[Federal Register Volume 60, Number 137 (Tuesday, July 18, 1995)]
[Rules and Regulations]
[Pages 36733-36736]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 95-17570]



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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.

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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