Medicare Program; Revisions to Payment Policies and Adjustments to the Relative Value Units Under the Physician Fee Schedule, Other Part B Payment Policies, and Establishment of the Clinical Psychologist Fee Schedule for Calendar Year 1998; Correction

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Health Care Financing Administration

42 CFR Parts 400, 405, 410, 411, and 414

[HCFA-1884-CN]

RIN 0938-AH94

Medicare Program; Revisions to Payment Policies and Adjustments

to the Relative Value Units Under the Physician Fee Schedule, Other

Part B Payment Policies, and Establishment of the Clinical Psychologist

Fee Schedule for Calendar Year 1998; Correction

AGENCY: Health Care Financing Administration (HCFA), HHS.

ACTION: Correction of final rule with comment period.

-----------------------------------------------------------------------

SUMMARY: This document corrects technical errors that appeared in the

final rule with comment period published in the Federal Register on

October 31, 1997 entitled ``Medicare Program; Revisions to Payment

Policies and Adjustments to the Relative Value Units Under the

Physician Fee Schedule, Other Part B Payment Policies, and

Establishment of the Clinical Psychologist Fee Schedule for Calendar

Year 1998.''

EFFECTIVE DATE: These corrections are effective October 31, 1997.

FOR FURTHER INFORMATION CONTACT:

Stanley Weintraub, (410) 786-4498.

SUPPLEMENTARY INFORMATION:

Background

In FR Doc. 97-28973 of October 31, 1997 (62 FR 59048), there were a

number of technical errors. The errors relate to an omission in the

preamble in the discussion of practice expense relative value units

(RVUs) for procedures furnished in both in-office and out-of-office

settings, to an inconsistency between the preamble discussion and

information in the addenda for HCPCS code G0101 (Cervical or Vaginal

Cancer Screening: Pelvic and Clinical Breast Examination), to

inconsistencies between the preamble discussion and the regulations

text for screening mammography and screening pelvic examinations, and

to an omission of a reference to status indicator ``I'' in the

explanation of the information in Addendum B. We also printed incorrect

information for certain procedure codes in Addendum B, beginning on

page 59103. The corrections appear in this document under the heading

``Correction of Errors.''

Correction of Errors

In FR Doc. 97-28973 of October 31, 1997 (62 FR 59048), make the

following corrections:

Page 59078

Addendum C of the proposed rule titled ``Medicare Program;

Revisions to Payment Policies Under the Physician Fee Schedule, Other

Part B Payment Policies, and Establishment of the Clinical Psychologist

Fee Schedule for Calendar Year 1998'' published in the Federal Register

on June 18, 1997 (62 FR 33158) generally provided resource-based

practice expense RVUs for both in-office and out-of-office settings. We

intended to calculate final resource-based practice expense RVUs by

code and for the two sites in the final rule. However, section 4505 of

the Balanced Budget Act of 1997 (BBA 1997) (Public Law 105-33), enacted

on August 5, 1997, postponed the implementation of this provision until

1999. For the final rule, we wanted the carriers to make the same site-

of-service calculations as they have done in previous years. However,

we neglected to change the language in the preamble to state that the

carriers will continue to calculate the differential. Therefore, on

page 59078, in the second column, in the fourth full paragraph, the

fourth sentence is incorrect and currently reads, ``To coordinate this

policy with the site-of-service distinctions in the June 1997 proposed

rule and the interaction of the provisions of section 4505 of the BBA

1997, we are listing in Addendum B the practice expense RVUs for the

two sites for the 700 procedure codes instead of allowing the carrier

to calculate the 50 percent reduction.'' Remove this sentence and

replace it with the following two sentences: ``Addendum B lists the

practice expense RVUs for both the facility and nonfacility settings.

If the code is subject to the site-of-service differential, the carrier

will reduce the facility practice expense RVU by 50 percent in

calculating the allowance for the code.''

Page 59091

On page 59091, in the first column, in the first full sentence, we

incorrectly stated that the RVUs assigned to HCPCS code G0101 (Cervical

or Vaginal Cancer Screening: Pelvic and Clinical Breast Examination)

are comparable to the RVUs assigned to a new patient office visit. This

statement is inconsistent with the RVUs assigned to this code, which

are correctly listed in Addenda B and C. We should have stated that the

RVUs for HCPCS code G0101 are comparable to the RVUs assigned to an

established patient office visit. Therefore, remove the first full

sentence in the first column on page 59091 and replace it with the

following: ``We decided that this service is comparable to a level 2

evaluation and management established patient office visit.''

Page 59100

On page 59100, there is an inaccuracy that needs to be corrected so

that the regulations text is consistent with the preamble discussion of

mammography services on pages 59078 through 59079, which states that

section 4101(a) of the BBA 1997 amends section 1834(c)(2)(A) of the

Social Security Act effective January 1, 1998 to simply provide that in

the case of any woman over 39 years of age, payment may be made for a

screening mammography if at least 11 months have passed following the

month in which the last screening mammography was performed. On page

59100, we failed to state in the amendatory language in item 4 for

Sec. 410.34 (Mammography services: Conditions for and limitations on

coverage) that we were removing paragraphs (d)(5) and (d)(6), which

specify certain age limitations on the frequency of screening

mammography before the enactment of the BBA 1997 and which are now

obsolete. In addition, because we should have removed these two

paragraphs, the line

[[Page 4596]]

of asterisks following paragraph (d)(4) in the regulations text itself

should not have been included. Therefore, on page 59100, in the first

column, correct the amendatory language in item 4 to read as follows:

``4. Section 410.34 is amended by revising the introductory text to

paragraph (d) and paragraph (d)(4), and by removing paragraphs (d)(5)

and (d)(6), to read as follows:'' Also on page 59100, in the

regulations text itself under Sec. 410.34 (Mammography services:

Conditions for and limitations on coverage), remove the asterisks that

follow paragraph (d)(4).

Page 59101

On page 59101, there is an inaccuracy that needs to be corrected so

that the regulations text is consistent with the law and the preamble

discussion of screening pelvic examinations on pages 59082 through

59083, which defines such an examination to be one performed for the

early detection of cervical or vaginal cancer without regard to whether

the results are normal or not. On page 59101, in the regulations text

under Sec. 410.56 (Screening pelvic examinations), correct paragraphs

(b)(1) and (b)(4) by removing the words ``and found to be normal'' at

the end of each sentence.

Page 59103

On page 59103, in the explanation of the information in Addendum B,

we omitted a reference to status indicator ``I.'' Therefore, on page

59103, add the following after the entry for status code ``G'':

``I=Code not valid for Medicare purposes. Medicare does not

recognize codes assigned this status. Medicare uses another code for

reporting of, and payment for, these services. This indicator is

treated in the same manner as status indicator ``G.'' Its use allows

for more efficient carrier processing of Medicare claims.

Addendum B, pages 59103 through 59247

We assigned incorrect RVUs to the following CPT codes. Entries on

the pages listed below for the codes listed are corrected as follows:

Page 59103 for CPT codes 11055, 11056, and 11057; page 59104 for CPT

code 11719; page 59158 for CPT codes 59150 and 59151; page 59183 for

CPT codes 76076 and 76076-TC; and page 59214 for CPT codes 92543,

92543-TC, and 92543-26.

--------------------------------------------------------------------------------------------------------------------------------------------------------

Non-

Physician facility Facility Non-

CPT \1\/HCPCS MOD Status Description work RVUs practice practice Malpractice facility Facility Global

\2\ \3\ \4\ expense expense RVUs total total

RVUs \5\ RVUs \5\

--------------------------------------------------------------------------------------------------------------------------------------------------------

* * * * * * *

11055......... ............ R Trim skin lesion.. 0.27 0.26 0.26 0.01 0.54 0.54 000

11056......... ............ R Trim 2-4 skin 0.39 0.35 0.35 0.02 0.76 0.76 000

lesions.

11057......... ............ R Trim over 4 skin 0.50 0.28 0.28 0.02 0.80 0.80 000

lesions.

* * * * * * *

11719......... ............ R Trim nail(s)...... 0.11 0.24 0.12 0.01 0.36 0.24 000

* * * * * * *

59150......... ............ A Treat ectopic..... *11.20 4.53 4.53 1.05 16.78 16.78 090

59151......... ............ A Treat ectopic *11.10 8.61 8.61 0.64 20.35 20.35 090

pregnancy.

76076......... ............ A Dual energy x-ray 0.22 0.82 0.82 0.07 1.11 1.11 XXX

study.

76076......... TC.......... A Dual energy x-ray 0.00 0.72 0.72 0.05 0.77 0.77 XXX

study.

* * * * * * *

92543......... ............ A Caloric vestibular 0.10 0.21 0.21 0.02 0.33 0.33 XXX

test.

92543......... TC.......... A Caloric vestibular 0.00 0.10 0.10 0.01 0.11 0.11 XXX

test.

92543......... 26.......... A Caloric vestibular 0.10 0.11 0.11 0.01 0.22 0.22 XXX

test.

* * * * * * *

--------------------------------------------------------------------------------------------------------------------------------------------------------

\1\ CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

\2\ Copyright 1994 American Dental Association. All rights reserved.

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

\4\ * Work RVUs increased in global surgical package.

\5\ # Indicates reduction of Practice Expense RVUs as a result of 110% PE reduction.

Page 59239

We erroneously assigned a status indicator of ``A'' (Active code)

in the column labeled ``Status'' for HCPCS code G0116 (NETT;

psychosocial counsel). The corrected status indicator should be ``R,''

which means restricted coverage.

--------------------------------------------------------------------------------------------------------------------------------------------------------

Non-

Physician facility Facility Non-

CPT \1\/HCPCS MOD Status Description work practice practice Malpractice facility Facility Global

\2\ RVUS\3\ \4\ expense expense RVUs total total

RVUs\5\ RVUs\5\

--------------------------------------------------------------------------------------------------------------------------------------------------------

* * * * * * *

G0116......... ............ R NETT; psychosocial 0.11 0.35 0.35 0.05 1.51 1.51 XXX

counsel.

* * * * * * *

--------------------------------------------------------------------------------------------------------------------------------------------------------

\1\ CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

\2\ Copyright 1994 American Dental Association. All rights reserved.

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

\4\ Work RVUs increased in global surgical package.

\5\ Indicates reduction of Practice Expense RVUs as a result of 110% PE reduction.

Additionally, we printed incorrect short descriptors for certain

codes in Addendum B. Entries on the pages listed below for the codes

listed are corrected as follows: Page 59107 for CTP code 17200; page

59194 for CPT codes 80004, 80009, 80010, 80018, and 80019; page 59202

for CTP codes 86287, 86290, 86295, and 86311; page 59208 for CPT

[[Page 4597]]

codes 88157, and 88157-26; page 59211 for CTP codes 90825 and 90855;

and page 59226 for CPT codes 99353 and 99376.

--------------------------------------------------------------------------------------------------------------------------------------------------------

Non-

facility Facility Non-

CPT \1\/ HCPCS MOD Status Description Physician practice practice Malpractice facility Facility Global

\2\ work RVUs 3 expense expense RVUs total total

4 RVUs \5\ RVUs \5\

--------------------------------------------------------------------------------------------------------------------------------------------------------

* * * * * * *

17200......... ............ D Electro-cautery of * 0.00 0.00 0.00 0.00 0.00 0.00 XXX

skin tags.

* * * * * * *

80004......... ............ D 4 clinical 0.00 0.00 0.00 0.00 0.00 0.00 XXX

chemistry tests.

* * * * * * *

80009......... ............ D 9 clinical 0.00 0.00 0.00 0.00 0.00 0.00 XXX

chemistry tests.

* * * * * * *

80010......... ............ D 10 clinical 0.00 0.00 0.00 0.00 0.00 0.00 XXX

chemistry tests.

* * * * * * *

80018......... ............ D 17-18 blood/urine 0.00 0.00 0.00 0.00 0.00 0.00 XXX

tests.

* * * * * * *

80019......... ............ D 19 blood/urine 0.00 0.00 0.00 0.00 0.00 0.00 XXX

tests.

* * * * * * *

86287......... ............ D Hepatitis B 0.00 0.00 0.00 0.00 0.00 0.00 XXX

(HBsAg).

* * * * * * *

86290......... ............ D Hepatitis BC 0.00 0.00 0.00 0.00 0.00 0.00 XXX

antibody test.

* * * * * * *

86295......... ............ D Hepatitis BE 0.00 0.00 0.00 0.00 0.00 0.00 XXX

antibody test.

* * * * * * *

86311......... ............ D HIV antigen test.. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

* * * * * * *

88157......... ............ D TBS smear 0.00 0.00 0.00 0.00 0.00 0.00 XXX

(bethesda system).

* * * * * * *

88157......... 26.......... D TSB smear 0.00 0.00 0.00 0.00 0.00 0.00 XXX

(bethesda system).

* * * * * * *

90825......... ............ D Evaluation of 0.00 0.00 0.00 0.00 0.00 0.00 XXX

tests/records.

* * * * * * *

90855......... ............ D Individual 0.00 0.00 0.00 0.00 0.00 0.00 XXX

psychotherapy.

* * * * * * *

99353......... ............ D Home visit/estab 0.00 0.00 0.00 0.00 0.00 0.00 XXX

patient.

* * * * * * *

99376......... ............ D Care plan 0.00 0.00 0.00 0.00 0.00 0.00 XXX

oversight/over 60.

* * * * * * *

--------------------------------------------------------------------------------------------------------------------------------------------------------

\1\ CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

\2\ Copyright 1994 American Dental Association. All rights reserved.

\3\ Inidcates RVUs are not used for Medicare payment.

\4\ Work RVUs increased in global surgical package.

\5\ Indicates reduction of Practice Expense RVUs as a result of 100% reduction.

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: January 14, 1998.

Neil J. Stillman,

Deputy Assistant, Secretary for, Information Resources Management.

[FR Doc. 98-2328 Filed 1-29-98; 8:45 am]

BILLING CODE 4120-01-M