[Federal Register Volume 63, Number 20 (Friday, January 30, 1998)]
[Rules and Regulations]
[Pages 4595-4597]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 98-2328]


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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.

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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