claims data for CPT codes 38240 and 38241 are flawed. The resource utilization of performing bone marrow and stem cell transplantations is similar to the resource utilization of performing infusion therapy services (which are paid $210 in APC 0110), since bone marrow and stem cell transplantations involve no incision and no unusual instruments or equipment. Therefore, we believe that the APC placement of CPT codes 38240 and 38241 in APC 0123 sufficiently captures the costs involved in performing these services. Although these codes will remain in APC 0123, their payment rate in APC 0123 will increase by $47.01 (from $288.53 to $335.54) above the rate stated in the November 7, 2003 final rule, as a result of moving CPT code 38230 out of APC 0123 and recalculating the median for APC 0123 based on CPT codes 38240 and 38241 that remain in APC 0123.

Cobalt 60-Based Stereotactic Radiosurgery

Comment:

A commenter requested that we combine CPT codes G0242 (Cobalt 60-based stereotactic radiosurgery plan) and G0243 (Cobalt 60-based stereotactic radiosurgery delivery). The commenter explained that, before 2000, we allowed Cobalt 60-based stereotactic radiosurgery to be appropriately billed using CPT code 61793 (stereotactic radiosurgery—particle beam, gamma ray or linear accelerator—one or more sessions), the same code that non-Medicare payers continue to use for this procedure.

However, our current guidelines for coding this procedure necessitate the billing of two codes (planning and delivery), and therefore, correct billing of this treatment using the current codes results in a multiple procedure claim. The commenter asserted that because we calculate medians using only single claims, the APC placement of Healthcare Common Procedure Coding System (HCPCS) codes G0242 and G0243 was based on aberrant single claims.

The commenter requested that these codes (G0242 and G0243) be combined into a single procedure code (that is, CPT code 61793) in order for us to accurately capture the costs of this treatment in a single claim because both parts of this treatment (planning and delivery) are always delivered on the same day in one surgical procedure. Based on resource consumption and clinical homogeneity, the commenter suggested that we place this single procedure code in one of the following APCs: 0222 (paying $12,670), 0226 (paying $7,437), or 0227 (paying $8,775).

Response:

In addition to the above comment, we received several other comments stating that HCPCS code G0242 (Cobalt 60-based stereotactic radiosurgery plan) was being used inappropriately for linear accelerator-based stereotactic radiosurgery (SRS) planning in addition to Cobalt 60-based SRS planning, due to the nonexistence of a code to bill for linear accelerator-based SRS planning. Considering the current misuse of HCPCS code G0242 and the potential for causing greater confusion by combining CPT codes G0242 and G0243, we created a planning code for linear accelerator-based SRS (G0338) to distinguish this procedure from Cobalt 60-based SRS planning. Since the claims data for G0242 represent costs for linear accelerator-based SRS planning (due to misuse of the code) in addition to Cobalt 60-based SRS planning, we are uncertain of how to combine these data with G0243 (Cobalt 60-based SRS delivery) to determine an accurate payment rate for a combined code for planning and delivery of Cobalt 60-based SRS. Therefore, we will solicit input from the APC Panel at its next meeting in early 2004.

In the meantime, we will maintain two separate HCPCS codes (G0242 and G0243) for the planning and delivery of Cobalt 60-based SRS treatment, consistent with the use of two G codes for the planning (G0338) and delivery (G0173, G0251, G0339, G0340, as applicable) of each type of linear accelerator-based SRS treatment, as described below.

Correct Coding for Various Types of Stereotactic Radiosurgery (SRS):

• Cobalt 60-based, multi-source SRS—

Planning—G0242 (APC 1516 paying $1,450)

Delivery—G0243 (APC 1528 paying $5,250)

• Linear accelerator-based SRS—

Non-robotic linear accelerator-based SRS (complete session)

—Planning—G0338 (APC 1516 paying $1,450)

—Delivery—G0173 (APC 1528 paying $5,250)

Non-robotic linear accelerator-based SRS (fractionated sessions)

—Planning—G0338 (APC 1516 paying $1,450)

—Delivery—G0251 (APC 1513 paying $1,150, per session)

Image-guided robotic linear accelerator-based SRS (complete session or first session of fractionated treatment)—

—Planning—G0338 (APC 1516 paying $1,450)

—Delivery—G0339 (APC 1528 paying $5,250)

Image-guided robotic linear accelerator-based SRS (fractionated treatment, 2nd—5th sessions)—

—Planning—G0338 (APC 1516 paying $1,450)

—Delivery—G0340 (APC 1525 paying $3,750, per session)

Comment:

A commenter urged us to recognize the cost and clinical differences between HCPCS codes G0243 and G0173 by placing them in separate APCs.

Response:

We believe that the low volume of single claims for HCPCS code G0243 (172 single claims out of 1,033 total claims = 17 percent of total claims) does not substantiate movement of this code into a procedural APC at this time, and there is no clinical reason for a reassignment. Therefore, we will keep HCPCS code G0243 in new technology APC 1528 with a payment of $5,250 for CY 2004.

ProstacScint

Comment:

The manufacturer of ProstaScint (indium capromab pendetide), a diagnostic agent used for the imaging of prostate cancer, indicated that this product's proposed payment rate is significantly below the cost that hospitals incur in acquiring ProstaScint. The manufacturer stated that reduced payment would restrict hospitals from providing ProstaScint studies to Medicare beneficiaries and have a significant negative effect on the treatment and outcomes of patients at risk for prostate cancer. The commenter submitted a survey of hospitals demonstrating their costs of purchasing ProstaScint.

Response:

We agree with the commenter that the use of only hospital claims data to set the payment rate for ProstaScint may adversely impact beneficiary access. We believe that the external data submitted by the manufacturer meets our preferred criteria; therefore, we will use the external data to establish an adjusted median cost for this product by blending the median cost derived from our dampening methodology with the external cost data on a one-to-one ratio.

APC

HCPCS

Short descriptor

2004 adjusted median cost

External acquisition cost

2004 1:1 Blended median cost

1604

A9507

Indium/111 capromab pendetide

$726.50

$1,610.75

$1,168.63

Arthroscopy

Comment:

One commenter requested that we assign CPT code 29827 to APC 0042 (Level II Arthroscopy). The code was new for 2003 and was assigned to APC 0041 (Level I Arthroscopy). The commenter provided information to support the assertion that the procedure described by CPT code 29827 is very similar to that described by CPT code 29826 with regard to operating room time required, equipment requirements, and complexity. However, procedures coded as CPT code 29826 are assigned to APC 0042.

Response:

Our medical staff evaluated this request and decided that they would like the advice of the APC Panel before making a determination. In their analysis of the assignments for CPT codes 29826 and 29827, they determined that it would be appropriate to solicit input from the APC Panel regarding the clinical coherence of both APCs 0041 and 0042. The APC Panel will meet in early 2004, and we plan to include these APCs on the agenda for its

consideration. The date for the APC Panel meeting and registration information will be published in the

Federal Register

and on the CMS OPPS Web site at least 60 days before the meeting date.

Photoselective Vaporization of the Prostate

Comment:

Several commenters urged us to increase payment for CPT codes 52647 and 52648 (photoselective vaporization of the prostate (PVP)). They expressed concern that other less effective procedures requiring less skill have a significantly higher proposed payment rate. Commenters stated that the proposed payment rate for PVP under APC 0163 does not cover the costs of providing access to this new technology.

Response:

Based on our claims data, we believe that CPT codes 52647 and 52648 are appropriately placed in APC 0163 for CY 2004, but the commenters may want to consider applying for a new CPT/HCPCS code for this procedure so that it is identifiable separately from other procedures. Alternatively, PVP may be a candidate for consideration under the OPPS new technology process. We refer interested parties to our Web site

www.cms.hhs.gov/providers/hopps/

for further information on the new technology application and evaluation process.

Inpatient-Only List

Comment:

We received a comment requesting that we remove several codes from the inpatient-only list. The codes are: 44901 (Incision and drainage of appendiceal abscess; percutaneous); 49021 (Drainage of peritoneal abscess or localized peritonitis, exclusive of appendiceal abscess; percutaneous); 49041 (Drainage of subdiaphragmatic or subphrenic abscess; percutaneous); and 49061 (Drainage of retroperitoneal abscess; percutaneous). The commenters based their request on the fact that codes they believe are similar to 44901, 49021, 49041, and 49061 are not on the inpatient-only list. Codes that they used as examples included 32201 (Pneumonostomy; with percutaneous drainage of abscess or cyst); and 50021 (Drainage of perirenal or renal abscess; percutaneous).

Response:

The information provided by the commenter did not provide an adequate basis for our medical staff to make a decision. Instead, our physicians will solicit input from additional specialty groups that provide care to the patients undergoing these procedures. We will also present this issue to the APC Panel for consideration at its next meeting in early 2004.

Neutron Radiotherapy

Comment:

We received a comment requesting that we create a new “G” code for neutron radiotherapy so that these procedures can be assigned to a new APC. At this time, the procedures are coded using a CPT code that includes other procedures that the commenter does not believe are related to neutron radiotherapy. The commenter believes the combination of procedures in the CPT code is inappropriate.

Response:

We evaluated this request and continue to believe that the current coding is appropriate. We do not believe that creation of a new “G” code is warranted in this case because there is a CPT code that specifically describes this procedure.

Magnetic Resonance Imaging and Magnetic Resonance Angiography

Comment:

We received a comment requesting that we assign magnetic resonance imaging and magnetic resonance angiography to separate APCs. These procedures are currently assigned to APCs 0336 and 0337.

Response:

We evaluated this request and continue to believe that the current assignments are appropriate and result in accurate payment for the procedures.

Fetal Echocardiogram

Comment:

We received one comment requesting that we reassign codes for fetal echocardiograms (CPT 76825 through 76827) to APC 0269. The codes are currently assigned to APCs 0671 and 0697.

Response:

We believe that the APC assignments for these CPT codes continue to be appropriate. We used most of the submitted claims for calculating medians for these codes. We believe the resource use and clinical coherence in the current APCs are appropriate.

New Orphan Drug

Comment:

We received a comment requesting that arsenic trioxide (Trisenox) be considered as a single-indication orphan drug for Medicare OPPS. The drug has orphan status from the FDA for treatment of multiple myeloma, myelodysplastic syndrome, chronic myeloid leukemia, and chronic lymphocystic anemia.

Response:

After careful evaluation, we agree that arsenic trioxide does meet our criteria for special payment as a single indication orphan drug. As we stated in our final rule (68 FR 63453), we are setting payment under the 2004 OPPS for single indication orphan drugs at 88 percent of the average wholesale price listed for these drugs in the April 1, 2003 single drug pricer unless we are presented with verifiable information that shows that our payment rate does not reflect the price that is widely available to the hospital market. For 2004, the payment rate for Trisenox will be $34.32 per unit.

C. Revisions and Corrections to Addenda A and B

As a result of a HCPCS coding change, the relative weight, payment rate, and minimum unadjusted copayment for APC 0012 as published on page 63478, are incorrect. Code 11057 moved from APC 0012 to APC 0013, and we failed to update the APCs in time for the final rule. The correct values for APC 0012 are: relative weight, 0.7612; payment rate, $41.53; and minimum unadjusted copayment amount, $8.31. The correct values for APC 0013 are relative weight, 1.1302; payment rate, $61.66; and the minimum unadjusted copayment is unchanged. These values are listed in bold type in Table 1 below.

As a result of our use of external data, APC 0108 has new values in Addendum A on page 63479. The correct relative weight is 452.6995, the payment rate increases to $24,669.74, and the minimum unadjusted copayment becomes $4,939.95. These values are listed in bold type in Table 1 below.

In response to a comment, we moved HCPCS code 43752 from APC 0272 to APC 0121. This move resulted in new Addendum A values for both of these APCs. The incorrect values on page 63479 for APC 0121 are corrected as follows: relative weight, 2.1114; payment rate, $115.2; and minimum unadjusted copayment amount, $23.04.

On page 63481, the incorrect values for APC 0272 are corrected as follows: relative weight, 1.4184; payment rate, $77.39; and minimum unadjusted copayment, $15.48.

In response to a comment that we overlooked, we moved CPT code 38230 from APC 0123 to APC 0111. This resulted in new values for APC 0123 in Addendum A. The values on page 63479 are corrected as follows: relative weight, 6.1499; payment rate, $335.54; and minimum unadjusted copayment amount, $67.11. There are no changes to the values for APC 0111. These values are listed in bold type in Table 1 below.

On page 63482, the values for APC 0321 are incorrect due to a change in the status indicator for HCPCS code 90901. The status indicator was changed to “A” and, therefore, does not contribute to the calculation of the APC median. We correct the values for APC 0321 by

replacing the values on page 63482 with the following: relative weight, 1.4817; payment rate, $80.84; and minimum unadjusted copayment amount, $16.17. These values are listed in bold type in Table 1 below.

The status indicator for HCPCS code 96105 was changed to “A” and, therefore, should not contribute to the calculation of the APC median. The values for APC 0373 on page 63482 are incorrect because the code (96105) was used under its previous status indicator “X” and was therefore included in the media calculation. We replace the values in Addendum A on page 63482 with the following correct values: relative weight, 2.3288; payment rate, $127.06; and minimum unadjusted copayment amount, $25.41. These values are listed in bold type in Table 1 below.

The relative weight, copayment and payment rates are incorrect for APC 0384 as published on page 63482. Two HCPCS codes (43268 and 43269) were moved from APC 0151 into APC 0384, and those changes were not reflected in the published Addendum A. We replace the values for APC 0384 with the following: relative weight, 36.54; payment rate, $1,993.66; national unadjusted copayment, $433.01; and minimum unadjusted copayment, $398.73. The values for APC 0151 do not change. These values are listed in bold type in Table 1 below.

APC 0413 was listed in Addendum A on page 63483 in error. No codes are assigned to this APC, so it no longer exists. We remove APC 0413.

We correct Addenda A and B by adding the relative weight for APC 0734 on page 63484 in Addendum A and for CPT/HCPCS codes C1774 and Q0137 on pages 63610 and 36350, respectively, in Addendum B. The relative weight is 0.0594 for both of these codes.

The values for APC 1604 are incorrect as published on page 63486. Additional data were available but inadvertently were not used in the median calculation for this APC. The new values reflect use of the additional data. We correct the values for APC 1604 as follows: relative weight, 20.2752; payment rate, $1,106.24; and minimum unadjusted copayment, $221.25. These values are listed in bold type in Table 1 below.

On page 63487, the payment rate for APC 9012 is corrected to reflect its new status as a single-indication orphan drug. We correct the payment rate to $34.32 and the minimum unadjusted copayment to $6.86.

On page 63488, the descriptor for APC 9116 is incorrect. We correct it to read “Inj. Ertapenem sodium, per 500 mg.”

For the following CPT/HCPCS codes on the pages identified, beginning on page 63488 and concluding on page 63644, we listed outdated descriptors. We correct the descriptor on page 63488 for code 0002T; page 63496 for code 15852; page 63548 for code 55870; page 63619 for code E0141; page 63622 for codes E0973 and E0974; page 63623 for code E0978; page 63624 for code E1226; page 63627 for codes G0210, G0213, G0214, G0215, G0230, G0246, G0247, G0248; page 63630 for code J1563; page 63631 for codes J2260 and J2324; page 63633 for code J8700; page 63636 for code K0560; page 63637 for codes K0600, K0607, K0614, K0615, K0616, and K0617; page 63643 for codes L4350, L4360, and L4386; and on page 63644 for codes L5646 and L5648. See Table 2—Corrections to Addendum B of the November 7, 2003, Final Rule for corrections to Addendum B for the codes identified above.

On page 63627, CPT/HCPCS G0244 is listed with an incorrect relative weight, payment rate, and copayment amount. We correct the current relative weight, payment rate, and copayment, by inserting 6.6961, $365.35, and $73.07, respectively. See Table 2 below for the corrected values.

On page 63634, CPT/HCPCS J9017 is listed with an incorrect relative weight, payment rate, and copayment. J9017 is an orphan drug and is reimbursed at 88 percent of AWP. We correct the addendum by replacing current values with a payment rate of $34.32 and minimum unadjusted copayment of $6.86.

On page 63590, we incorrectly assigned status indicator A to CPT/HCPCS 90918 through 90925. These codes are replaced by G0320 through G0327. Therefore, codes 90918 through 90925 are assigned status indicator E. On page 63590, for CPT/HCPCS 90918, 90919, 90920, 90921, 90922, 90924, and 90925, we remove the status indicator A and insert status indicator E. See Table 2—Corrections to Addendum B of the November 7, 2003, Final Rule for corrections to Addendum B for the codes identified above.

The following CPT/HCPCS codes were omitted from Addendum B of the November 7, 2003, final rule: 99375, status indicator E, home health care supervision, effective 1/1/03; 99378, status indicator E, hospice care supervision, effective 1/1/03; G0308, status indicator A, condition NI, ESRD related svc 4+mo<2yrs; G0309, status indicator A, condition NI, ESRD related svc 2-3mo<2rs; G0310, status indicator A, condition NI, ESRD related svc 1vst<2yr; G0311, status indicator A, condition NI, ESRD related svs 4+mo 2-11 yr; G0312, status indicator A, condition NI, ESRD related svs 2-3 mo 2-11 yr; G0313, status indicator A, condition NI, ESRD related svs 1 mon 2-11 yr; G0314, status indicator A, condition NI, ESRD related svs 4+mo 12-19; G0315, status indicator A, condition NI, ESRD related svs 2-3 mo 12-19; G0316, status indicator A, condition NI, ESRD related svs 1 vst 12-19y; G0317, status indicator A, condition NI, ESRD related svs 4+mo 20+yrs; G0318, status indicator A, condition NI, ESRD related svs 2-3 mo 20+y; G0319, status indicator A, condition NI, ESRD related svs 1 visit 20+y; G0320, status indicator A, condition NI, ESRD related svs home under 2; G0321, status indicator A, condition NI, ESRD related svs home mo<2ys; G0322, status indicator A, condition NI, ESRD related svs home mo12-19; G0328, status indicator A, condition NI, fecal blood scrn immunoassay; all effective 1/1/04; and P9603, status indicator A, One-way allow prorated miles, effective 1/1/92. See Table 2—Corrections to Addendum B of the November 7, 2003, Final Rule for corrections to Addendum B for the codes identified above.

On page 63608, we incorrectly assigned status indicator B and condition NI to CPT/HCPCS A9527, I-131 tositumomab therapeutic. New code A9534, with the same descriptor, replaces A9527, effective 1/1/04. A9527 is removed effective 1/1/04, with no grace period. On page 63608, for CPT/HCPCS A9527, we remove the status indicator of B and insert a status indicator of D. We remove the condition NI and insert a condition of DNG. See Table 2—Corrections to Addendum B of the November 7, 2003, Final Rule for corrections to Addendum B for the code identified above.

For the CPT/HCPCS codes on the pages identified, beginning on page 63490 and concluding on page 63653, we incorrectly listed status indicator E instead of status indicator B. We correct the status indicator on page 63490 for codes 0054T, 0055T, 0056T, 0057T, 0060T, and 0061T; page 63598 for codes 99002 and 99140; page 63604 for codes A4671, A4672, and A4673; page 63605 for codes A4674 and A4728; page 63624 for code E1634; page 63633 for J7330; page 63641 for L3350; and page 63653 for code V2761. See Table 2—Corrections to Addendum B of the November 7, 2003, Final Rule for corrections to Addendum B for the codes identified above.

For the following CPT/HCPCS codes on the pages identified, beginning on page 63490 and concluding on page 63619, we incorrectly listed condition

DG (deleted with grace). These codes are not deleted for 2004, and the condition should be blank. We correct the condition on page 63490 for codes 00546, 00548, 00550, 00560, 00562, 00563, and 00566; and page 63539 for codes 47135, 47136, 47300, and 47350; and page 63619 for E0165. See Table 2—Corrections to Addendum B of the November 7, 2003, Final Rule for corrections to Addendum B for the codes identified above.

On page 63569, CPT/HCPCS 76977 was inadvertently assigned an incorrect status indicator. We remove status indicator S and insert status indicator X. The payment rates are correct as is. See Table 2—Corrections to Addendum B of the November 7, 2003, Final Rule for corrections to Addendum B for the code identified above.

On page 63590, CPT/HCPCS 92019 was assigned an incorrect status indicator. We remove status indicator S and insert status indicator T. The payment rates are correct as is. See Table 2—Corrections to Addendum B of the November 7, 2003, Final Rule for corrections to Addendum B for the code identified above.

On page 63608, CPT/HCPCS A9700 was incorrectly assigned an APC, relative weight, payment rate, and copayment. A9700 is not payable under OPPS, and no payment should be made for this service. We remove the APC, relative weight, payment rate, and minimum unadjusted copayment. See Table 2—Corrections to Addendum B of the November 7, 2003, Final Rule for corrections to Addendum B for the code identified above.

On page 63588, CPT/HCPCS codes 90296 and 90581 are incorrectly assigned a status indicator, APC, relative weight, payment rate, and copayment. Effective 1/1/04, codes 90296 and 90581 are packaged services and therefore are assigned status indicator N. For codes 90296 and 90581, we remove status indicator K, APC, payment rate, and minimum unadjusted copayment, and insert status indicator N. See Table 2—Corrections to Addendum B of the November 7, 2003, Final Rule for corrections to Addendum B for the codes identified above.

On page 63623, CPT/HCPCS code E1065 omits condition DG. This code is deleted with grace period effective January 1, 2004. We correct this by inserting DG in the condition column.

Many codes were incorrectly listed with status indicator A that should be listed with the new status indicator Y, indicating that the code is not paid under OPPS, but should be billed to the Durable Medical Equipment Regional Carrier (DMERC). They are listed in Tables 3-5. In addition, codes A4232, A4632, E0188, E0189, E0218, E0602, E0740, E0760, E0765, K0610, K0611, K0612, and K0613 were incorrectly listed with status indicator E, but should be listed with status indicator Y. Codes E0967, E0969, E0977, E0980, E0994, E0997, E0998, E0999, E1001, E1035, E1065, and E1227 were incorrectly listed with status indicator B, but should be listed with status indicator Y. For all these codes, we remove the current status indicator and insert status indicator Y. See Tables 3-5 for a list of codes for which the status indicator has changed from A, E, or B to Y.

On page 63471 of the November 7, 2002 Final Rule, we specify that HCPCS codes for drugs, biologicals, and radiopharmaceuticals that are new for 2004 yet have no predecessor will be assigned packaged status for 2004.

On pages 63608 and 63652, HCPCS codes A9526 and Q4078, respectively, were incorrectly assigned a status indicator, APC, relative weight, payment rate, and copayment. Effective 1/1/04, codes A9526 and Q4078 are packaged services and therefore are assigned status indicator N. For these codes, we remove status indicator K, APC, payment rate, and minimum unadjusted copayment, and insert status indicator N.

On page 63415 of the November 7, 2003 Final Rule, we state that we plan to delete HCPCS C1088 effective 1/1/04. Addendum B does not list this code as deleted. For HCPCS C1088, we remove status indicator T, APC, payment rate, and minimum unadjusted copayment, and insert status indicator D and condition DNG (deleted with no grace period).

III. Waiver of 30-Day Delay in Effective Date

We ordinarily provide a 30-day delay in the effective date of the provisions of a notice. Section 553(d) of the Administrative Procedure Act (5 U.S.C. 553(d)) ordinarily requires a 30-day delay in the effective date of final rules after the date of their publication in the

Federal Register

. This 30-day delay in effective date can be waived, however, if an agency finds good cause that the delay is impracticable, unnecessary, or contrary to the public interest. In addition, section 1871(e)(1) of the Social Security Act, as amended by section 903(b)(1) of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (DIMA), also requires that a substantive change in a regulation shall not become effective before the end of the 30-day period that begins on the date that the Secretary has issued or published the substantive change. Section 1871(e)(1) of the Social Security Act, as amended by section 903(b)(1) of DIMA, provides an exception to that requirement if the Secretary finds that the waiver of such 30-day period is necessary to comply with statutory requirements or that the application of such 30-day period is contrary to the public interest. The agency must incorporate a statement of the good cause finding and rationale in the published rule.

In this case, we believe that it is in the public interest to make the corrections identified above effective January 1, 2004 without the 30-day delay in effective date. In most cases, these errors were the result of our inadvertent failure to address a number of public comments that were received timely, incorrect or potentially misleading responses, and omissions and typographical errors in Addenda A and B. In addition, we have added information to the addenda that was not available when we published the November 7, 2003 final rule. This information does not affect payment under the OPPS. A delay in the effective date of this notice would result, in most cases, in underpayment of hospitals beginning January 1, 2004. If we did not make these changes, hospitals would be paid improperly, and beneficiaries' access to care may be impeded. Therefore, we find good cause to waive the 30-day delay in effective date.

Table 1.—Addendum A Corrections as Corrected by This Federal Register Document

APC

Group title

Status indicator

Relative weight

Payment rate

National unadjusted copayment

Minimum unadjusted copayment

0012

Level I Debridement & Destruction

0.7612

41.53

11.18

8.31

0013

Level II Debridement & Destruction

1.1302

61.66

14.20

12.33

0108

Insertion/Replacement/Repair of Cardioverter-Defibrillator Leads

452.6995

24699.74

4939.95

0121

Level I Tube changes and Repositioning

2.1114

115.20

43.80

23.04

0123

Bone Marrow Harvesting and Bone Marrow/Stem Cell Transplant

6.1499

335.54

67.11

0272

Level I Fluoroscopy

1.4184

77.39

38.36

15.48

0321

Biofeedback and Other Training

1.4817

80.84

21.78

16.17

0339

Observation

6.6961

365.35

73.07

0373

Neuropsychological Testing

2.3288

127.06

25.41

0384

GI Procedures with Stents

36.5400

1993.66

433.01

398.73

APC 0413 is deleted

0734

Injection, darbepoetin alfa (for non-ESRD, per 1 mcg

0.0594

3.24

0.65

9012

Arsenic Trioxide

34.32

.6.86

1604

IN 111 capromab pendetide, per dose

20.2752

1106.24

221.25

Table 2.—Addendum B Corrections as Corrected by This Federal Register Document

CPT/HCPCS

Status

indicator

Condition

Description

APC

Relative

weight

Payment

rate

National

unadjusted

copayment

Minimum

unadjusted

copayment

0002T

endo repair abd aa aorto uni

00546

Anesth, lung, chest wall surg

00548

Anesth, trachea, bronchi surg

0054T

Bone surgery using computer

00550

Anesth, sternal debridement

0055T

Bone surgery using computer

00560

Anesth, open heart surgery

00562

Anesth, open heart surgery

00563

Anesth, heart proc w/pump

00566

Anesth, cabg w/o pump

0056T

Bone surgery using computer

0057T

Uppr gi scope w/ thrml txmnt

0060T

Electrical impedance scan

0061T

Destruction of tumor, breast

11001

Debride infected skin add-on

0012

0.7612

41.53

11.18

8.31

11055

Trim skin lesion

0012

0.7612

41.53

11.18

8.31

11056

Trim skin lesions, 2 to 4

0012

0.7612

41.53

11.18

8.31

11057

Trim skin lesions, over 4

0013

1.1302

61.66

14.20

12.33

11200

Removal of skin tags

0013

1.1302

61.66

14.20

12.33

11300

Shave skin lesion

0012

0.7612

41.53

11.18

8.31

11301

Shave skin lesion

0012

0.7612

41.53

11.18

8.31

11302

Shave skin lesion

0012

0.7612

41.53

11.18

8.31

11305

Shave skin lesion

0013

1.1302

61.66

14.20

12.33

11306

Shave skin lesion

0013

1.1302

61.66

14.20

12.33

11307

Shave skin lesion

0013

1.1302

61.66

14.20

12.33

11308

Shave skin lesion

0013

1.1302

61.66

14.20

12.33

11310

Shave skin lesion

0013

1.1302

61.66

14.20

12.33

11311

Shave skin lesion

0013

1.1302

61.66

14.20

12.33

11312

Shave skin lesion

0013

1.1302

61.66

14.20

12.33

11730

Removal of nail plate

0013

1.1302

61.66

14.20

12.33

11732

Remove nail plate, add-on

0012

0.7612

41.53

11.18

8.31

11900

Injection into skin lesions

0012

0.7612

41.53

11.18

8.31

11901

Added skin lesions injection

0012

0.7612

41.53

11.18

8.31

15786

Abrasion, lesion, single

0012

0.7612

41.53

11.18

8.31

15787

Abrasion, lesions, add-on

0013

1.1302

61.66

14.20

12.33

15788

Chemical peel, face, epiderm

0012

0.7612

41.53

11.18

8.31

15792

Chemical peel, nonfacial

0012

0.7612

41.53

11.18

8.31

15793

Chemical peel, nonfacial

0012

0.7612

41.53

11.18

8.31

15852

Dressing change not for burn

0340

0.6314

34.45

6.89

16000

Initial treatment of burn(s)

0012

0.7612

41.53

11.18

8.31

16020

Treatment of burn(s)

0013

1.1302

61.66

14.20

12.33

16025

Treatment of burn(s)

0012

0.7612

41.53

11.18

8.31

17250

Chemical cautery, tissue

0013

1.1302

61.66

14.20

12.33

17271

Destruction of skin lesions

0013

1.1302

61.66

14.20

12.33

17340

Cryotherapy of skin

0012

0.7612

41.53

11.18

8.31

17360

Skin peel therapy

0012

0.7612

41.53

11.18

8.31

17380

Hair removal by electrolysis

0012

0.7612

41.53

11.18

8.31

31502

Change of windpipe airway

0121

2.1114

115.20

43.80

23.04

38230

Bone marrow collection

0111

13.1719

718.67

200.18

143.73

38240

Bone marrow/stem transplant

0123

6.1499

335.54

67.11

38241

Bone marrow/stem transplant

0123

6.1499

335.54

67.11

43219

Esophagus endoscopy

0384

36.5400

1993.66

433.01

398.73

43256

Uppr gi endoscopy w stent

0384

36.5400

1993.66

433.01

398.73

43268

Endo cholangiopancreatograph

0384

36.5400

1993.66

433.01

398.73

43269

Endo cholangiopancreatograph

0384

36.5400

1993.66

433.01

398.73

43752

Nasal/orogastric w/stent

0121

2.1114

115.20

43.80

23.04

43760

Change gastrostomy tube

0121

2.1114

115.20

43.80

23.04

43761

Reposition gastrostomy tube

0121

2.1114

115.20

43.80

23.04

44370

Small bowel endoscopy/stent

0384

36.5400

1993.66

433.01

398.73

44379

S bowel endoscope w/stent

0384

36.5400

1993.66

433.01

398.73

44383

Ileoscopy w/stent

0384

36.5400

1993.66

433.01

398.73

44397

Colonoscopy w/stent

0384

36.5400

1993.66

433.01

398.73

44500

Intro, gastrointestinal tube

0121

2.1114

115.20

43.80

23.04

45327

Proctosigmoidoscopy w/stent

0384

36.5400

1993.66

433.01

398.73

45345

Sigmoidoscopy w/stent

0384

36.5400

1993.66

433.01

398.73

45387

Colonoscopy w/stent

0384

36.5400

1993.66

433.01

398.73

46916

Cryosurgery, anal lesion(s)

0013

1.1302

61.66

14.20

12.33

47135

Transplantation of liver

47136

Transplantation of liver

47300

Surgery for liver lesion

47350

Repair liver wound

51705

Change of bladder tube

0121

2.1114

115.20

43.80

23.04

54050

Destruction, penis lesion(s)

0013

1.1302

61.66

14.20

12.33

54056

Cryosurgery, penis lesion(s)

0012

0.7612

41.53

11.18

8.31

55870

Electroejaculation

0197

4.8280

263.42

52.68

62194

Replace/irrigate catheter

0121

2.1114

115.20

43.80

23.04

69220

Clean out mastoid cavity

0012

0.7612

41.53

11.18

8.31

70370

Throat x-ray & fluoroscopy

0272

1.4184

77.39

38.36

15.48

70371

Speech evaluation, complex

0272

1.4184

77.39

38.36

15.48

71023

Chest x-ray and fluoroscopy

0272

1.4184

77.39

38.36

15.48

71034

Chest x-ray and fluoroscopy

0272

1.4184

77.39

38.36

15.48

71090

X-ray & pacemaker insertion

0272

1.4184

77.39

38.36

15.48

74340

X-ray guide for GI tube

0272

1.4184

77.39

38.36

15.48

76000

Fluoroscope examination

0272

1.4184

77.39

38.36

15.48

76120

Cine/video x-rays

0272

1.4184

77.39

38.36

15.48

76496

Fluoroscopic procedure

0272

1.4184

77.39

38.36

15.48

76977

Us bone density measure

0340

0.6314

34.45

6.89

90296

Diphtheria antitoxin

90581

Anthrax vaccine, sc

90911

Biofeedback peri/uro/rectal

0321

1.4817

80.84

21.78

16.17

90918

ESRD related services, month

90919

ESRD related services, month

90920

ESRD related services, month

90921

ESRD related services, month

90922

ESRD related services, day

90923

ESRD related services, day

90924

ESRD related services, day

90925

ESRD related services, day

92019

Eye exam & treatment

0699

2.2303

121.69

47.46

24.34

96100

Psychological testing

0373

2.3288

127.06

25.41

96110

Developmental test, lim

0373

2.3288

127.06

25.41

96111

Developmental test, extend

0373

2.3288

127.06

25.41

96115

Neurobehavior status exam

0373

2.3288

127.06

25.41

96117

Neuropsych test battery

0373

2.3288

127.06

25.41

96920

Laser tx, skin < 250 sq cm

0012

0.7612

41.53

11.18

8.31

96921

Laser tx, skin 250-500 sq cm

0012

0.7612

41.53

11.18

8.31

96922

Laser tx, skin > 500 sq cm

0013

1.1302

61.66

14.20

12.33

99002

Device handling

99140

Emergency anesthesia

99375

Home health care supervision

99378

Hospice care supervision

A4671

Disposable cycler set

A4672

Drainage ext line, dialysis

A4673

Ext line w easy lock connect

A4674

Chem/antisept solution, 8oz

A4728

Dialysate solution, non-dex

A9507

Indium/111 capromab pendetid

1604

20.2752

1106.24

221.25

A9526

Ammonia N-13, per dose

A9527

DNG

I-131 tositumomab therapeut

A9700

Echocardiography Contrast

C1088

DNG

Laser Optic Tr Sys

0.65

C1774

Darbepoetin alfa, 1 mcg

0734

0.0594

3.24

E0141

Rigid wheeled walker adj/fix

E0165

Commode chair stationry det

E0973

W/Ch access det adj armrest

E0974

W/Ch access anti-rollback

E0978

W/C acc,saf belt pelv strap

E1065

Wheelchair power attachment

E1226

W/C access fully reclineback

E1634

Peritoneal dialysis clamp

G0210

PET img wholebody dxlung

1450.00

290.00

G0213

PET img wholbody dx

1450.00

290.00

G0214

PET img wholebod init

1450.00

290.00

G0215

PETimg wholebod restag

1450.00

290.00

G0230

PET myocard viability post

1450.00

290.00

G0244

Observ care by facility topt

0339

6.6961

365.35

73.07

G0246

Followup eval of foot pt lop

0600

0.9278

50.62

10.12

G0247

Routine footcare pt w lops

0009

0.6652

36.29

8.34

7.26

G0248

Demonstrate use home inr mon

1503

150.00

30.00

G0272

Naso/oro gastric tube pl MD

0272

1.4184

77.39

38.36

15.48

G0299

Inser/repos single icd+leads

0108

452.6995

24699.74

4939.95

G0300

Insert reposit lead dual+gen

0108

452.6995

24699.74

4939.95

G0308

ESRD related svc 4+mo<2yrs

G0309

ESRD related svc 2-3mo<2yrs

G0310

ESRD related svc 1vst<2yr

G0311

ESRD related svs 4+mo 2-11 yr

G0312

ESRD relate svs 2-3 mo 2-11 y

G0313

ESRD related svs 1 mon 2-11 y

G0314

ESRD related svs 4+mo 12-19

G0315

ESRD related svs 2-3 mo 12-19

G0316

ESRD related svs 1 vis/ 12-19y

G0317

ESRD related svs 4+mo 20+yrs

G0318

ESRD related svs 2-3 mo 20+y

G0319

ESRD related svs 1 visit 20+y

G0320

ESRD related svs home undr 2

G0321

ESRD related svs home mo<2ys

G0322

ESRD related svs hom mo12-19

G0328

Fecal blood scrn immunoassay

J1563

IV immune globulin

0905

0.8057

43.96

8.79

J2260

Inj milrinone lactate/5 MG

7007

0.2129

11.62

2.32

J2324

Nesiritide

9114

151.62

22.66

J7330

Cultured chondrocytes implnt

J8700

Temozolomide

1086

0.0690

3.76

0.75

J9017

Arsenic trioxide

9012

34.32

6.86

K0560

MCP joint 2-piece for implnt

K0600

Functional neuromuscularstim

K0607

Repl batt for AED

K0614

Chem/antisept solution, 8oz

K0615

SGD prerec mes >8min <=20min

K0616

SGD prerec mes>20min <=40min

K0617

SGD prerec mes > 40min

L3350

Shoe heel wedge

L4350

Ankle control orthosi prefab

L4360

Pneumati walking boot prefab

L4386

Non-pneum walk boot prefab

L5646

Below knee cushion socket

L5648

Above knee cushion socket

P9603

One-way allow prorated miles

Q0137

Darbepoetin alfa, non esrd

0734

0.0594

3.24

0.65

Q4078

Ammonia N-13, per dose

V2761

Mirror coating

Table 3.— HCPCS With Status Indicators That Changed From B to Y

CPT/ HCPCS

Description

E0967

Wheelchair hand rims.

E0969

Wheelchair narrowing device.

E0977

Wheelchair wedge cushion.

E0980

Wheelchair safety vest.

E0994

Wheelchair arm rest.

E0997

Wheelchair caster w/ a fork.

E0998

Wheelchair caster w/o a fork.

E0999

Wheelchr pneumatic tire w/wh.

E1001

Wheelchair wheel.

E1035

Patient transfer system.

E1065

Wheelchair power attachment.

E1227

Wheelchair spec sz spec ht a.

Table 4.—HCPCS With Status Indicators That Changed From A to Y.

CPT/HCPCS

Description

A4221

Maint drug infus cath per wk.

A4222

Drug infusion pump supplies.

A4230

Infus insulin pump non needle.

A4231

Infusion insulin pump needle.

A4253

Blood glucose/reagent strips.

A4254

Battery for glucose monitor.

A4255

Glucose monitor platforms.

A4256

Calibrator solution/chips.

A4257

Replace Lensshield Cartridge.

A4258

Lancet device each.

A4259

Lancets per box.

A4265

Paraffin.

A4556

Electrodes, pair.

A4557

Lead wires, pair.

A4558

Conductive paste or gel.

A4595

TENS suppl 2 lead per month.

A4608

Transtracheal oxygen cath.

A4609

Trach suction cath clsed sys.

A4610

Trach sctn cath 72h clsedsys.

A4611

Heavy duty battery.

A4612

Battery cables.

A4613

Battery charger.

A4615

Cannula nasal.

A4616

Tubing (oxygen) per foot.

A4617

Mouth piece.

A4618

Breathing circuits.

A4619

Face tent.

A4620

Variable concentration mask.

A4621

Tracheotomy mask or collar.

A4624

Tracheal suction tube.

A4628

Oropharyngeal suction cath.

A4630

Repl bat t.e.n.s. own by pt.

A4631

Wheelchair battery.

A4633

Uvl replacement bulb.

A4635

Underarm crutch pad.

A4636

Handgrip for cane etc.

A4637

Repl tip cane/crutch/walker.

A4639

Infrared ht sys replcmnt pad.

A4640

Alternating pressure pad.

A7000

Disposable canister for pump.

A7001

Nondisposable pump canister.

A7002

Tubing used w suction pump.

A7003

Nebulizer administration set.

A7004

Disposable nebulizer sml vol.

A7005

Nondisposable nebulizer set.

A7006

Filtered nebulizer admin set.

A7007

Lg vol nebulizer disposable.

A7008

Disposable nebulizer prefill.

A7009

Nebulizer reservoir bottle.

A7010

Disposable corrugated tubing.

A7011

Nondispos corrugated tubing.

A7012

Nebulizer water collec devic.

A7013

Disposable compressor filter.

A7014

Compressor nondispos filter.

A7015

Aerosol mask used w nebulize.

A7016

Nebulizer dome & mouthpiece.

A7017

Nebulizer not used w oxygen.

A7018

Water distilled w/nebulizer.

A7019

Saline solution dispenser.

A7020

Sterile H2O or NSS w lgv neb.

A7025

Replace chest compress vest.

A7026

Replace chst cmprss sys hose.

A7030

CPAP full face mask.

A7031

Replacement facemask interfa.

A7032

Replacement nasal cushion.

A7033

Replacement nasal pillows.

A7034

Nasal application device.

A7035

Pos airway press headgear.

A7036

Pos airway press chinstrap.

A7037

Pos airway pressure tubing.

A7038

Pos airway pressure filter.

A7039

Filter, non disposable w pap.

A7044

PAP oral interface.

E0100

Cane adjust/fixed with tip.

E0105

Cane adjust/fixed quad/3 pro.

E0110

Crutch forearm pair.

E0111

Crutch forearm each.

E0112

Crutch underarm pair wood.

E0113

Crutch underarm each wood.

E0114

Crutch underarm pair no wood.

E0116

Crutch underarm each no wood.

E0117

Underarm springassist crutch.

E0130

Walker rigid adjust/fixed ht.

E0135

Walker folding adjust/fixed.

E0141

Rigid wheeled walker adj/fix.

E0142

Walker rigid wheeled with se.

E0143

Walker folding wheeled w/o s.

E0144

Enclosed walker w rear seat.

E0145

Walker whled seat/crutch att.

E0146

Folding walker wheels w seat.

E0147

Walker variable wheel resist.

E0148

Heavyduty walker no wheels.

E0149

Heavy duty wheeled walker.

E0153

Forearm crutch platform atta.

E0154

Walker platform attachment.

E0155

Walker wheel attachment, pair.

E0156

Walker seat attachment.

E0157

Walker crutch attachment.

E0158

Walker leg extenders set of 4.

E0159

Brake for wheeled walker.

E0160

Sitz type bath or equipment.

E0161

Sitz bath/equipment w/faucet.

E0162

Sitz bath chair.

E0163

Commode chair stationry fxd.

E0164

Commode chair mobile fixed a.

E0165

Commode chair stationry det.

E0166

Commode chair mobile detach.

E0167

Commode chair pail or pan.

E0168

Heavyduty/wide commode chair.

E0169

Seatlift incorp commodechair.

E0175

Commode chair foot rest.

E0176

Air pressre pad/cushion nonp.

E0177

Water press pad/cushion nonp.

E0178

Gel pressre pad/cushion nonp.

E0179

Dry pressre pad/cushion nonp.

E0180

Press pad alternating w pump.

E0181

Press pad alternating w/pump.

E0182

Pressure pad alternating pump.

E0184

Dry pressure mattress.

E0185

Gel pressure mattress pad.

E0186

Air pressure mattress.

E0187

Water pressure mattress.

E0191

Protector heel or elbow.

E0192

Pad wheelchr low press/posit.

E0193

Powered air flotation bed.

E0194

Air fluidized bed.

E0196

Gel pressure mattress.

E0197

Air pressure pad for mattress.

E0198

Water pressure pad for mattr.

E0199

Dry pressure pad for mattress.

E0200

Heat lamp without stand.

E0202

Phototherapy light w/photom.

E0205

Heat lamp with stand.

E0210

Electric heat pad standard.

E0215

Electric heat pad moist.

E0217

Water circ heat pad w/pump.

E0220

Hot water bottle.

E0221

Infrared heating pad system.

E0225

Hydrocollator unit.

E0230

Ice cap or collar.

E0235

Paraffin bath unit portable.

E0236

Pump for water circulating p.

E0238

Heat pad non-electric moist.

E0239

Hydrocollator unit portable.

E0249

Pad water circulating heat u.

E0250

Hosp bed fixed ht w/mattress.

E0251

Hosp bed fixed ht w/o mattress.

E0255

Hospital bed var ht w/mattress.

E0256

Hospital bed var ht w/o matt.

E0260

Hosp bed semi-electr w/matt.

E0261

Hosp bed semi-electr w/o matt.

E0265

Hosp bed total electr w/matt.

E0266

Hosp bed total elec w/o matt.

E0271

Mattress innerspring.

E0272

Mattress foam rubber.

E0275

Bed pan standard.

E0276

Bed pan fracture.

E0277

Powered pres-redu air mattrs.

E0280

Bed cradle.

E0290

Hosp bed fx ht w/o rails w/m.

E0291

Hosp bed fx ht w/o rail w/o.

E0292

Hosp bed var ht w/o rail w/o.

E0293

Hosp bed var ht w/o rail w/.

E0294

Hosp bed semi-elect w/ mattrs.

E0295

Hosp bed semi-elect w/o matt.

E0296

Hosp bed total elect w/matt.

E0297

Hosp bed total elect w/o matt.

E0305

Rails bed side half length.

E0310

Rails bed side full length.

E0316

Bed safety enclosure.

E0325

Urinal male jug-type.

E0326

Urinal female jug-type.

E0371

Nonpower mattress overlay.

E0372

Powered air mattress overlay.

E0373

Nonpowered pressure mattress.

E0424

Stationary compressed gas 02.

E0431

Portable gaseous 02.

E0434

Portable liquid 02.

E0439

Stationary liquid 02.

E0441

Oxygen contents, gaseous.

E0442

Oxygen contents, liquid.

E0443

Portable 02 contents, gas.

E0444

Portable 02 contents, liquid.

E0450

Volume vent stationary/porta.

E0454

Pressure ventilator.

E0455

Oxygen tent excl croup/ped t.

E0457

Chest shell.

E0459

Chest wrap.

E0460

Neg press vent portabl/statn.

E0461

Vol vent noninvasive interfa.

E0462

Rocking bed w/ or w/o side r.

E0480

Percussor elect/pneum home m.

E0482

Cough stimulating device.

E0483

Chest compression gen system.

E0484

Non-elec oscillatory pep dvc.

E0500

Ippb all types.

E0550

Humidif extens supple w ippb.

E0555

Humidifier for use w/ regula.

E0560

Humidifier supplemental w/ I.

E0565

Compressor air power source.

E0570

Nebulizer with compression.

E0571

Aerosol compressor for svneb.

E0572

Aerosol compressor adjust pr.

E0574

Ultrasonic generator w svneb.

E0575

Nebulizer ultrasonic.

E0580

Nebulizer for use w/ regulat.

E0585

Nebulizer w/ compressor & he.

E0590

Dispensing fee dme neb drug.

E0600

Suction pump portab hom modl.

E0601

Cont airway pressure device.

E0605

Vaporizer room type.

E0606

Drainage board postural.

E0607

Blood glucose monitor home.

E0610

Pacemaker monitr audible/vis.

E0615

Pacemaker monitr digital/vis.

E0617

Automatic ext defibrillator.

E0620

Cap bld skin piercing laser.

E0621

Patient lift sling or seat.

E0627

Seat lift incorp lift-chair.

E0628

Seat lift for pt furn-electr.

E0629

Seat lift for pt furn-non-el.

E0630

Patient lift hydraulic.

E0635

Patient lift electric.

E0636

PT support & positioning sys.

E0650

Pneuma compresor non-segment.

E0651

Pneum compressor segmental.

E0652

Pneum compres w/cal pressure.

E0655

Pneumatic appliance half arm.

E0660

Pneumatic appliance full leg.

E0665

Pneumatic appliance full arm.

E0666

Pneumatic appliance half leg.

E0667

Seg pneumatic appl full leg.

E0668

Seg pneumatic appl full arm.

E0669

Seg pneumatic appli half leg.

E0671

Pressure pneum appl full leg.

E0672

Pressure pneum appl full arm.

E0673

Pressure pneum appl half leg.

E0691

Uvl pnl 2 sq ft or less.

E0692

Uvl sys panel 4 ft.

E0693

Uvl sys panel 6 ft.

E0694

Uvl md cabinet sys 6 ft.

E0701

Helmet w face guard prefab.

E0720

Tens two lead.

E0730

Tens four lead.

E0731

Conductive garment for tens/.

E0744

Neuromuscular stim for scoli.

E0745

Neuromuscular stim for shock.

E0747

Elec osteogen stim not spine.

E0748

Elec osteogen stim spinal.

E0776

Iv pole.

E0779

Amb infusion pump mechanical.

E0780

Mech amb infusion pump <8hrs.

E0781

External ambulatory infus pu.

E0784

Ext amb infusn pump insulin.

E0791

Parenteral infusion pump sta.

E0840

Tract frame attach headboard.

E0850

Traction stand free standing.

E0855

Cervical traction equipment.

E0860

Tract equip cervical tract.

E0870

Tract frame attach footboard.

E0880

Trac stand free stand extrem.

E0890

Traction frame attach pelvic.

E0900

Trac stand free stand pelvic.

E0910

Trapeze bar attached to bed.

E0920

Fracture frame attached to b.

E0930

Fracture frame free standing.

E0935

Exercise device passive moti.

E0940

Trapeze bar free standing.

E0941

Gravity assisted traction de.

E0942

Cervical head harness/halter.

E0943

Cervical pillow.

E0944

Pelvic belt/harness/boot.

E0945

Belt/harness extremity.

E0946

Fracture frame dual w cross.

E0947

Fracture frame attachmnts pe.

E0948

Fracture frame attachmnts ce.

E0962

Wheelchair 1 inch cushion.

E0963

Wheelchair 2 inch cushion.

E0964

Wheelchair 3 inch cushion.

E0965

Wheelchair 4 inch cushion.

E0968

Wheelchair commode seat.

E1011

Ped wc modify width adjustm.

E1012

Int seat sys planar ped w/c.

E1013

Int seat sys contour ped w/c.

E1014

Reclining back add ped w/c.

E1015

Shock absorber for man w/c.

E1016

Shock absorber for power w/c.

E1017

HD shck absrbr for hd man wc.

E1018

HD shck absrber for hd powwc.

E1020

Residual limb support system.

E1025

Pedwc lat/thor sup nocontour.

E1026

Pedwc contoured lat/thor sup.

E1027

Ped wc lat/ant support.

E1031

Rollabout chair with casters.

E1037

Transport chair, ped size.

E1038

Transport chair, adult size.

E1210

Whlchr moto ful arm leg rest.

E1211

Wheelchair motorized w/ det.

E1225

Wheelchair spec sz semi-recl.

E1228

Wheelchair spec sz spec ht b.

E1230

Power operated vehicle.

E1231

Rigid ped w/c tilt-in-space.

E1232

Folding ped wc tilt-in-space.

E1233

Rig ped wc tltnspc w/o seat.

E1234

Fld ped wc tltnspc w/o seat.

E1235

Rigid ped wc adjustable.

E1236

Folding ped wc adjustable.

E1237

Rgd ped wc adjstabl w/o seat.

E1238

Fld ped wc adjstabl w/o seat.

E1296

Wheelchair special seat heig.

E1297

Wheelchair special seat dept.

E1298

Wheelchair spec seat depth/w.

E1310

Whirlpool non-portable.

E1340

Repair for DME, per 15 min.

E1353

Oxygen supplies regulator.

E1355

Oxygen supplies stand/rack.

E1372

Oxy suppl heater for nebuliz.

E1390

Oxygen concentrator.

E1405

O2/water vapor enrich w/heat.

E1406

O2/water vapor enrich w/o he.

E1700

Jaw motion rehab system.

E1701

Repl cushions for jaw motion.

E1702

Repl measr scales jaw motion.

E1800

Adjust elbow ext/flex device.

E1801

SPS elbow device.

E1802

Adjst forearm pro/sup device.

E1805

Adjust wrist ext/flex device.

E1806

SPS wrist device.

E1810

Adjust knee ext/flex device.

E1811

SPS knee device.

E1815

Adjust ankle ext/flex device.

E1816

SPS ankle device.

E1818

SPS forearm device.

E1820

Soft interface material.

E1821

Replacement interface SPSD.

E1825

Adjust finger ext/flex devc.

E1830

Adjust toe ext/flex device.

E1840

Adj shoulder ext/flex device.

E2000

Gastric suction pump hme mdl.

E2100

Bld glucose monitor w voice.

E2101

Bld glucose monitor w lance.

K0001

Standard wheelchair.

K0002

Stnd hemi (low seat) whlchr.

K0003

Lightweight wheelchair.

K0004

High strength ltwt whlchr.

K0005

Ultralightweight wheelchair.

K0006

Heavy duty wheelchair.

K0007

Extra heavy duty wheelchair.

K0009

Other manual wheelchair/base.

K0010

Stnd wt frame power whlchr.

K0011

Stnd wt pwr whlchr w control.

K0012

Ltwt portbl power whlchr.

K0014

Other power whlchr base.

K0015

Detach non-adjus hght armrst.

K0016

Detach adjust armrst cmplete.

K0017

Detach adjust armrest base.

K0018

Detach adjust armrst upper.

K0019

Arm pad each.

K0020

Fixed adjust armrest pair.

K0022

Reinforced back upholstery.

K0023

Planr back insrt foam w/strp.

K0024

Plnr back insrt foam w/hrdwr.

K0025

Hook-on headrest extension.

K0026

Back upholst lgtwt whlchr.

K0027

Back upholst other whlchr.

K0028

Manual fully reclining back.

K0029

Reinforced seat upholstery.

K0030

Solid plnr seat sngl dnsfoam.

K0031

Safety belt/pelvic strap.

K0032

Seat uphols lgtwt whlchr.

K0033

Seat upholstery other whlchr.

K0035

Heel loop with ankle strap.

K0036

Toe loop each.

K0037

High mount flip-up footrest.

K0038

Leg strap each.

K0039

Leg strap h style each.

K0040

Adjustable angle footplate.

K0041

Large size footplate each.

K0042

Standard size footplate each.

K0043

Ftrst lower extension tube.

K0044

Ftrst upper hanger bracket.

K0045

Footrest complete assembly.

K0046

Elevat legrst low extension.

K0047

Elevat legrst up hangr brack.

K0048

Elevate legrest complete.

K0049

Calf pad each.

K0050

Ratchet assembly.

K0051

Cam relese assem ftrst/lgrst.

K0052

Swingaway detach footrest.

K0053

Elevate footrest articulate.

K0054

Seat wdth 10-12/15/17/20 wc.

K0055

Seat dpth 15/17/18 ltwt wc.

K0056

Seat ht <17 or >=21 ltwt wc.

K0057

Seat wdth 19/20 hvy dty wc.

K0058

Seat dpth 17/18 power wc.

K0059

Plastic coated handrim each.

K0060

Steel handrim each.

K0061

Aluminum handrim each.

K0062

Handrim 8-10 vert/obliq proj.

K0063

Hndrm 12-16 vert/obliq proj.

K0064

Zero pressure tube flat free.

K0065

Spoke protectors.

K0066

Solid tire any size each.

K0067

Pneumatic tire any size each.

K0068

Pneumatic tire tube each.

K0069

Rear whl complete solid tire.

K0070

Rear whl compl pneum tire.

K0071

Front castr compl pneum tire.

K0072

Frnt cstr cmpl sem-pneum tir.

K0073

Caster pin lock each.

K0074

Pneumatic caster tire each.

K0075

Semi-pneumatic caster tire.

K0076

Solid caster tire each.

K0077

Front caster assem complete.

K0078

Pneumatic caster tire tube.

K0079

Wheel lock extension pair.

K0080

Anti-rollback device pair.

K0081

Wheel lock assembly complete.

K0082

22 nf deep cycl acid battery.

K0083

22 nf gel cell battery each.

K0084

Grp 24 deep cycl acid battry.

K0085

Group 24 gel cell battery.

K0086

U-1 lead acid battery each.

K0087

U-1 gel cell battery each.

K0088

Battry chrgr acid/gel cell.

K0089

Battery charger dual mode.

K0090

Rear tire power wheelchair.

K0091

Rear tire tube power whlchr.

K0092

Rear assem cmplt powr whlchr.

K0093

Rear zero pressure tire tube.

K0094

Wheel tire for power base.

K0095

Wheel tire tube each base.

K0096

Wheel assem powr base complt.

K0097

Wheel zero presure tire tube.

K0098

Drive belt power wheelchair.

K0099

Pwr wheelchair front caster.

K0100

Amputee adapter pair.

K0102

Crutch and cane holder.

K0103

Transfer board < 25″.

K0104

Cylinder tank carrier.

K0105

Iv hanger.

K0106

Arm trough each.

K0107

Wheelchair tray.

K0108

W/c component-accessory NOS.

K0114

Whlchr back suprt inr frame.

K0115

Back module orthotic system.

K0116

Back & seat modul orthot sys.

K0195

Elevating whlchair leg rests.

K0268

Humidifier nonheated w PAP.

K0452

Wheelchair bearings.

K0455

Pump uninterrupted infusion.

K0460

WC power add-on joystick.

K0461

WC power add-on tiller cntrl.

K0462

Temporary replacement eqpmnt.

K0531

Heated humidifier used w pap.

K0532

Noninvasive assist wo backup.

K0533

Noninvasive assist w backup.

K0534

Invasive assist w backup.

K0538

Neg pressure wnd thrpy pump.

K0539

Neg pres wnd thrpy dsg set.

K0540

Neg pres wnd thrp canister.

K0541

SGD prerecorded msg <= 8 min.

K0542

SGD prerecorded msg > 8 min.

K0543

SGD msg formed by spelling.

K0544

SGD w multi methods msg/accs.

K0545

SGD sftwre prgrm for PC/PDA.

K0546

SGD accessory, mounting systm.

K0547

SGD accessory NOC.

K0549

Hosp bed hvy dty xtra wide.

K0550

Hosp bed xtra hvy dty x wide.

L3964

Seo mobile arm sup att to wc.

L3965

Arm supp att to wc rancho ty.

L3966

Mobile arm supports reclinin.

L3968

Friction dampening arm supp.

L3969

Monosuspension arm/hand supp.

L3970

Elevat proximal arm support.

L3972

Offset/lat rocker arm w/ ela.

L3974

Mobile arm support supinator.

Table 5.—HCPCS With Status Indicators That Changed From E to Y

CPT/HCPCS

Description

A4232

Syringe w/needle insulin 3cc.

A4632

Infus pump rplcemnt battery.

E0188

Synthetic sheepskin pad.

E0189

Lambswool sheepskin pad.

E0218

Water circ cold pad w pump.

E0602

Manual breast pump.

E0740

Incontinence treatment systm.

E0760

Osteogen ultrasound stimltor.

E0765

Nerve stimulator for tx n&v.

K0610

Peritoneal dialysis clamp.

K0611

Disposable cycler set.

K0612

Drainage ext line, dialysis.

K0613

Ext line w/easy lock connect.

K0614

Chem/antisept solution, 8oz.

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

Dated: December 22, 2003.

Ann C. Agnew,

Executive Secretary to the Department.

[FR Doc. 03-32016 Filed 12-24-03; 1:03 pm]

BILLING CODE 4120-01-P

This is a copy of a public record, reproduced as it was published. It is not legal advice, and it may not be the version a court would rely on. Check the official source before you cite it.