Medicare Program; Refinements to Geographic Adjustment Factor Values, Revisions to Payment Policies, Adjustments to the Relative Value Units (RVUs) Under the Physician Fee Schedule for Calendar Year 1995, and the 5-Year Refinement of RVUs; Correction
Federal RegisterJul 18, 1995
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Health Care Financing Administration
42 CFR Parts 410 and 414
[BPD-789-CN]
RIN 0938-AG52
Medicare Program; Refinements to Geographic Adjustment Factor
Values, Revisions to Payment Policies, Adjustments to the Relative
Value Units (RVUs) Under the Physician Fee Schedule for Calendar Year
1995, and the 5-Year Refinement of RVUs; Correction
AGENCY: Health Care Financing Administration (HCFA), HHS.
ACTION: Correction of final rule with comment period.
-----------------------------------------------------------------------
SUMMARY: This document is a second correction to technical errors that
appeared in the final rule with comment period entitled ``Medicare
Program; Refinements to Geographic Adjustment Factor Values, Revisions
to Payment Policies, Adjustments to the Relative Value Units (RVUs)
Under the Physician Fee Schedule for Calendar Year 1995, and the 5-Year
Refinement of RVUs'' published in the Federal Register on December 8,
1994. The first correction notice was published in the Federal Register
on January 3, 1995 (60 FR 46).
EFFECTIVE DATE: January 1, 1995.
FOR FURTHER INFORMATION CONTACT: Elizabeth Holland, (410) 966-1309.
SUPPLEMENTARY INFORMATION:
Background
In the FR Doc. (94-29916) dated December 8, 1994, there were a
number of technical and typographical errors in the preamble, in the
regulations text, and in the addenda. To correct these errors, we
published a correction notice in the Federal Register on January 3,
1995 (60 FR 46). Since the publication of that correction notice, we
discovered additional errors, beginning on page 63417, in the preamble,
in one section of the regulations text, in Addendum B (``Relative Value
Units (RVUs) and Related Information''), and in Addendum F (``Procedure
Codes Subject to the Site-of-Service Differential''). The corrections
appear later in this document, under the heading ``Correction of
Errors.''
In the preamble, on pages 63417 and 63432, we incorrectly referred
to the ``American Osteopathic Association'' as the ``American Academy
of Osteopathy.'' Also, on page 63425, we provided an incorrect response
to one of the public comments we received.
In the regulations text set forth at Sec. 414.39 (``Special rules
for payment of care plan oversight''), on page 63463, we inadvertently
failed to state, in paragraph (b)(2) concerning the conditions under
which separate payment may be made, that a physician may not have an
ownership interest in a home health agency.
In Addendum B, we inadvertently printed incorrect information for
certain codes. In Addendum F, we should not have included HCPCS codes
29530, 95880, and 95881.
Correction of Errors
In FR Doc. 94-29916 of December 8, 1994 (59 FR 63410) make the
following corrections:
A. Page 63417
On page 63417, in column one, in the second bullet point, replace
the ``American Academy of Osteopathy'' with the ``American Osteopathic
Association.''
B. Page 63425
On page 63425, in column three, remove the response to the second
comment, and, in its place, insert the following response: ``The
commenters correctly stated that psychotherapy codes are excluded from
the site-of-service list; however, the two codes listed are not
psychotherapy codes. They are diagnostic tests. Since these codes lack
work RVUs, these codes should be treated like CPT code 90830,
psychological testing. Therefore, we are modifying our proposed site-
of-service list and are removing CPT codes 95880 and 95881 from the
list.''
C. Page 63432
On page 63432, in column two, in the second bullet point, replace
the ``American Academy of Osteopathy'' with the ``American Osteopathic
Association.''
D. Page 63463
On page 63463, in column 2, in line 3, in Sec. 414.39(b)(2), insert
the phrase ``ownership interest in, or'' before the word ``financial,''
and insert a comma after the word ``with'' in line 4.
[[Page 36734]]
E. Page 63493, Addendum B
On page 63493, Addendum B is corrected to read as follows:
--------------------------------------------------------------------------------------------------------------------------------------------------------
Practice
HCPCS MOD Status Description Work expense Malpractice Total Global Update
\1\ RVUs RVUs \3\ RVUs period
-------------------------------------------------------------------------------------------\2\----------------------------------------------------------
31231... ....... A............ Nasal endoscopy, dx.................................. 1.10 1.37 0.15 2.62 000 S
31233... ....... A............ Nasal/sinus endoscopy, dx............................ 2.18 * 2.79 0.31 5.28 000 S
31235... ....... A............ Nasal/sinus endoscopy, dx............................ 2.64 2.39 0.26 5.29 000 S
31237... ....... A............ Nasal/sinus endoscopy, surg.......................... 2.98 3.37 0.37 6.72 000 S
--------------------------------------------------------------------------------------------------------------------------------------------------------
\1\ All numeric CPT HCPCS Copyright 1994 American Medical Association.
\2\ # Indicates RVUs are not used for Medicare payment.
\3\ * Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.
F. Page 63503, Addendum B
On page 63503, Addendum B is corrected to read as follows:
--------------------------------------------------------------------------------------------------------------------------------------------------------
Practice
HCPCS MOD Status Description Work expense Malpractice Total Global Update
\1\ RVUs RVUs \3\ RVUs period
-------------------------------------------------------------------------------------------\2\----------------------------------------------------------
36522... ....... A............ Photopheresis........................................ 1.67 * 3.31 0.37 5.35 000 S
--------------------------------------------------------------------------------------------------------------------------------------------------------
\1\ All numeric CPT HCPCS Copyright 1994 American Medical Association.
\2\ # Indicates RVUs are not used for Medicare payment.
\3\ * Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.
G. Page 63509, Addendum B
On page 63509, Addendum B is corrected to read as follows:
--------------------------------------------------------------------------------------------------------------------------------------------------------
Practice
HCPCS MOD Status Description Work expense Malpractice Total Global Update
\1\ RVUs RVUs \3\ RVUs period
-------------------------------------------------------------------------------------------\2\----------------------------------------------------------
43847... ....... A............ Gastric bypass for obesity........................... 19.87 14.80 3.30 37.97 090 S
--------------------------------------------------------------------------------------------------------------------------------------------------------
\1\ All numeric CPT HCPCS Copyright 1994 American Medical Association.
\2\ #Indicates RVUs are not used for Medicare payment.
\3\ *Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.
H. Page 63563, Addendum B
On page 63563, Addendum B is corrected to read as follows:
--------------------------------------------------------------------------------------------------------------------------------------------------------
Practice
HCPCS MOD Status Description Work expense Malpractice Total Global Update
\1\ RVUs RVUs \3\ RVUs period
----------------------------------------------------------------------------------------\2\-------------------------------------------------------------
78806... ....... A............ Abscess imaging, whole body....................... 0.86 6.51 0.45 7.82 XXX........ N
78806... 26..... A............ Abscess imaging, whole body....................... 0.86 0.38 0.06 1.30 XXX........ N
--------------------------------------------------------------------------------------------------------------------------------------------------------
\1\ All numeric CPT HCPCS Copyright 1994 American Medical Association.
\2\ #Indicates RVUs are not used for Medicare payment.
\3\ *Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.
I. Page 63580, Addendum B
On page 63580, Addendum B is corrected to read as follows:
--------------------------------------------------------------------------------------------------------------------------------------------------------
Practice
HCPCS MOD Status Description Work expense Malpractice Total Global Update
\1\ RVUs RVUs \3\ RVUs period
----------------------------------------------------------------------------------------\2\-------------------------------------------------------------
90846... ....... R............ Special family therapy............................ 1.82 0.62 0.08 2.52 XXX........ N
90847... ....... R............ Special family therapy............................ 2.19 0.58 0.08 2.85 XXX........ N
90887... ....... R............ Consultation with family.......................... 1.48 0.33 0.04 1.85 XXX........ N
--------------------------------------------------------------------------------------------------------------------------------------------------------
\1\ All numeric CPT HCPCS Copyright 1994 American Medical Association.
\2\ #Indicates RVUs are not used for Medicare payment.
\3\ *Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.
J. Page 63590, Addendum B
On page 63590, Addendum B is corrected to read as follows:
--------------------------------------------------------------------------------------------------------------------------------------------------------
Practice
HCPCS MOD Status Description Work expense Malpractice Total Global Update
\1\ RVUs RVUs \3\ RVUs period
----------------------------------------------------------------------------------------\2\-------------------------------------------------------------
95115... ....... A............ Immunotherapy, one injection...................... 0.00 0.37 0.02 0.39 000........ N
95117... ....... A............ Immunotherapy injections.......................... 0.00 0.48 0.02 0.50 000........ N
--------------------------------------------------------------------------------------------------------------------------------------------------------
\1\ All numeric CPT HCPCS Copyright 1994 American Medical Association.
[[Page 36735]]
\2\ #Indicates RVUs are not used for Medicare payment.
\3\ *Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.
K. Page 63591, Addendum B
On page 63591, Addendum B is corrected to read as follows:
--------------------------------------------------------------------------------------------------------------------------------------------------------
Practice
HCPCS MOD Status Description Work expense Malpractice Total Global Update
\1\ RVUs RVUs \3\ RVUs period
----------------------------------------------------------------------------------------\2\-------------------------------------------------------------
95144... ....... A............ Antigen therapy services.......................... 0.06 0.13 0.01 0.20 000........ N
95145... ....... A............ Antigen therapy services.......................... 0.06 0.34 0.03 0.43 000........ N
95146... ....... A............ Antigen therapy services.......................... 0.06 0.61 0.03 0.70 000........ N
95147... ....... A............ Antigen therapy services.......................... 0.06 0.91 0.03 1.00 000........ N
95148... ....... A............ Antigen therapy services.......................... 0.06 0.91 0.03 1.00 000........ N
95149... ....... A............ Antigen therapy services.......................... 0.06 1.14 0.03 1.23 000........ N
95165... ....... A............ Antigen therapy services.......................... 0.06 0.10 0.01 0.17 000........ N
95170... ....... A............ Antigen therapy services.......................... 0.06 0.35 0.03 0.44 000........ N
95180... ....... A............ Rapid desensitization............................. 2.01 0.14 0.01 2.16 000........ N
95199... ....... C............ Allergy immunology services....................... 0.00 0.00 0.00 0.00 000........ N
95807... ....... A............ Sleep study....................................... 1.66 8.75 0.67 11.08 XXX........ N
95807... 26..... A............ Sleep study....................................... 1.66 2.45 0.19 4.30 XXX........ N
95807... TC..... A............ Sleep study....................................... 0.00 6.30 0.48 6.78 XXX........ N
95808... ....... A............ Polysomnography, 1-3.............................. 2.65 8.75 0.67 12.07 XXX........ N
95808... 26..... A............ Polysomnography, 1-3.............................. 2.65 2.45 0.19 5.29 XXX........ N
95808... TC..... A............ Polysomnography, 1-3.............................. 0.00 6.30 0.48 6.78 XXX........ N
95810... ....... A............ Polysomnography, 4 or more........................ 3.53 8.75 0.67 12.95 XXX........ N
95810... 26..... A............ Polysomnography, 4 or more........................ 3.53 2.45 0.19 6.17 XXX........ N
95810... TC..... A............ Polysomnography, 4 or more........................ 0.00 6.30 0.48 6.78 XXX........ N
--------------------------------------------------------------------------------------------------------------------------------------------------------
\1\ All numeric CPT HCPCS Copyright 1994 American Medical Association.
\2\ #Indicates RVUs are not used for Medicare payment.
\3\ *Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.
L. Page 63594, Addendum B
On page 63594, Addendum B is corrected to read as follows:
--------------------------------------------------------------------------------------------------------------------------------------------------------
Practice
HCPCS\1\ MOD Status Description Work expense Malpractice Total Global Update
RVUs\2\ RVUs\3\ RVUs period
--------------------------------------------------------------------------------------------------------------------------------------------------------
97770... ....... A............ Cognitive skills development...................... 0.44 0.28 0.03 0.75 XXX........ N
--------------------------------------------------------------------------------------------------------------------------------------------------------
\1\ All numeric CPT HCPCS Copyright 1994 American Medical Association.
\2\ #Indicates RVUs are not used for Medicare payment.
\3\ *Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.
M. Page 63599, Addendum B
On page 63599, Addendum B is corrected to read as follows:
--------------------------------------------------------------------------------------------------------------------------------------------------------
Practice
HCPCS\1\ MOD Status Description Work expense Malpractice Total Global Update
RVUs\2\ RVUs\3\ RVUs period
--------------------------------------------------------------------------------------------------------------------------------------------------------
A4643... ....... E............ High dose contrast MRI............................ 0.00 0.00 0.00 0.00 XXX........ O
--------------------------------------------------------------------------------------------------------------------------------------------------------
\1\ All numeric CPT HCPCS Copyright 1994 American Medical Association.
\2\ #Indicates RVUs are not used for Medicare payment.
\3\ *Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.
N Page 63614, Addendum B
On page 63614, HCPCS code Q0126 in Addendum B is corrected and
HCPCS codes Q0137 and Q0138 are added to read as follows:
--------------------------------------------------------------------------------------------------------------------------------------------------------
Practice
HCPCS MOD Status Description Work Expense Malpractice Total Global Update
\1\ RVUs RVUs \3\ RVUs period
----------------------------------------------------------------------------------------\2\-------------------------------------------------------------
Q0126... ....... D............ Immunoassay inf agnt antigen...................... 0.00 0.00 0.00 0.00 000........ O
Q0137... ....... E............ Inj Dexamethasone Acet 8MG........................ 0.00 0.00 0.00 0.00 XXX........ O
Q0138... ....... E............ Inj Dexamethasone Acet 16MG....................... 0.00 0.00 0.00 0.00 XXX........ O
--------------------------------------------------------------------------------------------------------------------------------------------------------
\1\ All numeric CPT HCPCS Copyright 1994 American Medical Association.
\2\ #Indicates RVUs are not used for Medicare payment.
\3\ *Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.
O Page 63631, Addendum F
On page 63631, Addendum F, remove HCPCS *29530, Strapping of knee.
P. Page 63632, Addendum F
[[Page 36736]]
On page 63632, Addendum F, remove HCPCS *95880, Cerebral aphasia
testing and HCPCS *95881, Cerebral developmental test.
(Section 1848 of the Social Security Act (42 U.S.C. 1395w-4))
(Catalog of Federal Domestic Assistance Program No. 93.774,
Medicare--Supplementary Medical Insurance Program)
Dated: June 21, 1995.
Neil J. Stillman,
Deputy Assistant Secretary for Information Resources Management.
[FR Doc. 95-17570 Filed 7-17-95; 8:45 am]
BILLING CODE 4120-01-P
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