Medicare Program; Revisions to Payment Policies and Adjustments to the Relative Value Units Under the Physician Fee Schedule for Calendar Year 1999; Correction

Federal RegisterMay 12, 1999

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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Health Care Financing Administration

42 CFR Parts 405, 410, 413, 414, 415, 424, and 485

[HCFA-1006-CN]

RIN 0938-AI52

Medicare Program; Revisions to Payment Policies and Adjustments

to the Relative Value Units Under the Physician Fee Schedule for

Calendar Year 1999; 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

November 2, 1998, entitled ``Medicare Program; Revisions to Payment

Policies and Adjustments to the Relative Value Units Under the

Physician Fee Schedule for Calendar Year 1999.''

EFFECTIVE DATE: January 1, 1999.

FOR FURTHER INFORMATION CONTACT: Diane Milstead, (410) 786-3355

SUPPLEMENTARY INFORMATION:

Background

In FR Doc. 98-29181 of November 2, 1998, (63 FR 58814), there were

a number of technical errors. The errors relate to the omission of

background information, an incorrect reference, the qualification

requirements for nonphysician practitioners, a typographical error, a

correction to a CPT code modifier in Table 6, an inconsistency in the

preamble and addendum, the omission of status indicator references, the

omission of a facility type in the regulations text, and revisions to

Addendum B.

The provisions in this correction notice are effective as if they

had been included in the document published in the Federal Register on

November 2, 1998, that is, January 1, 1999.

Discussion of Addendum B

1. We inadvertently omitted the professional and technical portions

for the following CPT code. Entries on the page listed below are

corrected as follows: Page 59073 for CPT codes 78020-26 and 78020-TC.

These corrections are reflected in correction number 19 to follow.

2. We assigned incorrect status codes to the following CPT codes.

Entries on pages listed below are corrected as follows: Page 59087 for

CPT code 82251; page 59114 for CPT codes 90471 and 90472; page 59181

for CPT code R0070; and page 59182 for CPT code R0075. These

corrections are reflected in correction number 20 to follow.

3. We assigned incorrect RVUs or modifiers for the following CPT

codes. Entries on pages listed below are corrected as follows: Page

59109 for CPT code 88141; page 59132 for CPT codes 94014, 94014-26, and

94014-TC; 94015, 94015-26, 94015-TC; and 94016; page 59168 for CPT code

G0124; and page 59169 for CPT code G0141. These corrections are

reflected in correction number 21 to follow.

4. We stated that we would not provide a transition for codes

representing services that are new beginning in 1999. The codes

identified below are new CPT codes, but do not represent new services.

These codes were previously reported with a different CPT code. We

failed to apply the transition to these services. The corrected RVUs

for the codes are as follows: Page 58965 for CPT codes 31623, 31624,

and 31643; page 58977 for CPT codes 35682, and 35683; page 59133 for

CPT codes 94621, 94621-26, and 94621-TC. These corrections are

reflected in correction number 22 to follow.

5. We erroneously assigned relative value units to the following

CPT codes in the facility setting. By definition the following CPT

codes cannot be performed in the facility setting. Columns associated

with facility relative value units should be set to NA in Addendum B.

Entries on pages listed below are corrected as follows: Page 59144 for

CPT codes 99321, 99322, 99323, 99331, 99332, 99333, 99341, 99342,

99343, 99344, 99345, 99347, 99348, 99349, and 99350; page 59145 for CPT

codes 99374 and 99375. These corrections are reflected in correction

number 23 to follow.

Correction of Errors

In FR Doc. 98-29181 of November 2, 1998, make the following

corrections:

1. On page 58814, column three, ``Table of Contents'', after

subsection ``I.B'', add a new subsection ``C'' to read as follows:

``C. Components of the Fee Schedule Payment Amounts''

2. On page 58816, column one, add a new subsection ``C'', to read

as follows:

``C. Components of the Fee Schedule Payment Amounts''

Under the formula set forth in section 1848(b)(1) of the Act, the

payment amount for each service paid for under the physician fee

schedule is the product of three factors: (1) A nationally uniform

relative value for the service; (2) a geographic adjustment factor

(GAF) for each physician fee schedule area; and (3) a nationally

uniform conversion factor (CF) for the service. The CF converts the

relative values into payment amounts.

For each physician fee schedule service, there are three relative

values: (1) An RVU for physician work; (2) an RVU for practice expense

(NOTE: This RVU will vary on a code by code basis depending upon if the

service is performed in a facility or non-facility setting); and (3) an

RVU for malpractice

[[Page 25457]]

expense. For each of these components of the fee schedule there is a

geographic practice cost index (GPCI) for each fee schedule area. The

GPCIs reflect the relative costs of practice expenses, malpractice

insurance, and physician work in an area compared to the national

average for each component.

The general formula for calculating the Medicare fee schedule

amount for a given service in a given fee schedule area can be

expressed as:

Payment = [(RVU work * GPCI work) + (RVU practice expense * GPCI

practice expense) + (RVU malpractice * GPCI malpractice)] * CF

The CF for calendar year 1999 appears in Section V. ``Physician Fee

Schedule Update and Conversion Factor for Calendar Year 1999.'' The

RVUs for calendar year 1999 are in Addendum B. The GPCIs for calendar

year 1999 can be found in Addendum D of the October 31, 1997, final

rule (62 FR 59255).

Section 1848(e) of the Act requires the Secretary to develop GAFs

for all physician fee schedule areas. The total GAF for a fee schedule

area is equal to a weighted average of the individual GPCIs for each of

the three components of the service. Thus, the GPCIs reflect the

relative costs of practice expenses, malpractice insurance, and

physician work in an area compared to the national average. In

accordance with the law, however, the GAF for the physician's work

reflects one-quarter of the relative cost of physician's work compared

to the national average.''

3. On page 58827, in column three, bullet two, line two, ``REUS''

is corrected to read ``RVUs.''

4. On page 58828, in column 1, the first full paragraph, lines 4

and 11, ``REUS'' is corrected to read ``RVUs.''

5. On page 58844, there is an inaccuracy in the discussion

concerning physician direction of concurrent anesthesia services. In

the discussion, we inadvertently failed to include the revisions to the

policy that were made in the September 1, 1983 final rule (48 FR 39740)

and currently appear in section 15018C of the Medicare Carrier Manual

(MCM).

Therefore, on page 58844, column three, the second full paragraph

from the top is corrected to read as follows: ``If a physician is

directing four concurrent surgical procedures and devotes extensive

time to checking or discharging other patients in the recovery room or

handling scheduling matters, this could unduly diminish physician

involvement in the surgical cases. If significantly reduced, a

physician's involvement in the surgical cases would become

``supervision'' rather than ``medical direction.'' Also, a physician

cannot personally be extensively involved in recovery room or

scheduling matters of significant duration because such personal

services would diminish the scope of control necessary for medical

direction.''

6. On page 58874, in the second column, third paragraph beginning

``Result of evaluation of comments'' we discuss the qualifications

required for a nurse practitioner to be eligible for Medicare Part B

payment. We erred in establishing the effective date for the

requirements for nurse practitioners. The date should be January 1,

2000. The provisions for nurse practitioner qualifications will not be

effective until January 1, 2000. In column 2, paragraph 3, line 3,

insert the words ``after December 31, 1999,'' after the comma.

7. On page 58878, in the third column, fourth full paragraph, the

first bullet, the name of the national accreditation organization was

published incorrectly. Therefore, remove the word ``National.'' Also,

we inadvertently omitted the word ``or'' after the semicolon. The word

``or'' was included in the proposed rule and there was no change

intended in this area. Therefore, the word ``or'' should be added after

the semicolon. The first bullet should now read as follows: ``Has

graduated from a physician assistant educational program that is

accredited by the Commission on Accreditation of Allied Health

Education Programs; or''

In the second bullet, the third line we incorrectly stated that the

national certification examination is ``certified'' by the National

Commission on Certification of Physician Assistants. This organization

``administers'' the examination. Therefore, the word ``certified'' is

removed and replaced with ``administered.'' The second bullet should

now read as follows: ``Has passed the national certification

examination that is administered by the National Commission on

Certification of Physician Assistants; and'

8. On page 58889, in Table 6, the last line, the second column, the

modifier for CPT code 94014, remove ``26'' and leave the column blank.

9. On page 58892, in the third column, the third bullet, line 6,

remove the word ``National''. In line 7, remove the second use of the

word ``on'' and add the word ``of'', and add the word ``or'' after the

semicolon. Line 11, the word ``certified'' is replaced with

``administered.'' The third bullet should now read as follows: ``

Proposed Sec. 410.74(c) is revised to state that a physician assistant

is an individual who--

Has graduated from a physician assistant educational

program that is accredited by the Commission on Accreditation of Allied

Health Education Programs; or

Has passed the national certification examination that is

administered by the National Commission on Certification of Physician

Assistants; and

Is licensed by the State to practice as a physician

assistant.''

Sec. 410.74 [Corrected]

10. On page 58908, in column one, in the regulations text, under

Sec. 410.74, paragraph (c)(1), remove the word ``National'' and add the

word ``or'' after the semicolon. In paragraph (c)(2), line two, remove

the word ``of'' and add the phrase ``that is administered by.''

Sec. 410.75 [Corrected]

11. On page 58908, in column one, in the regulations text, under

Sec. 410.75, paragraph (b), ``For'' is corrected to read, ``After

December 31, 1999, for''.

Sec. 414.32 [Corrected]

12. On page 58911, in the first column, correct the amendatory

language in item 5, and add paragraph (a)(6) to read as follows:

``5. In Sec. 414.32, the heading and paragraphs (a)(6) and (b) are

revised to read as follows:

(a) Definition. * * *

(6) Skilled nursing facilities.''

Sec. 485.705 [Corrected]

13. On page 58913, in column one, in the regulations text, under

Sec. 485.705, paragraph (c)(8) introductory text is corrected to read

as follows:

``(c) * * *

(8) After December 31, 1999, a nurse practitioner is a person who

must:''

14. On page 58913, column one, Sec. 485.705(c)(10)(i) is corrected

by removing the word ``National'' and, after the semicolon, replacing

the word ``and'' with ``or'' and paragraph (c)(10)(ii) is corrected by,

removing the word ``certified'' and adding ``administered'' in its

place. In paragraph (c)(10)(iii), the first use of the phrase ``as a

physician assistant'' is removed.

Addendum B [Corrected]

15. On page 58913, in column three, add the following after the

entry for status code ``G':

``H = Deleted modifier (code used to have a modifier of TC and PC)

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

codes assigned this status. Medicare uses another code

[[Page 25458]]

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.''

16. On page 58914, in columns two and three, in the definitions for

``11'' and ``12'', remove the words ``for 1999.''

Addendum B

17. In the table of Addendum B, the following CPT codes are added

to read as follows:

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

Transi- Transi-

Non- tioned Facility tioned Transi- Transi-

CPT1 \1\ HCPCS Physi- facility non- practice facility Mal-prac- Non- tioned Facility tioned

\2\ Mod Status Description cian work practice facility expense pratice tice RVUs facility non- Total facility Global

RVUs \3\ expense expense RVUs expense total facility total

RVUs RVUs RVUs total

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

* * * * * * *

78020.......... 26 A Thyroid met uptake.. 0.60 0.02 0.02 0.02 0.02 0.02 0.64 0.64 0.64 0.64 ZZZ

78020.......... TC A Thyroid met uptake.. 0.00 0.15 0.15 0.15 0.15 0.06 0.21 0.21 0.21 0.21 ZZZ

* * * * * * *

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

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

18. In the table to Addendum B, the following CPT codes are

correctly revised to read as follows:

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

Non-

Physician facility Transitioned Facility Transitioned Non- Transitioned Transitioned

CPT1 \1\/ Mod Status Description work RVUs practice non-facility practice facility Malpractice facility non-facility Facility facility Global

HCPCS \2\ \3\ expense expense RVUs expense pratice RVUs total total total total

RVUs RVUs expense RVUs

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

* * * * * * *

82251........ X Assay Bilirubin.. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX

* * * * * * *

90471........ X Immunization 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX

admin, single.

90472........ X Immunization 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX

admin, 2+.

* * * * * * *

R0070........ C Transport 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX

portable x-ray.

R0075........ C Transport port x- 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX

ray multipl.

* * * * * * *

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

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

19. In the table to Addendum B, the following CPT codes are

correctly revised to read as follows:

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

Non-

Physician facility Transitioned Facility Transitioned Non- Transitioned Transitioned

CPT1 \1\/ Mod Status Description work RVUs practice non-facility practice facility Malpractice facility non-facility Facility facility Global

HCPCS \2\ \3\ expense expense RVUs expense pratice RVUs total total total total

RVUs RVUs expense RVUs

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

* * * * * * *

88141........ A Cytpath c/vag 0.42 0.18 0.56 0.18 0.31 0.03 .63 1.01 0.63 0.76 ZZZ

interpret.

* * * * * * *

94014........ A Patient recorded 0.52 0.63 0.63 0.63 0.63 0.04 1.19 1.19 1.19 1.19 XXX

spirometry.

94014........ 26 H Patient recorded 0.52 0.20 0.20 0.20 0.20 0.02 0.74 0.74 0.74 0.74 XXX

spirometry.

94014........ TC H Patient recorded 0.00 0.43 0.43 0.43 0.43 0.02 0.45 0.45 0.45 0.45 XXX

spirometry.

94015........ A Patient recorded 0.00 0.43 0.00 0.43 0.00 0.02 0.45 0.00 0.45 0.00 XXX

spirometry.

94015........ 26 H Patient recorded 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX

spirometry.

94015........ TC H Patient recorded 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX

spirometry.

94016........ A Review patient 0.52 0.20 0.20 0.20 0.20 0.02 0.74 0.74 0.74 0.74 XXX

spirometry.

* * * * * * *

G0124........ A Screen c/v thin 0.42 0.18 0.30 0.18 0.30 0.03 0.63 0.75 0.63 0.75 XXX

layer by MD.

G0141........ A Scr c/v cyto, 0.42 0.18 0.15 0.18 0.15 0.03 0.63 0.60 0.63 0.60 XXX

autosys and md.

* * * * * * *

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

20. In the table to Addendum B, the following CPT codes are

correctly revised to read as follows:

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

Non-

Physician facility Transitioned Facility Transitioned Non- Transitioned Transitioned

CPT1 \1\/ Mod Status Description work RVUs practice non-facility practice facility Malpractice facility non- Facility facility Global

HCPCS \2\ \3\ expense expense RVUs expense pratice RVUs total facility total total

RVUs RVUs expense RVUs total

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

* * * * * * *

31623........ A Dx Bronchoscope/ 3.07 3.33 3.34 1.25 2.82 0.27 6.67 6.68 4.59 6.16 OOO

brush.

31624........ A Dx Bronchoscope/ 3.11 3.35 3.34 1.26 2.82 0.27 6.73 6.72 4.64 6.20 OOO

lavage.

* * * * * * *

31643........ A Dx Bronchoscope/ 3.50 1.73 2.94 1.23 2.81 0.66 5.89 7.10 5.39 6.97 OOO

catheter.

[[Page 25459]]

* * * * * * *

35682........ A Composite bypass 7.20 2.81 7.92 2.74 7.90 2.75 12.76 17.87 12.69 17.85 ZZZ

graft.

35683........ A Composite bypass 8.50 3.32 8.05 3.22 8.02 2.75 14.57 19.30 14.47 19.27 ZZZ

graft.

* * * * * * *

94621........ A Plum stress/test 0.88 1.74 2.11 1.74 2.11 0.12 2.74 3.11 2.74 3.11 XXX

complex.

94621........ 26 A Plum stress/test 0.88 0.27 0.64 0.27 0.64 0.04 1.19 1.56 1.19 1.56 XXX

complex.

94621........ TC A Plum stress/test 0.00 1.47 1.47 1.47 1.47 0.08 1.55 1.55 1.55 1.55 XXX

complex.

* * * * * * *

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

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

21. In the table to Addendum B, the following CPT codes are

correctly revised to read as follows:

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

Non-

Physician facility Transitioned Facility Transitioned Non- Transitioned

CPT1\1\/ HCPCS\2\ Mod Status Description work practice non-facility practice facility Malpractice facility facility Facility Transitioned Global

RVUs\3\ expense expense RVUs expense practice RVUs total total total facility

RVUs RVUs expense RVUs

* * * * * * *

99321............................ ............. A.............. Rest home visit, 0.71 0.38 0.40 NA NA 0.02 1.11 1.13 NA NA XXX

new patient.

99322............................ ............. A.............. Rest home visit, 1.01 0.59 0.56 NA NA 0.04 1.64 1.61 NA NA XXX

new patient.

99323............................ ............. A.............. Rest home visit, 1.28 0.74 0.78 NA NA 0.05 2.07 2.11 NA NA XXX

new patient.

99331............................ ............. A.............. Rest home visit, 0.60 0.38 0.32 NA NA 0.02 1.00 0.94 NA NA XXX

estab pat.

99332............................ ............. A.............. Rest home visit, 0.80 0.48 0.41 NA NA 0.02 1.30 1.23 NA NA XXX

estab pat.

99333............................ ............. A.............. Rest home visit, 1.00 0.58 0.51 NA NA 0.02 1.60 1.53 NA NA XXX

estab pat.

99341............................ ............. A.............. Home visit, new 1.01 0.49 0.56 NA NA 0.04 1.54 1.61 NA NA XXX

patient.

99342............................ ............. A.............. Home visit, new 1.52 0.74 0.67 NA NA 0.04 2.30 2.23 NA NA XXX

patient.

99343............................ ............. A.............. Home visit, new 2.27 1.09 0.90 NA NA 0.05 3.41 3.22 NA NA XXX

patient.

99344............................ ............. A.............. Home visit, new 3.03 1.35 1.03 NA NA 0.07 4.45 4.13 NA NA XXX

patient.

99345............................ ............. A.............. Home visit, new 3.79 1.61 1.09 NA NA 0.07 5.47 4.95 NA NA XXX

patient.

99347............................ ............. A.............. Home visit, estab 0.76 0.41 0.47 NA NA 0.03 1.20 1.26 NA NA XXX

patient.

99348............................ ............. A.............. Home visit, estab 1.26 0.63 0.59 NA NA 0.03 1.92 1.88 NA NA XXX

patient.

99349............................ ............. A.............. Home visit, estab 2.02 0.91 0.72 NA NA 0.04 2.97 2.78 NA NA XXX

patient.

99350............................ ............. A.............. Home visit estab 3.03 1.24 0.93 NA NA 0.05 4.32 4.01 NA NA XXX

patient.

* * * * * * *

99374............................ ............... B.............. Home health care +1.10 1.03 0.67 NA NA 0.03 2.16 1.80 NA NA XXX

supervision.

99375............................ ............. A.............. Home health care 1.73 1.11 0.69 NA NA 0.03 2.87 2.45 NA NA XXX

supervision.

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

[[Page 25460]]

(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: April 30, 1999.

Neil J. Stillman,

Deputy Assistant Secretary for Information Resources Management.

[FR Doc. 99-11511 Filed 5-11-99; 8:45 am]

BILLING CODE 4120-01-P

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