[Federal Register Volume 69, Number 59 (Friday, March 26, 2004)]
[Rules and Regulations]
[Pages 15729-15730]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 04-6832]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
42 CFR Parts 410 and 414
CMS-1476-CN2
RIN 0938-AL96
Medicare Program; Revisions to Payment Policies Under the
Physician Fee Schedule for Calendar Year 2004: Correction
AGENCY: Centers for Medicare & Medicaid Services (CMS), 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 7, 2003 entitled ``Revisions to Payment Policies Under the
Physician Fee Schedule for Calendar Year 2004.''
EFFECTIVE DATE: This rule is effective January 1, 2004.
FOR FURTHER INFORMATION CONTACT: Diane Milstead (410) 786-3355.
SUPPLEMENTARY INFORMATION:
I. Background
In FR Doc. 03-27639 of November 7, 2003 (68 FR 63196), there were a
number of technical errors that we are identifying and correcting in
the Correction of Errors section below. Additionally, there are various
revisions to Addendum F. While there were other errors in the November
7, 2003 rule, they were corrected by the interim final rule with
comment period published in the January 7, 2004 Federal Register (69 FR
1084). (The provisions in this correction notice are effective as if
they were included in the document published November 7, 2003.)
Discussion of Addendum F
In Addendum F, concerning the physician self-referral prohibition,
we failed to include the new HCPCS code G0328 for fecal blood
screening. Therefore, we are adding in alphanumeric order ``G0328 Fecal
blood scrn immunoassay'' on page 63393, in the first column, in the
list of Clinical Laboratory Services and also on page 63395, in the
third column, under the heading ``Preventive Screening Tests,
Immunizations and Vaccines,'' following the entry for HCPCS code G0202.
Additionally, in Addendum F, we inadvertently included two HCPCS codes
for prostate brachytherapy that were deleted from the HCPCS effective
January 1, 2004. Consequently, we are removing HCPCS codes G0256
``Prostate brachy w palladium'' and G0261 ``Prostate brachytherapy w/
rad'' from the list of codes that appears on page 63395, in the second
column, under the subheading that reads ``INCLUDE the following CPT and
HCPCS level 2 codes classified elsewhere''.
II. Correction of Errors
0
In FR Doc. 03-27639 of November 7, 2003 (68 FR 63196), make the
following corrections--
0
1. On page 63204, column three, second full sentence revise as follows
to reference two additional E/M codes that were inadvertently omitted.
The sentence now reads, ``This will allow time for the PEAC to
reconsider these eight E/M codes, as well as the two nursing facility
discharge management codes (CPT 99315 and 99316).''
0
2. On page 63218, in Table 3, the age references for codes G0321,
G0322, G0325 and G0326 were labeled incorrectly. The correct references
are as follows:
2 to 11 G0321
12 to 19 G0322
2 to 11 G0325
12 to 19 G0326
0
3. On page 63226, in the discussion contained in the last paragraph of
the first column, which continues to the second column, we erroneously
characterized the history and usage of CPT code 17310. Replace the
first two sentences beginning with ``Prior to 2003, this code . . . and
ending with ``. . . during a particular stage of Mohs surgery.'' with
the following: ``Prior to 2003, this code was reported as each
additional specimen, after the first five specimens, per stage of Mohs
surgery. The reason for the 2003 CPT clarification was due to confusion
caused by an inaccurate description of the code published in 1992. The
description led some carriers to erroneously deny payment for CPT code
17310.''
0
4. On page 63230, column two, last sentence of second paragraph, add
``work RVUs'' after 0.00 so sentence reads ``We are also accepting the
RUC recommendation of 0.00 work RVUs for CPT code 93788.''
0
5. On page 63231, second column, in the response to comments about
inappropriate valuation of radiopharmaceutical G-codes, G0273 and
G0274, revise the last sentence of the response to read as follows
``CPT codes 79403, Radiopharmaceutical therapy, radiolabeled monoclonal
antibody by intravenous infusion, and 78802, Radiopharmaceutical
localization of tumor or distribution of radiopharmaceutical agent(s);
whole body single day imaging or 78804, Radiopharmaceutical
localization of tumor or distribution of radiopharmaceutical agent(s);
whole body, requiring two or more days imaging will be used to report
these services.''
0
6. On page 63234, in Table 6, we incorrectly state that we agreed with
the RUC recommendation to carrier price CPT code 47133. This service is
included in payment to the organ procurement facility and is not paid
under the physician fee schedule. In addition, the table erroneously
states that we disagree with the RUC recommendations for CPT codes
61863 and 61867. The table is corrected to read as follows:
[[Page 15730]]
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RUC HCPAC 2004 work
\1\CPT code Mod Description recommendation recommendation CMS decision RVU
----------------------------------------------------------------------------------------------------------------
47133........ ............. Removal of donor (\2\) ................ Disagree........ (\3\)
liver.
61863........ ............. Implant 19.00 ................ Agree........... 19.00
neuroelectrode.
61867........ ............. Implant 31.34 ................ Agree........... 31.34
neuroelectrode.
----------------------------------------------------------------------------------------------------------------
\1\ All CPT codes copyright 2003 American Medical Association.
\2\ Carrier.
\3\ ``X'' status.
0
7. On page 63236, second column, the discussion concerning CPT codes
61863 and 61867 is deleted, since we agreed with the RUC recommendation
for these services.
0
8. On page 63238, column 1, in the first and second sentences of the
first paragraph under the subheading entitled, ``C. Revisions Effective
for 2004,'' the references to ``Tables 7 and 8'' are corrected to read
``Tables 8 and 9.''
0
9. On page 63238, column 2 is amended as follows:
0
a. In Table 8, under the heading ``Preventive Screening Tests,
Immunizations and Vaccines,'' the following phrase is added as the last
entry: ``G0328 Fecal blood scrn immunoassay''.
0
b. In Table 9, immediately under the heading ``Radiation Therapy
Services and Supplies,'' the following phrases are added in
alphanumeric order:
G0256 Prostate brachy w palladium
G0261 Prostate brachytherapy w/rad
0
10. On page 63238, column 3, the third sentence of the third paragraph
is revised to read as follows: ``Table 8 also reflects the addition of
a screening mammography code (CPT 76083), a flu vaccine code (CPT
90655), and a fecal blood screening code (HCPCS G0328) to the list that
identifies preventive screening tests, immunizations and vaccines that
may qualify for the exception described in Sec. 411.355(h) for these
items and services.''
0
11. On page 63238, column 3, in the first sentence of the fourth
paragraph, the reference to ``Table 8'' is corrected to read ``Table
9'' and in the last line of the fifth paragraph, the reference to
``VI.B'' is corrected to read ``V.B''.
0
12. On page 63261, third column, first sentence, first paragraph under
``Addendum A--Explanation and Use of Addendum B,'' replace ``2003''
with ``2004''. The sentence now reads ``The addenda on the following
pages provide various data pertaining to the Medicare physician fee
schedule for physicians' services furnished in 2004''. In the heading
of the next section, replace references to ``2003'' with ``2004''. The
heading now reads ``Addendum B--2004 Relative Value Units and Related
Information Used in Determining Medicare payments for 2004''.
0
13. On page 63393, in Addendum F, in the first column, in the list of
Clinical Laboratory Services, the following HCPCS code and its
descriptor are added in alphanumeric order:
G0328 Fecal blood scrn immunoassay
0
14. On page 63395, in addendum F, in the third column, under the
heading ``Preventive Screening Tests, Immunizations and Vaccines,'' the
following HCPCS code and its descriptor are added in alphanumeric
order:
G0328 Fecal blood scrn immunoassay
0
15. On page 63395, in Addendum F, in the second column, under the
subheading, ``INCLUDE the following CPT and HCPCS level 2 codes
classified elsewhere,'' the following CPT codes and their descriptors
are removed:
G0256 Prostate brachy w palladium
G0261 Prostate brachytherapy w/rad
III. Waiver of Proposed Rulemaking
We ordinarily publish a notice of proposed rulemaking in the
Federal Register to provide a period for public comment before the
provisions of a notice take effect. We can waive this procedure,
however, if we find good cause that notice and comment procedure is
impracticable, unnecessary, or contrary to the public interest and
incorporate a statement of the finding and the reasons for it into the
notice issued.
In this case, we believe that it is unnecessary to subject the
corrections identified above to public comment. These errors were the
result of inadvertent omissions and typographical errors in Addendum F.
Our corrections of the pricing errors and addition of pricing
information in the addendum does not substantively change any policy
nor affect the payment methodology established under the new
legislation. For this reason, we find it unnecessary to provide the
opportunity for comment on the technical corrections made in this
notice. Therefore, we find good cause to waive notice and comment
procedures.
(Catalog of Federal Domestic Assistance Program No. 93.774,
Medicare--Supplementary Medical Insurance Program)
Dated: March 19, 2004.
Ann C. Agnew,
Executive Secretary to the Department.
[FR Doc. 04-6832 Filed 3-25-04; 8:45 am]
BILLING CODE 4120-01-P