[Federal Register Volume 64, Number 91 (Wednesday, May 12, 1999)]
[Rules and Regulations]
[Pages 25456-25460]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 99-11511]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Health Care Financing Administration

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

[HCFA-1006-CN]
RIN 0938-AI52


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

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

ACTION: Correction of final rule with comment period.

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

SUMMARY: This document corrects technical errors that appeared in the 
final rule with comment period published in the Federal Register on 
November 2, 1998, entitled ``Medicare Program; Revisions to Payment 
Policies and Adjustments to the Relative Value Units Under the 
Physician Fee Schedule for Calendar Year 1999.''

EFFECTIVE DATE: January 1, 1999.

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

SUPPLEMENTARY INFORMATION:

Background

    In FR Doc. 98-29181 of November 2, 1998, (63 FR 58814), there were 
a number of technical errors. The errors relate to the omission of 
background information, an incorrect reference, the qualification 
requirements for nonphysician practitioners, a typographical error, a 
correction to a CPT code modifier in Table 6, an inconsistency in the 
preamble and addendum, the omission of status indicator references, the 
omission of a facility type in the regulations text, and revisions to 
Addendum B.
    The provisions in this correction notice are effective as if they 
had been included in the document published in the Federal Register on 
November 2, 1998, that is, January 1, 1999.

Discussion of Addendum B

    1. We inadvertently omitted the professional and technical portions 
for the following CPT code. Entries on the page listed below are 
corrected as follows: Page 59073 for CPT codes 78020-26 and 78020-TC. 
These corrections are reflected in correction number 19 to follow.
    2. We assigned incorrect status codes to the following CPT codes. 
Entries on pages listed below are corrected as follows: Page 59087 for 
CPT code 82251; page 59114 for CPT codes 90471 and 90472; page 59181 
for CPT code R0070; and page 59182 for CPT code R0075. These 
corrections are reflected in correction number 20 to follow.
    3. We assigned incorrect RVUs or modifiers for the following CPT 
codes. Entries on pages listed below are corrected as follows: Page 
59109 for CPT code 88141; page 59132 for CPT codes 94014, 94014-26, and 
94014-TC; 94015, 94015-26, 94015-TC; and 94016; page 59168 for CPT code 
G0124; and page 59169 for CPT code G0141. These corrections are 
reflected in correction number 21 to follow.
    4. We stated that we would not provide a transition for codes 
representing services that are new beginning in 1999. The codes 
identified below are new CPT codes, but do not represent new services. 
These codes were previously reported with a different CPT code. We 
failed to apply the transition to these services. The corrected RVUs 
for the codes are as follows: Page 58965 for CPT codes 31623, 31624, 
and 31643; page 58977 for CPT codes 35682, and 35683; page 59133 for 
CPT codes 94621, 94621-26, and 94621-TC. These corrections are 
reflected in correction number 22 to follow.
    5. We erroneously assigned relative value units to the following 
CPT codes in the facility setting. By definition the following CPT 
codes cannot be performed in the facility setting. Columns associated 
with facility relative value units should be set to NA in Addendum B. 
Entries on pages listed below are corrected as follows: Page 59144 for 
CPT codes 99321, 99322, 99323, 99331, 99332, 99333, 99341, 99342, 
99343, 99344, 99345, 99347, 99348, 99349, and 99350; page 59145 for CPT 
codes 99374 and 99375. These corrections are reflected in correction 
number 23 to follow.

Correction of Errors

    In FR Doc. 98-29181 of November 2, 1998, make the following 
corrections:
    1. On page 58814, column three, ``Table of Contents'', after 
subsection ``I.B'', add a new subsection ``C'' to read as follows:
``C. Components of the Fee Schedule Payment Amounts''
    2. On page 58816, column one, add a new subsection ``C'', to read 
as follows:

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

    Under the formula set forth in section 1848(b)(1) of the Act, the 
payment amount for each service paid for under the physician fee 
schedule is the product of three factors: (1) A nationally uniform 
relative value for the service; (2) a geographic adjustment factor 
(GAF) for each physician fee schedule area; and (3) a nationally 
uniform conversion factor (CF) for the service. The CF converts the 
relative values into payment amounts.
    For each physician fee schedule service, there are three relative 
values: (1) An RVU for physician work; (2) an RVU for practice expense 
(NOTE: This RVU will vary on a code by code basis depending upon if the 
service is performed in a facility or non-facility setting); and (3) an 
RVU for malpractice

[[Page 25457]]

expense. For each of these components of the fee schedule there is a 
geographic practice cost index (GPCI) for each fee schedule area. The 
GPCIs reflect the relative costs of practice expenses, malpractice 
insurance, and physician work in an area compared to the national 
average for each component.
    The general formula for calculating the Medicare fee schedule 
amount for a given service in a given fee schedule area can be 
expressed as:

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

    The CF for calendar year 1999 appears in Section V. ``Physician Fee 
Schedule Update and Conversion Factor for Calendar Year 1999.'' The 
RVUs for calendar year 1999 are in Addendum B. The GPCIs for calendar 
year 1999 can be found in Addendum D of the October 31, 1997, final 
rule (62 FR 59255).
    Section 1848(e) of the Act requires the Secretary to develop GAFs 
for all physician fee schedule areas. The total GAF for a fee schedule 
area is equal to a weighted average of the individual GPCIs for each of 
the three components of the service. Thus, the GPCIs reflect the 
relative costs of practice expenses, malpractice insurance, and 
physician work in an area compared to the national average. In 
accordance with the law, however, the GAF for the physician's work 
reflects one-quarter of the relative cost of physician's work compared 
to the national average.''
    3. On page 58827, in column three, bullet two, line two, ``REUS'' 
is corrected to read ``RVUs.''
    4. On page 58828, in column 1, the first full paragraph, lines 4 
and 11, ``REUS'' is corrected to read ``RVUs.''
    5. On page 58844, there is an inaccuracy in the discussion 
concerning physician direction of concurrent anesthesia services. In 
the discussion, we inadvertently failed to include the revisions to the 
policy that were made in the September 1, 1983 final rule (48 FR 39740) 
and currently appear in section 15018C of the Medicare Carrier Manual 
(MCM).
    Therefore, on page 58844, column three, the second full paragraph 
from the top is corrected to read as follows: ``If a physician is 
directing four concurrent surgical procedures and devotes extensive 
time to checking or discharging other patients in the recovery room or 
handling scheduling matters, this could unduly diminish physician 
involvement in the surgical cases. If significantly reduced, a 
physician's involvement in the surgical cases would become 
``supervision'' rather than ``medical direction.'' Also, a physician 
cannot personally be extensively involved in recovery room or 
scheduling matters of significant duration because such personal 
services would diminish the scope of control necessary for medical 
direction.''
    6. On page 58874, in the second column, third paragraph beginning 
``Result of evaluation of comments'' we discuss the qualifications 
required for a nurse practitioner to be eligible for Medicare Part B 
payment. We erred in establishing the effective date for the 
requirements for nurse practitioners. The date should be January 1, 
2000. The provisions for nurse practitioner qualifications will not be 
effective until January 1, 2000. In column 2, paragraph 3, line 3, 
insert the words ``after December 31, 1999,'' after the comma.
    7. On page 58878, in the third column, fourth full paragraph, the 
first bullet, the name of the national accreditation organization was 
published incorrectly. Therefore, remove the word ``National.'' Also, 
we inadvertently omitted the word ``or'' after the semicolon. The word 
``or'' was included in the proposed rule and there was no change 
intended in this area. Therefore, the word ``or'' should be added after 
the semicolon. The first bullet should now read as follows: ``Has 
graduated from a physician assistant educational program that is 
accredited by the Commission on Accreditation of Allied Health 
Education Programs; or''
    In the second bullet, the third line we incorrectly stated that the 
national certification examination is ``certified'' by the National 
Commission on Certification of Physician Assistants. This organization 
``administers'' the examination. Therefore, the word ``certified'' is 
removed and replaced with ``administered.'' The second bullet should 
now read as follows: ``Has passed the national certification 
examination that is administered by the National Commission on 
Certification of Physician Assistants; and'
    8. On page 58889, in Table 6, the last line, the second column, the 
modifier for CPT code 94014, remove ``26'' and leave the column blank.
    9. On page 58892, in the third column, the third bullet, line 6, 
remove the word ``National''. In line 7, remove the second use of the 
word ``on'' and add the word ``of'', and add the word ``or'' after the 
semicolon. Line 11, the word ``certified'' is replaced with 
``administered.'' The third bullet should now read as follows: `` 
Proposed Sec. 410.74(c) is revised to state that a physician assistant 
is an individual who--
     Has graduated from a physician assistant educational 
program that is accredited by the Commission on Accreditation of Allied 
Health Education Programs; or
     Has passed the national certification examination that is 
administered by the National Commission on Certification of Physician 
Assistants; and
     Is licensed by the State to practice as a physician 
assistant.''


Sec. 410.74  [Corrected]

    10. On page 58908, in column one, in the regulations text, under 
Sec. 410.74, paragraph (c)(1), remove the word ``National'' and add the 
word ``or'' after the semicolon. In paragraph (c)(2), line two, remove 
the word ``of'' and add the phrase ``that is administered by.''


Sec. 410.75  [Corrected]

    11. On page 58908, in column one, in the regulations text, under 
Sec. 410.75, paragraph (b), ``For'' is corrected to read, ``After 
December 31, 1999, for''.


Sec. 414.32  [Corrected]

    12. On page 58911, in the first column, correct the amendatory 
language in item 5, and add paragraph (a)(6) to read as follows:
    ``5. In Sec. 414.32, the heading and paragraphs (a)(6) and (b) are 
revised to read as follows:
    (a) Definition. * * *
    (6) Skilled nursing facilities.''


Sec. 485.705  [Corrected]

    13. On page 58913, in column one, in the regulations text, under 
Sec. 485.705, paragraph (c)(8) introductory text is corrected to read 
as follows:
    ``(c) * * *
    (8) After December 31, 1999, a nurse practitioner is a person who 
must:''
    14. On page 58913, column one, Sec. 485.705(c)(10)(i) is corrected 
by removing the word ``National'' and, after the semicolon, replacing 
the word ``and'' with ``or'' and paragraph (c)(10)(ii) is corrected by, 
removing the word ``certified'' and adding ``administered'' in its 
place. In paragraph (c)(10)(iii), the first use of the phrase ``as a 
physician assistant'' is removed.

Addendum B [Corrected]

    15. On page 58913, in column three, add the following after the 
entry for status code ``G':

``H = Deleted modifier (code used to have a modifier of TC and PC)
I = Code not valid for Medicare purposes. Medicare does not recognize 
codes assigned this status. Medicare uses another code

[[Page 25458]]

for reporting of, and payment for, these services. This indicator is 
treated in the same manner as status indicator ``G.'' Its use allows 
for more efficient carrier processing of Medicare claims.''

    16. On page 58914, in columns two and three, in the definitions for 
``11'' and ``12'', remove the words ``for 1999.''

Addendum B

    17. In the table of Addendum B, the following CPT codes are added 
to read as follows:

------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                                            Transi-               Transi-
                                                                                   Non-      tioned    Facility    tioned                          Transi-               Transi-
 CPT1 \1\ HCPCS                                                        Physi-    facility     non-     practice   facility  Mal-prac-     Non-      tioned    Facility    tioned
      \2\             Mod           Status          Description      cian work   practice   facility   expense    pratice   tice RVUs   facility     non-      Total     facility      Global
                                                                      RVUs \3\   expense    expense      RVUs     expense                total     facility               total
                                                                                   RVUs       RVUs                  RVUs                            total
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
 
                                       *                  *                  *                  *                  *                  *                  *
78020..........  26             A              Thyroid met uptake..       0.60       0.02       0.02       0.02       0.02       0.02       0.64       0.64       0.64       0.64  ZZZ
78020..........  TC             A              Thyroid met uptake..       0.00       0.15       0.15       0.15       0.15       0.06       0.21       0.21       0.21       0.21  ZZZ
 
                                       *                  *                  *                  *                  *                  *                  *
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
\1\ CPT codes and descriptions only are copyright 1998 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.

    18. In the table to Addendum B, the following CPT codes are 
correctly revised to read as follows:

------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                        Non-
                                                          Physician   facility  Transitioned   Facility  Transitioned                  Non-    Transitioned             Transitioned
  CPT1 \1\/        Mod       Status       Description     work RVUs   practice  non-facility   practice    facility    Malpractice   facility  non-facility   Facility    facility      Global
  HCPCS \2\                                                  \3\      expense   expense RVUs   expense      pratice        RVUs       total        total       total        total
                                                                        RVUs                     RVUs    expense RVUs
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
 
                                       *                  *                  *                  *                  *                  *                  *
82251........              X           Assay Bilirubin..       0.00       0.00         0.00        0.00         0.00         0.00        0.00         0.00        0.00         0.00   XXX
 
                                       *                  *                  *                  *                  *                  *                  *
90471........              X           Immunization            0.00       0.00         0.00        0.00         0.00         0.00        0.00         0.00        0.00         0.00   XXX
                                        admin, single.
90472........              X           Immunization            0.00       0.00         0.00        0.00         0.00         0.00        0.00         0.00        0.00         0.00   XXX
                                        admin, 2+.
 
                                       *                  *                  *                  *                  *                  *                  *
R0070........              C           Transport               0.00       0.00         0.00        0.00         0.00         0.00        0.00         0.00        0.00         0.00   XXX
                                        portable x-ray.
R0075........              C           Transport port x-       0.00       0.00         0.00        0.00         0.00         0.00        0.00         0.00        0.00         0.00   XXX
                                        ray multipl.
 
                                       *                  *                  *                  *                  *                  *                  *
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
\1\ CPT codes and descriptions only are copyright 1998 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.

    19. In the table to Addendum B, the following CPT codes are 
correctly revised to read as follows:

------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                        Non-
                                                          Physician   facility  Transitioned   Facility  Transitioned                  Non-    Transitioned             Transitioned
  CPT1 \1\/        Mod       Status       Description     work RVUs   practice  non-facility   practice    facility    Malpractice   facility  non-facility   Facility    facility      Global
  HCPCS \2\                                                  \3\      expense   expense RVUs   expense      pratice        RVUs       total        total       total        total
                                                                        RVUs                     RVUs    expense RVUs
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
 
                                       *                  *                  *                  *                  *                  *                  *
88141........              A           Cytpath c/vag           0.42       0.18         0.56        0.18         0.31         0.03         .63         1.01        0.63         0.76   ZZZ
                                        interpret.
 
                                       *                  *                  *                  *                  *                  *                  *
94014........              A           Patient recorded        0.52       0.63         0.63        0.63         0.63         0.04        1.19         1.19        1.19         1.19   XXX
                                        spirometry.
94014........  26          H           Patient recorded        0.52       0.20         0.20        0.20         0.20         0.02        0.74         0.74        0.74         0.74   XXX
                                        spirometry.
94014........  TC          H           Patient recorded        0.00       0.43         0.43        0.43         0.43         0.02        0.45         0.45        0.45         0.45   XXX
                                        spirometry.
94015........              A           Patient recorded        0.00       0.43         0.00        0.43         0.00         0.02        0.45         0.00        0.45         0.00   XXX
                                        spirometry.
94015........  26          H           Patient recorded        0.00       0.00         0.00        0.00         0.00         0.00        0.00         0.00        0.00         0.00   XXX
                                        spirometry.
94015........  TC          H           Patient recorded        0.00       0.00         0.00        0.00         0.00         0.00        0.00         0.00        0.00         0.00   XXX
                                        spirometry.
94016........              A           Review patient          0.52       0.20         0.20        0.20         0.20         0.02        0.74         0.74        0.74         0.74   XXX
                                        spirometry.
 
                                       *                  *                  *                  *                  *                  *                  *
G0124........              A           Screen c/v thin         0.42       0.18         0.30        0.18         0.30         0.03        0.63         0.75        0.63         0.75   XXX
                                        layer by MD.
G0141........              A           Scr c/v cyto,           0.42       0.18         0.15        0.18         0.15         0.03        0.63         0.60        0.63         0.60   XXX
                                        autosys and md.
 
                                       *                  *                  *                  *                  *                  *                  *
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
\1\ CPT codes and descriptions only are copyright 1998 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.

    20. In the table to Addendum B, the following CPT codes are 
correctly revised to read as follows:

------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                        Non-
                                                          Physician   facility  Transitioned   Facility  Transitioned                  Non-    Transitioned             Transitioned
  CPT1 \1\/        Mod       Status       Description     work RVUs   practice  non-facility   practice    facility    Malpractice   facility      non-       Facility    facility      Global
  HCPCS \2\                                                  \3\      expense   expense RVUs   expense      pratice        RVUs       total      facility      total        total
                                                                        RVUs                     RVUs    expense RVUs                              total
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
 
                                       *                  *                  *                  *                  *                  *                  *
31623........              A           Dx Bronchoscope/        3.07       3.33         3.34        1.25         2.82         0.27        6.67         6.68        4.59         6.16   OOO
                                        brush.
31624........              A           Dx Bronchoscope/        3.11       3.35         3.34        1.26         2.82         0.27        6.73         6.72        4.64         6.20   OOO
                                        lavage.
 
                                       *                  *                  *                  *                  *                  *                  *
31643........              A           Dx Bronchoscope/        3.50       1.73         2.94        1.23         2.81         0.66        5.89         7.10        5.39         6.97   OOO
                                        catheter.
 

[[Page 25459]]

 
                                       *                  *                  *                  *                  *                  *                  *
35682........              A           Composite bypass        7.20       2.81         7.92        2.74         7.90         2.75       12.76        17.87       12.69        17.85   ZZZ
                                        graft.
35683........              A           Composite bypass        8.50       3.32         8.05        3.22         8.02         2.75       14.57        19.30       14.47        19.27   ZZZ
                                        graft.
 
                                       *                  *                  *                  *                  *                  *                  *
94621........              A           Plum stress/test        0.88       1.74         2.11        1.74         2.11         0.12        2.74         3.11        2.74         3.11   XXX
                                        complex.
94621........  26          A           Plum stress/test        0.88       0.27         0.64        0.27         0.64         0.04        1.19         1.56        1.19         1.56   XXX
                                        complex.
94621........  TC          A           Plum stress/test        0.00       1.47         1.47        1.47         1.47         0.08        1.55         1.55        1.55         1.55   XXX
                                        complex.
 
                                       *                  *                  *                  *                  *                  *                  *
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
\1\ CPT codes and descriptions only are copyright 1998 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.

    21. In the table to Addendum B, the following CPT codes are 
correctly revised to read as follows:

----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                                                       Non-
                                                                                         Physician   facility   Transitioned   Facility   Transitioned                  Non-     Transitioned
        CPT1\1\/ HCPCS\2\                Mod             Status         Description        work      practice   non-facility   practice     facility    Malpractice   facility     facility     Facility   Transitioned       Global
                                                                                          RVUs\3\     expense   expense RVUs    expense     practice        RVUs        total        total        total      facility
                                                                                                       RVUs                      RVUs     expense RVUs
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
 
                                                           *                  *                  *                  *                  *                  *                  *
99321............................    .............  A..............  Rest home visit,         0.71        0.38         0.40           NA           NA          0.02        1.11         1.13           NA           NA   XXX
                                                                      new patient.
99322............................    .............  A..............  Rest home visit,         1.01        0.59         0.56           NA           NA          0.04        1.64         1.61           NA           NA   XXX
                                                                      new patient.
99323............................    .............  A..............  Rest home visit,         1.28        0.74         0.78           NA           NA          0.05        2.07         2.11           NA           NA   XXX
                                                                      new patient.
99331............................    .............  A..............  Rest home visit,         0.60        0.38         0.32           NA           NA          0.02        1.00         0.94           NA           NA   XXX
                                                                      estab pat.
99332............................    .............  A..............  Rest home visit,         0.80        0.48         0.41           NA           NA          0.02        1.30         1.23           NA           NA   XXX
                                                                      estab pat.
99333............................    .............  A..............  Rest home visit,         1.00        0.58         0.51           NA           NA          0.02        1.60         1.53           NA           NA   XXX
                                                                      estab pat.
99341............................    .............  A..............  Home visit, new          1.01        0.49         0.56           NA           NA          0.04        1.54         1.61           NA           NA   XXX
                                                                      patient.
99342............................    .............  A..............  Home visit, new          1.52        0.74         0.67           NA           NA          0.04        2.30         2.23           NA           NA   XXX
                                                                      patient.
99343............................    .............  A..............  Home visit, new          2.27        1.09         0.90           NA           NA          0.05        3.41         3.22           NA           NA   XXX
                                                                      patient.
99344............................    .............  A..............  Home visit, new          3.03        1.35         1.03           NA           NA          0.07        4.45         4.13           NA           NA   XXX
                                                                      patient.
99345............................    .............  A..............  Home visit, new          3.79        1.61         1.09           NA           NA          0.07        5.47         4.95           NA           NA   XXX
                                                                      patient.
99347............................    .............  A..............  Home visit, estab        0.76        0.41         0.47           NA           NA          0.03        1.20         1.26           NA           NA   XXX
                                                                      patient.
99348............................    .............  A..............  Home visit, estab        1.26        0.63         0.59           NA           NA          0.03        1.92         1.88           NA           NA   XXX
                                                                      patient.
99349............................    .............  A..............  Home visit, estab        2.02        0.91         0.72           NA           NA          0.04        2.97         2.78           NA           NA   XXX
                                                                      patient.
99350............................    .............  A..............  Home visit estab         3.03        1.24         0.93           NA           NA          0.05        4.32         4.01           NA           NA   XXX
                                                                      patient.
 
                                                           *                  *                  *                  *                  *                  *                  *
99374............................  ...............  B..............  Home health care        +1.10        1.03         0.67           NA           NA          0.03        2.16         1.80           NA           NA   XXX
                                                                      supervision.
99375............................    .............  A..............  Home health care         1.73        1.11         0.69           NA           NA          0.03        2.87         2.45           NA           NA   XXX
                                                                      supervision.
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
\1\ CPT codes and descriptions only are copyright 1998 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.


[[Page 25460]]

(Section 1848 of the Social Security Act (42 U.S.C. 1395w-4))

(Catalog of Federal Domestic Assistance Program No. 93.774, 
Medicare--Supplementary Medical Insurance Program)

    Dated: April 30, 1999.
Neil J. Stillman,
Deputy Assistant Secretary for Information Resources Management.
[FR Doc. 99-11511 Filed 5-11-99; 8:45 am]
BILLING CODE 4120-01-P