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

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URL: https://www.frixlaw.com/law-library/documents/fr%3A03-32016

## Record

- **Collection:** Federal Register
- **Document type:** Rule
- **Published:** December 31, 2003
- **Citation:** 68 FR 75442

## Text

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
T
0.7612
41.53
11.18
8.31

0013
Level II Debridement & Destruction
T
1.1302
61.66
14.20
12.33

0108
Insertion/Replacement/Repair of Cardioverter-Defibrillator Leads
T
452.6995
24699.74

4939.95

0121
Level I Tube changes and Repositioning
T
2.1114
115.20
43.80
23.04

0123
Bone Marrow Harvesting and Bone Marrow/Stem Cell Transplant
S
6.1499
335.54

67.11

0272
Level I Fluoroscopy
X
1.4184
77.39
38.36
15.48

0321
Biofeedback and Other Training
S
1.4817
80.84
21.78
16.17

0339
Observation
S
6.6961
365.35

73.07

0373
Neuropsychological Testing
X
2.3288
127.06

25.41

0384
GI Procedures with Stents
T
36.5400
1993.66
433.01
398.73

APC 0413 is deleted

0734
Injection, darbepoetin alfa (for non-ESRD, per 1 mcg
K
0.0594
3.24

0.65

9012
Arsenic Trioxide
K

34.32

.6.86

1604
IN 111 capromab pendetide, per dose
K
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
C
DG
endo repair abd aa aorto uni

00546
C

Anesth, lung, chest wall surg

00548
N

Anesth, trachea, bronchi surg

0054T
B
NI
Bone surgery using computer

00550
N

Anesth, sternal debridement

0055T
B
NI
Bone surgery using computer

00560
C

Anesth, open heart surgery

00562
C

Anesth, open heart surgery

00563
N

Anesth, heart proc w/pump

00566
N

Anesth, cabg w/o pump

0056T
B
NI
Bone surgery using computer

0057T
B
NI
Uppr gi scope w/ thrml txmnt

0060T
B
NI
Electrical impedance scan

0061T
B
NI
Destruction of tumor, breast

11001
T

Debride infected skin add-on
0012
0.7612
41.53
11.18
8.31

11055
T

Trim skin lesion
0012
0.7612
41.53
11.18
8.31

11056
T

Trim skin lesions, 2 to 4
0012
0.7612
41.53
11.18
8.31

11057
T

Trim skin lesions, over 4
0013
1.1302
61.66
14.20
12.33

11200
T

Removal of skin tags
0013
1.1302
61.66
14.20
12.33

11300
T

Shave skin lesion
0012
0.7612
41.53
11.18
8.31

11301
T

Shave skin lesion
0012
0.7612
41.53
11.18
8.31

11302
T

Shave skin lesion
0012
0.7612
41.53
11.18
8.31

11305
T

Shave skin lesion
0013
1.1302
61.66
14.20
12.33

11306
T

Shave skin lesion
0013
1.1302
61.66
14.20
12.33

11307
T

Shave skin lesion
0013
1.1302
61.66
14.20
12.33

11308
T

Shave skin lesion
0013
1.1302
61.66
14.20
12.33

11310
T

Shave skin lesion
0013
1.1302
61.66
14.20
12.33

11311
T

Shave skin lesion
0013
1.1302
61.66
14.20
12.33

11312
T

Shave skin lesion
0013
1.1302
61.66
14.20
12.33

11730
T

Removal of nail plate
0013
1.1302
61.66
14.20
12.33

11732
T

Remove nail plate, add-on
0012
0.7612
41.53
11.18
8.31

11900
T

Injection into skin lesions
0012
0.7612
41.53
11.18
8.31

11901
T

Added skin lesions injection
0012
0.7612
41.53
11.18
8.31

15786
T

Abrasion, lesion, single
0012
0.7612
41.53
11.18
8.31

15787
T

Abrasion, lesions, add-on
0013
1.1302
61.66
14.20
12.33

15788
T

Chemical peel, face, epiderm
0012
0.7612
41.53
11.18
8.31

15792
T

Chemical peel, nonfacial
0012
0.7612
41.53
11.18
8.31

15793
T

Chemical peel, nonfacial
0012
0.7612
41.53
11.18
8.31

15852
X

Dressing change not for burn
0340
0.6314
34.45

6.89

16000
T

Initial treatment of burn(s)
0012
0.7612
41.53
11.18
8.31

16020
T

Treatment of burn(s)
0013
1.1302
61.66
14.20
12.33

16025
T

Treatment of burn(s)
0012
0.7612
41.53
11.18
8.31

17250
T

Chemical cautery, tissue
0013
1.1302
61.66
14.20
12.33

17271
T

Destruction of skin lesions
0013
1.1302
61.66
14.20
12.33

17340
T

Cryotherapy of skin
0012
0.7612
41.53
11.18
8.31

17360
T

Skin peel therapy
0012
0.7612
41.53
11.18
8.31

17380
T

Hair removal by electrolysis
0012
0.7612
41.53
11.18
8.31

31502
T

Change of windpipe airway
0121
2.1114
115.20
43.80
23.04

38230
S

Bone marrow collection
0111
13.1719
718.67
200.18
143.73

38240
S

Bone marrow/stem transplant
0123
6.1499
335.54

67.11

38241
S

Bone marrow/stem transplant
0123
6.1499
335.54

67.11

43219
T

Esophagus endoscopy
0384
36.5400
1993.66
433.01
398.73

43256
T

Uppr gi endoscopy w stent
0384
36.5400
1993.66
433.01
398.73

43268
T

Endo cholangiopancreatograph
0384
36.5400
1993.66
433.01
398.73

43269
T

Endo cholangiopancreatograph
0384
36.5400
1993.66
433.01
398.73

43752
T

Nasal/orogastric w/stent
0121
2.1114
115.20
43.80
23.04

43760
T

Change gastrostomy tube
0121
2.1114
115.20
43.80
23.04

43761
T

Reposition gastrostomy tube
0121
2.1114
115.20
43.80
23.04

44370
T

Small bowel endoscopy/stent
0384
36.5400
1993.66
433.01
398.73

44379
T

S bowel endoscope w/stent
0384
36.5400
1993.66
433.01
398.73

44383
T

Ileoscopy w/stent
0384
36.5400
1993.66
433.01
398.73

44397
T

Colonoscopy w/stent
0384
36.5400
1993.66
433.01
398.73

44500
T

Intro, gastrointestinal tube
0121
2.1114
115.20
43.80
23.04

45327
T

Proctosigmoidoscopy w/stent
0384
36.5400
1993.66
433.01
398.73

45345
T

Sigmoidoscopy w/stent
0384
36.5400
1993.66
433.01
398.73

45387
T

Colonoscopy w/stent
0384
36.5400
1993.66
433.01
398.73

46916
T

Cryosurgery, anal lesion(s)
0013
1.1302
61.66
14.20
12.33

47135
C

Transplantation of liver

47136
C

Transplantation of liver

47300
C

Surgery for liver lesion

47350
C

Repair liver wound

51705
T

Change of bladder tube
0121
2.1114
115.20
43.80
23.04

54050
T

Destruction, penis lesion(s)
0013
1.1302
61.66
14.20
12.33

54056
T

Cryosurgery, penis lesion(s)
0012
0.7612
41.53
11.18
8.31

55870
T

Electroejaculation
0197
4.8280
263.42

52.68

62194
T

Replace/irrigate catheter
0121
2.1114
115.20
43.80
23.04

69220
T

Clean out mastoid cavity
0012
0.7612
41.53
11.18
8.31

70370
X

Throat x-ray & fluoroscopy
0272
1.4184
77.39
38.36
15.48

70371
X

Speech evaluation, complex
0272
1.4184
77.39
38.36
15.48

71023
X

Chest x-ray and fluoroscopy
0272
1.4184
77.39
38.36
15.48

71034
X

Chest x-ray and fluoroscopy
0272
1.4184
77.39
38.36
15.48

71090
X

X-ray & pacemaker insertion
0272
1.4184
77.39
38.36
15.48

74340
X

X-ray guide for GI tube
0272
1.4184
77.39
38.36
15.48

76000
X

Fluoroscope examination
0272
1.4184
77.39
38.36
15.48

76120
X

Cine/video x-rays
0272
1.4184
77.39
38.36
15.48

76496
X

Fluoroscopic procedure
0272
1.4184
77.39
38.36
15.48

76977
X

Us bone density measure
0340
0.6314
34.45

6.89

90296
N

Diphtheria antitoxin

90581
N

Anthrax vaccine, sc

90911
S

Biofeedback peri/uro/rectal
0321
1.4817
80.84
21.78
16.17

90918
E

ESRD related services, month

90919
E

ESRD related services, month

90920
E

ESRD related services, month

90921
E

ESRD related services, month

90922
E

ESRD related services, day

90923
E

ESRD related services, day

90924
E

ESRD related services, day

90925
E

ESRD related services, day

92019
T

Eye exam & treatment
0699
2.2303
121.69
47.46
24.34

96100
X

Psychological testing
0373
2.3288
127.06

25.41

96110
X

Developmental test, lim
0373
2.3288
127.06

25.41

96111
X

Developmental test, extend
0373
2.3288
127.06

25.41

96115
X

Neurobehavior status exam
0373
2.3288
127.06

25.41

96117
X

Neuropsych test battery
0373
2.3288
127.06

25.41

96920
T

Laser tx, skin < 250 sq cm
0012
0.7612
41.53
11.18
8.31

96921
T

Laser tx, skin 250-500 sq cm
0012
0.7612
41.53
11.18
8.31

96922
T

Laser tx, skin > 500 sq cm
0013
1.1302
61.66
14.20
12.33

99002
B

Device handling

99140
B

Emergency anesthesia

99375
E

Home health care supervision

99378
E

Hospice care supervision

A4671
B
NI
Disposable cycler set

A4672
B
NI
Drainage ext line, dialysis

A4673
B
NI
Ext line w easy lock connect

A4674
B
NI
Chem/antisept solution, 8oz

A4728
B
NI
Dialysate solution, non-dex

A9507
K

Indium/111 capromab pendetid
1604
20.2752
1106.24

221.25

A9526
N
NI
Ammonia N-13, per dose

A9527
D
DNG
I-131 tositumomab therapeut

A9700
E

Echocardiography Contrast

C1088
D
DNG
Laser Optic Tr Sys

0.65

C1774
K
DG
Darbepoetin alfa, 1 mcg
0734
0.0594
3.24

E0141
Y

Rigid wheeled walker adj/fix

E0165
A

Commode chair stationry det

E0973
B

W/Ch access det adj armrest

E0974
B

W/Ch access anti-rollback

E0978
B

W/C acc,saf belt pelv strap

E1065
B
DG
Wheelchair power attachment

E1226
B

W/C access fully reclineback

E1634
B
NI
Peritoneal dialysis clamp

G0210
S

PET img wholebody dxlung

1450.00

290.00

G0213
S

PET img wholbody dx

1450.00

290.00

G0214
S

PET img wholebod init

1450.00

290.00

G0215
S

PETimg wholebod restag

1450.00

290.00

G0230
S

PET myocard viability post

1450.00

290.00

G0244
S

Observ care by facility topt
0339
6.6961
365.35

73.07

G0246
V

Followup eval of foot pt lop
0600
0.9278
50.62

10.12

G0247
T

Routine footcare pt w lops
0009
0.6652
36.29
8.34
7.26

G0248
S

Demonstrate use home inr mon
1503

150.00

30.00

G0272
X
DG
Naso/oro gastric tube pl MD
0272
1.4184
77.39
38.36
15.48

G0299
T
NF
Inser/repos single icd+leads
0108
452.6995
24699.74

4939.95

G0300
T
NF
Insert reposit lead dual+gen
0108
452.6995
24699.74

4939.95

G0308
A
NI
ESRD related svc 4+mo<2yrs

G0309
A
NI
ESRD related svc 2-3mo<2yrs

G0310
A
NI
ESRD related svc 1vst<2yr

G0311
A
NI
ESRD related svs 4+mo 2-11 yr

G0312
A
NI
ESRD relate svs 2-3 mo 2-11 y

G0313
A
NI
ESRD related svs 1 mon 2-11 y

G0314
A
NI
ESRD related svs 4+mo 12-19

G0315
A
NI
ESRD related svs 2-3 mo 12-19

G0316
A
NI
ESRD related svs 1 vis/ 12-19y

G0317
A
NI
ESRD related svs 4+mo 20+yrs

G0318
A
NI
ESRD related svs 2-3 mo 20+y

G0319
A
NI
ESRD related svs 1 visit 20+y

G0320
A
NI
ESRD related svs home undr 2

G0321
A
NI
ESRD related svs home mo<2ys

G0322
A
NI
ESRD related svs hom mo12-19

G0328
A
NI
Fecal blood scrn immunoassay

J1563
K

IV immune globulin
0905
0.8057
43.96

8.79

J2260
K

Inj milrinone lactate/5 MG
7007
0.2129
11.62

2.32

J2324
G

Nesiritide
9114

151.62

22.66

J7330
B

Cultured chondrocytes implnt

J8700
K

Temozolomide
1086
0.0690
3.76

0.75

J9017
K

Arsenic trioxide
9012

34.32

6.86

K0560
N
DG
MCP joint 2-piece for implnt

K0600
Y
NF
Functional neuromuscularstim

K0607
Y
NF
Repl batt for AED

K0614
Y
DG
Chem/antisept solution, 8oz

K0615
Y
DG
SGD prerec mes >8min <=20min

K0616
Y
DG
SGD prerec mes>20min <=40min

K0617
Y
DG
SGD prerec mes > 40min

L3350
B

Shoe heel wedge

L4350
A

Ankle control orthosi prefab

L4360
A

Pneumati walking boot prefab

L4386
A

Non-pneum walk boot prefab

L5646
A

Below knee cushion socket

L5648
A

Above knee cushion socket

P9603
A

One-way allow prorated miles

Q0137
K
NI
Darbepoetin alfa, non esrd
0734
0.0594
3.24

0.65

Q4078
N
DG
Ammonia N-13, per dose

V2761
B
NI
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

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Source: Frix Law Library, https://www.frixlaw.com/law-library/documents/fr%3A03-32016. Public record. Not legal advice.