65 FR 70 pgs. 19329-19334 - Medicare Program; Revisions to Payment Policies Under the Physician Fee Schedule for Calendar Year 2000
Type: RULEVolume: 65Number: 70Pages: 19329 - 19334
Docket number: [HCFA-1065-CN]
FR document: [FR Doc. 00-8717 Filed 4-10-00; 8:45 am]
Agency: Health and Human Services Department
Sub Agency: Health Care Financing Administration
Official PDF Version: PDF Version
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Health Care Financing Administration
42 CFR Parts 410, 411, 414, 415, and 485
[HCFA-1065-CN]
RIN 0938-AJ61
Medicare Program; Revisions to Payment Policies Under the Physician Fee Schedule for Calendar Year 2000
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, 1999, entitled "Medicare Program; Revisions to Payment Policies Under the Physician Fee Schedule for Calendar Year 2000."
EFFECTIVE DATE:
January 1, 2000.
FOR FURTHER INFORMATION CONTACT:
Diane Milstead, (410) 786-3355.
SUPPLEMENTARY INFORMATION:
Background
In FR Doc. 99-28367 of November 2, 1999, (64 FR 59380), there were a number of technical errors. The errors relate to the omission of language discussing payment for pulse oximetry, temperature gradient studies and venous pressure determinations and the removal of the x-ray requirement before chiropractic manipulation; acceptance of the RUC recommendations for work relative value units (RVUs); RUC recommendations for CPT codes 17276 and 95165; a comment on codes in the "zero work" pool; discussion of CPT code 61862 and the correct billing procedures; and regulations text definitions concerning the coverage of prostate screening. Additionally there are various revisions to Addenda B and C.
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, 1999, that is, January 1, 2000.
Discussion of Addenda B and C
1. On page 39626 of the July 22, 1999 proposed rule, we discussed revising the work RVUs for certain pediatric surgical services to reflect more appropriate data. We inadvertently omitted these work RVU changes from Addendum B of the November 2, 1999 final rule. Entries on the pages listed below are corrected as follows: Page 59451 for CPT code 21740; page 59476 for CPT codes 38550 and 38555; page 59477 for CPT code 39503; page 59479 for CPT codes 42810 and 42815; page 59480 for CPT codes 43305, 43310, 43312, and 43831; page 59482 for CPT codes 45120 and 45121; page 59483 for CPT codes 46715, 46716, 46730, 46735, 46740, and 46751; page 59484 for CPT codes 47700 and 47701; page 59485 for CPT codes 49215, 49495, 49580, 49600, 49605, and 49606; page 59488 for CPT code 51940; and page 59495 for CPT code 60280. These corrections are reflected in correction number 8 to follow.
2. On page 59421 of the November 2, 1999 final rule, we assigned 5.85 work RVUs to CPT code 61885. We inadvertently omitted this value from Addenda B and C. Entries on the pages listed below are corrected as follows: Page 59497 and page 59582 for CPT code 61885. These corrections are reflected in correction number 9 to follow.
3. In Addendum B, we assigned incorrect status indicators for the following CPT codes: Page 59553 for CPT codes 94760 and 94761; and page 59578 for HCFA Common Procedure Coding System (HCPCS) codes Q0183, Q0184, Q0185, Q0186, Q1001, Q1002, Q1003, Q1004, and Q1005. These corrections are reflected in correction number 10 to follow.
4. On page 39630 of the July 22, 1999 proposed rule, we discussed accepting the RUC work RVU recommendations for five CPT codes that were carrier priced for 1999. The status of these codes would also change from Carrier Priced (C) to Active (A) in the final rule. We inadvertently omitted the work RVUs, status indicator, and correct global indicator changes from Addendum B of the final rule. Entries on the pages listed below are corrected as follows: Page 59473 for CPT code 35500; page 59475 for CPT code 36823; page 59476 for CPT code 38792; page 59495 for CPT 60650 (renumbered from CPT code 56321 for which we accepted the RUC recommendation); page 59476 for CPT code 38120 (renumbered from CPT code 56345 for which we accepted the RUC recommendation); and page 59481 for CPT code 44201 (renumbered from CPT code 56347 for which we accepted the RUC recommendation). In addition, we failed to reflect the practice expense values assigned to these codes. These corrections are reflected in correction 11 to follow.
5. In Addendum B, we inadvertently published incorrect global periods for CPT codes 33968, 47560, 62263, 96570 and 96571. Entries on pages listed below are corrected as follows: Pages 59472 and 59582 for CPT code 33968; page 59484 for CPT code 47560; pages 59497 and 59582 for CPT code 62263; and pages 59556 and 59583 for CPT codes 96570 and 96571. These corrections are reflected in correction number 12 to follow.
6. On page 39629 of the July 22, 1999 proposed rule, we proposed changing ventricular assist device insertions, CPT codes 33975 and 33976, to an XXX global and reducing the work RVUs accordingly. In the November 2, 1999 final rule, in Addendum B, we changed the global periods to XXX but inadvertently failed to reduce the work RVUs as stated in the proposed rule. Entries on the page listed below are corrected as follows: Page 59472 for CPT codes 33975 and 33976. In addition, we failed to show the adjustments to the CPEP data made to accommodate the changing global periods. These corrections are reflected in correction number 13 to follow.
7. In Addendum B, we inadvertently assigned incorrect practice expense and malpractice RVUs to HCPCS codes G0102, G0104, G0105, and incorrect malpractice relative value units for CPT codes 59000 through 59899. Entries on the pages listed below are corrected as follows: Page 59571 for HCPCS codes G0102, G0104, and G0105; pages 59494 and 59495 for CPT codes 59000 through 59899. These corrections are reflected in correction number 14 to follow.
8. On pages 59448 and 59582 of Addendum B, we assigned an incorrect procedure status and global period to CPT code 20979. Entries on pages listed below are corrected as follows: Pages 59448 and 59582 for CPT code 20979. These corrections are reflected in correction number 15 to follow.
9. In Addendum B, we inadvertently assigned incorrect practice expense RVUs for HCPCS codes G0106, G0106-26, G0106-TC, G0120, G0120-26, G0120-TC, G0170, G0171 and CPT code 45378-53. Entries on pages listed below are corrected as follows: Page 59571 for HCPCS codes G0106, G0106-26, G0106-TC, G0120, G0120-26 and G0120-TC; page 59572 and page 59583 for G0170 and G0171; and page 59482 for CPT 45378-53. These corrections are reflected in correction number 16 to follow.
10. We incorrectly denoted that CPT code 40814 was not applicable in a non-facility setting. On page 59477 of Addendum B, the applicable practice expense values are included for the nonfacility setting for CPT code 40814. These corrections are reflected in correction number 17 to follow.
11. In Addendum B, we assigned incorrect practice expense and/or malpractice RVUs for HCPCS codes G0163, G0163-26, G0163-TC, G0164, G0164-26, G0164-TC, G0165, G0165-26, and G0165-TC. Entries on the pages listed below are corrected as follows: Page 59571 for HCPCS codes G0163, G0163-26, and G0163-TC and page 59572 for G0164, G0164-26, G0164-TC, G0165, G0165-26 and G0165-TC. These corrections are reflected in correction number 18 to follow.
Correction of Errors
In FR Doc. 99-28367 of November 2, 1999, make the following corrections:
1. On page 59395, second column, after the sixth full paragraph, add the following:
CPT code 17276, Destruction, malignant lesion, any method scalp, neck, hands, feet, genitalia; lesion diameter over 4.0cm
The RUC forwarded a recommendation for supplies. We accepted the recommendation but deleted what appeared to be duplicated gauze supplies."
2. On page 59398, first column, after the last paragraph insert the following:
"CPT Code 95165, professional services for the supervision and provision of antigens for allergen immunotherapy.
The nature of the RUC's recommendation regarding this code was significantly different than its recommendations regarding other codes. The RUC did not examine the direct expense inputs for code 95165 but commented on the definition of dose used for claims involving this code. Because the direct expense inputs have not been reviewed, we believe that it is not appropriate to revise the practice expense value at this time."
3. On page 59406, in the last line of column two, insert the words ", in Table 7," between the words "95956" and "should".
4. On page 59413, column three, after line 7, add the following:
"Result of Evaluation of Comments:
We are adopting our proposal to bundle payment for these services beginning January 2000 with the exception of code 94762, which we will continue to pay separately when continuous overnight monitoring is medically necessary as a separate procedure.
M. Removal of Requirement for X-ray Before Chiropractic Manipulation
We are conforming our regulations to section 4513(a) of the BBA that deleted the requirement that a spinal subluxation be demonstrated by an x-ray for a chiropractor to receive payment under Medicare Part B for manual manipulation of the spine to correct a subluxation.
Comment : We received one comment requesting we revise § 410.22 (Limitations on services of a chiropractor) to recognize chiropractors as physicians for purposes of ordering and furnishing diagnostic tests and other services and supplies related to manual manipulation for treatment of subluxation of the spine.
Response : We believe that extending the scope of services of the chiropractor to include other services, such as ordering and furnishing diagnostic tests, is inconsistent with section 1861(r) of the Act. Thus, we cannot implement this comment.
Comment : Two commenters expressed concern that the x-ray requirement has been removed without being replaced by clear"
5. On page 59418, in the third column, line 6 from the top, replace "69" with "85", and line 9, replace "31" with "15".
§ 410.39 [Corrected]
6. On page 59440, in the second column, § 410.39 is corrected by adding paragraphs (a)(4) and (a)(5) as follows:
§ 410.39 Prostate cancer screening tests: Conditions for and limitations on coverage.
(a) * * *
(4) A physician for purposes of this provision means a doctor of medicine or osteopathy (as defined in section 1861(r)(1) of the Act) who is fully knowledgeable about the beneficiary, and who would be responsible for explaining the results of the screening examination or test.
(5) A physician assistant, nurse practitioner, clinical nurse specialist, or certified nurse midwife for purposes of this provision means a physician assistant, nurse practitioner, clinical nurse specialist, or certified nurse midwife (as defined in sections 1861(aa) and 1861(gg) of the Act) who is fully knowledgeable about the beneficiary, and who would be responsible for explaining the results of the screening examination or test.
7. On page 59440, in the second and third columns, in § 410.39, paragraphs (b) and (d), add the phrase "as defined in paragraphs (a)(4) or (a)(5) of this section," after the word "midwife."
Addendum B[Corrected]
8. In the table of Addendum B, the following CPT codes are corrected to read as follows:
| CPT1 /HCPCS2 | MOD | Status | Description | Physician Work RVUs3 | Fully implemented nonfacility PE RVUs | Year 2000 transitional nonfacility PE RVUs | Fully implemented facility PE RVUs | Year 2000 transitional facility PE RVUs | Malpractice RVUs | Fully Implemented non facility total | Year 2000 transitional nonfacility total | Fully implemented facility total | Year 2000 transitional facility total | Global |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 21740 | A | Reconstruction of sternum | 16.80 | NA | NA | 15.80 | 12.78 | 1.95 | NA | NA | 34.55 | 31.53 | 090 | |
| 38550 | A | Removal, neck/armpit lesion | 6.92 | NA | NA | 5.24 | 4.38 | 0.50 | NA | NA | 12.66 | 11.80 | 090 | |
| 38555 | A | Removal, neck/armpit lesion | 14.14 | NA | NA | 11.47 | 9.68 | 1.53 | NA | NA | 27.14 | 25.35 | 090 | |
| 39503 | A | Repair of diaphragm hernia | 37.54 | NA | NA | 14.98 | 21.16 | 3.26 | NA | NA | 55.78 | 61.96 | 090 | |
| 42810 | A | Excision of neck cyst | 3.25 | 4.77 | 4.09 | 3.83 | 3.62 | 0.27 | 8.29 | 7.61 | 7.35 | 7.14 | 090 | |
| 42815 | A | Excision of neck cyst | 7.07 | NA | NA | 6.06 | 7.35 | 0.55 | NA | NA | 13.68 | 14.97 | 090 | |
| 43305 | A | Repair esophagus and fistula | 17.39 | NA | NA | 12.60 | 13.74 | 1.32 | NA | NA | 31.31 | 32.45 | 090 | |
| 43310 | A | Repair of esophagus | 27.47 | NA | NA | 17.64 | 18.04 | 3.07 | NA | NA | 48.18 | 48.58 | 090 | |
| 43312 | A | Repair esophagus and fistula | 30.50 | NA | NA | 23.15 | 19.02 | 3.46 | NA | NA | 57.11 | 52.98 | 090 | |
| 43831 | A | Place gastrostomy tube | 7.84 | NA | NA | 4.15 | 4.90 | 0.74 | NA | NA | 12.73 | 13.48 | 090 | |
| 45120 | A | Removal of rectum | 25.00 | NA | NA | 11.45 | 14.62 | 2.31 | NA | NA | 38.76 | 41.93 | 090 | |
| 45121 | A | Removal of rectum and colon | 27.51 | NA | NA | 12.98 | 12.35 | 2.65 | NA | NA | 43.14 | 42.51 | 090 | |
| 46715 | A | Repair of anovaginal fistula | 7.46 | NA | NA | 4.31 | 4.06 | 0.86 | NA | NA | 12.63 | 12.38 | 090 | |
| 46716 | A | Repair of anovaginal fistula | 12.85 | NA | NA | 6.50 | 6.54 | 1.21 | NA | NA | 20.56 | 20.60 | 090 | |
| 46730 | A | Construction of absent anus | 22.39 | NA | NA | 11.74 | 11.70 | 1.91 | NA | NA | 36.04 | 36.00 | 090 | |
| 46735 | A | Construction of absent anus | 27.02 | NA | NA | 12.15 | 13.15 | 2.59 | NA | NA | 41.76 | 42.76 | 090 | |
| 46740 | A | Construction of absent anus | 24.19 | NA | NA | 10.40 | 11.47 | 2.31 | NA | NA | 36.90 | 37.97 | 090 | |
| 46751 | A | Repair of anal sphincter | 8.77 | NA | NA | 5.53 | 4.98 | 0.86 | NA | NA | 15.16 | 14.61 | 090 | |
| 47700 | A | Exploration of bile ducts | 15.62 | NA | NA | 8.23 | 8.26 | 1.37 | NA | NA | 25.22 | 25.25 | 090 | |
| 47701 | A | Bile duct revision | 29.55 | NA | NA | 13.21 | 11.06 | 2.87 | NA | NA | 45.63 | 43.48 | 090 | |
| 49215 | A | Excise sacral spine tumor | 23.20 | NA | NA | 10.50 | 9.86 | 2.18 | NA | NA | 35.88 | 35.24 | 090 | |
| 49495 | A | Repair inguinal hernia, init | 5.84 | NA | NA | 3.67 | 4.54 | 0.56 | NA | NA | 10.07 | 10.94 | 090 | |
| 49580 | A | Repair umbilical hernia | 3.34 | NA | NA | 2.74 | 3.47 | 0.34 | NA | NA | 6.42 | 7.15 | 090 | |
| 49600 | A | Repair umbilical lesion | 10.96 | NA | NA | 5.66 | 5.69 | 0.95 | NA | NA | 17.57 | 17.60 | 090 | |
| 49605 | A | Repair umbilical lesion | 24.94 | NA | NA | 11.31 | 10.31 | 2.20 | NA | NA | 38.45 | 37.45 | 090 | |
| 49606 | A | Repair umbilical lesion | 21.31 | NA | NA | 8.89 | 8.96 | 1.91 | NA | NA | 32.11 | 32.18 | 090 | |
| 51940 | A | Correction of bladder defect | 28.43 | NA | NA | 13.38 | 16.98 | 1.90 | NA | NA | 43.71 | 47.31 | 090 | |
| 60280 | A | Remove thyroid duct lesion | 5.87 | NA | NA | 4.86 | 6.06 | 0.48 | NA | NA | 11.21 | 12.41 | 090 | |
| 1 CPT codes and descriptions only are copyright 1999 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. | ||||||||||||||
| 2 Copyright 1994 American Dental Association. All rights reserved (D0110-D9999). | ||||||||||||||
| 3 + Indicates RVUs are not used for Medicare payment. | ||||||||||||||
| 4 PE RVUs = Practice Expense Relative Value Units. | ||||||||||||||
9. In the table of Addenda's B and C, the following CPT code is corrected to read as follows:
| CPT1 /HCPCS2 | MOD | Status | Description | Physician work RVUs3 | Fully implemented nonfacility PE RVUs4 | Year 2000 transitional nonfacility PE RVUs4 | Fully implemented facility PE RVUs4 | Year 2000 transitional facility PE RVUs4 | Malpractice RVUs | Fully implemented nonfacility total | Year 2000 transitional non-facility total | Fully implemented facility total | Year 2000 transitional facility total | Global |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 61885 | A | Implant neurostim one array | 5.85 | NA | NA | 4.86 | 6.06 | 0.48 | NA | NA | 11.21 | 12.41 | 090 | |
| 1 CPT codes and descriptions only are copyright 1999 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. | ||||||||||||||
| 2 Copyright 1994 American Dental Association. All rights reserved (D0110-D9999). | ||||||||||||||
| 3 + Indicates RVUs are not used for Medicare payment. | ||||||||||||||
| 4 PE RVUs = Practice Expense Relative Value Units. | ||||||||||||||
10. In the table of Addendum B, the following HCPCS codes are corrected to read as follows:
| CPT1 /HCPCS2 | MOD | Status | Description | Physician work RVUs3 | Fully implemented nonfacility PE RVUs4 | Year 2000 transitional nonfacility PE RVUs4 | Fully implemented facility PE RVUs4 | Year 2000 transitional facility PE RVUs4 | Malpractice RVUs | Fully implemented nonfacility total | Year 2000 transitional non-facility total | Fully implemented facility total | Year 2000 transitional facility total | Global |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Q0183 | X | Nonmetabolic active tissue | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | XXX | |
| Q0184 | X | Metabolically active tissue | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | XXX | |
| Q0185 | X | Metabolic active D/E tissue | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | XXX | |
| Q0186 | X | Paramedic intercept, rural | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | XXX | |
| Q1001 | X | Ntiol category 1 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | XXX | |
| Q1002 | X | Ntiol category 2 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | XXX | |
| Q1003 | X | Ntiol category 3 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | XXX | |
| Q1004 | X | Ntiol category 4 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | XXX | |
| Q1005 | X | Ntiol category 5 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | XXX | |
| 94760 | T | Measure blood oxygen level | 0.00 | 0.08 | 0.18 | 0.08 | 0.18 | 0.02 | 0.10 | 0.20 | 0.10 | 0.20 | XXX | |
| 94761 | T | Measure blood oxygen level | 0.00 | 0.15 | 0.42 | 0.15 | 0.42 | 0.05 | 0.20 | 0.47 | 0.20 | 0.47 | XXX | |
| 1 CPT codes and descriptions only are copyright 1999 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. | ||||||||||||||
| 2 Copyright 1994 American Dental Association. All rights reserved (D0110-D9999). | ||||||||||||||
| 3 + Indicates RVUs are not used for Medicare payment. | ||||||||||||||
| 4 PE RVUs = Practice Expense Relative Value Units. | ||||||||||||||
11. In the table of Addendum B, the following CPT codes are corrected to read as follows:
| CPT1 /HCPCS2 | MOD | Status | Description | Physician work RVUs3 | Fully implemented nonfacility PE RVUs | Year 2000 trasitional nonfacility PE RVUs | Fully implemented facility PE RVUs | Year 2000 transitional facility PE RVUs | Malpractice RVUs | Fully implemented nonfacility total | Year 2000 transitional facility total | Fully implemented facility total | Year 2000 transitional facility total | Global |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 35500 | A | Harvest vein for bypass | 6.45 | NA | NA | 2.43 | 2.43 | 0.73 | NA | NA | 9.61 | 9.61 | ZZZ | |
| 36823 | A | Insert cannula(s) | 21.00 | NA | NA | 11.54 | 11.54 | 0.67 | NA | NA | 33.21 | 33.21 | 090 | |
| 38120 | A | Laparoscopic splenectomy | 17.00 | NA | NA | 7.83 | 7.83 | 1.04 | NA | NA | 25.87 | 25.87 | 090 | |
| 38792 | A | Identify sentinel node | 0.52 | NA | NA | 0.20 | 0.20 | 0.01 | NA | NA | 0.73 | 0.73 | 000 | |
| 44201 | A | Laparoscopic jejunostomy | 9.78 | NA | NA | 3.61 | 3.61 | 1.35 | NA | NA | 14.74 | 14.74 | 090 | |
| 60650 | A | Laparoscopy adrenalectomy | 20.00 | NA | NA | 9.10 | 9.10 | 1.35 | NA | NA | 30.45 | 30.45 | 090 | |
| 1 CPT codes and descriptions only are copyright 1999 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. | ||||||||||||||
| 2 Copyright 1994 American Dental Association. All rights reserved (D0110-D9999). | ||||||||||||||
| 3 + Indicates RVUs are not used for Medicare payment. | ||||||||||||||
| 4 PE RVUs = Practice Expense Relative Value Units. | ||||||||||||||
12. In the table of Addenda's B and/or C, the following CPT codes are corrected to read as follows:
| CPT1 /HCPC2 | MOD | Status | Description | Physician work RVUs3 | Fully implemented nonfacility PE RVUs | Year 2000 trasitional nonfacility PE RVUs | Fully implemented facility PE RVUs | Year 2000 transitional facility PE RVUs | Malpractice RVUs | Fully implemented nonfacility total | Year 2000 transitional facility total | Fully implemented facility total | Year 2000 transitional facility total | Global |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 33968 | A | Remove aortic assist device | 0.64 | 0.25 | 0.25 | 0.25 | 0.25 | 0.27 | 1.16 | 1.16 | 1.16 | 1.16 | 000 | |
| 47560 | A | Laparoscopy w/ cholangio | 4.89 | N/A | N/A | 1.95 | 2.48 | 0.46 | N/A | N/A | 7.30 | 7.83 | 000 | |
| 62263 | A | Lysis epidural adhesions | 6.02 | 4.61 | 4.61 | 2.18 | 2.18 | 0.88 | 11.51 | 11.51 | 9.08 | 9.08 | 010 | |
| 96570 | A | Photodynamic tx, 30 min | 1.10 | 0.71 | 0.71 | 0.43 | 0.43 | 0.28 | 2.09 | 2.09 | 1.81 | 1.81 | ZZZ | |
| 96571 | A | Photodynamc tx, addl 15 min | 0.55 | 0.31 | 0.31 | 0.21 | 0.21 | 0.28 | 1.14 | 1.14 | 1.04 | 1.04 | ZZZ | |
| 1 CPT codes and descriptions only are copyright 1999 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. | ||||||||||||||
| 2 Copyright 1994 American Dental Association. All rights reserved (D0110-D9999). | ||||||||||||||
| 3 + Indicates RVUs are not used for Medicare payment. | ||||||||||||||
| 4 PE RVUs = Practice Expense Relative Value Units. | ||||||||||||||
13. In table of Addendum B, the following CPT codes are corrected to read as follows:
| CPT1 /HCPC2 | MOD | Status | Description | Physician work RVUs3 | Fully implemented nonfacility PE RVUs | Year 2000 trasitional nonfacility PE RVUs | Fully implemented facility PE RVUs | Year 2000 transitional facility PE RVUs | Malpractice RVUs | Fully implemented nonfacility total | Year 2000 transitional facility total | Fully implemented facility total | Year 2000 transitional facility total | Global |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 33975 | A | Implant ventricular device | 21.00 | NA | NA | 16.80 | 16.10 | 2.86 | NA | NA | 40.66 | 39.96 | XXX | |
| 33976 | A | Implant ventricular device | 23.00 | NA | NA | 18.65 | 19.82 | 3.91 | NA | NA | 45.56 | 46.73 | XXX | |
| 1 CPT codes and descriptions only are copyright 1999 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. | ||||||||||||||
| 2 Copyright 1994 American Dental Association. All rights reserved (D0110-D9999). | ||||||||||||||
| 3 + Indicates RVUs are not used for Medicare payment. | ||||||||||||||
| 4 PE RVUs = Practice Expense Relative Value Units. | ||||||||||||||
14. In table of Addendum B, the following CPT codes are corrected to read as follows:
| CPT1 /HCPC2 | MOD | Status | Description | Physician work RVUs3 | Fully implemented nonfacility PE RVUs | Year 2000 trasitional nonfacility PE RVUs | Fully implemented facility PE RVUs | Year 2000 transitional facility PE RVUs | Malpractice RVUs | Fully implemented nonfacility total | Year 2000 transitional facility total | Fully implemented facility total | Year 2000 transitional facility total | Global |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| G0102 | A | Prostate ca screening; dre | 0.17 | 0.51 | 0.37 | 0.06 | 0.09 | 0.01 | 0.69 | 0.55 | 0.24 | 0.27 | XXX | |
| G0104 | A | CA screen; flexi sigmoidscope | 0.96 | 1.35 | 1.34 | 0.33 | 0.46 | 0.07 | 2.38 | 2.37 | 1.36 | 1.49 | 000 | |
| G0105 | A | Colorectal scrn; hi risk ind | 3.70 | 5.99 | 5.24 | 1.29 | 2.86 | 0.26 | 9.95 | 9.20 | 5.25 | 6.82 | 000 | |
| 59000 | A | Amniocentesis | 1.30 | 1.54 | 1.30 | 0.49 | 0.77 | 0.19 | 3.03 | 2.79 | 1.98 | 2.26 | 000 | |
| 59012 | A | Fetal cord punture, prenatal | 3.45 | NA | NA | 1.38 | 2.11 | 0.51 | NA | NA | 5.34 | 6.07 | 000 | |
| 59015 | A | Chorion biopsy | 2.20 | 1.27 | 1.29 | 0.85 | 1.08 | 0.32 | 3.79 | 3.81 | 3.37 | 3.60 | 000 | |
| 59020 | A | Fetal contract stress test | 0.66 | 0.78 | 1.06 | 0.78 | 1.06 | 0.21 | 1.65 | 1.93 | 1.65 | 1.93 | 000 | |
| 59020 | 26 | A | Fetal contract stress test | 0.66 | 0.26 | 0.53 | 0.26 | 0.53 | 0.13 | 1.05 | 1.32 | 1.05 | 1.32 | 000 |
| 59020 | TC | A | Fetal contract stress test | 0.00 | 0.52 | 0.53 | 0.52 | 0.53 | 0.08 | 0.60 | 0.61 | 0.60 | 0.61 | 000 |
| 59025 | A | Fetal non-stress test | 0.53 | 0.43 | 0.55 | 0.43 | 0.55 | 0.10 | 1.06 | 1.18 | 1.06 | 1.18 | 000 | |
| 59025 | 26 | A | Fetal non-stress test | 0.53 | 0.20 | 0.31 | 0.20 | 0.31 | 0.08 | 0.81 | 0.92 | 0.81 | 0.92 | 000 |
| 59025 | TC | A | Fetal non-stress test | 0.00 | 0.23 | 0.24 | 0.23 | 0.24 | 0.02 | 0.25 | 0.26 | 0.25 | 0.26 | 000 |
| 59030 | A | Fetal scalp blood sample | 1.99 | NA | NA | 0.77 | 1.24 | 0.30 | NA | NA | 3.06 | 3.53 | 000 | |
| 59050 | A | Fetal monitor w/ report | 0.89 | NA | NA | 0.34 | 0.61 | 0.12 | NA | NA | 1.35 | 1.62 | XXX | |
| 59051 | A | Fetal monitor/interpret only | 0.74 | NA | NA | 0.28 | 0.58 | 0.10 | NA | NA | 1.12 | 1.12 | XXX | |
| 59100 | A | Remove uterus lesion | 12.35 | NA | NA | 6.05 | 5.27 | 1.80 | NA | NA | 20.20 | 19.42 | 090 | |
| 59120 | A | Treat ectopic pregnancy | 11.49 | NA | NA | 5.73 | 7.13 | 1.67 | NA | NA | 18.89 | 20.29 | 090 | |
| 59121 | A | Treat ectopic pregnancy | 11.67 | NA | NA | 5.84 | 5.84 | 1.70 | NA | NA | 19.21 | 19.21 | 090 | |
| 59130 | A | Treat ectopic pregnancy | 14.22 | NA | NA | 6.89 | 6.68 | 2.07 | NA | NA | 23.18 | 22.97 | 090 | |
| 59135 | A | Treat ectopic pregnancy | 13.88 | NA | NA | 6.76 | 8.73 | 2.01 | NA | NA | 22.65 | 24.62 | 090 | |
| 59136 | A | Treat ectopic pregnancy | 13.18 | NA | NA | 6.49 | 6.62 | 1.92 | NA | NA | 21.59 | 21.72 | 090 | |
| 59140 | A | Treat ectopic pregnancy | 5.46 | NA | NA | 3.40 | 4.23 | 0.79 | NA | NA | 9.65 | 10.48 | 090 | |
| 59150 | A | Treat ectopic pregnancy | 6.89 | NA | NA | 3.95 | 4.44 | 1.00 | NA | NA | 11.84 | 12.33 | 090 | |
| 59151 | A | Treat ectopic pregnancy | 7.86 | NA | NA | 4.01 | 6.68 | 1.15 | NA | NA | 13.02 | 15.69 | 090 | |
| 59160 | A | D C after delivery | 2.71 | 3.30 | 3.24 | 2.07 | 2.63 | 0.39 | 6.40 | 6.34 | 5.17 | 5.73 | 010 | |
| 59200 | A | Insert cervical dilator | 0.79 | 1.19 | 0.89 | 0.29 | 0.3 | 0.11 | 2.09 | 1.79 | 1.19 | 1.20 | 000 | |
| 59300 | A | Episiotomy or vaginal repair | 2.41 | 1.56 | 1.32 | 0.92 | 0.73 | 0.34 | 4.31 | 4.07 | 3.67 | 3.48 | 000 | |
| 59320 | A | Revision of cervix | 2.48 | NA | NA | 1.30 | 1.62 | 0.36 | NA | NA | 4.14 | 4.46 | 000 | |
| 59325 | A | Revision of cervix | 4.07 | NA | NA | 1.92 | 2.53 | 0.59 | NA | NA | 6.58 | 7.19 | 000 | |
| 59350 | A | Repair of uterus | 4.95 | NA | NA | 1.84 | 2.84 | 0.73 | NA | NA | 7.52 | 8.52 | 000 | |
| 59400 | A | Obstetrical care | 23.06 | NA | NA | 13.44 | 14.86 | 3.35 | NA | NA | 39.85 | 41.27 | MMM | |
| 59409 | A | Obstetrical care | 13.50 | NA | NA | 5.08 | 7.69 | 1.97 | NA | NA | 20.55 | 23.16 | MMM | |
| 59410 | A | Obstetrical care | 14.78 | NA | NA | 6.01 | 8.6 | 2.15 | NA | NA | 22.94 | 25.53 | MMM | |
| 59412 | A | Antepartum manipulation | 1.71 | 1.16 | 1.24 | 0.65 | 0.99 | 0.25 | 3.12 | 3.20 | 2.61 | 2.95 | MMM | |
| 59414 | A | Deliver placenta | 1.61 | NA | NA | 1.13 | 1.19 | 0.24 | NA | NA | 2.98 | 3.04 | MMM | |
| 59425 | A | Antepartum care only | 4.81 | 4.62 | 3.88 | 4.62 | 3.1 | 0.71 | 10.14 | 9.40 | 10.14 | 8.62 | MMM | |
| 59426 | A | Antepartum care only | 8.28 | 7.85 | 6.61 | 7.81 | 5.25 | 1.20 | 17.33 | 16.09 | 17.29 | 14.73 | MMM | |
| 59430 | A | Care after delivery | 2.13 | 1.14 | 0.78 | 1.14 | 0.68 | 0.32 | 3.59 | 3.23 | 3.59 | 3.13 | MMM | |
| 59510 | A | Cesarean delivery | 26.22 | NA | NA | 15.40 | 16.87 | 3.82 | NA | NA | 45.44 | 46.91 | MMM | |
| 59514 | A | Cesarean delivery only | 15.97 | NA | NA | 6.01 | 8.97 | 2.32 | NA | NA | 24.30 | 27.26 | MMM | |
| 59515 | A | Cesarean delivery | 17.37 | NA | NA | 7.56 | 10.2 | 2.53 | NA | NA | 27.46 | 30.10 | MMM | |
| 59525 | A | Remover uterus after cesarean | 8.54 | NA | NA | 3.19 | 3.66 | 1.24 | NA | NA | 12.97 | 13.44 | ZZZ | |
| 59610 | A | Vbac delivery | 24.62 | NA | NA | 9.36 | 12.82 | 3.58 | NA | NA | 37.56 | 41.02 | MMM | |
| 59612 | A | Vbac delivery only | 15.06 | NA | NA | 5.77 | 8.03 | 2.20 | NA | NA | 23.03 | 25.29 | MMM | |
| 59614 | A | Vbac care after delivery | 16.34 | NA | NA | 6.29 | 8.74 | 2.38 | NA | NA | 25.01 | 27.46 | MMM | |
| 59618 | A | Attempted Vbac delivery | 27.78 | NA | NA | 10.51 | 14.43 | 4.05 | NA | NA | 42.34 | 46.26 | MMM | |
| 59620 | A | Attempted Vbac delivery only | 17.53 | NA | NA | 6.67 | 9.30 | 2.55 | NA | NA | 26.75 | 29.38 | MMM | |
| 59622 | A | Attempted Vbac after care | 18.93 | NA | NA | 7.27 | 10.05 | 2.76 | NA | NA | 28.96 | 31.74 | MMM | |
| 59812 | A | Treatment of miscarriage | 3.25 | 4.21 | 4.07 | 2.23 | 3.06 | 0.48 | 7.94 | 7.80 | 5.96 | 6.79 | 090 | |
| 59820 | A | Care of miscarriage | 4.01 | 4.40 | 4.24 | 2.52 | 3.3 | 0.59 | 9.00 | 8.84 | 7.12 | 7.90 | 090 | |
| 59821 | A | Treatment of miscarriage | 4.47 | 4.87 | 3.91 | 2.71 | 2.83 | 0.66 | 10.00 | 9.04 | 7.84 | 7.96 | 090 | |
| 59830 | A | Treat uterus infection | 6.11 | NA | NA | 3.64 | 4.28 | 0.89 | NA | NA | 10.64 | 11.28 | 090 | |
| 59840 | R | Abortion | 3.01 | 4.64 | 4.07 | 2.14 | 2.82 | 0.44 | 8.09 | 7.52 | 5.59 | 6.27 | 010 | |
| 59841 | R | Abortion | 5.24 | 6.01 | 5.04 | 3.35 | 3.71 | 0.75 | 12.00 | 11.03 | 9.34 | 9.70 | 010 | |
| 59850 | R | Abortion | 5.91 | NA | NA | 2.52 | 3.43 | 0.86 | NA | NA | 9.29 | 10.20 | 090 | |
| 59851 | R | Abortion | 5.93 | NA | NA | 2.87 | 3.76 | 0.86 | NA | NA | 9.66 | 10.55 | 090 | |
| 59852 | R | Abortion | 8.24 | NA | NA | 4.34 | 5.16 | 1.19 | NA | NA | 13.77 | 14.59 | 090 | |
| 59855 | R | Abortion | 6.12 | NA | NA | 3.17 | 3.83 | 0.89 | NA | NA | 10.18 | 10.84 | 090 | |
| 59856 | R | Abortion | 7.48 | NA | NA | 3.55 | 4.55 | 1.09 | NA | NA | 12.12 | 13.12 | 090 | |
| 59857 | R | Abortion | 9.29 | NA | NA | 4.28 | 5.52 | 1.36 | NA | NA | 14.93 | 16.17 | 090 | |
| 59866 | R | Abortion (mpr) | 4.00 | NA | NA | 1.55 | 2.33 | 0.58 | NA | NA | 6.13 | 6.91 | 000 | |
| 59870 | A | Evacuate mole of uterus | 4.28 | NA | NA | 2.85 | 3.01 | 0.62 | NA | NA | 7.75 | 7.91 | 090 | |
| 59871 | A | Remove cerclage suture | 2.13 | 1.89 | 1.91 | 0.81 | 1.37 | 0.32 | 4.34 | 4.36 | 3.26 | 3.82 | 000 | |
| 59898 | C | Laparo proc, ob care/delivery | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | YYY | |
| 59899 | C | Maternity care procedure | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | YYY | |
| 1 CPT codes and descriptions only are copyright 1999 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. | ||||||||||||||
| 2 Copyright 1994 American Dental Association. All rights reserved (D0110-D9999). | ||||||||||||||
| 3 + Indicates RVUs are not used for Medicare payment. | ||||||||||||||
| 4 PE RVUs = Practice Expense Relative Value Units. | ||||||||||||||
15. In table of Addenda B and C, the following CPT code is corrected to read as follows:
| CPT1 /HCPCS2 | MOD | Status | Description | Physician work RVUs3 | Fully implemented facility PE RVUs | Year 2000 transitional nonfacility PE RVUs | Fully implemented facility PE RVUs | Year 2000 transitional facility PE RVUs | Malpractice RVUs | Fully implemented nonfacility total | Year 2000 transitional nonfacility total | Fully implemented facility total | Year 2000 transitional facility total | Global |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 20979 | N | U.S. bone stimulation | 0.17 | 0.25 | 0.25 | 0.07 | 0.07 | 0.01 | 0.43 | 0.43 | 0.25 | 0.25 | XXX | |
| 1 CPT codes and descriptions only are copyright 1999 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. | ||||||||||||||
| 2 Copyright 1994 American Dental Association. All rights reserved (D0110-D9999). | ||||||||||||||
| 3 + Indicates RVUs are not used for Medicare payment. | ||||||||||||||
| 4 PE RVUs = Practice Expense Relative Value Units. | ||||||||||||||
16. In the table of Addendum B, the following CPT codes are corrected to read as follows:
| CPT1 / HCPCS2 | MOD | Status | Description | Physician work RVUs3 | Fully implemented nonfacility PE RVUs | Year 2000 transitional nonfacility PE RVUs | Fully implemented facility PE RVUs | Year 2000 Transitional nonfacility PE RVUs | Malpractice RVUs | Fully implemented nonfacility total | Year 2000 Transitional nonfacility total | Fully implemented facility total | Year 2000 Transitional facility total | Global |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| G0106 | A | Colon CA screen; barium enema | 0.99 | 2.51 | 2.66 | 2.51 | 2.66 | 0.15 | 3.65 | 3.80 | 3.65 | 3.80 | XXX | |
| G0106 | 26 | A | Colon CA screen; barium enema | 0.99 | 0.27 | 0.38 | 0.27 | 0.38 | 0.04 | 1.30 | 1.41 | 1.30 | 1.41 | XXX |
| G0106 | TC | A | Colon CA screen; barium enema | 0.00 | 2.24 | 2.28 | 2.24 | 2.28 | 0.11 | 2.35 | 2.39 | 2.35 | 2.39 | XXX |
| G0120 | A | A | Colon ca scrn barium enema | 0.99 | 2.51 | 2.66 | 2.51 | 2.66 | 0.15 | 3.65 | 3.80 | 3.65 | 3.80 | XXX |
| G0120 | 26 | A | Colon ca scrn barium enema | 0.99 | 0.27 | 0.38 | 0.27 | 0.38 | 0.04 | 1.30 | 1.41 | 1.30 | 1.41 | XXX |
| G0120 | TC | A | Colon ca scrn barium enema | 0.00 | 2.24 | 2.28 | 2.24 | 2.28 | 0.11 | 2.35 | 2.39 | 2.35 | 2.39 | XXX |
| G0170 | A | Skin biograft | 1.50 | 3.14 | 3.14 | 1.10 | 1.10 | 0.39 | 5.03 | 5.03 | 2.99 | 2.99 | 10 | |
| G0171 | A | Skin biograft add-on | 0.38 | 0.30 | 0.30 | 0.15 | 0.15 | 0.39 | 1.07 | 1.07 | 0.92 | 0.92 | ZZZ | |
| 45378 | 53 | A | Diagnostic colonoscopy | 0.96 | 1.35 | 1.34 | 0.33 | 0.46 | 0.07 | 2.38 | 2.37 | 1.36 | 1.49 | 000 |
| 1 CPT codes and descriptions only are copyright 1999 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. | ||||||||||||||
| 2 Copyright 1994 American Dental Association. All rights reserved (D0110-D9999). | ||||||||||||||
| 3 + Indicates RVUs are not used for Medicare payment. | ||||||||||||||
| 4 PE RVUs = Practice Expense Relative Value Units. | ||||||||||||||
17. In the table of Addendum B, the following CPT code is corrected to read as follows:
| CPT1 / HCPCS2 | MOD | Status | Description | Physician work RVUs3 | Fully implemented nonfacility PE RVUs | Year 2000 transitional nonfacility PE RVUs | Fully implemented facility PE RVUs | Year 2000 Transitional nonfacility PE RVUs | Malpractice RVUs | Fully implemented nonfacility total | Year 2000 Transitional nonfacility total | Fully implemented facility total | Year 2000 Transitional facility total | Global |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 40814 | A | Excise/repair mouth lesion | 3.42 | 3.64 | 3.58 | 3.64 | 2.70 | 0.25 | 7.31 | 7.25 | 7.31 | 6.37 | 90 | |
| 1 CPT codes and descriptions only are copyright 1999 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. | ||||||||||||||
| 2 Copyright 1994 American Dental Association. All rights reserved (D0110-D9999). | ||||||||||||||
| 3 + Indicates RVUs are not used for Medicare payment. | ||||||||||||||
| 4 PE RVUs = Practice Expense Relative Value Units. | ||||||||||||||
18. In the table of Addendum B, the following HCPCS codes are corrected to read as follows:
| CPT1 /HCPCS2 | MOD | Status | Description | Physician work RVUs3 | Fully implemented nonfacility PE RVUs | Year 2000 transitional nonfacility PE RVUs | Fully implemented facility PE RVUs | Year 2000 transitional facility PE RVUs | Malpractice RVUs | Fully implemented nonfacility total | Year 2000 transitional nonfacility total | Fully implemented facility total | Year 2000 transitional facility total | Global |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| G0163 | A | PET for rec of colorectal ca | 1.50 | 56.21 | 56.21 | 56.21 | 56.21 | 2.06 | 59.77 | 59.77 | 59.77 | 59.77 | XXX | |
| G0163 | 26 | A | PET for rec of colorectal ca | 1.50 | 0.58 | 0.58 | 0.58 | 0.58 | 0.05 | 2.13 | 2.13 | 2.13 | 2.13 | XXX |
| G0163 | TC | A | PET for rec of colorectal ca | 0.00 | 55.63 | 55.63 | 55.63 | 55.63 | 2.01 | 57.64 | 57.64 | 57.64 | 57.64 | XXX |
| G0164 | A | PET for lymphoma staging | 1.87 | 56.35 | 56.35 | 56.35 | 56.35 | 2.06 | 60.28 | 60.28 | 60.28 | 60.28 | XXX | |
| G0164 | 26 | A | PET for lymphoma staging | 1.87 | 0.72 | 0.72 | 0.72 | 0.72 | 0.05 | 2.64 | 2.64 | 2.64 | 2.64 | XXX |
| G0164 | TC | A | PET for lymphoma staging | 0.00 | 55.63 | 55.63 | 55.63 | 55.63 | 2.01 | 57.64 | 57.64 | 57.64 | 57.64 | XXX |
| G0165 | A | PET, rec of melanoma/met ca | 1.50 | 56.21 | 56.21 | 56.21 | 56.21 | 2.06 | 59.77 | 59.77 | 59.77 | 59.77 | XXX | |
| G0165 | 26 | A | PET, rec of melanoma/met ca | 1.50 | 0.58 | 0.58 | 0.58 | 0.58 | 0.05 | 2.13 | 2.13 | 2.13 | 2.13 | XXX |
| G0165 | TC | A | PET, rec of melanoma/met ca | 0.00 | 55.63 | 55.63 | 55.63 | 55.63 | 2.01 | 57.64 | 57.64 | 57.64 | 57.64 | XXX |
| 1 CPT codes and descriptions only are copyright 1999 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. | ||||||||||||||
| 2 Copyright 1994 American Dental Association. All rights reserved (D0110-D9999). | ||||||||||||||
| 3 + Indicates RVUs are not used for Medicare payment. | ||||||||||||||
| 4 PE RVUs = Practice Expense Relative Value Units. | ||||||||||||||
(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: March 23, 2000.
Brian P. Burns,
Deputy Assistant Secretary for Information Resources Management.
[FR Doc. 00-8717 Filed 4-10-00; 8:45 am]
BILLING CODE 4120-01-P