[Federal Register Volume 65, Number 70 (Tuesday, April 11, 2000)]
[Rules and Regulations]
[Pages 19329-19334]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 00-8717]
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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.
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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
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,
[[Page 19330]]
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
Sec. 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.
[[Page 19331]]
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''.
Sec. 410.39 [Corrected]
6. On page 59440, in the second column, Sec. 410.39 is corrected by
adding paragraphs (a)(4) and (a)(5) as follows:
Sec. 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 Sec. 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:
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Fully
Physician Fully Year 2000 Fully Year 2000 Implemented Year 2000 Fully Year 2000
CPT\1\/ MOD Status Description Work implemented transitional implemented transitional Malpractice non transitional implemented transitional Global
HCPCS\2\ RVUs\3\ nonfacility nonfacility facility PE facility PE RVUs facility nonfacility facility facility
PE RVUs PE RVUs RVUs RVUs total total total total
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
21740 A Reconstruction of 16.80 NA NA 15.80 12.78 1.95 NA NA 34.55 31.53 090
sternum.
38550 A Removal, neck/ 6.92 NA NA 5.24 4.38 0.50 NA NA 12.66 11.80 090
armpit lesion.
38555 A Removal, neck/ 14.14 NA NA 11.47 9.68 1.53 NA NA 27.14 25.35 090
armpit lesion.
39503 A Repair of 37.54 NA NA 14.98 21.16 3.26 NA NA 55.78 61.96 090
diaphragm hernia.
42810 A Excision of neck 3.25 4.77 4.09 3.83 3.62 0.27 8.29 7.61 7.35 7.14 090
cyst.
42815 A Excision of neck 7.07 NA NA 6.06 7.35 0.55 NA NA 13.68 14.97 090
cyst.
43305 A Repair esophagus 17.39 NA NA 12.60 13.74 1.32 NA NA 31.31 32.45 090
and fistula.
43310 A Repair of 27.47 NA NA 17.64 18.04 3.07 NA NA 48.18 48.58 090
esophagus.
43312 A Repair esophagus 30.50 NA NA 23.15 19.02 3.46 NA NA 57.11 52.98 090
and fistula.
43831 A Place gastrostomy 7.84 NA NA 4.15 4.90 0.74 NA NA 12.73 13.48 090
tube.
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 27.51 NA NA 12.98 12.35 2.65 NA NA 43.14 42.51 090
and colon.
46715 A Repair of 7.46 NA NA 4.31 4.06 0.86 NA NA 12.63 12.38 090
anovaginal
fistula.
46716 A Repair of 12.85 NA NA 6.50 6.54 1.21 NA NA 20.56 20.60 090
anovaginal
fistula.
46730 A Construction of 22.39 NA NA 11.74 11.70 1.91 NA NA 36.04 36.00 090
absent anus.
46735 A Construction of 27.02 NA NA 12.15 13.15 2.59 NA NA 41.76 42.76 090
absent anus.
46740 A Construction of 24.19 NA NA 10.40 11.47 2.31 NA NA 36.90 37.97 090
absent anus.
46751 A Repair of anal 8.77 NA NA 5.53 4.98 0.86 NA NA 15.16 14.61 090
sphincter.
47700 A Exploration of 15.62 NA NA 8.23 8.26 1.37 NA NA 25.22 25.25 090
bile ducts.
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 23.20 NA NA 10.50 9.86 2.18 NA NA 35.88 35.24 090
spine tumor.
49495 A Repair inguinal 5.84 NA NA 3.67 4.54 0.56 NA NA 10.07 10.94 090
hernia, init.
49580 A Repair umbilical 3.34 NA NA 2.74 3.47 0.34 NA NA 6.42 7.15 090
hernia.
49600 A Repair umbilical 10.96 NA NA 5.66 5.69 0.95 NA NA 17.57 17.60 090
lesion.
49605 A Repair umbilical 24.94 NA NA 11.31 10.31 2.20 NA NA 38.45 37.45 090
lesion.
49606 A Repair umbilical 21.31 NA NA 8.89 8.96 1.91 NA NA 32.11 32.18 090
lesion.
51940 A Correction of 28.43 NA NA 13.38 16.98 1.90 NA NA 43.71 47.31 090
bladder defect.
60280 A Remove thyroid 5.87 NA NA 4.86 6.06 0.48 NA NA 11.21 12.41 090
duct lesion.
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
\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:
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Fully Year 2000 Fully Year 2000 Fully Year 2000 Fully Year 2000
CPT \1\/ Physician implemented transitional implemented transitional Malpractice implemented transitional implemented transitional
HCPCS MOD Status Description work RVUs nonfacility nonfacility facility PE facility PE RVUs nonfacility non-facility facility facility Global
\2\ \3\ PE RVUs \4\ PE RVUs \4\ RVUs \4\ RVUs \4\ total total total total
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
61885 A Implant neurostim 5.85 NA NA 4.86 6.06 0.48 NA NA 11.21 12.41 090
one array.
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
\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:
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Fully Year 2000 Fully Year 2000 Fully Year 2000 Fully Year 2000
CPT \1\/ Physician implemented transitional implemented transitional Malpractice implemented transitional implemented transitional
HCPCS MOD Status Description work RVUs nonfacility nonfacility facility PE facility PE RVUs nonfacility non-facility facility facility Global
\2\ \3\ PE RVUs \4\ PE RVUs \4\ RVUs \4\ RVUs \4\ total total total total
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Q0183 X Nonmetabolic 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
active tissue.
Q0184 X Metabolically 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
active tissue.
Q0185 X Metabolic active D/ 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
E tissue.
Q0186 X Paramedic 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 XXX
intercept, rural.
[[Page 19332]]
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 0.00 0.08 0.18 0.08 0.18 0.02 0.10 0.20 0.10 0.20 XXX
oxygen level.
94761 T Measure blood 0.00 0.15 0.42 0.15 0.42 0.05 0.20 0.47 0.20 0.47 XXX
oxygen level.
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
\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:
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Fully Year 2000 Fully Year 2000 Fully Year 2000 Fully Year 2000
CPT \1\/ Physician implemented trasitional implemented transitional Malpractice implemented transitional implemented transitional
HCPCS MOD Status Description work nonfacility nonfacility facility PE facility PE RVUs nonfacility facility facility facility Global
\2\ RVUs\3\ PE RVUs PE RVUs RVUs RVUs total total total total
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
35500 .......... A Harvest vein for 6.45 NA NA 2.43 2.43 0.73 NA NA 9.61 9.61 ZZZ
bypass.
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 17.00 NA NA 7.83 7.83 1.04 NA NA 25.87 25.87 090
splenectomy.
38792 .......... A Identify sentinel 0.52 NA NA 0.20 0.20 0.01 NA NA 0.73 0.73 000
node.
44201 .......... A Laparoscopic 9.78 NA NA 3.61 3.61 1.35 NA NA 14.74 14.74 090
jejunostomy.
60650 .......... A Laparoscopy 20.00 NA NA 9.10 9.10 1.35 NA NA 30.45 30.45 090
adrenalectomy.
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
\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:
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Fully Year 2000 Fully Year 2000 Fully Year 2000 Fully Year 2000
CPT \1\/ Physician implemented trasitional implemented transitional Malpractice implemented transitional implemented transitional
HCPC \2\ MOD Status Description work nonfacility nonfacility facility PE facility PE RVUs nonfacility facility facility facility Global
RVUs\3\ PE RVUs PE RVUs RVUs RVUs total total total total
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
33968 .......... A Remove aortic 0.64 0.25 0.25 0.25 0.25 0.27 1.16 1.16 1.16 1.16 000
assist device.
47560 .......... A Laparoscopy w/ 4.89 N/A N/A 1.95 2.48 0.46 N/A N/A 7.30 7.83 000
cholangio.
62263 .......... A Lysis epidural 6.02 4.61 4.61 2.18 2.18 0.88 11.51 11.51 9.08 9.08 010
adhesions.
96570 .......... A Photodynamic tx, 1.10 0.71 0.71 0.43 0.43 0.28 2.09 2.09 1.81 1.81 ZZZ
30 min.
96571 .......... A Photodynamc tx, 0.55 0.31 0.31 0.21 0.21 0.28 1.14 1.14 1.04 1.04 ZZZ
addl 15 min.
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
\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:
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Fully Year 2000 Fully Year 2000 Fully Year 2000 Fully Year 2000
CPT \1\/ Physician implemented trasitional implemented transitional Malpractice implemented transitional implemented transitional
HCPC \2\ MOD Status Description work nonfacility nonfacility facility PE facility PE RVUs nonfacility facility facility facility Global
RVUs\3\ PE RVUs PE RVUs RVUs RVUs total total total total
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
33975 .......... A Implant 21.00 NA NA 16.80 16.10 2.86 NA NA 40.66 39.96 XXX
ventricular
device.
33976 .......... A Implant 23.00 NA NA 18.65 19.82 3.91 NA NA 45.56 46.73 XXX
ventricular
device.
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
\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:
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Fully Year 2000 Fully Year 2000 Fully Year 2000 Fully Year 2000
CPT \1\/ Physician implemented trasitional implemented transitional Malpractice implemented transitional implemented transitional
HCPC \2\ MOD Status Description work nonfacility nonfacility facility PE facility PE RVUs nonfacility facility facility facility Global
RVUs\3\ PE RVUs PE RVUs RVUs RVUs total total total total
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
G0102 A Prostate ca 0.17 0.51 0.37 0.06 0.09 0.01 0.69 0.55 0.24 0.27 XXX
screening; dre.
G0104 A CA screen; flexi 0.96 1.35 1.34 0.33 0.46 0.07 2.38 2.37 1.36 1.49 000
sigmoidscope.
G0105 A Colorectal scrn; 3.70 5.99 5.24 1.29 2.86 0.26 9.95 9.20 5.25 6.82 000
hi risk ind.
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 3.45 NA NA 1.38 2.11 0.51 NA NA 5.34 6.07 000
punture, prenatal.
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 0.66 0.78 1.06 0.78 1.06 0.21 1.65 1.93 1.65 1.93 000
stress test.
59020 26 A Fetal contract 0.66 0.26 0.53 0.26 0.53 0.13 1.05 1.32 1.05 1.32 000
stress test.
59020 TC A Fetal contract 0.00 0.52 0.53 0.52 0.53 0.08 0.60 0.61 0.60 0.61 000
stress test.
59025 A Fetal non-stress 0.53 0.43 0.55 0.43 0.55 0.10 1.06 1.18 1.06 1.18 000
test.
59025 26 A Fetal non-stress 0.53 0.20 0.31 0.20 0.31 0.08 0.81 0.92 0.81 0.92 000
test.
59025 TC A Fetal non-stress 0.00 0.23 0.24 0.23 0.24 0.02 0.25 0.26 0.25 0.26 000
test.
59030 A Fetal scalp blood 1.99 NA NA 0.77 1.24 0.30 NA NA 3.06 3.53 000
sample.
59050 A Fetal monitor w/ 0.89 NA NA 0.34 0.61 0.12 NA NA 1.35 1.62 XXX
report.
59051 A Fetal monitor/ 0.74 NA NA 0.28 0.58 0.10 NA NA 1.12 1.12 XXX
interpret only.
59100 A Remove uterus 12.35 NA NA 6.05 5.27 1.80 NA NA 20.20 19.42 090
lesion.
[[Page 19333]]
59120 A Treat ectopic 11.49 NA NA 5.73 7.13 1.67 NA NA 18.89 20.29 090
pregnancy.
59121 A Treat ectopic 11.67 NA NA 5.84 5.84 1.70 NA NA 19.21 19.21 090
pregnancy.
59130 A Treat ectopic 14.22 NA NA 6.89 6.68 2.07 NA NA 23.18 22.97 090
pregnancy.
59135 A Treat ectopic 13.88 NA NA 6.76 8.73 2.01 NA NA 22.65 24.62 090
pregnancy.
59136 A Treat ectopic 13.18 NA NA 6.49 6.62 1.92 NA NA 21.59 21.72 090
pregnancy.
59140 A Treat ectopic 5.46 NA NA 3.40 4.23 0.79 NA NA 9.65 10.48 090
pregnancy.
59150 A Treat ectopic 6.89 NA NA 3.95 4.44 1.00 NA NA 11.84 12.33 090
pregnancy.
59151 A Treat ectopic 7.86 NA NA 4.01 6.68 1.15 NA NA 13.02 15.69 090
pregnancy.
59160 A D & C after 2.71 3.30 3.24 2.07 2.63 0.39 6.40 6.34 5.17 5.73 010
delivery.
59200 A Insert cervical 0.79 1.19 0.89 0.29 0.3 0.11 2.09 1.79 1.19 1.20 000
dilator.
59300 A Episiotomy or 2.41 1.56 1.32 0.92 0.73 0.34 4.31 4.07 3.67 3.48 000
vaginal repair.
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 1.71 1.16 1.24 0.65 0.99 0.25 3.12 3.20 2.61 2.95 MMM
manipulation.
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 4.81 4.62 3.88 4.62 3.1 0.71 10.14 9.40 10.14 8.62 MMM
only.
59426 A Antepartum care 8.28 7.85 6.61 7.81 5.25 1.20 17.33 16.09 17.29 14.73 MMM
only.
59430 A Care after 2.13 1.14 0.78 1.14 0.68 0.32 3.59 3.23 3.59 3.13 MMM
delivery.
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 15.97 NA NA 6.01 8.97 2.32 NA NA 24.30 27.26 MMM
only.
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 8.54 NA NA 3.19 3.66 1.24 NA NA 12.97 13.44 ZZZ
after cesarean.
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 16.34 NA NA 6.29 8.74 2.38 NA NA 25.01 27.46 MMM
delivery.
59618 A Attempted Vbac 27.78 NA NA 10.51 14.43 4.05 NA NA 42.34 46.26 MMM
delivery.
59620 A Attempted Vbac 17.53 NA NA 6.67 9.30 2.55 NA NA 26.75 29.38 MMM
delivery only.
59622 A Attempted Vbac 18.93 NA NA 7.27 10.05 2.76 NA NA 28.96 31.74 MMM
after care.
59812 A Treatment of 3.25 4.21 4.07 2.23 3.06 0.48 7.94 7.80 5.96 6.79 090
miscarriage.
59820 A Care of 4.01 4.40 4.24 2.52 3.3 0.59 9.00 8.84 7.12 7.90 090
miscarriage.
59821 A Treatment of 4.47 4.87 3.91 2.71 2.83 0.66 10.00 9.04 7.84 7.96 090
miscarriage.
59830 A Treat uterus 6.11 NA NA 3.64 4.28 0.89 NA NA 10.64 11.28 090
infection.
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 4.28 NA NA 2.85 3.01 0.62 NA NA 7.75 7.91 090
uterus.
59871 A Remove cerclage 2.13 1.89 1.91 0.81 1.37 0.32 4.34 4.36 3.26 3.82 000
suture.
59898 C Laparo proc, ob 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 YYY
care/delivery.
59899 C Maternity care 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 YYY
procedure.
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
\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:
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Fully Year 2000 Fully Year 2000 Fully Year 2000 Fully Year 2000
CPT \1\/ Physician implemented transitional implemented transitional Malpractice implemented transitional implemented transitional
HCPCS MOD Status Description work RVUs facility PE nonfacility facility PE facility PE RVUs nonfacility nonfacility facility facility Global
\2\ \3\ RVUs PE RVUs RVUs RVUs total total total total
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
20979 N U.S. bone 0.17 0.25 0.25 0.07 0.07 0.01 0.43 0.43 0.25 0.25 XXX
stimulation.
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
\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:
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Fully Year 2000 Fully Year 2000 Fully Year 2000 Fully Year 2000
CPT \1\/ Physician implemented transitional implemented Transitional Malpractice implemented Transitional implemented Transitional
HCPCS MOD Status Description work RVUs nonfacility nonfacility facility PE nonfacility RVUs nonfacility nonfacility facility facility Global
\2\ \3\ PE RVUs PE RVUs RVUs PE RVUs total total total total
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
G0106 A Colon CA screen; 0.99 2.51 2.66 2.51 2.66 0.15 3.65 3.80 3.65 3.80 XXX
barium enema.
G0106 26 A Colon CA screen; 0.99 0.27 0.38 0.27 0.38 0.04 1.30 1.41 1.30 1.41 XXX
barium enema.
G0106 TC A Colon CA screen; 0.00 2.24 2.28 2.24 2.28 0.11 2.35 2.39 2.35 2.39 XXX
barium enema.
G0120 A A Colon ca scrn 0.99 2.51 2.66 2.51 2.66 0.15 3.65 3.80 3.65 3.80 XXX
barium enema.
G0120 26 A Colon ca scrn 0.99 0.27 0.38 0.27 0.38 0.04 1.30 1.41 1.30 1.41 XXX
barium enema.
G0120 TC A Colon ca scrn 0.00 2.24 2.28 2.24 2.28 0.11 2.35 2.39 2.35 2.39 XXX
barium enema.
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- 0.38 0.30 0.30 0.15 0.15 0.39 1.07 1.07 0.92 0.92 ZZZ
on.
45378 53 A Diagnostic 0.96 1.35 1.34 0.33 0.46 0.07 2.38 2.37 1.36 1.49 000
colonoscopy.
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
\1\ CPT codes and descriptions only are copyright 1999 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.
[[Page 19334]]
\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:
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Fully Year 2000 Fully Year 2000 Fully Year 2000 Fully Year 2000
CPT \1\/ Physician implemented transitional implemented Transitional Malpractice implemented Transitional implemented Transitional
HCPCS MOD Status Description work RVUs nonfacility nonfacility facility PE nonfacility RVUs nonfacility nonfacility facility facility Global
\2\ \3\ PE RVUs PE RVUs RVUs PE RVUs total total total total
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
40814 A Excise/repair 3.42 3.64 3.58 3.64 2.70 0.25 7.31 7.25 7.31 6.37 90
mouth lesion.
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
\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:
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Fully Year 2000 Fully Year 2000 Fully Year 2000 Fully Year 2000
CPT \1\/ Physician implemented transitional implemented transitional Malpractice implemented transitional implemented transitional
HCPCS MOD Status Description work nonfacility nonfacility facility PE facility PE RVUs nonfacility nonfacility facility facility Global
\2\ RVUs\3\ PE RVUs PE RVUs RVUs RVUs total total total total
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
G0163 ......... A PET for rec of 1.50 56.21 56.21 56.21 56.21 2.06 59.77 59.77 59.77 59.77 XXX
colorectal ca.
G0163 26....... A PET for rec of 1.50 0.58 0.58 0.58 0.58 0.05 2.13 2.13 2.13 2.13 XXX
colorectal ca.
G0163 TC....... A PET for rec of 0.00 55.63 55.63 55.63 55.63 2.01 57.64 57.64 57.64 57.64 XXX
colorectal ca.
G0164 ......... A PET for lymphoma 1.87 56.35 56.35 56.35 56.35 2.06 60.28 60.28 60.28 60.28 XXX
staging.
G0164 26....... A PET for lymphoma 1.87 0.72 0.72 0.72 0.72 0.05 2.64 2.64 2.64 2.64 XXX
staging.
G0164 TC....... A PET for lymphoma 0.00 55.63 55.63 55.63 55.63 2.01 57.64 57.64 57.64 57.64 XXX
staging.
G0165 ......... A PET, rec of 1.50 56.21 56.21 56.21 56.21 2.06 59.77 59.77 59.77 59.77 XXX
melanoma/met ca.
G0165 26....... A PET, rec of 1.50 0.58 0.58 0.58 0.58 0.05 2.13 2.13 2.13 2.13 XXX
melanoma/met ca.
G0165 TC....... A PET, rec of 0.00 55.63 55.63 55.63 55.63 2.01 57.64 57.64 57.64 57.64 XXX
melanoma/met ca.
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
\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