[Federal Register Volume 71, Number 125 (Thursday, June 29, 2006)]
[Notices]
[Pages 37169-37430]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 06-5665]



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Part II





Department of Health and Human Services





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Centers for Medicare & Medicaid Services



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Medicare Program; Five-Year Review of Work Relative Value Units Under 
the Physician Fee Schedule and Proposed Changes to the Practice Expense 
Methodology; Notice

Federal Register / Vol. 71, No. 125 / Thursday, June 29, 2006 / 
Notices

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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[CMS-1512-PN]
RIN 0938-AO22


Medicare Program; Five-Year Review of Work Relative Value Units 
Under the Physician Fee Schedule and Proposed Changes to the Practice 
Expense Methodology

AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.

ACTION: Proposed notice.

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SUMMARY: This proposed notice sets forth proposed revisions to work 
relative value units (RVUs) affecting payment for physicians' services. 
The statute requires that we review RVUs no less often than every 5 
years. This is our third review of work RVUs since we implemented the 
physician fee schedule (PFS) on January 1, 1992. These revisions to 
work RVUs are proposed to be effective for services furnished beginning 
January 1, 2007. These revisions reflect changes in medical practice, 
coding changes, new data on relative value components, and the addition 
of new procedures that affect the relative amount of physician work 
required to perform each service as required by the statute. In 
addition, we are proposing revisions to our methodology for calculating 
practice expense (PE) RVUs, including changes based on supplemental 
survey data for PE. This revised methodology would be used to establish 
payment for services beginning January 1, 2007.

DATES: To be assured consideration, comments must be received at one of 
the addresses provided below, no later than 5 p.m. on Monday, August 
21, 2006.

ADDRESSES: In commenting, please refer to file code CMS-1512-PN. 
Because of staff and resource limitations, we cannot accept comments by 
facsimile (FAX) transmission.
    You may submit comments in one of four ways (no duplicates, 
please):
    1. Electronically. You may submit electronic comments on specific 
issues in this regulation to http://www.cms.hhs.gov/eRulemaking. Click 
on the link ``Submit electronic comments on CMS regulations with an 
open comment period.'' (Attachments should be in Microsoft Word, 
WordPerfect, or Excel; however, we prefer Microsoft Word.)
    2. By regular mail. You may mail written comments (one original and 
two copies) to the following address ONLY:
    Centers for Medicare & Medicaid Services, Department of Health and 
Human Services, Attention: CMS-1512-PN, P.O. Box 8014, Baltimore, MD 
21244-8014.
    Please allow sufficient time for mailed comments to be received 
before the close of the comment period.
    3. By express or overnight mail. You may send written comments (one 
original and two copies) to the following address ONLY:
    Centers for Medicare & Medicaid Services, Department of Health and 
Human Services, Attention: CMS-1512-PN, Mail Stop C4-26-05, 7500 
Security Boulevard, Baltimore, MD 21244-1850.
    4. By hand or courier. If you prefer, you may deliver (by hand or 
courier) your written comments (one original and two copies) before the 
close of the comment period to one of the following addresses. If you 
intend to deliver your comments to the Baltimore address, please call 
telephone number (410) 786-7195 in advance to schedule your arrival 
with one of our staff members.
    Room 445-G, Hubert H. Humphrey Building, 200 Independence Avenue, 
SW., Washington, DC 20201; or 7500 Security Boulevard, Baltimore, MD 
21244-1850.
    (Because access to the interior of the HHH Building is not readily 
available to persons without Federal Government identification, 
commenters are encouraged to leave their comments in the CMS drop slots 
located in the main lobby of the building. A stamp-in clock is 
available for persons wishing to retain a proof of filing by stamping 
in and retaining an extra copy of the comments being filed.)
    Comments mailed to the addresses indicated as appropriate for hand 
or courier delivery may be delayed and received after the comment 
period.
    For information on viewing public comments, see the beginning of 
the SUPPLEMENTARY INFORMATION section.

FOR FURTHER INFORMATION CONTACT: Diane Milstead, (410) 786-3355, or 
Gaysha Brooks, (410) 786-9649

SUPPLEMENTARY INFORMATION: Submitting Comments: We welcome comments 
from the public on the proposed work RVUs set forth in Addendum C, the 
proposed practice expense methodology, and other issues set forth in 
this proposed notice to assist us in fully considering issues and 
developing policies. You can assist us by referencing the file code 
CMS-1512-PN and the specific ``issue identifier'' that precedes the 
section on which you choose to comment.
    Inspection of Public Comments: All comments received before the 
close of the comment period are available for viewing by the public, 
including any personally identifiable or confidential business 
information that is included in a comment. We post all comments 
received before the close of the comment period on the following Web 
site as soon as possible after they are received: http://www.cms.hhs.gov/eRulemaking. Click on the link ``Electronic Comments on 
CMS Regulations'' on that Web site to view public comments.
    Comments received timely will be available for public inspection as 
they are received, generally beginning approximately 3 weeks after 
publication of a document, at the headquarters of the Centers for 
Medicare & Medicaid Services, 7500 Security Boulevard, Baltimore, 
Maryland 21244, Monday through Friday of each week from 8:30 a.m. to 4 
p.m. To schedule an appointment to view public comments, phone 1-800-
743-3951.
    Information on the PFS can be found on the CMS homepage. You can 
access this data by using the following directions:
    1. Go to the following Web site http://www.cms.hhs.gov/PhysicianFeeSched/.
    2. Select ``Physician Fee Schedule Federal Regulation Notices.''
    To assist readers in referencing sections contained in this 
preamble, we are providing the following table of contents.

Table of Contents

I. Background
    A. Legislative History
    B. Published Changes to the Physician Fee Schedule
    C. Current Proposed Notice
    D. The 5-Year Review Process
II. Discussion of Comments and Decisions
    A. Review of Comments
    B. Discussion of Comments by Clinical Area
    1. Dermatology and Plastic Surgery
    2. Orthopedic Surgery
    3. Gynecology, Urology, Pain Medicine, and Neurosurgery
    4. Radiology, Pathology, and Other Miscellaneous Services
    5. Evaluation and Management Services
    6. Cardiothoracic Surgery
    7. General, Colorectal and Vascular Surgery
    8. Otolaryngology and Ophthalmology
    9. HCPAC Codes
    C. Other Issues Under the 5-Year Review
    1. Anesthesia Services
    2. Discussion of Post-Operative Visits Included in the Global 
Surgical Packages
    3. Codes Referred to CPT Editorial Panel from Five-Year Review 
of Work Relative Value Units
    4. Budget Neutrality

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    5. Effect on Practice Expense Inputs Stemming From the 5-Year 
Review
    6. Nature and Format of Comments on Work RVUs
    D. Resource-Based Practice Expense (PE) RVUs
    1. Current Methodology
    2. PE Proposed Methodology for CY 2006
    3. Modifications to PE Proposals
III. Collection of Information Requirements
IV. Response to Comments
V. Regulatory Impact Analysis
Addendum A: Explanation and Use of Addendum B
Addendum B: Relative Value Units and Related Information
Addendum C: Codes With Work RVUs Subject to Comment

    In addition, because of the many organizations and terms to 
which we refer by acronym in this proposed notice, we are listing 
these acronyms and their corresponding terms in alphabetical order 
below:

AAD American Academy of Dermatology
AAN American Academy of Neurology
AANEM American Association of Neuromuscular and Electrodiagnostic 
Medicine
AAFP American Academy of Family Physicians
AAGP American Association for Geriatric Psychiatry
AAHCP American Academy of Home Care Physicians
AANS American Association of Neurological Surgeons
AAO American Academy of Ophthalmology
AAO-HNS American Academy of Otolaryngology-Head and Neck Surgery
AAOA American Academy of Otolaryngic Allergy
AAOS American Academy of Orthopaedic Surgeons
AAP American Academy of Pediatrics
AAPM American Academy of Pain Medicine
AAPMR American Academy of Physical Medicine and Rehabilitation
AATS American Association for Thoracic Surgery
ACC American College of Cardiology
ACG American College of Gastroenterology
ACNS American Clinical Neurophysiology Society
ACOG American College of Obstetricians and Gynecologists
ACR American College of Radiology
ACS American College of Surgeons
AFROC Association of Freestanding Radiation Oncology Centers
AGA American Gastroenterological Association
AGS American Geriatric Society
AK Actinic keratoses
AMA American Medical Association
AMDA American Medical Directors Association
AOA American Optometric Association
ASA American Society of Anesthesiologists
ASC Ambulatory surgical center
ASCRS American Society of Colon and Rectal Surgeons
ASGE American Society of Gastrointestinal Endoscopy
ASHA American Speech-Language-Hearing Association
ASPS American Society of Plastic Surgeons
ASSH American Society for Surgery of the Hand
ASTRO American Society for Therapeutic Radiology and Oncology
AUA American Urological Association
BBA 97 Balanced Budget Act of 1997 (Pub. L. 105-33)
BBRA [Medicare, Medicaid and State Child Health Insurance Program] 
Balanced Budget Refinement Act of 1999 (Pub. L. 106-113)
BNF Budget neutrality factor
CAPU Coalition for the Advancement of Prosthetic Urology
CF Conversion factor
CNS Congress of Neurological Surgeons
CPEP Clinical Practice Expert Panels
CPT Current Procedural Terminology
CY Calendar year
DRG Diagnosis-Related Group
E/M Evaluation and management
FR Federal Register
HCPAC Health Care Professionals Advisory Committee
HCPCS Healthcare Common Procedure Coding System
HHS Health and Human Services
ICU Intensive care unit
IDTF Independent diagnostic testing facility
IWPUT Intra-service work per unit of time
JCAAI Joint Council of Allergy, Asthma, and Immunology
MMA Medicare Prescription Drug, Improvement, and Modernization Act 
of 2003 (Pub. L. 108-173)
MMSV Minimum multi-specialty visit
MPC [the RUC's] Multi-Specialty Points of Comparison
NCQDIS National Coalition of Quality Diagnostic Imaging Services
NPWP Non-physician work pool
NSQIP National Surgical Quality Improvement Program
PC Professional component
PE Practice Expense
PE/HR Practice expense per hour
PEAC Practice Expense Advisory Committee
PERC Practice Expense Review Committee
PFS Physician fee schedule
RFA Regulatory Flexibility Act
RIA Regulatory impact analysis
RN Registered nurse
RUC [AMA's Specialty Society] Relative [Value] Update Committee
RVU Relative value unit
SMS [AMA's] Socioeconomic Monitoring System
SNF Skilled nursing facility
STS Society of Thoracic Surgeons
SVS Society for Vascular Surgery
TC Technical component
VA [Department of] Veterans Affairs

I. Background

    [If you choose to comment on issues in this section, please include 
the caption ``BACKGROUND'' at the beginning of your comments.]

A. Legislative History

    Since January 1, 1992, Medicare has paid for physicians' services 
under section 1848 of the Social Security Act (the Act), ``Payment for 
Physicians' Services.'' Section 1848 of the Act contains three major 
elements: (1) A fee schedule for the payment of physicians' services; 
(2) a sustainable growth rate for the rates of increase in Medicare 
expenditures for physicians' services; and (3) limits on the amounts 
that nonparticipating physicians can charge beneficiaries. The Act 
requires that payments under the fee schedule be based on national 
uniform relative value units (RVUs) based on the resources used in 
furnishing a service. Section 1848(c) of the Act requires that national 
RVUs be established for physician work, practice expense (PE), and 
malpractice expense.
    Section 1848(c)(2)(B)(ii)(II) of the Act provides that adjustments 
in RVUs may not cause total physician fee schedule (PFS) payments for 
the year to differ by more than $20 million from the amount that would 
have been paid had the adjustments not been made. If this tolerance is 
exceeded, we must make adjustments to the conversion factors (CFs) to 
preserve budget neutrality.

B. Published Changes to the Physician Fee Schedule

    On an annual basis, we publish regulations relating to updates to 
the RVUs and revisions to the payment policies under the PFS. In the 
Calendar Year (CY) 2006 Physician Fee Schedule final rule with comment 
period that appeared in the Federal Register on November 21, 2005 (70 
FR 70116) (hereinafter referred to as the CY 2006 PFS final rule with 
comment period), we finalized the CY 2005 interim physician work RVUs, 
issued new interim work RVUs for new and revised codes for CY 2006, and 
finalized several other payment policies related to the PFS. This final 
rule with comment also discussed the status of the third 5-Year Review 
of work RVUs.

C. Current Proposed Notice

    This proposed notice sets forth proposed revisions to work RVUs 
affecting payment for physicians' services. Section 1848(c)(2)(B)(i) of 
the Act requires that we review RVUs no less often than every 5 years. 
We implemented the PFS effective for services furnished beginning 
January 1, 1992. The first 5-Year Review of work was initiated in 
December 1994 and was effective for services furnished beginning 
January 1, 1997. The second 5-Year Review of work was initiated in 
November 1999 and was effective for services furnished beginning 
January 1 2002. The third 5-Year Review of work was initiated in 
November 2004.

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Revisions of physician work RVUs proposed in this proposed notice are 
subject to a 60-day public comment period. We will review public 
comments, make adjustments to our proposals in response to comments, as 
appropriate, and include revised values in our CY 2007 Physician Fee 
Schedule final rule with comment period, effective for services 
furnished beginning January 1, 2007.

D. The 5-Year Review Process

    We initiated the third 5-Year Review by soliciting public comments 
on potentially misvalued work RVUs for all services in the CY 2005 
Physician Fee Schedule final rule with comment period that appeared in 
the Federal Register on November 15, 2004 (69 FR 66370) and provided a 
60-day comment period.
    We received comments from approximately 35 specialty groups, 
organizations, and individuals involving over 500 Current Procedural 
Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) 
codes. As explained in the CY 2006 PFS final rule with comment period 
(70 FR 70283), we shared these comments with the American Medical 
Association (AMA) Specialty Society Relative Value Update Committee 
(RUC). The RUC was formed in November 1991 and grew out of a series of 
discussions between the AMA and major national medical specialty 
societies. The work of the RUC is supported by the RUC Advisory 
Committee, which is made up of representatives of 100 specialty 
societies in the AMA's House of Delegates.
    The RUC currently makes annual recommendations to us on RVUs for 
new and revised CPT codes. The RUC also provided recommendations on 
changes to the work RVUs for existing codes during the previous 5-Year 
Reviews. We believe that the RUC's participation was beneficial because 
the RUC is experienced in recommending RVUs for the codes that have 
been added to or revised by the CPT Editorial Panel since we 
implemented the PFS in 1992. By virtue of its multispecialty membership 
and consultation with specialty societies, the RUC involves the medical 
community in formulating its recommendations. For codes used primarily 
by nonphysician practitioners, the Health Care Professionals Advisory 
Committee (HCPAC), a companion to the RUC, has made recommendations to 
us.
    As we stated in the previous 5-Year Reviews, we retain the 
responsibility for analyzing any comments and recommendations received, 
developing the proposed rule, evaluating the comments on the proposed 
rule, and deciding whether and how to revise the work RVUs for any 
given service.
    After we sent the RUC the comments we received on potentially 
misvalued services, as well as a list of approximately 160 services 
that we had identified as being potentially misvalued, the RUC 
identified the specialty societies that expressed interest in making 
presentations concerning those services. To prepare for presentations 
to the RUC, most specialty societies compiled data using a standard 
survey instrument whereby respondents compared the surveyed service 
with similar ``reference'' services that have established, agreed upon 
work values. Respondents were asked to estimate: the work for the 
survey code; the time to perform the ``pre-'', ``intra-'', and ``post-
'' service activities; and the technical skill, risk, and judgment 
involved with performing the service. Post-service activities were 
broken down into hospital and office visits and were assigned an 
appropriate evaluation and management (E/M) code by the respondent. 
Each specialty society selected the physician sample that was surveyed. 
A minimum of 30 responses was required by the RUC for the survey to be 
considered adequate.
    For this 5-Year Review, the RUC permitted a specialty society to 
use a ``minisurvey'' for some codes if the number of codes a specialty 
society was reviewing was extremely high. These minisurveys required 
less information from the respondent, but were similar in design. In 
addition, the RUC approved the use of information from the National 
Surgical Quality Improvement Program (NSQIP) database and the Society 
of Thoracic Surgeons (STS) national database in the valuation of some 
services.
    The NSQIP was started by the Department of Veterans Affairs (VA) 
for quality improvement purposes in 1991 with 128 VA medical centers, 
but now includes a large volume of surgical procedures from non-VA 
medical centers as well. The total number of cases for VA and non-VA 
medical centers is greater than one million. The NSQIP database 
contains pre-, intra-, and post-operative data, including intra-service 
times and length of stay data.
    The STS National database is a voluntary reporting system for the 
collection of outcomes data related to thoracic surgical services. This 
database currently contains over two million patient records collected 
from more than 450 practices (from 1995 through 2004). Over 70 percent 
of the hospitals currently performing heart surgeries in the U.S. 
reportedly participate in this database.
    Some specialty societies used a ``building-block'' approach to 
validate the survey results for surgical services. In constructing the 
building blocks, a service is divided into pre-, intra-, and post-
service components. The pre-service component consists of all services 
furnished before the physician makes the skin incision (for example, 
pre-operative evaluation and scrubbing); the intra-service component 
consists of the ``skin-to-skin'' time; and the post-service component 
includes immediate post-surgery services and subsequent hospital and 
office visits. Each component (or building block) is then assigned work 
RVUs. Pre-service and intra-service work RVUs are based on time and the 
intensity of the activities, and post-service work is based on the 
specified E/M service for each post-operative visit. These three values 
are then summed to compute ``building-block'' work RVUs.
    The results of the surveys were reviewed and organized by the 
specialty societies and then presented to the RUC. The RUC used eight 
workgroups, comprised of RUC members, to evaluate a series of 
clinically related codes based on the survey results and additional 
discussion. The workgroups also evaluated the relative work (time and 
intensity) for each service compared to other services on the fee 
schedule. The workgroups submitted their recommendations to the full 
RUC, which then considered the workgroup reports and then sent the 
final RUC recommendations to us.

II. Discussion of Comments and Decisions

A. Review of Comments

    As previously stated, we sent the RUC a list of codes for review. 
The RUC submitted work RVU recommendations for these codes, with the 
exception of the codes that were withdrawn or referred to the CPT 
Editorial Panel for further review or action, and one CPT code (32020) 
for which no specialty society expressed an interest in conducting a 
survey. In the future, we will consider an alternative method to re-
evaluate codes when no specialties express an interest in conducting a 
survey and we would appreciate suggestions from commenters on what 
alternative methods could be used.
    We analyzed all of the RUC recommendations by evaluating the 
methodology used by each workgroup to develop the recommendations, the 
recommended work RVUs, and the rationale for the recommendations.

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When appropriate and feasible, if we had concerns about the application 
of a particular methodology, we assessed whether the recommended work 
RVUs were appropriate by using alternative methodologies.
    In conducting our review of the RUC recommendations we considered 
whether: (1) The code was part of a completed survey process; (2) the 
methodology used by the specialty society followed the standard RUC 
process; (3) the survey respondents stated the work had or had not 
changed in the past 5 years; (4) databases (for example, STS, NSQIP, 
and Medicare diagnosis-related group (DRG)) were used in lieu of the 
standard RUC methodology or as a supplement to the standard 
methodology; and (5) the intra-service work per unit of time (IWPUT) 
calculation was used to determine work RVUs in lieu of the standard RUC 
process. (The IWPUT is derived from components of the ``building-
block'' approach, described above, and is used as a measure of service 
intensity.) Although CMS recognizes that the work values of codes may 
change over time, it is the responsibility of the specialty society to 
present compelling evidence that a code is misvalued.
    We have some concerns that many of the codes that were reviewed in 
the second 5-Year Review have been brought back again for further 
consideration. The main purpose of the 5-Year Review is to identify 
those services that need to be revalued because the work involved in 
performing the service has changed. Since there have been three 
opportunities for specialties to have services that are believed to be 
undervalued reviewed, we expect that, for the most part, only those 
services where there is compelling evidence of a change in the work 
will be considered for further review. However, because there has been 
little incentive for specialties to bring codes that may be overvalued 
for review, such services will still need to be identified for the next 
5-Year Review.
    Table 1, Five-Year Review of Work Relative Value Units, lists the 
codes reviewed during the 5-Year Review. This table includes the 
following information:
     CPT/HCPCS Code. This is the CPT or alphanumeric HCPCS code 
for a service.
     Modifier. A modifier -26 is shown if the work RVUs 
represent the professional component of the service.
     Description. This is an abbreviated version of the 
narrative description of the code.
     2005 Work RVU. The work RVUs that appeared in the CY 2005 
Physician Fee Schedule final rule with comment period are shown for 
each reviewed code.
     Requested Work RVU. This column identifies the work RVUs 
requested by the commenting specialty society or individual commenter. 
If we received more than one comment on a code, the code is listed more 
than once with the recommended RVUs. If the commenters did not 
recommend specific RVUs, we indicate this by ``N/A''. A ``WD'' 
(withdrawal) indicates that the commenter withdrew the request for 
review of a code and chose not to pursue review of the code under the 
5-Year Review and that no RUC recommendation was received.
     RUC Recommendation. This column identifies the work RVUs 
recommended by the RUC. ``CPT'' indicates that the RUC referred this 
code to the AMA CPT Editorial Panel for review and clarification and 
recommended maintaining the current work RVUs. An ``(a)'' indicates the 
commenting specialty society withdrew the proposal, and therefore, the 
RUC recommends maintaining the current work RVUs. A ``(b)'' in this 
column indicates there was no RUC recommendation.
    HCPAC Recommendation. This column identifies the work RVUs 
recommended by the HCPAC. An ``(a)'' indicates that the commenting 
specialty society withdrew the proposal; therefore, the HCPAC 
recommends maintaining the current work RVUs. A ``(b)'' in this column 
indicates there was no HCPAC recommendation.
     CMS Proposal. This column indicates whether we agreed with 
the RUC recommendation (``Agree''); we are instead proposing to 
maintain the present work RVUs (``Disagree''); we are proposing work 
RVUs higher than the RUC recommendation (``Disagree/+''); or we are 
proposing work RVUs that are less than the RUC recommendation 
(``Disagree/-''). Codes for which we did not accept the RUC 
recommendation are discussed in greater detail following Table 1. A 
``(c)'' in this column indicates that in the absence of a RUC/HCPAC 
recommendation we are proposing to maintain the present work RVUs.
     Proposed base work RVU. This column contains the 2007 
proposed work RVUs. The proposed work RVUs for surgical services with a 
10- or 90-day global period do not include the application of the RUC-
recommended work values for E/M services. However, the additional work 
value attributed to the increase for E/M services included as part of 
the global period is reflected in the work RVUs contained in Addenda B 
and C of this proposed rule. (Note: ** denotes codes that were deleted 
for 2006.)
    The following is a summary of our response to the RUC-recommended 
work RVUs for the 5-Year Review of work. We sent the RUC approximately 
709 codes to review. The RUC referred 136 codes to the CPT Editorial 
Panel for review and 151 codes were withdrawn by the specialty 
societies. We accepted the RUC's recommended work RVUs for 299 of the 
services reviewed and disagreed with the RUC's recommended work RVUs 
for 123 of the services reviewed. Of the 123 services for which we did 
not accept the RUC's recommended work RVUs, we increased the work RVUs 
for 3 services, recommended maintaining the current work RVUs for 48 
services, and decreased the work RVUs for 72 services. (Note: 12 CPT 
codes for nursing facility and rest home services that were referred to 
the AMA CPT Editorial Panel were deleted for 2007.)
    Additionally, the HCPAC reviewed a total of 7 services as part of 
the 5-Year Review. Of the 7 services reviewed by the HCPAC, we accepted 
the HCPAC recommendations for 1 service, recommended maintaining the 
current work RVU for 1 service, decreased the work RVUs for 4 services, 
and 1 code was withdrawn by the specialty society.
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B. Discussion of Comments by Clinical Area

1. Dermatology and Plastic Surgery
    [If you choose to comment on issues in this section, please include 
the caption ``DISCUSSION OF COMMENTS-DERMATOLOGY AND PLASTIC SURGERY'' 
at the beginning of your comments.]
a. Hidradenitis
    The American Society of Plastic Surgeons (ASPS) submitted the 
hidradenitis services (CPT codes 11450, 11451, 11462, 11463, 11470 and 
11471) as undervalued but, based on the very low response rate to the 
survey they conducted the ASPS withdrew these codes from the 5-Year 
Review.
b. Craniofacial Surgery
    The ASPS originally requested that 10 craniofacial reconstruction 
and fracture codes be reviewed. ASPS conducted a standard RUC survey 
for these services and, based on the low survey response rate, withdrew 
the following six CPT codes from the 5-Year Review: 21365, 21366, 
21432, 21435, 21436, and 21470. ASPS presented survey data for the 
remaining four CPT codes listed in Table 2 to the RUC indicating there 
is compelling evidence that these codes had been valued based on an 
incorrect assumption regarding the value of the bone graft portion of 
each service.

                                 Table 2
------------------------------------------------------------------------
              CPT code                            Descriptor
------------------------------------------------------------------------
21145..............................  Reconstruction midface, LeFort I;
                                      single piece, segment movement in
                                      any direction, requiring bone
                                      grafts (includes obtaining
                                      autografts).
21146..............................  Reconstruction midface, LeFort I;
                                      two pieces, segment movement in
                                      any direction, requiring bone
                                      grafts (includes obtaining
                                      autografts) (e.g., ungrafted
                                      unilateral alveolar cleft).
21147..............................  Reconstruction midface, LeFort I;
                                      three or more pieces, segment
                                      movement in any direction,
                                      requiring bone grafts (includes
                                      obtaining autografts) (e.g.,
                                      ungrafted bilateral alveolar cleft
                                      or multiple osteotomies).
21395..............................  Open treatment of orbital floor
                                      blowout fracture; periorbital
                                      approach with bone graft (includes
                                      obtaining graft).
------------------------------------------------------------------------

RUC Recommendations
    The RUC agreed that the appropriate increment of work for the bone 
graft should be 50 percent of CPT code 20902, Bone graft, any donor 
area; major or large (7.54 work RVUs x 50 percent = 3.77 work RVUs). 
The RUC recommended that this increment of 3.77 be used and added to 
the base code for each of these services.
    The RUC-recommended work RVUs for these CPT codes are as follows: 
21145 = 21.84 work RVUs; 21146 = 22.55 work RVUs, 21147 = 23.32 work 
RVUs; and 21395 = 13.88 work RVUs.
CMS Proposed Valuation
    We agree with the RUC recommendations for craniofacial surgery 
services.
c. Other Plastic Surgery Services
    ASPS initially submitted five additional services for review (see 
Table 3). However, the specialty society was unable to obtain an 
adequate survey response rate for these codes and withdrew them from 
the RUC review. In addition, the RUC recommended that CPT code 15831 
should be referred to the CPT Editorial Panel for review to capture the 
new population of patients using this service.

                                 Table 3
------------------------------------------------------------------------
              CPT code                            Descriptor
------------------------------------------------------------------------
11960..............................  Insertion of tissue expander(s) for
                                      other than breast, including
                                      subsequent expansion.
15831..............................  Excision, excessive skin and
                                      subcutaneous tissue (including
                                      lipectomy); abdomen
                                      (abdominoplasty).
19361..............................  Breast reconstruction with
                                      latissimus dorsi flap, with or
                                      without prosthetic implant.
43496..............................  Free jejunum transfer with
                                      microvascular anastomosis.
49906..............................  Free omental flap with
                                      microvascular anastomosis.
------------------------------------------------------------------------

    We submitted four plastic surgery services for the 5-Year Review as 
services that had never been reviewed by the RUC (see Table 4). In 
addition, CPT code 15732 was submitted as it had been valued as an 
inpatient service and it is now performed as an outpatient service.

                                 Table 4
------------------------------------------------------------------------
              CPT code                            Descriptor
------------------------------------------------------------------------
15100..............................  Split-thickness autograft, trunk,
                                      arms, legs; first 100 sq cm or
                                      less, or one percent of body area
                                      of infants and children (except
                                      15050).
15240..............................  Full thickness graft, free,
                                      including direct closure of donor
                                      site, forehead, cheeks, chin,
                                      mouth, neck, axillae, genitalia,
                                      hands, and/or feet; 20 sq cm or
                                      less.
15732..............................  Muscle, myocutaneous, or
                                      fasciocutaneous flap; head and
                                      neck (e.g., temporalis, masseter
                                      muscle, sternocleidomastoid,
                                      levator scapulae).
15734..............................  Muscle, myocutaneous, or
                                      fasciocutaneous flap; trunk.
------------------------------------------------------------------------


[[Page 37190]]

RUC Recommendations
    The RUC was convinced that the survey data validated the current 
valuation of CPT codes 15100, 15240, and 15734. The RUC recommended 
that the current work RVUs be maintained for these CPT codes as 
follows: 15100 = 9.04 work RVUs; 15240 = 9.03 work RVUs; and 15734 = 
17.76 work RVUs. The RUC reviewed and discussed the issue concerning 
the change in setting from inpatient to outpatient for CPT code 15732 
and determined that this code describes two disparate procedures; 
therefore, the RUC recommended that this CPT code be forwarded to the 
CPT Editorial Panel for review.
CMS Proposed Valuation
    We agree with the RUC recommendations for these plastic surgery 
services.
d. Other Dermatology Services
    The American Academy of Dermatology (AAD) and a pharmaceutical 
company submitted CPT code 96567, Photodynamic therapy by external 
application of light to destroy premalignant and/or malignant lesions 
of the skin and adjacent mucosa (e.g., lip) by activation of 
photosensitive drug(s), each phototherapy exposure session, for the 5-
Year Review but, subsequent to discussions with the RUC regarding the 
need for potential CPT revisions, withdrew the code from the 5-Year 
Review.
    We submitted the CPT codes for integumentary services in Table 5 
for review because they had never been previously reviewed by the RUC.

                                 Table 5
------------------------------------------------------------------------
              CPT code                            Descriptor
------------------------------------------------------------------------
11100..............................  Biopsy of skin, subcutaneous tissue
                                      and/or mucous membrane (including
                                      simple closure), unless otherwise
                                      listed; single lesion.
12052..............................  Layer closure of wounds of face,
                                      ears, eyelids, nose, lips and/or
                                      mucous membranes; 2.6 cm to 5.0
                                      cm.
13121..............................  Repair, complex, scalp, arms, and/
                                      or legs; 2.6 cm to 7.5 cm.
14040..............................  Adjacent tissue transfer or
                                      rearrangement, forehead, cheeks,
                                      chin, mouth, neck, axillae,
                                      genitalia, hands and/or feet;
                                      defect 10 sq cm or less.
14060..............................  Adjacent tissue transfer or
                                      rearrangement, eyelids, nose, ears
                                      and/or lips; defect 10 sq cm or
                                      less.
17003..............................  Destruction (e.g., laser surgery,
                                      electrosurgery, cryosurgery,
                                      chemosurgery, surgical
                                      curettement), all benign or
                                      premalignant lesions (e.g.,
                                      actinic keratoses) other than skin
                                      tags or cutaneous vascular
                                      proliferative lesions; second
                                      through 14 lesions, each (List
                                      separately in addition to code for
                                      first lesion).
17262..............................  Destruction, malignant lesion
                                      (e.g., laser surgery,
                                      electrosurgery, cryosurgery,
                                      chemosurgery, surgical
                                      curettement), trunk, arms or legs;
                                      lesion diameter 1.1 to 2.0 cm.
17281..............................  Destruction, malignant lesion
                                      (e.g., laser surgery,
                                      electrosurgery, cryosurgery,
                                      chemosurgery, surgical
                                      curettement), face, ears, eyelids,
                                      nose, lips, mucous membrane;
                                      lesion diameter 0.6 to 1.0 cm.
------------------------------------------------------------------------

    We requested that CPT code 17003 be reviewed because we believe 
that advances in technology have likely resulted in a modification to 
the physician work required to accomplish the procedure. In discussions 
at the RUC meeting, we noted that new Medicare coverage policies 
related to actinic keratoses (AK) have increased the reporting of this 
service to describe cryosurgical destruction of AK. Standard RUC 
surveys were conducted for all of these services.
RUC Recommendations
    Based on a review of the survey data, the RUC was convinced that 
the survey data validated the current valuation of the following 
services and recommended the work RVUs for these CPT codes be 
maintained as follows: 11100 = 0.81 work RVUs; 12052 = 2.77 work RVUs; 
13121 = 4.32 work RVUs; 14040 = 7.86 work RVUs; 14060 = 8.49 work RVUs; 
17262 = 1.58 work RVUs; and 17281 = 1.72 work RVUs.
    For CPT code 17003, the RUC reviewed previous and current survey 
data and agreed that the application of cryosurgery to each lesion 
requires no more than two minutes of physician time. Therefore, the RUC 
recommended a work RVU of 0.07 for CPT code 17003. The RUC determined 
that the revision to the work RVUs for CPT code 17003 created a rank 
order anomaly in this family of codes. In addition to referring codes 
in this family to the CPT Editorial Panel to clarify the code 
descriptors, the RUC in February 2006 also recommended a change to the 
work RVUs for CPT code 17004, Destruction (e.g., laser surgery, 
electrosurgery, cryosurgery, chemosurgery, surgical curettement), all 
benign or premalignant lesions (e.g., actinic keratoses) other than 
skin tags or cutaneous vascular proliferative lesions; 15 or more 
lesions. This was based on the understanding that when rank order 
anomalies were identified, the specialty could bring these additional 
codes forward for consideration for re-evaluation under the 5-Year 
Review at the next RUC meeting (that is, February 2006).
    A standard RUC survey was conducted for this code and based on the 
survey responses, the specialty society recommended a change in the 
intra-service work descriptions to reflect a greater time based on 
their belief that the destruction of premalignant lesions requires more 
time than benign lesions. Thus, the intra-service period for CPT code 
17004 was changed to 20 minutes which is twice as much as the time 
associated with the destruction of benign lesion in CPT code 17111, 
Destruction (e.g., laser surgery, electrosurgery, cryosurgery, 
chemosurgery, surgical curettement), of flat warts, molluscum 
contagiosum, or milia; 15 or more lesions, of 10 minutes. The RUC 
agreed to this time change and recommended work RVUs of 1.80 for CPT 
code 17004.
CMS Proposed Valuation
    We are in agreement with the RUC-recommended work RVUs for these 
services with the exception of CPT code 17004. For CPT code 17004, we 
believe that the work associated with benign and premalignant lesions 
is comparable and, therefore, the work RVUs for CPT code 17004 should 
be more similar to that of CPT code 17111, which is 0.92. Based on our 
proposed valuation of 17003 (the code used for 2-14 lesions), of 0.07 
work RVUs, the 14th lesion would equal 0.91 work RVUs (0.07 x 13 
lesions) plus 0.6 work RVUs for the initial lesion, that is, base code 
CPT code 17000, which is billed once in conjunction with 17003. We are 
proposing to value CPT code 17004, for 15 or more lesions, at 1.58 work 
RVUs by adding the 0.07 work RVU increment of 17003 and the 0.6 work 
RVUs for the base code, CPT code 17000, which is not billed in 
conjunction with CPT code 17004.

[[Page 37191]]

e. Mohs Surgery
    We referred the Mohs surgery codes for review because this family 
of services has never been surveyed and reviewed by the RUC (see Table 
6).

                                 Table 6
------------------------------------------------------------------------
              CPT code                            Descriptor
------------------------------------------------------------------------
17304..............................  Chemosurgery (Mohs micrographic
                                      technique), including removal of
                                      all gross tumor, surgical excision
                                      of tissue specimens, mapping,
                                      color coding of specimens,
                                      microscopic examination of
                                      specimens by the surgeon, and
                                      complete histopathologic
                                      preparation including the first
                                      routine stain (e.g., hematoxylin
                                      and eosin, toluidine blue); first
                                      stage, fresh tissue technique, up
                                      to 5 specimens.
17305..............................  Chemosurgery (Mohs micrographic
                                      technique), including removal of
                                      all gross tumor, surgical excision
                                      of tissue specimens, mapping,
                                      color coding of specimens,
                                      microscopic examination of
                                      specimens by the surgeon, and
                                      complete histopathologic
                                      preparation including the first
                                      routine stain (e.g., hematoxylin
                                      and eosin, toluidine blue); second
                                      stage, fixed or fresh tissue, up
                                      to 5 specimens).
------------------------------------------------------------------------

    The specialty society conducted surveys to collect data for these 
two codes. The workgroup then reviewed the history of these services, 
including the fact that the nomenclature for these services is not 
consistent with other integumentary coding conventions in CPT and that 
the RUC had previously indicated that the specialty society should work 
with the CPT Editorial Panel to redefine these services.
RUC Recommendations
    The RUC recommended that these CPT codes be referred to the CPT 
Editorial Panel.
CMS Proposed Valuation
    We will maintain the current valuation for these services pending 
the results of the review of the CPT Editorial Panel.
f. Excision of Lesions
    We submitted all of the excision of lesion codes for review, noting 
that these services should be surveyed and reviewed by the RUC (see 
Table 7--benign: CPT codes 11400 through 11446, and malignant: CPT 
codes 11600 through 11646).
    The work RVUs for the codes predominantly performed by the surgical 
specialties (CPT codes representing services to excise larger lesions) 
were all valued, with the exception of two CPT codes, by acceptable RUC 
surveys. However, there were no acceptable RUC surveys for the 18 
services predominantly performed by the dermatologists (CPT codes 
representing services to excise smaller lesions) due to incomplete 
surveys and low response rates.
RUC Recommendations
    The RUC agreed that the primary difference in the work between the 
family of codes for excision of benign lesions versus those codes for 
excision of malignant lesions (see Table 7) is in the pre-evaluation 
time (that is, additional planning, and discussions with the patient), 
the intensity of the intra-service time, and the level of post-
operative visit.
    The workgroup used the RUC surveys to determine the work RVUs for 
those services performed by the surgeons and then applied the building-
block approach using the IWPUT values of the codes primarily performed 
by the surgical specialties to derive IWPUT values and corresponding 
work RVUs for the CPT codes primarily performed by dermatology. (The 
IWPUT is derived by dividing the intra-service work by the intra-
service time, and is used to measure the relative intensity of the work 
between services.)
    As a result of the application of the building-block methodology to 
the codes without RUC acceptable surveys, the RUC recommended that 24 
codes retain their current work RVUs, 5 codes have decreased work RVUs, 
and 7 codes have increased work RVUs. The specific RUC recommendations 
for these CPT codes are presented in Table 7.

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[GRAPHIC] [TIFF OMITTED] TN29JN06.038

BILLING CODE 4120-01-C
CMS Proposed Valuation
    We are in agreement with the RUC recommendations for the excision 
of lesions services.
2. Orthopedic Surgery
    [If you choose to comment on issues in this section, please include 
the caption ``DISCUSSION OF COMMENTS--ORTHOPEDIC SURGERY'' at the 
beginning of your comments.]
a. Tumor Procedures
    The American Academy of Orthopaedic Surgeons (AAOS) submitted CPT 
codes in the following three families of tumor procedures for review. 
(See Table 8, Table 9, and Table 10.)

          Table 8.--Family 1--Excision of Deep Soft Tissue Mass
------------------------------------------------------------------------
              CPT code                           Description
------------------------------------------------------------------------
21556..............................  Excision tumor, soft tissue of neck
                                      or thorax; deep, subfascial,
                                      intramuscular
23076..............................  Excision, soft tissue tumor,
                                      shoulder area; deep, subfascial,
                                      or intramuscular.
24076..............................  Excision, tumor, soft tissue of
                                      upper arm or elbow area; deep
                                      (subfascial or intramuscular).
25076..............................  Excision, tumor, soft tissue of
                                      forearm and/or wrist area; deep
                                      (subfascial or intramuscular).
27048..............................  Excision, tumor, pelvis and hip
                                      area; deep, subfascial,
                                      intramuscular.
27328..............................  Excision, tumor, thigh or knee
                                      area, deep, subfascial, or
                                      intramuscular.
27619..............................  Excision, tumor, leg or ankle area;
                                      deep (subfascial or
                                      intramuscular).
28045..............................  Excision, tumor, foot; deep,
                                      subfascial, intramuscular.
------------------------------------------------------------------------


      Table 9.--Family 2--Radical Resection of Soft Tissue Sarcoma
------------------------------------------------------------------------
              CPT code                           Description
------------------------------------------------------------------------
24077..............................  Radical resection of tumor (e.g.,
                                      malignant neoplasm), soft tissue
                                      of upper arm or elbow area.
25077..............................  Radical resection of tumor (e.g.,
                                      malignant neoplasm), soft tissue
                                      of forearm and/or wrist area.
27049..............................  Radical resection of tumor, soft
                                      tissue of pelvis and hip area
                                      (e.g., malignant neoplasm).
27329..............................  Radical resection of tumor (e.g.,
                                      malignant neoplasm), soft tissue
                                      of thigh or knee area.
27615..............................  Radical resection of tumor (e.g.,
                                      malignant neoplasm), soft tissue
                                      of leg or ankle area).
------------------------------------------------------------------------


         Table 10.--Family 3--Radical Resection of Bone Sarcoma
------------------------------------------------------------------------
              CPT code                           Description
------------------------------------------------------------------------
21935..............................  Radical resection of tumor (e.g.,
                                      malignant neoplasm), soft tissue
                                      of back or flank.
23200..............................  Radical resection for tumor;
                                      clavicle.
23210..............................  Radical resection for tumor;
                                      scapula.
23220..............................  Radical resection of bone tumor,
                                      proximal humerus.
24150..............................  Radical resection for tumor, shaft
                                      or distal humerus.
24151..............................  Radical resection for tumor, shaft
                                      or distal humerus; with autograft
                                      (includes obtaining graft).

[[Page 37196]]

 
24152..............................  Radical resection for tumor, radial
                                      head or neck.
24153..............................  Radical resection for tumor, radial
                                      head or neck; with autograft
                                      (includes obtaining graft).
25170..............................  Radical resection for tumor, radius
                                      or ulna.
27076..............................  Radical resection of tumor or
                                      infection; ilium, including
                                      acetabulum, both pubic rami, or
                                      ischium and acetabulum.
27078..............................  Radical resection of tumor or
                                      infection; ischial tuberosity and
                                      greater trochanter of femur.
27365..............................  Radical resection of tumor, bone,
                                      femur or knee.
27645..............................  Radical resection of tumor, bone;
                                      tibia.
27646..............................  Radical resection of tumor, bone;
                                      fibula.
27647..............................  Radical resection of tumor; talus
                                      or calcaneus.
------------------------------------------------------------------------

    The specialty subsequently withdrew CPT codes 21935, 24151, and 
24153 from the 5-Year Review. A minisurvey methodology was used for all 
three families of codes.
RUC Recommendations
    Based on a review of the survey results for the codes in Families 1 
and 2, the RUC recommended referring these codes to the CPT Editorial 
Panel for clarification. The RUC indicated that the survey data from 
the specialty society described a hospitalized patient as the typical 
patient. However, our data indicates that the typical patient is not 
hospitalized and that this inconsistency could be the result of 
ambiguous CPT descriptors.
    For the services in Family 3, the RUC discussion focused on the 
issue of whether there may also be different patient populations 
covered by each of these codes.
    The RUC also recommended referring the codes in Family 3 to the CPT 
Editorial Panel for clarification.
CMS Proposed Valuation
    We will maintain the current valuation for these services pending 
the results of the review by the CPT Editorial Panel.
b. Trauma Procedures
    The AAOS submitted the following trauma procedure codes for review 
(see Table 11). Standard RUC surveys of these services were conducted.

                                Table 11
------------------------------------------------------------------------
              CPT code                           Description
------------------------------------------------------------------------
20680..............................  Removal of implant; deep (e.g.,
                                      buried wire, pin, screw, metal
                                      band, nail, rod or plate).
20692..............................  Application of a multiplane (pins
                                      or wires in more than one plane),
                                      unilateral, external fixation
                                      system (e.g., Ilizarov, Monticelli
                                      type).
24430..............................  Repair of nonunion or malunion,
                                      humerus; without graft (e.g.,
                                      compression technique).
27465..............................  Osteoplasty, femur; shortening
                                      (excluding 64876).
27470..............................  Repair, nonunion or malunion,
                                      femur, distal to head and neck;
                                      without graft (e.g., compression
                                      technique).
27472..............................  Repair, nonunion or malunion,
                                      femur, distal to head and neck;
                                      with iliac or other autogeneous
                                      bone graft (includes obtaining
                                      graft).
27709..............................  Osteotomy; tibia and fibula.
27720..............................  Repair of nonunion or malunion,
                                      tibia; without graft, (e.g.,
                                      compression technique).
------------------------------------------------------------------------

RUC Recommendations
    Based on a review of the compelling evidence, the RUC made the 
following recommendations.
    For CPT code 20680, the RUC agreed that the intra-operative time 
for this code is misvalued based on the significant changes in 
physician work for the removal of deep implants due to changes in 
technology. Using the survey's 25th percentile value for the work RVUs 
along with the 25th percentile value for intra-service time, and 
adjusting for the fact that this procedure is typically performed in an 
outpatient setting, the RUC recommended a work RVU of 5.86 for this 
service.
    For CPT code 24430, the workgroup did not believe that the current 
work value for CPT code 24430 accounts for all the work typically 
involved with this service. This is based on the survey's physician 
time and visit data and a comparison to CPT code 24515, Open treatment 
of humeral shaft fracture with plate/screws, with or without cerclage, 
which is a less complex procedure than CPT code 24430. The RUC 
recommended a work RVU of 14.00 and an intra-service time of 102 
minutes for this service, which was the 25th percentile for work of the 
survey data.
    Based on a comparison to CPT code 27506, Open treatment of femoral 
shaft fracture, with or without external fixation, with insertion of 
intramedullary implant, with or without and/or locking screws, the 
workgroup determined that the current work RVUs for CPT code 27465, do 
not fully account for the work typically involved in shortening the 
femur because it typically includes the insertion of an intermedullary 
nail. However, the workgroup believed that CPT code 27465 should be 
valued lower than the reference service code, CPT code 27454, 
Osteotomy, multiple, with realignment on intramedullary rod, femoral 
shaft (e.g., Sofield type procedure), which has a work RVU of 17.53, 
and is a greater intensity procedure. The RUC-recommended work RVU for 
CPT code 27645 was 17.50, based on the median of the survey data.
    Based on a review of the survey data, the workgroup did not believe 
that there was compelling evidence to change the work RVU for CPT code 
27470. Therefore, the RUC recommended that the current work RVU of 
16.05 be maintained for this service. However, the workgroup also 
recommended using the new survey times as they believed the Harvard 
times from the original Harvard relative value study, which was used to 
establish RVUs at the outset of the Medicare PFS, are inflated.
    For CPT code 27709, Osteotomy; tibia and fibula, the RUC reviewed 
the survey time and compared this service to CPT

[[Page 37197]]

code 27705, Osteomy, tibia, which has a work RVU of 10.36. The RUC 
recommended a work RVU of 16.50 for CPT code 27709 which would place 
the code in proper rank order with CPT code 27705.
    The RUC recommended the referral of CPT codes 20692, 27472, and 
27720 to the CPT Editorial Panel to clarify whether these 90-day global 
period codes should be exempt from modifier 51. (Modifier 51 denotes 
that a multiple procedure was performed.) The RUC was concerned that 
attempting to value these codes would lead to double counting some of 
the work.
    The RUC-recommended valuation for these CPT codes was as follows: 
20680 = 5.86 work RVUs; 24430 = 14.00 work RVUs; 27465 = 17.50 work 
RVUs; 27470 = 16.05 work RVUs; and 27709 = 16.50 work RVUs.
CMS Proposed Valuation
    We are in agreement with the RUC-recommended work values for these 
trauma services.
c. Total Elbow and General Procedures
    AAOS submitted the following elbow athroplasty service for review 
(see Table 12).

                                Table 12
------------------------------------------------------------------------
              CPT code                           Description
------------------------------------------------------------------------
24363..............................  Arthroplasty, elbow; with distal
                                      humerus and proximal ulnar
                                      prosthetic replacement (e.g.,
                                      total elbow).
------------------------------------------------------------------------

    In addition, we submitted the following CPT codes, in Table 13, for 
review.

                                Table 13
------------------------------------------------------------------------
              CPT code                           Description
------------------------------------------------------------------------
20600..............................  Arthrocentesis, aspiration and/or
                                      injection; small joint or bursa
                                      (e.g., fingers, toes).
20610..............................  Arthrocentesis, aspiration and/or
                                      injection; major joint or bursa
                                      (e.g., shoulder, hip, knee joint,
                                      subacromial bursa).
29075..............................  Application, cast; elbow to finger
                                      (short arm).
------------------------------------------------------------------------

    Standard RUC surveys of these services were conducted.
RUC Recommendations
    The RUC recommended maintaining the current work RVUs for CPT codes 
20600, 20610, and 29075 because of the low response rate for the 
surveys and the lack of compelling evidence for changing the work 
value.
    Based on a review of the survey data and information provided by 
the presenting specialty societies, AAOS and the American Society of 
Shoulder and Elbow Surgeons, the RUC concluded that the CPT code 24363 
should be valued the same as CPT code 23472, Arthroplasty, glenohumeral 
joint; total shoulder (glenoid and proximal humeral replacement (e.g., 
total shoulder), and recommended a work RVU of 21.07 to maintain 
appropriate rank-order alignment with this family of codes. The RUC-
recommended valuation for these CPT codes was as follows: 20600 = 0.66 
work RVUs; 20610 = 0.79 work RVUs; 24363 = 21.07 work RVUs; and 29075 = 
0.77 work RVUs.
CMS Proposed Valuation
    We agree with the RUC-recommended work RVUs for these elbow and 
general procedure services.
d. Wrist, Hand and Finger
    We submitted the CPT codes in Table 14 for review.

                                Table 14
------------------------------------------------------------------------
              CPT code                           Description
------------------------------------------------------------------------
25447..............................  Arthroplasty, interposition,
                                      intercarpal or carpometacarpal
                                      joints.
26055..............................  Tendon sheath incision (e.g., for
                                      trigger finger).
26160..............................  Excision of lesion of tendon sheath
                                      or joint capsule (e.g., cyst,
                                      mucous cyst, or ganglion), hand or
                                      finger.
26600..............................  Closed treatment of metacarpal
                                      fracture, single; without
                                      manipulation, each bone.
26951..............................  Amputation, finger or thumb,
                                      primary or secondary, any joint or
                                      phalanx, single, including
                                      neurectomies; with direct closure.
64721..............................  Neuroplasty and/or transposition;
                                      median nerve at carpal tunnel.
------------------------------------------------------------------------

    CPT code 64702, Neuroplasty; digital, one or both, same digit, was 
submitted by the American Society for Surgery of the Hand (ASSH) with 
the rationale that this code is based on inaccurate Harvard physician 
times that are low compared to other hand surgery codes. Standard RUC 
surveys of these services were conducted.
RUC Recommendations
    Based on a review of the survey data, the RUC recommended that the 
current work RVUs be maintained for CPT codes 25447, 26055, 26160, and 
64721.
    For CPT code 26600, the workgroup examined the survey data 
presented by the specialty society and agreed that the current work 
value of 1.96 RVUs may not fully reflect the value of all post-
operative visits that are the current standard of care and that the CPT 
code most frequently cited as a reference code (CPT code 26720, Closed 
treatment of phalangeal shaft fracture, proximal or middle phalanx, 
finger or thumb; without manipulation, each), also understates the 
number of post-operative visits. The workgroup validated the survey 
median value of 2.40 work RVUs by performing a

[[Page 37198]]

building-block calculation that added the value of an additional post-
operative visit (CPT code 99212 at 0.43 work RVUs) to the current work 
value for CPT code 26600 of 1.96 for a total of 2.39 work RVUs. Since 
this value was almost identical to the median survey value of 2.40, the 
RUC recommended accepting this median value for the work RVUs for CPT 
code 26600.
    For CPT code 26951, the RUC workgroup agreed that the current value 
of 4.58 work RVUs for this code creates a rank order anomaly when 
compared to the reference code (CPT code 26185, Sesamoidectomy, thumb 
or finger (separate procedure)), which has a work RVU of 5.24. Based on 
a review of survey data, the RUC recommended that CPT code 26951 should 
be assigned work RVUs of 5.25 (the 25th percentile survey value) but 
that the survey median intra-service time of 45 minutes should be used 
since that is equal to the reference code.
    For CPT code 64702, the RUC workgroup agreed that the current value 
for this service of 4.22 work RVUs does not include the number of post-
operative days typically associated with this procedure. The workgroup 
believed that adding the work RVUs (1.3 work RVUs) associated with two 
additional outpatient visits, represented by CPT code 99213, produces 
an appropriate work RVU for this service and also places CPT code 64702 
in the proper rank order with the reference service. The RUC 
recommended 5.52 work RVUs for CPT code 64702.
    The RUC-recommended work RVUs for these CPT codes are as follows: 
25447 = 10.35 work RVUs; 26055 = 2.69 work RVUs; 26160 = 3.15 work 
RVUs; 26600 = 2.40 work RVUs; 26951 = 5.25 work RVUs; 64702 = 5.52 work 
RVUs; and 64721 = 4.28 work RVUs.
CMS Proposed Valuation
    We are in agreement with the RUC-recommended work values for wrist, 
hand and finger services.
e. Total Joint and Hip Fracture
    We submitted three CPT codes for review (see Table 15).

                                Table 15
------------------------------------------------------------------------
              CPT code                           Description
------------------------------------------------------------------------
27130..............................  Arthroplasty, acetabular and
                                      proximal femoral prosthetic
                                      replacement (total hip
                                      arthroplasty), with or without
                                      autograft or allograft.
27236..............................  Open treatment of femoral fracture,
                                      proximal end, neck, internal
                                      fixation or prosthetic
                                      replacement.
27447..............................  Arthroplasty, knee, condyle and
                                      plateau; medial AND lateral
                                      compartments with or without
                                      patella resurfacing (total knee
                                      arthroplasty).
------------------------------------------------------------------------

    The specialty society did not submit surveys for these codes, which 
is the accepted RUC method, for the RUC's consideration of changes to 
current work RVUs. Instead the specialty society developed proposed 
values for these services based on data obtained from the VA NSQIP 
database and the Medicare DRG database. The specialty society did 
survey its membership to obtain the data, but did not provide the 
workgroup or the RUC with this information, stating the vignettes did 
not describe a typical patient for this series of codes. Thus, the 
survey data for these codes was not available for the RUC workgroup to 
review at its August 2005 meeting.
    The RUC requested that the specialty society survey its members on 
these three codes so that survey data could be used to evaluate the 
codes at the September 2005 RUC meeting. The specialty society used 
survey data, as well as NSQIP data and Medicare DRG data, to evaluate 
pre-service and intra-service times for these codes. The workgroup, as 
well as the RUC, was uncomfortable with mixing data from three separate 
sources in lieu of the established and accepted methodology of the RUC. 
The specialty society maintained the NSQIP data was more accurate than 
the survey data.
RUC Recommendations
    The RUC did not find any compelling evidence to change the current 
work RVUs assigned to these services. Based on a review of the data, 
the RUC recommended maintaining the current work RVUs of 20.09 for CPT 
code 27130, 15.58 for CPT code 27236 and 21.45 for CPT code 27447, but 
also recommended using the new physician time data for each of these 
services.
CMS Proposed Valuation
    For these three CPT codes (27130, 27236,and 27447), the specialty 
society used NSQIP and Medicare DRG data instead of the standard RUC 
survey methodology to create an intra-service time. Medicare DRG data 
has not been used by CMS or the RUC to evaluate new or existing CPT 
codes. CPT code 27130 has never been reviewed by the RUC. It currently 
has 20.09 work RVUs which is based on the following Harvard time data: 
pre-service time of 68 minutes, intra-service time of 128 minutes, 
post-service time of 36 minutes and eight hospital days. We believe 
that this service can be compared to CPT codes 43641, Vagotomy 
including pyloroplasty, with or without gastrostomy; parietal cell 
(highly selective), and 60260, Thyroidectomy, removal of all remaining 
thyroid tissue following previous removal of a portion of thyroid. Both 
codes were reviewed by the RUC during the second 5-Year Review. CPT 
code 43641 has 60 minutes pre-service time, 150 minutes intra-service 
time, 30 minutes post-service time, and 6 hospital days, resulting in 
work RVUs of 17.24. CPT code 60260 has 60 minutes pre-service time, 145 
minutes intra-service time and 30 minutes post-service time with 2 
hospital days, resulting in work RVUs of 17.44. We believe CPT code 
27130 is similar in work and intensity to CPT code 43641, and if one 
removes 2 hospital days (code 99231), this would result in a work RVU 
of 15.96. Therefore, we recommend a work RVU of 15.96 for CPT code 
27130.
    CPT code 27236 has never been reviewed by the RUC. It has a pre-
service time of 74 minutes, an intra-service time of 89 minutes, a 
post-service time of 27 minutes, 100 minutes for hospital days, and 57 
minutes for office visits for a total time of 347 minutes based on the 
Harvard time data, resulting in work RVUs of 15.58. We believe CPT 
codes 34421, Thrombectomy, direct or with catheter; vena cava, iliac, 
femoropopliteal vein, by leg incision, and 47600, Cholecystectomy, 
which were included in the second 5-Year Review, are similar in work 
intensity and time to CPT code 27236. CPT code 34421 has a pre-service 
time of 70 minutes, an intra-service time of 95 minutes, a post-service 
time of 221 minutes, and total time of 386 minutes, resulting in work 
RVUs of 11.98. CPT code 47600 has a pre-service time of 75 minutes, an 
intra-service time of 80 minutes, and a post-service time of 194 
minutes for a total time of 349 minutes, resulting in work

[[Page 37199]]

RVUs of 13.56. We propose a work RVU of 12.77 for CPT code 27236, which 
is the median value for these two codes and maintains relativity within 
this family of codes.
    CPT Code 27447 has never been reviewed by the RUC. It has 21.45 
work RVUs, which is based on the following Harvard time data: pre-
service time of 60 minutes, intra-service time 139 minutes, post-
service time of 37 minutes, 118 minutes for hospital days, and 54 
minutes for office visits for a total time of 408 minutes. We believe 
this service is comparable to CPT code 35671, Bypass graft, with other 
than vein; popliteal-tibial or -peroneal artery, which was reviewed 
during the second 5-Year Review. This service has a pre-service time of 
70 minutes, an intra-service time of 135 minutes, and a post-service 
time of 206 minutes for a total time of 411 minutes, resulting in work 
RVUs of 19.30. We believe CPT code 27447 is similar in work intensity 
and time to CPT code 35671 and propose work RVUs of 19.30 for CPT code 
27447.
f. Additional Fracture Codes
    The AAOS also submitted the following CPT codes listed in Table 16 
and the ASSH submitted CPT code 25620. However, the specialty societies 
believed clarification was needed for the CPT descriptor for these 
services, as there was a question whether the current valuation for 
these codes includes the application of internal and external fixation 
to a fracture site.

                                Table 16
------------------------------------------------------------------------
              CPT code                           Description
------------------------------------------------------------------------
23515..............................  Open treatment of clavicle
                                      fracture, with or without internal
                                      or external fixation.
23585..............................  Open treatment of scapular fracture
                                      (body, glenoid or acromion) with
                                      or without internal fixation.
23615..............................  Open treatment of proximal humeral
                                      (surgical or anatomical neck)
                                      fracture, with or without internal
                                      or external fixation, with or
                                      without repair of tuberosity(s).
23616..............................  Open treatment of proximal humeral
                                      (surgical or anatomical neck)
                                      fracture, with or without internal
                                      or external fixation, with or
                                      without repair of tuberosity(s);
                                      with proximal humeral prosthetic
                                      replacement.
23630..............................  Open treatment of greater humeral
                                      tuberosity fracture, with or
                                      without internal or external
                                      fixation.
23670..............................  Open treatment of shoulder
                                      dislocation, with fracture of
                                      greater humeral tuberosity, with
                                      or without internal or external
                                      fixation.
23680..............................  Open treatment of shoulder
                                      dislocation, with surgical or
                                      anatomical neck fracture, with or
                                      without internal or external
                                      fixation.
24545..............................  Open treatment of humeral
                                      supracondylar or transcondylar
                                      fracture, with or without internal
                                      or external fixation; without
                                      intercondylar extension.
24546..............................  Open treatment of humeral
                                      supracondylar or transcondylar
                                      fracture, with or without internal
                                      or external fixation; with
                                      intercondylar extension.
24575..............................  Open treatment of humeral
                                      epicondylar fracture, medial of
                                      lateral, with or without internal
                                      or external fixation.
24579..............................  Open treatment of humeral condylar
                                      fracture, medial or lateral, with
                                      or without internal or external
                                      fixation.
24635..............................  Open treatment of Monteggia type of
                                      fracture dislocation at elbow
                                      (fracture proximal end of ulna
                                      with dislocation of radial head),
                                      with or without internal or
                                      external fixation.
24665..............................  Open treatment of radial head or
                                      neck fracture, with or without
                                      internal fixation or radial head
                                      excision.
24685..............................  Open treatment of ulnar fracture
                                      proximal end (olecranon process),
                                      with or without internal or
                                      external fixation.
25515..............................  Open treatment of radial shaft
                                      fracture, with or without internal
                                      or external fixation.
25526..............................  Open treatment of radial shaft
                                      fracture, with internal and/or
                                      external fixation and open
                                      treatment, with or without
                                      internal or external fixation of
                                      distal radioulnar joint (Galeazzi
                                      fracture/dislocation), includes
                                      repair of triangular
                                      fibrocartilage complex.
25545..............................  Open treatment of ulnar shaft
                                      fracture, with or without internal
                                      or external fixation.
25574..............................  Open treatment of radial AND ulnar
                                      shaft fractures, with internal or
                                      external fixation; of radius OR
                                      ulna.
25575..............................  Open treatment of radial AND ulnar
                                      shaft fractures, with internal or
                                      external fixation; of radius AND
                                      ulna.
25620..............................  Open treatment of distal radial
                                      fracture (e.g., Colles or Smith
                                      type) or epiphyseal separation,
                                      with or without fracture of ulnar
                                      styloid, with or without internal
                                      or external fixation.
25628..............................  Open treatment of carpal scaphoid
                                      (navicular) fracture, with or
                                      without internal or external
                                      fixation.
26615..............................  Open treatment of metacarpal
                                      fracture, single, with or without
                                      internal or external fixation,
                                      each bone.
26665..............................  Open treatment of carpometacarpal
                                      fracture dislocation, thumb
                                      (Bennett fracture), with or
                                      without internal or external
                                      fixation.
26685..............................  Open treatment of carpometacarpal
                                      dislocation, other than thumb,
                                      with or without internal or
                                      external fixation, each joint.
26715..............................  Open treatment of
                                      metacarpophalangeal dislocation,
                                      single, with or without internal
                                      or external fixation.
26735..............................  Open treatment of phalangeal shaft
                                      fracture, proximal or middle
                                      phalanx, finger or thumb, with or
                                      without internal or external
                                      fixation, each.
26746..............................  Open treatment of articular
                                      fracture, involving
                                      metacarpophalangeal or
                                      interphalangeal joint, with or
                                      without internal or external
                                      fixation, each.
26765..............................  Open treatment of distal phalangeal
                                      fracture, finger or thumb, with or
                                      without internal or external
                                      fixation, each.
26785..............................  Open treatment of interphalangeal
                                      joint dislocation, with or without
                                      internal or external fixation,
                                      single.
27248..............................  Open treatment of greater
                                      trochanteric fracture, with or
                                      without internal of external
                                      fixation.
27511..............................  Open treatment of femoral
                                      supracondylar or transcondylar
                                      fracture without intercondylar
                                      extension, with or without
                                      internal or external fixation.
27513..............................  Open treatment of femoral
                                      supracondylar or transcondylar
                                      fracture with intercondylar
                                      extension, with or without
                                      internal or external fixation.
27514..............................  Open treatment of femoral fracture,
                                      distal end, medial of lateral
                                      condyle, with or without internal
                                      or external fixation.
27519..............................  Open treatment of distal femoral
                                      epiphyseal separation, with or
                                      without internal or external
                                      fixation.
27535..............................  Open treatment of tibial fracture,
                                      proximal (plateau); unicondylar,
                                      with or without internal of
                                      external fixation.
27540..............................  Open treatment of intercondylar
                                      spine(s) and/or tuberosity
                                      fracture(s) of the knee, with or
                                      without internal or external
                                      fixation.
27556..............................  Open treatment of knee dislocation,
                                      with or without internal or
                                      external fixation; without primary
                                      ligamentous repair of augmentation/
                                      reconstruction.
27766..............................  Open treatment of medial malleolus
                                      fracture, with or without internal
                                      or external fixation.
27784..............................  Open treatment of proximal fibula
                                      or shaft fracture, with or without
                                      internal or external fixation.

[[Page 37200]]

 
27792..............................  Open treatment of distal fibular
                                      fracture (lateral malleolus), with
                                      or without internal or external
                                      fixation.
27814..............................  Open treatment of bimalleolar ankle
                                      fracture, with or without internal
                                      or external fixation.
27822..............................  Open treatment of trimalleolar
                                      ankle fracture, with or without
                                      internal or external fixation,
                                      medial and/or lateral malleolus;
                                      without fixation of posterior lip.
27826..............................  Open treatment of fracture of
                                      weight bearing articular surface/
                                      portion of distal tibia (e.g.,
                                      pilon or tibial plafond), with
                                      internal or external fixation; of
                                      fibula only.
27827..............................  Open treatment of fracture of
                                      weight bearing articular surface/
                                      portion of distal tibia (e.g.,
                                      pilon or tibial plafond), with
                                      internal or external fixation; of
                                      tibia only.
27828..............................  Open treatment of fracture of
                                      weight bearing articular surface/
                                      portion of distal tibia (e.g.,
                                      pilon or tibial plafond), with
                                      internal or external fixation; of
                                      both tibia and fibula.
27829..............................  Open treatment of distal
                                      tibiofibular joint (syndesmosis)
                                      disruption, with or without
                                      internal or external fixation.
27832..............................  Open treatment of proximal
                                      tibiofibular joint dislocation,
                                      with or without internal or
                                      external fixation, or with
                                      excision of proximal fibula.
28415..............................  Open treatment of calcaneal
                                      fracture, with or without internal
                                      or external fixation.
28445..............................  Open treatment of talus fracture,
                                      with or without internal or
                                      external fixation.
28465..............................  Open treatment of tarsal bone
                                      fracture (except talus and
                                      calcaneus), with or without
                                      internal or external fixation,
                                      each.
28485..............................  Open treatment of metatarsal
                                      fracture, with or without internal
                                      or external fixation, each.
28505..............................  Open treatment of fracture of great
                                      toe, phalanx or phalanges, with or
                                      without internal or external
                                      fixation.
28525..............................  Open treatment of fracture, phalanx
                                      or phalanges, other than great
                                      toe, with or without internal or
                                      external fixation, each.
28555..............................  Open treatment of tarsal bone
                                      dislocation, with or without
                                      internal or external fixation.
28585..............................  Open treatment of talotarsal joint
                                      dislocation, with or without
                                      internal or external fixation.
28615..............................  Open treatment of tarsometatarsal
                                      joint dislocation, with or without
                                      internal or external fixation.
28645..............................  Open treatment of
                                      metatarsophalangeal joint
                                      dislocation, with or without
                                      internal or external fixation.
28675..............................  Open treatment of interphalangeal
                                      joint dislocation, with or without
                                      internal or external fixation.
------------------------------------------------------------------------

RUC Recommendations
    The RUC recommended that these CPT codes be referred to the CPT 
Editorial Panel for review and clarification.
CMS Proposed Valuation
    We will maintain the current valuation for these services pending 
the results of the review by the CPT Editorial Panel.
3. Gynecology, Urology, Pain Medicine, and Neurosurgery
    [If you choose to comment on issues in this section, please include 
the caption ``DISCUSSION OF COMMENTS--GYNECOLOGY, UROLOGY, PAIN 
MEDICINE, AND NEUROSURGERY'' at the beginning of your comments.]
a. Obstetrics and Gynecology
    The American College of Obstetricians and Gynecologists (ACOG) 
submitted the CPT codes in Table 17 for review.

                                Table 17
------------------------------------------------------------------------
              CPT code                           Description
------------------------------------------------------------------------
49200..............................  Excision or destruction, open,
                                      intra-abdominal or retroperitoneal
                                      tumors or cysts or endometriomas.
49201..............................  Excision or destruction, open,
                                      intra-abdominal or retroperitoneal
                                      tumors or cysts or endometriomas;
                                      extensive.
56631..............................  Vulvectomy, radical, partial; with
                                      unilateral inguinofemoral
                                      lymphadenectomy.
56632..............................  Vulvectomy, radical, partial; with
                                      bilateral inguinofemoral
                                      lymphadenectomy.
56634..............................  Vulvectomy, radical, complete; with
                                      unilateral inguinofemoral
                                      lymphadenectomy.
56637..............................  Vulvectomy, radical, complete; with
                                      bilateral inguinofemoral
                                      lymphadenectomy.
56640..............................  Vulvectomy, radical, complete, with
                                      inguinofemoral, iliac, and pelvic
                                      lymphadenectomy.
57160..............................  Fitting and insertion of pessary or
                                      other intravaginal support device.
57240..............................  Anterior colporrhaphy, repair of
                                      cystocele with or without repair
                                      of urethrocele.
57250..............................  Posterior colporrhaphy, repair of
                                      rectocele with or without
                                      perineorrhaphy.
57260..............................  Combined anteroposterior
                                      colporrhaphy.
57265..............................  Combined anteroposterior
                                      colporrhaphy; with enterocele
                                      repair.
57550..............................  Excision of cervical stump, vaginal
                                      approach.
57555..............................  Excision of cervical stump, vaginal
                                      approach; with anterior and/or
                                      posterior repair.
57556..............................  Excision of cervical stump, vaginal
                                      approach; with repair of
                                      enterocele.
------------------------------------------------------------------------

    However, the specialty society subsequently withdrew the following 
CPT codes: 49200, 49201, 56631, 56632, 56634, 56637, 56640, 57550, 
57555, and 57556.
    We identified five CPT codes for review but withdrew one code, CPT 
code 58260 (see Table 18).

                                Table 18
------------------------------------------------------------------------
              CPT code                           Description
------------------------------------------------------------------------
57500..............................  Biopsy, single or multiple, or
                                      local excision of lesion, with or
                                      without fulguration (separate
                                      procedure).
58120..............................  Dilation and curettage, diagnostic
                                      and/or therapeutic
                                      (nonobstetrical).
58150..............................  Total abdominal hysterectomy
                                      (corpus and cervix), with or
                                      without removal of tube(s), with
                                      or without removal of ovary(s).
58260..............................  Vaginal hysterectomy, for uterus
                                      250 grams or less.

[[Page 37201]]

 
58720..............................  Salpingo-oophorectomy, complete or
                                      partial, unilateral or bilateral
                                      (separate procedure).
------------------------------------------------------------------------

    A standard RUC survey with over 30 responses was used for these 
codes.
RUC Recommendations
    The RUC recommended maintaining the existing RVUs for CPT codes 
57160, 58120 and 58720. The RUC believed there was no compelling 
evidence presented to indicate that there had been a change in work for 
CPT code 57160. The RUC also agreed with the specialty society that the 
survey data collected validated the existing times and existing RVUs 
for CPT codes 58120 and 58720.
    The RUC recommended increasing the work value for the remaining CPT 
codes. The RUC agreed with the specialty society that these procedures 
were currently undervalued because of rank-order anomalies, changes in 
patient population or incorrect assumptions made in the previous 
valuation of the service. However, the RUC-recommended work values for 
each service were below the level presented by the specialty society. 
The RUC recommended the use of the surveys' 25th percentile work RVUs 
for four of the services, CPT codes 57240, 57250, 57500 and 58150, and 
the 75th percentile for CPT codes 57260 and 57265. The 75th percentile 
was used because the workgroup believed that otherwise there would be a 
rank order anomaly between the more complex vagina repair services, CPT 
codes 57280 and 57265, and the simpler procedures, CPT codes 57240 and 
57250.
    The RUC-recommended work values for these services are as follows: 
57160 = 0.89 work RVUs; 57240 = 10.56 work RVUs; 57250 = 10.56 work 
RVUs; 57260 = 13.50 work RVUs; 57265 = 15.00 work RVUs; 57500 = 1.20 
work RVUs; 58120 = 3.27 work RVUs; 58150 = 15.98 work RVUs; and 58720 = 
11.34 work RVUs.
CMS Proposed Valuation
    We propose to accept the RUC recommendations for these obstetrics 
and gynecology services. We initially had concerns with the use of the 
surveys' 75th percentile for the recommendation of work RVUs for CPT 
codes 57260 and 57265, but in comparison with similar services, we 
believe that the RUC recommendations for these services create the 
correct rank order, both within the family of codes and with other 
similar services.
b. Urology
    The American Urological Association (AUA) and the Coalition for the 
Advancement of Prosthetic Urology (CAPU) submitted five CPT codes for 
review (see Table 19). However, the specialty society subsequently 
withdrew four CPT codes (53445, 54400, 54405, and 54411).

                                Table 19
------------------------------------------------------------------------
              CPT code                           Description
------------------------------------------------------------------------
51798..............................  Measurement of post-voiding
                                      residual urine and/or bladder
                                      capacity by ultrasound, non-
                                      imaging.
53445..............................  Insertion of inflatable urethral/
                                      bladder neck sphincter, including
                                      placement of pump, reservoir, and
                                      cuff.
54400..............................  Insertion of penile prosthesis; non-
                                      inflatable (semi-rigid).
54405..............................  Insertion of multi-component,
                                      inflatable penile prosthesis,
                                      including placement of pump,
                                      cylinders, and reservoir.
54411..............................  Removal and replacement of all
                                      components of a multi-component
                                      inflatable penile prosthesis
                                      through an infected field at the
                                      same operative session, including
                                      irrigation and debridement of
                                      infected tissue.
------------------------------------------------------------------------

    In addition, we identified seven CPT codes for review because of 
possible changes in technology or because the service had never been 
reviewed by the RUC (see Table 20). A standard RUC survey with over 30 
responses was used for the following codes.

                                Table 20
------------------------------------------------------------------------
              CPT code                           Description
------------------------------------------------------------------------
50590..............................  Lithotripsy, extracorporeal shock
                                      wave.
51720..............................  Bladder instillation of
                                      anticarcinogenic agent (including
                                      detention time).
52000..............................  Cystourethroscopy (separate
                                      procedure).
52204..............................  Cystourethroscopy, with biopsy.
52601..............................  Transurethral electrosurgical
                                      resection of prostate, including
                                      control of postoperative bleeding,
                                      complete (vasectomy, meatotomy,
                                      cystourethroscopy, urethral
                                      calibration and/or dilation, and
                                      internal urethrotomy are
                                      included).
55700..............................  Biopsy, prostate; needle or punch,
                                      single or multiple, any approach.
57288..............................  Sling operation for stress
                                      incontinence (e.g., fascia or
                                      synthetic).
------------------------------------------------------------------------

RUC Recommendations
    Of the eight codes presented with survey data, the RUC recommended 
maintaining the existing work RVUs for two codes. For CPT code 57288, 
the RUC believed that the survey median supported the specialty 
society's contention that the work currently associated with the code 
is accurate. For CPT code 50590, the RUC believed that the current work 
value more accurately reflected the work involved in the service than 
did the survey, which increased the work RVUs while decreasing the 
physician intra-time substantially.
    The RUC recommended decreasing the current work RVUs for CPT code 
51720 to reflect the median work RVU from the survey.
    The RUC agreed with the specialty society's recommendations for an 
increase to the existing RVUs for CPT code 51798. This procedure was

[[Page 37202]]

originally reviewed by the RUC in April 2002 with a recommendation 0.38 
work RVUs to reflect the physician work believed to be typically 
associated with this procedure. However, in the CY 2002 Physician Fee 
Schedule final rule with comment period (66 FR 55246), we contended 
that there was no physician work associated with this service and 
assigned work RVUs of 0.00. This decision was upheld by the refinement 
process that is used to address comments received on the valuation of 
new and revised CPT codes and that was discussed in the CY 2004 
Physician Fee Schedule final rule with comment period (67 FR 63227). 
However, the RUC agreed with the specialty society that this procedure 
is performed by physicians and reaffirmed its previous recommendation 
of 0.38 work RVUs for this procedure.
    The RUC recommended increasing the work RVUs for four codes, but 
below the level requested by the specialty society (that is, 
recommending work RVUs equal to the surveys' 25th percentile for CPT 
codes 52000 and 55700, equal to the median for CPT code 52601 and less 
than the 25th percentile for CPT code 52204). The RUC agreed with the 
specialty society that these procedures were currently undervalued due 
to changes in technology, changes in patient populations and incorrect 
assumptions that were made in the previous valuation of the service.
    The RUC-recommended work values for these CPT codes for urology 
services are as follows: 50590 = 9.08 work RVUs; 51720 = 1.50 work 
RVUs; 51798 = 0.38 work RVUs; 52000 = 2.23 work RVUs; 52204 = 2.59 work 
RVUs; 52601 = 14.00 work RVUs; 55700 = 2.58 work RVUs; and 57288 = 
13.00 work RVUs.
CMS Proposed Valuation
    We accept the RUC recommendations for these urology services except 
for CPT code 51798. The RUC recommendation for bladder ultrasound was 
based on CPT code 79857 (the pelvic ultrasound (nonobstetric) 
procedure) as the reference code. (CPT code 76857 should be used if the 
urinary bladder alone is imaged, whereas CPT code 51798 should be 
utilized if a bladder volume or post-void residual measurement is 
obtained without imaging the bladder.) We disagree that this is an 
appropriate reference code because the pelvic ultrasound procedure is 
very different from a bladder ultrasound procedure. The bladder 
ultrasound procedure only results in a ``numerical reading'' of 
milliliters of residual urine in the bladder and does not produce an 
image on a screen for a physician to interpret like many other 
ultrasound procedures (for example, the pelvic ultrasound). Therefore, 
we disagree with the RUC recommendation to use the 0.38 physician work 
RVUs for the professional component of code 76857 as the work RVUs for 
CPT code 51798 because we do not believe this procedure involves 
physician work since the machine only produces a numerical reading.
c. Spine Surgery
    We identified the CPT codes in Table 21 for the 5-Year Review.

                                Table 21
------------------------------------------------------------------------
              CPT code                           Description
------------------------------------------------------------------------
22520..............................  Percutaneous vertbroplasty, one
                                      vertebral body, unilateral or
                                      bilateral, injection; thoracic.
22554..............................  Arthrodesis, anterior interbody
                                      technique, including minimal
                                      diskectomy to prepare interspace
                                      (other than for decompression);
                                      cervical below C2.
22612..............................  Arthrodesis, posterior or
                                      posterolateral technique, single
                                      level; lumbar (with or without
                                      lateral transverse technique).
22840..............................  Posterior non-segmental
                                      instrumentation (e.g., Harrington
                                      rod technique, pedicle fixation
                                      across one interspace,
                                      atlantoaxial transarticular screw
                                      fixation, sublaminar wiring at C1,
                                      facet screw fixation).
63047..............................  Laminectomy, facetectomy and
                                      foraminotomy (unilateral or
                                      bilateral with decompression of
                                      spinal cord, cauda equina and/or
                                      nerve root(s), (e.g., spinal or
                                      lateral recess stenosis)), single
                                      vertebral segment; lumbar.
63048..............................  Laminectomy, facetectomy and
                                      foraminotomy (unilateral or
                                      bilateral with decompression of
                                      spinal cord, cauda equina and/or
                                      nerve root(s), (e.g., spinal or
                                      lateral recess stenosis)), single
                                      vertebral segment; each additional
                                      segment, cervical, thoracic, or
                                      lumbar (List separately in
                                      addition to code for primary
                                      procedure).
63075..............................  Diskectomy, anterior, with
                                      decompression of spinal cord and/
                                      or nerve root(s), including
                                      osteophytectomy; cervical, single
                                      interspace.
------------------------------------------------------------------------

    With approval of the RUC, the specialty society used a modified RUC 
survey that included surveys of time (pre-service, intra-service, 
immediate post-service), post-operative visits and estimates of total 
work. Two reference codes were used to survey the estimates of 
intensity and complexity. There were well over 100 responses to each 
survey.
RUC Recommendations
    The RUC accepted the specialty society's recommendations to 
decrease the existing work RVUs for three procedures: CPT codes 22554, 
63047 and 63075. The RUC agreed that these procedures were overvalued 
due to decreases in the length of stay and physician time. The RUC also 
accepted the specialty society's recommendation to maintain the work 
associated with CPT codes 22520 and 22840. The RUC agreed with the 
specialty society that the survey data collected validated the existing 
work RVUs associated with these codes. For CPT codes 22612 and 63048, 
the RUC recommended increases in the work RVUs, but less than the 
increases requested by the specialty society. The RUC agreed that these 
procedures were undervalued due to increases in length of stay and the 
incorrect assumptions made in the previous valuation of the service.
    The specific RUC-recommended work RVUs were as follows: 22520 = 
8.90 work RVUs; 22554 = 16.40 work RVUs; 22612 = 22.00 work RVUs; 22840 
= 12.52 work RVUs; 63047 = 14.08 work RVUs; 63048 = 3.55 work RVUs; and 
63075 = 18.58 work RVUs.
CMS Proposed Valuation
    We accept the work RVUs recommended by the RUC for CPT codes 22520, 
22554, 22840, 63047 and 63075. However, we have technical concerns with 
the recommendations for CPT codes 22612 and 63048.
    The workgroup recommended the survey's 25th percentile for CPT code 
22612 to keep the appropriate rank order with the reference service, 
CPT code 22595, which is a more complex procedure. However, there was a 
typographical error in the information presented by the specialty 
society that listed the work RVUs for the reference code as 23.36, 
rather than the correct value of 19.36 work RVUs. Therefore, the 
recommended work value of 22.00 RVUs is clearly inappropriate and we

[[Page 37203]]

are proposing to maintain the current work RVUs of 20.97 for this 
service.
    There is an additional typographical error in the specialty society 
survey data for CPT code 63048. The summary information lists the 
reference code as also being CPT code 63048. Therefore, there is no 
information given that compares the respondents' estimates of 
complexity and intensity between CPT code 63048 and the reference code. 
Because we do not have sufficient information to decide if the 
recommended work RVUs are appropriate, we are proposing to maintain the 
current work RVUs of 3.26 for CPT code 63048.
d. Spinal Pump Infusion and Stimulators
    The American Academy of Pain Medicine (AAPM) and the American 
Society of Anesthesiologists (ASA) initially submitted several CPT 
codes that were subsequently withdrawn from the 5-Year Review (see 
Table 22).

                                Table 22
------------------------------------------------------------------------
              CPT code                           Description
------------------------------------------------------------------------
62350..............................  Implantation, revision or
                                      repositioning of tunneled
                                      intrathecal or epidural catheter,
                                      for long-term medication
                                      administration via an external
                                      pump or implantable reservoir/
                                      infusion pump; without
                                      laminectomy.
62351..............................  Implantation, revision or
                                      repositioning of tunneled
                                      intrathecal or epidural catheter,
                                      for long-term medication
                                      administration via an external
                                      pump or implantable reservoir/
                                      infusion pump; with laminectomy.
62355..............................  Removal of previously implanted
                                      intrathecal or epidural catheter.
62360..............................  Implantation or replacement of
                                      device for intrathecal or epidural
                                      drug infusion; subcutaneous
                                      reservoir.
62361..............................  Implantation or replacement of
                                      device for intrathecal or epidural
                                      drug infusion; non-programmable
                                      pump.
62362..............................  Implantation or replacement of
                                      device for intrathecal or epidural
                                      drug infusion; programmable pump,
                                      including preparation of pump,
                                      with or without programming.
62365..............................  Removal of subcutaneous reservoir
                                      or pump, previously implanted for
                                      intrathecal or epidural infusion.
63650..............................  Percutaneous implantation of
                                      neurostimulator electrode array,
                                      epidural.
63655..............................  Laminectomy for implantation of
                                      neurostimulator electrodes, plate/
                                      paddle, epidural.
63660..............................  Revision or removal of spinal
                                      neurostimulator electrode
                                      percutaneous array(s) or plate/
                                      paddle(s).
63685..............................  Insertion or replacement of spinal
                                      neurostimulator pulse generator or
                                      receiver, direct or inductive
                                      coupling.
63688..............................  Revision or removal of implanted
                                      spinal neurostimulator pulse
                                      generator or receiver.
64550..............................  Application of surface
                                      (transcutaneous) neurostimulator.
64553..............................  Percutaneous implantation of
                                      neurostimulator electrodes;
                                      cranial nerve.
64555..............................  Percutaneous implantation of
                                      neurostimulator electrodes;
                                      peripheral nerve (excludes sacral
                                      nerve).
64560..............................  Percutaneous implantation of
                                      neurostimulator electrodes;
                                      autonomic nerve.
64561..............................  Percutaneous implantation of
                                      neurostimulator electrodes; sacral
                                      nerve (transforaminal placement).
64565..............................  Percutaneous implantation of
                                      neurostimulator electrodes;
                                      neuromuscular.
64573..............................  Incision for implantation of
                                      neurostimulator electrodes;
                                      cranial nerve.
64575..............................  Incision for implantation of
                                      neurostimulator electrodes;
                                      peripheral nerve (excludes sacral
                                      nerve).
64577..............................  Incision for implantation of
                                      neurostimulator electrodes;
                                      autonomic nerve.
64580..............................  Incision for implantation of
                                      neurostimulator electrodes;
                                      neuromuscular.
64581..............................  Incision for implantation of
                                      neurostimulator electrodes; sacral
                                      nerve (transforaminal placement).
64585..............................  Revision or removal of peripheral
                                      neurostimulator electrodes.
64590..............................  Insertion or replacement of
                                      peripheral neurostimulator pulse
                                      generator or receiver, direct or
                                      inductive coupling.
64595..............................  Revision or removal of peripheral
                                      neurostimulator pulse generator or
                                      receiver.
------------------------------------------------------------------------

e. Aneurysm, Epilepsy and Skull Procedures
    The American Association of Neurological Surgeons (AANS) and 
Congress of Neurological Surgeons (CNS) submitted six CPT codes for 
review (see Table 23).

                                Table 23
------------------------------------------------------------------------
              CPT code                           Description
------------------------------------------------------------------------
61537..............................  Craniotomy with elevation of bone
                                      flap; for lobectomy, temporal
                                      lobe, without electrocorticography
                                      during surgery.
61538..............................  Craniotomy with elevation of bone
                                      flap; for lobectomy, temporal
                                      lobe, with electrocorticography
                                      during surgery.
61697..............................  Surgery of complex intracranial
                                      aneurysm, intracranial approach;
                                      carotid circulation.
61698..............................  Surgery of complex intracranial
                                      aneurysm, intracranial approach;
                                      vertebrobasilar circulation.
61700..............................  Surgery of simple intracranial
                                      aneurysm, intracranial approach;
                                      carotid circulation.
61702..............................  Surgery of simple intracranial
                                      aneurysm, intracranial approach;
                                      vertebrobasilar circulation).
------------------------------------------------------------------------

    We submitted two CPT codes for review (see Table 24).

                                Table 24
------------------------------------------------------------------------
              CPT code                           Description
------------------------------------------------------------------------
61154..............................  Burr hole(s) with evacuation and/or
                                      drainage of hematoma, extradural
                                      or subdural.
61312..............................  Craniectomy or craniotomy for
                                      evacuation of hematoma,
                                      supratentorial; extradural or
                                      subdural.
------------------------------------------------------------------------


[[Page 37204]]

    A standard RUC survey with over 30 responses was used for six of 
the codes. The surveys for CPT codes 61537 and 61538 had only 12 and 14 
responses, respectively.
RUC Recommendations
    The RUC agreed with the specialty society that the existing RVUs 
for CPT code 61154 should be maintained because there was no compelling 
evidence that the work currently associated with this procedure has 
changed. The RUC accepted the specialty society's requested increase to 
the existing work RVUs, as reflected by the survey median, for CPT code 
61312, agreeing with the specialty society that the increased use of 
anticoagulants by these patients has increased the intensity of the 
intra-service work. The RUC recommended increasing the work RVUs for 
CPT codes 61697, 61698, 61700 and 61702, but at or below the surveys' 
25th percentile.
    While the workgroup recommended maintaining the current work RVUs 
for CPT codes 61537 and 61538, at the subsequent RUC meeting, the 
specialty society extracted these codes for discussion and the RUC 
recommended the 25th percentile from the surveys for the work RVU.
    The RUC-recommended work RVUs for these CPT codes are as follows: 
61154 = 14.97 work RVUs; 61312 = 27.00 work RVUs; 61537 = 35.00 work 
RVUs; 61538 = 38.00 work RVUs; 61697 = 57.31 work RVUs; 61698 = 64.03 
work RVUs; 61700 = 46.01 work RVUs; and 61702 = 54.28 work RVUs.
CMS Proposed Valuation
    We accept the RUC-recommended work RVUs for these neurosurgery 
services.
4. Radiology, Pathology, and Other Miscellaneous Services
    [If you choose to comment on issues in this section, please include 
the caption ``DISCUSSION OF COMMENTS-RADIOLOGY, PATHOLOGY, and OTHER 
MISC. SERVICES'' at the beginning of your comments.]
a. Pathology
    The College of American Pathologists submitted four CPT codes for 
review using the rationale that there have been changes in cancer 
protocols and the content of work (see Table 25). The specialty society 
conducted a full RUC survey for these codes.

                                Table 25
------------------------------------------------------------------------
              CPT code                           Description
------------------------------------------------------------------------
88309..............................  Level VI--Surgical pathology, gross
                                      and microscopic examination; Bone
                                      Resection; Breast, Mastectomy--
                                      with Regional Lymph Nodes; Colon,
                                      Segmental Resection for Tumor;
                                      Colon, Total Resection; Esophagus,
                                      Partial/Total Resection;
                                      Extremity, Disarticulation; Fetus,
                                      with Dissection; Larynx, Partial/
                                      Total Resection--with Regional
                                      Lymph Nodes; Lung--Total/Lobe/
                                      Segment Resection; Pancreas, Total/
                                      Subtotal Resection; Prostate,
                                      Radical Resection; Small
                                      Intestine, Resection for Tumor;
                                      Soft Tissue Tumor, Extensive
                                      Resection; Stomach--Subtotal/Total
                                      Resection for Tumor; Testis,
                                      Tumor; Tongue/Tonsil--Resection
                                      for Tumor; Urinary Bladder,
                                      Partial/Total Resection; Uterus,
                                      with or without Tubes and Ovaries,
                                      Neoplastic; Vulva, Total/Subtotal
                                      Resection.
88321..............................  Consultation and report on referred
                                      slides prepared elsewhere.
88323..............................  Consultation and report on referred
                                      material requiring preparation of
                                      slides.
88325..............................  Consultation, comprehensive, with
                                      review of records and specimens,
                                      with report on referred material.
------------------------------------------------------------------------

RUC Recommendations
    The RUC reviewed the specialty's survey results for each code and 
believed the specialty society had presented compelling evidence to 
change the relative work value for each code because all were 
undervalued for the increased physician work now involved in the 
services. The RUC believed that the change in work was due to the 
increased number and type of slides undergoing review in the typical 
case, and, in particular, the number of immunohistochemical slides that 
must undergo review. Based on recent literature, the RUC also believed 
that the clinical practice of these pathology consultations had 
changed. In addition, the RUC agreed with the specialty society that 
the survey's 25th percentile reflected the true physician work for each 
of the codes.
    The RUC-recommended work RVUs for these CPT codes are as follows: 
88309 = 2.80 work RVUs, 88321 = 1.63 work RVUs, 88323 = 1.83 work RVUs, 
and 88325 = 2.50 work RVUs.
CMS Proposed Valuation
    We are in agreement with all of these RUC-recommended work RVUs for 
pathology services.
b. Radiation Oncology
    We submitted the radiation oncology CPT codes in Table 26 for 
review.

                                Table 26
------------------------------------------------------------------------
              CPT code                           Description
------------------------------------------------------------------------
77263..............................  Therapeutic radiology treatment
                                      planning; complex.
77280..............................  Therapeutic radiology simulation-
                                      aided field setting; simple.
77290..............................  Therapeutic radiology simulation-
                                      aided field setting; complex.
77300..............................  Basic radiation dosimetry
                                      calculation, central axis depth
                                      dose calculation, TDF, NSD, gap
                                      calculation, off axis factor,
                                      tissue inhomogeneity factors,
                                      calculation of non-ionizing
                                      radiation surface and depth dose,
                                      as required during course of
                                      treatment, only when prescribed by
                                      the treating physician.
77315..............................  Teletherapy, isodose plan (whether
                                      hand or computer calculated);
                                      complex (mantle or inverted Y,
                                      tangential ports, the use of
                                      wedges, compensators, complex
                                      blocking, rotational beam, or
                                      special beam considerations).
77331..............................  Special dosimetry (e.g., TLD,
                                      microdosimetry) (specify), only
                                      when prescribed by the treating
                                      physician.
77334..............................  Treatment devices, design and
                                      construction; complex (irregular
                                      blocks, special shields,
                                      compensators, wedges, molds or
                                      casts).
77470..............................  Special treatment procedure (e.g.,
                                      total body irradiation, hemibody
                                      radiation, per oral, endocavitary
                                      or intraoperative cone
                                      irradiation).
------------------------------------------------------------------------


[[Page 37205]]

    Standard RUC surveys were conducted for these services. The survey 
results indicated that the work RVUs for each code should be maintained 
at their current level, and the specialty society, the American Society 
for Therapeutic Radiology and Oncology (ASTRO), recommended no change 
in the work RVU.
RUC Recommendations
    The RUC agreed with the survey results and supported the specialty 
society's recommendation to maintain the work RVUs. The RUC found no 
compelling evidence to change the work RVUs for these CPT codes, and 
therefore, recommended maintaining the current work values for these 
CPT codes as follows: 77263 = 3.14 work RVUs; 77280 = 0.70 work RVUs; 
77290 = 1.56 work RVUs; 77300 = 0.62 work RVUs; 77315 = 1.56 work RVUs; 
77331 = 0.87 work RVUs; 77334 = 1.24 work RVUs; and 77470 = 2.09 work 
RVUs.
CMS Proposed Valuation
    We are in agreement with all of these RUC-recommended work RVUs for 
radiology oncology.
c. Radiology
    We requested that the CPT codes for radiology services in Table 27 
be reviewed.

                                Table 27
------------------------------------------------------------------------
              CPT code                           Description
------------------------------------------------------------------------
70355..............................  Orthopantogram.
71010..............................  Radiologic examination, chest;
                                      single view, frontal.
71020..............................  Radiologic examination, chest, two
                                      views, frontal and lateral.
71260..............................  Computed tomography, thorax; with
                                      contrast material(s).
72192..............................  Computed tomography, pelvis;
                                      without contrast material.
72193..............................  Computed tomography, pelvis; with
                                      contrast material(s).
73100..............................  Radiologic examination, wrist; two
                                      views.
73110..............................  Radiologic examination, wrist;
                                      complete, minimum of three views.
73120..............................  Radiologic examination, hand; two
                                      views.
73130..............................  Radiologic examination, hand;
                                      minimum of three views.
73140..............................  Radiologic examination, finger(s),
                                      minimum of two views.
74000..............................  Radiologic examination, abdomen;
                                      single anteroposterior view.
74020..............................  Radiologic examination, abdomen;
                                      complete, including decubitus and/
                                      or erect views.
74022..............................  Radiologic examination, abdomen;
                                      complete acute abdomen series,
                                      including supine, erect, and/or
                                      decubitus views, single view
                                      chest.
74150..............................  Computed tomography, abdomen;
                                      without contrast material.
74160..............................  Computed tomography, abdomen; with
                                      contrast material(s).
76075..............................  Dual energy x-ray absorptiometry
                                      (DXA), bone density study, one or
                                      more sites; axial skeleton (e.g.,
                                      hips, pelvis, spine).
76700..............................  Ultrasound, abdominal, B-scan and/
                                      or real time with image
                                      documentation; complete.
76830..............................  Ultrasound, transvaginal.
78306..............................  Bone and/or joint imaging; whole
                                      body.
78315..............................  Bone and/or joint imaging; three
                                      phase study.
78465..............................  Myocardial perfusion imaging;
                                      tomographic (SPECT), multiple
                                      studies (including attenuation
                                      correction when performed), at
                                      rest and/or stress (exercise and/
                                      or pharmacologic) and
                                      redistribution and/or rest
                                      injection, with or without
                                      quantification.
78478..............................  Myocardial perfusion study with
                                      wall motion, qualitative or
                                      quantitative study (List
                                      separately in addition to code for
                                      primary procedure).
78480..............................  Myocardial perfusion study with
                                      ejection fraction (List separately
                                      in addition to code for primary
                                      procedure).
------------------------------------------------------------------------

    In addition, the American College of Cardiology (ACC) and American 
College of Radiology (ACR) recommended four cardiac imaging codes be 
sent to the CPT Editorial Panel for review and clarification so that 
they may reflect current practice patterns (see Table 28). The RUC 
agreed with this recommendation.

                                Table 28
------------------------------------------------------------------------
              CPT code                           Description
------------------------------------------------------------------------
75552..............................  Cardiac magnetic resonance imaging
                                      for morphology; without contrast
                                      material.
75553..............................  Cardiac magnetic resonance imaging
                                      for morphology; with contrast
                                      material.
75554..............................  Cardiac magnetic resonance imaging
                                      for function, with or without
                                      morphology; complete study.
75555..............................  Cardiac magnetic resonance imaging
                                      for function, with or without
                                      morphology; limited study).
------------------------------------------------------------------------

    The specialty societies conducted standard RUC surveys for the 
remaining services.
RUC Recommendations
    The RUC agreed with the survey results and found there was no 
compelling evidence to change the work RVUs for CPT codes 70355, 71010, 
71020, 71260, 72192, 72193, 73100, 73110, 73120, 73130, 73140, 74000, 
74020, 74022, 74150, 74160, 76700, 76830, 78306, 78315, and 78465.
    The RUC recommended a reduction in the work RVU for the DXA 
service, CPT code 76075, because the workgroup believed that the actual 
work is less intense and more mechanical than the specialty society's 
description of the work. In addition, the RUC believed that the survey 
results provided insufficient evidence to support the current work RVU 
associated with CPT code 78478 and also believed that the physician 
time was overestimated. The RUC also recommended a reduction in the 
work RVUs for CPT code 78480 because it was not in the correct rank 
order and was therefore overvalued.

[[Page 37206]]

    The RUC-recommended work RVUs for these CPT codes are as follows: 
70355 = 0.20 work RVUs; 71010 = 0.18 work RVUs; 71020 = 0.22 work RVUs; 
71260 = 1.24 work RVUs; 72192 = 1.09 work RVUs; 72193 = 1.16 work RVUs; 
73100 = 0.16 work RVUs; 73110 = 0.17 work RVUs; 73120 = 0.16 work RVUs; 
73130 = 0.17 work RVUs; 73140 = 0.13 work RVUs; 74000 = 0.18 work RVUs; 
74020 = 0.27 work RVUs; 74022 = 0.32 work RVUs; 74150 = 1.19 work RVUs; 
74160 = 1.27 work RVUs; 76075 = 0.20 work RVUs; 76700 = 0.81 work RVUs; 
76830 = 0.69 work RVUs; 78306 = 0.86 work RVUs; 78315 = 1.02 work RVUs; 
78465 = 1.46 work RVUs; 78478 = 0.50 work RVUs; and 78480 = 0.30 work 
RVUs.
CMS Proposed Valuation
    We are in agreement with all of these RUC-recommended work RVUs for 
radiology services.
d. Endoscopy Procedures
    We requested the RUC to review five endoscopy CPT codes because 
they had never been reviewed by the RUC (see Table 29). Standard RUC 
surveys were conducted.

                                Table 29
------------------------------------------------------------------------
              CPT code                           Description
------------------------------------------------------------------------
43235..............................  Upper gastrointestinal endoscopy
                                      including esophagus, stomach, and
                                      either the duodenum and/or jejunum
                                      as appropriate; diagnostic, with
                                      or without collection of
                                      specimen(s) by brushing or washing
                                      (separate procedure).
43246..............................  Upper gastrointestinal endoscopy
                                      including esophagus, stomach, and
                                      either the duodenum and/or jejunum
                                      as appropriate; with directed
                                      placement of percutaneous
                                      gastrostomy tube.
43750..............................  Percutaneous placement of
                                      gastrostomy tube.
45330..............................  Sigmoidoscopy, flexible;
                                      diagnostic, with or without
                                      collection of specimen(s) by
                                      brushing or washing (separate
                                      procedure).
45378..............................  Colonoscopy, flexible, proximal to
                                      splenic flexure; diagnostic, with
                                      or without collection of
                                      specimen(s) by brushing or
                                      washing, with or without colon
                                      decompression (separate
                                      procedure).
------------------------------------------------------------------------

RUC Recommendations
    The RUC agreed with the survey results and found no compelling 
evidence to change the work RVUs for any of these services. Therefore, 
the RUC recommended the work values for these CPT codes be maintained 
as follows: 43235 = 2.39 work RVUs; 43246 = 4.32 work RVUs; 43750 = 
4.48 work RVUs; 45330 = 0.96 work RVUs; and 45378 = 3.69 work RVUs.
CMS Proposed Valuation
    We are in agreement with the RUC-recommended work RVUs for 
endoscopic procedure codes.
e. Neurology, Neuromuscular, and Nervous System
    The American Academy of Neurology (AAN), American Clinical 
Neurophysiology Society (ACNS), American Association of Neuromuscular 
and Electrodiagnostic Medicine (AANEM), and the American Academy of 
Physical Medicine and Rehabilitation (AAPMR) submitted five neurology 
and neuromuscular CPT codes for this 5-Year Review and AAN and the 
American Academy of Pediatrics (AAP) jointly submitted CPT code 62270 
(see Table 30).

                                Table 30
------------------------------------------------------------------------
              CPT code                           Description
------------------------------------------------------------------------
62270..............................  Spinal puncture, lumbar,
                                      diagnostic.
95872..............................  Needle electromyography using
                                      single fiber electrode, with
                                      quantitative measurement of
                                      jitter, blocking and/or fiber
                                      density, any/all sites of each
                                      muscle studied.
95925..............................  Short-latency somatosensory evoked
                                      potential study, stimulation of
                                      any/all peripheral nerves or skin
                                      sites, recording from the central
                                      nervous system; in upper limbs.
95926..............................  Short-latency somatosensory evoked
                                      potential study, stimulation of
                                      any/all peripheral nerves or skin
                                      sites, recording from the central
                                      nervous system; in lower limbs.
95927..............................  Short-latency somatosensory evoked
                                      potential study, stimulation of
                                      any/all peripheral nerves or skin
                                      sites, recording from the central
                                      nervous system; in the trunk or
                                      head.
95953..............................  Monitoring for localization of
                                      cerebral seizure focus by
                                      computerized portable 16 or more
                                      channel EEG,
                                      electroencephalographic (EEG)
                                      recording and interpretation, each
                                      24 hours.
------------------------------------------------------------------------

    In addition, we requested the RUC to review five neurological CPT 
codes (see Table 31).

                                Table 31
------------------------------------------------------------------------
              CPT code                           Description
------------------------------------------------------------------------
95816..............................  Electroencephalogram (EEG);
                                      including recording awake and
                                      drowsy.
95819..............................  Electroencephalogram (EEG);
                                      including recording awake and
                                      asleep.
95861..............................  Needle electromyography; two
                                      extremities with or without
                                      related paraspinal areas.
95900..............................  Nerve conduction, amplitude and
                                      latency/velocity study, each
                                      nerve; motor, without F-wave
                                      study.
95904..............................  Nerve conduction, amplitude and
                                      latency/velocity study, each
                                      nerve; sensory.
------------------------------------------------------------------------


[[Page 37207]]

    Standard RUC surveys were conducted for these services. The 
specialty societies believed the survey results indicated that the 
current work RVUs were either correctly valued or undervalued.
RUC Recommendations
    The RUC found no compelling evidence to change the work RVUs for 
CPT codes 95816, 95819, 95861, 95900, 95904, 95925, 95926, and 95927. 
However, the RUC agreed that there was compelling evidence that CPT 
codes 95872 and 95953 were undervalued and recommended increasing their 
existing RVUs.
    The RUC-recommended work RVUs for these services are as follows: 
95816 = 1.08 work RVUs; 95819 = 1.08 work RVUs; 95861 = 1.54 work RVUs; 
95872 = 3.00 work RVUs; 95900 = 0.42 work RVUs; 95904 = 0.34 work RVUs; 
95925 = 0.54 work RVUs; 95926 = 0.54 work RVUs; 95927 = 0.54 work RVUs; 
and 95953 = 3.30 work RVUs.
    For CPT code 62270, the RUC believed that there is a bimodal 
distribution of physician work associated with the code because there 
are two different typical patient types, infants and young children. 
The RUC and the specialty societies believed that the infant population 
requires less work than in the young child population. The RUC 
suggested that it may be reasonable for the specialty societies to 
eventually consider splitting the code into the two typical patient 
types to capture any differences in physician work. However, for the 
current CPT code 62270, the RUC recommended that it should be valued 
higher and recommended a work RVU of 1.37.
CMS Proposed Valuation
    We are in agreement with all of the RUC-recommended work RVUs for 
neurology, neuromuscular and nervous system services except for the 
recommendation for CPT code 95872. We have concerns that the work 
recommendation for this service, which was based on the survey's 75th 
percentile for work, is not the correct valuation and is inappropriate 
for this service. We calculated the pre-service and post-service work 
RVU using the surveyed physician time data. Then, we subtracted the 
surveyed intra-service time from the current time. Next, we multiplied 
this difference in time by the calculated IWPUT using the specialty 
recommended total work RVUs to determine an intra-service work RVU. 
Adding the calculated work RVUs resulted in a work RVU of slightly less 
than 2.0, which is close to the same value as the survey median work 
RVU. In accordance with this analysis and the survey median, we are 
recommending a work RVU of 2.00.
f. Pulmonary Medicine
    We requested the RUC to review three pulmonary medicine CPT codes 
(see Table 32).

                                Table 32
------------------------------------------------------------------------
              CPT code                           Description
------------------------------------------------------------------------
31622..............................  Bronchoscopy, rigid or flexible,
                                      with or without fluoroscopic
                                      guidance; diagnostic, with or
                                      without cell washing (separate
                                      procedure).
94010..............................  Spirometry, including graphic
                                      record, total and timed vital
                                      capacity, expiratory flow rate
                                      measurement(s), with or without
                                      maximal voluntary ventilation.
94657..............................  Ventilation assist and management,
                                      initiation of pressure or volume
                                      preset ventilators for assisted or
                                      controlled breathing; subsequent
                                      days.
------------------------------------------------------------------------

    Standard RUC surveys were conducted. The specialty societies 
believed the survey results indicated that the current work RVUs were 
either correctly valued or undervalued.
RUC Recommendations
    The RUC reviewed the survey results and recommendations from the 
specialty society for CPT codes 31622 and 94010 and found no compelling 
reason to change the work RVUs for these codes. However, the RUC agreed 
with the specialty society that the time data elements from the survey 
results reflected the typical patient encounter.
    The RUC did find compelling evidence to support the specialty 
society's recommendation and survey work value results for CPT code 
94657. However, the RUC determined that a rank order anomaly would be 
created with CPT code 94656 if the recommended value for CPT code 94657 
was adopted. Therefore, the RUC recommended that this code be referred 
to the CPT Editorial Panel.
    The RUC-recommended work RVUs for these codes are as follows: 31622 
= 2.78 work RVUs and 94010 = 0.17 work RVUs.
CMS Proposed Valuation
    We are in agreement with these RUC-recommended work RVUs for 
pulmonary medicine services.
g. Miscellaneous Services
(i) Anesthesia
    The ASA requested that the RUC review code 00797, Anesthesia for 
intraperitoneal procedures in upper abdomen including laparoscopy; 
gastric restrictive procedure for morbid obesity. The ASA believed that 
the results of the standard RUC survey conducted by the specialty 
society indicated the physician work was undervalued for this code.
RUC Recommendations
    The RUC reviewed the survey results and specialty society 
recommendation and agreed with its recommended median base unit value 
and physician time for the code. The RUC recommended base unit 
valuation for this service was 11.00.
CMS Proposed Valuation
    We are in agreement with the RUC recommendation for CPT code 00797.
(ii) Allergy and Immunology
    The Joint Council of Allergy, Asthma, and Immunology (JCAAI) and 
the American Academy of Otolaryngic Allergy (AAOA) submitted five codes 
without work relative values for this 5-Year Review based on the 
rationale that physician work was inherent in the service (see Table 
33). The specialties subsequently withdrew CPT codes 95115 and 95117 
from consideration.

                                Table 33
------------------------------------------------------------------------
              CPT code                           Description
------------------------------------------------------------------------
95004..............................  Percutaneous tests (scratch,
                                      puncture, prick) with allergenic
                                      extracts, immediate type reaction,
                                      specify number of tests.

[[Page 37208]]

 
95024..............................  Intracutaneous (intradermal) tests
                                      with allergenic extracts,
                                      immediate type reaction, specify
                                      number of tests.
95027..............................  Intracutaneous (intradermal) tests,
                                      sequential and incremental, with
                                      allergenic extracts for airborne
                                      allergens, immediate type
                                      reaction, specify number of tests.
95115..............................  Professional services for allergen
                                      immunotherapy not including
                                      provision of allergenic extracts;
                                      single injection.
95117..............................  Professional services for allergen
                                      immunotherapy not including
                                      provision of allergenic extracts;
                                      two or more injections.
------------------------------------------------------------------------

    In addition, we requested the RUC to review the immunotherapy CPT 
codes in Table 34 because they had never been reviewed by the RUC. 
Standard RUC surveys were conducted.

                                Table 34
------------------------------------------------------------------------
              CPT code                           Description
------------------------------------------------------------------------
95144..............................  Professional services for the
                                      supervision of preparation and
                                      provision of antigens for allergen
                                      immunotherapy, single dose vial(s)
                                      (specify number of vials).
95165..............................  Professional services for the
                                      supervision of preparation and
                                      provision of antigens for allergen
                                      immunotherapy; single or multiple
                                      antigens (specify number of
                                      doses).
------------------------------------------------------------------------

RUC Recommendations
    The RUC reviewed the specialty society recommendations, and survey 
results recommended that CPT codes 95004, 95024, and 95027 be referred 
to the CPT Editorial Panel for clarification and possible revision. The 
RUC recommended that the current work RVUs be maintained for CPT codes 
95144 and 95165, because there was no compelling evidence for a change. 
The RUC-recommended work RVUs for these CPT codes are: 95144 = 0.06 
work RVUs; and 95165 = 0.06 work RVUs.
CMS Proposed Valuation
    We are in agreement with these RUC-recommended work RVUs for 
allergy and immunology services.
(iii) Pediatric codes
    The AAP requested that the RUC review eight pediatric-related CPT 
codes for this 5-Year Review (see Table 35). However, two of these CPT 
codes (90473 and 90474) were subsequently withdrawn by AAP. The 
remaining six codes were referred to the CPT Editorial Panel for 
review.

                                Table 35
------------------------------------------------------------------------
              CPT code                            Descriptor
------------------------------------------------------------------------
54150..............................  Circumcision, using clamp or other
                                      device; newborn.
54152..............................  Circumcision, using clamp or other
                                      device; except newborn.
90465..............................  Immunization administration under 8
                                      years of age (includes
                                      percutaneous, intradermal,
                                      subcutaneous, or intramuscular
                                      injections) when the physician
                                      counsels the patient/family; first
                                      injection (single or combination
                                      vaccine/toxoid), per day.
90466..............................  Immunization administration under 8
                                      years of age (includes
                                      percutaneous, intradermal,
                                      subcutaneous, or intramuscular
                                      injections) when the physician
                                      counsels the patient/family; each
                                      additional injection (single or
                                      combination vaccine/toxoid), per
                                      day (List separately in addition
                                      to code for primary procedure).
90467..............................  Immunization administration under
                                      age 8 years (includes intranasal
                                      or oral routes of administration)
                                      when the physician counsels the
                                      patient/family; first
                                      administration (single or
                                      combination vaccine/toxoid), per
                                      day.
90468..............................  Immunization administration under
                                      age 8 years (includes intranasal
                                      or oral routes of administration)
                                      when the physician counsels the
                                      patient/family; each additional
                                      administration (single or
                                      combination vaccine/toxoid), per
                                      day (List separately in addition
                                      to code for primary procedure).
90473..............................  Immunization administration by
                                      intranasal or oral route; one
                                      vaccine (single or combination
                                      vaccine/toxoid).
90474..............................  Immunization administration by
                                      intranasal or oral route; each
                                      additional vaccine (single or
                                      combination vaccine/toxoid) (List
                                      separately in addition to code for
                                      primary procedure).
------------------------------------------------------------------------

(iv) Cardiology-Related Services
    We requested that the RUC review five cardiology-related CPT codes 
(see Table 36). The specialty societies believed that the standard RUC 
survey results indicated that the work RVUs for each code should be 
either maintained or decreased from their current level.

                                Table 36
------------------------------------------------------------------------
              CPT code                           Description
------------------------------------------------------------------------
33208..............................  Insertion or replacement of
                                      permanent pacemaker with
                                      transvenous electrode(s); atrial
                                      and ventricular.
93010..............................  Electrocardiogram, routine ECG with
                                      at least 12 leads; interpretation
                                      and report only.
93015..............................  Cardiovascular stress test using
                                      maximal or submaximal treadmill or
                                      bicycle exercise, continuous
                                      electrocardiographic monitoring,
                                      and/or pharmacological stress;
                                      with physician supervision, with
                                      interpretation and report.
93018..............................  Cardiovascular stress test using
                                      maximal or submaximal treadmill or
                                      bicycle exercise, continuous
                                      electrocardiographic monitoring,
                                      and/or pharmacological stress;
                                      interpretation and report only.

[[Page 37209]]

 
93325..............................  Doppler echocardiography color flow
                                      velocity mapping (List separately
                                      in addition to codes for
                                      echocardiography).
------------------------------------------------------------------------

RUC Recommendations
    The RUC reviewed the survey results and found no compelling 
evidence to change the work RVUs for CPT codes 33208, 93010, 93015, and 
93018. However, CPT code 93325 was referred to the CPT Editorial Panel 
by the RUC with the recommendation that this service be bundled with 
CPT code 93307, Echocardiography, transthoracic, real-time with image 
documentation (2D) with or without M-mode recording; complete.
    The RUC-recommended work RVUs for these CPT codes are as follows: 
33208 = 8.12 work RVUs; 93010 = 0.17 work RVUs; 93015 = 0.75 work RVUs; 
and 93018 = 0.30 work RVUs.
CMS Proposed Valuation
    We are in agreement with these RUC-recommended work RVUs for 
cardiology related services.
5. Evaluation and Management (E/M) Services
    [If you choose to comment on issues in this section, please include 
the caption ``DISCUSSION OF COMMENTS--EVALUATION AND MANAGEMENT 
SERVICES'' at the beginning of your comments.]
    A consortium of 27 organizations submitted a consensus comment 
letter stating that the work of E/M services has changed significantly 
since the E/M codes were reviewed during the first 5-Year Review and 
requested that the E/M codes be reviewed (see Table 37).
    In addition, the following specialty societies submitted requests 
that individual E/M CPT codes be reviewed: The American Academy of 
Family Physicians (AAFP), the American Medical Directors Association 
(AMDA), the American Geriatric Society (AGS), the American Association 
for Geriatric Psychiatry (AAGP), the ASA, and the American Academy of 
Home Care Physicians (AAHCP).

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BILLING CODE 4120-01-C

    Standard RUC surveys of the E/M services were conducted by a 
coalition of medical specialty societies. Recommendations of the 
coalition, as well as comments from the coalition of surgical 
specialties, were considered by the RUC workgroup.
RUC Recommendations
    The RUC E/M workgroup conferred via conference call throughout the 
summer of 2005 and reviewed previous studies and methodologies used to 
evaluate the physician work related to the E/M services. At the first 
meeting in August of 2005, the workgroup considered the recommendations 
of the coalition of medical specialty societies, as well as the 
comments of the coalition of surgical specialties that countered the 
arguments presented regarding increased physician work. After extensive 
discussion, the workgroup agreed that there was evidence that incorrect 
assumptions were made in the previous valuation of these services. The 
workgroup reviewed each E/M code extensively, reviewing the survey from 
the coalition of medical specialties, comparing the codes to reference 
codes and considering comments from the surgical coalition and other 
meeting attendees.
    At the RUC meeting in October 2005, the RUC agreed that there was 
compelling evidence to review the E/M services because of evidence that 
incorrect assumptions were made in the previous valuation of the 
services. The RUC approved final recommendations for 26 of these codes, 
interim recommendations for six codes (CPT codes 99222, 99223, 99232, 
99233, 99291, and 99292) and postponed the review of three codes (CPT 
codes 99213, 99214, and 99215) to the February 2006 meeting.
    At the February 2006 meeting, the RUC reached consensus on the 
recommended work values for all the

[[Page 37218]]

outstanding E/M codes. As an example of the RUC review process, we are 
including the RUC notes on the rationale used to recommend a revised 
work value for CPT code 99213, the mid-level office visit, which is 
also the most frequently billed code in the PFS:

    ``The RUC agreed that the compelling evidence to review CPT code 
99213 is that incorrect assumptions were made in the previous 
valuation of CPT code 99213 (that is, the assumptions made by 
Harvard and CMS are flawed). The RUC extensively discussed CPT code 
99213 (physician time: pre- = 3, intra- = 15, and post- = 5) and 
agreed that this code is slightly more work than CPT code 99202 
(recommended work RVU = 0.88; physician time: pre- = 2, intra- = 15, 
and post- = 5). It was noted the content for CPT code 99213 
represents a higher level of intensity as the medical decision 
making is ``low'' for CPT code 99213, versus ``straightforward'' for 
CPT code 99202. CMS also provided utilization data that indicated 
that diagnosis and number of diagnosis were more significant for CPT 
code 99213 than CPT code 99202. Finally, the survey respondents 
agreed with this relationship, as the survey median work RVU for 
``all'' survey respondents was 1.10 for CPT code 99213 and 1.05 for 
CPT code 99202. Utilizing this relationship and the recommended work 
RVU of 0.88 for CPT code 99202, the RUC determined that a work RVU 
of 0.92 for CPT code 99213 is appropriate. In addition, the RUC 
agreed that CPT code 99213 is similar in work to CPT code 93307 
Echocardiography, transthoracic, real-time with image documentation 
(2D) with or without M-mode recording; complete (work RVU = 0.92, 
physician time: pre- = 5, intra- = 18, and post- = 5), which is a 
code included on the RUC's Multi-Specialty Points of Comparison 
(MPC). It was also noted that the 25th percentile of the `all' 
survey respondent, weighted survey data was 0.95 RVUs. The RUC 
recommends a work RVU of 0.92 for CPT code 99213 (physician time: 
pre- = 3, intra- = 15, and post- = 5).''

    The RUC also recommended that the full increase for these codes be 
incorporated into the surgical global periods for each CPT code with a 
global period of 010 and 090.
    Based on a review of the survey information, the RUC recommended 
that the work RVUs for the following CPT codes be maintained: 99201 = 
0.45 work RVUs; 99202 = 0.88 work RVUs; 99203 = 1.34 work RVUs; 99211 = 
0.17 work RVUs; 99212 = 0.45 work RVUs; 99238 = 1.28 work RVUs; and 
99241 = 0.64 work RVUs.
    The RUC also recommended that the work RVUs for the following CPT 
codes be increased: 99204 = 2.30 work RVUs; 99205 = 3.00 work RVUs; 
99213 = 0.92 work RVUs; 99214 = 1.42 work RVUs; 99215 = 2.00 work RVUs; 
99221 = 1.88 work RVUs; 99222 = 2.56 work RVUs; 99223 = 3.78 work RVUs; 
99231 = 0.76 work RVUs; 99232 = 1.39 work RVUs; 99233 = 2.00 work RVUs; 
99239 = 1.90 work RVUs; 99242 = 1.34 work RVUs; 99243 = 1.88 work RVUs; 
99244 = 3.02 work RVUs; 99245 = 3.77 work RVUs; 99251 = 1.00 work RVUs; 
99252 = 1.50 work RVUs; 99253 = 2.27 work RVUs; 99254 = 3.29 work RVUs; 
99255 = 4.00 work RVUs; 99281 = 0.45 work RVUs; 99282 = 0.88 work RVUs; 
99283 = 1.34 work RVUs; 99284 = 2.56 work RVUs; 99285 = 3.80 work RVUs; 
99291 = 4.50 work RVUs; and 99292 = 2.25 work RVUs.
    The RUC also noted that twelve E/M codes (nursing facility and 
domiciliary care) originally submitted had been deleted by CPT and 
replaced by new CPT codes that were reviewed by the RUC last year. 
These new CPT codes were included in the CY 2006 PFS final rule with 
comment period (70 FR 70116) and the associated RVUs were considered 
interim and subject to comment. Therefore, these new CPT codes were not 
included as part of the 5-Year Review.
CMS Proposed Valuation
    We are in agreement with these RUC recommended work RVUs for E/M 
services. We also agree with the recommendation that the full increase 
for these codes should be incorporated into the surgical global periods 
for each CPT code with a global period of 010 and 090.
6. Cardiothoracic Surgery
    [If you choose to comment on issues in this section, please include 
the caption ``DISCUSSION OF COMMENTS--CARDIOTHORACIC SURGERY'' at the 
beginning of your comments.]
a. Congenital Codes
    The STS/ American Association for Thoracic Surgery (AATS) submitted 
the congenital cardiac surgical CPT codes for review (see Table 38).

                                Table 38
------------------------------------------------------------------------
              CPT code                            Descriptor
------------------------------------------------------------------------
33414..............................  Repair of left ventricular outflow
                                      tract obstruction by patch
                                      enlargement of the outflow tract.
33416..............................  Ventriculomyotomy (-myectomy) for
                                      idiopathic hypertrophic subaortic
                                      stenosis (e.g., asymmetric septal
                                      hypertrophy).
33505..............................  Repair of anomalous coronary artery
                                      from pulmonary artery origin; with
                                      construction of intrapulmonary
                                      artery tunnel (Takeuchi
                                      procedure).
33665..............................  Repair of intermediate or
                                      transitional atrioventricular
                                      canal, with or without
                                      atrioventricular valve repair.
33684..............................  Closure of ventricular septal
                                      defect, with or without patch;
                                      with pulmonary valvotomy or
                                      infundibular resection
                                      (acyanotic).
33688..............................  Closure of ventricular septal
                                      defect, with or without patch;
                                      with removal of pulmonary artery
                                      band, with or without gusset.
33771..............................  Repair of transposition of the
                                      great arteries with ventricular
                                      septal defect and subpulmonary
                                      stenosis; with surgical
                                      enlargement of ventricular septal
                                      defect.
33779..............................  Repair of transposition of the
                                      great arteries, aortic pulmonary
                                      artery reconstruction (e.g.,
                                      Jatene type); with removal of
                                      pulmonary band.
33781..............................  Repair of transposition of the
                                      great arteries, aortic pulmonary
                                      artery reconstruction (e.g.,
                                      Jatene type); with repair of
                                      subpulmonic obstruction.
------------------------------------------------------------------------

    The commenters stated that at the second 5-Year Review, many of the 
more common congenital cardiac surgical codes were reviewed, and the 
values were adjusted. However, at that time, these much less commonly 
performed congenital cardiac surgical codes were not surveyed due to 
resource and time constraints. The commenter believed that this has 
created rank order anomalies within these families of codes.
    Standard RUC surveys were conducted for the services in Table 38. 
However, there was a low response rate that was attributable to these 
procedures being infrequently performed by a small number of surgeons.
RUC Recommendations
    The RUC believed that the current work RVUs for the codes presented 
created rank order anomalies in terms of the physician work relative 
value, but, during the review, the RUC agreed that a number of the 
reference procedures had inaccurate physician times. When the reference 
code times were compared

[[Page 37219]]

with the surveyed times for the codes under review, the RUC noted 
inconsistencies in all time segments, including intra-service time. The 
RUC reviewed the survey data and the data for the reference codes, and 
made recommendations for work RVUs to place the surveyed codes in 
proper rank order. Recommendations for work RVUs reflected the survey's 
25th percentile, the median survey value, or the time-adjusted survey 
data, which was based on time adjustments for certain portions of the 
service when compared to the reference codes. Due to concern about the 
accuracy of time for some of the reference codes, the RUC also 
recommended that the specialty society conduct future surveys for 
physician time only for CPT codes 33660, 33670, 33506, 33770, and 
33780. However, the RUC agreed that the new 5-Year Review values and 
times could not be used to justify changes in the relative values of 
the reference services.
    The RUC-recommended work RVUs for these CPT codes are as follows: 
33414 = 36.52 work RVUs; 33416 = 34.25 work RVUs; 33505 = 36.00 work 
RVUs; 33665 = 32.98 work RVUs; 33684 = 32.50 work RVUs; 33688 = 32.88 
work RVUs; 33771 = 38.50 work RVUs; 33779 = 41.00 work RVUs; and 33781 
= 41.00 work RVUs.
b. Adult Cardiac and General Thoracic Codes
    The STS/ATTS submitted 46 adult cardiac CPT codes for review and 27 
general thoracic CPT codes for review but subsequently withdrew two CPT 
codes (32095 and 35600). The specialty believed many of these CPT codes 
needed to be reviewed due to the rank order anomalies that exist in 
these families of CPT codes (see Table 39).
    We submitted two CPT codes for review, 32020 and 39400; however, no 
specialty expressed an interest in conducting a survey for CPT code 
32020 so there was no RUC recommendation forwarded for this service. 
(See Table 39 for all codes submitted.)
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[[Page 37224]]

    The RUC had previously approved a building-block methodology based 
on the STS database, which would provide a mean intra-service time for 
the adult cardiac and general thoracic codes, as well as the procedure-
specific length of stay. Two intensity surveys were also conducted and 
the final recommended intensity was an average of the two survey 
results. The remaining pre-service and post-service inputs were derived 
through a panel of cardiac surgeons.
    The add-on CPT codes (33141, 33517 through 33523 and 33530) were 
evaluated by subtracting the time data for the base code from the time 
data for the combined base and add-on codes, with the results weighted 
for frequency of occurrence.
RUC Recommendations
    The RUC workgroup reviewed the data elements for each code on a 
code-by-code basis. Most of the discussion focused on the number and 
level of post-operative visits, as well as the pre-service time. For 
the adult cardiac and general thoracic codes, the RUC agreed that the 
pre-service time was overstated and needed to reflect previously 
approved RUC pre-service times. Also, the RUC questioned the total 
times allocated to the codes when compared to a normal surgical work 
week. The workgroup developed a pre-service time standard that was used 
for a majority of the codes. This standard consisted of 60 minutes for 
evaluation, 15 minutes for positioning, and 20 minutes for scrub dress 
and wait time. For emergent procedures, the pre-service times were set 
at 10 minutes for evaluation, 12 minutes for positioning, and 15 
minutes for scrub dress and wait time. The immediate post-service time 
was examined in conjunction with other visits on the same day of 
surgery. For most of the codes, the immediate post-service time was 
standardized at 40 minutes.
    The intra-service times were derived from the STS database with 
mean times used for the adult cardiac codes and median times for the 
general thoracic codes. Because the general thoracic codes have a much 
lower number of cases in the database, the STS believed that the median 
was more appropriate. The RUC agreed with the specialty society that 
critical care visits should be used in the STS building-block 
methodology for all of the adult cardiac codes and for 13 of the 
general thoracic codes.
    The assignment of the level of critical care services was 
recommended for each code based on the STS panel's knowledge and 
experience in caring for these patients, within the framework of the 
duration of mechanical ventilation and the length of intensive care 
unit (ICU) stay provided by appropriate data in the STS database. The 
RUC also made changes to the hospital visits on a line-by-line basis, 
but used the STS length of stay data as a guide. Generally, the level 
of hospital visits was reduced so that the total number of visits 
equaled the length of stay. On the day of discharge, the RUC assigned a 
discharge day management code as the only service provided on that day.
    During the review of various cardiothoracic surgery procedures, the 
RUC determined that several of the reference service codes used in the 
analysis of surveyed codes (specifically, CPT codes 33506, 33660, 
33670, 33770 and 33780) had inaccurate physician times associated with 
them. The RUC instructed the specialty society to conduct a survey of 
time for these reference codes; however, these times could not be used 
to justify new relative values.
    The RUC recommended work RVUs for these CPT codes were as follows:
    General Thoracic codes: 32141 = 23.90 work RVUs; 32442 = 51.45 work 
RVUs; 32445 = 57.74 work RVUs; 32484= 23.25 work RVUs; 32486 = 39.44 
work RVUs; 32488 = 38.95 work RVUs; 32540 = 26.42 work RVUs; 32651 = 
16.64 work RVUs; 32652 = 26.35 work RVUs; 32653 = 16.24 work RVUs; 
32654 = 17.73 work RVUs; 32655 = 14.69 work RVUs; 32657 = 11.90 work 
RVUs; 32662 = 14.29 work RVUs; 32663 = 23.00 work RVUs; 32665 = 19.56 
work RVUs; 32815 = 42.94 work RVUs; 39220 = 18.40 work RVUs; 39400 = 
7.61 work RVUs; 43108 = 76.55 work RVUs; 43113 = 73.23 work RVUs; 43116 
= 87.16 work RVUs; 43118 = 61.08 work RVUs; 43121 = 46.59 work RVUs; 
43123 = 76.14 work RVUs; 43124 = 60.61 work RVUs; 43135 = 24.20 work 
RVUs. As noted above in this section, there was no RUC recommendation 
forwarded for CPT code 32020.
    Adult Cardiac codes: 33140 = 25.49 work RVUs; 33141 = 2.43 work 
RVUs; 33300 = 40.03 work RVUs; 33305 = 70.21 work RVUs; 33400 = 38.33 
work RVUs; 33405 = 37.82 work RVUs; 33406 = 49.18 work RVUs; 33410 = 
42.91 work RVUs; 33411 = 56.91 work RVUs; 33413 = 56.19 work RVUs; 
33415 = 34.58 work RVUs; 33425 = 45.97 work RVUs; 33426 = 39.78 work 
RVUs; 33427 = 41.82 work RVUs; 33430 = 46.45 work RVUs; 33460 = 40.19 
work RVUs; 33463 = 50.93 work RVUs; 33464 = 40.30 work RVUs; 33465 = 
45.72 work RVUs; 33474 = 36.39 work RVUs; 33475 = 39.39 work RVUs; 
33510 = 31.75 work RVUs; 33511 = 35.22 work RVUs; 33512 = 40.26 work 
RVUs; 33513 = 41.65 work RVUs; 33514 = 44.36 work RVUs; 33516 = 46.04 
work RVUs; 33517 = 3.36 work RVUs; 33518 = 7.41 work RVUs; 33519 = 9.91 
work RVUs; 33521 = 12.01 work RVUs; 33522 = 13.53 work RVUs; 33523 = 
15.39 work RVUs; 33530 = 9.78 work RVUs; 33533 = 30.85 work RVUs; 33534 
= 36.98 work RVUs; 33535 = 41.85 work RVUs; 33536 = 45.53 work RVUs; 
33542 = 44.20 work RVUs; 33545 = 52.49 work RVUs; 33641 = 27.71 work 
RVUs; 33860 = 55.45 work RVUs; 33863 = 55.10 work RVUs; 33945 = 80.84 
work RVUs; and 35820 = 32.24 work RVUs.
CMS Proposed Valuation
    We are in agreement with the RUC-recommended work RVUs for the 
congenital cardiac surgery services.
    As mentioned above, the general thoracic and adult cardiac surgery 
codes submitted to the RUC for review did not undergo the standard RUC 
survey methodology. Rather, the data pertaining to these codes were 
derived from the STS database, a voluntary registry developed by the 
STS that has reportedly captured data on approximately 70 percent of 
all cardiac surgical procedures in the United States.
    We believe that the STS database, which also captures outcomes 
data, is a significant tool in the effort to improve the quality of 
patient care and we hope that this kind of data collection will be 
emulated by other specialties. We also believe that the time and visit 
data contained in this database could be a useful adjunct to the RUC's 
validation of the standard RUC survey results. However, we have 
significant concerns with its use as a tool to derive work RVUs without 
reference to a standard RUC survey. We have questions regarding the 
representativeness of the data in the STS database because it is 
unclear what percentage of the patients in the database is derived from 
academic medical centers versus community hospitals or whether the 
cases are selectively reported (for example, does the case mix contain 
a disproportionate number of complex cases?) We also would like 
information regarding the type of hospitals that chose not to 
participate in the database. Additionally, while we recognize this 
database has collected large numbers of cases for cardiac services, the 
database was not robust for the non-cardiac thoracic service.
    In addition, we would also want to know the median values, as well 
as the mean values, for the intra-service time for the adult cardiac 
services because the RUC's standard methodology is based on median 
values. Therefore, we are concerned about maintaining the relativity 
between these services and those where the median values were

[[Page 37225]]

used to recommend the work RVUs. We also believe the median is a better 
estimate of central tendency when more extreme cases occur in either 
direction.
    However, our main concern is not with the time data itself, but 
rather with how these data were translated into work RVUs because work 
RVUs are not calculated solely on the basis of the time it takes to 
perform a given procedure. The other equally important variable is the 
intensity of the procedure, which is a measure of the technical skill, 
mental effort, and psychological stress involved in performing the 
procedure. The standard RUC survey captures these data by comparisons 
to the key reference procedure, asking the responders to rate both the 
surveyed and reference codes on the specific intensity measures, using 
a scale of one to five.
    The presenting specialties used an entirely different methodology 
to arrive at their intensity measures by estimating the IWPUT of each 
service. The presenters stated that the IWPUT was estimated using two 
methods: IWPUT magnitude estimation and RASCH paired analysis for each 
code. According to the presenters, the IWPUT magnitude estimation 
produced direct IWPUT values and the RASCH analysis produced arbitrary 
scalar values as estimates of CPT code intensity rank and dispersion. 
These values were converted to IWPUT values by regression of the 
results to obtain slope, and offset of the results was based on the 
median value of the magnitude estimation survey. Each RASCH scalar was 
then converted to IWPUT with the formula y = mx + b where m is the 
slope and b is the y-intercept.
    Though we appreciate the effort that went into such a method, we 
have several concerns with this approach: (1) We do not believe that 
the RASCH paired analysis methodology has been approved by the RUC, and 
has certainly not yet been accepted by CMS as a method for calculating 
the intensity of a service; (2) we also would want to know more about 
the surveys themselves, as well as the instructions to the surveyees, 
before agreeing to any work RVUs based on this method; and (3) we are 
concerned that the relativity of the fee schedule could be compromised 
by using such a different method to determine the work relative values 
of a small number of codes because current work RVUs for other services 
are not based on this methodology. In addition, we have a further 
concern regarding the appropriate relativity of the RUC recommendations 
for these thoracic and cardiac procedures. If we assume the times in 
the STS database are accurate, by comparing the intra-service times in 
the STS database to the median times from the surveys done in 2000 for 
these codes, it appears that surgeons might often underestimate the 
time spent in the intra-service period. If this is actually the case 
here, then this could also be true for other services that would not 
have the benefit of this database. The acceptance of the work RVUs 
derived by this methodology could then produce rank order anomalies 
with codes done by other specialties and the relativity of the fee 
schedule could be compromised by the selective use of this database.
    We would not want to see the RUC abandon its survey methodology, 
unless a better approach can be found that can be applied to all 
services. We understand that the standard RUC survey process is not 
perfect, but it does provide an even playing field for all specialties 
and we would be concerned if each specialty was allowed to develop its 
own unique method for estimating work RVUs. Therefore, we would 
recommend that the RUC review this issue again to determine the 
appropriate use of data sources other than the RUC survey.
    It is our responsibility to assure all medical specialties that we 
will review and evaluate their services using an approach that is 
accepted by the AMA and CMS. However, we do not know how to use this 
STS data to compare the relativity of these thoracic and cardiac 
surgery services to services of similar intensity in other clinical 
areas. Therefore, we are proposing not to accept the RUC work RVU 
recommendations for these codes. Because the RUC did approve the use of 
the STS database and the specialty societies put forth a substantial 
effort to present their data to the RUC, based on that approval, we 
also do not think it would be appropriate to propose maintaining the 
current values.
    We believe the standard RUC survey process used to evaluate the 
cardiac surgery codes during the second 5-Year Review had the correct 
incremental increase in work RVUs between codes, as well as the 
appropriate intensity for each code. We have calculated the IWPUT for 
the current values for all of the cardiac codes submitted for review 
(excluding the add-on codes discussed below) and multiplied the IWPUT 
of each code with the time proposed for that code to yield a new RVU 
for that service. We also calculated an IWPUT for the thoracic codes 
using the current values. Because we do not have survey data, we 
believe this is a fair way to value the proposed codes while 
maintaining the incremental increase between codes. We look forward to 
comments on this issue and would be willing to consider future RUC 
recommendations if the specialty societies wish to submit standard RUC 
surveys for these codes.
    CPT codes 33517, 33518, 33519, 33521, 33522, and 33523 are coronary 
surgery bypass codes using venous grafts and arterial grafts. These are 
add-on codes used in conjunction with the primary code, a coronary 
arterial graft. Add-on codes reflect the additional intra-service time 
required to perform the additional venous anastomoses. These codes do 
not contain post-service time, critical care time, or hospital care. 
When presented to the RUC, this series of codes had critical care time 
and inpatient hospital care time added to the total value of the code. 
We will maintain the current RVU valuation for CPT codes 33517, 33518, 
33519, 33521, 33522, and 33523.
    Therefore, the proposed work RVUs for these CPT codes are as 
follows: 32141 = 13.98 work RVUs; 32442 = 32.86 work RVUs; 32445 = 
34.95 work RVUs; 32484 = 20.66 work RVUs; 32486 = 28.40 work RVUs; 
32488 = 28.87 work RVUs; 32540 = 19.94 work RVUs; 32651 = 14.26 work 
RVUs; 32652 = 20.75 work RVUs; 32653 = 18.05 work RVUs; 32654 = 15.82 
work RVUs; 32655 = 13.59 work RVUs; 32657 = 13.63 work RVUs; 32662 = 
16.42 work RVUs; 32663 = 18.44 work RVUs; 32665 = 15.52 work RVUs; 
32815 = 31.17 work RVUs; 33140 = 19.97 work RVUs; 33141 = 4.83 work 
RVUs; 33300 = 25.09 work RVUs; 33305 = 27.05 work RVUs; 33400 = 36.23 
work RVUs; 33405 = 36.64 work RVUs; 33406 = 45.54 work RVUs; 33410 = 
35.36 work RVUs; 33411 = 52.12 work RVUs; 33413 = 51.76 work RVUs; 
33414 = 36.52 work RVUs; 33415 = 27.11 work RVUs; 33416 = 34.25 work 
RVUs; 33425 = 34.55 work RVUs; 33426 = 37.95 work RVUs; 33427 = 39.94 
work RVUs; 33430 = 45.57 work RVUs; 33460 = 23.56 work RVUs; 33463 = 
36.59 work RVUs; 33464 = 26.78 work RVUs; 33465 = 28.75 work RVUs; 
33474 = 23.01 work RVUs; 33475 = 41.97 work RVUs; 33505 = 36.00 work 
RVUs; 33510 = 30.37 work RVUs; 33511 = 31.51 work RVUs; 33512 = 35.16 
work RVUs; 33513 = 36.12 work RVUs; 33514 = 36.93 work RVUs; 33516 = 
38.39 work RVUs; 33517 = 2.57 work RVUs; 33518 = 4.84 work RVUs; 33519 
= 7.11 work RVUs; 33521 = 9.39 work RVUs; 33522 = 11.65 work RVUs; 
33523 = 13.93 work RVUs; 33530 = 5.85 work RVUs; 33533 = 34.63 work 
RVUs; 33534 = 36.06 work RVUs; 33535 = 38.73 work RVUs; 33536 = 38.04 
work RVUs; 33542 = 28.81 work RVUs; 33545 = 36.72 work RVUs; 33641 = 
26.70 work RVUs; 33665 = 32.98 work RVUs; 33684 = 32.50 work

[[Page 37226]]

RVUs; 33688 = 32.88 work RVUs; 33771 = 38.50 work RVUs; 33779 = 41.00 
work RVUs; 33781 = 41.00 work RVUs; 33860= 39.29 work RVUs; 33863 = 
44.93 work RVUs; 33945 = 42.04 work RVUs; 35820 = 25.53 work RVUs; 
39220 = 17.39 work RVUs; 39400 = 5.60 work RVUs; 43108 = 57.20 work 
RVUs; 43113 = 40.41 work RVUs; 43116 = 65.85 work RVUs; 43118 = 46.37 
work RVUs; 43121 = 41.80 work RVUs; 43123 = 57.14 work RVUs; 43124 = 
56.51 work RVUs; and 43135 = 20.52 work RVUs.
    For CPT code 32020, Tube thoracostomy with or without water seal 
(e.g., for abscess, hemothorax, empyema)(separate procedure), although 
there was no RUC recommendation provided due to the lack of a level 
interest for surveying this code, we continue to believe that this 
service is misvalued. This code was presented to the RUC during the two 
previous 5-Year Reviews. Based on a lack of compelling evidence, the 
RUC recommended maintaining the work RVUs, and we accepted this 
recommendation. However, we believe that since valuation of this CPT 
code continues to be based on Harvard time data, changes in practice 
and technology have not been incorporated, leading to an overvaluation 
of this service. The Harvard time data for this service includes: Pre-
service time of 46 minutes, intra-service time of 24 minutes, post-
service time of 25 minutes, 9 minutes for ICU time, 15 minutes for 
hospital days, and 2 minutes for office visits for a total time of 121 
minutes. We believe that CPT code 32020 is comparable to CPT code 
38300, Drainage of lymph node abscess or lymphadenitis; simple, or CPT 
code 38500, Biopsy or excision of lymph node(s); open, superficial. 
Both of these CPT codes were reviewed by the RUC during the second 5-
Year Review. The RUC times for CPT code 38500 are: pre-service time of 
35 minutes, intra-service time of 30 minutes and post-service time of 
15 minutes, for a total time of 80 minutes, this includes one 
outpatient visit resulting in a work RVU of 3.74. If the value of the 
outpatient visit is removed from CPT code 38500, this results in an RVU 
of 3.29. We believe CPT code 32020 compares favorably to 38500 and 
propose a work RVU of 3.29 for CPT code 32020.
7. General, Colorectal and Vascular Surgery
    [If you choose to comment on issues in this section, please include 
the caption ``DISCUSSION OF COMMENTS--GENERAL, COLORECTAL AND VASCULAR 
SURGERY'' at the beginning of your comments.]
a. General Surgery
    The American College of Surgeons (ACS) submitted the following CPT 
codes in Table 40 for review.

                                Table 40
------------------------------------------------------------------------
              CPT code                            Descriptor
------------------------------------------------------------------------
38100..............................  Splenectomy; total (separate
                                      procedure).
38101..............................  Splenectomy; partial (separate
                                      procedure).
38115..............................  Repair of ruptured spleen
                                      (splenorrhaphy) with or without
                                      partial splenectomy.
43620..............................  Gastrectomy, total; with
                                      esophagoenterostomy.
43621..............................  Gastrectomy, total; with Roux-en-Y
                                      reconstruction.
43622..............................  Gastrectomy, total; with formation
                                      of intestinal pouch, any type.
43632..............................  Gastrectomy, partial, distal; with
                                      gastrojejunostomy.
43633..............................  Gastrectomy, partial, distal; with
                                      Roux-en-Y reconstruction.
43634..............................  Gastrectomy, partial, distal; with
                                      formation of intestinal pouch.
43820..............................  Gastrojejunostomy; without
                                      vagotomy.
43840..............................  Gastrorrhaphy, suture of perforated
                                      duodenal or gastric ulcer, wound,
                                      or injury.
44120..............................  Enterectomy, resection of small
                                      intestine; single resection and
                                      anastomosis.
44130..............................  Enteroenterostomy, anastomosis of
                                      intestine, with or without
                                      cutaneous enterostomy (separate
                                      procedure).
44143..............................  Colectomy, partial; with end
                                      colostomy and closure of distal
                                      segment (Hartmann type procedure).
44602..............................  Suture of small intestine
                                      (enterorrhaphy) for perforated
                                      ulcer, diverticulum, wound, injury
                                      or rupture; single perforation.
44603..............................  Suture of small intestine
                                      (enterorrhaphy) for perforated
                                      ulcer, diverticulum, wound, injury
                                      or rupture; multiple perforations.
44604..............................  Suture of large intestine
                                      (colorrhaphy) for perforated
                                      ulcer, diverticulum, wound, injury
                                      or rupture (single or multiple
                                      perforations); without colostomy.
44605..............................  Suture of large intestine
                                      (colorrhaphy) for perforated
                                      ulcer, diverticulum, wound, injury
                                      or rupture (single or multiple
                                      perforations); with colostomy.
47480..............................  Cholecystotomy or cholecystostomy
                                      with exploration, drainage, or
                                      removal of calculus (separate
                                      procedure).
47490..............................  Percutaneous cholecystostomy.
47510..............................  Introduction of percutaneous
                                      transhepatic catheter for biliary
                                      drainage.
47511..............................  Introduction of percutaneous
                                      transhepatic stent for internal
                                      and external biliary drainage.
47525..............................  Change of percutaneous biliary
                                      drainage catheter.
47530..............................  Revision and/or reinsertion of
                                      transhepatic tube.
47760..............................  Anastomosis, of extrahepatic
                                      biliary ducts and gastrointestinal
                                      tract.
47765..............................  Anastomosis, of intrahepatic ducts
                                      and gastrointestinal tract.
47780..............................  Anastomosis, Roux-en-Y, of
                                      extrahepatic biliary ducts and
                                      gastrointestinal tract.
47785..............................  Anastomosis, Roux-en-Y, of
                                      intrahepatic biliary ducts and
                                      gastrointestinal tract.
49000..............................  Exploratory laparotomy, exploratory
                                      celiotomy with or without
                                      biopsy(s) (separate procedure).
49002..............................  Reopening of recent laparotomy.
49010..............................  Exploration, retroperitoneal area
                                      with or without biopsy(s)
                                      (separate procedure).
------------------------------------------------------------------------

    In addition, the American Society of Colon and Rectal Surgeons 
(ASCRS) submitted six CPT codes for review (see Table 41).

[[Page 37227]]



                                Table 41
------------------------------------------------------------------------
              CPT code                            Descriptor
------------------------------------------------------------------------
44150..............................  Colectomy, total, abdominal,
                                      without proctectomy; with
                                      ileostomy or ileoproctostomy.
44151..............................  Colectomy, total, abdominal,
                                      without proctectomy; with
                                      continent ileostomy.
44152..............................  Colectomy, total, abdominal,
                                      without proctectomy; with rectal
                                      mucosectomy, ileoanal anastomosis,
                                      with or without loop ileostomy.
44153..............................  Colectomy, total, abdominal,
                                      without proctectomy; with rectal
                                      mucosectomy, ileoanal anastomosis,
                                      creation of ileal reservoir (S or
                                      J), with or without loop
                                      ileostomy.
44155..............................  Colectomy, total, abdominal, with
                                      proctectomy; with ileostomy.
44156..............................  Colectomy, total, abdominal, with
                                      proctectomy; with continent
                                      ileostomy.
------------------------------------------------------------------------

    We submitted the CPT codes in Table 42 for review.

                                Table 42
------------------------------------------------------------------------
              CPT code                            Descriptor
------------------------------------------------------------------------
19180..............................  Mastectomy, simple, complete.
44140..............................  Colectomy, partial; with
                                      anastomosis.
47562..............................  Laparoscopy, surgical;
                                      cholecystectomy.
49505..............................  Repair initial inguinal hernia, age
                                      5 years or over; reducible.
47600..............................  Cholecystectomy.
------------------------------------------------------------------------

    However, the following CPT codes were subsequently withdrawn from 
the 5-Year Review: 44604, 44605, 47480, 47490, 47510, 47511, 47525 and 
47530. ASCRS also withdrew CPT codes 44152 and 44153, and is referring 
them to the CPT Editorial Panel.
    For most codes, a standard RUC survey with over 30 responses was 
used. However, the surveys for CPT code 43622 had 29 responses and CPT 
code 43634 had 26 responses. Minisurveys, with over 30 responses, were 
used for CPT codes 44151 and 44156. Where NSQIP data was available, the 
specialty society also used an alternative methodology based on a 
building-block approach that used intra-service times and length of 
stay data from the NSQIP database to develop the recommendations. A 
specialty society consensus panel then assigned pre-service times, 
immediate post-service times, as well as IWPUT estimates, with the 
number and level of office visits determined based on comparisons to 
codes requiring similar physician work.
RUC Recommendations
    The RUC recommended maintaining the existing RVUs for CPT codes 
44140 and 49505 because the RUC believed there was a lack of compelling 
evidence that the work had changed.
    For those services without NSQIP data, where only survey data was 
used as a basis for review, the RUC recommended the survey median for 
CPT codes 38100, 38101, 38115, 43620, 43632, 43634, 44156, 47765. For 
CPT code 49010, the RUC recommended use of the survey's 25th percentile 
because the RUC recommended deleting one hospital visit. For CPT code 
47760, the RUC recommended the 25th percentile because the RUC believed 
that the 25th percentile was closer to the reference code. The RUC 
recommended use of the surveyed 75th percentile (25 work RVUs) for: CPT 
code 44603, which represents the suturing of multiple small intestinal 
perforations, to keep the correct rank order with CPT code 44602 (22.00 
recommended work RVUs) that is used for the repair of a single 
perforation; CPT code 43622 because the RUC believed that the use of 
the median value would create a rank order anomaly; and CPT code 44151 
because the RUC believed that the survey underestimated the physician 
time required for the service.
    For CPT codes 47780 and 47785, the RUC used a building-block method 
to arrive at a recommendation which added 4.00 work RVUs to the 
recommended work RVUs for the respective base CPT codes 47760 and 47765 
to account for the Roux-en-Y procedure. This resulted in recommended 
RVUs that were lower than the survey median for CPT code 47780 and 
higher for CPT code 47785.
    For services for which NSQIP data were presented along with survey 
data, the RUC recommended the use of the surveys 25th percentile for 
CPT codes 19180, 47562, and 49002. The RUC used the NSQIP data to 
validate the recommendation to use the surveyed median work RVUs for 
CPT codes 43632, 43633, 43820, 43840, 44143, 44150, 44155 and 44602. 
Other RUC recommendations used the NSQIP data to increase the work RVUs 
above the survey median and, in one instance, beyond the survey's 75th 
percentile. For CPT codes 44120, 44130 and 47600, the RUC believed the 
physicians responding to the survey underestimated their intra-service 
time. Therefore, the RUC applied what was believed to be an appropriate 
IWPUT to the additional NSQIP time and added the resulting work RVUs to 
the survey median.
    The RUC recommended that CPT code 49000 be referred to the CPT 
Editorial Panel because this code is currently used for two distinct 
patient populations and needs to be separated into two codes to be 
appropriately valued.
    The 5-Year Review process allows specialty societies to request 
that the RUC review the work RVUs of additional codes where a rank 
order anomaly might have been caused by a RUC 5-Year Review 
recommendation for codes in the same family. Upon reviewing the 
workgroup recommendations for the partial colectomy procedures, CPT 
codes 44140 and 44143, the RUC determined that other codes in the 
family, CPT codes 44141, 44144, 44145, 44146 and 44147, needed to be 
reviewed to avoid rank order anomalies.
    The RUC considered these CPT codes at their February 2006 meeting. 
The specialty society presented standard RUC surveys for all these 
services. For CPT codes 44141, 44144, 44146 and 44147, the RUC 
recommended the survey median. However, for CPT code 44145, the RUC 
recommended to maintain the current value of 26.38

[[Page 37228]]

work RVUs because the post-operative work is slightly less than the CPT 
code 44144 for which 27.00 work RVUs are recommended.
    The RUC-recommended work RVUs for these CPT codes were as follows: 
19180 = 14.67 work RVUs; 38100 = 18.00 work RVUs; 38101 = 18.00 work 
RVUs; 38115 = 20.00 work RVUs; 43620 = 31.00 work RVUs; 43621 = 36.00 
work RVUs; 43622 = 36.50 work RVUs; 43632 = 32.00 work RVUs; 43633 = 
30.00 work RVUs; 43634 = 33.50 work RVUs; 43820 = 20.00 work RVUs; 
43840 = 20.00 work RVUs; 44120 = 20.11 work RVUs; 44130 = 20.87 work 
RVUs; 44140 = 20.97 work RVUs; 44141 = 27.00 work RVUs; 44143 = 25.00 
work RVUs; 44144 = 27.00 work RVUs; 44145 = 26.38 work RVUs; 44146 = 
33.00 work RVUs; 44147 = 31.00 work RVUs; 44150 = 27.50 work RVUs; 
44151 = 32.00 work RVUs; 44155 = 31.50 work RVUs; 44156 = 34.50 work 
RVUs; 44602 = 22.00 work RVUs; 44603 = 25.00 work RVUs; 47562 = 11.07 
work RVUs; 47600 = 15.88 work RVUs; 47760 = 34.75 work RVUs; 47765 = 
48.50 work RVUs; 47780 = 38.75 work RVUs; 47785 = 52.50 work RVUs; 
49002 = 15.75 work RVUs; 49010 = 15.00 work RVUs; and 49505 = 7.59 work 
RVUs.
CMS Proposed Valuation
    We agree with the RUC-recommended work RVUs for CPT codes 19180, 
38100, 38101, 38115, 43620, 43621, 43622, 43632, 43633, 43634, 43820, 
43840, 44140, 44141, 44143, 44144, 44145, 44146, 44147, 44150, 44151, 
44155, 44156, 44602, 44603, 47562, 47760, 47765, 47780, 47785, 49002, 
49010 and 49505.
    We have concerns with the RUC recommendations to use the NSQIP data 
to increase the work RVUs for CPT codes 44120, 44130 and 47600 above 
the median, and, for 47600 above the 75th percentile, from the survey. 
While we support the use of such a database as validation for survey 
results, we believe that the application of the NSQIP IWPUT to the 25-
minute difference in intra-time between the survey and NSQIP is 
questionable. First, it is still not clear whether the NSQIP data is 
truly representative. Second, the IWPUT applied to the additional 25 
minutes is higher than the IWPUT for the rest of the intra-time. Third, 
such a methodology assumes, without evidence, that there is a linear 
relationship between the survey respondents' estimate of time and 
estimate of work RVUs; however, even if the survey time estimates had 
matched the NSQIP data, it is not clear whether or by how much the 
respondents would have increased their work value estimate. Fourth, 
until we have available valid and representative data such as the NSQIP 
for all procedures, there is the risk that applying the data randomly 
could distort the relativity between services. Therefore, we are 
proposing to use the median survey values of 18.00, 20.00 and 14.00 as 
the work RVUs for CPT codes 44120, 44130 and 47600, respectively.
b. Colon and Rectal Surgery
    The ASCRS submitted several colorectal surgery CPT codes (see Table 
43).

                                Table 43
------------------------------------------------------------------------
              CPT code                            Descriptor
------------------------------------------------------------------------
45020..............................  Incision and drainage of deep
                                      supralevator, pelvirectal, or
                                      retrorectal abscess.
45300..............................  Proctosigmoidoscopy, rigid;
                                      diagnostic, with or without
                                      collection of specimen(s) by
                                      brushing or washing (separate
                                      procedure).
45303..............................  Proctosigmoidoscopy, rigid; with
                                      dilation (e.g., balloon, guide
                                      wire, bougie).
45305..............................  Proctosigmoidoscopy, rigid; with
                                      biopsy, single or multiple.
45307..............................  Proctosigmoidoscopy, rigid; with
                                      removal of foreign body.
45308..............................  Proctosigmoidoscopy, rigid; with
                                      removal of single tumor, polyp, or
                                      other lesion by hot biopsy forceps
                                      or bipolar cautery.
45309..............................  Proctosigmoidoscopy, rigid; with
                                      removal of single tumor, polyp, or
                                      other lesion by snare technique.
45315..............................  Proctosigmoidoscopy, rigid; with
                                      removal of multiple tumors,
                                      polyps, or other lesions by hot
                                      biopsy forceps, bipolar cautery or
                                      snare technique.
45317..............................  Proctosigmoidoscopy, rigid; with
                                      control of bleeding (e.g.,
                                      injection, bipolar cautery,
                                      unipolar cautery, laser, heater
                                      probe, stapler, plasma
                                      coagulator).
45320..............................  Proctosigmoidoscopy, rigid; with
                                      ablation of tumor(s), polyp(s), or
                                      other lesion(s) not amenable to
                                      removal by hot biopsy forceps,
                                      bipolar cautery or snare technique
                                      (e.g., laser).
45321..............................  Proctosigmoidoscopy, rigid; with
                                      decompression of volvulus.
45327..............................  Proctosigmoidoscopy, rigid; with
                                      transendoscopic stent placement
                                      (includes predilation).
46040..............................  Incision and drainage of
                                      ischiorectal and/or perirectal
                                      abscess (separate procedure).
46045..............................  Incision and drainage of
                                      intramural, intramuscular, or
                                      submucosal abscess, transanal,
                                      under anesthesia.
46060..............................  Incision and drainage of
                                      ischiorectal or intramural
                                      abscess, with fistulectomy or
                                      fistulotomy, submuscular, with or
                                      without placement of seton.
46270..............................  Surgical treatment of anal fistula
                                      (fistulectomy/fistulotomy);
                                      subcutaneous.
46275..............................  Surgical treatment of anal fistula
                                      (fistulectomy/fistulotomy);
                                      submuscular.
46280..............................  Surgical treatment of anal fistula
                                      (fistulectomy/fistulotomy);
                                      complex or multiple, with or
                                      without placement of seton.
46285..............................  Surgical treatment of anal fistula
                                      (fistulectomy/fistulotomy); second
                                      stage.
46600..............................  Anoscopy; diagnostic, with or
                                      without collection of specimen(s)
                                      by brushing or washing (separate
                                      procedure).
46604..............................  Anoscopy; with dilation (e.g.,
                                      balloon, guide wire, bougie).
46606..............................  Anoscopy; with biopsy, single or
                                      multiple.
46608..............................  Anoscopy; with removal of foreign
                                      body.
46610..............................  Anoscopy; with removal of single
                                      tumor, polyp, or other lesion by
                                      hot biopsy forceps or bipolar
                                      cautery.
46611..............................  Anoscopy; with removal of single
                                      tumor, polyp, or other lesion by
                                      snare technique.
46612..............................  Anoscopy; with removal of multiple
                                      tumors, polyps, or other lesions
                                      by hot biopsy forceps, bipolar
                                      cautery or snare technique.
46614..............................  Anoscopy; with control of bleeding
                                      (e.g., injection, bipolar cautery,
                                      unipolar cautery, laser, heater
                                      probe, stapler, plasma
                                      coagulator).
46615..............................  Anoscopy; with ablation of
                                      tumor(s), polyp(s), or other
                                      lesion(s) not amenable to removal
                                      by hot biopsy forceps, bipolar
                                      cautery or snare technique.
46760..............................  Sphincteroplasty, anal, for
                                      incontinence, adult; muscle
                                      transplant.
46761..............................  Sphincteroplasty, anal, for
                                      incontinence, adult; levator
                                      muscle imbrication (Park posterior
                                      anal repair).
46762..............................  Sphincteroplasty, anal, for
                                      incontinence, adult; implantation
                                      artificial sphincter.
------------------------------------------------------------------------


[[Page 37229]]

    ASCRS subsequently withdrew CPT codes 46760, 46761 and 46762 from 
the 5-Year Review.
    For most codes, a standard RUC survey with over 30 responses was 
used. A minisurvey was used for a few codes.
RUC Recommendations
    The RUC agreed with the specialty society's recommendations to 
maintain the current work RVUs for CPT codes 46040, 46060 and 46280 
because the survey data supported the existing work associated with the 
code.
    The RUC recommended the increased work RVUs at the surveys' median 
work values, as requested by the specialty society, for CPT codes 
45020, 46045, 46270, 46275 and 46285.
    For the proctoscopy-anoscopy family of codes, the RUC agreed that 
the surveyed median work RVUs, and often even the 25th percentile, were 
inconsistent with the reference code. Therefore, the RUC did not 
reference the surveyed RVUs in arriving at the recommendations. Rather, 
the RUC used the surveyed times for each service and applied what the 
workgroup considered an appropriate IWPUT to these times to arrive at 
the recommended work RVUs for this family.
    The specific RUC work RVU recommendations for these colon and 
rectal surgery CPT codes were as follows: 45020 = 7.75 work RVUs; 45300 
= 0.91 work RVUs; 45303 = 2.22 work RVUs; 45305 = 2.01 work RVUs; 45307 
= 2.22 work RVUs; 45308 = 2.01 work RVUs; 45309 = 2.22 work RVUs; 45315 
= 2.22 work RVUs; 45317 = 1.08 work RVUs; 45320 = 2.43 work RVUs; 45321 
= 2.76 work RVUs; 45327 = 3.63 work RVUs; 46040 = 4.95 work RVUs; 46045 
= 5.50 work RVUs; 46060 = 5.68 work RVUs; 46270 = 4.50 work RVUs; 46275 
= 5.00 work RVUs; 46280 = 5.97 work RVUs; 46285 = 5.00 work RVUs; 46600 
= 0.49 work RVUs; 46604 = 1.08 work RVUs; 46606 = 1.76 work RVUs; 46608 
= 1.95 work RVUs; 46610 = 1.95 work RVUs; 46611 = 1.08 work RVUs; 46612 
= 2.14 work RVUs; 46614 = 1.08 work RVUs; and 46615 = 1.18 work RVUs.
CMS Proposed Valuation
    We agree with the RUC-recommended work RVUs for CPT codes 45020, 
46040, 46045, 46060, 46270, 46275, 46280, and 46285.
    We are proposing not to accept the RUC recommendations for all the 
presented codes in the proctoscopy-anoscopy family. We are proposing to 
maintain the current work RVUs for CPT codes 45300, 45303, 45305, 
45307, 45308, 45309, 45315, 45317, 45320, 45321, 45327, 46600, 46604, 
46606, 46608, 46610, 46611, 46612, 46614 and 46615.
    We believe that the method used by the RUC to obtain work values 
for these services was flawed. The calculation of the recommended work 
RVUs depended solely on applying a workgroup-derived IWPUT to the 
surveyed physician time from surveys that were considered otherwise 
unusable. We do not believe that the use of IWPUT, in the absence of 
other supporting data, has been previously accepted by the RUC. We 
believe the RUC has established rules that state that IWPUT cannot be 
the sole rationale for valuation and it appears that this workgroup 
might not have adhered to that standard. We believe that this use of 
IWPUT differs from that used by workgroup one, as described above. 
There were acceptable surveys that were used as anchors to create the 
correct rank order for the dermatology codes without adequate surveys. 
In addition, for the dermatology codes, the calculation was generally 
used to validate the current or lower work RVUs for the services, while 
for these scope codes, the calculation was not used to validate but to 
support significant increases for many of the services. However, if the 
specialty society wishes to resurvey these codes and the RUC submits 
work RVU recommendations to CMS, we would certainly be willing to 
consider them.
c. Vascular Surgery
    The Society for Vascular Surgery (SVS) submitted the CPT codes in 
Table 44 for review. However, the specialty society subsequently 
withdrew CPT codes 27603, 35612 and 35642 from review.

                                Table 44
------------------------------------------------------------------------
              CPT code                            Descriptor
------------------------------------------------------------------------
27603..............................  Incision and drainage, leg or
                                      ankle; deep abscess or hematoma.
27880..............................  Amputation, leg, through tibia and
                                      fibula.
28805..............................  Amputation, foot; transmetatarsal.
33877..............................  Repair of thoracoabdominal aortic
                                      aneurysm with graft, with or
                                      without cardiopulmonary bypass.
34001..............................  Embolectomy or thrombectomy, with
                                      or without catheter; carotid,
                                      subclavian or innominate artery,
                                      by neck incision.
34201..............................  Embolectomy or thrombectomy, with
                                      or without catheter;
                                      femoropopliteal, aortoiliac
                                      artery, by leg incision.
34471..............................  Thrombectomy, direct or with
                                      catheter; subclavian vein, by neck
                                      incision.
35081..............................  Direct repair of aneurysm,
                                      pseudoaneurysm, or excision
                                      (partial or total) and graft
                                      insertion, with or without patch
                                      graft; for aneurysm,
                                      pseudoaneurysm, and associated
                                      occlusive disease, abdominal
                                      aorta.
35102..............................  Direct repair of aneurysm,
                                      pseudoaneurysm, or excision
                                      (partial or total) and graft
                                      insertion, with or without patch
                                      graft; for aneurysm,
                                      pseudoaneurysm, and associated
                                      occlusive disease, abdominal aorta
                                      involving iliac vessels (common,
                                      hypogastric, external).
35216..............................  Repair blood vessel, direct;
                                      intrathoracic, without bypass.
35381..............................  Thromboendarterectomy, with or
                                      without patch graft; femoral and/
                                      or popliteal, and/or
                                      tibioperoneal.
35501..............................  Bypass graft, with vein; carotid.
35506..............................  Bypass graft, with vein; carotid-
                                      subclavian.
35507..............................  Bypass graft, with vein; subclavian-
                                      carotid.
35508..............................  Bypass graft, with vein; carotid-
                                      vertebral.
35509..............................  Bypass graft, with vein; carotid-
                                      carotid.
35515..............................  Bypass graft, with vein; subclavian-
                                      vertebral.
35516..............................  Bypass graft, with vein; subclavian-
                                      axillary.
 35541.............................  Bypass graft, with vein; aortoiliac
                                      or bi-iliac.
35546..............................  Bypass graft, with vein;
                                      aortofemoral or bifemoral.
35556..............................  Bypass graft, with vein; femoral-
                                      popliteal.
35566..............................  Bypass graft, with vein; femoral-
                                      anterior tibial, posterior tibial,
                                      peroneal artery or other distal
                                      vessels.
35583..............................  In-situ vein bypass; femoral-
                                      popliteal.
35585..............................  In-situ vein bypass; femoral-
                                      anterior tibial, posterior
                                      tibial,or peroneal artery.
35601..............................  Bypass graft, with other than vein;
                                      carotid.
35606..............................  Bypass graft, with other than vein;
                                      carotid-subclavian.

[[Page 37230]]

 
35612..............................  Bypass graft, with other than vein;
                                      subclavian-subclavian.
35616..............................  Bypass graft, with other than vein;
                                      subclavian-axillary.
35641..............................  Bypass graft, with other than vein;
                                      aortoiliac or bi-iliac.
35642..............................  Bypass graft, with other than vein;
                                      carotid-vertebral.
37720..............................  Ligation and division and complete
                                      stripping of long or short
                                      saphenous veins.
60600..............................  Excision of carotid body tumor;
                                      without excision of carotid
                                      artery.
60605..............................  Excision of carotid body tumor;
                                      with excision of carotid artery.
------------------------------------------------------------------------

    For all codes, a standard RUC survey was used. All but the 
following CPT codes had 30 or more responses: 34471 (28 responses), 
35508 (23 responses), 35515 (18 responses), 35516 (29 responses), 35616 
(29 responses), 60600 (19 responses). The specialty society also used 
the intra-service times and length of stay data from the NSQIP database 
to develop some of its recommendations. A specialty society consensus 
panel then assigned pre-service times, and immediate post-service 
times, as well as IWPUT estimates.
RUC Recommendations
    The RUC agreed with the specialty society that the following CPT 
codes cannot undergo the RUC evaluation process before having their 
descriptors revised and recommended referring these CPT codes to the 
CPT Editorial panel: 35381, 35501, 35507, 35509, 35541, 35546, 35601, 
35641 and 37720. (Note that CPT code 37720 was subsequently deleted by 
CPT for CY 2006.) For the remaining codes, the RUC reviewed both the 
survey data and the NSQIP data, where provided, for each procedure. In 
many instances, where the NSQIP time and length of stay data were 
available, the RUC believed that the physicians responding to the 
survey underestimated their intra-service time and that the NSQIP data 
more accurately reflected the actual intra-service times for these 
procedures.
    The RUC accepted the specialty society's requested increase in work 
RVUs for 12 CPT codes, agreeing with the specialty society that these 
procedures were undervalued due to compelling evidence such as changes 
in length of stay, changes in patient populations, and incorrect 
assumptions made in the previous valuation of the service. For CPT 
codes 27880, 28805, 34001, 34471, 35506, 35508, 35515, 35516, 35606, 
60600 and 60605, the RUC-recommended work RVUs were at the survey 
median or lower. However, for CPT code 33877, the RUC accepted a work 
value greater than the survey's 75th percentile that was derived from a 
building-block approach using the NSQIP data for the service. The RUC 
increased the work RVUs for nine codes. For eight of the codes, the 
increases were at levels below those requested by the specialty 
society, and for one code the increase was slightly higher than the 
requested work RVUs. For CPT codes 35081, 35216, 35583 and 35616, the 
recommended increase was no higher than the surveyed median work RVUs. 
For CPT codes 34201, 35102, 35556, 35566, and 35585, the RUC accepted 
work values greater than the survey's median percentile that were 
derived from a building-block approach using the NSQIP data for the 
service.
    The specific RUC-recommended work RVUs for these CPT codes are as 
follows: 27880 = 13.75 work RVUs; 28805 = 11.25 work RVUs; 33877 = 
64.04 work RVUs; 34001 = 16.25 work RVUs; 34201 = 18.31 work RVUs; 
34471 = 20.00 work RVUs; 35081 = 31.00 work RVUs; 35102 = 36.28 work 
RVUs; 35216 = 34.00 work RVUs; 35506 = 23.75 work RVUs; 35508 = 25.00 
work RVUs; 35515 = 25.00 work RVUs; 35516 = 23.00 work RVUs; 35556 = 
27.25 work RVUs; 35566 = 32.00 work RVUs; 35583 = 26.00 work RVUs; 
35585 = 32.00 work RVUs; 35606 = 21.00 work RVUs; 35616 = 21.00 work 
RVUs; 60600 = 24.00 work RVUs; and 60605 = 30.50 work RVUs.
CMS Proposed Valuation
    We accept the RUC-recommended work RVUs for CPT codes 27880, 28805, 
34001, 34471, 35216, 35506, 35508, 35515, 35516, 35606, 60600, 60605, 
35081, 35583, and 35616.
    We disagree with the RUC recommendations for CPT codes 33877, 
34201, 35102, 35556, 35566, and 35585. For these services, the RUC used 
the NSQIP time data to increase the work values above the survey 
median, and even for above several codes the 75th percentile. For the 
reasons discussed above, we reject such a use of the NSQIP data at this 
time. Therefore, we are proposing to use the survey median work RVUs 
for these CPT codes: 33877 = 53.00 work RVUs; 34201 = 17.00 work RVUs; 
35102 = 34.00 work RVUs; 35556 = 25.00 work RVUs; 35566 = 30.00 work 
RVUs; and 35585 = 30.00 work RVUs.
8. Otolaryngology and Ophthalmology
    [If you choose to comment on issues in this section, please include 
the caption ``DISCUSSION OF COMMENTS-OTOLARYNGOLOGY AND OPTHALMOLOGY'' 
at the beginning of your comments.]
a. Otolaryngology Procedures
    The American Academy of Otolaryngology--Head and Neck Surgery (AAO-
HNS) submitted the CPT codes in Table 45 for review.

                                Table 45
------------------------------------------------------------------------
              CPT code                            Descriptor
------------------------------------------------------------------------
31225..............................  Maxillectomy; without orbital
                                      extenteration.
31230..............................  Maxillectomy; with orbital
                                      exenteration (en bloc).
31360..............................  Laryngectomy; total, without
                                      radical neck dissection.
31365..............................  Laryngectomy; total, with radical
                                      neck dissection.
31367..............................  Laryngectomy; subtotal
                                      supraglottic, without radical neck
                                      dissection.
31368..............................  Laryngectomy; subtotal
                                      supraglottic, with radical neck
                                      dissection.
31370..............................  Partial laryngectomy
                                      (hemilaryngectomy); horizontal.
31375..............................  Partial laryngectomy
                                      (hemilaryngectomy);
                                      laterovertical.
31380..............................  Partial laryngectomy
                                      (hemilaryngectomy);
                                      anterovertical.
31382..............................  Partial laryngectomy
                                      (hemilaryngectomy); antero-latero-
                                      vertical.

[[Page 37231]]

 
31390..............................  Pharyngolaryngectomy, with radical
                                      neck dissection; without
                                      reconstruction.
31395..............................  Pharyngolaryngectomy, with radical
                                      neck dissection; with
                                      reconstruction.
38700..............................  Suprahyoid lymphadenectomy.
38720..............................  Cervical lymphadenectomy
                                      (complete).
38724..............................  Cervical lymphadenectomy (modified
                                      radical neck dissection).
41120..............................  Glossectomy; less than one-half
                                      tongue.
41130..............................  Glossectomy; hemiglossectomy.
41135..............................  Glossectomy; partial, with
                                      unilateral radical neck
                                      dissection.
41140..............................  Glossectomy; complete or total,
                                      with or without tracheostomy,
                                      without radical neck dissection.
41145..............................  Glossectomy; complete or total,
                                      with or without tracheostomy, with
                                      unilateral radical neck
                                      dissection.
41150..............................  Glossectomy; composite procedure
                                      with resection floor of mouth and
                                      mandibular resection, without
                                      radical neck dissection.
41153..............................  Glossectomy; composite procedure
                                      with resection floor of mouth,
                                      with suprahyoid neck dissection.
41155..............................  Glossectomy; composite procedure
                                      with resection floor of mouth,
                                      mandibular resection, and radical
                                      neck dissection (Commando type).
42120..............................  Resection of palate or extensive
                                      resection of lesion.
42842..............................  Radical resection of tonsil,
                                      tonsillar pillars, and/or
                                      retromolar trigone; without
                                      closure.
42844..............................  Radical resection of tonsil,
                                      tonsillar pillars, and/or
                                      retromolar trigone; closure with
                                      local flap (e.g., tongue, buccal).
42845..............................  Radical resection of tonsil,
                                      tonsillar pillars, and/or
                                      retromolar trigone; closure with
                                      other flap.
42890..............................  Limited pharyngectomy.
42892..............................  Resection of lateral pharyngeal
                                      wall or pyriform sinus, direct
                                      closure by advancement of lateral
                                      and posterior pharyngeal walls.
42894..............................  Resection of pharyngeal wall
                                      requiring closure with
                                      myocutaneous flap.
------------------------------------------------------------------------

    We initially requested that the RUC review five CPT codes but then 
withdrew CPT code 31255 from the 5-Year Review (see Table 46).

                                Table 46
------------------------------------------------------------------------
              CPT code                            Descriptor
------------------------------------------------------------------------
30520..............................  Septoplasty or submucous resection,
                                      with or without cartilage scoring,
                                      contouring replacement with graft.
31255..............................  Nasal/sinus endoscopy, surgical;
                                      with ethmoidectomy, total
                                      (anterior and posterior).
31575..............................  Laryngoscopy, flexible fiberoptic;
                                      diagnostic.
31579..............................  Laryngoscopy, flexible or rigid
                                      fiberoptic, with stroboscopy.
41100..............................  Biopsy of tongue; anterior two-
                                      thirds.
69210..............................  Removal impacted cerumen (separate
                                      procedure), one or both ears.
------------------------------------------------------------------------

RUC Recommendations
    For one CPT code 42120, palate resection procedure, the RUC, based 
on the data presented by the specialty society, agreed that there was 
increased work and intensity involved in comparison to other codes with 
similar intensity. The RUC believed the survey results reflected the 
complexity of the patient, physician time and work necessary in 
performing this procedure, and recommended work RVUs of 11.00 for CPT 
code 42120.
    The specialty society presented data on two maxillectomy 
procedures, CPT codes 31225 and 31230, which the RUC also viewed as 
undervalued. The RUC believed that the re-evaluation of these two codes 
corrects rank order anomalies and accounts for the appropriate 
intensity for each procedure. The RUC recommended work RVUs of 24.00 
for CPT code 31225 and 28.00 for CPT code 31230.
    For three lymphadendectomy procedures, CPT codes 38700, 38720, and 
38724, the specialty society presented data with the rationale that the 
previous valuation was flawed because the procedures were not evaluated 
by otolaryngologists. The RUC believed that the survey results 
reflected the appropriate complexity of the patient, physician time and 
work necessary in performing the procedure, and justified an increase 
in physician work. The RUC-recommended work RVUs for these CPT codes 
are as follows: 38700 = 12.00 work RVUs; 38720 = 20.00 work RVUs; and 
38724 = 22.00 work RVUs.
    The specialty society presented survey data on three pharyngectomy 
procedures, CPT codes 42890, 42892, and 42894, which had never been 
reviewed by the RUC. The RUC agreed that there was a change in the 
patient population and that the increased intensity involved in these 
procedures was comparable to other codes with similar intensity. The 
RUC recommended the increase demonstrated by the survey median which 
was 17.00 work RVUs for CPT code 42890, 23.09 work RVUs for CPT code 
42892, and 30.00 work RVUs for CPT code 42894.
    The specialty society presented survey data on three tonsillectomy 
procedures, CPT codes 42842, 42844, and 42845, which the RUC agreed 
were undervalued due to a previous flawed methodology. The RUC believed 
that the survey results reflected the appropriate physician work and 
time necessary in performing this procedure and recommended the 
following work RVUs for these CPT codes: 42842 = 11.00 work RVUs; 42844 
= 16.10 work RVUs; and 42845 = 32.00 work RVUs.
    For the partial glossectomy procedures, CPT codes 41120, 41130, and 
41135, the RUC believed that there was not compelling evidence to 
increase the work for CPT code 41120, and, therefore, recommended 
maintaining the current value for this service. The RUC also agreed 
that increasing the values for the two remaining procedures would 
correct the existing rank order anomalies and that these increases were

[[Page 37232]]

justified by survey results. The recommendation for the work RVUs for 
these CPT codes is as follows: 41120 = 9.76 work RVUs; 41130 = 14.00 
work RVUs; and 41135 = 27.00 work RVUs.
    For complete glossectomy procedures, CPT codes 41140 and 41145, the 
specialty society presented survey data on these procedures and 
suggested decreasing the work RVU of CPT code 41140. The RUC believed 
that the survey results did not justify decreasing the work RVUs for 
this service, particularly because over half of the survey respondents 
indicated that the work of performing CPT code 41140 has not changed in 
the past 5 years. Therefore, the RUC recommended maintaining the value 
for this code. The RUC believed that the flawed methodology previously 
used for valuing CPT code 41145 caused this procedure to be misvalued 
and that an increase in work was validated by the survey median 
results. The RUC recommended the following work RVUs for these CPT 
codes: 41140 = 25.46 work RVUs; and 41145 = 34.00 work RVUs.
    For the composite glossectomy procedures, CPT codes 41150, 41153, 
and 41155, the specialty society presented survey data on each of these 
procedures, noting that the current work RVUs for each of these 
services create a rank order anomaly. The RUC agreed that increasing 
the RVUs would correct these rank order anomalies and that these 
increases were justified by the survey results. The RUC-recommended 
work RVUs for these CPT codes are as follows: 41150 = 26.50 work RVUs; 
41153 = 34.00 work RVUs; and 41155 = 40.00 work RVUs.
    For the laryngopharyngectomy procedures, CPT codes 31360, 31365, 
31390 and 31395, the specialty society presented as compelling evidence 
the rationale that the current work RVUs create rank order anomalies, 
and that there also has been a change in the patient population. The 
RUC agreed that increasing the RVUs of these procedures by accepting 
the 75th percentile of survey results corrected the specific rank order 
anomalies and also accounted for the change in the patient population. 
The RUC-recommended work RVUs for these CPT codes are as follows: 31360 
= 28.00 work RVUs; 31365 = 37.00 work RVUs; 31390 = 40.00 work RVUs; 
and 31395 = 44.00 work RVUs.
    For the laryngectomy procedures, CPT codes 31367, 31368, 31370, 
31375, 31380 and 31382, the specialty society presented survey data 
with the rationale that the current work values are based on a flawed 
methodology that creates rank order anomalies, and that there also has 
been a change in patient population. The RUC agreed with the specialty 
society and recommended increasing the work RVUs for these services to 
maintain rank order between the codes in the family and to establish 
the correct intensity of the procedure based on the change in patient 
population. The RUC-recommended work RVUs for these CPT codes are: 
31367 = 27.36 work RVUs; 31368 = 36.00 work RVUs; 31370 = 25.00 work 
RVUs; 31375 = 25.00 work RVUs; 31380 = 25.00 work RVUs; and 31382 = 
28.00 work RVUs.
    For CPT code 30520, based on the increase in physician time in the 
current survey data, the RUC believed that the service was misvalued 
and that there was additional work involved which was not previously 
captured. Using the building-block methodology, the RUC recommended a 
work RVU of 6.27 for CPT code 30520.
    For CPT codes 31575 and 31579, the RUC agreed with the specialty 
society that the surveys validate the current values. The RUC also 
believed that the survey validated the current work value for CPT code 
41100, particularly because 98 percent of survey respondents indicated 
that the work in performing this service has not changed in the past 5 
years. The RUC recommended maintaining the original work values of 1.10 
work RVUs for CPT code 31575, 2.26 work RVUs for CPT code 31579, and 
1.63 work RVUs for CPT code 41100.
    The specialty society provided survey data for CPT code 69210 using 
the rationale that the patient population had become more complex. The 
RUC did not agree with the specialty society that the patient 
population had changed because 94 percent of the survey respondents 
indicated that the work in performing this service has not changed in 
the past 5 years. The RUC recommended maintaining the current work 
value of 0.61 for this service.
CMS Proposed Valuation
    We are in agreement with the RUC-recommended work RVUs for the 
following otolaryngology CPT codes: 38700, 38720, 38724, 41120, 41130, 
41135, 41140, 41145, 42120, 42890, 42892, and 42894.
    For the tonsillectomy procedures, CPT codes 42842, 42844, and 
42845, the number of hospital days decreased by at least two days 
(including critical care visits for one code), but the outpatient post-
operative visits increased by one. The median values for intra-service 
times were accepted by the RUC for these services, which is an 
indication that a value other than the 75th percentile for work also 
may be appropriate. CPT codes 42842 and 42844 were valued at the median 
work RVU obtained from the surveys. However, CPT code 42845 was valued 
by the RUC at the 75th percentile for work. Therefore, we are accepting 
the median recommended work values for CPT codes 42842 of 11.00 work 
RVUs and 42844 of 16.10 work RVUs and, consistent with use of the 
median, proposing work RVUs for CPT code 42845 of 29.00.
    For the composite glossectomy procedures, CPT codes 41150, 41153, 
and 41155, the number of hospital days decreased by at least 2 days 
(including, in some instances, critical care visits). CPT codes 41153 
and 41155 were valued by the RUC at the 75th percentile for work, but 
CPT code 41150 was valued based on the median work value. The median 
values for intra-service times were accepted by the RUC for these 
services, which is an indication that a value other than the 75th 
percentile for work also may be appropriate. Therefore, we are 
accepting the RUC-recommended work RVUs of 26.50 for CPT code 41150 
which were based on the median work value, and consistent with use of 
the median proposing work RVUs of 30.00 for CPT code 41153 and 36.00 
for CPT code 41155.
    For the laryngopharyngectomy procedures, CPT codes 31360, 31365, 
31367, 31368, 31370, 31375, 31380, 31382, 31390 and 31395, the number 
of hospital days decreased by at least two days and the post-operative 
outpatient visits increased by one day. However, in one instance the 
number of outpatient visits decreased (CPT code 31395). The median 
values for intra-service times were accepted by the RUC for these 
services, which is an indication that a value other than the 75th 
percentile for work also may be appropriate. Therefore, we are 
proposing using median values for these services resulting in the 
following work RVUs for these CPT codes: 31360 = 24.00 work RVUs; 31365 
= 31.50 work RVUs; 31367 = 24.00 work RVUs; 31368 = 30.50 work RVUs; 
31370 = 24.00 work RVUs; 31375 = 22.50 work RVUs; 31380 = 22.00 work 
RVUs; 31382 = 25.00 work RVUs; 31390 = 35.00 work RVUs; and 31395 = 
39.50 work RVUs.
    For CPT codes 30520, 31575, 31579, 41100 and 69210, we are in 
agreement with the RUC-recommended work RVUs for these services, except 
for CPT code 41100. The RUC recommended maintaining the current work 
RVUs of 1.63 for this service, which is even greater than the 75th 
percentile for work, which is what the specialty

[[Page 37233]]

society had recommended. We believe the more appropriate work RVUs for 
this service is represented by the median, which is 1.37, and, 
therefore, we are recommending 1.37 work RVUs for CPT code 41100.
    We would note that although we accepted the RUC's recommendation of 
a work RVU of 0.61 for CPT code 69210, we are concerned with this 
valuation for the use of this code for routine removal of ear wax 
during a physical examination of a patient. This code is listed with a 
``separate procedure'' designation in the CPT code book, meaning that 
it is billed most properly when it is the only service provided for a 
particular date of service. However, Medicare data used for evaluation 
of codes in the current 5-Year Review indicate that CPT code 69210 was 
billed with an E/M service 63 percent of the time. It is our 
understanding that CPT code 69210 is to be used when there is a 
substantial amount of cerumen in the external ear canal that is very 
difficult to remove and that impairs the patient's auditory function. 
We will continue to monitor the use of this code for the appropriate 
circumstances.
b. Ophthalmology Services
    The American Academy of Ophthalmology (AAO), the American 
Optometric Association (AOA) and the American Society of Cataract and 
Refractive Surgery submitted 15 codes for the 5-Year Review (see Table 
47). However, the specialty societies subsequently withdrew five of 
these codes (CPT codes 65420, 65900, 67917, 67924 and 68750) from the 
5-Year Review.

                                Table 47
------------------------------------------------------------------------
              CPT code                            Descriptor
------------------------------------------------------------------------
65420..............................  Excision or transposition of
                                      pterygium; without graft.
65426..............................  Excision or transposition of
                                      pterygium; with graft.
65850..............................  Trabeculotomy ab externo.
65900..............................  Removal of epithelial downgrowth,
                                      anterior chamber of eye.
67414..............................  Orbitotomy without bone flap
                                      (frontal or transconjunctival
                                      approach); with removal of bone
                                      for decompression.
67445..............................  Orbitotomy with bone flap or
                                      window, lateral approach (e.g.,
                                      Kroenlein); with removal of bone
                                      for decompression.
67500..............................  Retrobulbar injection; medication
                                      (separate procedure, does not
                                      include supply of medication).
67505..............................  Retrobulbar injection; alcohol.
67515..............................  Injection of medication or other
                                      substance into Tenon's capsule.
67904..............................  Repair of blepharoptosis; (tarso)
                                      levator resection or advancement,
                                      external approach.
67911..............................  Correction of lid retraction.
67917..............................  Repair of ectropion; extensive
                                      (e.g., tarsal strip operations).
67924..............................  Repair of entropion; extensive
                                      (e.g., tarsal strip or
                                      capsulopalpebral fascia repairs
                                      operation).
67966..............................  Excision and repair of eyelid,
                                      involving lid margin, tarsus,
                                      conjunctiva, canthus, or full
                                      thickness, may include preparation
                                      for skin graft or pedicle flap
                                      with adjacent tissue transfer or
                                      rearrangement; over one-fourth of
                                      lid margin.
68750..............................  Conjunctivorhinostomy
                                      (fistulization of conjunctiva to
                                      nasal cavity); with insertion of
                                      tube or stent .
------------------------------------------------------------------------

    We submitted the following ophthalmology CPT codes for review (see 
Table 48).

                                Table 48
------------------------------------------------------------------------
              CPT code                            Descriptor
------------------------------------------------------------------------
66761..............................  Iridotomy/iridectomy by laser
                                      surgery (e.g., for glaucoma) (one
                                      or more sessions).
66821..............................  Discission of secondary membranous
                                      cataract (opacified posterior lens
                                      capsule and/or anterior hyaloid);
                                      laser surgery (e.g., YAG laser)
                                      (one or more stages).
66984..............................  Extracapsular cataract removal with
                                      insertion of intraocular lens
                                      prosthesis (one stage procedure),
                                      manual or mechanical technique
                                      (e.g., irrigation and aspiration
                                      or phacoemulsification).
67038..............................  Vitrectomy, mechanical, pars plana
                                      approach; with epiretinal membrane
                                      stripping.
67221..............................  Destruction of localized lesion of
                                      choroid (e.g., choroidal
                                      neovascularization); photodynamic
                                      therapy (includes intravenous
                                      infusion).
67228..............................  Destruction of extensive or
                                      progressive retinopathy (e.g.,
                                      diabetic retinopathy), one or more
                                      sessions; photocoagulation (laser
                                      or xenon arc).
67820..............................  Correction of trichiasis;
                                      epilation, by forceps only.
67840..............................  Excision of lesion of eyelid
                                      (except chalazion) without closure
                                      or with simple direct closure.
68840..............................  Probing of lacrimal canaliculi,
                                      with or without irrigation.
76519..............................  Ophthalmic biometry by ultrasound
                                      echography, A-scan; with
                                      intraocular lens power
                                      calculation.
92083..............................  Visual field examination,
                                      unilateral or bilateral, with
                                      interpretation and report;
                                      extended examination (e.g.,
                                      Goldmann visual fields with at
                                      least 3 isopters plotted and
                                      static determination within the
                                      central 30[deg], or quantitative,
                                      automated threshold perimetry,
                                      Octopus program G-1, 32 or 42,
                                      Humphrey visual field analyzer
                                      full threshold programs 30-2, 24-2
                                      or 30/60-2.
92226..............................  Ophthalmoscopy, extended, with
                                      retinal drawing (e.g., for retinal
                                      detachment, melanoma), with
                                      interpretation and report;
                                      subsequent.
92235..............................  Fluorescein angiography (includes
                                      multiframe imaging) with
                                      interpretation and report.
92250..............................  Fundus photography with
                                      interpretation and report.
------------------------------------------------------------------------


[[Page 37234]]

RUC Recommendations
    The RUC questioned the survey results for CPT codes 67038 and 67228 
and indicated that the survey data may be flawed because respondents 
may have based their answers on a different number of membranes 
stripped or sessions conducted. The RUC recommended that these two CPT 
codes be referred to the CPT Editorial Panel for clarification.
    Based on a review of the survey data, the RUC agreed with the 
specialty society that the survey results demonstrated that the work 
had not changed and, thus, that the current work RVUs should be 
retained for the following CPT codes: 66761 = 4.06 work RVUs; 67840 = 
2.04 work RVUs; 68840 = 1.25 work RVUs; 76519 = 0.54 work RVUs; 92226 = 
0.33 work RVUs; 92235 = 0.81 work RVUs; and 92250 = 0.44 work RVUs. In 
addition, the RUC recommended retaining the work RVU of 0.50 for CPT 
code 92083 because the specialty society had not presented compelling 
evidence that the physician work had changed.
    For CPT codes 67221, 67820, and 66984, the RUC recommended 
reductions in the work RVUs. The RUC used a building-block approach 
based on the work RVU of 3.24 for the reference CPT code 67141, 
Prophylaxis of retinal detachment (e.g., retinal break, lattice 
degeneration) without drainage, one or more sessions; cryotherapy, 
diathermy, and the work RVUs of 0.21 for the infusion code G0347, which 
contain comparable work. The RUC recommended work RVUs of 3.45 for CPT 
code 67221.
    The RUC supported the specialty society's recommendation to 
decrease the work value for CPT code 67820 based on evidence that the 
previous Harvard survey data was flawed. The RUC agreed with assigning 
work RVUs of 0.71 to CPT code 67820 based on a comparison/crosswalk to 
the key reference service, CPT code 65205, Removal of foreign body, 
external eye; conjunctival superficial, which has work RVUs of 0.71.
    For CPT code 66984, the RUC did not agree with the specialty 
society recommendation that the current work RVU of 10.21 should be 
maintained, because changes in technology and technique in the last 10 
years have led to increased efficiencies. The RUC concluded that these 
efficiencies resulted in a lower overall time for the procedure. The 
RUC used the previous survey pre-service time of 44 minutes and 
subtracted the current survey pre-service time of 25 minutes for a 
difference of 19 minutes. These 19 minutes were then multiplied by an 
IWPUT of 0.0224, resulting in an RVU of 0.43, which was subtracted from 
the current value. The RUC agreed that although the intra-service 
physician time has decreased from the historical 50 minutes to the 
current survey time of 30 minutes as indicated by the survey 
respondents, the decrease in time reflects a decrease of only low 
intensity work (that is, suturing) and no further decrease in work RVUs 
was recommended. Therefore, the RUC recommended work RVUs of 9.78 for 
CPT code 66984.
    The RUC agreed with the specialty society that there was compelling 
evidence to support the increases for CPT codes 67414, 67445, 67500, 
67515, 67904, 67911, and 67966, either because the current work RVUs 
caused rank order anomalies, the previous Harvard survey data was 
misvalued when compared to codes with similar values, or there was a 
change in the technique of performing the procedures (specifically for 
CPT codes 67911 and 67966, in which skin-grafting is bundled into these 
codes). However, for two CPT codes, 65426 and 65850, while the RUC 
recognized that there was compelling evidence to support increases, the 
RUC did not agree with the specific increases recommended by the 
specialty society.
    For CPT code 65426, the RUC believed that evidence suggested a 
change in technique for this procedure, and believed that a value close 
to the survey's 25th percentile was justified by using a building-block 
approach. For CPT code 65850, the RUC agreed that there is a rank order 
anomaly between CPT codes 65850 and 66170, Fistualization of sclera for 
glaucoma; trabeculectomy ab externo in absence of previous surgery, as 
well as a change in the patient population. The RUC believed an 
increase in value was justified by using a building-block approach. The 
RUC recommended 5.85 work RVUs for CPT code 65426 and 11.14 work RVUs 
for CPT code 65850.
    For CPT code 66821, the RUC agreed that the intensity of this 
procedure was misvalued and that an increase in the relative value 
would be appropriate. The RUC disagreed with our previous intensity 
crosswalk to CPT code 66984, Extracapsular cataract removal with 
insertion of intraocular lens prosthesis (one stage procedure), manual 
or mechanical technique (e.g., irrigation and aspiration or 
phacoemulsification), specified in the Five-Year Review of Work 
Relative Value Units Under the Physician Fee Schedule proposed notice 
(May 3, 1996; 61 FR 20027). The RUC believed that the previous survey 
from 1995 should stand on its own as an acceptable survey due to the 
inappropriate selection by HCFA in 1995 of intensity for this code. The 
RUC-recommended work RVU for this service is 2.78, the same value 
recommended by the RUC in 1995.
CMS Proposed Valuation
    We are in agreement with the RUC recommended work values for these 
ophthalmology services.
c. Additional Codes
    The American Speech-Language-Hearing Association (ASHA) submitted 
the following speech and audiology CPT codes (see Table 49) but 
subsequently withdrew them from the 5-Year Review.

                                Table 49
------------------------------------------------------------------------
              CPT code                            Descriptor
------------------------------------------------------------------------
92506..............................  Evaluation of speech, language,
                                      voice, communication, and/or
                                      auditory processing.
92507..............................  Treatment of speech, language,
                                      voice, communication, and/or
                                      auditory processing disorder;
                                      individual.
92508..............................  Treatment of speech, language,
                                      voice, communication, and/or
                                      auditory processing disorder;
                                      group, two or more individuals.
92510..............................  Aural rehabilitation following
                                      cochlear implant (includes
                                      evaluation of aural rehabilitation
                                      status and hearing, therapeutic
                                      services) with or without speech
                                      processor programming
92516..............................  Facial nerve function studies
                                      (e.g., electroneuronography).
92520..............................  Laryngeal function studies (ie,
                                      aerodynamic testing and acoustic
                                      testing).
92526..............................  Treatment of swallowing dysfunction
                                      and/or oral function for feeding.
92541..............................  Spontaneous nystagmus test,
                                      including gaze and fixation
                                      nystagmus, with recording.
92542..............................  Positional nystagmus test, minimum
                                      of 4 positions, with recording.
92543..............................  Caloric vestibular test, each
                                      irrigation (binaural, bithermal
                                      stimulation constitutes four
                                      tests), with recording.
92544..............................  Optokinetic nystagmus test,
                                      bidirectional, foveal or
                                      peripheral stimulation, with
                                      recording.

[[Page 37235]]

 
92545..............................  Oscillating tracking test, with
                                      recording.
92546..............................  Sinusoidal vertical axis rotational
                                      testing.
92547..............................  Use of vertical electrodes (List
                                      separately in addition to code for
                                      primary procedure).
92548..............................  Computerized dynamic posturography.
92551..............................  Screening test, pure tone, air
                                      only.
92552..............................  Pure tone audiometry (threshold);
                                      air only.
92553..............................  Pure tone audiometry (threshold);
                                      air and bone.
92555..............................  Speech audiometry threshold.
92556..............................  Speech audiometry threshold; with
                                      speech recognition.
92557..............................  Comprehensive audiometry threshold
                                      evaluation and speech recognition
                                      (92553 and 92556 combined).
92559..............................  Audiometric testing of groups.
92560..............................  Bekesy audiometry; screening.
92561..............................  Bekesy audiometry; diagnostic.
92562..............................  Loudness balance test, alternate
                                      binaural or monaural.
92563..............................  Tone decay test.
92564..............................  Short increment sensitivity index
                                      (SISI).
92565..............................  Stenger test, pure tone.
92567..............................  Tympanometry (impedance testing).
92568..............................  Acoustic reflex testing; threshold.
92569..............................  Acoustic reflex testing; decay.
92571..............................  Filtered speech test.
92572..............................  Staggered spondaic word test.
92573..............................  Lombard test.
92575..............................  Sensorineural acuity level test.
92576..............................  Synthetic sentence identification
                                      test.
92579..............................  Visual reinforcement audiometry
                                      (VRA)
92582..............................  Conditioning play audiometry.
92583..............................  Select picture audiometry.
92584..............................  Electrocochleography.
92585..............................  Auditory evoked potentials for
                                      evoked response audiometry and/or
                                      testing of the central nervous
                                      system; comprehensive.
92586..............................  Auditory evoked potentials for
                                      evoked response audiometry and/or
                                      testing of the central nervous
                                      system; limited.
92587..............................  Evoked otoacoustic emissions;
                                      limited (single stimulus level,
                                      either transient or distortion
                                      products).
92588..............................  Evoked otoacoustic emissions;
                                      comprehensive or diagnostic
                                      evaluation (comparison of
                                      transient and/or distortion
                                      product otoacoustic emissions at
                                      multiple levels and frequencies).
92596..............................  Ear protector attenuation
                                      measurements.
92597..............................  Evaluation for use and/or fitting
                                      of voice prosthetic device to
                                      supplement oral speech.
92601..............................  Diagnostic analysis of cochlear
                                      implant, patient under 7 years of
                                      age; with programming.
92602..............................  Diagnostic analysis of cochlear
                                      implant, patient under 7 years of
                                      age; subsequent reprogramming.
92603..............................  Diagnostic analysis of cochlear
                                      implant, age 7 years or older;
                                      with programming.
92604..............................  Diagnostic analysis of cochlear
                                      implant, age 7 years or older;
                                      subsequent reprogramming.
92605..............................  Evaluation for prescription of non-
                                      speech-generating augmentative and
                                      alternative communication device.
92606..............................  Therapeutic service(s) for the use
                                      of non-speech-generating device,
                                      including programming and
                                      modification.
92607..............................  Evaluation for prescription for
                                      speech-generating augmentative and
                                      alternative communication device,
                                      face-to-face with the patient;
                                      first hour.
92608..............................  Evaluation for prescription for
                                      speech-generating augmentative and
                                      alternative communication device,
                                      face-to-face with the patient;
                                      each additional 30 minutes (List
                                      separately in addition to code for
                                      primary procedure).
92609..............................  Therapeutic services for the use of
                                      speech-generating device,
                                      including programming and
                                      modification
92610..............................  Evaluation of oral and pharyngeal
                                      swallowing function.
92611..............................  Motion fluoroscopic evaluation of
                                      swallowing function by cine or
                                      video recording.
92612..............................  Flexible fiberoptic endoscopic
                                      evaluation of swallowing by cine
                                      or video recording.
92614..............................  Flexible fiberoptic endoscopic
                                      evaluation, laryngeal sensory
                                      testing by cine or video
                                      recording.
92616..............................  Flexible fiberoptic endoscopic
                                      evaluation of swallowing and
                                      laryngeal sensory testing by cine
                                      or video recording.
92620..............................  Evaluation of central auditory
                                      function, with report; initial 60
                                      minutes.
92621..............................  Evaluation of central auditory
                                      function, with report; each
                                      additional 15 minutes.
92625..............................  Assessment of tinnitus (includes
                                      pitch, loudness matching, and
                                      masking).
------------------------------------------------------------------------

9. HCPAC Codes
a. Podiatric Services
    [If you choose to comment on issues in this section, please include 
the caption ``DISCUSSION OF COMMENTS--HCPAC CODES'' at the beginning of 
your comments.]
    We submitted the podiatric services in Table 50 for review.

                                Table 50
------------------------------------------------------------------------
              CPT code                            Descriptor
------------------------------------------------------------------------
10060..............................  Incision and drainage of abscess
                                      (e.g., carbuncle, suppurative
                                      hidradenitis, cutaneous or
                                      subcutaneous abscess, cyst,
                                      furuncle, or paronychia); simple
                                      or single.
11040..............................  Debridement; skin, partial
                                      thickness.

[[Page 37236]]

 
11041..............................  Debridement; skin, full thickness.
11042..............................  Debridement; skin, and subcutaneous
                                      tissue.
11730..............................  Avulsion of nail plate, partial or
                                      complete, simple; single.
29580..............................  Strapping; Unna boot.
------------------------------------------------------------------------

HCPAC Recommendation
    The HCPAC agreed with the specialty society that there was 
compelling evidence that the valuation of these services was incorrect 
due to a flawed methodology used in the previous Harvard valuation for 
all six podiatric codes. Based on the survey data, the specialty 
society requested that the work RVU increase for four codes and 
decrease for two codes.
    For CPT codes 10060 and 29580, the HCPAC supported an increase in 
the existing work values for these codes and recommended a work RVU of 
1.50 for CPT code 10060 and 0.60 for CPT code 29580, which represent 
the survey median of the survey data for these services.
    For CPT code 11040, the HCPAC did not support the work RVU increase 
recommended by the specialty society, but instead recommended a work 
RVU of 0.55, which represented the 25th percentile work RVU from the 
survey data.
    For CPT codes 11041 and 11730, the HCPAC recommended a decrease in 
the work RVUs and, based on the median from the survey data, 
recommended a work RVU of 0.80 for CPT code 11041 and 1.10 for CPT code 
11730.
    For CPT code 11042, the HCPAC did not agree with the specialty 
society that the work RVU should be increased to 1.20 work RVUs. The 
HCPAC recommended maintaining the current work RVU of 1.12 for this CPT 
code, which was slightly higher than the survey's 25th percentile work 
value of 1.10 work RVUs.
    The HCPAC-recommended work values for these services are as 
follows: 10060 = 1.50 work RVUs; 11040 = 0.55 work RVUs; 11041 = 0.80 
work RVUs; 11042 = 1.12 work RVUs; 11730 = 1.10 work RVUs; and 29580 = 
0.60 work RVUs.
CMS Proposed Valuation
    For CPT code 10060, we compared the survey times them with the 
current Harvard-based times used to value this service. These times are 
comparable and, therefore, we are recommending maintaining the current 
work RVUs of 1.17 for this code.
    For CPT code 29580, we compared the current Harvard-based times 
with the survey times. Due to the small reduction in time, the 
recommended increase in work RVUs is not supported. Therefore, we are 
proposing to assign 0.55 work RVUs to this service, which represents 
the 25th percentile of the survey and more accurately represents the 
time associated with this service.
    For CPT code 11730, the current work RVUs are slightly more (0.03) 
than the recommended value and the survey time is approximately 30 
percent greater than the current Harvard-based time. For these reasons, 
we agree with the HCPAC's recommendation of 1.10 work RVUs for 11730 
which represents the median survey value.
    For CPT codes 11040, 11041 and 11042, the survey times all reflect 
significant reductions from current Harvard-based times used to value 
these services. Based on this comparison which shows decreases in time 
ranging from 47 percent to 68 percent, we believe that the low values 
from the surveys more accurately represent the valuation of these 
services. Therefore, we are proposing to assign work RVUs as follows: 
11040 = 0.48 work RVUs; 11041 = 0.60 work RVUs; and 11042 = 0.80 work 
RVUs. In addition, to ensure that the other codes in this family are 
properly valued, we recommend the RUC should review the valuation of 
CPT codes 11043 and 11044.
b. Other HCPAC Codes
    The American Dietetic Association submitted five CPT and HCPCS 
codes related to medical nutrition services that were referred to the 
CPT Editorial Panel (see Table 51).

                                Table 51
------------------------------------------------------------------------
              CPT code                            Descriptor
------------------------------------------------------------------------
97802..............................  Medical nutrition therapy; initial
                                      assessment and intervention,
                                      individual, face-to-face with the
                                      patient, each 15 minutes.
97803..............................  Medical nutrition therapy; re-
                                      assessment and intervention,
                                      individual, face-to-face with the
                                      patient, each 15 minutes.
97804..............................  Medical nutrition therapy; group (2
                                      or more individual(s)), each 30
                                      minutes G0270 Medical nutrition
                                      therapy; reassessment and
                                      subsequent intervention(s)
                                      following second referral in same
                                      year for change in diagnosis,
                                      medical condition, or treatment
                                      regimen (including additional
                                      hours needed for renal disease),
                                      individual, face to face with the
                                      patient, each 15 minutes.
G0270..............................  Medical nutrition therapy;
                                      reassessment and subsequent
                                      intervention(s) following second
                                      referral in same year for change
                                      in diagnosis, medical condition,
                                      or treatment regimen (including
                                      additional hours needed for renal
                                      disease), individual, face to face
                                      with the patient, each 15 minutes.
G0271..............................  Medical nutrition therapy;
                                      reassessment and subsequent
                                      intervention(s) following second
                                      referral in same year for change
                                      in diagnosis, medical condition,
                                      or treatment regimen (including
                                      additional hours needed for renal
                                      disease), group (2 or more
                                      individuals), each 30 minutes.
------------------------------------------------------------------------

    Additionally, the ASHA submitted CPT code 96105, Assessment of 
aphasia (includes assessment of expressive and receptive speech and 
language function, language comprehension, speech production ability, 
reading, spelling, writing, e.g., by Boston Diagnostic Aphasia 
Examination) with interpretation and report, per hour, for review but 
subsequently withdrew this code.

C. Other Issues Under the 5-Year Review

    [If you choose to comment on issues in this section, please include 
the caption ``OTHER ISSUES'' at the beginning of your comments.]

[[Page 37237]]

1. Anesthesia Services
    Although anesthesia services are paid under the PFS, they are paid 
on the basis of an anesthesia code-specific base unit and time units 
that vary based on the anesthesia time of the case. Since anesthesia 
services do not have a work value per code as do other medical and 
surgical services, a work value must be imputed for each anesthesia 
code. For the last 5-Year Review, this imputed work value was compared 
to an actual work value determined by the RUC and the ASA through a 
building-block approach. Under the building-block approach, each 
anesthesia code was uniformly divided into five components: pre-
anesthesia, equipment and supply preparation, induction period, post-
induction anesthesia period, and post-anesthesia. The work was 
determined for each of the five components and summed to calculate 
total anesthesia work for the anesthesia code.
    Although the ASA submitted one anesthesia code and several other 
codes for this 5-Year Review, they continue to believe the work of 
anesthesia services remain seriously undervalued. The last 5-Year 
Review of anesthesia services proved to be a very laborious and 
exhaustive process involving several different RUC workgroups. The 
valuation of anesthesia work is a very complex process as it involves 
relating components of anesthesia services to other medical and 
surgical services of similar time and work. The ASA was dissatisfied 
with the recommendations made by the RUC for the last 5-Year Review for 
anesthesia work. The major points of disagreement were the use and 
extent of extrapolation and the work value for the post-induction 
anesthesia period, which is the longest period of the anesthesia 
service.
    For the last 5-Year Review, the ASA requested the RUC to 
extrapolate from 19 high volume anesthesia services, which were studied 
and accounted for over 50 percent of Medicare payments for anesthesia 
services, to all anesthesia services. The RUC thought that 
extrapolation should be limited. That is, an analysis of a single 
anesthesia code based on a single surgical code was insufficient when 
the anesthesia code covers a large number of surgical codes. For the 
last 5-Year Review, the building-block approach used a value of 0.025 
for the IWPUT for the post-induction anesthesia period. This was a 
value that the RUC agreed to, which we approved, although the ASA 
thought it was too low.
    As a result of its relationship with the RUC and the past 
recommendations, the ASA requested that we address the valuation of 
anesthesia services reported under CPT codes 00100 through 01999. The 
ASA furnished an analysis that builds on the methodology used in the 
last 5-Year Review for the valuation of work for anesthesia services.
    Based on comparable physicians' services, the ASA believes that the 
more appropriate IWPUT for the post-induction period is 0.043. Using 
this IWPUT, the ASA calculated a scaling factor and used this to 
recalculate the post-induction work value and an adjusted total work 
RVU for each of the 19 codes. Based on an extrapolation from the 19 
surveyed services used in the last 5-Year Review, the ASA proposed that 
the anesthesia work value should be increased by 37.5 percent. The 
extrapolation proposed by the ASA is more far reaching than the 
extrapolation used by the RUC in the last 5-Year Review. We do not 
favor using extrapolation other than on the limited basis it was used 
in the last 5-Year Review.
    Since the ASA believes that the RUC process does not work well for 
their codes, they requested that we directly evaluate their 
recommendations independent of any RUC review of input. Although there 
may be some merit to the ASA approach, we believe this analysis is more 
appropriately done by a multispecialty workgroup within the RUC itself. 
Thus, we are recommending the valuation of anesthesia services, namely 
the proposed valuation of the post-induction time period, be referred 
to the RUC for their review and consideration. For example, the ASA and 
the RUC could review the IWPUT for post-induction time, as currently 
proposed by the ASA and compare this to the corresponding IWPUT 
recognized in the last 5-Year Review of anesthesia work for the 19 
surveyed codes.
    A second issue concerning anesthesia services pertains to the 
impact of the revised work values for E/M services and their 
relationship to the valuation of pre- and post-anesthesia services, 
components of the building-block approach. The pre- and post-anesthesia 
services derive their work values from the lower level E/M codes for 
new patients, the subsequent hospital care codes and the initial 
inpatient consultation codes. We are proposing to substitute the 
proposed revised work values for E/M codes where applicable and 
recompute the anesthesia work values and their impact on the increase 
in total anesthesia work. While this results in a very minor adjustment 
to anesthesia work (that is, less than 1 percent), we believe this 
approach provides for the consistent application of the proposed work 
RVUs changes.
2. Discussion of Post-Operative Visits Included in the Global Surgical 
Packages
    We have established a national definition for a global surgical 
package so that payment is made consistently for the same set of 
services across all contractor jurisdictions. In constructing the RVUs 
for a global surgery service, all services that are believed to be 
typically included in the defined global period are built into the 
final resource-based RVUs and are not separately billable within the 
defined global period; this is reflected in the proposed work RVUs in 
Addenda B and C. This would include pre-surgery work, the intra-service 
time of actually performing the surgical procedure, and the post-
operative (follow-up) visits associated with the monitoring and 
recovery of the patient.
    As stated above in this section, we are proposing to apply the RUC-
recommended new values for the E/M services to all surgical services 
with a 10 or 90-day global period. However, because of variations in 
the patient population and in practice patterns, there is some question 
whether the assumptions about the number and level of visits within the 
global period reflect the actual post-operative work performed. Some 
surgeons have commented to us that they perform more visits than are 
included in the global period for their services. It is also likely 
that some patients require fewer than the ``typical'' number of follow-
up visits included in the global period.
    Although we are not proposing any changes to our global policy at 
this time, we would be interested in receiving comments concerning our 
current policy of including these post-operative visits in the global 
surgical packages and what advantages or disadvantages might be 
associated with proposing a change to this policy in the future.
3. Codes Referred to CPT Editorial Panel From Five-Year Review of Work 
Relative Value Units

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BILLING CODE 4120-01-C
4. Budget Neutrality
    Section 1848(c)(2)(B)(ii) of the Act requires that increases or 
decreases in RVUs for a year may not cause the amount of expenditures 
for the year to differ by more than $20 million from what expenditures 
would have been in the absence of these changes. If this threshold is 
exceeded, we must make adjustments to preserve budget neutrality. This 
year, we expect that budget-neutrality adjustments will be required as 
a result of changes in RVUs resulting from the 5-Year Review. Revisions 
in payment policies, including the establishment of interim and final 
RVUs for coding changes that will be announced later this year, may 
result in additional budget-neutrality adjustments.
    We considered making the statutorily required budget-neutrality 
adjustments (under section 1848(c)(2)(B)(ii) of the Act) to account for 
the 5-Year Review of physician work by reducing all work RVUs. We 
currently estimate that all work RVUs would have to be reduced by 10 
percent under this option. Alternatively, we considered making an 
adjustment to the PFS CF to meet the provisions of section 
1848(c)(2)(B)(ii). This option would require an estimated 5 percent 
reduction in the CF. We note that the application of the budget 
neutrality adjustment to the CF would negatively impact all PFS 
services; whereas the application of the budget neutrality adjustment 
to the work RVUs would impact only those services that have physician 
work RVUs. Because the need for a budget neutrality adjustment would be 
largely due to changes proposed as a result of the 5-Year Review of 
work RVUs, we believe it is more equitable to apply the adjustment 
across services that have work RVUs. For this third 5-Year Review, we 
are proposing to establish a budget neutrality adjustor that would 
reduce all work RVUs by an estimated 10 percent to meet the budget 
neutrality provisions of section 1848(c)(2)(B)(ii).
    As we noted in the CY 2005 Physician Fee Schedule final rule with 
comment period (69 FR 66371), PE and malpractice expense RVUs were not 
subject to comment and will not be recalculated (other than changes to 
PE RVUs that result from changes in PE inputs due to changes in 
physician time or in the number of post procedure visits as part of the 
5-Year Review of work RVUs).
5. Effect on Practice Expense Inputs Stemming From the 5-Year Review
    The proposed changes for work RVUs reflect, in part, the 
physician's time needed to perform each service, as well as the number 
and level of assumed post-operative visits. To the extent that the RUC 
recommended changes in the times associated with the intra-service 
portion of the procedure, we are also proposing to adjust the clinical 
labor time assigned for assisting the physician in the nonfacility 
setting. In addition, if an accepted new work RVU reflects a change in 
the number or level of post-operative visits, we are proposing to 
modify the clinical staff time to reflect the change. This adjusted 
time is also applied to the equipment used in the post-operative 
visits. Where the number of post-operative visits has changed, the 
number of minimum multi-specialty visit (MMSV) packs will also be 
adjusted accordingly. A MMSV pack consists of the following supplies: 
exam table paper, 2 pairs of non-sterile gloves, a patient gown, a 
pillow case, and a thermometer probe cover. These changes in clinical 
labor and equipment time and in the quantity of supplies will have a 
minimal impact on the PE component.
6. Nature and Format of Comments on Work RVUs
    We will accept comments on the proposed work RVUs for the codes 
identified in the Addendum C of this notice. We will also accept 
comments on the anesthesia code, CPT code 00797. Comments should 
discuss how the work associated with a given CPT or HCPCS code is 
analogous to the work in other services, or discuss the rationale for 
agreeing or disagreeing with the proposed work RVU. We are especially 
interested in information or discussions that were not presented in 
earlier comments.

D. Resource-Based Practice Expense (PE) RVUs

    [If you choose to comment on issues in this section, please include 
the caption ``PRACTICE EXPENSE'' at the beginning of your comments.]
    Based on section 1848(c)(1)(B) of the Act, practice expense (PE) is 
the portion of the resources used in furnishing the service that 
reflects the general categories of physician and practitioner expenses, 
such as office rent and wages of personnel, but excluding malpractice 
expenses.

[[Page 37242]]

    Section 121 of the Social Security Amendments of 1994 (Pub. L. 103-
432), enacted on October 31, 1994, required CMS to develop a 
methodology for a resource-based system for determining PE RVUs for 
each physician's service. Until that time, physicians' PEs were based 
on historical allowed charges. This legislation stated that the revised 
PE methodology must consider the staff, equipment, and supplies used in 
the provision of various medical and surgical services in various 
settings beginning in 1998. The Secretary has interpreted this to mean 
that Medicare payments for each service would be based on the relative 
PE resources typically involved with performing the service.
    The initial implementation of resource-based PE RVUs was delayed 
from January 1, 1998, until January 1, 1999, by section 4505(a) of the 
Balanced Budget Act of 1997 (BBA 97) (Pub. L. 105-33). In addition, 
section 4505(b) of the BBA 97 required that the new payment methodology 
be phased-in over 4 years, effective for services furnished in CY 1999, 
and fully effective in CY 2002. The first step toward implementation of 
the statute was to adjust the PE values for certain services for CY 
1998. Section 4505(d) of BBA 97 required that, in developing the 
resource-based PE RVUs, the Secretary must:
     Use, to the maximum extent possible, generally accepted 
cost accounting principles that recognize all staff, equipment, 
supplies, and expenses, not solely those that can be linked to specific 
procedures.
     Develop a refinement method to be used during the 
transition.
     Consider, in the course of notice and comment rulemaking, 
impact projections that compare new proposed payment amounts to data on 
actual physician PEs.
    Beginning in CY 1999, we began the four year transition to 
resource-based PE RVUs. In CY 2002, the resource-based PE RVUs were 
fully transitioned.
1. Current Methodology
    The following sections discuss the current PE methodology.
a. Data Sources
    There are two primary data sources used to calculate PE. The AMA's 
Socioeconomic Monitoring System (SMS) survey data are used to develop 
the PE per hour (PE/HR) for each specialty. The second source of data 
used to calculate PE was originally developed by the Clinical Practice 
Expert Panels (CPEP). The CPEP data include the supplies, equipment and 
staff times specific to each procedure.
    The AMA developed the SMS survey in 1981 and discontinued it in 
1999. Beginning in 2002, we incorporated the 1999 SMS survey data into 
our calculation of the PE RVUs, using a 5-year average of SMS survey 
data. (See Revisions to Payment Policies and Five-Year Review of and 
Adjustments to the Relative Value Units Under the Physician Fee 
Schedule for CY 2002 final rule, published November 1, 2001 (66 FR 
55246).) The SMS PE survey data are adjusted to a common year, 1995. 
The SMS data provide the following six categories of PE costs:
     Clinical payroll expenses, which are payroll expenses 
(including fringe benefits) for nonphysician personnel.
     Administrative payroll expenses, which are payroll 
expenses (including fringe benefits) for nonphysician personnel 
involved in administrative, secretarial or clerical activities.
     Office expenses, which include expenses for rent, mortgage 
interest, depreciation on medical buildings, utilities and telephones.
     Medical material and supply expenses, which include 
expenses for drugs, x-ray films, and disposable medical products.
     Medical equipment expenses, which include expenses 
depreciation, leases, and rent of medical equipment used in the 
diagnosis or treatment of patients.
     All other expenses, which include expenses for legal 
services, accounting, office management, professional association 
memberships, and any professional expenses not mentioned above.
    In accordance with section 212 of the Medicare, Medicaid and State 
Child Health Insurance Program Balanced Budget Refinement Act of 1999 
(BBRA) (Pub. L. 106-113), we established a process to supplement the 
SMS data for a specialty with data collected by entities and 
organizations other than the AMA (that is, the specialty itself). (See 
the Criteria for Submitting Supplemental Practice Expense Survey Data 
interim final rule with comment period, published on May 3, 2000 (65 FR 
25664).) Originally, the deadline to submit supplementary survey data 
was through August 1, 2001. In the Revisions to Payment Policies and 
Five-Year Review of and Adjustments to the Relative Value Units Under 
the Physician Fee Schedule for CY 2002 final rule (November 1, 2001; 66 
FR 55246), the deadline was extended through August 1, 2003. To ensure 
maximum opportunity for specialties to submit supplementary survey 
data, we extended the deadline to submit surveys until March 1, 2005 in 
the Revisions to Payment Policies Under the Physician Fee Schedule for 
CY 2004 final rule, (November 7, 2003; 68 FR 63196) (hereinafter 
referred to as CY 2004 PFS final rule).
    The CPEPs consisted of panels of physicians, practice 
administrators, and nonphysicians (registered nurses (RNs), for 
example) who were nominated by physician specialty societies and other 
groups. There were 15 CPEPs consisting of 180 members from more than 61 
specialties and subspecialties. Approximately 50 percent of the 
panelists were physicians.
    The CPEPs identified specific inputs involved in each physician 
service provided in an office or facility setting. The inputs 
identified were the quantity and type of nonphysician labor, medical 
supplies, and medical equipment.
    In 1999, the AMA's RUC established the Practice Expense Advisory 
Committee (PEAC). Since 1999, and until March 2004, the PEAC, a multi-
specialty committee, reviewed the original CPEP inputs and provided us 
with recommendations for refining these direct PE inputs for existing 
CPT codes. Through its last meeting in March 2004, the PEAC provided 
recommendations, which we have reviewed and accepted, for over 7,600 
codes. As a result, the current CPEP inputs differ markedly from those 
originally recommended by the CPEPs. The PEAC has now been replaced by 
the Practice Expense Review Committee (PERC), which acts to assist the 
RUC in recommending PE inputs.
b. Allocation of PEs to Services
    To establish PE RVUs for specific services, it is necessary to 
establish the direct and indirect PE associated with each service. Our 
current approach allocates aggregate specialty practice costs to 
specific procedures and, thus, is often referred to as a ``top-down'' 
approach. The specialty PEs are derived from the AMA's SMS survey and 
supplementary survey data. The PEs for a given specialty are allocated 
to the services performed by that specialty on the basis of the CPEP 
data and work RVUs assigned to each CPT code. The specific process is 
detailed as follows:

Step 1--Calculation of the SMS Cost Pool for Each Specialty

    The six SMS cost categories can be described as either direct or 
indirect expenses. The three direct expense categories include clinical 
labor, medical supplies and medical equipment. Indirect expenses 
include administrative labor, office expense, and

[[Page 37243]]

all other expenses. We combine these indirect expenses into a single 
category. The SMS cost pool for each specialty is calculated as 
follows:
     The specialty PE/HR for each of the three direct and one 
indirect cost categories from the SMS is calculated by dividing the 
aggregate PE per specialty by the specialty's total hours spent in 
patient care activities (also determined by the SMS survey). The PE/HR 
is divided by 60 to obtain the PE per minute (PE/MIN).
     Each specialty's PE pools (for each of the three direct 
and one indirect cost categories) are created by multiplying the PE/MIN 
for the specialty by the total time the specialty spent treating 
Medicare patients for all procedures (determined using Medicare 
utilization data). Physician time on a procedure-specific level is 
available through RUC surveys of new or revised codes and through 
surveys conducted as part of the 5-Year Review process. For codes that 
the RUC has not yet reviewed, the original data from the Harvard 
resource-based RVU system survey are used. Physician time includes time 
spent on the case prior to, during, and after the procedure. The 
physician procedure time is multiplied by the frequency that each 
procedure is performed on Medicare patients by the specialty.
     The total specialty-specific SMS PE for each cost category 
is the sum, for each direct and indirect cost category, of all of the 
procedure-specific total PEs.

Step 2--Calculation of CPEP Cost Pool

    CPEP data provide expenditure amounts for the direct expense 
categories (clinical labor, supplies and equipment cost) at the 
procedure level. Multiplying the CPEP procedure-level PEs for each of 
these three categories by the number of times the specialty provided 
the procedure, produces a total category cost, per procedure, for that 
specialty. The sum of the total expenses from each procedure results in 
the total CPEP category cost for the specialty.

Step 3--Calculation and Application of Scaling Factors

    This step ensures that the total of the CPEP costs across all 
procedures performed by the specialty equates with the total direct 
costs for the specialty as reflected by the SMS data. To accomplish 
this, the CPEP data are scaled to SMS data by a scaling factor so that 
the total CPEP costs for each specialty equals the total SMS cost for 
the specialty. (The scaling factor is calculated by dividing the 
specialty's SMS pool by the specialty's CPEP pool.)
    The unscaled CPEP cost per procedure value, at the direct cost 
level, is then multiplied by the respective specialty scalar to yield 
the scaled CPEP procedure value. The sum of the scaled CPEP direct cost 
pool expenditures equals the total scaled direct expense for the 
specific procedure at the specialty level.

Step 4--Calculation of Indirect Expenses

    Indirect PEs cannot be directly attributed to a specific service 
because they are incurred by the practice as a whole. Indirect costs 
include rent, utilities, office equipment and supplies, and accounting 
and legal fees. There is not a single, universally accepted approach 
for allocating indirect practice costs to individual procedure codes. 
Rather allocation involves judgment in identifying the base or bases 
that are the best measures of a practice's indirect costs.
    To allocate the indirect PEs to a specific service, we use the 
following methodology:
     The scaled direct expenses and the converted work RVU (the 
work RVU for the service is multiplied by $34.5030, the 1995 CF) are 
added together, and then multiplied by the number of services provided 
by the specialty to Medicare patients;
     The total indirect PEs per specialty are calculated by 
summing the indirect expenses for all other procedures provided by that 
specialty.

Step 5--Calculation and Application of Indirect Scaling Factors

    Similar to the direct costs, the indirect costs are scaled to 
ensure that the total across all procedures performed by the specialty 
equates with the total indirect costs for the specialty as reflected by 
the SMS data. To accomplish this, the indirect costs calculated in Step 
4 are scaled to SMS data. The calculation of the indirect scaling 
factors is as follows:
     The specialty's total SMS indirect expense pool is divided 
by the specialty's total indirect expense pool calculated in Step 4, to 
yield the indirect expense scaling factor.
     The unscaled indirect expense amount, at the procedure 
level, is multiplied by the specialty's scaling factor to calculate the 
procedure's scaled indirect expenses.
     The sum of the scaled indirect expense amount and the 
procedure's direct expenses yields the total PEs for the specialty for 
this procedure.

Step 6--Weighted Average of RVUs for Procedures Performed by More Than 
One Specialty

    For codes that are performed by more than one specialty, a weighted 
average PE is calculated based on Medicare frequency data of all 
specialties performing the procedure.

Step 7--Budget Neutrality and Final RVU Calculation

    Section 1848(c)(2)(B)(ii)(II) of the Act provides that adjustments 
in RVUs may not cause total PFS payments to differ by more than $20 
million from what they would have been if the adjustments were not 
made. If the aggregate adjustments to PE RVUs would cause PFS 
expenditures to exceed the $20 million threshold, the total scaled 
direct and indirect inputs are then adjusted by a budget neutrality 
factor (BNF) to calculate RVUs. Budget neutrality for the upcoming year 
is determined relative to the sum of PE RVUs for the current year. 
Although the PE RVUs for any particular code may vary from year-to-
year, the sum of PE RVUs across all codes is set equal to the current 
year. The BNF is equal to the sum of the current year's PE RVUs, 
divided by the sum of the direct and indirect inputs across all codes 
for the upcoming year. The BNF is applied to (multiplied by) the scaled 
direct and indirect expenses for each code to set the PE RVU for the 
upcoming year.
c. Other Methodological Issues: Non-Physician Work Pool (NPWP)
    As an interim measure, until we could further analyze the effect of 
the top-down methodology on the Medicare payment for services with no 
physician work (including the technical components (TCs) of radiation 
oncology, radiology and other diagnostic tests), we created a separate 
PE pool for these services. However, any specialty society could 
request that its services be removed from the non-physician work pool 
(NPWP). We will remove services from the NPWP if we find that the 
requesting specialty provides the service the majority of the time.

NPWP Step 1--Calculation of the SMS Cost Pool for Each Specialty

    This step parallels the calculations described above for the 
standard ``top-down'' PE allocation methodology. For codes in the NPWP, 
the direct and indirect SMS costs are set equal to the weighted average 
of the PE/HR for the specialties that provide the services in the pool. 
Clinical staff time is substituted for physician time in the 
calculation. The clinical staff time for the code is from CPEP data. 
Otherwise,

[[Page 37244]]

the calculation is similar to the method described previously for codes 
with physician time.

NPWP Step 2--Calculation of Charge-based PE RVU Cost Pool

    The NPWP calculation uses the 1998 (charge-based) PE RVU value for 
the code, multiplied by the 1995 CF (25.74 x $34.503 = $888.11). The 
percentage of clinical labor, supplies and equipment are the percentage 
that each PE category represents for all physicians relative to the 
total PE for all physicians (calculated from the SMS data).

NPWP Step 3--Calculation and Application of Scaling Factors

    After the total cost pools for each specialty and code performed by 
the specialty are calculated, the steps to ensure the total costs for 
all of the procedures performed by a specialty do not exceed the total 
costs for the specialty (scaling) are the same as those described 
previously for codes with physician work.

NPWP Step 4--Calculation of Indirect Expenses

    Because codes in the NPWP do not have work RVUs, indirect expenses 
are set equal to direct expenses (for codes with physician work, 
indirect expenses equal the sum of the scaled direct expenses and the 
converted work RVU). This amount is then multiplied by the number of 
times the procedure is performed.

NPWP Step 5--Calculation and Application of Indirect Scaling Factors

    Similar to the direct costs, the indirect costs are scaled to 
ensure that the total of the charge-based PE RVU costs across all 
procedures equates with the total indirect costs as reflected by the 
SMS data for the NPWP. To accomplish this, the charge-based data are 
scaled to SMS data so the total charge-based costs equal the total SMS 
costs.

NPWP Step 6--Budget Neutrality and Final RVU Calculation

    Similar to the calculation for codes with physician work, when a 
budget neutrality adjustment is necessary, the BNF is applied to 
(multiplied by) the scaled direct and indirect expenses for each code 
to set the PE RVU for the upcoming year.
d. Facility/Non-facility Costs
    Procedures that can be performed in a physician's office, as well 
as in a hospital have two PE RVUs: Facility and non-facility. The non-
facility setting includes physicians' offices, patients' homes, 
freestanding imaging centers, and independent pathology labs. Facility 
settings include hospitals, ambulatory surgical centers (ASCs), and 
skilled nursing facilities (SNFs). The methodology for calculating the 
PE RVU is the same for both facility and non-facility RVUs, but is 
applied independently to yield two separate PE RVUs. Because the PEs 
for services provided in a facility setting are generally included in 
the payment to the facility (rather than the payment to the physician 
under the fee schedule), the PE RVUs are generally lower for services 
provided in the facility setting.
2. PE Proposals Methodology for CY 2006
    The following discussions outline the specific PE related proposals 
for CY 2007.
    We have three major goals for our resource-based PE methodology:
     To ensure that the PE portion of PFS payments reflect, to 
the greatest extent possible, the relative resources required for each 
of the services on the PFS. This could only be accomplished by using 
the best available data to calculate the PE RVUs.
     To develop a payment system for PE that is understandable 
and at least somewhat intuitive, so that specialties could better 
predict the impacts of changes in the PE data.
     To stabilize the PE portion of PFS payments so that 
changes in PE RVUs do not produce large fluctuations in the payment for 
given procedures from year-to-year.
    These goals have also been supported in numerous comments we have 
received from the medical community.
    In the CY 2006 PFS proposed rule (70 FR 45764), we proposed the 
following changes to the PE methodology that we believed would help in 
achieving our three major goals (stated above in this section):
     Using the PE/HR data from seven specialty-specific 
supplementary surveys.
     Calculating the direct PE using a bottom-up methodology.
     Eliminating the NPWP.
    We also proposed an indirect PE methodology that was to assign to 
each service the higher of the current indirect PE RVUs or the indirect 
PE RVUs calculated using the supplementary survey data.
    In the CY 2006 PFS final rule with comment period (70 FR 70116), we 
withdrew these proposals primarily because a programming error for the 
indirect PE RVU calculation had led to the publication of inaccurate 
proposed PE RVUs. On February 15, 2006, we sponsored a PE Town Hall 
Meeting and invited the public, including all specialty representatives 
to attend. At this meeting, we supplied a detailed description of the 
bottom-up approach to the calculation of resource-based PE RVUs. Three 
examples were examined in detail that illustrated the impact of the 
various assumptions that could be used under a bottom-up approach. We 
specifically requested input from all interested parties on possible 
changes to our PE methodology, including the move to a bottom-up 
approach and the various methods of calculating indirect PE.
    We have reviewed the approximately 35 comments that we received in 
response to our solicitation. Many of the comments were combined 
efforts from related specialty organizations. Additionally, the AMA RUC 
also supplied a letter that captured the comments of nearly 30 
specialty organizations. The following is a summary of some of the 
comments we received.
     Delaying Implementation of Changes to the Current PE 
Methodology: There were mixed opinions from commenters on whether we 
should proceed with a proposal to use a bottom-up approach. Some 
commenters emphasized that the CPEP data has been refined and is now 
the best available source of data, and asserted that it should be used 
for the calculation of resource-based PE RVUs. Other comments suggested 
a delay in changing to a bottom-up approach because of the other issues 
that are affecting PFS payments this year (such as, the effect of 
imaging payment provisions in the Deficit Reduction Act (DRA), the 
impact of the negative update, and the uncertainty regarding the impact 
of the 5-Year Review of work RVUs).
     Transition to a Bottom-Up Approach: The majority of 
commenters requested a minimum one-year transition to a maximum 3-year 
transition period to fully implement any change to a bottom-up 
approach. All of the commenters supported a transition period whether 
or not they supported the implementation of a bottom-up approach.
     Use of Supplemental Survey Data: A large number of 
commenters stated that, irrespective of what we propose for 2007, the 
supplemental survey data that has already been accepted should be used. 
Other commenters believed that the supplemental survey data grossly 
overstated PEs and should not be utilized in the development of 
resource based PE RVUs.
     Multi-Specialty PE Survey: The majority of commenters 
supported the construction and use of a multi-

[[Page 37245]]

specialty survey to collect PE data. Commenters believed that the 
supplemental survey data is inflated and that the SMS survey data are 
outdated.
     Review Equipment Utilization Assumptions and Interest 
Rates: Many commenters supported the review and revision of both the 
current utilization assumptions and the interest rates associated with 
high cost equipment. Commenters had mixed reactions as to whether the 
utilization rates should be higher or lower, and some suggested that we 
review the possibility of equipment-specific utilization assumptions 
for the future. Most commenters believed that the current 11 percent 
interest rate is significantly higher then the actual interest rates 
and many commenters suggested a rate of approximately prime plus 2 
percent.
     Proxy Work RVUs for No Physician Work Services: Commenters 
were divided on the assignment of a proxy work RVU to services that 
contain no physician work. Some commenters believed that no physician 
work services are unfairly penalized under any bottom-up approach, 
while other comments stated that the inclusion of a proxy work RVU 
would double count the clinical labor associated with the no physician 
work services.
    After considering the comments we received on the CY 2006 PFS 
proposed rule (70 FR 45764) and in response to comments received during 
and following the Town Hall meeting, we believe that the use of a 
bottom-up methodology for direct costs, use of the supplementary survey 
data and elimination of the NPWP would assist us in meeting our goal of 
a PE methodology that is equitable, understandable and stable. 
Therefore, we are again proposing these changes to our PE methodology. 
We are also proposing a change in the methodology used to calculate the 
indirect PE for each service that is different than previously 
proposed. The following is a summary of our proposals.
a. Use a Bottom-Up Method to Calculate the Direct PEs
    We believe that we have consistently made a good faith effort to 
ensure fairness in our PE RVU-setting system by using the best data 
available at any one time. The reason we did not adopt the bottom-up 
methodology originally proposed in 1997 and instead adopted the top-
down methodology finalized in 1998 was because we recognized the 
concerns among the physician community that the resource input data 
developed in 1995 by the CPEP were less reliable than the aggregate 
specialty cost data derived from the SMS process.
    However, the situation has now changed. The PEAC/PERC/RUC has 
completed the refinement of the original CPEP data and we believe that 
the refined PE inputs now, in general, accurately capture the relative 
direct costs of performing PFS services. Conversely, although we have 
now accepted supplementary survey data from 13 specialties, we have not 
received updated aggregate cost data from most specialties. Thus, we 
believe that, in the aggregate, the refined CPEP data represent more 
reliably the relative direct cost PE inputs for physicians' services.
    Therefore, instead of using the top-down approach to calculate the 
direct PE RVUs, where the aggregate CPEP/RUC costs for each specialty 
are scaled to match the aggregate SMS costs, we propose to adopt a 
bottom-up method of determining the relative direct costs for each 
service. Under this method, the direct costs would be determined by 
adding the costs of the resources (that is, the clinical staff, 
equipment and supplies) typically required to provide the service. The 
costs of the resources, in turn, would be calculated from the refined 
CPEP/RUC inputs in our PE database.
    We believe that this proposed change, which was welcomed by most 
commenters in the CY 2006 PFS proposed rule, will lead to greater 
stability and accuracy in the PE portion of our payment system. 
Currently, under the top-down methodology, the need to scale the CPEP 
costs to equal the SMS costs meant that any changes in the direct PE 
inputs for one service often leads to unexpected results for other 
services where the inputs had not been altered. In addition, the 
current PE RVUs for a procedure do not necessarily change 
proportionately with changes in the direct inputs, creating possible 
anomalous values. We believe that our proposed bottom-up methodology 
would resolve these issues, so that changes in the PE RVUs would be 
more intuitive and would result in fewer surprises.
b. Use the PE/HR Data From the Seven Surveys We Have Previously 
Accepted and, in Addition, Use the PE/HR Data From the Survey Submitted 
by the National Coalition of Quality Diagnostic Imaging Services 
(NCQDIS)
    As explained in the CY 2005 PFS final rule with comment period (69 
FR 66242), we received surveys from the ACC, the ACR, and the ASTRO by 
March 1, 2004. The data submitted by the ACC and the ACR met our 
criteria. However, as requested by the ACC and the ACR, we deferred 
using their data until issues related to the NPWP could be addressed. 
(The survey data from ASTRO did not meet the precision criteria 
established for supplemental surveys; therefore, we did not accept or 
use it in the calculation of PE RVUs for 2005.)
    In March 2005, we also received surveys from the Association of 
Freestanding Radiation Oncology Centers (AFROC), the AUA, the AAD, the 
JCAAI, the NCQDIS, and a joint survey from the American 
Gastroenterological Association (AGA), the American Society of 
Gastrointestinal Endoscopy (ASGE) and the American College of 
Gastroenterology (ACG).
    All the surveys, with the exception of the survey from NCQDIS, met 
our criteria. Therefore, we proposed in the CY 2006 PFS proposed rule 
(70 FR 45775) to use the survey data from all the surveys meeting our 
criteria in the calculation of PE RVUs for 2006; but, as discussed in 
the CY 2006 PFS final rule with comment period (70 FR 70116) and above 
in this section, this proposal was not finalized.
    We contracted with the Lewin Group (Lewin) to evaluate whether the 
supplemental survey data that were submitted met our criteria and to 
make recommendations to us regarding their suitability for use in 
calculating PE RVUs. As described in the CY 2006 PFS proposed rule (70 
FR 45775), Lewin recommended blending the radiation oncology data from 
the AFROC survey data with the ASTRO survey data submitted in 2004 to 
calculate the PE/HR. According to Lewin, the goal of the AFROC survey 
was to represent the population of freestanding radiation oncology 
centers only. To develop an overall average for the radiation oncology 
PE pool, the Lewin Group recommended we use the AFROC survey for 
freestanding radiation oncology centers, and the hospital-based subset 
of last year's ASTRO survey. We agreed that this blending of the AFROC 
and ASTRO data was a reasonable way to calculate an average PE/HR that 
fully reflects the practice of radiation oncology in all settings. 
Blending the survey data overcame the initial problem that the ASTRO 
data do not meet the precision criteria as discussed in the CY 2005 PFS 
final rule (69 FR 66242). In addition, as discussed in the CY 2006 PFS 
proposed rule (70 FR 45776), blending of the data allowed for a broader 
base of radiation oncology providers to be represented.
    Also, as discussed in the CY 2006 PFS proposed rule (70 FR 45764), 
Lewin indicated that the survey data submitted

[[Page 37246]]

by the NCQDIS on independent diagnostic testing facilities (IDTFs) did 
not meet our precision criterion. However, upon further analysis, Lewin 
agreed with NCQDIS' determination that the inclusion of one inaccurate 
record skewed the findings outside the acceptable precision range. 
Lewin recalculated the precision level at 8.1 percent of the mean PE/HR 
(weighted by the number of physicians in the practice). Lewin indicated 
that the level of precision for the total PE/HR satisfies the level of 
precision requirement, and recommended acceptance of the survey.
    We are now proposing to use the PE/HR data from all of the above 
surveys, including the NCQDIS survey, in the calculation of the PE RVUs 
for 2007. We are again proposing for radiation oncology to use the new 
PE/HR derived from combining the AFROC and ASTRO survey data, as 
recommended by Lewin.
    We propose to use the PE per physician hour figures in Table 52. It 
should be noted that the relatively high PE per physician hour values 
for IDTFs result from the fact that there are far fewer hours for this 
specialty than most others. IDTFs use relatively few physician hours, 
so the same practice expenses in the numerator divided by the smaller 
denominator results in considerably higher values for practice expenses 
per hour. Although these values of PE/HR appear to be outliers, they 
actually contribute little to the overall value for practice expenses 
per hour, because the volume of each of the services performed by the 
IDTFs represents a relatively small percentage of the total services.

                                                 Table 52.--Practice Expense Per Physician Hour Figures
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                 Clinical                                   Administrative       Office        Other
                          Specialty                               labor        Supplies      Equipment          expense         expense       expense
--------------------------------------------------------------------------------------------------------------------------------------------------------
Allergy/Immunology...........................................         65.9           22.5            6.3                56.3         65.9           31.1
Cardiology...................................................         59.6           25.9           18.6                53.3         52.7           25
Dermatology..................................................         40.6           15.4           11                  51.5         78.8           28.2
Gastro-enterology............................................         30.2            8.2            5.9                39.6         48.4           13.3
IDTF.........................................................        111.6           55            302.5               155.5        121.2          189.5
Radiology....................................................         29.1           11.3           27.3                37.8         23.9           44.8
Radiation Oncology...........................................         49.7            4.8           27.6                26           39.7           28.1
Urology......................................................         27.9           14.4           11.2                42.3         53.8           23.4
--------------------------------------------------------------------------------------------------------------------------------------------------------

    Section 303(a)(1)(B) of the Medicare Prescription Drug, 
Improvement, and Modernization Act of 2003 (MMA) (Pub. L. 108-173) 
added section 1848(c)(2)(I) of the Act to require CMS to use survey 
data submitted by a specialty group where at least 40 percent of the 
specialty's payments for Part B services are attributable to the 
administration of drugs in 2002 to adjust PE RVUs for drug 
administration services. The statute applies to surveys that include 
expenses for the administration of drugs and biologicals, and were 
received by March 1, 2005 for determining the CY 2006 PE RVUs. Section 
303(a)(1)(A)(ii) of the MMA also added section 1848(c)(2)(B)(iv)(II) of 
the Act to provide an exemption from budget neutrality in 2005 and 2006 
for any additional expenditures resulting from the use of these 
surveys. In the Changes to Medicare Payment for Drugs and Physician Fee 
Schedule Payments for CY 2004 interim final rule published January 7, 
2004 (69 FR 1084), we stated that the specialties of urology, 
gynecology, and rheumatology meet the above criteria. As described in 
the CY 2006 PFS final rule with comment period (70 FR 70116), we 
accepted for the purposes of calculating the 2006 PE RVUs for drug 
administration services the new survey data from the AUA and exempted 
from the budget neutrality adjustment any impacts of accepting these 
data for purposes of calculating PE RVUs for drug administration 
services. (Note: Rheumatology and gynecology did not submit 
supplemental survey data.)
c. Eliminate the NPWP and Calculate the PE RVUs for All Services Using 
the Same Methodology
    Primarily because of the lack of representative SMS data or 
accurate direct cost inputs for specialties such as radiology and 
radiation oncology, the adoption of the top-down approach necessitated 
the creation of the NPWP. This separate work pool was created to 
allocate PE RVUs for TC codes and codes that are not performed by 
physicians and, thus, have no work RVUs. In the CY 2000 Physician Fee 
Schedule; Payment Policies and Relative Value Unit Adjustment final 
rule, we indicated that ``the purpose of this pool was only to protect 
the (TC) services from the substantial decreases'' caused by inaccurate 
CPEP data and the lack of physician work RVU in the allocation of the 
indirect costs (64 FR 59406). Unfortunately, the services priced by the 
NPWP methodology have proven to be especially vulnerable to any change 
in the work pool's composition. This has led to significant 
fluctuations from year to year in the PE RVUs calculated for these 
services.
    The major specialties comprising the NPWP (radiology, radiation 
oncology and cardiology) have now submitted supplemental survey data 
that we have accepted and are proposing to use in their PE 
calculations. (See the discussion on supplementary surveys above in 
this section.) Now that we have representative aggregate PE data for 
these specialties, and with the completion of the refinement of the 
direct cost inputs, the continued necessity and equity of treating 
these technical services outside the PE methodology applied to other 
services is questionable.
    Therefore, we are proposing to eliminate the NPWP and to calculate 
the PE RVUs for the services currently in the work pool by the same 
methodology used for all other services. This would also allow the use 
of the refined CPEP/RUC data to price the direct costs of individual 
services, rather than utilizing the pre-1998 charge-based PE RVUs. In 
addition, this proposal would lead to greater stability for the PE RVUs 
for these services and would lead to more intuitive results than have 
occurred with the NPWP methodology.
d. Modify the Current Indirect PE RVUs Methodology
    As described previously, the SMS and supplementary survey data are 
the source for the specialty-specific aggregate indirect costs used in 
our PE calculations. We then allocate the indirect costs to particular 
codes on the basis of the direct costs allocated to a code and the work 
RVUs. In the CY 2006 PFS proposed rule (70 FR 45764), we stated that we 
had no information that would indicate that the current indirect PE 
methodology is inaccurate. At that time, we also were not aware of

[[Page 37247]]

any alternative approaches or data sources that we could use to 
calculate more appropriately the indirect PE, other than the new 
supplementary survey data, which we propose to incorporate into our PE 
calculations. Therefore, we proposed to use the current indirect PEs in 
our calculation, incorporating the new survey data into the codes 
performed by the specialties submitting the surveys. We also indicated 
in that same proposed rule that we would welcome any suggestions that 
would assist us in further refinement of this indirect PE methodology. 
For example, we were considering whether we should continue to accept 
supplementary survey data or whether it would be preferable and 
feasible to have an SMS-type survey of only indirect costs for all 
specialties, or whether a more formula-based methodology independent of 
the SMS data should be adopted, perhaps using the specialty-specific 
indirect-to-total cost percentage as a basis of the calculation. For a 
prior discussion of many of the issues associated with allocating 
indirect costs, please refer to the CY 2000 Physician Fee Schedule; 
Payment Policies and Relative Value Unit Adjustment proposed rule (63 
FR 30823).
3. Modifications to PE Proposals
    As a result of collaboration with the PFS community and public 
comments on this issue, we are now in a position to propose 
modifications to the indirect PE methodology.
a. Indirect Percentage Factor: Use of the Specialty-Specific Percentage 
That Indirect PEs Represent of Total PEs Based on the Survey Data
    We currently allocate indirect expenses on the sum of the direct 
expenses and the work RVUs (converted to dollars by multiplying by the 
CF). We are proposing to allocate indirect expenses by applying a 
specialty-specific indirect percentage factor to the direct expenses in 
order to recognize the varying proportion that indirect costs represent 
of total costs by specialty. This would have the effect of relatively 
increasing the indirect expense allocation for services that are on 
average performed by specialties with higher indirect PE percentages, 
and relatively decreasing the indirect expense allocation for services 
that are performed by specialties with lower indirect PE percentages. 
For a given service, the specific indirect percentage factor to apply 
to the direct costs for the purpose of the indirect allocation would be 
calculated as the weighted average of the ratio of the indirect to 
direct costs (based on the survey data) for the specialties that 
perform the code. For example, if a service is performed by a single 
specialty with indirect PEs that were 75 percent of total PEs, the 
indirect percentage factor to apply to the direct costs for the 
purposes of the indirect allocation would be (0.75/0.25) = 3.0.
b. Continued Use of the Specialty-Specific Indirect Scaling Factors
    As described earlier, we incorporate the indirect PE/HR surveys 
into the methodology through the use of specialty-specific indirect 
scaling factors. We would continue to use the specialty-specific 
indirect scaling factors; however, to apply them in a simpler manner we 
propose to create an index. This index would reflect the relationship 
between each specialty's indirect scaling factor and the overall 
indirect scaling factor for the entire PFS. For example, if a specialty 
had an indirect practice cost index of 2.00, this specialty would have 
an indirect scaling factor that was twice the overall average indirect 
scaling factor. If a specialty had an indirect practice cost index of 
0.50, this specialty would have an indirect scaling factor that was 
half the overall average indirect scaling factor. The calculation and 
application of the indirect practice cost index is described in more 
detail below in this section.
c. Use of the Clinical Labor Costs in the Indirect Allocation for a 
Service When the Clinical Labor Costs are Greater Than the Physician 
Work RVU
    We have received numerous comments that services with little or no 
physician work RVUs are disadvantaged under our current indirect 
allocation methodology based on the direct costs and the work RVUs. In 
response to these comments, when the clinical labor portion of the 
direct PE RVU is greater than the physician work RVU for a particular 
service, we are proposing to allocate on the direct costs and the 
clinical labor costs. For example, if a service has no physician work, 
the direct PE RVU is 1.10 and the clinical labor portion of the direct 
PE RVU is 0.65 RVUs, we would use the 1.10 direct PE RVUs and the 0.65 
clinical labor portion of the direct PE RVUs for the indirect PE 
allocation for that service. As another example, if the physician work 
RVUs for a service are 0.25, the direct PE RVU is 1.10 and the clinical 
labor portion of the direct PE RVU is 0.65 RVUs, we would use the 1.10 
direct PE RVUs and the 0.65 clinical labor RVUs for the indirect 
allocation for that service. We would not use the 0.25 physician work 
RVUs for the indirect PE allocation since the 0.65 clinical labor RVUs 
are greater than the 0.25 physician work RVUs.
d. Use of 2005 Utilization Data in the Indirect PE RVU Calculation
    Under the current PE methodology, we predominately use the 1997-
2000 utilization data in the calculation of the indirect PE RVUs when 
the service existed during 1997-2000 or the first year of utilization 
data if the service did not exist during that time period. We used 
those years of utilization data primarily to increase the year to year 
stability of the PE RVUs. With the changes we are proposing to make to 
PE RVUs, in particular the elimination of the NPWP, we will increase 
the year-to-year stability of the PE RVUs. We believe it is now 
appropriate to use updated utilization data in the calculation of the 
indirect PEs. We believe the other proposed changes in the PE 
methodology will help obtain the year-to-year stability we were 
attempting to achieve by continuing to use the older utilization data. 
Additionally, the use of more current utilization data would reflect 
the more current practice patterns. We are proposing to use the 2005 
utilization data in the calculation of the 2007 indirect PE RVUs. We 
are also seeking comments on whether the utilization data should be 
updated yearly, which would increase the accuracy of the PE 
calculations, or less often, which would increase the stability of the 
PE RVUs.
e. Elimination of the Special Methodologies for Services With Technical 
and Professional Components
    Under the PFS, when services have technical, professional, and 
global components that can be billed separately, the payment for the 
global component equals the sum of the payment for the technical and 
professional components. Under the current PE methodology, the 
different mix of specialties that perform the global, technical and 
professional components can cause the PE RVUs, otherwise created by the 
methodology, to fail to add together properly; that is, the global 
component does not equal the sum of the professional and technical 
components. The global component might exceed the sum of the technical 
and professional components or it might be less than the sum of the 
technical and professional components. We ensure that the technical and 
professional components add to the global component in one of two ways. 
For services in the NPWP, we set the PE RVUs for the global component 
equal to the sum of the professional component PE RVU and the technical 
component

[[Page 37248]]

PE RVU. For services outside the NPWP, we set the PE RVUs for the 
technical component equal to the difference between the global PE RVUs 
and the professional component RVUs.
    With our proposed change to a bottom-up methodology for the direct 
PEs, there would be no weighted averaging of the direct costs inputs 
necessary to create the direct PE RVUs and, therefore, the direct PE 
RVUs for the professional and technical components would sum to the 
global component. Under the current methodology, as a result of the 
process used to ensure the professional and technical components sum to 
the global, RVUs for a service with a global component can be either 
more or less than the RVUs that would have been calculated for the 
service if the professional and technical components did not have to 
sum to the global.
    Given the proposed change to bottom-up methodology and the 
elimination of the NPWP, we believe it is inappropriate to have codes 
for which the global, and the technical and professional components are 
assigned RVUs that are either less than or greater than the methodology 
would otherwise produce, and thus, are paid at a rate that is either 
less than or greater than the methodology would otherwise specify. (See 
section II.D.1. of this proposed notice for the discussion of the 
current methodology.) Therefore, we are proposing that in the 
calculation of the indirect percentage factor described earlier in 
section II.D.3.a., we would use a weighted average of the ratio of 
indirect to direct costs across all the specialties that perform the 
global, technical, and professional components; that is, we would apply 
the same weighted average indirect percentage factor to allocate 
indirect expenses to the global, professional, and technical components 
for a service. We also propose to utilize a similar weighted averaging 
approach across all the specialties that perform the components when 
calculating the indirect PE scaling factor. Because the direct PE RVUs 
for the technical and professional components sum to the global under 
the bottom-up methodology, and we are proposing to calculate the 
indirect percentage factor and the indirect scaling factor so that they 
do not vary between the technical, professional, and global components, 
our proposed methodology would create technical and professional 
components that sum to the global, and no other special methodology 
would need to be employed.
(i) Proposed PE RVU Methodology
    Below is a description of the proposed PE RVU methodology.
(a) Setup File
    First, we create a setup file for the PE methodology. The setup 
file contains the direct cost inputs, the utilization for each 
procedure code at the specialty and facility/nonfacility place of 
service level, and the specialty-specific survey PE per physician hour 
data. Information specific to the creation of the setup file can be 
found at the end of section II.D.
(b) Calculate the Direct Cost PE RVUs
    Sum the costs of each direct input.
    Step 1: Sum the direct costs of the inputs for each service. The 
direct costs consist of the costs of the direct inputs for clinical 
labor, medical supplies, and medical equipment. The clinical labor cost 
is the sum of the cost of all the staff types associated with the 
service; it is the product of the time for each staff type and the wage 
rate for that staff type. The medical supplies cost is the sum of the 
supplies associated with the service; it is the product of the quantity 
of each supply and the cost of the supply. The medical equipment cost 
is the sum of the cost of the equipment associated with the service; it 
is the product of the number of minutes each piece of equipment is used 
in the service and the equipment cost per minute. The equipment cost 
per minute is calculated as described at the end of this section.
    Apply a budget neutrality adjustment to the direct inputs.
    Step 2: Calculate the current aggregate pool of direct PE costs. To 
do this, multiply the current aggregate pool of total direct and 
indirect PE costs (that is, the current aggregate PE RVUs multiplied by 
the CF) by the average direct PE percentage from the SMS and 
supplementary specialty survey data.
    Step 3: Calculate the aggregate pool of proposed direct costs. To 
do this, for all PFS services, sum the product of the direct costs for 
each service from Step 1 and the utilization data for that service.
    Step 4: Using the results of Step 2 and Step 3 calculate a direct 
PE budget neutrality adjustment so that the proposed aggregate direct 
cost pool does not exceed the current aggregate direct cost pool and 
apply it to the direct costs from Step 1 for each service.
    Step 5: Convert the results of Step 4 to an RVU scale for each 
service. To do this, divide the results of Step 4 by the Medicare PFS 
CF.
(c) Create the Indirect PE RVUs
    Create indirect allocators.
    Step 6: Based on the SMS and supplementary specialty survey data, 
calculate direct and indirect PE percentages for each physician 
specialty.
    Step 7: Calculate direct and indirect PE percentages at the service 
level by taking a weighted average of the results of Step 6 for the 
specialties that perform the service. Note that for services with 
technical and professional components we are calculating the direct and 
indirect percentages across the global, professional and technical 
components. That is, the direct and indirect percentages for a given 
service (for example, echocardiogram) do not vary by the professional, 
technical and global components.
    Step 8: Calculate the service level allocators for the indirect PEs 
based on the percentages calculated in Step 7. The indirect PEs are 
allocated based on the three components: the direct PE RVU, the 
clinical PE RVU and the work RVU. (Note that the work RVU used in the 
calculation includes the separate work budget neutrality adjustment 
from the 5-Year Review of the work RVUs discussed elsewhere in this 
proposed notice.)
    For most services the indirect allocator is: Indirect percentage * 
(direct PE RVU/direct percentage) + work RVU.
    There are two situations where this formula is modified:
     If the service is a global service (that is, a service 
with global, professional and technical components), then the indirect 
allocator is: indirect percentage * (direct PERVU/direct percentage) + 
clinical PE RVU + work RVU.
     If the clinical labor PE RVU exceeds the work RVU (and the 
service is not a global service), then the indirect allocator is: 
indirect percentage * (direct PERVU/direct percentage) + clinical PE 
RVU.


    Note that for global services the indirect allocator is based on 
both the work RVU and the clinical labor PE RVU. We do this to 
recognize that, for the professional service, indirect PEs will be 
allocated using the work RVUs, and for the technical component 
service, indirect PEs will be allocated using the direct PE RVU and 
the clinical labor PE RVU. This also allows the global component 
RVUs to equal the sum of the professional and technical component 
RVUs.)

    For presentation purposes in the examples in the Table 53, the 
formulas are divided into two parts for each service. The first part 
does not vary by service and is the indirect percentage * (direct PE 
RVU/direct percentage). The second part is either the work RVU, 
clinical PE RVU, or both depending on whether the service is a global 
service and whether the clinical PE RVU

[[Page 37249]]

exceeds the work RVU (as described earlier in this step.)
    Apply a budget neutrality adjustment to the indirect allocators.
    Step 9: Calculate the current aggregate pool of indirect PE RVUs by 
multiplying the current aggregate pool of PE RVUs by the average 
indirect PE percentage from the physician specialty survey data. This 
is similar to the Step 2 calculation for the direct PE RVUs.
    Step 10: Calculate an aggregate pool of proposed indirect PE RVUs 
for all PFS services by adding the product of the indirect PE 
allocators for a service from Step 8 and the utilization data for that 
service. This is similar to the Step 3 calculation for the direct PE 
RVUs.
    Step 11: Using the results of Step 9 and Step 10, calculate an 
indirect PE adjustment so that the proposed aggregate indirect 
allocation does not exceed the available aggregate indirect PE RVUs and 
apply it to indirect allocators calculated in Step 8. This is similar 
to the Step 4 calculation for the direct PE RVUs.
    Calculate the Indirect Practice Cost Index.
    Step 12: Using the results of Step 11, calculate aggregate pools of 
specialty-specific adjusted indirect PE allocators for all PFS services 
for a specialty by adding the product of the adjusted indirect PE 
allocator for each service and the utilization data for that service.
    Step 13: Using the specialty-specific indirect PE/HR data, 
calculate specialty-specific aggregate pools of indirect PE for all PFS 
services for that specialty by adding the product of the indirect PE/HR 
for the specialty, the physician time for the service, and the 
specialty's utilization for the service.
    Step 14: Using the results of Step 12 and Step 13, calculate the 
specialty-specific indirect PE scaling factors as under the current 
methodology.
    Step 15: Using the results of Step 14, calculate an indirect 
practice cost index at the specialty level by dividing each specialty-
specific indirect scaling factor by the average indirect scaling factor 
for the entire PFS.
    Step 16: Calculate the indirect practice cost index at the service 
level to ensure the capture of all indirect costs. Calculate a weighted 
average of the practice cost index values for the specialties that 
perform the service. Note that for services with technical and 
professional components, we calculate the indirect practice cost index 
across the global, professional and technical components. Under this 
method, the indirect practice cost index for a given service (for 
example, echocardiogram) does not vary by the professional, technical 
and global components.
    Step 17: Apply the service level indirect practice cost index 
calculated in Step 16 to the service level adjusted indirect allocators 
calculated in Step 11 to get the indirect PE RVU.
(d) Calculate the Final PE RVUs
    Step 18: Add the direct PE RVUs from Step 6 to the indirect PE RVUs 
from Step 17.
    Step 19: Calculate and apply the final PE budget neutrality 
adjustment by comparing the results of Step 18 to the current pool of 
PE RVUs. This final budget neutrality adjustment is primarily required 
because certain specialties are excluded from the PE RVU calculation 
for ratesetting purposes, but all specialties are included for purposes 
of calculating the final budget neutrality adjustment. (See 
``Specialties excluded from rate-setting calculation'' below in this 
section.)
(e) Setup File Information
     Specialties excluded from rate-setting calculation: For 
the purposes of calculating the PE RVUs, we exclude certain specialties 
such as midlevel practitioners paid at a percentage of the PFS, 
audiology, and low volume specialties from the calculation. This is the 
same approach used under the current methodology. These specialties are 
included for the purposes of calculating the budget neutrality 
adjustment.
     Crosswalk certain low volume physician specialties: 
Crosswalk the utilization of certain specialties with relatively low 
PFS utilization to the associated specialties. This is the same 
approach used under the current methodology.
     Physical therapy utilization: Crosswalk physical therapy 
utilization to the specialty of physical therapy. This is the same 
approach used under the current methodology.
     Identify professional and technical services not 
identified under the usual TC and 26 modifier: Flag the services that 
are professional and technical component services, but do not use TC 
and 26 modifiers (for example, electrocardiograms). This flag 
associates the professional and technical component with the associated 
global code for use in creating the indirect PE RVU. For example, the 
professional service code 93010 is associated with the global code 
93000.
     Payment modifiers: Payment modifiers are accounted for in 
the creation of the file. For example, services billed with the 
assistant at surgery modifier are paid 16 percent of the PFS amount for 
that service; therefore, the utilization file is modified to only 
account for 16 percent of any service that contains the assistant at 
surgery modifier.
     Proposed work RVUs from the 5-Year Review: The setup file 
contains the proposed work RVUs from the 5-Year Review.
    The equipment cost per minute is calculated as:
(f) Equipment Cost Per Minute =
(1/(minutes per year * usage)) * price * ((interest rate/(1-(1/((1 + 
interest rate) * life of equipment))) + maintenance)

Where:
    Minutes per year = maximum minutes per year if usage were 
continuous (that is, usage = 1); 150,000 minutes.
    Usage = equipment utilization assumption; 0.5.
    Price = price of the particular piece of equipment.
    Interest rate = 0.11.
    Life of equipment = useful life of the particular piece of 
equipment.
    Maintenance = factor for maintenance; 0.05.

[[Page 37250]]

[GRAPHIC] [TIFF OMITTED] TN29JN06.055


[[Page 37251]]


[GRAPHIC] [TIFF OMITTED] TN29JN06.056

BILLING CODE 4120-01-C

[[Page 37252]]

(ii) Transition the Resulting Revised PE RVUs over a Four-Year Period
    A complete analysis of the impacts of these changes is contained in 
the impact analysis in section V. of this proposed rule. We are 
concerned that, when combined with a proposed negative update factor 
for CY 2007 and the proposed changes to the work RVUs under the 5-Year 
Review, the shifts in some of the PE RVUs resulting from the immediate 
implementation of our proposals could potentially cause some disruption 
for medical practices. Therefore, we are proposing to transition the 
proposed PE changes over a 4-year period. This would also give ample 
opportunity for us, as well as the medical specialties and the RUC, to 
identify any anomalies in the PE data, to make any further appropriate 
revisions, and to collect additional data as needed prior to the full 
implementation of the proposed PE changes.
    During the transition period, the PE RVUs would be calculated on 
the basis of a blend of RVUs calculated using our proposed methodology 
described above (weighted by 25 percent during CY 2007, 50 percent 
during CY 2008, 75 percent during CY 2009, and 100 percent 
thereinafter), and the current CY 2006 PE RVUs for each existing code. 
PE RVUs for codes that are new during this period would be calculated 
using only the proposed methodology, and paid at the fully transitioned 
rate. We believe that implementing all of these proposed changes would 
further our goal of producing a more accurate, more intuitive and more 
stable PE methodology.
    For example, as stated above in this section, now that the direct 
PE inputs have been refined, we believe that the proposed CPEP/RUC 
direct input data are superior to the specialty-specific SMS PE/HR data 
for the purposes of determining the typical direct PE resources 
required to perform each service on the PFS. First, we have received 
recommendations on the procedure-specific inputs from the multi-
specialty PEAC that were based on presentations from the relevant 
specialties, after the inputs were closely scrutinized by the PEAC 
using standards and packages that were agreed upon by all involved 
specialties. Second, the refined CPEP/RUC data are more current than 
the aggregate specialty-specific data for the majority of specialties. 
Third, for direct costs, we believe that it is reasonable to assume 
that the costs of the clinical staff, supplies and equipment are the 
same for a given service, regardless of the specialty that is 
performing it. This does not happen under the top-down direct cost 
methodology, where the specialty-specific scaling factors can create 
differing direct costs for the same service.
    We also believe the proposed methodology is less confusing and more 
intuitive than the current approach. First, the NPWP would be 
eliminated and all services would be priced using one methodology, 
eliminating the complicated calculations needed to price NPWP services. 
Second, any revisions made to the direct inputs for one or more 
services would now have predictable results. Changes in the direct 
practice inputs for a service would proportionately change the PE RVUs 
for that service without significantly affecting the PE RVUs for 
unrelated services (except, of course, to the extent that a budget 
neutrality adjustment is required to be applied by the statute).
    The proposed methodology would also create a system that would be 
significantly more stable from year-to-year than the current approach. 
Specialties should no longer experience the wide fluctuations in 
payment for a given service due to an aberrant direct cost scaling 
factor. Direct PEs should only change for a service if the service is 
further refined or when prices are updated, while indirect PEs should 
change only when there are changes in the mix of specialties furnishing 
the service or if any future new survey data for indirect costs are 
utilized.
    We recognize that there may be some outstanding issues that need 
further consideration, and we welcome input from the medical community 
regarding those issues. We also believe the proposed transition period 
would give us the opportunity to work with the affected specialties to 
collect any needed data or to determine whether further revisions to 
our PE methodology are needed before payment is based entirely on the 
proposed methodology. As we gain experience with the new methodology, 
we will reexamine this policy beginning next year and propose necessary 
revisions through future rulemaking.
    Therefore, we welcome all comments on these proposed changes, 
particularly those concerning additional modifications to the indirect 
PE methodology that might help us further our intended goals.

III. Collection of Information Requirements

    This document does not impose information collection and 
recordkeeping requirements. Consequently, it need not be reviewed by 
the Office of Management and Budget under the authority of the 
Paperwork Reduction Act of 1995 (44 U.S.C. 3501 et seq.)

IV. Response to Comments

    Because of the large number of public comments we normally receive 
on Federal Register documents, we are not able to acknowledge or 
respond to them individually. We will consider all comments received by 
the date and time specified in the DATES section of this preamble, and, 
we will respond to the comments in the CY 2007 Physician Fee Schedule 
final rule with comment period.

V. Regulatory Impact Analysis

    [If you choose to comment on issues in this section, please include 
the caption ``REGULATORY IMPACT ANALYSIS'' at the beginning of your 
comments.]

A. Overall Impact

    We have examined the impacts of this proposed notice as required by 
Executive Order 12866 (September 1993, Regulatory Planning and Review), 
the Regulatory Flexibility Act (RFA) (September 19, 1980, Pub. L. 96-
354), section 1102(b) of the Social Security Act, the Unfunded Mandates 
Reform Act of 1995 (Pub. L. 104-4), and Executive Order 13132.
    Executive Order 12866 (as amended by Executive Order 13258, which 
merely reassigns responsibilities of duties) directs agencies to assess 
all costs and benefits of available regulatory alternatives and, if 
regulation is necessary, to select regulatory approaches that maximize 
net benefits (including potential economic, environmental, public 
health and safety effects, distributive impacts, and equity). A 
regulatory impact analysis (RIA) must be prepared for major rules with 
economically significant effects ($100 million or more in any 1 year). 
As indicated in more detail below, we estimate that the PFS work RVU 
provisions included in this proposed notice will redistribute more than 
$100 million in one year. We are considering this proposed notice to be 
economically significant because its provisions are estimated to result 
in an increase, decrease or aggregate redistribution of Medicare 
spending that will exceed $100 million. Therefore, this proposed notice 
is a major rule and we have prepared a regulatory impact analysis.
    The RFA requires agencies to analyze options for regulatory relief 
of small businesses. For purposes of the RFA, small entities include 
small businesses,

[[Page 37253]]

nonprofit organizations, and small governmental jurisdictions. Most 
hospitals and most other providers and suppliers are small entities, 
either by nonprofit status or by having revenues of $6 million to $29 
million in any one year. We prepare a regulatory flexibility analysis 
unless we certify that a rule would not have a significant economic 
impact on a substantial number of small entities. The analysis must 
include a justification concerning the reason action is being taken, 
the kinds and number of small entities the rule affects, and an 
explanation of any meaningful options that achieve the objectives with 
less significant adverse economic impact on the small entities.
    Section 1102(b) of the Act requires us to prepare a regulatory 
impact analysis if a rule may have a significant impact on the 
operations of a substantial number of small rural hospitals. This 
analysis must conform to the provisions of section 603 of the RFA. For 
purposes of section 1102(b) of the Act, we define a small rural 
hospital as a hospital that is located outside a Metropolitan 
Statistical Area and has fewer than 100 beds. For purposes of the RFA, 
physicians, nonphysician practitioners, and suppliers are considered 
small businesses if they generate revenues of $6 million or less. 
Approximately 95 percent of physicians are considered to be small 
entities. There are over 980,000 physicians, other practitioners and 
medical suppliers that receive Medicare payment under the PFS. The 
analysis and discussion provided in this section, as well as elsewhere 
in this proposed notice, complies with the RFA requirements.
    Section 202 of the Unfunded Mandates Reform Act of 1995 also 
requires that agencies assess anticipated costs and benefits before 
issuing any rule whose mandates require spending in any one year of 
$100 million in 1995 dollars, updated annually for inflation. That 
threshold level is currently approximately $120 million. Medicare 
beneficiaries are considered to be part of the private sector for this 
purpose. A discussion concerning the impact of this proposed notice on 
beneficiaries is found later in this section.
    Executive Order 13132 establishes certain requirements that an 
agency must meet when it issues a proposed rule (and subsequent final 
rule) that imposes substantial direct requirement costs on State and 
local governments, preempts State law, or otherwise has Federalism 
implications.
    We have examined this proposed notice in accordance with Executive 
Order 13132 and have determined that this regulation would not have any 
significant impact on the rights, roles, or responsibilities of State, 
local, or tribal governments. A discussion concerning the impact of 
this proposed notice on beneficiaries is found later in this section.

B. Anticipated Effects

    We have prepared the following analysis, which, together with the 
information provided in the rest of this preamble, meets all assessment 
requirements. It explains the rationale for and purposes of the 
proposed notice; details the costs and benefits of the rule; analyzes 
alternatives; and presents the measures we propose to use to minimize 
the burden on small entities.
    Section 1848(c)(2)(B)(ii) of the Act requires that increases or 
decreases in RVUs may not cause the amount of expenditures for the year 
to differ by more than $20 million from what expenditures would have 
been in the absence of these changes. If this threshold is exceeded, we 
make adjustments to preserve budget neutrality. This year, the 
estimated $4 billion impact of proposed changes in work RVUs resulting 
from the 5-year refinement will require that a budget-neutrality 
adjustment be made. Revisions in payment policies, including the 
establishment of interim and final RVUs for coding changes that will be 
announced later this year, may result in additional budget-neutrality 
adjustments.
    We considered making the statutorily required budget-neutrality 
adjustment to account for the 5-Year Review of physician work by 
reducing all work RVUs. We estimate that all work RVUs would have to be 
reduced by 10 percent under this option. Alternatively, we considered 
making the budget neutrality adjustment to the PFS CF. This option 
would require an estimated 5 percent reduction in the CF and would also 
affect services that do not have work RVUs, and were thus not part of 
the 5-Year Review. Therefore, to confine the impact to services that 
have physician work RVUs, we are proposing to establish a budget 
neutrality adjustor that would reduce the work RVUs by an estimated 10 
percent to meet the provisions of section 1848(c)(2)(B)(ii) of the Act.
    Table 54 shows the specialty-level impact on payment of the work 
and PE changes discussed in this proposed notice for the CY 2007 
Medicare PFS, including the effect of the separate work budget 
neutrality adjustor discussed above. Because we have proposed a four-
year transition for the new PE changes, we also show the impact of the 
fully implemented PE changes in 2010. Our estimates of changes in 
Medicare revenues for PFS services compare payment rates for 2006 with 
proposed payment rates for 2007 and 2010 using 2005 Medicare 
utilization for all years. These impacts do not include estimates of 
the annual updates to the Medicare PFS CF for 2007 through 2010. We are 
using 2005 Medicare claims processed and paid through March 30, 2005, 
that we estimate are 98 percent complete. Using a single year of 
utilization, as opposed to multiple years, limits the estimated changes 
to the proposed work and PE. This approach is consistent with the 
methodology outlined in section II.D.3.d. of this proposed notice, 
``Use of 2005 utilization data in the indirect PE RVU calculation.'' To 
the extent that there are year-to-year changes in the volume and mix of 
services provided by physicians, the actual impact on total Medicare 
revenues will be different than those shown here. The payment impacts 
reflect averages for each specialty based on Medicare utilization. The 
payment impact for an individual physician would be different from the 
average, based on the mix of services the physician provides. The 
average change in total revenues would be less than the impact 
displayed here because physicians furnish services to both Medicare and 
non-Medicare patients and specialties may receive substantial Medicare 
revenues for services that are not paid under the PFS. For instance, 
independent laboratories receive approximately 80 percent of their 
Medicare revenues from clinical laboratory services that are not paid 
under the PFS.
    Table 54 shows only the payment impact on PFS services. The 
following is an explanation of the information represented in Table 54:
     Specialty: The physician specialty or type of 
practitioner/supplier.
     Allowed Charges: Allowed charges are the Medicare Fee 
Schedule amounts for covered services and include co-payments and 
deductibles (which are the financial responsibility of the 
beneficiary). These amounts have been summed across all services 
provided by physicians, practitioners or suppliers with a specialty to 
arrive at the total allowed charges for the specialty.
     Impact of Work RVU Changes: The percentage increase or 
decrease in allowed charges attributed to changes in the valuation of 
physician/clinical work for the given specialty.
     Impact of PE RVU Changes: The percentage increase or 
decrease in allowed charges attributed to changes in the valuation of 
practice expense for the services provided by physicians,

[[Page 37254]]

practitioners or suppliers within each specialty (shown in the first 
year of phase-in (2007) and at full implementation (2010)).
     Combined impact of Work and PE RVU changes: The percentage 
increase or decrease in allowed charges attributed to the sum of 
changes to the valuation of physician/clinical work and the valuation 
of practice expense for services provided by physicians, practitioners 
or suppliers within each specialty (shown in the first year of phase-in 
of PE changes (2007) and at full implementation of PE changes (2010)).
BILLING CODE 4120-01-P

[[Page 37255]]

[GRAPHIC] [TIFF OMITTED] TN29JN06.057

    This is the third 5-Year Review of physician work RVUs. The first 
5-Year Review occurred as part of the 1996 regulatory process and was 
effective for services furnished on or after January 1, 1997. The 
second 5-Year Review of

[[Page 37256]]

physician work RVUs occurred as part of the 2001 regulatory process and 
was effective for services furnished on or after January 1, 2002. Table 
55 compares some basic data points from the three 5-Year Reviews.
[GRAPHIC] [TIFF OMITTED] TN29JN06.058

BILLING CODE 4120-01-C

    We are currently developing the CY 2007 PFS proposed rule that will 
contain our estimate of all other proposed policies and changes that 
will affect payment for PFS services in CY 2007. We will show the 
combined impact of all policy and other changes affecting PFS payments 
in the final CY 2007 PFS rule.

C. Alternatives Considered

    This proposed notice discusses the proposed revisions to the work 
RVUs under the PFS. The preamble provides descriptions of the statutory 
provisions that are addressed, identifies those areas when discretion 
has been exercised, presents rationale for our decisions and, where 
relevant, alternatives that were considered.

D. Impact on Beneficiaries

    Overall, we believe these changes would improve beneficiary access 
to reasonable and necessary services since services would now be more 
appropriately valued. The payment changes would also affect beneficiary 
liability. Any changes in aggregate beneficiary liability from a 
particular work RVU change will be a function of the coinsurance (20 
percent if applicable for the particular service after the beneficiary 
has met the deductible) and the effect of the aggregate impact of the 
work RVU changes on the calculation of the Medicare Part B premium rate 
(generally, 25 percent of the aggregate payment change).

E. Accounting Statement

    As required by OMB Circular A-4 (available at http://www.whitehouse.gov/omb/circulars/a004/a-4.pdf), in Table 56, we have 
prepared an accounting statement showing the classification of the 
expenditures associated with the provisions of this proposed notice.
    Expenditures are classified as transfers between Medicare 
providers/suppliers (that is physicians, other practitioners medical 
suppliers, and providers that receive payment under or based on the 
PFS) and the Federal government. The -$40 million shown in Table 56 
represents the net impact of an increase in FY 2007 payments for 
mammography and a decrease in FY 2007 payments for physical therapy.

      Table 56.--Accounting Statement--Classification of Estimated
           Expenditures, from FY 2006 to FY 2007 (in millions)
------------------------------------------------------------------------
             Category                             Transfers
------------------------------------------------------------------------
Annualized Monetized Transfers      -$40
From Whom To Whom?................  Providers of physical therapy and
                                     mammography services that are paid
                                     based on Medicare Physician Fee
                                     Schedule to the Federal government.
------------------------------------------------------------------------

    In accordance with the provisions of Executive Order 12866, this 
proposed notice was reviewed by the Office of Management and Budget.

(Catalog of Federal Domestic Assistance Program No. 93.773, 
Medicare--Hospital Insurance; and Program No. 93.774, Medicare--
Supplementary Medical Insurance Program)

    Dated: May 4, 2006.
Mark B. McClellan,
Administrator, Centers for Medicare & Medicaid Services.

    Approved: June 9, 2006.
Michael O. Leavitt,
Secretary.

    Note: These addenda will not appear in the Code of Federal 
Regulations.

Addendum A: Explanation and Use of Addenda B

    The addenda on the following pages provide various data 
pertaining to the Medicare fee schedule for physicians' services 
furnished in 2007. Addendum B contains the RVUs for work, non-
facility PE, facility PE, and malpractice expense, and other 
information for all services included in the PFS.

[[Page 37257]]

    In previous years, we have listed many services in Addendum B 
that are not paid under the PFS. To avoid publishing as many pages 
of codes for these services, we are not including clinical 
laboratory codes and most alphanumeric codes (Healthcare Common 
Procedure Coding System (HCPCS) codes not included in CPT) in 
Addendum B.

Addendum B--2007 Relative Value Units and Related Information Used in 
Determining Medicare Payments for 2007

    This addendum contains the following information for each CPT 
code and alphanumeric HCPCS code, except for: alphanumeric codes 
beginning with B (enteral and parenteral therapy), E (durable 
medical equipment), K (temporary codes for nonphysicians' services 
or items), or L (orthotics); and codes for anesthesiology. The 
Addendum B included in this proposed notice does not include codes 
which are carrier priced since the RVUs for these services are set 
at 0.00.
    Please also note the following:
     An ``NA'' in the ``Non-facility PE RVUs'' column of 
Addendum B means that CMS has not developed a PE RVU in the non-
facility setting for the service because it is typically performed 
in the hospital (for example, an open heart surgery is generally 
performed in the hospital setting and not a physician's office).
     Services that have an ``NA'' in the ``Facility PE 
RVUs'' column of Addendum B are typically not paid using the PFS 
when provided in a facility setting. These services (which include 
``incident to'' services and the technical portion of diagnostic 
tests) are generally paid under either the outpatient hospital 
prospective payment system or bundled into the hospital inpatient 
prospective payment system payment.
    1. CPT/HCPCS code. This is the CPT or alphanumeric HCPCS number 
for the service. Alphanumeric HCPCS codes are included at the end of 
this addendum.
    2. Modifier. A modifier is shown if there is a technical 
component (modifier TC) and a professional component (PC) (modifier 
-26) for the service. If there is a PC and a TC for the service, 
Addendum B contains three entries for the code. A code for: the 
global values (both professional and technical); modifier -26 (PC); 
and, modifier TC. The global service is not designated by a 
modifier, and physicians must bill using the code without a modifier 
if the physician furnishes both the PC and the TC of the service.
    Modifier-53 is shown for a discontinued procedure. There will be 
RVUs for the code (CPT code 45378) with this modifier.
    3. Status indicator. This indicator shows whether the CPT/HCPCS 
code is in the PFS and whether it is separately payable if the 
service is covered.
    A = Active code. These codes are separately payable under the 
PFS if covered. There will be RVUs for codes with this status. The 
presence of an ``A'' indicator does not mean that Medicare has made 
a national coverage determination regarding the service. Carriers 
remain responsible for coverage decisions in the absence of a 
national Medicare policy.
    B = Bundled code. Payments for covered services are always 
bundled into payment for other services not specified. If RVUs are 
shown, they are not used for Medicare payment. If these services are 
covered, payment for them is subsumed by the payment for the 
services to which they are incident (an example is a telephone call 
from a hospital nurse regarding care of a patient).
    C = Carrier-priced code. Carriers will establish RVUs and 
payment amounts for these services, generally on an individual case 
basis following review of documentation, such as an operative 
report.
    D = Deleted/discontinued code. These codes are deleted effective 
with the beginning of the CY and are always subject to a 90-day 
grace period.
    E = Excluded from the PFS by regulation. These codes are for 
items and services that CMS excludes from payment under the PFS by 
regulation. No RVUs are shown, and no payment may be made under the 
PFS for these codes. Payment for them, when covered, continues under 
reasonable charge procedures.
    F = Deleted/discontinued codes. (Code not subject to a 90-day 
grace period.) These codes are deleted effective with the beginning 
of the CY and are never subject to a grace period. This indicator is 
no longer effective as of January 1, 2006.
    G = 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. (Codes subject to a 
90-day grace period.) This indicator is no longer effective with the 
2006 PFS as of January 1, 2006.
    H = Deleted modifier. For 2000 and later years, either the TC or 
PC component shown for the code has been deleted or the deleted 
component is shown in the database with the H status indicator.
    I = Not valid for Medicare purposes. Medicare uses another code 
for the reporting of, and the payment for these services. (Codes not 
subject to a 90-day grace period.)
    N = Noncovered service. These codes are noncovered services. 
Medicare payment may not be made for these codes. If RVUs are shown, 
they are not used for Medicare payment.
    P = Bundled or excluded code. There are no RVUs for these 
services. No separate payment is made for them under the PFS.

--If the item or service is covered as incident to a physician's 
service and is furnished on the same day as a physician's service, 
payment for it is bundled into the payment for the physician's 
service to which it is incident (an example is an elastic bandage 
furnished by a physician incident to a physician's service).
--If the item or service is covered as other than incident to a 
physician's service, it is excluded from the PFS (for example, 
colostomy supplies) and is paid under the other payment provisions 
of the Act.

    R = Restricted coverage. Special coverage instructions apply. If 
the service is covered and no RVUs are shown, it is carrier-priced.
    T = There are RVUs for these services, but they are only paid if 
there are no other services payable under the PFS billed on the same 
date by the same provider. If any other services payable under the 
PFS are billed on the same date by the same provider, these services 
are bundled into the service(s) for which payment is made.
    X = Exclusion by law. These codes represent an item or service 
that is not within the definition of ``physicians' services'' for 
PFS payment purposes. No RVUs are shown for these codes, and no 
payment may be made under the PFS. (Examples are ambulance services 
and clinical diagnostic laboratory services.)
    4. Description of code. This is an abbreviated version of the 
narrative description of the code.
    5. Physician work RVUs. These are the RVUs for the physician 
work for this service in 2007. The RVUs for codes with a 10- or 90-
day global period reflect the application of the RUC-recommended 
values for the E/M services that are included as part of the global 
period for the service. Codes that are not used for Medicare payment 
are identified with a ``+.'' Note: The separate budget neutrality 
adjustor is not reflected in these physician work RVUs.
    6. Fully implemented non-facility practice expense RVUs. These 
are the fully implemented resource-based PE RVUs for non-facility 
settings.
    7. Transitional Non-facility practice expense RVUs. These are 
the 2007 resource-based PE RVUs for non-facility settings.
    8. Fully implemented facility practice expense RVUs. These are 
the fully implemented resource-based PE RVUs for facility settings.
    9. Transitional facility practice expense RVUs. These are the 
2007 resource-based PE RVUs for facility settings.
    10. Malpractice expense RVUs. These are the RVUs for the 
malpractice expense for the service for 2006.
    11. Non-facility total. This is the sum of the work, fully 
implemented non-facility PE, and malpractice expense RVUs.
    12. Transitional non-facility total. This is the sum of the 
work, 2007 transitional non-facility PE, and malpractice expense 
RVUs.
    13. Facility total. This is the sum of the work, fully 
implemented facility PE, and malpractice expense RVUs.
    14. Transitional facility total. This is the sum of the work, 
2007 transitional facility PE, and malpractice expense RVUs.
    15. Global period. This indicator shows the number of days in 
the global period for the code (0, 10, or 90 days). An explanation 
of the alpha codes follows:
    MMM = Code describes a service furnished in uncomplicated 
maternity cases including antepartum care, delivery, and postpartum 
care. The usual global surgical concept does not apply. See the 1999 
Physicians' CPT for specific definitions.
    XXX = The global concept does not apply.
    YYY = The global period is to be set by the carrier (for 
example, unlisted surgery codes).
    ZZZ = Code related to another service that is always included in 
the global period of the other service. (Note: Physician work and PE 
are associated with intra service time and in some instances the 
post service time.)

[[Page 37258]]



                                         Addendum B.--Relative Value Units (RVUs) and Related Information Used In Determining Medicare Payments for 2007
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                   Fully                                                            Fully
                                                     Physician  implemented    Year 2007      Fully       Year 2007      Mal-    implemented    Year 2007      Fully       Year 2007
CPT \1\  HCPCS     Mod     Status     Description    work RVUs      non-     transitional  implemented  transitional   practice      non-     transitional  implemented  transitional    Global
      \2\                                               \3\     facility PE  non-facility  facility PE   facility PE     RVUs      facility   non-facility    facility     facility
                                                                    RVUs        PE RVUs        RVUs         RVUs                    total         total        total         total
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
0073T.........  ........  A         Radiation tx          0.00       13.15         16.84           NA            NA        0.13       13.28         16.97           NA            NA         XXX
                                     delivery, imrt.
10021.........  ........  A         Fna w/o image..       1.27        2.11          2.15         0.35          0.49        0.10        3.48          3.52         1.72          1.86         XXX
10022.........  ........  A         Fna w/image....       1.27        2.21          2.47         0.40          0.42        0.08        3.56          3.82         1.75          1.77         XXX
10040.........  ........  A         Acne surgery...       1.18        1.28          1.08         0.95          0.83        0.05        2.51          2.31         2.18          2.06         010
10060.........  ........  A         Drainage of           1.17        1.49          1.28         1.07          0.97        0.12        2.78          2.57         2.36          2.26         010
                                     skin abscess.
10061.........  ........  A         Drainage of           2.40        2.05          1.89         1.49          1.50        0.26        4.71          4.55         4.15          4.16         010
                                     skin abscess.
10080.........  ........  A         Drainage of           1.17        2.63          2.99         1.08          1.10        0.11        3.91          4.27         2.36          2.38         010
                                     pilonidal cyst.
10081.........  ........  A         Drainage of           2.45        3.46          3.93         1.42          1.48        0.24        6.15          6.62         4.11          4.17         010
                                     pilonidal cyst.
10120.........  ........  A         Remove foreign        1.22        2.09          2.16         0.93          0.96        0.12        3.43          3.50         2.27          2.30         010
                                     body.
10121.........  ........  A         Remove foreign        2.69        3.49          3.51         1.62          1.75        0.33        6.51          6.53         4.64          4.77         010
                                     body.
10140.........  ........  A         Drainage of           1.53        2.25          1.90         1.28          1.29        0.19        3.97          3.62         3.00          3.01         010
                                     hematoma/fluid.
10160.........  ........  A         Puncture              1.20        1.85          1.66         1.07          1.08        0.14        3.19          3.00         2.41          2.42         010
                                     drainage of
                                     lesion.
10180.........  ........  A         Complex               2.25        3.28          3.06         1.81          1.95        0.35        5.88          5.66         4.41          4.55         010
                                     drainage,
                                     wound.
11000.........  ........  A         Debride               0.60        0.72          0.62         0.16          0.21        0.07        1.39          1.29         0.83          0.88         000
                                     infected skin.
11001.........  ........  A         Debride               0.30        0.23          0.23         0.08          0.10        0.04        0.57          0.57         0.42          0.44         ZZZ
                                     infected skin
                                     add-on.
11004.........  ........  A         Debride              10.31          NA            NA         3.00          3.68        0.67          NA            NA        13.98         14.66         000
                                     genitalia &
                                     perineum.
11005.........  ........  A         Debride abdom        13.75          NA            NA         3.98          5.18        0.96          NA            NA        18.69         19.89         000
                                     wall.
11006.........  ........  A         Debride genit/       12.61          NA            NA         3.55          4.53        1.28          NA            NA        17.44         18.42         000
                                     per/abdom wall.
11008.........  ........  A         Remove mesh           5.00          NA            NA         1.33          1.86        0.61          NA            NA         6.94          7.47         ZZZ
                                     from abd wall.
11010.........  ........  A         Debride skin,         4.19        6.71          6.85         2.29          2.55        0.66       11.56         11.70         7.14          7.40         010
                                     fx.
11011.........  ........  A         Debride skin/         4.94        7.04          7.90         2.01          2.27        0.74       12.72         13.58         7.69          7.95         000
                                     muscle, fx.
11012.........  ........  A         Debride skin/         6.87        8.91         11.33         3.05          3.65        1.16       16.94         19.36        11.08         11.68         000
                                     muscle/bone,
                                     fx.
11040.........  ........  A         Debride skin,         0.50        0.68          0.56         0.16          0.20        0.06        1.24          1.12         0.72          0.76         000
                                     partial.
11041.........  ........  A         Debride skin,         0.82        0.77          0.69         0.24          0.31        0.10        1.69          1.61         1.16          1.23         000
                                     full.
11042.........  ........  A         Debride skin/         1.12        1.04          0.99         0.33          0.41        0.13        2.29          2.24         1.58          1.66         000
                                     tissue.
11043.........  ........  A         Debride tissue/       3.00        3.61          3.45         2.68          2.62        0.32        6.93          6.77         6.00          5.94         010
                                     muscle.
11044.........  ........  A         Debride tissue/       4.05        4.91          4.57         3.64          3.73        0.43        9.39          9.05         8.12          8.21         010
                                     muscle/bone.
11055.........  ........  R         Trim skin             0.43        0.81          0.62         0.11          0.16        0.05        1.29          1.10         0.59          0.64         000
                                     lesion.
11056.........  ........  R         Trim skin             0.61        0.88          0.70         0.15          0.21        0.07        1.56          1.38         0.83          0.89         000
                                     lesions, 2 to
                                     4.
11057.........  ........  R         Trim skin             0.79        0.99          0.80         0.20          0.28        0.10        1.88          1.69         1.09          1.17         000
                                     lesions, over
                                     4.
11100.........  ........  A         Biopsy, skin          0.81        1.86          1.40         0.38          0.37        0.03        2.70          2.24         1.22          1.21         000
                                     lesion.
11101.........  ........  A         Biopsy, skin          0.41        0.40          0.35         0.19          0.19        0.02        0.83          0.78         0.62          0.62         ZZZ
                                     add-on.
11200.........  ........  A         Removal of skin       0.77        1.21          1.08         0.88          0.79        0.04        2.02          1.89         1.69          1.60         010
                                     tags.
11201.........  ........  A         Remove skin           0.29        0.16          0.16         0.11          0.12        0.02        0.47          0.47         0.42          0.43         ZZZ
                                     tags add-on.
11300.........  ........  A         Shave skin            0.51        1.18          1.04         0.20          0.21        0.03        1.72          1.58         0.74          0.75         000
                                     lesion.
11301.........  ........  A         Shave skin            0.85        1.48          1.20         0.37          0.38        0.04        2.37          2.09         1.26          1.27         000
                                     lesion.
11302.........  ........  A         Shave skin            1.05        1.75          1.41         0.47          0.46        0.05        2.85          2.51         1.57          1.56         000
                                     lesion.
11303.........  ........  A         Shave skin            1.24        1.99          1.68         0.53          0.52        0.07        3.30          2.99         1.84          1.83         000
                                     lesion.
11305.........  ........  A         Shave skin            0.67        1.05          0.90         0.20          0.25        0.07        1.79          1.64         0.94          0.99         000
                                     lesion.
11306.........  ........  A         Shave skin            0.99        1.40          1.18         0.37          0.41        0.07        2.46          2.24         1.43          1.47         000
                                     lesion.
11307.........  ........  A         Shave skin            1.14        1.68          1.39         0.46          0.48        0.07        2.89          2.60         1.67          1.69         000
                                     lesion.
11308.........  ........  A         Shave skin            1.41        1.72          1.52         0.50          0.57        0.13        3.26          3.06         2.04          2.11         000
                                     lesion.
11310.........  ........  A         Shave skin            0.73        1.37          1.18         0.31          0.32        0.04        2.14          1.95         1.08          1.09         000
                                     lesion.
11311.........  ........  A         Shave skin            1.05        1.62          1.33         0.47          0.49        0.05        2.72          2.43         1.57          1.59         000
                                     lesion.
11312.........  ........  A         Shave skin            1.20        1.89          1.54         0.55          0.55        0.06        3.15          2.80         1.81          1.81         000
                                     lesion.
11313.........  ........  A         Shave skin            1.62        2.15          1.90         0.71          0.72        0.10        3.87          3.62         2.43          2.44         000
                                     lesion.
11400.........  ........  A         Exc tr-ext            0.85        1.86          1.97         0.92          0.89        0.06        2.77          2.88         1.83          1.80         010
                                     b9+marg 0.5 <
                                     cm.
11401.........  ........  A         Exc tr-ext            1.23        2.15          2.08         1.12          1.05        0.10        3.48          3.41         2.45          2.38         010
                                     b9+marg 0.6-1
                                     cm.
11402.........  ........  A         Exc tr-ext            1.40        2.35          2.26         1.18          1.11        0.13        3.88          3.79         2.71          2.64         010
                                     b9+marg 1.1-2
                                     cm.
11403.........  ........  A         Exc tr-ext            1.79        2.52          2.43         1.54          1.38        0.17        4.48          4.39         3.50          3.34         010
                                     b9+marg 2.1-3
                                     cm.
11404.........  ........  A         Exc tr-ext            2.06        2.83          2.74         1.61          1.45        0.21        5.10          5.01         3.88          3.72         010
                                     b9+marg 3.1-4
                                     cm.
11406.........  ........  A         Exc tr-ext            3.45        3.37          3.15         1.94          1.72        0.32        7.14          6.92         5.71          5.49         010
                                     b9+marg > 4.0
                                     cm.
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
\1\ CPT codes and descriptors only are copyright 2005 American Medical Association. All rights reserved. Applicable FARS/DFARS apply.
\2\ Copyright 2005 American Dental Association. All rights reserved.
\3\ Indicates RVUs are not used for Medicare payment.


[[Page 37259]]


                                   Addendum B.--Relative Value Units (RVUs) and Related Information Used In Determining Medicare Payments for 2007--Continued
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                   Fully                                                            Fully
                                                     Physician  implemented    Year 2007      Fully       Year 2007      Mal-    implemented    Year 2007      Fully       Year 2007
CPT \1\  HCPCS     Mod     Status     Description    work RVUs      non-     transitional  implemented  transitional   practice      non-     transitional  implemented  transitional    Global
      \2\                                               \3\     facility PE  non-facility  facility PE   facility PE     RVUs      facility   non-facility    facility     facility
                                                                    RVUs        PE RVUs        RVUs         RVUs                    total         total        total         total
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
11420.........  ........  A         Exc h-f-nk-sp         0.98        1.81          1.78         0.92          0.93        0.09        2.88          2.85         1.99          2.00         010
                                     b9+marg 0.5 <.
11421.........  ........  A         Exc h-f-nk-sp         1.42        2.18          2.10         1.14          1.12        0.13        3.73          3.65         2.69          2.67         010
                                     b9+marg 0.6-1.
11422.........  ........  A         Exc h-f-nk-sp         1.63        2.38          2.29         1.49          1.37        0.16        4.17          4.08         3.28          3.16         010
                                     b9+marg 1.1-2.
11423.........  ........  A         Exc h-f-nk-sp         2.01        2.62          2.60         1.62          1.49        0.20        4.83          4.81         3.83          3.70         010
                                     b9+marg 2.1-3.
11424.........  ........  A         Exc h-f-nk-sp         2.43        2.93          2.84         1.74          1.64        0.25        5.61          5.52         4.42          4.32         010
                                     b9+marg 3.1-4.
11426.........  ........  A         Exc h-f-nk-sp         4.02        3.55          3.51         2.14          2.12        0.44        8.01          7.97         6.60          6.58         010
                                     b9+marg > 4 cm.
11440.........  ........  A         Exc face-mm           1.00        1.98          2.15         1.29          1.31        0.08        3.06          3.23         2.37          2.39         010
                                     b9+marg 0.5 <
                                     cm.
11441.........  ........  A         Exc face-mm           1.48        2.34          2.34         1.52          1.50        0.13        3.95          3.95         3.13          3.11         010
                                     b9+marg 0.6-1
                                     cm.
11442.........  ........  A         Exc face-mm           1.72        2.58          2.56         1.61          1.58        0.16        4.46          4.44         3.49          3.46         010
                                     b9+marg 1.1-2
                                     cm.
11443.........  ........  A         Exc face-mm           2.29        2.81          2.89         1.79          1.81        0.22        5.32          5.40         4.30          4.32         010
                                     b9+marg 2.1-3
                                     cm.
11444.........  ........  A         Exc face-mm           3.14        3.21          3.41         2.03          2.15        0.30        6.65          6.85         5.47          5.59         010
                                     b9+marg 3.1-4
                                     cm.
11446.........  ........  A         Exc face-mm           4.73        3.86          4.00         2.47          2.70        0.43        9.02          9.16         7.63          7.86         010
                                     b9+marg > 4 cm.
11450.........  ........  A         Removal, sweat        3.10        5.15          5.07         2.41          2.13        0.34        8.59          8.51         5.85          5.57         090
                                     gland lesion.
11451.........  ........  A         Removal, sweat        4.31        6.14          6.50         2.77          2.61        0.53       10.98         11.34         7.61          7.45         090
                                     gland lesion.
11462.........  ........  A         Removal, sweat        2.88        5.31          5.17         2.45          2.13        0.32        8.51          8.37         5.65          5.33         090
                                     gland lesion.
11463.........  ........  A         Removal, sweat        4.31        6.58          6.78         2.94          2.75        0.54       11.43         11.63         7.79          7.60         090
                                     gland lesion.
11470.........  ........  A         Removal, sweat        3.62        5.57          5.20         2.67          2.37        0.40        9.59          9.22         6.69          6.39         090
                                     gland lesion.
11471.........  ........  A         Removal, sweat        4.77        6.42          6.65         2.95          2.82        0.58       11.77         12.00         8.30          8.17         090
                                     gland lesion.
11600.........  ........  A         Exc tr-ext            1.56        2.61          2.63         1.01          0.98        0.10        4.27          4.29         2.67          2.64         010
                                     mlg+marg 0.5 <
                                     cm.
11601.........  ........  A         Exc tr-ext            2.00        3.27          2.85         1.35          1.25        0.12        5.39          4.97         3.47          3.37         010
                                     mlg+marg 0.6-1
                                     cm.
11602.........  ........  A         Exc tr-ext            2.20        3.65          3.04         1.52          1.33        0.12        5.97          5.36         3.84          3.65         010
                                     mlg+marg 1.1-2
                                     cm.
11603.........  ........  A         Exc tr-ext            2.75        3.85          3.27         1.69          1.42        0.16        6.76          6.18         4.60          4.33         010
                                     mlg+marg 2.1-3
                                     cm.
11604.........  ........  A         Exc tr-ext            3.10        4.15          3.57         1.76          1.48        0.20        7.45          6.87         5.06          4.78         010
                                     mlg+marg 3.1-4
                                     cm.
11606.........  ........  A         Exc tr-ext            4.95        5.28          4.37         2.27          1.87        0.36       10.59          9.68         7.58          7.18         010
                                     mlg+marg > 4
                                     cm.
11620.........  ........  A         Exc h-f-nk-sp         1.57        2.70          2.63         1.05          0.98        0.09        4.36          4.29         2.71          2.64         010
                                     mlg+marg 0.5 <.
11621.........  ........  A         Exc h-f-nk-sp         2.01        3.32          2.86         1.38          1.28        0.12        5.45          4.99         3.51          3.41         010
                                     mlg+marg 0.6-1.
11622.........  ........  A         Exc h-f-nk-sp         2.34        3.70          3.15         1.57          1.44        0.14        6.18          5.63         4.05          3.92         010
                                     mlg+marg 1.1-2.
11623.........  ........  A         Exc h-f-nk-sp         3.04        3.92          3.49         1.78          1.63        0.20        7.16          6.73         5.02          4.87         010
                                     mlg+marg 2.1-3.
11624.........  ........  A         Exc h-f-nk-sp         3.55        4.23          3.87         1.90          1.81        0.27        8.05          7.69         5.72          5.63         010
                                     *mlg+marg 3.1-
                                     4.
11626.........  ........  A         Exc h-f-nk-sp         4.54        4.88          4.70         2.26          2.37        0.45        9.87          9.69         7.25          7.36         010
                                     mlg+mar > 4 cm.
11640.........  ........  A         Exc face-mm           1.60        2.89          2.72         1.14          1.12        0.11        4.60          4.43         2.85          2.83         010
                                     malig+marg 0.5
                                     <.
11641.........  ........  A         Exc face-mm           2.10        3.44          3.13         1.44          1.51        0.16        5.70          5.39         3.70          3.77         010
                                     malig+marg 0.6-
                                     1.
11642.........  ........  A         Exc face-mm           2.55        3.82          3.51         1.66          1.70        0.19        6.56          6.25         4.40          4.44         010
                                     malig+marg 1.1-
                                     2.
11643.........  ........  A         Exc face-mm           3.35        4.06          3.87         1.92          1.96        0.26        7.67          7.48         5.53          5.57         010
                                     malig+marg 2.1-
                                     3.
11644.........  ........  A         Exc face-mm           4.27        4.82          4.72         2.25          2.41        0.37        9.46          9.36         6.89          7.05         010
                                     malig+marg 3.1-
                                     4.
11646.........  ........  A         Exc face-mm           6.19        5.73          5.76         3.01          3.36        0.61       12.53         12.56         9.81         10.16         010
                                     mlg+marg > 4
                                     cm.
11719.........  ........  R         Trim nail(s)...       0.17        0.38          0.28         0.04          0.06        0.02        0.57          0.47         0.23          0.25         000
11720.........  ........  A         Debride nail, 1-      0.32        0.47          0.37         0.08          0.11        0.04        0.83          0.73         0.44          0.47         000
                                     5.
11721.........  ........  A         Debride nail, 6       0.54        0.54          0.47         0.14          0.19        0.07        1.15          1.08         0.75          0.80         000
                                     or more.
11730.........  ........  A         Removal of nail       1.13        1.34          1.11         0.29          0.40        0.14        2.61          2.38         1.56          1.67         000
                                     plate.
11732.........  ........  A         Remove nail           0.57        0.54          0.47         0.14          0.20        0.07        1.18          1.11         0.78          0.84         ZZZ
                                     plate, add-on.
11740.........  ........  A         Drain blood           0.37        0.80          0.61         0.43          0.37        0.04        1.21          1.02         0.84          0.78         000
                                     from under
                                     nail.
11750.........  ........  A         Removal of nail       2.36        2.94          2.36         1.86          1.79        0.22        5.52          4.94         4.44          4.37         010
                                     bed.
11752.........  ........  A         Remove nail bed/      3.42        4.07          3.27         2.77          2.94        0.35        7.84          7.04         6.54          6.71         010
                                     finger tip.
11755.........  ........  A         Biopsy, nail          1.31        2.01          1.68         0.75          0.77        0.14        3.46          3.13         2.20          2.22         000
                                     unit.
11760.........  ........  A         Repair of nail        1.58        3.41          2.83         1.42          1.70        0.21        5.20          4.62         3.21          3.49         010
                                     bed.
11762.........  ........  A         Reconstruction        2.89        3.67          3.09         1.66          2.18        0.36        6.92          6.34         4.91          5.43         010
                                     of nail bed.
11765.........  ........  A         Excision of           0.69        2.67          2.01         1.00          0.82        0.08        3.44          2.78         1.77          1.59         010
                                     nail fold, toe.
11770.........  ........  A         Removal of            2.61        3.47          3.49         1.52          1.51        0.33        6.41          6.43         4.46          4.45         010
                                     pilonidal
                                     lesion.
11771.........  ........  A         Removal of            5.91        6.67          5.91         3.70          3.42        0.74       13.32         12.56        10.35         10.07         090
                                     pilonidal
                                     lesion.
11772.........  ........  A         Removal of            7.15        8.00          7.64         5.51          5.19        0.89       16.04         15.68        13.55         13.23         090
                                     pilonidal
                                     lesion.
11900.........  ........  A         Injection into        0.52        0.90          0.71         0.24          0.22        0.02        1.44          1.25         0.78          0.76        000
                                     skin lesions.
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
\1\ CPT codes and descriptors only are copyright 2005 American Medical Association. All rights reserved. Applicable FARS/DFARS apply.
\2\ Copyright 2005 American Dental Association. All rights reserved.
\3\ Indicates RVUs are not used for Medicare payment.


[[Page 37260]]


                                   Addendum B.--Relative Value Units (RVUs) and Related Information Used In Determining Medicare Payments for 2007--Continued
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                   Fully                                                            Fully
                                                     Physician  implemented    Year 2007      Fully       Year 2007      Mal-    implemented    Year 2007      Fully       Year 2007
CPT \1\  HCPCS     Mod     Status     Description    work RVUs      non-     transitional  implemented  transitional   practice      non-     transitional  implemented  transitional    Global
      \2\                                               \3\     facility PE  non-facility  facility PE   facility PE     RVUs      facility   non-facility    facility     facility
                                                                    RVUs        PE RVUs        RVUs         RVUs                    total         total        total         total
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
11901.........  ........  A         Added skin            0.80        1.00          0.75         0.38          0.36        0.03        1.83          1.58         1.21          1.19         000
                                     lesions
                                     injection.
11920.........  ........  R         Correct skin          1.61        2.37          3.38         1.10          1.09        0.24        4.22          5.23         2.95          2.94         000
                                     color defects.
11921.........  ........  R         Correct skin          1.93        2.63          3.64         1.24          1.26        0.29        4.85          5.86         3.46          3.48         000
                                     color defects.
11922.........  ........  R         Correct skin          0.49        0.92          1.09         0.22          0.24        0.07        1.48          1.65         0.78          0.80         ZZZ
                                     color defects.
11950.........  ........  R         Therapy for           0.84        0.86          1.07         0.35          0.38        0.06        1.76          1.97         1.25          1.28         000
                                     contour
                                     defects.
11951.........  ........  R         Therapy for           1.19        1.17          1.41         0.52          0.51        0.11        2.47          2.71         1.82          1.81         000
                                     contour
                                     defects.
11952.........  ........  R         Therapy for           1.69        1.69          1.82         0.79          0.71        0.16        3.54          3.67         2.64          2.56         000
                                     contour
                                     defects.
11954.........  ........  R         Therapy for           1.85        1.78          2.28         0.77          0.87        0.25        3.88          4.38         2.87          2.97         000
                                     contour
                                     defects.
11960.........  ........  A         Insert tissue        10.85          NA            NA        10.40         10.42        1.31          NA            NA        22.56         22.58         090
                                     expander(s).
11970.........  ........  A         Replace tissue        7.80          NA            NA         5.94          6.10        1.05          NA            NA        14.79         14.95         090
                                     expander.
11971.........  ........  A         Remove tissue         3.13        7.33          8.69         3.95          3.84        0.32       10.78         12.14         7.40          7.29         090
                                     expander(s).
11975.........  ........  N         Insert                1.48        1.53          1.45         0.33          0.51        0.17        3.18          3.10         1.98          2.16         XXX
                                     contraceptive
                                     cap.
11976.........  ........  R         Removal of            1.78        1.68          1.71         0.45          0.62        0.21        3.67          3.70         2.44          2.61         000
                                     contraceptive
                                     cap.
11977.........  ........  N         Removal/              3.30        1.96          2.20         0.74          1.13        0.37        5.63          5.87         4.41          4.80         XXX
                                     reinsert
                                     contra cap.
11980.........  ........  A         Implant hormone       1.48        1.17          1.10         0.55          0.54        0.13        2.78          2.71         2.16          2.15         000
                                     pellet(s).
11981.........  ........  A         Insert drug           1.48        1.96          1.77         0.61          0.66        0.12        3.56          3.37         2.21          2.26         XXX
                                     implant device.
11982.........  ........  A         Remove drug           1.78        2.09          1.99         0.73          0.81        0.17        4.04          3.94         2.68          2.76         XXX
                                     implant device.
11983.........  ........  A         Remove/insert         3.30        2.74          2.40         1.38          1.45        0.23        6.27          5.93         4.91          4.98         XXX
                                     drug implant.
12001.........  ........  A         Repair                1.70        1.71          1.92         0.71          0.76        0.15        3.56          3.77         2.56          2.61         010
                                     superficial
                                     wound(s).
12002.........  ........  A         Repair                1.86        1.77          1.98         0.82          0.88        0.17        3.80          4.01         2.85          2.91         010
                                     superficial
                                     wound(s).
12004.........  ........  A         Repair                2.24        2.05          2.26         0.90          0.98        0.21        4.50          4.71         3.35          3.43         010
                                     superficial
                                     wound(s).
12005.........  ........  A         Repair                2.86        2.50          2.75         1.05          1.16        0.27        5.63          5.88         4.18          4.29         010
                                     superficial
                                     wound(s).
12006.........  ........  A         Repair                3.66        3.00          3.30         1.27          1.45        0.35        7.01          7.31         5.28          5.46         010
                                     superficial
                                     wound(s).
12007.........  ........  A         Repair                4.11        3.37          3.72         1.46          1.73        0.45        7.93          8.28         6.02          6.29         010
                                     superficial
                                     wound(s).
12011.........  ........  A         Repair                1.76        1.88          2.08         0.74          0.77        0.16        3.80          4.00         2.66          2.69         010
                                     superficial
                                     wound(s).
12013.........  ........  A         Repair                1.99        2.03          2.22         0.87          0.92        0.18        4.20          4.39         3.04          3.09         010
                                     superficial
                                     wound(s).
12014.........  ........  A         Repair                2.46        2.25          2.50         0.96          1.04        0.23        4.94          5.19         3.65          3.73         010
                                     superficial
                                     wound(s).
12015.........  ........  A         Repair                3.19        2.73          3.04         1.09          1.21        0.29        6.21          6.52         4.57          4.69         010
                                     superficial
                                     wound(s).
12016.........  ........  A         Repair                3.92        3.12          3.45         1.26          1.46        0.37        7.41          7.74         5.55          5.75         010
                                     superficial
                                     wound(s).
12017.........  ........  A         Repair                4.70          NA            NA         1.45          1.79        0.47          NA            NA         6.62          6.96         010
                                     superficial
                                     wound(s).
12018.........  ........  A         Repair                5.52          NA            NA         1.94          2.18        0.64          NA            NA         8.10          8.34         010
                                     superficial
                                     wound(s).
12020.........  ........  A         Closure of            2.62        3.73          3.81         1.76          1.89        0.30        6.65          6.73         4.68          4.81         010
                                     split wound.
12021.........  ........  A         Closure of            1.84        1.84          1.83         1.32          1.39        0.24        3.92          3.91         3.40          3.47         010
                                     split wound.
12031.........  ........  A         Layer closure         2.15        3.84          2.68         1.74          1.16        0.17        6.16          5.00         4.06          3.48         010
                                     of wound(s).
12032.........  ........  A         Layer closure         2.47        5.13          4.17         2.23          1.91        0.16        7.76          6.80         4.86          4.54         010
                                     of wound(s).
12034.........  ........  A         Layer closure         2.92        4.52          3.53         1.94          1.57        0.25        7.69          6.70         5.11          4.74         010
                                     of wound(s).
12035.........  ........  A         Layer closure         3.42        5.23          5.22         2.07          2.14        0.39        9.04          9.03         5.88          5.95         010
                                     of wound(s).
12036.........  ........  A         Layer closure         4.04        5.35          5.52         2.20          2.46        0.55        9.94         10.11         6.79          7.05         010
                                     of wound(s).
12037.........  ........  A         Layer closure         4.66        5.90          6.06         2.57          2.87        0.66       11.22         11.38         7.89          8.19         010
                                     of wound(s).
12041.........  ........  A         Layer closure         2.37        3.78          2.86         1.72          1.28        0.19        6.34          5.42         4.28          3.84         010
                                     of wound(s).
12042.........  ........  A         Layer closure         2.74        4.40          3.55         2.06          1.61        0.17        7.31          6.46         4.97          4.52         010
                                     of wound(s).
12044.........  ........  A         Layer closure         3.14        5.27          3.73         1.88          1.67        0.27        8.68          7.14         5.29          5.08         010
                                     of wound(s).
12045.........  ........  A         Layer closure         3.63        5.04          5.22         2.04          2.23        0.41        9.08          9.26         6.08          6.27         010
                                     of wound(s).
12046.........  ........  A         Layer closure         4.24        5.60          6.29         2.24          2.63        0.54       10.38         11.07         7.02          7.41         010
                                     of wound(s).
12047.........  ........  A         Layer closure         4.64        6.11          6.30         2.47          2.94        0.58       11.33         11.52         7.69          8.16         010
                                     of wound(s).
12051.........  ........  A         Layer closure         2.47        4.03          3.47         1.87          1.56        0.20        6.70          6.14         4.54          4.23         010
                                     of wound(s).
12052.........  ........  A         Layer closure         2.77        4.34          3.51         2.06          1.59        0.17        7.28          6.45         5.00          4.53         010
                                     of wound(s).
12053.........  ........  A         Layer closure         3.12        5.26          3.75         2.06          1.66        0.23        8.61          7.10         5.41          5.01         010
                                     of wound(s).
12054.........  ........  A         Layer closure         3.45        5.31          4.01         2.00          1.72        0.30        9.06          7.76         5.75          5.47         010
                                     of wound(s).
12055.........  ........  A         Layer closure         4.42        5.98          4.86         2.08          2.12        0.45       10.85          9.73         6.95          6.99         010
                                     of wound(s).
12056.........  ........  A         Layer closure         5.23        6.15          6.62         2.34          2.88        0.59       11.97         12.44         8.16          8.70         010
                                     of wound(s).
12057.........  ........  A         Layer closure         5.95        7.34          6.45         2.74          3.51        0.56       13.85         12.96         9.25         10.02         010
                                     of wound(s).
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
\1\ CPT codes and descriptors only are copyright 2005 American Medical Association. All rights reserved. Applicable FARS/DFARS apply.
\2\ Copyright 2005 American Dental Association. All rights reserved.
\3\ Indicates RVUs are not used for Medicare payment.


[[Page 37261]]


                                   Addendum B.--Relative Value Units (RVUs) and Related Information Used In Determining Medicare Payments for 2007--Continued
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                   Fully                                                            Fully
                                                     Physician  implemented    Year 2007      Fully       Year 2007      Mal-    implemented    Year 2007      Fully       Year 2007
CPT \1\  HCPCS     Mod     Status     Description    work RVUs      non-     transitional  implemented  transitional   practice      non-     transitional  implemented  transitional    Global
      \2\                                               \3\     facility PE  non-facility  facility PE   facility PE     RVUs      facility   non-facility    facility     facility
                                                                    RVUs        PE RVUs        RVUs         RVUs                    total         total        total         total
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
13100.........  ........  A         Repair of wound       3.12        4.34          4.13         2.40          2.33        0.26        7.72          7.51         5.78          5.71         010
                                     or lesion.
13101.........  ........  A         Repair of wound       3.91        5.85          4.97         2.91          2.75        0.26       10.02          9.14         7.08          6.92         010
                                     or lesion.
13102.........  ........  A         Repair wound/         1.24        1.33          1.21         0.52          0.56        0.13        2.70          2.58         1.89          1.93         ZZZ
                                     lesion add-on.
13120.........  ........  A         Repair of wound       3.30        4.48          4.23         2.51          2.39        0.26        8.04          7.79         6.07          5.95         010
                                     or lesion.
13121.........  ........  A         Repair of wound       4.32        6.13          5.18         3.10          2.88        0.25       10.70          9.75         7.67          7.45         010
                                     or lesion.
13122.........  ........  A         Repair wound/         1.44        1.36          1.47         0.57          0.62        0.15        2.95          3.06         2.16          2.21         ZZZ
                                     lesion add-on.
13131.........  ........  A         Repair of wound       3.78        4.90          4.50         2.80          2.72        0.26        8.94          8.54         6.84          6.76         010
                                     or lesion.
13132.........  ........  A         Repair of wound       6.44        7.73          6.37         4.83          4.34        0.32       14.49         13.13        11.59         11.10         010
                                     or lesion.
13133.........  ........  A         Repair wound/         2.19        1.82          1.70         0.94          1.01        0.18        4.19          4.07         3.31          3.38         ZZZ
                                     lesion add-on.
13150.........  ........  A         Repair of wound       3.80        4.60          4.81         2.63          2.74        0.34        8.74          8.95         6.77          6.88         010
                                     or lesion.
13151.........  ........  A         Repair of wound       4.44        5.39          4.96         3.13          3.15        0.31       10.14          9.71         7.88          7.90         010
                                     or lesion.
13152.........  ........  A         Repair of wound       6.32        7.38          6.38         3.80          3.99        0.40       14.10         13.10        10.52         10.71         010
                                     or lesion.
13153.........  ........  A         Repair wound/         2.38        1.96          1.95         0.97          1.10        0.24        4.58          4.57         3.59          3.72         ZZZ
                                     lesion add-on.
13160.........  ........  A         Late closure of      11.76          NA            NA         6.98          7.13        1.54          NA            NA        20.28         20.43         090
                                     wound.
14000.........  ........  A         Skin tissue           6.75        8.78          8.10         5.91          5.59        0.59       16.12         15.44        13.25         12.93         090
                                     rearrangement.
14001.........  ........  A         Skin tissue           9.52       10.90          9.81         7.40          7.17        0.82       21.24         20.15        17.74         17.51         090
                                     rearrangement.
14020.........  ........  A         Skin tissue           7.58        9.80          8.92         6.70          6.59        0.64       18.02         17.14        14.92         14.81         090
                                     rearrangement.
14021.........  ........  A         Skin tissue          11.10       12.18         10.55         8.43          8.33        0.81       24.09         22.46        20.34         20.24         090
                                     rearrangement.
14040.........  ........  A         Skin tissue           8.36       10.23          9.18         7.06          7.18        0.62       19.21         18.16        16.04         16.16         090
                                     rearrangement.
14041.........  ........  A         Skin tissue          12.59       13.27         11.28         9.10          8.80        0.73       26.59         24.60        22.42         22.12         090
                                     rearrangement.
14060.........  ........  A         Skin tissue           8.99        9.94          9.09         7.47          7.46        0.68       19.61         18.76        17.14         17.13         090
                                     rearrangement.
14061.........  ........  A         Skin tissue          13.57       14.52         12.35         9.92          9.63        0.76       28.85         26.68        24.25         23.96         090
                                     rearrangement.
14300.........  ........  A         Skin tissue          13.16       13.25         11.68         9.22          9.21        1.16       27.57         26.00        23.54         23.53         090
                                     rearrangement.
14350.........  ........  A         Skin tissue          10.72          NA            NA         6.78          7.07        1.34          NA            NA        18.84         19.13         090
                                     rearrangement.
15000.........  ........  A         Wound prep, 1st       3.99        4.19          3.90         1.70          2.07        0.54        8.72          8.43         6.23          6.60         000
                                     100 sq cm.
15001.........  ........  A         Wound prep,           1.00        0.55          1.15         0.34          0.39        0.14        1.69          2.29         1.48          1.53         ZZZ
                                     addl 100 sq cm.
15040.........  ........  A         Harvest               2.00        3.82          4.38         1.01          1.10        0.24        6.06          6.62         3.25          3.34         000
                                     cultured skin
                                     graft.
15050.........  ........  A         Skin pinch            5.29        7.58          7.09         4.97          5.08        0.57       13.44         12.95        10.83         10.94         090
                                     graft.
15100.........  ........  A         Skin splt grft,       9.66       10.25         12.03         7.16          7.67        1.28       21.19         22.97        18.10         18.61         090
                                     trnk/arm/leg.
15101.........  ........  A         Skin splt grft        1.72        2.48          3.43         0.85          1.09        0.24        4.44          5.39         2.81          3.05         ZZZ
                                     t/a/l, add-on.
15110.........  ........  A         Epidrm autogrft      10.82        8.81         10.23         6.40          6.87        1.31       20.94         22.36        18.53         19.00         090
                                     trnk/arm/leg.
15111.........  ........  A         Epidrm autogrft       1.85        0.87          1.19         0.63          0.75        0.26        2.98          3.30         2.74          2.86         ZZZ
                                     t/a/l add-on.
15115.........  ........  A         Epidrm a-grft        11.13        9.05          9.20         6.58          7.17        1.15       21.33         21.48        18.86         19.45         090
                                     face/nck/hf/g.
15116.........  ........  A         Epidrm a-grft f/      2.50        1.20          1.49         0.86          1.06        0.33        4.03          4.32         3.69          3.89         ZZZ
                                     n/hf/g addl.
15120.........  ........  A         Skn splt a-grft      10.88       11.06         10.83         7.22          7.66        1.16       23.10         22.87        19.26         19.70         090
                                     fac/nck/hf/g.
15121.........  ........  A         Skn splt a-grft       2.67        3.42          4.24         1.30          1.71        0.36        6.45          7.27         4.33          4.74         ZZZ
                                     f/n/hf/g add.
15130.........  ........  A         Derm autograft,       7.33        7.94          9.40         5.56          6.16        0.97       16.24         17.70        13.86         14.46         090
                                     trnk/arm/leg.
15131.........  ........  A         Derm autograft        1.50        0.68          0.97         0.51          0.61        0.21        2.39          2.68         2.22          2.32         ZZZ
                                     t/a/l add-on.
15135.........  ........  A         Derm autograft       10.83        9.30          9.75         6.89          7.84        1.23       21.36         21.81        18.95         19.90         090
                                     face/nck/hf/g.
15136.........  ........  A         Derm autograft,       1.50        0.66          0.83         0.52          0.63        0.20        2.36          2.53         2.22          2.33         ZZZ
                                     f/n/hf/g add.
15150.........  ........  A         Cult epiderm          9.24        7.12          8.14         5.83          6.30        1.14       17.50         18.52        16.21         16.68         090
                                     grft t/arm/leg.
15151.........  ........  A         Cult epiderm          2.00        0.88          1.20         0.68          0.81        0.28        3.16          3.48         2.96          3.09         ZZZ
                                     grft t/a/l
                                     addl.
15152.........  ........  A         Cult epiderm          2.50        1.05          1.43         0.85          1.01        0.35        3.90          4.28         3.70          3.86         ZZZ
                                     graft t/a/l +%.
15155.........  ........  A         Cult epiderm          9.99        7.51          7.76         6.17          6.78        1.05       18.55         18.80        17.21         17.82         090
                                     graft, f/n/hf/
                                     g.
15156.........  ........  A         Cult epidrm           2.75        1.16          1.46         0.95          1.17        0.36        4.27          4.57         4.06          4.28         ZZZ
                                     grft f/n/hfg
                                     add.
15157.........  ........  A         Cult epiderm          3.00        1.34          1.67         1.04          1.27        0.39        4.73          5.06         4.43          4.66         ZZZ
                                     grft f/n/hfg
                                     +%.
15170.........  ........  A         Acell graft           5.99        3.60          3.78         2.31          2.36        0.55       10.14         10.32         8.85          8.90         090
                                     trunk/arms/
                                     legs.
15171.........  ........  A         Acell graft t/        1.55        0.63          0.67         0.50          0.59        0.19        2.37          2.41         2.24          2.33         ZZZ
                                     arm/leg add-on.
15175.........  ........  A         Acellular             7.99        5.17          5.37         3.68          3.93        0.82       13.98         14.18        12.49         12.74         090
                                     graft, f/n/hf/
                                     g.
15176.........  ........  A         Acell graft, f/       2.45        1.05          1.10         0.79          0.94        0.29        3.79          3.84         3.53          3.68         ZZZ
                                     n/hf/g add-on.
15200.........  ........  A         Skin full             8.89        9.76          9.51         6.22          6.22        0.98       19.63         19.38        16.09         16.09         090
                                     graft, trunk.
15201.........  ........  A         Skin full graft       1.32        2.08          2.45         0.55          0.60        0.19        3.59          3.96         2.06          2.11         ZZZ
                                     trunk add-on.
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
\1\ CPT codes and descriptors only are copyright 2005 American Medical Association. All rights reserved. Applicable FARS/DFARS apply.
\2\ Copyright 2005 American Dental Association. All rights reserved.
\3\ Indicates RVUs are not used for Medicare payment.


[[Page 37262]]


                                   Addendum B.--Relative Value Units (RVUs) and Related Information Used In Determining Medicare Payments for 2007--Continued
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                   Fully                                                            Fully
                                                     Physician  implemented    Year 2007      Fully       Year 2007      Mal-    implemented    Year 2007      Fully       Year 2007
CPT \1\  HCPCS     Mod     Status     Description    work RVUs      non-     transitional  implemented  transitional   practice      non-     transitional  implemented  transitional    Global
      \2\                                               \3\     facility PE  non-facility  facility PE   facility PE     RVUs      facility   non-facility    facility     facility
                                                                    RVUs        PE RVUs        RVUs         RVUs                    total         total        total         total
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
15220.........  ........  A         Skin full graft       7.86       10.19          9.46         6.48          6.65        0.84       18.89         18.16        15.18         15.35         090
                                     sclp/arm/leg.
15221.........  ........  A         Skin full graft       1.19        1.99          2.25         0.49          0.54        0.16        3.34          3.60         1.84          1.89         ZZZ
                                     add-on.
15240.........  ........  A         Skin full grft       10.03       11.05         10.44         7.96          7.97        0.92       22.00         21.39        18.91         18.92         090
                                     face/genit/hf.
15241.........  ........  A         Skin full graft       1.86        2.48          2.46         0.78          0.88        0.23        4.57          4.55         2.87          2.97         ZZZ
                                     add-on.
15260.........  ........  A         Skin full graft      11.29       12.67         10.85         9.05          8.71        0.69       24.65         22.83        21.03         20.69         090
                                     een & lips.
15261.........  ........  A         Skin full graft       2.23        2.89          2.75         1.11          1.33        0.21        5.33          5.19         3.55          3.77         ZZZ
                                     add-on.
15300.........  ........  A         Apply                 4.65        3.31          3.24         2.06          2.20        0.49        8.45          8.38         7.20          7.34         090
                                     skinallogrft,
                                     t/arm/lg.
15301.........  ........  A         Apply                 1.00        0.47          0.47         0.33          0.38        0.14        1.61          1.61         1.47          1.52         ZZZ
                                     sknallogrft t/
                                     a/l addl.
15320.........  ........  A         Apply skin            5.36        3.69          3.65         2.27          2.47        0.58        9.63          9.59         8.21          8.41         090
                                     allogrft f/n/
                                     hf/g.
15321.........  ........  A         Aply                  1.50        0.67          0.69         0.49          0.57        0.21        2.38          2.40         2.20          2.28         ZZZ
                                     sknallogrft f/
                                     n/hfg add.
15330.........  ........  A         Aply acell            3.99        3.10          3.18         1.86          2.14        0.49        7.58          7.66         6.34          6.62         090
                                     alogrft t/arm/
                                     leg.
15331.........  ........  A         Aply acell grft       1.00        0.45          0.46         0.33          0.38        0.14        1.59          1.60         1.47          1.52         ZZZ
                                     t/a/l add-on.
15335.........  ........  A         Apply acell           4.50        3.35          3.45         2.02          2.34        0.55        8.40          8.50         7.07          7.39         090
                                     graft, f/n/hf/
                                     g.
15336.........  ........  A         Aply acell grft       1.43        0.70          0.69         0.47          0.55        0.20        2.33          2.32         2.10          2.18         ZZZ
                                     f/n/hf/g add.
15340.........  ........  A         Apply cult skin       3.72        3.74          3.94         2.68          2.74        0.41        7.87          8.07         6.81          6.87         010
                                     substitute.
15341.........  ........  A         Apply cult skin       0.50        0.72          0.64         0.16          0.19        0.06        1.28          1.20         0.72          0.75         ZZZ
                                     sub add-on.
15360.........  ........  A         Apply cult derm       3.87        4.26          4.43         3.07          3.09        0.43        8.56          8.73         7.37          7.39         090
                                     sub, t/a/l.
15361.........  ........  A         Aply cult derm        1.15        0.56          0.58         0.37          0.44        0.14        1.85          1.87         1.66          1.73         ZZZ
                                     sub t/a/l add.
15365.........  ........  A         Apply cult derm       4.15        4.30          4.50         3.14          3.19        0.46        8.91          9.11         7.75          7.80         090
                                     sub f/n/hf/g.
15366.........  ........  A         Apply cult derm       1.45        0.67          0.69         0.47          0.55        0.17        2.29          2.31         2.09          2.17         ZZZ
                                     f/hf/g add.
15400.........  ........  A         Apply skin            4.32        4.87          4.23         3.66          3.93        0.47        9.66          9.02         8.45          8.72         090
                                     xenograft, t/a/
                                     l.
15401.........  ........  A         Apply skn             1.00        1.01          1.68         0.33          0.41        0.14        2.15          2.82         1.47          1.55         ZZZ
                                     xenogrft t/a/l
                                     add.
15420.........  ........  A         Apply skin            4.83        5.01          4.85         3.82          3.81        0.52       10.36         10.20         9.17          9.16         090
                                     xgraft, f/n/hf/
                                     g.
15421.........  ........  A         Apply skn xgrft       1.50        1.18          1.29         0.50          0.59        0.21        2.89          3.00         2.21          2.30         ZZZ
                                     f/n/hf/g add.
15430.........  ........  A         Apply acellular       5.75        6.95          6.93         6.37          6.57        0.66       13.36         13.34        12.78         12.98         090
                                     xenograft.
15570.........  ........  A         Form skin             9.94       10.21         11.05         6.35          6.67        1.34       21.49         22.33        17.63         17.95         090
                                     pedicle flap.
15572.........  ........  A         Form skin             9.88        9.61          9.54         6.51          6.48        1.20       20.69         20.62        17.59         17.56         090
                                     pedicle flap.
15574.........  ........  A         Form skin            10.48       10.26         10.60         6.81          7.56        1.20       21.94         22.28        18.49         19.24         090
                                     pedicle flap.
15576.........  ........  A         Form skin             9.18        9.42          9.69         6.32          6.76        0.87       19.47         19.74        16.37         16.81         090
                                     pedicle flap.
15600.........  ........  A         Skin graft.....       1.91        5.21          7.02         2.67          2.97        0.27        7.39          9.20         4.85          5.15         090
15610.........  ........  A         Skin graft.....       2.42        5.49          4.90         2.99          3.32        0.35        8.26          7.67         5.76          6.09         090
15620.........  ........  A         Skin graft.....       3.56        6.26          7.42         3.74          3.85        0.35       10.17         11.33         7.65          7.76         090
15630.........  ........  A         Skin graft.....       3.89        6.86          7.01         4.16          4.16        0.34       11.09         11.24         8.39          8.39         090
15650.........  ........  A         Transfer skin         4.58        7.00          7.12         4.19          4.21        0.42       12.00         12.12         9.19          9.21         090
                                     pedicle flap.
15732.........  ........  A         Muscle-skin          19.62       14.42         17.17        10.88         11.91        1.99       36.03         38.78        32.49         33.52         090
                                     graft, head/
                                     neck.
15734.........  ........  A         Muscle-skin          19.52       14.95         17.36        11.12         12.09        2.61       37.08         39.49        33.25         34.22         090
                                     graft, trunk.
15736.........  ........  A         Muscle-skin          16.86       13.54         17.10         9.75         10.88        2.45       32.85         36.41        29.06         30.19         090
                                     graft, arm.
15738.........  ........  A         Muscle-skin          18.86       13.82         16.97        10.22         11.37        2.65       35.33         38.48        31.73         32.88         090
                                     graft, leg.
15740.........  ........  A         Island pedicle       11.47       13.20         10.92         9.13          8.49        0.63       25.30         23.02        21.23         20.59         090
                                     flap graft.
15750.........  ........  A         Neurovascular        12.63          NA            NA         8.53          8.94        1.42          NA            NA        22.58         22.99         090
                                     pedicle graft.
15756.........  ........  A         Free myo/skin        36.64          NA            NA        17.98         19.96        4.61          NA            NA        59.23         61.21         090
                                     flap microvasc.
15757.........  ........  A         Free skin flap,      36.85          NA            NA        16.45         20.35        3.89          NA            NA        57.19         61.09         090
                                     microvasc.
15758.........  ........  A         Free fascial         36.60          NA            NA        16.06         20.24        4.23          NA            NA        56.89         61.07         090
                                     flap,
                                     microvasc.
15760.........  ........  A         Composite skin        9.60       10.03         10.05         6.74          7.15        0.85       20.48         20.50        17.19         17.60         090
                                     graft.
15770.........  ........  A         Derma-fat-            8.63          NA            NA         6.43          6.63        1.05          NA            NA        16.11         16.31         090
                                     fascia graft.
15775.........  ........  R         Hair transplant       3.95        3.51          4.06         1.70          1.40        0.52        7.98          8.53         6.17          5.87         000
                                     punch grafts.
15776.........  ........  R         Hair transplant       5.53        3.91          5.01         1.56          2.50        0.72       10.16         11.26         7.81          8.75         000
                                     punch grafts.
15780.........  ........  A         Abrasion              8.40       11.63         11.57         6.71          7.88        0.67       20.70         20.64        15.78         16.95         090
                                     treatment of
                                     skin.
15781.........  ........  A         Abrasion              4.84        8.47          7.32         5.49          5.41        0.34       13.65         12.50        10.67         10.59         090
                                     treatment of
                                     skin.
15782.........  ........  A         Abrasion              4.31        9.52          9.79         5.47          6.30        0.34       14.17         14.44        10.12         10.95         090
                                     treatment of
                                     skin.
15783.........  ........  A         Abrasion              4.28        7.95          7.16         4.97          4.39        0.28       12.51         11.72         9.53          8.95         090
                                     treatment of
                                     skin.
15786.........  ........  A         Abrasion,             2.03        3.77          3.46         1.22          1.30        0.11        5.91          5.60         3.36          3.44         010
                                     lesion, single.
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
\1\ CPT codes and descriptors only are copyright 2005 American Medical Association. All rights reserved. Applicable FARS/DFARS apply.
\2\ Copyright 2005 American Dental Association. All rights reserved.
\3\ Indicates RVUs are not used for Medicare payment.


[[Page 37263]]


                                   Addendum B.--Relative Value Units (RVUs) and Related Information Used In Determining Medicare Payments for 2007--Continued
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                   Fully                                                            Fully
                                                     Physician  implemented    Year 2007      Fully       Year 2007      Mal-    implemented    Year 2007      Fully       Year 2007
CPT \1\  HCPCS     Mod     Status     Description    work RVUs      non-     transitional  implemented  transitional   practice      non-     transitional  implemented  transitional    Global
      \2\                                               \3\     facility PE  non-facility  facility PE   facility PE     RVUs      facility   non-facility    facility     facility
                                                                    RVUs        PE RVUs        RVUs         RVUs                    total         total        total         total
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
15787.........  ........  A         Abrasion,             0.33        0.82          1.02         0.10          0.15        0.04        1.19          1.39         0.47          0.52         ZZZ
                                     lesions, add-
                                     on.
15788.........  ........  R         Chemical peel,        2.09        8.47          7.17         3.67          3.24        0.11       10.67          9.37         5.87          5.44         090
                                     face, epiderm.
15789.........  ........  R         Chemical peel,        4.91        9.11          8.36         5.63          5.02        0.20       14.22         13.47        10.74         10.13         090
                                     face, dermal.
15792.........  ........  R         Chemical peel,        1.86        6.78          7.03         3.43          4.20        0.13        8.77          9.02         5.42          6.19         090
                                     nonfacial.
15793.........  ........  A         Chemical peel,        3.73        5.47          6.09         3.22          4.10        0.19        9.39         10.01         7.14          8.02         090
                                     nonfacial.
15819.........  ........  A         Plastic              10.37          NA            NA         6.54          7.04        0.97          NA            NA        17.88         18.38         090
                                     surgery, neck.
15820.........  ........  A         Revision of           6.01        6.09          6.77         4.94          5.42        0.40       12.50         13.18        11.35         11.83         090
                                     lower eyelid.
15821.........  ........  A         Revision of           6.58        6.32          7.11         5.08          5.57        0.45       13.35         14.14        12.11         12.60         090
                                     lower eyelid.
15822.........  ........  A         Revision of           4.44        4.97          5.63         3.88          4.35        0.37        9.78         10.44         8.69          9.16         090
                                     upper eyelid.
15823.........  ........  A         Revision of           8.04        7.14          7.69         5.91          6.32        0.50       15.68         16.23        14.45         14.86         090
                                     upper eyelid.
15831.........  ........  A         Excise               13.56          NA            NA         8.57          8.28        1.75          NA            NA        23.88         23.59         090
                                     excessive skin
                                     tissue.
15832.........  ........  A         Excise               12.57          NA            NA         8.11          8.30        1.66          NA            NA        22.34         22.53         090
                                     excessive skin
                                     tissue.
15833.........  ........  A         Excise               11.62          NA            NA         7.11          7.95        1.49          NA            NA        20.22         21.06         090
                                     excessive skin
                                     tissue.
15834.........  ........  A         Excise               11.89          NA            NA         7.63          7.69        1.61          NA            NA        21.13         21.19         090
                                     excessive skin
                                     tissue.
15835.........  ........  A         Excise               12.71          NA            NA         7.67          7.59        1.60          NA            NA        21.98         21.90         090
                                     excessive skin
                                     tissue.
15836.........  ........  A         Excise               10.33          NA            NA         6.78          6.80        1.34          NA            NA        18.45         18.47         090
                                     excessive skin
                                     tissue.
15837.........  ........  A         Excise                9.29        8.63          8.59         5.65          6.96        1.18       19.10         19.06        16.12         17.43         090
                                     excessive skin
                                     tissue.
15838.........  ........  A         Excise                7.99          NA            NA         4.79          5.76        0.58          NA            NA        13.36         14.33         090
                                     excessive skin
                                     tissue.
15839.........  ........  A         Excise               10.24        9.21          8.94         6.05          6.32        1.22       20.67         20.40        17.51         17.78         090
                                     excessive skin
                                     tissue.
15840.........  ........  A         Graft for face       14.66          NA            NA         8.37          9.59        1.32          NA            NA        24.35         25.57         090
                                     nerve palsy.
15841.........  ........  A         Graft for face       25.57          NA            NA        12.70         14.45        2.54          NA            NA        40.81         42.56         090
                                     nerve palsy.
15842.........  ........  A         Flap for face        40.54          NA            NA        20.48         22.36        4.93          NA            NA        65.95         67.83         090
                                     nerve palsy.
15845.........  ........  A         Skin and muscle      13.92          NA            NA         8.43          9.11        0.81          NA            NA        23.16         23.84         090
                                     repair, face.
15850.........  ........  B         Removal of            0.78        1.20          1.47         0.18          0.27        0.05        2.03          2.30         1.01          1.10         XXX
                                     sutures.
15851.........  ........  A         Removal of            0.86        1.32          1.59         0.23          0.29        0.06        2.24          2.51         1.15          1.21         000
                                     sutures.
15852.........  ........  A         Dressing change       0.86        1.61          1.79         0.25          0.31        0.09        2.56          2.74         1.20          1.26         000
                                     not for burn.
15860.........  ........  A         Test for blood        1.95        0.68          0.79         0.68          0.76        0.27        2.90          3.01         2.90          2.98         000
                                     flow in graft.
15920.........  ........  A         Removal of tail       8.06          NA            NA         5.74          5.61        1.04          NA            NA        14.84         14.71         090
                                     bone ulcer.
15922.........  ........  A         Removal of tail      10.13          NA            NA         6.89          7.15        1.42          NA            NA        18.44         18.70         090
                                     bone ulcer.
15931.........  ........  A         Remove sacrum         9.89          NA            NA         5.50          5.65        1.25          NA            NA        16.64         16.79         090
                                     pressure sore.
15933.........  ........  A         Remove sacrum        11.49          NA            NA         7.27          7.72        1.52          NA            NA        20.28         20.73         090
                                     pressure sore.
15934.........  ........  A         Remove sacrum        13.45          NA            NA         7.50          7.92        1.78          NA            NA        22.73         23.15         090
                                     pressure sore.
15935.........  ........  A         Remove sacrum        15.45          NA            NA         9.93         10.25        2.09          NA            NA        27.47         27.79         090
                                     pressure sore.
15936.........  ........  A         Remove sacrum        12.96          NA            NA         7.38          8.03        1.76          NA            NA        22.10         22.75         090
                                     pressure sore.
15937.........  ........  A         Remove sacrum        14.91          NA            NA         8.81          9.59        2.06          NA            NA        25.78         26.56         090
                                     pressure sore.
15940.........  ........  A         Remove hip           10.05          NA            NA         5.76          6.08        1.31          NA            NA        17.12         17.44         090
                                     pressure sore.
15941.........  ........  A         Remove hip           12.13          NA            NA         8.37          9.20        1.66          NA            NA        22.16         22.99         090
                                     pressure sore.
15944.........  ........  A         Remove hip           12.16          NA            NA         8.10          8.49        1.65          NA            NA        21.91         22.30         090
                                     pressure sore.
15945.........  ........  A         Remove hip           13.45          NA            NA         8.99          9.50        1.84          NA            NA        24.28         24.79         090
                                     pressure sore.
15946.........  ........  A         Remove hip           23.72          NA            NA        13.66         14.22        3.16          NA            NA        40.54         41.10         090
                                     pressure sore.
15950.........  ........  A         Remove thigh          7.83          NA            NA         5.33          5.41        1.04          NA            NA        14.20         14.28         090
                                     pressure sore.
15951.........  ........  A         Remove thigh         11.30          NA            NA         7.84          7.87        1.49          NA            NA        20.63         20.66         090
                                     pressure sore.
15952.........  ........  A         Remove thigh         12.03          NA            NA         7.66          7.74        1.60          NA            NA        21.29         21.37         090
                                     pressure sore.
15953.........  ........  A         Remove thigh         13.27          NA            NA         8.91          8.99        1.79          NA            NA        23.97         24.05         090
                                     pressure sore.
15956.........  ........  A         Remove thigh         16.46          NA            NA         9.51         10.48        2.21          NA            NA        28.18         29.15         090
                                     pressure sore.
15958.........  ........  A         Remove thigh         16.42          NA            NA        10.13         10.84        2.25          NA            NA        28.80         29.51         090
                                     pressure sore.
16000.........  ........  A         Initial               0.89        0.72          0.83         0.23          0.25        0.08        1.69          1.80         1.20          1.22         000
                                     treatment of
                                     burn(s).
16020.........  ........  A         Dress/debrid p-       0.80        1.10          1.24         0.55          0.57        0.08        1.98          2.12         1.43          1.45         000
                                     thick burn, s.
16025.........  ........  A         Dress/debrid p-       1.85        1.59          1.73         0.87          0.94        0.19        3.63          3.77         2.91          2.98         000
                                     thick burn, m.
16030.........  ........  A         Dress/debrid p-       2.08        1.95          2.12         0.94          1.08        0.24        4.27          4.44         3.26          3.40         000
                                     thick burn, l.
16035.........  ........  A         Incision of           3.74          NA            NA         1.23          1.49        0.46          NA            NA         5.43          5.69         090
                                     burn scab,
                                     initi.
16036.........  ........  A         Escharotomy;          1.50          NA            NA         0.47          0.57        0.20          NA            NA         2.17          2.27        ZZZ
                                     addIl incision.
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
\1\ CPT codes and descriptors only are copyright 2005 American Medical Association. All rights reserved. Applicable FARS/DFARS apply.
\2\ Copyright 2005 American Dental Association. All rights reserved.
\3\ Indicates RVUs are not used for Medicare payment.


[[Page 37264]]


                                   Addendum B.--Relative Value Units (RVUs) and Related Information Used In Determining Medicare Payments for 2007--Continued
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                   Fully                                                            Fully
                                                     Physician  implemented    Year 2007      Fully       Year 2007      Mal-    implemented    Year 2007      Fully       Year 2007
CPT \1\  HCPCS     Mod     Status     Description    work RVUs      non-     transitional  implemented  transitional   practice      non-     transitional  implemented  transitional    Global
      \2\                                               \3\     facility PE  non-facility  facility PE   facility PE     RVUs      facility   non-facility    facility     facility
                                                                    RVUs        PE RVUs        RVUs         RVUs                    total         total        total         total
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
17000.........  ........  A         Destroy benign/       0.60        1.38          1.07         0.72          0.59        0.03        2.01          1.70         1.35          1.22         010
                                     premlg lesion.
17003.........  ........  A         Destroy               0.07        0.10          0.11         0.03          0.06        0.01        0.18          0.19         0.11          0.14         ZZZ
                                     lesions, 2-14.
17004.........  ........  A         Destroy               1.58        1.94          2.22         1.32          1.52        0.11        3.63          3.91         3.01          3.21         010
                                     lesions, 15 or
                                     more.
17106.........  ........  A         Destruction of        4.58        4.58          4.60         3.19          3.30        0.35        9.51          9.53         8.12          8.23         090
                                     skin lesions.
17107.........  ........  A         Destruction of        9.15        7.14          7.20         5.05          5.37        0.63       16.92         16.98        14.83         15.15         090
                                     skin lesions.
17108.........  ........  A         Destruction of       13.18        9.25          9.28         6.69          7.43        0.54       22.97         23.00        20.41         21.15         090
                                     skin lesions.
17110.........  ........  A         Destruct              0.65        1.74          1.65         0.85          0.74        0.05        2.44          2.35         1.55          1.44         010
                                     lesion, 1-14.
17111.........  ........  A         Destruct              0.92        2.25          1.82         1.10          0.88        0.05        3.22          2.79         2.07          1.85         010
                                     lesion, 15 or
                                     more.
17250.........  ........  A         Chemical              0.50        1.31          1.24         0.38          0.35        0.06        1.87          1.80         0.94          0.91         000
                                     cautery,
                                     tissue.
17260.........  ........  A         Destruction of        0.91        1.39          1.31         0.69          0.68        0.04        2.34          2.26         1.64          1.63         010
                                     skin lesions.
17261.........  ........  A         Destruction of        1.17        2.45          1.82         1.04          0.88        0.05        3.67          3.04         2.26          2.10         010
                                     skin lesions.
17262.........  ........  A         Destruction of        1.58        2.79          2.12         1.24          1.08        0.06        4.43          3.76         2.88          2.72         010
                                     skin lesions.
17263.........  ........  A         Destruction of        1.79        3.01          2.30         1.33          1.15        0.07        4.87          4.16         3.19          3.01         010
                                     skin lesions.
17264.........  ........  A         Destruction of        1.94        3.22          2.48         1.40          1.19        0.08        5.24          4.50         3.42          3.21         010
                                     skin lesions.
17266.........  ........  A         Destruction of        2.34        3.47          2.75         1.56          1.31        0.09        5.90          5.18         3.99          3.74         010
                                     skin lesions.
17270.........  ........  A         Destruction of        1.32        2.40          1.88         1.07          0.92        0.05        3.77          3.25         2.44          2.29         010
                                     skin lesions.
17271.........  ........  A         Destruction of        1.49        2.62          1.99         1.19          1.03        0.06        4.17          3.54         2.74          2.58         010
                                     skin lesions.
17272.........  ........  A         Destruction of        1.77        2.92          2.23         1.33          1.17        0.07        4.76          4.07         3.17          3.01         010
                                     skin lesions.
17273.........  ........  A         Destruction of        2.05        3.16          2.45         1.46          1.27        0.08        5.29          4.58         3.59          3.40         010
                                     skin lesions.
17274.........  ........  A         Destruction of        2.59        3.56          2.82         1.71          1.51        0.10        6.25          5.51         4.40          4.20         010
                                     skin lesions.
17276.........  ........  A         Destruction of        3.20        3.83          3.17         1.94          1.75        0.16        7.19          6.53         5.30          5.11         010
                                     skin lesions.
17280.........  ........  A         Destruction of        1.17        2.32          1.79         1.01          0.86        0.05        3.54          3.01         2.23          2.08         010
                                     skin lesions.
17281.........  ........  A         Destruction of        1.72        2.69          2.11         1.30          1.14        0.07        4.48          3.90         3.09          2.93         010
                                     skin lesions.
17282.........  ........  A         Destruction of        2.04        3.09          2.39         1.46          1.30        0.08        5.21          4.51         3.58          3.42         010
                                     skin lesions.
17283.........  ........  A         Destruction of        2.64        3.50          2.79         1.73          1.55        0.11        6.25          5.54         4.48          4.30         010
                                     skin lesions.
17284.........  ........  A         Destruction of        3.21        3.92          3.18         1.99          1.82        0.13        7.26          6.52         5.33          5.16         010
                                     skin lesions.
17286.........  ........  A         Destruction of        4.43        4.31          3.84         2.40          2.44        0.23        8.97          8.50         7.06          7.10         010
                                     skin lesions.
17304.........  ........  A         1 stage mohs,         7.59       11.81          9.15         3.65          3.59        0.30       19.70         17.04        11.54         11.48         000
                                     up to 5 spec.
17305.........  ........  A         2 stage mohs,         2.85        6.85          4.64         1.37          1.35        0.11        9.81          7.60         4.33          4.31         000
                                     up to 5 spec.
17306.........  ........  A         3 stage mohs,         2.85        7.09          4.71         1.36          1.35        0.11       10.05          7.67         4.32          4.31         000
                                     up to 5 spec.
17307.........  ........  A         Mohs addl stage       2.85        6.84          4.39         1.37          1.36        0.11        9.80          7.35         4.33          4.32         000
                                     up to 5 spec.
17310.........  ........  A         Mohs any stage        0.95        1.97          1.71         0.46          0.46        0.03        2.95          2.69         1.44          1.44         ZZZ
                                     > 5 spec each.
17340.........  ........  A         Cryotherapy of        0.76        0.32          0.36         0.36          0.36        0.05        1.13          1.17         1.17          1.17         010
                                     skin.
17360.........  ........  A         Skin peel             1.43        1.40          1.43         0.97          0.90        0.06        2.89          2.92         2.46          2.39         010
                                     therapy.
19000.........  ........  A         Drainage of           0.84        1.96          1.98         0.26          0.30        0.08        2.88          2.90         1.18          1.22         000
                                     breast lesion.
19001.........  ........  A         Drain breast          0.42        0.26          0.25         0.13          0.14        0.04        0.72          0.71         0.59          0.60         ZZZ
                                     lesion add-on.
19020.........  ........  A         Incision of           3.68        6.64          6.42         3.02          2.77        0.45       10.77         10.55         7.15          6.90         090
                                     breast lesion.
19030.........  ........  A         Injection for         1.53        2.76          2.84         0.53          0.51        0.09        4.38          4.46         2.15          2.13         000
                                     breast x-ray.
19100.........  ........  A         Bx breast             1.27        2.09          2.09         0.33          0.40        0.16        3.52          3.52         1.76          1.83         000
                                     percut w/o
                                     image.
19101.........  ........  A         Biopsy of             3.18        4.34          4.47         1.76          1.88        0.39        7.91          8.04         5.33          5.45         010
                                     breast, open.
19102.........  ........  A         Bx breast             2.00        3.58          3.78         0.66          0.66        0.14        5.72          5.92         2.80          2.80         000
                                     percut w/image.
19103.........  ........  A         Bx breast             3.69       10.42         11.25         1.17          1.22        0.30       14.41         15.24         5.16          5.21         000
                                     percut w/
                                     device.
19110.........  ........  A         Nipple                4.29        6.41          5.96         3.25          2.97        0.57       11.27         10.82         8.11          7.83         090
                                     exploration.
19112.........  ........  A         Excise breast         3.66        6.26          6.13         3.14          2.80        0.48       10.40         10.27         7.28          6.94         090
                                     duct fistula.
19120.........  ........  A         Removal of            5.80        5.08          4.68         3.35          3.14        0.73       11.61         11.21         9.88          9.67         090
                                     breast lesion.
19125.........  ........  A         Excision,             6.55        5.55          4.98         3.64          3.38        0.80       12.90         12.33        10.99         10.73         090
                                     breast lesion.
19126.........  ........  A         Excision, addl        2.93          NA            NA         0.74          0.94        0.38          NA            NA         4.05          4.25         ZZZ
                                     breast lesion.
19140.........  ........  A         Removal of            5.13        8.01          7.37         3.81          3.50        0.69       13.83         13.19         9.63          9.32         090
                                     breast tissue.
19160.........  ........  A         Partial               5.98          NA            NA         3.60          3.47        0.79          NA            NA        10.37         10.24         090
                                     mastectomy.
19162.........  ........  A         P-mastectomy w/      13.81          NA            NA         6.08          6.28        1.79          NA            NA        21.68         21.88         090
                                     ln removal.
19180.........  ........  A         Removal of           15.61          NA            NA         7.01          5.53        1.18          NA            NA        23.80         22.32         090
                                     breast.
19182.........  ........  A         Removal of            7.72          NA            NA         4.97          4.81        1.04          NA            NA        13.73         13.57         090
                                     breast.
19200.........  ........  A         Removal of           17.13          NA            NA         8.11          8.01        1.92          NA            NA        27.16         27.06        090
                                     breast.
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
\1\ CPT codes and descriptors only are copyright 2005 American Medical Association. All rights reserved. Applicable FARS/DFARS apply.
\2\ Copyright 2005 American Dental Association. All rights reserved.
\3\ Indicates RVUs are not used for Medicare payment.


[[Page 37265]]


                                   Addendum B.--Relative Value Units (RVUs) and Related Information Used In Determining Medicare Payments for 2007--Continued
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                   Fully                                                            Fully
                                                     Physician  implemented    Year 2007      Fully       Year 2007      Mal-    implemented    Year 2007      Fully       Year 2007
CPT \1\  HCPCS     Mod     Status     Description    work RVUs      non-     transitional  implemented  transitional   practice      non-     transitional  implemented  transitional    Global
      \2\                                               \3\     facility PE  non-facility  facility PE   facility PE     RVUs      facility   non-facility    facility     facility
                                                                    RVUs        PE RVUs        RVUs         RVUs                    total         total        total         total
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
19220.........  ........  A         Removal of           17.73          NA            NA         8.58          8.33        2.07          NA            NA        28.38         28.13         090
                                     breast.
19240.........  ........  A         Removal of           17.83          NA            NA         8.74          8.35        2.12          NA            NA        28.69         28.30         090
                                     breast.
19260.........  ........  A         Removal of           17.52          NA            NA        10.28         10.96        2.13          NA            NA        29.93         30.61         090
                                     chest wall
                                     lesion.
19271.........  ........  A         Revision of          21.72          NA            NA        16.08         17.52        2.62          NA            NA        40.42         41.86         090
                                     chest wall.
19272.........  ........  A         Extensive chest      24.68          NA            NA        17.30         18.56        2.99          NA            NA        44.97         46.23         090
                                     wall surgery.
19290.........  ........  A         Place needle          1.27        3.00          2.90         0.44          0.43        0.07        4.34          4.24         1.78          1.77         000
                                     wire, breast.
19291.........  ........  A         Place needle          0.63        1.18          1.20         0.22          0.21        0.04        1.85          1.87         0.89          0.88         ZZZ
                                     wire, breast.
19295.........  ........  A         Place breast          0.00        2.38          2.62           NA            NA        0.01        2.39          2.63           NA            NA         ZZZ
                                     clip, percut.
19296.........  ........  A         Place po breast       3.63       85.16         115.6         1.19          1.45        0.36       89.15         119.6         5.18          5.44         000
                                     cath for rad.
19297.........  ........  A         Place breast          1.72          NA            NA         0.46          0.60        0.17          NA            NA         2.35          2.49         ZZZ
                                     cath for rad.
19298.........  ........  A         Place breast          6.00       23.02         37.47         1.94          2.30        0.43       29.45         43.90         8.37          8.73         000
                                     rad tube/caths.
19316.........  ........  A         Suspension of        10.92          NA            NA         6.94          7.38        1.64          NA            NA        19.50         19.94         090
                                     breast.
19318.........  ........  A         Reduction of         15.85          NA            NA         9.75         10.84        2.92          NA            NA        28.52         29.61         090
                                     large breast.
19324.........  ........  A         Enlarge breast.       6.59          NA            NA         4.56          4.82        0.84          NA            NA        11.99         12.25         090
19325.........  ........  A         Enlarge breast        8.44          NA            NA         6.33          6.49        1.33          NA            NA        16.10         16.26         090
                                     with implant.
19328.........  ........  A         Removal of            6.29          NA            NA         4.94          5.01        0.91          NA            NA        12.14         12.21         090
                                     breast implant.
19330.........  ........  A         Removal of            8.33          NA            NA         5.96          6.03        1.26          NA            NA        15.55         15.62         090
                                     implant
                                     material.
19340.........  ........  A         Immediate             6.32          NA            NA         2.78          3.04        1.06          NA            NA        10.16         10.42         ZZZ
                                     breast
                                     prosthesis.
19342.........  ........  A         Delayed breast       12.30          NA            NA         8.68          8.88        1.83          NA            NA        22.81         23.01         090
                                     prosthesis.
19350.........  ........  A         Breast                8.91        9.75         12.85         6.46          7.01        1.41       20.07         23.17        16.78         17.33         090
                                     reconstruction.
19355.........  ........  A         Correct               8.31        7.67          9.63         4.84          4.74        0.92       16.90         18.86        14.07         13.97         090
                                     inverted
                                     nipple(s).
19357.........  ........  A         Breast               20.33          NA            NA        15.17         15.54        2.93          NA            NA        38.43         38.80         090
                                     reconstruction.
19361.........  ........  A         Breast               20.63          NA            NA        12.06         12.37        2.92          NA            NA        35.61         35.92         090
                                     reconstruction.
19364.........  ........  A         Breast               42.30          NA            NA        22.32         23.29        6.22          NA            NA        70.84         71.81         090
                                     reconstruction.
19366.........  ........  A         Breast               21.62          NA            NA         9.92         11.19        3.24          NA            NA        34.78         36.05         090
                                     reconstruction.
19367.........  ........  A         Breast               26.51          NA            NA        14.97         16.30        4.03          NA            NA        45.51         46.84         090
                                     reconstruction.
19368.........  ........  A         Breast               33.51          NA            NA        17.75         18.67        5.52          NA            NA        56.78         57.70         090
                                     reconstruction.
19369.........  ........  A         Breast               30.92          NA            NA        15.55         17.73        4.50          NA            NA        50.97         53.15         090
                                     reconstruction.
19370.........  ........  A         Surgery of            8.91          NA            NA         6.71          6.87        1.29          NA            NA        16.91         17.07         090
                                     breast capsule.
19371.........  ........  A         Removal of           10.34          NA            NA         7.57          7.77        1.62          NA            NA        19.53         19.73         090
                                     breast capsule.
19380.........  ........  A         Revise breast        10.13          NA            NA         7.50          7.67        1.44          NA            NA        19.07         19.24         090
                                     reconstruction.
19396.........  ........  A         Design custom         2.17        4.46          1.93         1.21          1.05        0.30        6.93          4.40         3.68          3.52         000
                                     breast implant.
20000.........  ........  A         Incision of           2.12        2.77          2.72         1.51          1.68        0.25        5.14          5.09         3.88          4.05         010
                                     abscess.
20005.........  ........  A         Incision of           3.53        3.70          3.55         2.02          2.20        0.46        7.69          7.54         6.01          6.19         010
                                     deep abscess.
20100.........  ........  A         Explore wound,       10.31          NA            NA         3.56          4.24        1.21          NA            NA        15.08         15.76         010
                                     neck.
20101.........  ........  A         Explore wound,        3.22        6.46          6.07         1.50          1.59        0.44       10.12          9.73         5.16          5.25         010
                                     chest.
20102.........  ........  A         Explore wound,        3.93        6.95          7.35         1.83          1.89        0.49       11.37         11.77         6.25          6.31         010
                                     abdomen.
20103.........  ........  A         Explore wound,        5.29        7.63          8.36         2.68          3.22        0.75       13.67         14.40         8.72          9.26         010
                                     extremity.
20150.........  ........  A         Excise               14.54          NA            NA         7.57          7.18        2.03          NA            NA        24.14         23.75         090
                                     epiphyseal bar.
20200.........  ........  A         Muscle biopsy..       1.46        3.16          3.07         0.70          0.74        0.23        4.85          4.76         2.39          2.43         000
20205.........  ........  A         Deep muscle           2.35        3.83          3.88         1.09          1.17        0.33        6.51          6.56         3.77          3.85         000
                                     biopsy.
20206.........  ........  A         Needle biopsy,        0.99        5.45          6.25         0.57          0.62        0.07        6.51          7.31         1.63          1.68         000
                                     muscle.
20220.........  ........  A         Bone biopsy,          1.27        2.81          4.13         0.68          0.76        0.08        4.16          5.48         2.03          2.11         000
                                     trocar/needle.
20225.........  ........  A         Bone biopsy,          1.87       13.50         21.77         1.07          1.12        0.22       15.59         23.86         3.16          3.21         000
                                     trocar/needle.
20240.........  ........  A         Bone biopsy,          3.23          NA            NA         2.06          2.44        0.44          NA            NA         5.73          6.11         010
                                     excisional.
20245.........  ........  A         Bone biopsy,          8.71          NA            NA         5.70          6.37        1.31          NA            NA        15.72         16.39         010
                                     excisional.
20250.........  ........  A         Open bone             5.14          NA            NA         3.67          3.55        1.02          NA            NA         9.83          9.71         010
                                     biopsy.
20251.........  ........  A         Open bone             5.67          NA            NA         3.84          4.09        1.15          NA            NA        10.66         10.91         010
                                     biopsy.
20500.........  ........  A         Injection of          1.23        1.33          2.04         0.87          1.37        0.12        2.68          3.39         2.22          2.72         010
                                     sinus tract.
20501.........  ........  A         Inject sinus          0.76        2.47          2.81         0.27          0.26        0.04        3.27          3.61         1.07          1.06         000
                                     tract for x-
                                     ray.
20520.........  ........  A         Removal of            1.85        2.57          2.83         1.42          1.68        0.21        4.63          4.89         3.48          3.74         010
                                     foreign body.
20525.........  ........  A         Removal of            3.49        7.02          8.63         2.16          2.51        0.51       11.02         12.63         6.16          6.51         010
                                     foreign body.
20526.........  ........  A         Ther injection,       0.94        0.80          0.93         0.40          0.49        0.13        1.87          2.00         1.47          1.56        000
                                     carp tunnel.
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
\1\ CPT codes and descriptors only are copyright 2005 American Medical Association. All rights reserved. Applicable FARS/DFARS apply.
\2\ Copyright 2005 American Dental Association. All rights reserved.
\3\ Indicates RVUs are not used for Medicare payment.


[[Page 37266]]


                                   Addendum B.--Relative Value Units (RVUs) and Related Information Used In Determining Medicare Payments for 2007--Continued
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                   Fully                                                            Fully
                                                     Physician  implemented    Year 2007      Fully       Year 2007      Mal-    implemented    Year 2007      Fully       Year 2007
CPT \1\  HCPCS     Mod     Status     Description    work RVUs      non-     transitional  implemented  transitional   practice      non-     transitional  implemented  transitional    Global
      \2\                                               \3\     facility PE  non-facility  facility PE   facility PE     RVUs      facility   non-facility    facility     facility
                                                                    RVUs        PE RVUs        RVUs         RVUs                    total         total        total         total
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
20550.........  ........  A         Inj tendon            0.75        0.62          0.69         0.28          0.24        0.09        1.46          1.53         1.12          1.08         000
                                     sheath/
                                     ligament.
20551.........  ........  A         Inj tendon            0.75        0.63          0.67         0.28          0.32        0.08        1.46          1.50         1.11          1.15         000
                                     origin/
                                     insertion.
20552.........  ........  A         Inj trigger           0.66        0.58          0.69         0.24          0.21        0.05        1.29          1.40         0.95          0.92         000
                                     point, 1/2
                                     muscl.
20553.........  ........  A         Inject trigger        0.75        0.64          0.78         0.26          0.23        0.04        1.43          1.57         1.05          1.02         000
                                     points, =/> 3.
20600.........  ........  A         Drain/inject,         0.66        0.66          0.65         0.31          0.34        0.08        1.40          1.39         1.05          1.08         000
                                     joint/bursa.
20605.........  ........  A         Drain/inject,         0.68        0.73          0.75         0.32          0.35        0.08        1.49          1.51         1.08          1.11         000
                                     joint/bursa.
20610.........  ........  A         Drain/inject,         0.79        1.06          0.98         0.39          0.41        0.11        1.96          1.88         1.29          1.31         000
                                     joint/bursa.
20612.........  ........  A         Aspirate/inj          0.70        0.69          0.71         0.31          0.35        0.10        1.49          1.51         1.11          1.15         000
                                     ganglion cyst.
20615.........  ........  A         Treatment of          2.28        2.69          3.31         1.39          1.74        0.20        5.17          5.79         3.87          4.22         010
                                     bone cyst.
20650.........  ........  A         Insert and            2.23        2.47          2.40         1.45          1.53        0.31        5.01          4.94         3.99          4.07         010
                                     remove bone
                                     pin.
20660.........  ........  A         Apply, rem            2.51        3.33          3.13         1.46          1.57        0.59        6.43          6.23         4.56          4.67         000
                                     fixation
                                     device.
20661.........  ........  A         Application of        5.06          NA            NA         5.87          5.16        1.14          NA            NA        12.07         11.36         090
                                     head brace.
20662.........  ........  A         Application of        6.18          NA            NA         4.96          5.40        0.56          NA            NA        11.70         12.14         090
                                     pelvis brace.
20663.........  ........  A         Application of        5.54          NA            NA         5.04          4.89        0.94          NA            NA        11.52         11.37         090
                                     thigh brace.
20664.........  ........  A         Halo brace            9.78          NA            NA         7.92          7.28        1.74          NA            NA        19.44         18.80         090
                                     application.
20665.........  ........  A         Removal of            1.31        1.40          1.97         0.98          1.26        0.19        2.90          3.47         2.48          2.76         010
                                     fixation
                                     device.
20670.........  ........  A         Removal of            1.74        6.63         10.34         1.66          2.00        0.28        8.65         12.36         3.68          4.02         010
                                     support
                                     implant.
20680.........  ........  A         Removal of            5.86        8.09          8.63         4.02          3.80        0.56       14.51         15.05        10.44         10.22         090
                                     support
                                     implant.
20690.........  ........  A         Apply bone            3.63          NA            NA         2.22          2.45        0.59          NA            NA         6.44          6.67         090
                                     fixation
                                     device.
20692.........  ........  A         Apply bone            6.40          NA            NA         3.20          3.64        1.05          NA            NA        10.65         11.09         090
                                     fixation
                                     device.
20693.........  ........  A         Adjust bone           5.91          NA            NA         4.45          5.21        0.98          NA            NA        11.34         12.10         090
                                     fixation
                                     device.
20694.........  ........  A         Remove bone           4.15        5.29          6.69         3.50          3.91        0.71       10.15         11.55         8.36          8.77         090
                                     fixation
                                     device.
20802.........  ........  A         Replantation,        42.16          NA            NA        12.96         19.00        3.81          NA            NA        58.93         64.97         090
                                     arm, complete.
20805.........  ........  A         Replant              51.00          NA            NA        23.26         31.62        4.84          NA            NA        79.10         87.46         090
                                     forearm,
                                     complete.
20808.........  ........  A         Replantation         62.63          NA            NA        37.95         41.24        6.86          NA            NA        107.4         110.7         090
                                     hand, complete.
20816.........  ........  A         Replantation         31.64          NA            NA        24.04         34.44        4.52          NA            NA        60.20         70.60         090
                                     digit,
                                     complete.
20822.........  ........  A         Replantation         26.30          NA            NA        21.95         31.51        4.18          NA            NA        52.43         61.99         090
                                     digit,
                                     complete.
20824.........  ........  A         Replantation         31.64          NA            NA        25.31         33.82        4.61          NA            NA        61.56         70.07         090
                                     thumb,
                                     complete.
20827.........  ........  A         Replantation         27.12          NA            NA        23.48         33.31        3.66          NA            NA        54.26         64.09         090
                                     thumb,
                                     complete.
20838.........  ........  A         Replantation         42.42          NA            NA        13.13         20.04        1.12          NA            NA        56.67         63.58         090
                                     foot, complete.
20900.........  ........  A         Removal of bone       5.69        9.21          8.64         4.87          5.49        0.94       15.84         15.27        11.50         12.12         090
                                     for graft.
20902.........  ........  A         Removal of bone       7.90          NA            NA         5.74          6.61        1.30          NA            NA        14.94         15.81         090
                                     for graft.
20910.........  ........  A         Remove                5.33          NA            NA         4.54          5.04        0.71          NA            NA        10.58         11.08         090
                                     cartilage for
                                     graft.
20912.........  ........  A         Remove                6.34          NA            NA         4.58          5.50        0.69          NA            NA        11.61         12.53         090
                                     cartilage for
                                     graft.
20920.........  ........  A         Removal of            5.36          NA            NA         4.33          4.26        0.66          NA            NA        10.35         10.28         090
                                     fascia for
                                     graft.
20922.........  ........  A         Removal of            6.78        7.54          7.56         4.97          4.90        0.70       15.02         15.04        12.45         12.38         090
                                     fascia for
                                     graft.
20924.........  ........  A         Removal of            6.53          NA            NA         4.91          5.65        1.04          NA            NA        12.48         13.22         090
                                     tendon for
                                     graft.
20926.........  ........  A         Removal of            5.64          NA            NA         4.33          4.65        0.87          NA            NA        10.84         11.16         090
                                     tissue for
                                     graft.
20931.........  ........  A         Spinal bone           1.81          NA            NA         0.67          0.87        0.43          NA            NA         2.91          3.11         ZZZ
                                     allograft.
20937.........  ........  A         Spinal bone           2.79          NA            NA         1.06          1.35        0.54          NA            NA         4.39          4.68         ZZZ
                                     autograft.
20938.........  ........  A         Spinal bone           3.02          NA            NA         1.13          1.45        0.64          NA            NA         4.79          5.11         ZZZ
                                     autograft.
20950.........  ........  A         Fluid pressure,       1.26        4.14          6.18         0.87          0.96        0.20        5.60          7.64         2.33          2.42         000
                                     muscle.
20955.........  ........  A         Fibula bone          39.90          NA            NA        17.66         22.67        4.89          NA            NA        62.45         67.46         090
                                     graft,
                                     microvasc.
20956.........  ........  A         Iliac bone           40.79          NA            NA        20.30         23.68        7.01          NA            NA        68.10         71.48         090
                                     graft,
                                     microvasc.
20957.........  ........  A         Mt bone graft,       42.17          NA            NA        18.97         18.99        7.05          NA            NA        68.19         68.21         090
                                     microvasc.
20962.........  ........  A         Other bone           39.21          NA            NA        20.73         25.13        6.55          NA            NA        66.49         70.89         090
                                     graft,
                                     microvasc.
20969.........  ........  A         Bone/skin            44.99          NA            NA        19.75         24.97        4.79          NA            NA        69.53         74.75         090
                                     graft,
                                     microvasc.
20970.........  ........  A         Bone/skin            44.14          NA            NA        19.85         24.05        6.60          NA            NA        70.59         74.79         090
                                     graft, iliac
                                     crest.
20972.........  ........  A         Bone/skin            44.07          NA            NA        17.15         19.77        5.30          NA            NA        66.52         69.14         090
                                     graft,
                                     metatarsal.
20973.........  ........  A         Bone/skin            46.83          NA            NA        14.61         22.58        5.54          NA            NA        66.98         74.95         090
                                     graft, great
                                     toe.
20974.........  ........  A         Electrical bone       0.62        1.00          0.77         0.49          0.53        0.11        1.73          1.50         1.22          1.26         000
                                     stimulation.
20975.........  ........  A         Electrical bone       2.60          NA            NA         1.45          1.65        0.51          NA            NA         4.56          4.76         000
                                     stimulation.
20979.........  ........  A         Us bone               0.62        0.61          0.75         0.20          0.31        0.09        1.32          1.46         0.91          1.02        000
                                     stimulation.
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
\1\ CPT codes and descriptors only are copyright 2005 American Medical Association. All rights reserved. Applicable FARS/DFARS apply.
\2\ Copyright 2005 American Dental Association. All rights reserved.
\3\ Indicates RVUs are not used for Medicare payment.


[[Page 37267]]


                                   Addendum B.--Relative Value Units (RVUs) and Related Information Used In Determining Medicare Payments for 2007--Continued
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                   Fully                                                            Fully
                                                     Physician  implemented    Year 2007      Fully       Year 2007      Mal-    implemented    Year 2007      Fully       Year 2007
CPT \1\  HCPCS     Mod     Status     Description    work RVUs      non-     transitional  implemented  transitional   practice      non-     transitional  implemented  transitional    Global
      \2\                                               \3\     facility PE  non-facility  facility PE   facility PE     RVUs      facility   non-facility    facility     facility
                                                                    RVUs        PE RVUs        RVUs         RVUs                    total         total        total         total
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
20982.........  ........  A         Ablate, bone          7.27       86.78         104.1         2.87          2.95        0.69       94.74         112.1        10.83         10.91         000
                                     tumor(s) perq.
21010.........  ........  A         Incision of jaw      10.82          NA            NA         6.35          6.92        1.11          NA            NA        18.28         18.85         090
                                     joint.
21015.........  ........  A         Resection of          5.53          NA            NA         4.34          4.85        0.70          NA            NA        10.57         11.08         090
                                     facial tumor.
21025.........  ........  A         Excision of          10.99       12.43         12.32         8.65          9.20        1.32       24.74         24.63        20.96         21.51         090
                                     bone, lower
                                     jaw.
21026.........  ........  A         Excision of           5.46        8.65          8.07         5.79          6.20        0.60       14.71         14.13        11.85         12.26         090
                                     facial bone(s).
21029.........  ........  A         Contour of face       8.20        9.15          9.34         6.18          6.82        0.94       18.29         18.48        15.32         15.96         090
                                     bone lesion.
21030.........  ........  A         Excise max/           4.74        7.18          6.56         4.67          4.95        0.54       12.46         11.84         9.95         10.23         090
                                     zygoma b9
                                     tumor.
21031.........  ........  A         Remove                3.24        5.99          5.38         3.51          3.60        0.48        9.71          9.10         7.23          7.32         090
                                     exostosis,
                                     mandible.
21032.........  ........  A         Remove                3.24        6.08          5.54         3.38          3.49        0.47        9.79          9.25         7.09          7.20         090
                                     exostosis,
                                     maxilla.
21034.........  ........  A         Excise max/          17.09       12.98         15.22         9.35         11.86        1.71       31.78         34.02        28.15         30.66         090
                                     zygoma mlg
                                     tumor.
21040.........  ........  A         Excise mandible       4.74        7.26          6.62         4.67          4.72        0.54       12.54         11.90         9.95         10.00         090
                                     lesion.
21044.........  ........  A         Removal of jaw       12.53          NA            NA         7.38          8.90        1.12          NA            NA        21.03         22.55         090
                                     bone lesion.
21045.........  ........  A         Extensive jaw        18.03          NA            NA         9.84         11.75        1.52          NA            NA        29.39         31.30         090
                                     surgery.
21046.........  ........  A         Remove mandible      13.85          NA            NA        11.39         11.80        1.85          NA            NA        27.09         27.50         090
                                     cyst complex.
21047.........  ........  A         Excise lwr jaw       19.71          NA            NA         9.62         12.52        2.12          NA            NA        31.45         34.35         090
                                     cyst w/repair.
21048.........  ........  A         Remove maxilla       14.35          NA            NA        11.34         11.96        1.76          NA            NA        27.45         28.07         090
                                     cyst complex.
21049.........  ........  A         Excis uppr jaw       18.96          NA            NA         8.93         12.03        1.59          NA            NA        29.48         32.58         090
                                     cyst w/repair.
21050.........  ........  A         Removal of jaw       11.44          NA            NA         8.10          9.13        1.47          NA            NA        21.01         22.04         090
                                     joint.
21060.........  ........  A         Remove jaw           10.83          NA            NA         7.48          8.34        1.38          NA            NA        19.69         20.55         090
                                     joint
                                     cartilage.
21070.........  ........  A         Remove coronoid       8.44          NA            NA         6.09          6.86        1.27          NA            NA        15.80         16.57         090
                                     process.
21076.........  ........  A         Prepare face/        13.40        7.88         11.26         4.81          8.73        1.99       23.27         26.65        20.20         24.12         010
                                     oral
                                     prosthesis.
21077.........  ........  A         Prepare face/        33.70       18.22         28.12        12.26         22.63        4.55       56.47         66.37        50.51         60.88         090
                                     oral
                                     prosthesis.
21079.........  ........  A         Prepare face/        22.31       13.41         19.52         8.32         14.98        3.15       38.87         44.98        33.78         40.44         090
                                     oral
                                     prosthesis.
21080.........  ........  A         Prepare face/        25.06       15.49         22.29         9.25         16.88        3.74       44.29         51.09        38.05         45.68         090
                                     oral
                                     prosthesis.
21081.........  ........  A         Prepare face/        22.85       14.23         20.33         8.51         15.28        3.20       40.28         46.38        34.56         41.33         090
                                     oral
                                     prosthesis.
21082.........  ........  A         Prepare face/        20.84       14.20         18.10         8.46         13.95        3.11       38.15         42.05        32.41         37.90         090
                                     oral
                                     prosthesis.
21083.........  ........  A         Prepare face/        19.27       14.14         17.67         7.96         12.84        2.88       36.29         39.82        30.11         34.99         090
                                     oral
                                     prosthesis.
21084.........  ........  A         Prepare face/        22.48       15.59         20.77         8.82         15.52        2.18       40.25         45.43        33.48         40.18         090
                                     oral
                                     prosthesis.
21085.........  ........  A         Prepare face/         8.99        6.56          7.87         3.58          6.00        1.27       16.82         18.13        13.84         16.26         010
                                     oral
                                     prosthesis.
21086.........  ........  A         Prepare face/        24.88       12.72         21.04         8.70         16.79        3.71       41.31         49.63        37.29         45.38         090
                                     oral
                                     prosthesis.
21087.........  ........  A         Prepare face/        24.88       12.92         20.74         8.87         16.66        3.44       41.24         49.06        37.19         44.98         090
                                     oral
                                     prosthesis.
21100.........  ........  A         Maxillofacial         4.46       13.92         12.15         5.13          4.85        0.34       18.72         16.95         9.93          9.65         090
                                     fixation.
21110.........  ........  A         Interdental           5.70       13.34         10.53         9.95          8.77        0.72       19.76         16.95        16.37         15.19         090
                                     fixation.
21116.........  ........  A         Injection, jaw        0.81        2.47          3.87         0.22          0.30        0.06        3.34          4.74         1.09          1.17         000
                                     joint x-ray.
21120.........  ........  A         Reconstruction        4.92       10.08         10.48         6.95          7.37        0.60       15.60         16.00        12.47         12.89         090
                                     of chin.
21121.........  ........  A         Reconstruction        7.63       10.47          9.94         7.41          7.73        0.90       19.00         18.47        15.94         16.26         090
                                     of chin.
21122.........  ........  A         Reconstruction        8.51          NA            NA         7.54          8.37        1.07          NA            NA        17.12         17.95         090
                                     of chin.
21123.........  ........  A         Reconstruction       11.14          NA            NA        10.14         10.66        1.40          NA            NA        22.68         23.20         090
                                     of chin.
21125.........  ........  A         Augmentation,        10.60       68.82         58.74         7.01          8.01        0.79       80.21         70.13        18.40         19.40         090
                                     lower jaw bone.
21127.........  ........  A         Augmentation,        12.16       87.70         54.12         7.88          9.08        1.52       101.4         67.80        21.56         22.76         090
                                     lower jaw bone.
21137.........  ........  A         Reduction of         10.06          NA            NA         6.18          7.36        1.32          NA            NA        17.56         18.74         090
                                     forehead.
21138.........  ........  A         Reduction of         12.67          NA            NA         8.46          9.29        1.74          NA            NA        22.87         23.70         090
                                     forehead.
21139.........  ........  A         Reduction of         14.84          NA            NA         6.89         10.04        1.18          NA            NA        22.91         26.06         090
                                     forehead.
21141.........  ........  A         Reconstruct          19.13          NA            NA        11.24         13.08        2.35          NA            NA        32.72         34.56         090
                                     midface,
                                     lefort.
21142.........  ........  A         Reconstruct          19.84          NA            NA        10.35         12.23        2.38          NA            NA        32.57         34.45         090
                                     midface,
                                     lefort.
21143.........  ........  A         Reconstruct          20.61          NA            NA         8.69         12.94        1.66          NA            NA        30.96         35.21         090
                                     midface,
                                     lefort.
21145.........  ........  A         Reconstruct          23.52          NA            NA        12.44         13.57        2.84          NA            NA        38.80         39.93         090
                                     midface,
                                     lefort.
21146.........  ........  A         Reconstruct          24.41          NA            NA         9.15         13.82        3.09          NA            NA        36.65         41.32         090
                                     midface,
                                     lefort.
21147.........  ........  A         Reconstruct          26.01          NA            NA        13.44         14.68        1.84          NA            NA        41.29         42.53         090
                                     midface,
                                     lefort.
21150.........  ........  A         Reconstruct          25.70          NA            NA        13.48         15.98        2.55          NA            NA        41.73         44.23         090
                                     midface,
                                     lefort.
21151.........  ........  A         Reconstruct          28.76          NA            NA        11.43         20.12        2.30          NA            NA        42.49         51.18         090
                                     midface,
                                     lefort.
21154.........  ........  A         Reconstruct          30.95          NA            NA        20.76         22.58        2.48          NA            NA        54.19         56.01         090
                                     midface,
                                     lefort.
21155.........  ........  A         Reconstruct          34.88          NA            NA        13.09         21.24        6.64          NA            NA        54.61         62.76         090
                                     midface,
                                     lefort.
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
\1\ CPT codes and descriptors only are copyright 2005 American Medical Association. All rights reserved. Applicable FARS/DFARS apply.
\2\ Copyright 2005 American Dental Association. All rights reserved.
\3\ Indicates RVUs are not used for Medicare payment.


[[Page 37268]]


                                   Addendum B.--Relative Value Units (RVUs) and Related Information Used In Determining Medicare Payments for 2007--Continued
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                   Fully                                                            Fully
                                                     Physician  implemented    Year 2007      Fully       Year 2007      Mal-    implemented    Year 2007      Fully       Year 2007
CPT \1\  HCPCS     Mod     Status     Description    work RVUs      non-     transitional  implemented  transitional   practice      non-     transitional  implemented  transitional    Global
      \2\                                               \3\     facility PE  non-facility  facility PE   facility PE     RVUs      facility   non-facility    facility     facility
                                                                    RVUs        PE RVUs        RVUs         RVUs                    total         total        total         total
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
21159.........  ........  A         Reconstruct          42.80          NA            NA        14.87         25.59        8.18          NA            NA        65.85         76.57         090
                                     midface,
                                     lefort.
21160.........  ........  A         Reconstruct          46.85          NA            NA        23.14         26.45        4.13          NA            NA        74.12         77.43         090
                                     midface,
                                     lefort.
21172.........  ........  A         Reconstruct          28.01          NA            NA        12.81         13.55        3.55          NA            NA        44.37         45.11         090
                                     orbit/forehead.
21175.........  ........  A         Reconstruct          33.37          NA            NA        12.26         16.45        4.83          NA            NA        50.46         54.65         090
                                     orbit/forehead.
21179.........  ........  A         Reconstruct          22.47          NA            NA        10.75         13.32        2.80          NA            NA        36.02         38.59         090
                                     entire
                                     forehead.
21180.........  ........  A         Reconstruct          25.40          NA            NA        12.14         14.60        3.48          NA            NA        41.02         43.48         090
                                     entire
                                     forehead.
21181.........  ........  A         Contour cranial      10.14          NA            NA         6.63          7.27        1.32          NA            NA        18.09         18.73         090
                                     bone lesion.
21182.........  ........  A         Reconstruct          32.39          NA            NA        13.71         17.81        2.80          NA            NA        48.90         53.00         090
                                     cranial bone.
21183.........  ........  A         Reconstruct          35.51          NA            NA        15.01         19.42        4.47          NA            NA        54.99         59.40         090
                                     cranial bone.
21184.........  ........  A         Reconstruct          38.43          NA            NA        20.38         21.60        5.70          NA            NA        64.51         65.73         090
                                     cranial bone.
21188.........  ........  A         Reconstruction       22.91          NA            NA        14.49         17.81        1.69          NA            NA        39.09         42.41         090
                                     of midface.
21193.........  ........  A         Reconst lwr jaw      18.55          NA            NA         9.96         12.01        2.23          NA            NA        30.74         32.79         090
                                     w/o graft.
21194.........  ........  A         Reconst lwr jaw      21.42          NA            NA        11.23         13.15        2.02          NA            NA        34.67         36.59         090
                                     w/graft.
21195.........  ........  A         Reconst lwr jaw      18.76          NA            NA        13.08         14.42        1.64          NA            NA        33.48         34.82         090
                                     w/o fixation.
21196.........  ........  A         Reconst lwr jaw      20.43          NA            NA        13.01         15.06        2.07          NA            NA        35.51         37.56         090
                                     w/fixation.
21198.........  ........  A         Reconstr lwr         15.38          NA            NA        10.89         12.28        1.44          NA            NA        27.71         29.10         090
                                     jaw segment.
21199.........  ........  A         Reconstr lwr         16.56          NA            NA         6.65          8.52        1.39          NA            NA        24.60         26.47         090
                                     jaw w/advance.
21206.........  ........  A         Reconstruct          15.26          NA            NA        11.18         12.30        1.33          NA            NA        27.77         28.89         090
                                     upper jaw bone.
21208.........  ........  A         Augmentation of      11.03       32.29         24.87         7.65          9.12        1.09       44.41         36.99        19.77         21.24         090
                                     facial bones.
21209.........  ........  A         Reduction of          7.46       12.20         11.17         7.33          7.90        0.90       20.56         19.53        15.69         16.26         090
                                     facial bones.
21210.........  ........  A         Face bone graft      11.28       44.00         29.71         7.72          8.97        1.30       56.58         42.29        20.30         21.55         090
21215.........  ........  A         Lower jaw bone       11.82       86.93         53.23         8.01          9.05        1.53       100.3         66.58        21.36         22.40         090
                                     graft.
21230.........  ........  A         Rib cartilage        11.00          NA            NA         6.67          7.71        1.29          NA            NA        18.96         20.00         090
                                     graft.
21235.........  ........  A         Ear cartilage         7.21        9.63          9.81         5.83          6.28        0.61       17.45         17.63        13.65         14.10         090
                                     graft.
21240.........  ........  A         Reconstruction       15.65          NA            NA        10.97         11.80        2.24          NA            NA        28.86         29.69         090
                                     of jaw joint.
21242.........  ........  A         Reconstruction       14.20          NA            NA        10.36         11.25        1.78          NA            NA        26.34         27.23         090
                                     of jaw joint.
21243.........  ........  A         Reconstruction       23.83          NA            NA        15.37         16.95        3.25          NA            NA        42.45         44.03         090
                                     of jaw joint.
21244.........  ........  A         Reconstruction       13.23          NA            NA        10.80         11.80        1.25          NA            NA        25.28         26.28         090
                                     of lower jaw.
21245.........  ........  A         Reconstruction       12.78       13.18         14.13         7.85          9.37        1.19       27.15         28.10        21.82         23.34         090
                                     of jaw.
21246.........  ........  A         Reconstruction       12.70          NA            NA         6.58          8.45        1.35          NA            NA        20.63         22.50         090
                                     of jaw.
21247.........  ........  A         Reconstruct          23.91          NA            NA        13.25         16.36        2.83          NA            NA        39.99         43.10         090
                                     lower jaw bone.
21248.........  ........  A         Reconstruction       12.46       12.63         12.29         7.52          8.95        1.55       26.64         26.30        21.53         22.96         090
                                     of jaw.
21249.........  ........  A         Reconstruction       18.49       16.05         16.59         9.87         12.02        2.48       37.02         37.56        30.84         32.99         090
                                     of jaw.
21255.........  ........  A         Reconstruct          18.00          NA            NA        13.24         15.45        2.38          NA            NA        33.62         35.83         090
                                     lower jaw bone.
21256.........  ........  A         Reconstruction       17.32          NA            NA         9.67         11.31        1.50          NA            NA        28.49         30.13         090
                                     of orbit.
21260.........  ........  A         Revise eye           17.66          NA            NA         9.32         11.93        0.97          NA            NA        27.95         30.56         090
                                     sockets.
21261.........  ........  A         Revise eye           33.66          NA            NA        14.53         21.86        3.42          NA            NA        51.61         58.94         090
                                     sockets.
21263.........  ........  A         Revise eye           30.60          NA            NA        13.85         17.81        2.62          NA            NA        47.07         51.03         090
                                     sockets.
21267.........  ........  A         Revise eye           20.35          NA            NA        15.78         18.82        1.70          NA            NA        37.83         40.87         090
                                     sockets.
21268.........  ........  A         Revise eye           26.66          NA            NA        15.47         19.07        3.65          NA            NA        45.78         49.38         090
                                     sockets.
21270.........  ........  A         Augmentation,        10.46       10.98         11.51         5.74          6.89        0.72       22.16         22.69        16.92         18.07         090
                                     cheek bone.
21275.........  ........  A         Revision,            11.59          NA            NA         7.17          7.93        1.29          NA            NA        20.05         20.81         090
                                     orbitofacial
                                     bones.
21280.........  ........  A         Revision of           6.84          NA            NA         5.64          5.87        0.42          NA            NA        12.90         13.13         090
                                     eyelid.
21282.........  ........  A         Revision of           4.05          NA            NA         4.10          4.39        0.26          NA            NA         8.41          8.70         090
                                     eyelid.
21295.........  ........  A         Revision of jaw       1.78          NA            NA         2.58          2.55        0.16          NA            NA         4.52          4.49         090
                                     muscle/bone.
21296.........  ........  A         Revision of jaw       4.61          NA            NA         5.45          5.05        0.34          NA            NA        10.40         10.00         090
                                     muscle/bone.
21300.........  ........  A         Treatment of          0.72        0.27          1.85         0.27          0.26        0.13        1.12          2.70         1.12          1.11         000
                                     skull fracture.
21310.........  ........  A         Treatment of          0.58        1.95          2.21         0.10          0.14        0.05        2.58          2.84         0.73          0.77         000
                                     nose fracture.
21315.........  ........  A         Treatment of          1.76        4.41          4.28         1.63          1.83        0.14        6.31          6.18         3.53          3.73         010
                                     nose fracture.
21320.........  ........  A         Treatment of          1.85        4.00          3.94         1.23          1.52        0.18        6.03          5.97         3.26          3.55         010
                                     nose fracture.
21325.........  ........  A         Treatment of          4.01          NA            NA         6.67          8.15        0.31          NA            NA        10.99         12.47         090
                                     nose fracture.
21330.........  ........  A         Treatment of          5.62          NA            NA         7.31          9.13        0.56          NA            NA        13.49         15.31         090
                                     nose fracture.
21335.........  ........  A         Treatment of          8.85          NA            NA         7.62          9.14        0.74          NA            NA        17.21         18.73         090
                                     nose fracture.
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
\1\ CPT codes and descriptors only are copyright 2005 American Medical Association. All rights reserved. Applicable FARS/DFARS apply.
\2\ Copyright 2005 American Dental Association. All rights reserved.
\3\ Indicates RVUs are not used for Medicare payment.


[[Page 37269]]


                                   Addendum B.--Relative Value Units (RVUs) and Related Information Used In Determining Medicare Payments for 2007--Continued
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                   Fully                                                            Fully
                                                     Physician  implemented    Year 2007      Fully       Year 2007      Mal-    implemented    Year 2007      Fully       Year 2007
CPT \1\  HCPCS     Mod     Status     Description    work RVUs      non-     transitional  implemented  transitional   practice      non-     transitional  implemented  transitional    Global
      \2\                                               \3\     facility PE  non-facility  facility PE   facility PE     RVUs      facility   non-facility    facility     facility
                                                                    RVUs        PE RVUs        RVUs         RVUs                    total         total        total         total
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
21336.........  ........  A         Treat nasal           6.46          NA            NA         8.03          9.24        0.55          NA            NA        15.04         16.25         090
                                     septal
                                     fracture.
21337.........  ........  A         Treat nasal           3.20        5.80          6.06         3.32          3.52        0.28        9.28          9.54         6.80          7.00         090
                                     septal
                                     fracture.
21338.........  ........  A         Treat                 6.70          NA            NA         9.58         12.94        0.82          NA            NA        17.10         20.46         090
                                     nasoethmoid
                                     fracture.
21339.........  ........  A         Treat                 8.33          NA            NA        10.51         13.08        0.96          NA            NA        19.80         22.37         090
                                     nasoethmoid
                                     fracture.
21340.........  ........  A         Treatment of         11.25          NA            NA         7.17          8.11        1.15          NA            NA        19.57         20.51         090
                                     nose fracture.
21343.........  ........  A         Treatment of         14.01          NA            NA        12.29         14.71        1.47          NA            NA        27.77         30.19         090
                                     sinus fracture.
21344.........  ........  A         Treatment of         21.26          NA            NA        12.89         15.64        2.43          NA            NA        36.58         39.33         090
                                     sinus fracture.
21345.........  ........  A         Treat nose/jaw        8.77        9.60          9.80         5.91          6.87        0.92       19.29         19.49        15.60         16.56         090
                                     fracture.
21346.........  ........  A         Treat nose/jaw       11.21          NA            NA        10.60         11.83        1.21          NA            NA        23.02         24.25         090
                                     fracture.
21347.........  ........  A         Treat nose/jaw       13.29          NA            NA        11.39         15.03        1.47          NA            NA        26.15         29.79         090
                                     fracture.
21348.........  ........  A         Treat nose/jaw       17.28          NA            NA         6.74         10.04        2.48          NA            NA        26.50         29.80         090
                                     fracture.
21355.........  ........  A         Treat cheek           4.26        5.55          6.08         2.96          3.36        0.34       10.15         10.68         7.56          7.96         010
                                     bone fracture.
21356.........  ........  A         Treat cheek           4.64        6.70          7.03         3.86          4.39        0.46       11.80         12.13         8.96          9.49         010
                                     bone fracture.
21360.........  ........  A         Treat cheek           6.95          NA            NA         5.17          5.76        0.74          NA            NA        12.86         13.45         090
                                     bone fracture.
21365.........  ........  A         Treat cheek          16.42          NA            NA         8.73         10.33        1.69          NA            NA        26.84         28.44         090
                                     bone fracture.
21366.........  ........  A         Treat cheek          18.36          NA            NA        10.04         11.03        2.49          NA            NA        30.89         31.88         090
                                     bone fracture.
21385.........  ........  A         Treat eye             9.40          NA            NA         6.77          7.92        0.97          NA            NA        17.14         18.29         090
                                     socket
                                     fracture.
21386.........  ........  A         Treat eye             9.40          NA            NA         5.62          6.72        0.97          NA            NA        15.99         17.09         090
                                     socket
                                     fracture.
21387.........  ........  A         Treat eye             9.94          NA            NA         7.14          8.52        1.08          NA            NA        18.16         19.54         090
                                     socket
                                     fracture.
21390.........  ........  A         Treat eye            11.01          NA            NA         6.64          7.53        0.90          NA            NA        18.55         19.44         090
                                     socket
                                     fracture.
21395.........  ........  A         Treat eye            14.58          NA            NA         7.77          8.73        1.44          NA            NA        23.79         24.75         090
                                     socket
                                     fracture.
21400.........  ........  A         Treat eye             1.40        2.68          2.64         1.94          1.90        0.15        4.23          4.19         3.49          3.45         090
                                     socket
                                     fracture.
21401.........  ........  A         Treat eye             3.51        7.07          7.78         3.02          3.38        0.38       10.96         11.67         6.91          7.27         090
                                     socket
                                     fracture.
21406.........  ........  A         Treat eye             7.25          NA            NA         4.91          5.80        0.73          NA            NA        12.89         13.78         090
                                     socket
                                     fracture.
21407.........  ........  A         Treat eye             8.85          NA            NA         5.68          6.58        0.94          NA            NA        15.47         16.37         090
                                     socket
                                     fracture.
21408.........  ........  A         Treat eye            12.61          NA            NA         7.66          8.60        1.44          NA            NA        21.71         22.65         090
                                     socket
                                     fracture.
21421.........  ........  A         Treat mouth           5.70       12.01         10.02         8.89          8.47        0.73       18.44         16.45        15.32         14.90         090
                                     roof fracture.
21422.........  ........  A         Treat mouth           8.56          NA            NA         6.72          7.76        0.99          NA            NA        16.27         17.31         090
                                     roof fracture.
21423.........  ........  A         Treat mouth          10.63          NA            NA         7.16          8.80        1.27          NA            NA        19.06         20.70         090
                                     roof fracture.
21431.........  ........  A         Treat                 7.66          NA            NA         9.33          9.50        0.70          NA            NA        17.69         17.86         090
                                     craniofacial
                                     fracture.
21432.........  ........  A         Treat                 8.72          NA            NA         7.15          7.85        0.81          NA            NA        16.68         17.38         090
                                     craniofacial
                                     fracture.
21433.........  ........  A         Treat                26.05          NA            NA        12.22         15.39        2.78          NA            NA        41.05         44.22         090
                                     craniofacial
                                     fracture.
21435.........  ........  A         Treat                19.92          NA            NA        10.63         12.21        1.98          NA            NA        32.53         34.11         090
                                     craniofacial
                                     fracture.
21436.........  ........  A         Treat                29.89          NA            NA        14.95         17.44        3.09          NA            NA        47.93         50.42         090
                                     craniofacial
                                     fracture.
21440.........  ........  A         Treat dental          3.20       10.28          7.91         7.61          6.54        0.38       13.86         11.49        11.19         10.12         090
                                     ridge fracture.
21445.........  ........  A         Treat dental          5.94       12.42         10.44         8.55          8.43        0.78       19.14         17.16        15.27         15.15         090
                                     ridge fracture.
21450.........  ........  A         Treat lower jaw       3.47       10.39          8.15         7.63          7.08        0.33       14.19         11.95        11.43         10.88         090
                                     fracture.
21451.........  ........  A         Treat lower jaw       5.36       12.91         10.26         9.62          8.72        0.63       18.90         16.25        15.61         14.71         090
                                     fracture.
21452.........  ........  A         Treat lower jaw       2.23       11.76         12.74         5.88          4.94        0.27       14.26         15.24         8.38          7.44         090
                                     fracture.
21453.........  ........  A         Treat lower jaw       6.28       14.68         11.75        11.54         10.96        0.74       21.70         18.77        18.56         17.98         090
                                     fracture.
21454.........  ........  A         Treat lower jaw       7.07          NA            NA         5.57          6.10        0.82          NA            NA        13.46         13.99         090
                                     fracture.
21461.........  ........  A         Treat lower jaw       8.95       41.00         28.65        12.50         12.65        0.98       50.93         38.58        22.43         22.58         090
                                     fracture.
21462.........  ........  A         Treat lower jaw      10.65       42.32         31.35        13.10         12.84        1.27       54.24         43.27        25.02         24.76         090
                                     fracture.
21465.........  ........  A         Treat lower jaw      12.76          NA            NA         8.12          9.41        1.50          NA            NA        22.38         23.67         090
                                     fracture.
21470.........  ........  A         Treat lower jaw      17.12          NA            NA         9.90         11.51        1.96          NA            NA        28.98         30.59         090
                                     fracture.
21480.........  ........  A         Reset                 0.61        1.50          1.71         0.17          0.19        0.06        2.17          2.38         0.84          0.86         000
                                     dislocated jaw.
21485.........  ........  A         Reset                 4.48       12.24          9.24         9.21          8.06        0.51       17.23         14.23        14.20         13.05         090
                                     dislocated jaw.
21490.........  ........  A         Repair               12.59          NA            NA         7.75          9.23        1.96          NA            NA        22.30         23.78         090
                                     dislocated jaw.
21495.........  ........  A         Treat hyoid           6.43          NA            NA         9.46          8.70        0.46          NA            NA        16.35         15.59         090
                                     bone fracture.
21497.........  ........  A         Interdental           4.35       11.91          9.33         9.09          8.02        0.50       16.76         14.18        13.94         12.87         090
                                     wiring.
21501.........  ........  A         Drain neck/           3.80        6.39          6.43         3.41          3.73        0.43       10.62         10.66         7.64          7.96         090
                                     chest lesion.
21502.........  ........  A         Drain chest           7.35          NA            NA         4.75          5.43        0.97          NA            NA        13.07         13.75         090
                                     lesion.
21510.........  ........  A         Drainage of           5.97          NA            NA         4.68          5.43        0.80          NA            NA        11.45         12.20        090
                                     bone lesion.
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
\1\ CPT codes and descriptors only are copyright 2005 American Medical Association. All rights reserved. Applicable FARS/DFARS apply.
\2\ Copyright 2005 American Dental Association. All rights reserved.
\3\ Indicates RVUs are not used for Medicare payment.


[[Page 37270]]


                                   Addendum B.--Relative Value Units (RVUs) and Related Information Used In Determining Medicare Payments for 2007--Continued
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                   Fully                                                            Fully
                                                     Physician  implemented    Year 2007      Fully       Year 2007      Mal-    implemented    Year 2007      Fully       Year 2007
CPT \1\  HCPCS     Mod     Status     Description    work RVUs      non-     transitional  implemented  transitional   practice      non-     transitional  implemented  transitional    Global
      \2\                                               \3\     facility PE  non-facility  facility PE   facility PE     RVUs      facility   non-facility    facility     facility
                                                                    RVUs        PE RVUs        RVUs         RVUs                    total         total        total         total
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
21550.........  ........  A         Biopsy of neck/       2.06        4.36          3.78         1.76          1.73        0.16        6.58          6.00         3.98          3.95         010
                                     chest.
21555.........  ........  A         Remove lesion,        4.34        5.72          5.58         3.37          3.24        0.56       10.62         10.48         8.27          8.14         090
                                     neck/chest.
21556.........  ........  A         Remove lesion,        5.56          NA            NA         3.87          4.05        0.65          NA            NA        10.08         10.26         090
                                     neck/chest.
21557.........  ........  A         Remove tumor,         8.87          NA            NA         4.35          5.12        1.08          NA            NA        14.30         15.07         090
                                     neck/chest.
21600.........  ........  A         Partial removal       7.06          NA            NA         5.72          5.74        0.99          NA            NA        13.77         13.79         090
                                     of rib.
21610.........  ........  A         Partial removal      15.70          NA            NA         8.03          8.68        3.07          NA            NA        26.80         27.45         090
                                     of rib.
21615.........  ........  A         Removal of rib.      10.22          NA            NA         5.52          6.41        1.45          NA            NA        17.19         18.08         090
21616.........  ........  A         Removal of rib       12.44          NA            NA         7.22          7.84        1.86          NA            NA        21.52         22.14         090
                                     and nerves.
21620.........  ........  A         Partial removal       7.08          NA            NA         4.86          5.71        0.98          NA            NA        12.92         13.77         090
                                     of sternum.
21627.........  ........  A         Sternal               7.10          NA            NA         5.63          6.15        1.02          NA            NA        13.75         14.27         090
                                     debridement.
21630.........  ........  A         Extensive            18.89          NA            NA        10.40         11.50        2.58          NA            NA        31.87         32.97         090
                                     sternum
                                     surgery.
21632.........  ........  A         Extensive            19.40          NA            NA         9.70         10.78        2.65          NA            NA        31.75         32.83         090
                                     sternum
                                     surgery.
21685.........  ........  A         Hyoid myotomy &      14.77          NA            NA         7.68          9.42        1.06          NA            NA        23.51         25.25         090
                                     suspension.
21700.........  ........  A         Revision of           6.18          NA            NA         3.98          4.33        0.32          NA            NA        10.48         10.83         090
                                     neck muscle.
21705.........  ........  A         Revision of           9.77          NA            NA         4.86          5.42        1.43          NA            NA        16.06         16.62         090
                                     neck muscle/
                                     rib.
21720.........  ........  A         Revision of           5.67        1.94          2.34         4.29          2.93        0.91        8.52          8.92        10.87          9.51         090
                                     neck muscle.
21725.........  ........  A         Revision of           7.04          NA            NA         4.52          5.23        1.21          NA            NA        12.77         13.48         090
                                     neck muscle.
21740.........  ........  A         Reconstruction       17.43          NA            NA         8.70          8.58        2.36          NA            NA        28.49         28.37         090
                                     of sternum.
21750.........  ........  A         Repair of            11.33          NA            NA         5.50          5.97        1.63          NA            NA        18.46         18.93         090
                                     sternum
                                     separation.
21800.........  ........  A         Treatment of          0.96          NA            NA         1.40          1.36        0.09          NA            NA         2.45          2.41         090
                                     rib fracture.
21805.........  ........  A         Treatment of          2.75          NA            NA         3.51          3.29        0.38          NA            NA         6.64          6.42         090
                                     rib fracture.
21810.........  ........  A         Treatment of          6.85          NA            NA         5.28          5.06        0.94          NA            NA        13.07         12.85         090
                                     rib
                                     fracture(s).
21820.........  ........  A         Treat sternum         1.28        1.78          1.82         1.84          1.79        0.16        3.22          3.26         3.28          3.23         090
                                     fracture.
21825.........  ........  A         Treat sternum         7.58          NA            NA         5.46          6.17        1.11          NA            NA        14.15         14.86         090
                                     fracture.
21920.........  ........  A         Biopsy soft           2.06        4.36          3.56         1.83          1.56        0.14        6.56          5.76         4.03          3.76         010
                                     tissue of back.
21925.........  ........  A         Biopsy soft           4.48        5.47          5.25         3.43          3.30        0.60       10.55         10.33         8.51          8.38         090
                                     tissue of back.
21930.........  ........  A         Remove lesion,        4.99        6.01          5.80         3.74          3.49        0.66       11.66         11.45         9.39          9.14         090
                                     back or flank.
21935.........  ........  A         Remove tumor,        18.29          NA            NA         8.40          9.34        2.47          NA            NA        29.16         30.10         090
                                     back.
22010.........  ........  A         I&d, p-spine, c/     12.49          NA            NA         8.06          8.70        1.73          NA            NA        22.28         22.92         090
                                     t/cerv-thor.
22015.........  ........  A         I&d, p-spine, l/     12.38          NA            NA         8.02          8.64        1.71          NA            NA        22.11         22.73         090
                                     s/ls.
22100.........  ........  A         Remove part of       10.72          NA            NA         7.85          7.63        2.13          NA            NA        20.70         20.48         090
                                     neck vertebra.
22101.........  ........  A         Remove part,         10.80          NA            NA         7.79          7.78        1.90          NA            NA        20.49         20.48         090
                                     thorax
                                     vertebra.
22102.........  ........  A         Remove part,         10.80          NA            NA         7.08          7.87        1.87          NA            NA        19.75         20.54         090
                                     lumbar
                                     vertebra.
22103.........  ........  A         Remove extra          2.34          NA            NA         0.86          1.12        0.44          NA            NA         3.64          3.90         ZZZ
                                     spine segment.
22110.........  ........  A         Remove part of       13.72          NA            NA         8.88          9.11        2.76          NA            NA        25.36         25.59         090
                                     neck vertebra.
22112.........  ........  A         Remove part,         13.79          NA            NA         8.76          9.17        2.52          NA            NA        25.07         25.48         090
                                     thorax
                                     vertebra.
22114.........  ........  A         Remove part,         13.79          NA            NA         8.84          9.17        2.63          NA            NA        25.26         25.59         090
                                     lumbar
                                     vertebra.
22116.........  ........  A         Remove extra          2.32          NA            NA         0.84          1.09        0.50          NA            NA         3.66          3.91         ZZZ
                                     spine segment.
22210.........  ........  A         Revision of          25.03          NA            NA        14.35         15.18        5.44          NA            NA        44.82         45.65         090
                                     neck spine.
22212.........  ........  A         Revision of          20.64          NA            NA        12.20         13.03        3.90          NA            NA        36.74         37.57         090
                                     thorax spine.
22214.........  ........  A         Revision of          20.67          NA            NA        12.30         13.46        3.91          NA            NA        36.88         38.04         090
                                     lumbar spine.
22216.........  ........  A         Revise, extra         6.03          NA            NA         2.30          2.93        1.29          NA            NA         9.62         10.25         ZZZ
                                     spine segment.
22220.........  ........  A         Revision of          22.59          NA            NA        13.09         13.52        5.06          NA            NA        40.74         41.17         090
                                     neck spine.
22222.........  ........  A         Revision of          22.74          NA            NA        12.03         11.38        4.12          NA            NA        38.89         38.24         090
                                     thorax spine.
22224.........  ........  A         Revision of          22.74          NA            NA        12.88         13.92        4.18          NA            NA        39.80         40.84         090
                                     lumbar spine.
22226.........  ........  A         Revise, extra         6.03          NA            NA         2.08          2.85        1.29          NA            NA         9.40         10.17         ZZZ
                                     spine segment.
22305.........  ........  A         Treat spine           2.05        2.12          2.27         1.77          1.89        0.39        4.56          4.71         4.21          4.33         090
                                     process
                                     fracture.
22310.........  ........  A         Treat spine           3.61        2.94          2.84         2.45          2.38        0.50        7.05          6.95         6.56          6.49         090
                                     fracture.
22315.........  ........  A         Treat spine           9.83        9.62          9.69         7.24          7.32        1.85       21.30         21.37        18.92         19.00         090
                                     fracture.
22318.........  ........  A         Treat odontoid       22.46          NA            NA        12.88         13.29        5.28          NA            NA        40.62         41.03         090
                                     fx w/o graft.
22319.........  ........  A         Treat odontoid       25.07          NA            NA        13.69         14.49        6.03          NA            NA        44.79         45.59         090
                                     fx w/graft.
22325.........  ........  A         Treat spine          19.52          NA            NA        11.67         12.00        3.87          NA            NA        35.06         35.39         090
                                     fracture.
22326.........  ........  A         Treat neck           20.56          NA            NA        11.71         12.48        4.42          NA            NA        36.69         37.46        090
                                     spine fracture.
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
\1\ CPT codes and descriptors only are copyright 2005 American Medical Association. All rights reserved. Applicable FARS/DFARS apply.
\2\ Copyright 2005 American Dental Association. All rights reserved.
\3\ Indicates RVUs are not used for Medicare payment.


[[Page 37271]]


                                   Addendum B.--Relative Value Units (RVUs) and Related Information Used In Determining Medicare Payments for 2007--Continued
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                   Fully                                                            Fully
                                                     Physician  implemented    Year 2007      Fully       Year 2007      Mal-    implemented    Year 2007      Fully       Year 2007
CPT \1\  HCPCS     Mod     Status     Description    work RVUs      non-     transitional  implemented  transitional   practice      non-     transitional  implemented  transitional    Global
      \2\                                               \3\     facility PE  non-facility  facility PE   facility PE     RVUs      facility   non-facility    facility     facility
                                                                    RVUs        PE RVUs        RVUs         RVUs                    total         total        total         total
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
22327.........  ........  A         Treat thorax         20.42          NA            NA        11.94         12.29        3.98          NA            NA        36.34         36.69         090
                                     spine fracture.
22328.........  ........  A         Treat each add        4.60          NA            NA         1.75          2.14        0.94          NA            NA         7.29          7.68         ZZZ
                                     spine fx.
22505.........  ........  A         Manipulation of       1.87          NA            NA         1.04          0.97        0.36          NA            NA         3.27          3.20         010
                                     spine.
22520.........  ........  A         Percut                9.15       46.33         57.96         4.66          5.00        1.71       57.19         68.82        15.52         15.86         010
                                     vertebroplasty
                                     thor.
22521.........  ........  A         Percut                8.58       47.63         54.01         4.46          4.84        1.60       57.81         64.19        14.64         15.02         010
                                     vertebroplasty
                                     lumb.
22522.........  ........  A         Percut                4.30          NA            NA         1.51          1.64        0.82          NA            NA         6.63          6.76         ZZZ
                                     vertebroplasty
                                     addIl.
22523.........  ........  A         Percut                9.19          NA            NA         4.74          5.63        1.71          NA            NA        15.64         16.53         010
                                     kyphoplasty,
                                     thor.
22524.........  ........  A         Percut                8.79          NA            NA         4.59          5.43        1.60          NA            NA        14.98         15.82         010
                                     kyphoplasty,
                                     lumbar.
22525.........  ........  A         Percut                4.47          NA            NA         1.67          2.13        0.82          NA            NA         6.96          7.42         ZZZ
                                     kyphoplasty,
                                     add-on.
22532.........  ........  A         Lat thorax           25.73          NA            NA        13.40         14.50        4.34          NA            NA        43.47         44.57         090
                                     spine fusion.
22533.........  ........  A         Lat lumbar           24.53          NA            NA        13.12         13.50        3.15          NA            NA        40.80         41.18         090
                                     spine fusion.
22534.........  ........  A         Lat thor/lumb,        5.99          NA            NA         2.25          2.84        1.25          NA            NA         9.49         10.08         ZZZ
                                     addIl seg.
22548.........  ........  A         Neck spine           26.78          NA            NA        14.66         15.55        5.59          NA            NA        47.03         47.92         090
                                     fusion.
22554.........  ........  A         Neck spine           17.48          NA            NA        11.21         12.09        4.45          NA            NA        33.14         34.02         090
                                     fusion.
22556.........  ........  A         Thorax spine         24.42          NA            NA        12.78         14.27        4.34          NA            NA        41.54         43.03         090
                                     fusion.
22558.........  ........  A         Lumbar spine         23.25          NA            NA        11.36         12.84        3.15          NA            NA        37.76         39.24         090
                                     fusion.
22585.........  ........  A         Additional            5.52          NA            NA         2.02          2.61        1.25          NA            NA         8.79          9.38         ZZZ
                                     spinal fusion.
22590.........  ........  A         Spine & skull        21.48          NA            NA        12.77         13.21        4.78          NA            NA        39.03         39.47         090
                                     spinal fusion.
22595.........  ........  A         Neck spinal          20.36          NA            NA        12.29         12.73        4.40          NA            NA        37.05         37.49         090
                                     fusion.
22600.........  ........  A         Neck spine           17.12          NA            NA        11.00         11.17        3.72          NA            NA        31.84         32.01         090
                                     fusion.
22610.........  ........  A         Thorax spine         17.00          NA            NA        10.63         11.24        3.52          NA            NA        31.15         31.76         090
                                     fusion.
22612.........  ........  A         Lumbar spine         22.50          NA            NA        12.61         13.83        4.46          NA            NA        39.57         40.79         090
                                     fusion.
22614.........  ........  A         Spine fusion,         6.43          NA            NA         2.42          3.13        1.38          NA            NA        10.23         10.94         ZZZ
                                     extra segment.
22630.........  ........  A         Lumbar spine         21.81          NA            NA        12.31         13.31        4.72          NA            NA        38.84         39.84         090
                                     fusion.
22632.........  ........  A         Spine fusion,         5.22          NA            NA         1.95          2.49        1.16          NA            NA         8.33          8.87         ZZZ
                                     extra segment.
22800.........  ........  A         Fusion of spine      19.22          NA            NA        10.91         12.34        3.75          NA            NA        33.88         35.31         090
22802.........  ........  A         Fusion of spine      31.83          NA            NA        15.80         18.69        6.15          NA            NA        53.78         56.67         090
22804.........  ........  A         Fusion of spine      37.22          NA            NA        17.76         21.51        6.98          NA            NA        61.96         65.71         090
22808.........  ........  A         Fusion of spine      27.23          NA            NA        13.54         15.65        4.92          NA            NA        45.69         47.80         090
22810.........  ........  A         Fusion of spine      31.22          NA            NA        14.63         17.47        5.13          NA            NA        50.98         53.82         090
22812.........  ........  A         Fusion of spine      33.90          NA            NA        16.45         19.20        5.28          NA            NA        55.63         58.38         090
22818.........  ........  A         Kyphectomy, 1-2      34.12          NA            NA        16.28         18.26        6.45          NA            NA        56.85         58.83         090
                                     segments.
22819.........  ........  A         Kyphectomy, 3        39.10          NA            NA        18.97         19.83        7.65          NA            NA        65.72         66.58         090
                                     or more.
22830.........  ........  A         Exploration of       11.07          NA            NA         6.95          7.72        2.29          NA            NA        20.31         21.08         090
                                     spinal fusion.
22840.........  ........  A         Insert spine         12.52          NA            NA         4.70          6.06        2.78          NA            NA        20.00         21.36         ZZZ
                                     fixation
                                     device.
22842.........  ........  A         Insert spine         12.56          NA            NA         4.72          6.07        2.74          NA            NA        20.02         21.37         ZZZ
                                     fixation
                                     device.
22843.........  ........  A         Insert spine         13.44          NA            NA         5.11          6.24        2.85          NA            NA        21.40         22.53         ZZZ
                                     fixation
                                     device.
22844.........  ........  A         Insert spine         16.42          NA            NA         6.29          8.16        3.18          NA            NA        25.89         27.76         ZZZ
                                     fixation
                                     device.
22845.........  ........  A         Insert spine         11.94          NA            NA         4.40          5.67        2.85          NA            NA        19.19         20.46         ZZZ
                                     fixation
                                     device.
22846.........  ........  A         Insert spine         12.40          NA            NA         4.57          5.91        2.95          NA            NA        19.92         21.26         ZZZ
                                     fixation
                                     device.
22847.........  ........  A         Insert spine         13.78          NA            NA         5.17          6.57        2.99          NA            NA        21.94         23.34         ZZZ
                                     fixation
                                     device.
22848.........  ........  A         Insert pelv           5.99          NA            NA         2.30          2.97        1.15          NA            NA         9.44         10.11         ZZZ
                                     fixation
                                     device.
22849.........  ........  A         Reinsert spinal      19.02          NA            NA         9.92         11.30        3.89          NA            NA        32.83         34.21         090
                                     fixation.
22850.........  ........  A         Remove spine          9.69          NA            NA         6.26          6.82        2.04          NA            NA        17.99         18.55         090
                                     fixation
                                     device.
22851.........  ........  A         Apply spine           6.70          NA            NA         2.50          3.15        1.49          NA            NA        10.69         11.34         ZZZ
                                     prosth device.
22852.........  ........  A         Remove spine          9.24          NA            NA         5.99          6.61        1.89          NA            NA        17.12         17.74         090
                                     fixation
                                     device.
22855.........  ........  A         Remove spine         15.71          NA            NA         8.93          9.50        3.51          NA            NA        28.15         28.72         090
                                     fixation
                                     device.
22900.........  ........  A         Remove                6.09          NA            NA         3.47          3.29        0.76          NA            NA        10.32         10.14         090
                                     abdominal wall
                                     lesion.
23000.........  ........  A         Removal of            4.35        7.75          8.35         3.63          4.23        0.68       12.78         13.38         8.66          9.26         090
                                     calcium
                                     deposits.
23020.........  ........  A         Release               9.16          NA            NA         6.37          7.28        1.54          NA            NA        17.07         17.98         090
                                     shoulder joint.
23030.........  ........  A         Drain shoulder        3.42        6.26          7.12         2.38          2.78        0.57       10.25         11.11         6.37          6.77         010
                                     lesion.
23031.........  ........  A         Drain shoulder        2.74        6.44          7.52         2.19          2.60        0.46        9.64         10.72         5.39          5.80        010
                                     bursa.
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
\1\ CPT codes and descriptors only are copyright 2005 American Medical Association. All rights reserved. Applicable FARS/DFARS apply.
\2\ Copyright 2005 American Dental Association. All rights reserved.
\3\ Indicates RVUs are not used for Medicare payment.


[[Page 37272]]


                                   Addendum B.--Relative Value Units (RVUs) and Related Information Used In Determining Medicare Payments for 2007--Continued
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                   Fully                                                            Fully
                                                     Physician  implemented    Year 2007      Fully       Year 2007      Mal-    implemented    Year 2007      Fully       Year 2007
CPT \1\  HCPCS     Mod     Status     Description    work RVUs      non-     transitional  implemented  transitional   practice      non-     transitional  implemented  transitional    Global
      \2\                                               \3\     facility PE  non-facility  facility PE   facility PE     RVUs      facility   non-facility    facility     facility
                                                                    RVUs        PE RVUs        RVUs         RVUs                    total         total        total         total
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
23035.........  ........  A         Drain shoulder        8.96          NA            NA         6.91          7.95        1.47          NA            NA        17.34         18.38         090
                                     bone lesion.
23040.........  ........  A         Exploratory           9.55          NA            NA         6.65          7.57        1.60          NA            NA        17.80         18.72         090
                                     shoulder
                                     surgery.
23044.........  ........  A         Exploratory           7.41          NA            NA         5.48          6.21        1.24          NA            NA        14.13         14.86         090
                                     shoulder
                                     surgery.
23065.........  ........  A         Biopsy shoulder       2.27        2.93          2.60         1.71          1.64        0.20        5.40          5.07         4.18          4.11         010
                                     tissues.
23066.........  ........  A         Biopsy shoulder       4.15        7.67          7.69         3.56          3.88        0.63       12.45         12.47         8.34          8.66         090
                                     tissues.
23075.........  ........  A         Removal of            2.39        3.71          3.68         1.72          1.77        0.34        6.44          6.41         4.45          4.50         010
                                     shoulder
                                     lesion.
23076.........  ........  A         Removal of            7.68          NA            NA         5.25          5.49        1.13          NA            NA        14.06         14.30         090
                                     shoulder
                                     lesion.
23077.........  ........  A         Remove tumor of      17.98          NA            NA         9.59         10.08        2.33          NA            NA        29.90         30.39         090
                                     shoulder.
23100.........  ........  A         Biopsy of             6.02          NA            NA         5.04          5.51        1.04          NA            NA        12.10         12.57         090
                                     shoulder joint.
23101.........  ........  A         Shoulder joint        5.57          NA            NA         4.49          5.14        0.96          NA            NA        11.02         11.67         090
                                     surgery.
23105.........  ........  A         Remove shoulder       8.28          NA            NA         5.99          6.85        1.42          NA            NA        15.69         16.55         090
                                     joint lining.
23106.........  ........  A         Incision of           5.95          NA            NA         4.55          5.43        0.99          NA            NA        11.49         12.37         090
                                     collarbone
                                     joint.
23107.........  ........  A         Explore treat         8.67          NA            NA         6.14          7.09        1.49          NA            NA        16.30         17.25         090
                                     shoulder joint.
23120.........  ........  A         Partial               7.16          NA            NA         5.38          6.21        1.23          NA            NA        13.77         14.60         090
                                     removal,
                                     collar bone.
23125.........  ........  A         Removal of            9.44          NA            NA         6.22          7.24        1.62          NA            NA        17.28         18.30         090
                                     collar bone.
23130.........  ........  A         Remove shoulder       7.54          NA            NA         5.98          6.86        1.30          NA            NA        14.82         15.70         090
                                     bone, part.
23140.........  ........  A         Removal of bone       6.94          NA            NA         4.73          5.11        1.08          NA            NA        12.75         13.13         090
                                     lesion.
23145.........  ........  A         Removal of bone       9.20          NA            NA         5.70          7.02        1.49          NA            NA        16.39         17.71         090
                                     lesion.
23146.........  ........  A         Removal of bone       7.88          NA            NA         5.86          6.81        1.35          NA            NA        15.09         16.04         090
                                     lesion.
23150.........  ........  A         Removal of            8.71          NA            NA         5.94          6.69        1.32          NA            NA        15.97         16.72         090
                                     humerus lesion.
23155.........  ........  A         Removal of           10.63          NA            NA         7.20          8.06        1.80          NA            NA        19.63         20.49         090
                                     humerus lesion.
23156.........  ........  A         Removal of            8.91          NA            NA         6.28          7.12        1.50          NA            NA        16.69         17.53         090
                                     humerus lesion.
23170.........  ........  A         Remove collar         7.03          NA            NA         5.01          5.78        1.12          NA            NA        13.16         13.93         090
                                     bone lesion.
23172.........  ........  A         Remove shoulder       7.13          NA            NA         4.90          5.95        1.01          NA            NA        13.04         14.09         090
                                     blade lesion.
23174.........  ........  A         Remove humerus        9.80          NA            NA         7.15          8.07        1.65          NA            NA        18.60         19.52         090
                                     lesion.
23180.........  ........  A         Remove collar         8.76          NA            NA         6.96          8.51        1.47          NA            NA        17.19         18.74         090
                                     bone lesion.
23182.........  ........  A         Remove shoulder       8.38          NA            NA         6.80          8.13        1.37          NA            NA        16.55         17.88         090
                                     blade lesion.
23184.........  ........  A         Remove humerus        9.67          NA            NA         7.41          8.86        1.63          NA            NA        18.71         20.16         090
                                     lesion.
23190.........  ........  A         Partial removal       7.29          NA            NA         5.32          5.97        1.17          NA            NA        13.78         14.43         090
                                     of scapula.
23195.........  ........  A         Removal of head      10.16          NA            NA         6.65          7.48        1.70          NA            NA        18.51         19.34         090
                                     of humerus.
23200.........  ........  A         Removal of           12.60          NA            NA         7.41          8.42        1.93          NA            NA        21.94         22.95         090
                                     collar bone.
23210.........  ........  A         Removal of           13.07          NA            NA         8.09          8.79        2.02          NA            NA        23.18         23.88         090
                                     shoulder blade.
23220.........  ........  A         Partial removal      15.26          NA            NA         8.92         10.37        2.48          NA            NA        26.66         28.11         090
                                     of humerus.
23221.........  ........  A         Partial removal      18.31          NA            NA         6.48         10.43        3.05          NA            NA        27.84         31.79         090
                                     of humerus.
23222.........  ........  A         Partial removal      25.36          NA            NA        13.27         15.19        3.94          NA            NA        42.57         44.49         090
                                     of humerus.
23330.........  ........  A         Remove shoulder       1.85        3.34          3.60         1.51          1.80        0.24        5.43          5.69         3.60          3.89         010
                                     foreign body.
23331.........  ........  A         Remove shoulder       7.43          NA            NA         5.77          6.55        1.27          NA            NA        14.47         15.25         090
                                     foreign body.
23332.........  ........  A         Remove shoulder      12.14          NA            NA         7.85          8.98        2.02          NA            NA        22.01         23.14         090
                                     foreign body.
23350.........  ........  A         Injection for         1.00        2.83          3.31         0.35          0.34        0.06        3.89          4.37         1.41          1.40         000
                                     shoulder x-ray.
23395.........  ........  A         Muscle               18.19          NA            NA        11.02         12.43        2.93          NA            NA        32.14         33.55         090
                                     transfer,shoul
                                     der/arm.
23397.........  ........  A         Muscle               16.53          NA            NA         9.49         10.92        2.73          NA            NA        28.75         30.18         090
                                     transfers.
23400.........  ........  A         Fixation of          13.64          NA            NA         8.38          9.67        2.29          NA            NA        24.31         25.60         090
                                     shoulder blade.
23405.........  ........  A         Incision of           8.36          NA            NA         5.85          6.67        1.45          NA            NA        15.66         16.48         090
                                     tendon &
                                     muscle.
23406.........  ........  A         Incise               10.83          NA            NA         6.80          7.97        1.87          NA            NA        19.50         20.67         090
                                     tendon(s) &
                                     muscle(s).
23410.........  ........  A         Repair rotator       12.55          NA            NA         7.66          8.99        2.16          NA            NA        22.37         23.70         090
                                     cuff, acute.
23412.........  ........  A         Repair rotator       13.47          NA            NA         8.04          9.45        2.31          NA            NA        23.82         25.23         090
                                     cuff, chronic.
23415.........  ........  A         Release of           10.02          NA            NA         6.48          7.63        1.73          NA            NA        18.23         19.38         090
                                     shoulder
                                     ligament.
23420.........  ........  A         Repair of            14.65          NA            NA         9.58         10.55        2.31          NA            NA        26.54         27.51         090
                                     shoulder.
23430.........  ........  A         Repair biceps         9.97          NA            NA         6.66          7.76        1.73          NA            NA        18.36         19.46         090
                                     tendon.
23440.........  ........  A         Remove/              10.46          NA            NA         6.67          7.88        1.82          NA            NA        18.95         20.16         090
                                     transplant
                                     tendon.
23450.........  ........  A         Repair shoulder      13.50          NA            NA         8.02          9.41        2.32          NA            NA        23.84         25.23         090
                                     capsule.
23455.........  ........  A         Repair shoulder      14.47          NA            NA         8.41          9.96        2.49          NA            NA        25.37         26.92        090
                                     capsule.
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
\1\ CPT codes and descriptors only are copyright 2005 American Medical Association. All rights reserved. Applicable FARS/DFARS apply.
\2\ Copyright 2005 American Dental Association. All rights reserved.
\3\ Indicates RVUs are not used for Medicare payment.


[[Page 37273]]


                                   Addendum B.--Relative Value Units (RVUs) and Related Information Used In Determining Medicare Payments for 2007--Continued
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                   Fully                                                            Fully
                                                     Physician  implemented    Year 2007      Fully       Year 2007      Mal-    implemented    Year 2007      Fully       Year 2007
CPT \1\  HCPCS     Mod     Status     Description    work RVUs      non-     transitional  implemented  transitional   practice      non-     transitional  implemented  transitional    Global
      \2\                                               \3\     facility PE  non-facility  facility PE   facility PE     RVUs      facility   non-facility    facility     facility
                                                                    RVUs        PE RVUs        RVUs         RVUs                    total         total        total         total
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
23460.........  ........  A         Repair shoulder      15.59          NA            NA         9.17         10.84        2.66          NA            NA        27.42         29.09         090
                                     capsule.
23462.........  ........  A         Repair shoulder      15.52          NA            NA         8.90         10.31        2.59          NA            NA        27.01         28.42         090
                                     capsule.
23465.........  ........  A         Repair shoulder      16.07          NA            NA         9.40         10.76        2.76          NA            NA        28.23         29.59         090
                                     capsule.
23466.........  ........  A         Repair shoulder      15.45          NA            NA         9.89         11.02        2.46          NA            NA        27.80         28.93         090
                                     capsule.
23470.........  ........  A         Reconstruct          17.66          NA            NA         9.99         11.72        2.98          NA            NA        30.63         32.36         090
                                     shoulder joint.
23472.........  ........  A         Reconstruct          22.39          NA            NA        11.99         13.84        3.66          NA            NA        38.04         39.89         090
                                     shoulder joint.
23480.........  ........  A         Revision of          11.34          NA            NA         7.21          8.40        1.94          NA            NA        20.49         21.68         090
                                     collar bone.
23485.........  ........  A         Revision of          13.71          NA            NA         8.14          9.48        2.33          NA            NA        24.18         25.52         090
                                     collar bone.
23490.........  ........  A         Reinforce            11.96          NA            NA         6.76          8.23        1.47          NA            NA        20.19         21.66         090
                                     clavicle.
23491.........  ........  A         Reinforce            14.31          NA            NA         8.69         10.23        2.46          NA            NA        25.46         27.00         090
                                     shoulder bones.
23500.........  ........  A         Treat clavicle        2.08        2.61          2.81         2.68          2.57        0.30        4.99          5.19         5.06          4.95         090
                                     fracture.
23505.........  ........  A         Treat clavicle        3.68        3.97          4.31         3.57          3.78        0.61        8.26          8.60         7.86          8.07         090
                                     fracture.
23515.........  ........  A         Treat clavicle        7.40          NA            NA         5.48          6.30        1.28          NA            NA        14.16         14.98         090
                                     fracture.
23520.........  ........  A         Treat clavicle        2.16        2.60          2.80         2.67          2.73        0.34        5.10          5.30         5.17          5.23         090
                                     dislocation.
23525.........  ........  A         Treat clavicle        3.59        4.45          4.53         3.87          3.93        0.46        8.50          8.58         7.92          7.98         090
                                     dislocation.
23530.........  ........  A         Treat clavicle        7.30          NA            NA         5.18          5.76        1.20          NA            NA        13.68         14.26         090
                                     dislocation.
23532.........  ........  A         Treat clavicle        8.00          NA            NA         5.97          6.74        1.38          NA            NA        15.35         16.12         090
                                     dislocation.
23540.........  ........  A         Treat clavicle        2.23        2.59          2.80         2.66          2.44        0.29        5.11          5.32         5.18          4.96         090
                                     dislocation.
23545.........  ........  A         Treat clavicle        3.25        3.71          4.08         3.23          3.34        0.35        7.31          7.68         6.83          6.94         090
                                     dislocation.
23550.........  ........  A         Treat clavicle        7.41          NA            NA         5.43          6.15        1.25          NA            NA        14.09         14.81         090
                                     dislocation.
23552.........  ........  A         Treat clavicle        8.62          NA            NA         6.12          7.04        1.46          NA            NA        16.20         17.12         090
                                     dislocation.
23570.........  ........  A         Treat shoulder        2.23        2.76          2.96         2.90          2.90        0.36        5.35          5.55         5.49          5.49         090
                                     blade fx.
23575.........  ........  A         Treat shoulder        4.05        4.29          4.74         3.80          4.19        0.59        8.93          9.38         8.44          8.83         090
                                     blade fx.
23585.........  ........  A         Treat scapula         9.07          NA            NA         6.38          7.34        1.54          NA            NA        16.99         17.95         090
                                     fracture.
23600.........  ........  A         Treat humerus         2.93        4.03          4.43         3.61          3.57        0.48        7.44          7.84         7.02          6.98         090
                                     fracture.
23605.........  ........  A         Treat humerus         4.86        5.34          5.96         4.55          4.98        0.84       11.04         11.66        10.25         10.68         090
                                     fracture.
23615.........  ........  A         Treat humerus        10.83          NA            NA         8.16          8.69        1.62          NA            NA        20.61         21.14         090
                                     fracture.
23616.........  ........  A         Treat humerus        21.60          NA            NA        11.29         13.46        3.69          NA            NA        36.58         38.75         090
                                     fracture.
23620.........  ........  A         Treat humerus         2.40        3.38          3.56         3.11          3.02        0.40        6.18          6.36         5.91          5.82         090
                                     fracture.
23625.........  ........  A         Treat humerus         3.92        4.37          4.81         3.85          4.18        0.67        8.96          9.40         8.44          8.77         090
                                     fracture.
23630.........  ........  A         Treat humerus         7.40          NA            NA         5.57          6.38        1.27          NA            NA        14.24         15.05         090
                                     fracture.
23650.........  ........  A         Treat shoulder        3.38        3.24          3.65         2.77          2.77        0.30        6.92          7.33         6.45          6.45         090
                                     dislocation.
23655.........  ........  A         Treat shoulder        4.56          NA            NA         4.11          4.16        0.69          NA            NA         9.36          9.41         090
                                     dislocation.
23660.........  ........  A         Treat shoulder        7.48          NA            NA         5.52          6.18        1.29          NA            NA        14.29         14.95         090
                                     dislocation.
23665.........  ........  A         Treat                 4.46        4.77          5.21         4.19          4.60        0.71        9.94         10.38         9.36          9.77         090
                                     dislocation/
                                     fracture.
23670.........  ........  A         Treat                 7.95          NA            NA         5.75          6.58        1.36          NA            NA        15.06         15.89         090
                                     dislocation/
                                     fracture.
23675.........  ........  A         Treat                 6.04        6.06          6.65         5.08          5.66        1.01       13.11         13.70        12.13         12.71         090
                                     dislocation/
                                     fracture.
23680.........  ........  A         Treat                10.22          NA            NA         6.87          7.82        1.75          NA            NA        18.84         19.79         090
                                     dislocation/
                                     fracture.
23700.........  ........  A         Fixation of           2.52          NA            NA         1.88          2.11        0.44          NA            NA         4.84          5.07         010
                                     shoulder.
23800.........  ........  A         Fusion of            14.50          NA            NA         7.41          9.68        2.35          NA            NA        24.26         26.53         090
                                     shoulder joint.
23802.........  ........  A         Fusion of            18.07          NA            NA        10.76         10.34        2.70          NA            NA        31.53         31.11         090
                                     shoulder joint.
23900.........  ........  A         Amputation of        20.47          NA            NA        10.49         11.43        3.18          NA            NA        34.14         35.08         090
                                     arm & girdle.
23920.........  ........  A         Amputation at        15.95          NA            NA         9.37          9.81        2.46          NA            NA        27.78         28.22         090
                                     shoulder joint.
23921.........  ........  A         Amputation            5.54          NA            NA         4.80          5.02        0.78          NA            NA        11.12         11.34         090
                                     follow-up
                                     surgery.
23930.........  ........  A         Drainage of arm       2.94        4.97          6.00         1.97          2.23        0.43        8.34          9.37         5.34          5.60         010
                                     lesion.
23931.........  ........  A         Drainage of arm       1.79        4.30          5.52         1.72          2.07        0.28        6.37          7.59         3.79          4.14         010
                                     bursa.
23935.........  ........  A         Drain arm/elbow       6.20          NA            NA         5.04          5.71        1.05          NA            NA        12.29         12.96         090
                                     bone lesion.
24000.........  ........  A         Exploratory           5.93          NA            NA         4.69          5.25        0.97          NA            NA        11.59         12.15         090
                                     elbow surgery.
24006.........  ........  A         Release elbow         9.54          NA            NA         6.53          7.46        1.50          NA            NA        17.57         18.50         090
                                     joint.
24065.........  ........  A         Biopsy arm/           2.08        4.12          3.45         1.89          1.79        0.17        6.37          5.70         4.14          4.04         010
                                     elbow soft
                                     tissue.
24066.........  ........  A         Biopsy arm/           5.20        8.25          8.78         3.89          4.08        0.80       14.25         14.78         9.89         10.08         090
                                     elbow soft
                                     tissue.
24075.........  ........  A         Remove arm/           3.91        7.16          7.32         3.24          3.37        0.56       11.63         11.79         7.71          7.84         090
                                     elbow lesion.
24076.........  ........  A         Remove arm/           6.29          NA            NA         4.51          4.78        0.95          NA            NA        11.75         12.02        090
                                     elbow lesion.
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
\1\ CPT codes and descriptors only are copyright 2005 American Medical Association. All rights reserved. Applicable FARS/DFARS apply.
\2\ Copyright 2005 American Dental Association. All rights reserved.
\3\ Indicates RVUs are not used for Medicare payment.


[[Page 37274]]


                                   Addendum B.--Relative Value Units (RVUs) and Related Information Used In Determining Medicare Payments for 2007--Continued
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                   Fully                                                            Fully
                                                     Physician  implemented    Year 2007      Fully       Year 2007      Mal-    implemented    Year 2007      Fully       Year 2007
CPT \1\  HCPCS     Mod     Status     Description    work RVUs      non-     transitional  implemented  transitional   practice      non-     transitional  implemented  transitional    Global
      \2\                                               \3\     facility PE  non-facility  facility PE   facility PE     RVUs      facility   non-facility    facility     facility
                                                                    RVUs        PE RVUs        RVUs         RVUs                    total         total        total         total
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
24077.........  ........  A         Remove tumor of      11.86          NA            NA         6.82          7.53        1.72          NA            NA        20.40         21.11         090
                                     arm/elbow.
24100.........  ........  A         Biopsy elbow          4.92          NA            NA         4.19          4.45        0.85          NA            NA         9.96         10.22         090
                                     joint lining.
24101.........  ........  A         Explore/treat         6.12          NA            NA         4.98          5.71        1.03          NA            NA        12.13         12.86         090
                                     elbow joint.
24102.........  ........  A         Remove elbow          8.08          NA            NA         5.69          6.58        1.33          NA            NA        15.10         15.99         090
                                     joint lining.
24105.........  ........  A         Removal of            3.60          NA            NA         3.96          4.29        0.61          NA            NA         8.17          8.50         090
                                     elbow bursa.
24110.........  ........  A         Remove humerus        7.38          NA            NA         5.55          6.40        1.28          NA            NA        14.21         15.06         090
                                     lesion.
24115.........  ........  A         Remove/graft          9.92          NA            NA         6.68          7.09        1.67          NA            NA        18.27         18.68         090
                                     bone lesion.
24116.........  ........  A         Remove/graft         12.03          NA            NA         7.50          8.70        2.05          NA            NA        21.58         22.78         090
                                     bone lesion.
24120.........  ........  A         Remove elbow          6.64          NA            NA         5.12          5.74        1.10          NA            NA        12.86         13.48         090
                                     lesion.
24125.........  ........  A         Remove/graft          7.94          NA            NA         5.90          6.11        1.06          NA            NA        14.90         15.11         090
                                     bone lesion.
24126.........  ........  A         Remove/graft          8.42          NA            NA         6.09          6.80        1.16          NA            NA        15.67         16.38         090
                                     bone lesion.
24130.........  ........  A         Removal of head       6.24          NA            NA         5.02          5.79        1.04          NA            NA        12.30         13.07         090
                                     of radius.
24134.........  ........  A         Removal of arm       10.02          NA            NA         7.35          8.50        1.64          NA            NA        19.01         20.16         090
                                     bone lesion.
24136.........  ........  A         Remove radius         8.22          NA            NA         5.93          6.91        1.38          NA            NA        15.53         16.51         090
                                     bone lesion.
24138.........  ........  A         Remove elbow          8.22          NA            NA         6.58          7.50        1.34          NA            NA        16.14         17.06         090
                                     bone lesion.
24140.........  ........  A         Partial removal       9.35          NA            NA         7.07          8.62        1.51          NA            NA        17.93         19.48         090
                                     of arm bone.
24145.........  ........  A         Partial removal       7.63          NA            NA         6.19          7.61        1.25          NA            NA        15.07         16.49         090
                                     of radius.
24147.........  ........  A         Partial removal       7.59          NA            NA         6.79          8.16        1.30          NA            NA        15.68         17.05         090
                                     of elbow.
24149.........  ........  A         Radical              15.80          NA            NA        10.66         11.40        2.34          NA            NA        28.80         29.54         090
                                     resection of
                                     elbow.
24150.........  ........  A         Extensive            13.61          NA            NA         8.37          9.61        2.32          NA            NA        24.30         25.54         090
                                     humerus
                                     surgery.
24151.........  ........  A         Extensive            15.98          NA            NA         9.58         11.05        2.59          NA            NA        28.15         29.62         090
                                     humerus
                                     surgery.
24152.........  ........  A         Extensive            10.16          NA            NA         6.17          7.36        1.48          NA            NA        17.81         19.00         090
                                     radius surgery.
24153.........  ........  A         Extensive            11.64          NA            NA         6.32          5.77        0.74          NA            NA        18.70         18.15         090
                                     radius surgery.
24155.........  ........  A         Removal of           11.89          NA            NA         7.46          8.18        1.92          NA            NA        21.27         21.99         090
                                     elbow joint.
24160.........  ........  A         Remove elbow          7.82          NA            NA         5.73          6.62        1.30          NA            NA        14.85         15.74         090
                                     joint implant.
24164.........  ........  A         Remove radius         6.28          NA            NA         4.84          5.55        1.03          NA            NA        12.15         12.86         090
                                     head implant.
24200.........  ........  A         Removal of arm        1.76        2.75          3.25         1.36          1.56        0.20        4.71          5.21         3.32          3.52         010
                                     foreign body.
24201.........  ........  A         Removal of arm        4.55        7.88          9.35         3.68          4.10        0.72       13.15         14.62         8.95          9.37         090
                                     foreign body.
24220.........  ........  A         Injection for         1.31        2.73          3.41         0.45          0.44        0.08        4.12          4.80         1.84          1.83         000
                                     elbow x-ray.
24300.........  ........  A         Manipulate            3.74          NA            NA         5.10          5.57        0.65          NA            NA         9.49          9.96         090
                                     elbow w/anesth.
24301.........  ........  A         Muscle/tendon        10.18          NA            NA         6.72          7.83        1.66          NA            NA        18.56         19.67         090
                                     transfer.
24305.........  ........  A         Arm tendon            7.44          NA            NA         5.56          6.44        1.15          NA            NA        14.15         15.03         090
                                     lengthening.
24310.........  ........  A         Revision of arm       5.97          NA            NA         4.71          5.38        0.96          NA            NA        11.64         12.31         090
                                     tendon.
24320.........  ........  A         Repair of arm        10.66          NA            NA         6.97          7.41        1.73          NA            NA        19.36         19.80         090
                                     tendon.
24330.........  ........  A         Revision of arm       9.59          NA            NA         6.52          7.56        1.60          NA            NA        17.71         18.75         090
                                     muscles.
24331.........  ........  A         Revision of arm      10.75          NA            NA         6.40          8.13        1.77          NA            NA        18.92         20.65         090
                                     muscles.
24332.........  ........  A         Tenolysis,            7.69          NA            NA         5.69          6.52        1.23          NA            NA        14.61         15.44         090
                                     triceps.
24340.........  ........  A         Repair of             7.88          NA            NA         5.89          6.72        1.36          NA            NA        15.13         15.96         090
                                     biceps tendon.
24341.........  ........  A         Repair arm            9.14          NA            NA         7.40          7.81        1.36          NA            NA        17.90         18.31         090
                                     tendon/muscle.
24342.........  ........  A         Repair of            10.66          NA            NA         6.97          8.15        1.85          NA            NA        19.48         20.66         090
                                     ruptured
                                     tendon.
24343.........  ........  A         Repr elbow lat        8.89          NA            NA         6.90          7.85        1.43          NA            NA        17.22         18.17         090
                                     ligmnt w/tiss.
24344.........  ........  A         Reconstruct          14.85          NA            NA         9.86         11.13        2.36          NA            NA        27.07         28.34         090
                                     elbow lat
                                     ligmnt.
24345.........  ........  A         Repr elbw med         8.89          NA            NA         6.85          7.74        1.44          NA            NA        17.18         18.07         090
                                     ligmnt w/tissu.
24346.........  ........  A         Reconstruct          14.85          NA            NA         9.87         11.00        2.33          NA            NA        27.05         28.18         090
                                     elbow med
                                     ligmnt.
24350.........  ........  A         Repair of             5.24          NA            NA         4.81          5.40        0.87          NA            NA        10.92         11.51         090
                                     tennis elbow.
24351.........  ........  A         Repair of             5.90          NA            NA         4.92          5.69        1.02          NA            NA        11.84         12.61         090
                                     tennis elbow.
24352.........  ........  A         Repair of             6.42          NA            NA         5.13          5.93        1.10          NA            NA        12.65         13.45         090
                                     tennis elbow.
24354.........  ........  A         Repair of             6.47          NA            NA         5.16          5.92        1.07          NA            NA        12.70         13.46         090
                                     tennis elbow.
24356.........  ........  A         Revision of           6.67          NA            NA         5.23          6.06        1.11          NA            NA        13.01         13.84         090
                                     tennis elbow.
24360.........  ........  A         Reconstruct          12.44          NA            NA         7.82          9.08        2.05          NA            NA        22.31         23.57         090
                                     elbow joint.
24361.........  ........  A         Reconstruct          14.18          NA            NA         8.60         10.11        2.18          NA            NA        24.96         26.47         090
                                     elbow joint.
24362.........  ........  A         Reconstruct          15.09          NA            NA         9.11          9.83        2.60          NA            NA        26.80         27.52        090
                                     elbow joint.
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
\1\ CPT codes and descriptors only are copyright 2005 American Medical Association. All rights reserved. Applicable FARS/DFARS apply.
\2\ Copyright 2005 American Dental Association. All rights reserved.
\3\ Indicates RVUs are not used for Medicare payment.


[[Page 37275]]


                                   Addendum B.--Relative Value Units (RVUs) and Related Information Used In Determining Medicare Payments for 2007--Continued
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                   Fully                                                            Fully
                                                     Physician  implemented    Year 2007      Fully       Year 2007      Mal-    implemented    Year 2007      Fully       Year 2007
CPT \1\  HCPCS     Mod     Status     Description    work RVUs      non-     transitional  implemented  transitional   practice      non-     transitional  implemented  transitional    Global
      \2\                                               \3\     facility PE  non-facility  facility PE   facility PE     RVUs      facility   non-facility    facility     facility
                                                                    RVUs        PE RVUs        RVUs         RVUs                    total         total        total         total
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
24363.........  ........  A         Replace elbow        22.39          NA            NA        12.69         13.49        3.01          NA            NA        38.09         38.89         090
                                     joint.
24365.........  ........  A         Reconstruct           8.44          NA            NA         5.83          6.87        1.41          NA            NA        15.68         16.72         090
                                     head of radius.
24366.........  ........  A         Reconstruct           9.18          NA            NA         6.19          7.22        1.52          NA            NA        16.89         17.92         090
                                     head of radius.
24400.........  ........  A         Revision of          11.10          NA            NA         7.48          8.53        1.92          NA            NA        20.50         21.55         090
                                     humerus.
24410.........  ........  A         Revision of          14.86          NA            NA         9.14         10.04        2.57          NA            NA        26.57         27.47         090
                                     humerus.
24420.........  ........  A         Revision of          13.48          NA            NA         8.65         10.09        2.17          NA            NA        24.30         25.74         090
                                     humerus.
24430.........  ........  A         Repair of            14.99          NA            NA         8.73          9.51        2.21          NA            NA        25.93         26.71         090
                                     humerus.
24435.........  ........  A         Repair humerus       14.64          NA            NA         9.68         10.60        2.27          NA            NA        26.59         27.51         090
                                     with graft.
24470.........  ........  A         Revision of           8.73          NA            NA         6.31          7.38        1.48          NA            NA        16.52         17.59         090
                                     elbow joint.
24495.........  ........  A         Decompression         8.23          NA            NA         6.68          8.25        1.18          NA            NA        16.09         17.66         090
                                     of forearm.
24498.........  ........  A         Reinforce            12.08          NA            NA         7.59          8.87        2.06          NA            NA        21.73         23.01         090
                                     humerus.
24500.........  ........  A         Treat humerus         3.21        4.38          4.74         3.75          3.71        0.50        8.09          8.45         7.46          7.42         090
                                     fracture.
24505.........  ........  A         Treat humerus         5.16        5.78          6.41         4.82          5.26        0.89       11.83         12.46        10.87         11.31         090
                                     fracture.
24515.........  ........  A         Treat humerus        11.87          NA            NA         7.94          9.04        2.02          NA            NA        21.83         22.93         090
                                     fracture.
24516.........  ........  A         Treat humerus        11.99          NA            NA         7.56          8.75        2.02          NA            NA        21.57         22.76         090
                                     fracture.
24530.........  ........  A         Treat humerus         3.49        4.67          5.08         3.94          4.02        0.57        8.73          9.14         8.00          8.08         090
                                     fracture.
24535.........  ........  A         Treat humerus         6.86        6.73          7.58         5.77          6.42        1.18       14.77         15.62        13.81         14.46         090
                                     fracture.
24538.........  ........  A         Treat humerus         9.54          NA            NA         7.12          8.33        1.64          NA            NA        18.30         19.51         090
                                     fracture.
24545.........  ........  A         Treat humerus        10.80          NA            NA         7.10          8.13        1.82          NA            NA        19.72         20.75         090
                                     fracture.
24546.........  ........  A         Treat humerus        15.91          NA            NA         9.12         10.79        2.73          NA            NA        27.76         29.43         090
                                     fracture.
24560.........  ........  A         Treat humerus         2.80        4.00          4.37         3.33          3.23        0.44        7.24          7.61         6.57          6.47         090
                                     fracture.
24565.........  ........  A         Treat humerus         5.55        5.76          6.41         4.88          5.38        0.93       12.24         12.89        11.36         11.86         090
                                     fracture.
24566.........  ........  A         Treat humerus         8.78          NA            NA         6.86          7.85        1.30          NA            NA        16.94         17.93         090
                                     fracture.
24575.........  ........  A         Treat humerus        10.94          NA            NA         7.15          8.10        1.86          NA            NA        19.95         20.90         090
                                     fracture.
24576.........  ........  A         Treat humerus         2.86        4.38          4.67         3.68          3.71        0.46        7.70          7.99         7.00          7.03         090
                                     fracture.
24577.........  ........  A         Treat humerus         5.78        5.95          6.70         5.01          5.65        0.95       12.68         13.43        11.74         12.38         090
                                     fracture.
24579.........  ........  A         Treat humerus        11.88          NA            NA         7.53          8.53        2.02          NA            NA        21.43         22.43         090
                                     fracture.
24582.........  ........  A         Treat humerus         9.79          NA            NA         8.07          8.87        1.48          NA            NA        19.34         20.14         090
                                     fracture.
24586.........  ........  A         Treat elbow          15.55          NA            NA         9.18         10.74        2.64          NA            NA        27.37         28.93         090
                                     fracture.
24587.........  ........  A         Treat elbow          15.56          NA            NA         9.23         10.60        2.52          NA            NA        27.31         28.68         090
                                     fracture.
24600.........  ........  A         Treat elbow           4.22        3.82          4.61         3.24          3.44        0.50        8.54          9.33         7.96          8.16         090
                                     dislocation.
24605.........  ........  A         Treat elbow           5.41          NA            NA         4.88          5.26        0.89          NA            NA        11.18         11.56         090
                                     dislocation.
24615.........  ........  A         Treat elbow           9.65          NA            NA         6.46          7.50        1.60          NA            NA        17.71         18.75         090
                                     dislocation.
24620.........  ........  A         Treat elbow           6.97          NA            NA         5.38          6.05        1.07          NA            NA        13.42         14.09         090
                                     fracture.
24635.........  ........  A         Treat elbow          13.47          NA            NA        10.05         13.08        2.28          NA            NA        25.80         28.83         090
                                     fracture.
24640.........  ........  A         Treat elbow           1.20        1.46          1.75         0.79          0.80        0.12        2.78          3.07         2.11          2.12         010
                                     dislocation.
24650.........  ........  A         Treat radius          2.16        3.39          3.69         2.96          2.81        0.35        5.90          6.20         5.47          5.32         090
                                     fracture.
24655.........  ........  A         Treat radius          4.39        5.13          5.76         4.35          4.69        0.70       10.22         10.85         9.44          9.78         090
                                     fracture.
24665.........  ........  A         Treat radius          8.13          NA            NA         6.23          7.21        1.41          NA            NA        15.77         16.75         090
                                     fracture.
24666.........  ........  A         Treat radius          9.66          NA            NA         6.68          7.74        1.62          NA            NA        17.96         19.02         090
                                     fracture.
24670.........  ........  A         Treat ulnar           2.54        3.68          4.01         3.11          3.09        0.41        6.63          6.96         6.06          6.04         090
                                     fracture.
24675.........  ........  A         Treat ulnar           4.71        5.24          5.83         4.44          4.85        0.81       10.76         11.35         9.96         10.37         090
                                     fracture.
24685.........  ........  A         Treat ulnar           8.85          NA            NA         6.17          7.20        1.52          NA            NA        16.54         17.57         090
                                     fracture.
24800.........  ........  A         Fusion of elbow      11.18          NA            NA         7.51          8.46        1.63          NA            NA        20.32         21.27         090
                                     joint.
24802.........  ........  A         Fusion/graft of      14.09          NA            NA         8.42          9.91        2.37          NA            NA        24.88         26.37         090
                                     elbow joint.
24900.........  ........  A         Amputation of         9.95          NA            NA         6.38          6.91        1.53          NA            NA        17.86         18.39         090
                                     upper arm.
24920.........  ........  A         Amputation of         9.95          NA            NA         6.28          6.79        1.61          NA            NA        17.84         18.35         090
                                     upper arm.
24925.........  ........  A         Amputation            7.12          NA            NA         4.92          5.81        1.14          NA            NA        13.18         14.07         090
                                     follow-up
                                     surgery.
24930.........  ........  A         Amputation           10.65          NA            NA         5.88          6.92        1.67          NA            NA        18.20         19.24         090
                                     follow-up
                                     surgery.
24931.........  ........  A         Amputate upper       13.24          NA            NA         8.08          6.33        1.89          NA            NA        23.21         21.46         090
                                     arm & implant.
24935.........  ........  A         Revision of          16.20          NA            NA         7.29          7.85        2.13          NA            NA        25.62         26.18         090
                                     amputation.
25000.........  ........  A         Incision of           3.37          NA            NA         4.99          6.42        0.55          NA            NA         8.91         10.34        090
                                     tendon sheath.
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
\1\ CPT codes and descriptors only are copyright 2005 American Medical Association. All rights reserved. Applicable FARS/DFARS apply.
\2\ Copyright 2005 American Dental Association. All rights reserved.
\3\ Indicates RVUs are not used for Medicare payment.


[[Page 37276]]


                                   Addendum B.--Relative Value Units (RVUs) and Related Information Used In Determining Medicare Payments for 2007--Continued
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                   Fully                                                            Fully
                                                     Physician  implemented    Year 2007      Fully       Year 2007      Mal-    implemented    Year 2007      Fully       Year 2007
CPT \1\  HCPCS     Mod     Status     Description    work RVUs      non-     transitional  implemented  transitional   practice      non-     transitional  implemented  transitional    Global
      \2\                                               \3\     facility PE  non-facility  facility PE   facility PE     RVUs      facility   non-facility    facility     facility
                                                                    RVUs        PE RVUs        RVUs         RVUs                    total         total        total         total
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
25001.........  ........  A         Incise flexor         3.62          NA            NA         3.79          4.13        0.55          NA            NA         7.96          8.30         090
                                     carpi radialis.
25020.........  ........  A         Decompress            5.91          NA            NA         6.81          8.90        0.93          NA            NA        13.65         15.74         090
                                     forearm 1
                                     space.
25023.........  ........  A         Decompress           13.60          NA            NA        11.31         14.06        2.03          NA            NA        26.94         29.69         090
                                     forearm 1
                                     space.
25024.........  ........  A         Decompress           10.52          NA            NA         7.11          7.40        1.36          NA            NA        18.99         19.28         090
                                     forearm 2
                                     spaces.
25025.........  ........  A         Decompress           17.67          NA            NA         8.92          9.73        1.82          NA            NA        28.41         29.22         090
                                     forearm 2
                                     spaces.
25028.........  ........  A         Drainage of           5.24          NA            NA         6.19          7.68        0.81          NA            NA        12.24         13.73         090
                                     forearm lesion.
25031.........  ........  A         Drainage of           4.13          NA            NA         5.40          7.31        0.63          NA            NA        10.16         12.07         090
                                     forearm bursa.
25035.........  ........  A         Treat forearm         7.47          NA            NA         8.75         12.41        1.24          NA            NA        17.46         21.12         090
                                     bone lesion.
25040.........  ........  A         Explore/treat         7.35          NA            NA         5.80          6.94        1.15          NA            NA        14.30         15.44         090
                                     wrist joint.
25065.........  ........  A         Biopsy forearm        1.99        4.23          3.48         1.92          1.91        0.15        6.37          5.62         4.06          4.05         010
                                     soft tissues.
25066.........  ........  A         Biopsy forearm        4.12          NA            NA         5.39          6.66        0.64          NA            NA        10.15         11.42         090
                                     soft tissues.
25075.........  ........  A         Removal forearm       3.73          NA            NA         4.86          5.65        0.55          NA            NA         9.14          9.93         090
                                     lesion subcu.
25076.........  ........  A         Removal forearm       4.91          NA            NA         6.83          8.89        0.74          NA            NA        12.48         14.54         090
                                     lesion deep.
25077.........  ........  A         Remove tumor,         9.81          NA            NA         8.82         11.30        1.42          NA            NA        20.05         22.53         090
                                     forearm/wrist.
25085.........  ........  A         Incision of           5.49          NA            NA         5.36          6.70        0.85          NA            NA        11.70         13.04         090
                                     wrist capsule.
25100.........  ........  A         Biopsy of wrist       3.89          NA            NA         4.21          5.02        0.59          NA            NA         8.69          9.50         090
                                     joint.
25101.........  ........  A         Explore/treat         4.68          NA            NA         4.75          5.62        0.75          NA            NA        10.18         11.05         090
                                     wrist joint.
25105.........  ........  A         Remove wrist          5.84          NA            NA         5.73          6.92        0.92          NA            NA        12.49         13.68         090
                                     joint lining.
25107.........  ........  A         Remove wrist          7.42          NA            NA         7.04          8.03        0.99          NA            NA        15.45         16.44         090
                                     joint
                                     cartilage.
25110.........  ........  A         Remove wrist          3.91          NA            NA         5.23          6.61        0.62          NA            NA         9.76         11.14         090
                                     tendon lesion.
25111.........  ........  A         Remove wrist          3.38          NA            NA         4.05          4.55        0.53          NA            NA         7.96          8.46         090
                                     tendon lesion.
25112.........  ........  A         Reremove wrist        4.52          NA            NA         4.47          5.07        0.70          NA            NA         9.69         10.29         090
                                     tendon lesion.
25115.........  ........  A         Remove wrist/         9.81          NA            NA        10.05         13.07        1.31          NA            NA        21.17         24.19         090
                                     forearm lesion.
25116.........  ........  A         Remove wrist/         7.28          NA            NA         8.95         12.12        1.11          NA            NA        17.34         20.51         090
                                     forearm lesion.
25118.........  ........  A         Excise wrist          4.36          NA            NA         4.56          5.46        0.68          NA            NA         9.60         10.50         090
                                     tendon sheath.
25119.........  ........  A         Partial removal       6.03          NA            NA         5.77          7.16        0.96          NA            NA        12.76         14.15         090
                                     of ulna.
25120.........  ........  A         Removal of            6.09          NA            NA         7.82         11.05        1.00          NA            NA        14.91         18.14         090
                                     forearm lesion.
25125.........  ........  A         Remove/graft          7.47          NA            NA         8.63         11.82        1.06          NA            NA        17.16         20.35         090
                                     forearm lesion.
25126.........  ........  A         Remove/graft          7.54          NA            NA         8.65         11.95        1.27          NA            NA        17.46         20.76         090
                                     forearm lesion.
25130.........  ........  A         Removal of            5.25          NA            NA         5.13          6.11        0.80          NA            NA        11.18         12.16         090
                                     wrist lesion.
25135.........  ........  A         Remove & graft        6.88          NA            NA         6.02          7.15        1.02          NA            NA        13.92         15.05         090
                                     wrist lesion.
25136.........  ........  A         Remove & graft        5.96          NA            NA         5.44          6.32        1.03          NA            NA        12.43         13.31         090
                                     wrist lesion.
25145.........  ........  A         Remove forearm        6.36          NA            NA         8.00         11.07        1.01          NA            NA        15.37         18.44         090
                                     bone lesion.
25150.........  ........  A         Partial removal       7.20          NA            NA         6.27          7.74        1.14          NA            NA        14.61         16.08         090
                                     of ulna.
25151.........  ........  A         Partial removal       7.50          NA            NA         8.39         11.67        1.18          NA            NA        17.07         20.35         090
                                     of radius.
25170.........  ........  A         Extensive            11.25          NA            NA        10.37         13.99        1.77          NA            NA        23.39         27.01         090
                                     forearm
                                     surgery.
25210.........  ........  A         Removal of            5.94          NA            NA         5.44          6.47        0.88          NA            NA        12.26         13.29         090
                                     wrist bone.
25215.........  ........  A         Removal of            7.94          NA            NA         6.72          8.27        1.19          NA            NA        15.85         17.40         090
                                     wrist bones.
25230.........  ........  A         Partial removal       5.22          NA            NA         4.88          5.84        0.79          NA            NA        10.89         11.85         090
                                     of radius.
25240.........  ........  A         Partial removal       5.16          NA            NA         5.19          6.53        0.81          NA            NA        11.16         12.50         090
                                     of ulna.
25246.........  ........  A         Injection for         1.45        2.80          3.29         0.51          0.49        0.09        4.34          4.83         2.05          2.03         000
                                     wrist x-ray.
25248.........  ........  A         Remove forearm        5.13          NA            NA         6.50          8.03        0.72          NA            NA        12.35         13.88         090
                                     foreign body.
25250.........  ........  A         Removal of            6.59          NA            NA         5.23          5.90        1.01          NA            NA        12.83         13.50         090
                                     wrist
                                     prosthesis.
25251.........  ........  A         Removal of            9.62          NA            NA         6.59          7.60        1.26          NA            NA        17.47         18.48         090
                                     wrist
                                     prosthesis.
25259.........  ........  A         Manipulate            3.74          NA            NA         5.06          5.57        0.62          NA            NA         9.42          9.93         090
                                     wrist w/
                                     anesthes.
25260.........  ........  A         Repair forearm        7.79          NA            NA         9.08         12.28        1.19          NA            NA        18.06         21.26         090
                                     tendon/muscle.
25263.........  ........  A         Repair forearm        7.81          NA            NA         8.83         12.18        1.18          NA            NA        17.82         21.17         090
                                     tendon/muscle.
25265.........  ........  A         Repair forearm        9.87          NA            NA         9.85         13.23        1.47          NA            NA        21.19         24.57         090
                                     tendon/muscle.
25270.........  ........  A         Repair forearm        5.99          NA            NA         7.78         10.99        0.95          NA            NA        14.72         17.93         090
                                     tendon/muscle.
25272.........  ........  A         Repair forearm        7.03          NA            NA         8.25         11.69        1.11          NA            NA        16.39         19.83         090
                                     tendon/muscle.
25274.........  ........  A         Repair forearm        8.74          NA            NA         9.06         12.51        1.36          NA            NA        19.16         22.61         090
                                     tendon/muscle.
25275.........  ........  A         Repair forearm        8.74          NA            NA         6.38          7.30        1.31          NA            NA        16.43         17.35         090
                                     tendon sheath.
25280.........  ........  A         Revise wrist/         7.21          NA            NA         8.33         11.59        1.08          NA            NA        16.62         19.88        090
                                     forearm tendon.
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
\1\ CPT codes and descriptors only are copyright 2005 American Medical Association. All rights reserved. Applicable FARS/DFARS apply.
\2\ Copyright 2005 American Dental Association. All rights reserved.
\3\ Indicates RVUs are not used for Medicare payment.


[[Page 37277]]


                                   Addendum B.--Relative Value Units (RVUs) and Related Information Used In Determining Medicare Payments for 2007--Continued
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                   Fully                                                            Fully
                                                     Physician  implemented    Year 2007      Fully       Year 2007      Mal-    implemented    Year 2007      Fully       Year 2007
CPT \1\  HCPCS     Mod     Status     Description    work RVUs      non-     transitional  implemented  transitional   practice      non-     transitional  implemented  transitional    Global
      \2\                                               \3\     facility PE  non-facility  facility PE   facility PE     RVUs      facility   non-facility    facility     facility
                                                                    RVUs        PE RVUs        RVUs         RVUs                    total         total        total         total
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
25290.........  ........  A         Incise wrist/         5.28          NA            NA         9.05         13.54        0.82          NA            NA        15.15         19.64         090
                                     forearm tendon.
25295.........  ........  A         Release wrist/        6.54          NA            NA         8.02         11.15        1.00          NA            NA        15.56         18.69         090
                                     forearm tendon.
25300.........  ........  A         Fusion of             8.79          NA            NA         7.06          8.12        1.26          NA            NA        17.11         18.17         090
                                     tendons at
                                     wrist.
25301.........  ........  A         Fusion of             8.39          NA            NA         6.61          7.71        1.29          NA            NA        16.29         17.39         090
                                     tendons at
                                     wrist.
25310.........  ........  A         Transplant            8.19          NA            NA         8.68         11.97        1.21          NA            NA        18.08         21.37         090
                                     forearm tendon.
25312.........  ........  A         Transplant            9.62          NA            NA         9.46         12.85        1.41          NA            NA        20.49         23.88         090
                                     forearm tendon.
25315.........  ........  A         Revise palsy         10.48          NA            NA         9.82         13.29        1.58          NA            NA        21.88         25.35         090
                                     hand tendon(s).
25316.........  ........  A         Revise palsy         12.67          NA            NA        10.89         14.93        1.74          NA            NA        25.30         29.34         090
                                     hand tendon(s).
25320.........  ........  A         Repair/revise        12.28          NA            NA        10.20         11.12        1.61          NA            NA        24.09         25.01         090
                                     wrist joint.
25332.........  ........  A         Revise wrist         11.51          NA            NA         7.59          8.80        1.83          NA            NA        20.93         22.14         090
                                     joint.
25335.........  ........  A         Realignment of       13.16          NA            NA         6.87         10.43        1.92          NA            NA        21.95         25.51         090
                                     hand.
25337.........  ........  A         Reconstruct          11.36          NA            NA         9.24         10.64        1.61          NA            NA        22.21         23.61         090
                                     ulna/
                                     radioulnar.
25350.........  ........  A         Revision of           8.89          NA            NA         9.12         12.79        1.46          NA            NA        19.47         23.14         090
                                     radius.
25355.........  ........  A         Revision of          10.33          NA            NA         9.86         13.45        1.73          NA            NA        21.92         25.51         090
                                     radius.
25360.........  ........  A         Revision of           8.54          NA            NA         8.99         12.68        1.41          NA            NA        18.94         22.63         090
                                     ulna.
25365.........  ........  A         Revise radius &      12.68          NA            NA        10.88         14.49        2.15          NA            NA        25.71         29.32         090
                                     ulna.
25370.........  ........  A         Revise radius        13.82          NA            NA        11.76         15.03        2.28          NA            NA        27.86         31.13         090
                                     or ulna.
25375.........  ........  A         Revise radius &      13.32          NA            NA        11.14         15.14        2.26          NA            NA        26.72         30.72         090
                                     ulna.
25390.........  ........  A         Shorten radius       10.50          NA            NA         9.78         13.41        1.65          NA            NA        21.93         25.56         090
                                     or ulna.
25391.........  ........  A         Lengthen radius      14.05          NA            NA        11.46         15.32        2.21          NA            NA        27.72         31.58         090
                                     or ulna.
25392.........  ........  A         Shorten radius       14.35          NA            NA        11.59         14.91        2.10          NA            NA        28.04         31.36         090
                                     & ulna.
25393.........  ........  A         Lengthen radius      16.33          NA            NA        12.90         16.45        2.76          NA            NA        31.99         35.54         090
                                     & ulna.
25394.........  ........  A         Repair carpal        10.63          NA            NA         6.67          7.73        1.59          NA            NA        18.89         19.95         090
                                     bone, shorten.
25400.........  ........  A         Repair radius        11.08          NA            NA        10.01         13.93        1.82          NA            NA        22.91         26.83         090
                                     or ulna.
25405.........  ........  A         Repair/graft         14.78          NA            NA        11.72         15.92        2.32          NA            NA        28.82         33.02         090
                                     radius or ulna.
25415.........  ........  A         Repair radius &      13.57          NA            NA        10.81         15.12        2.17          NA            NA        26.55         30.86         090
                                     ulna.
25420.........  ........  A         Repair/graft         16.79          NA            NA        12.55         16.88        2.61          NA            NA        31.95         36.28         090
                                     radius & ulna.
25425.........  ........  A         Repair/graft         13.49          NA            NA        13.91         19.57        2.08          NA            NA        29.48         35.14         090
                                     radius or ulna.
25426.........  ........  A         Repair/graft         16.22          NA            NA        12.27         15.52        2.54          NA            NA        31.03         34.28         090
                                     radius & ulna.
25430.........  ........  A         Vasc graft into       9.49          NA            NA         6.67          7.19        1.27          NA            NA        17.43         17.95         090
                                     carpal bone.
25431.........  ........  A         Repair nonunion      10.67          NA            NA         7.13          8.10        1.90          NA            NA        19.70         20.67         090
                                     carpal bone.
25440.........  ........  A         Repair/graft         10.48          NA            NA         7.36          8.91        1.63          NA            NA        19.47         21.02         090
                                     wrist bone.
25441.........  ........  A         Reconstruct          13.06          NA            NA         8.32          9.60        2.07          NA            NA        23.45         24.73         090
                                     wrist joint.
25442.........  ........  A         Reconstruct          10.89          NA            NA         7.19          8.48        1.53          NA            NA        19.61         20.90         090
                                     wrist joint.
25443.........  ........  A         Reconstruct          10.43          NA            NA         6.54          8.24        1.37          NA            NA        18.34         20.04         090
                                     wrist joint.
25444.........  ........  A         Reconstruct          11.19          NA            NA         7.51          8.67        1.71          NA            NA        20.41         21.57         090
                                     wrist joint.
25445.........  ........  A         Reconstruct           9.68          NA            NA         6.59          7.66        1.55          NA            NA        17.82         18.89         090
                                     wrist joint.
25446.........  ........  A         Wrist                17.07          NA            NA         9.68         11.38        2.47          NA            NA        29.22         30.92         090
                                     replacement.
25447.........  ........  A         Repair wrist         10.85          NA            NA         7.30          8.34        1.61          NA            NA        19.76         20.80         090
                                     joint(s).
25449.........  ........  A         Remove wrist         14.71          NA            NA         8.87         10.24        2.21          NA            NA        25.79         27.16         090
                                     joint implant.
25450.........  ........  A         Revision of           7.86          NA            NA         7.22          9.47        1.36          NA            NA        16.44         18.69         090
                                     wrist joint.
25455.........  ........  A         Revision of           9.48          NA            NA         6.38          9.76        0.96          NA            NA        16.82         20.20         090
                                     wrist joint.
25490.........  ........  A         Reinforce             9.53          NA            NA         9.32         12.66        1.43          NA            NA        20.28         23.62         090
                                     radius.
25491.........  ........  A         Reinforce ulna.       9.95          NA            NA         9.57         13.27        1.60          NA            NA        21.12         24.82         090
25492.........  ........  A         Reinforce            12.43          NA            NA        10.42         14.11        2.14          NA            NA        24.99         28.68         090
                                     radius and
                                     ulna.
25500.........  ........  A         Treat fracture        2.45        3.29          3.51         2.85          2.75        0.35        6.09          6.31         5.65          5.55         090
                                     of radius.
25505.........  ........  A         Treat fracture        5.20        5.78          6.37         4.93          5.31        0.90       11.88         12.47        11.03         11.41         090
                                     of radius.
25515.........  ........  A         Treat fracture        9.29          NA            NA         6.44          7.22        1.59          NA            NA        17.32         18.10         090
                                     of radius.
25520.........  ........  A         Treat fracture        6.25        5.89          6.63         5.31          5.89        1.08       13.22         13.96        12.64         13.22         090
                                     of radius.
25525.........  ........  A         Treat fracture       12.59          NA            NA         8.39          9.61        2.12          NA            NA        23.10         24.32         090
                                     of radius.
25526.........  ........  A         Treat fracture       13.33          NA            NA        10.05         12.67        2.19          NA            NA        25.57         28.19         090
                                     of radius.
25530.........  ........  A         Treat fracture        2.09        3.43          3.69         2.92          2.88        0.34        5.86          6.12         5.35          5.31        090
                                     of ulna.
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
\1\ CPT codes and descriptors only are copyright 2005 American Medical Association. All rights reserved. Applicable FARS/DFARS apply.
\2\ Copyright 2005 American Dental Association. All rights reserved.
\3\ Indicates RVUs are not used for Medicare payment.


[[Page 37278]]


                                   Addendum B.--Relative Value Units (RVUs) and Related Information Used In Determining Medicare Payments for 2007--Continued
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                   Fully                                                            Fully
                                                     Physician  implemented    Year 2007      Fully       Year 2007      Mal-    implemented    Year 2007      Fully       Year 2007
CPT \1\  HCPCS     Mod     Status     Description    work RVUs      non-     transitional  implemented  transitional   practice      non-     transitional  implemented  transitional    Global
      \2\                                               \3\     facility PE  non-facility  facility PE   facility PE     RVUs      facility   non-facility    facility     facility
                                                                    RVUs        PE RVUs        RVUs         RVUs                    total         total        total         total
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
25535.........  ........  A         Treat fracture        5.13        5.60          5.92         4.85          5.20        0.89       11.62         11.94        10.87         11.22         090
                                     of ulna.
25545.........  ........  A         Treat fracture        9.01          NA            NA         6.33          7.34        1.53          NA            NA        16.87         17.88         090
                                     of ulna.
25560.........  ........  A         Treat fracture        2.44        3.34          3.61         2.83          2.67        0.35        6.13          6.40         5.62          5.46         090
                                     radius & ulna.
25565.........  ........  A         Treat fracture        5.62        5.88          6.51         4.90          5.31        0.93       12.43         13.06        11.45         11.86         090
                                     radius & ulna.
25574.........  ........  A         Treat fracture        7.37          NA            NA         6.34          7.00        1.21          NA            NA        14.92         15.58         090
                                     radius & ulna.
25575.........  ........  A         Treat fracture       11.92          NA            NA         8.65          9.32        1.81          NA            NA        22.38         23.05         090
                                     radius/ulna.
25600.........  ........  A         Treat fracture        2.63        3.64          3.99         3.13          3.02        0.42        6.69          7.04         6.18          6.07         090
                                     radius/ulna.
25605.........  ........  A         Treat fracture        6.92        6.80          7.14         6.08          6.20        1.00       14.72         15.06        14.00         14.12         090
                                     radius/ulna.
25611.........  ........  A         Treat fracture        9.13          NA            NA         8.01          8.75        1.34          NA            NA        18.48         19.22         090
                                     radius/ulna.
25620.........  ........  A         Treat fracture        8.54          NA            NA         5.98          6.96        1.42          NA            NA        15.94         16.92         090
                                     radius/ulna.
25622.........  ........  A         Treat wrist           2.61        3.85          4.17         3.31          3.16        0.41        6.87          7.19         6.33          6.18         090
                                     bone fracture.
25624.........  ........  A         Treat wrist           4.52        5.52          6.12         4.67          4.98        0.76       10.80         11.40         9.95         10.26         090
                                     bone fracture.
25628.........  ........  A         Treat wrist           9.42          NA            NA         7.02          7.64        1.37          NA            NA        17.81         18.43         090
                                     bone fracture.
25630.........  ........  A         Treat wrist           2.88        3.71          4.07         3.20          3.01        0.45        7.04          7.40         6.53          6.34         090
                                     bone fracture.
25635.........  ........  A         Treat wrist           4.38        5.31          5.80         4.50          4.06        0.74       10.43         10.92         9.62          9.18         090
                                     bone fracture.
25645.........  ........  A         Treat wrist           7.24          NA            NA         5.52          6.37        1.20          NA            NA        13.96         14.81         090
                                     bone fracture.
25650.........  ........  A         Treat wrist           3.05        3.80          4.19         3.40          3.24        0.45        7.30          7.69         6.90          6.74         090
                                     bone fracture.
25651.........  ........  A         Pin ulnar             5.60          NA            NA         5.04          5.39        0.86          NA            NA        11.50         11.85         090
                                     styloid
                                     fracture.
25652.........  ........  A         Treat fracture        7.84          NA            NA         6.11          6.79        1.21          NA            NA        15.16         15.84         090
                                     ulnar styloid.
25660.........  ........  A         Treat wrist           4.75          NA            NA         4.42          4.65        0.58          NA            NA         9.75          9.98         090
                                     dislocation.
25670.........  ........  A         Treat wrist           7.91          NA            NA         5.70          6.68        1.28          NA            NA        14.89         15.87         090
                                     dislocation.
25671.........  ........  A         Pin radioulnar        6.24          NA            NA         5.44          5.99        1.00          NA            NA        12.68         13.23         090
                                     dislocation.
25675.........  ........  A         Treat wrist           4.66        4.82          5.46         4.09          4.52        0.62       10.10         10.74         9.37          9.80         090
                                     dislocation.
25676.........  ........  A         Treat wrist           8.09          NA            NA         6.05          7.00        1.34          NA            NA        15.48         16.43         090
                                     dislocation.
25680.........  ........  A         Treat wrist           5.98          NA            NA         4.29          4.64        0.78          NA            NA        11.05         11.40         090
                                     fracture.
25685.........  ........  A         Treat wrist           9.89          NA            NA         6.38          7.46        1.60          NA            NA        17.87         18.95         090
                                     fracture.
25690.........  ........  A         Treat wrist           5.49          NA            NA         4.76          5.33        0.88          NA            NA        11.13         11.70         090
                                     dislocation.
25695.........  ........  A         Treat wrist           8.33          NA            NA         5.90          6.81        1.32          NA            NA        15.55         16.46         090
                                     dislocation.
25800.........  ........  A         Fusion of wrist       9.87          NA            NA         7.15          8.63        1.57          NA            NA        18.59         20.07         090
                                     joint.
25805.........  ........  A         Fusion/graft of      11.50          NA            NA         8.02          9.72        1.80          NA            NA        21.32         23.02         090
                                     wrist joint.
25810.........  ........  A         Fusion/graft of      11.67          NA            NA         8.40          9.55        1.67          NA            NA        21.74         22.89         090
                                     wrist joint.
25820.........  ........  A         Fusion of hand        7.44          NA            NA         6.18          7.45        1.22          NA            NA        14.84         16.11         090
                                     bones.
25825.........  ........  A         Fuse hand bones       9.44          NA            NA         7.43          8.80        1.41          NA            NA        18.28         19.65         090
                                     with graft.
25830.........  ........  A         Fusion,              10.61          NA            NA        10.30         13.41        1.55          NA            NA        22.46         25.57         090
                                     radioulnar jnt/
                                     ulna.
25900.........  ........  A         Amputation of         9.36          NA            NA         9.16         11.74        1.30          NA            NA        19.82         22.40         090
                                     forearm.
25905.........  ........  A         Amputation of         9.41          NA            NA         8.39         11.35        1.40          NA            NA        19.20         22.16         090
                                     forearm.
25907.........  ........  A         Amputation            7.91          NA            NA         7.75         10.78        1.10          NA            NA        16.76         19.79         090
                                     follow-up
                                     surgery.
25909.........  ........  A         Amputation            9.13          NA            NA         8.90         11.46        1.44          NA            NA        19.47         22.03         090
                                     follow-up
                                     surgery.
25915.........  ........  A         Amputation of        17.30          NA            NA         8.05         16.21        2.93          NA            NA        28.28         36.44         090
                                     forearm.
25920.........  ........  A         Amputate hand         8.85          NA            NA         6.61          7.56        1.35          NA            NA        16.81         17.76         090
                                     at wrist.
25922.........  ........  A         Amputate hand         7.47          NA            NA         6.27          6.87        1.12          NA            NA        14.86         15.46         090
                                     at wrist.
25924.........  ........  A         Amputation            8.63          NA            NA         6.58          7.73        1.32          NA            NA        16.53         17.68         090
                                     follow-up
                                     surgery.
25927.........  ........  A         Amputation of         8.91          NA            NA         8.51         10.91        1.27          NA            NA        18.69         21.09         090
                                     hand.
25929.........  ........  A         Amputation            7.64          NA            NA         5.30          5.74        1.14          NA            NA        14.08         14.52         090
                                     follow-up
                                     surgery.
25931.........  ........  A         Amputation            7.86          NA            NA         8.38         10.71        1.15          NA            NA        17.39         19.72         090
                                     follow-up
                                     surgery.
26010.........  ........  A         Drainage of           1.54        3.98          5.18         1.49          1.60        0.18        5.70          6.90         3.21          3.32         010
                                     finger abscess.
26011.........  ........  A         Drainage of           2.19        6.22          8.19         1.95          2.24        0.33        8.74         10.71         4.47          4.76         010
                                     finger abscess.
26020.........  ........  A         Drain hand            4.90          NA            NA         4.67          5.20        0.73          NA            NA        10.30         10.83         090
                                     tendon sheath.
26025.........  ........  A         Drainage of           4.93          NA            NA         4.38          4.94        0.76          NA            NA        10.07         10.63         090
                                     palm bursa.
26030.........  ........  A         Drainage of           6.10          NA            NA         4.90          5.53        0.92          NA            NA        11.92         12.55         090
                                     palm bursa(s).
26034.........  ........  A         Treat hand bone       6.40          NA            NA         5.46          6.14        1.01          NA            NA        12.87         13.55         090
                                     lesion.
26035.........  ........  A         Decompress           11.04          NA            NA         7.85          7.88        1.47          NA            NA        20.36         20.39         090
                                     fingers/hand.
26037.........  ........  A         Decompress            7.42          NA            NA         5.41          6.11        1.13          NA            NA        13.96         14.66        090
                                     fingers/hand.
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
\1\ CPT codes and descriptors only are copyright 2005 American Medical Association. All rights reserved. Applicable FARS/DFARS apply.
\2\ Copyright 2005 American Dental Association. All rights reserved.
\3\ Indicates RVUs are not used for Medicare payment.


[[Page 37279]]


                                   Addendum B.--Relative Value Units (RVUs) and Related Information Used In Determining Medicare Payments for 2007--Continued
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                   Fully                                                            Fully
                                                     Physician  implemented    Year 2007      Fully       Year 2007      Mal-    implemented    Year 2007      Fully       Year 2007
CPT \1\  HCPCS     Mod     Status     Description    work RVUs      non-     transitional  implemented  transitional   practice      non-     transitional  implemented  transitional    Global
      \2\                                               \3\     facility PE  non-facility  facility PE   facility PE     RVUs      facility   non-facility    facility     facility
                                                                    RVUs        PE RVUs        RVUs         RVUs                    total         total        total         total
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
26040.........  ........  A         Release palm          3.33          NA            NA         3.54          3.93        0.53          NA            NA         7.40          7.79         090
                                     contracture.
26045.........  ........  A         Release palm          5.55          NA            NA         4.80          5.45        0.93          NA            NA        11.28         11.93         090
                                     contracture.
26055.........  ........  A         Incise finger         2.94        8.65         12.96         3.45          3.83        0.43       12.02         16.33         6.82          7.20         090
                                     tendon sheath.
26060.........  ........  A         Incision of           2.81          NA            NA         3.00          3.39        0.45          NA            NA         6.26          6.65         090
                                     finger tendon.
26070.........  ........  A         Explore/treat         3.68          NA            NA         2.99          3.28        0.48          NA            NA         7.15          7.44         090
                                     hand joint.
26075.........  ........  A         Explore/treat         3.78          NA            NA         3.36          3.68        0.53          NA            NA         7.67          7.99         090
                                     finger joint.
26080.........  ........  A         Explore/treat         4.29          NA            NA         4.27          4.71        0.66          NA            NA         9.22          9.66         090
                                     finger joint.
26100.........  ........  A         Biopsy hand           3.66          NA            NA         3.52          3.99        0.54          NA            NA         7.72          8.19         090
                                     joint lining.
26105.........  ........  A         Biopsy finger         3.70          NA            NA         3.68          4.10        0.59          NA            NA         7.97          8.39         090
                                     joint lining.
26110.........  ........  A         Biopsy finger         3.52          NA            NA         3.54          3.92        0.53          NA            NA         7.59          7.97         090
                                     joint lining.
26115.........  ........  A         Removal hand          3.85        9.73         12.28         4.16          4.63        0.59       14.17         16.72         8.60          9.07         090
                                     lesion subcut.
26116.........  ........  A         Removal hand          5.52          NA            NA         5.21          5.82        0.84          NA            NA        11.57         12.18         090
                                     lesion, deep.
26117.........  ........  A         Remove tumor,         8.54          NA            NA         6.09          6.83        1.26          NA            NA        15.89         16.63         090
                                     hand/finger.
26121.........  ........  A         Release palm          7.53          NA            NA         5.83          6.69        1.17          NA            NA        14.53         15.39         090
                                     contracture.
26123.........  ........  A         Release palm         10.53          NA            NA         8.08          8.68        1.43          NA            NA        20.04         20.64         090
                                     contracture.
26125.........  ........  A         Release palm          4.60          NA            NA         1.85          2.30        0.70          NA            NA         7.15          7.60         ZZZ
                                     contracture.
26130.........  ........  A         Remove wrist          5.41          NA            NA         4.76          5.21        0.94          NA            NA        11.11         11.56         090
                                     joint lining.
26135.........  ........  A         Revise finger         6.95          NA            NA         5.39          6.21        1.07          NA            NA        13.41         14.23         090
                                     joint, each.
26140.........  ........  A         Revise finger         6.16          NA            NA         5.08          5.82        0.92          NA            NA        12.16         12.90         090
                                     joint, each.
26145.........  ........  A         Tendon                6.31          NA            NA         5.10          5.83        0.97          NA            NA        12.38         13.11         090
                                     excision, palm/
                                     finger.
26160.........  ........  A         Remove tendon         3.40        8.79         11.51         3.73          4.03        0.49       12.68         15.40         7.62          7.92         090
                                     sheath lesion.
26170.........  ........  A         Removal of palm       4.76          NA            NA         4.29          4.79        0.69          NA            NA         9.74         10.24         090
                                     tendon, each.
26180.........  ........  A         Removal of            5.17          NA            NA         4.69          5.25        0.78          NA            NA        10.64         11.20         090
                                     finger tendon.
26185.........  ........  A         Remove finger         6.24          NA            NA         5.72          5.97        0.81          NA            NA        12.77         13.02         090
                                     bone.
26200.........  ........  A         Remove hand           5.50          NA            NA         4.51          5.16        0.88          NA            NA        10.89         11.54         090
                                     bone lesion.
26205.........  ........  A         Remove/graft          7.75          NA            NA         5.75          6.62        1.20          NA            NA        14.70         15.57         090
                                     bone lesion.
26210.........  ........  A         Removal of            5.14          NA            NA         4.67          5.25        0.79          NA            NA        10.60         11.18         090
                                     finger lesion.
26215.........  ........  A         Remove/graft          7.09          NA            NA         5.46          6.11        0.98          NA            NA        13.53         14.18         090
                                     finger lesion.
26230.........  ........  A         Partial removal       6.32          NA            NA         4.92          5.68        1.01          NA            NA        12.25         13.01         090
                                     of hand bone.
26235.........  ........  A         Partial               6.18          NA            NA         4.87          5.59        0.95          NA            NA        12.00         12.72         090
                                     removal,
                                     finger bone.
26236.........  ........  A         Partial               5.31          NA            NA         4.47          5.12        0.81          NA            NA        10.59         11.24         090
                                     removal,
                                     finger bone.
26250.........  ........  A         Extensive hand        7.54          NA            NA         5.14          6.12        1.07          NA            NA        13.75         14.73         090
                                     surgery.
26255.........  ........  A         Extensive hand       12.71          NA            NA         8.22          9.11        1.68          NA            NA        22.61         23.50         090
                                     surgery.
26260.........  ........  A         Extensive             7.02          NA            NA         5.27          5.97        1.01          NA            NA        13.30         14.00         090
                                     finger surgery.
26261.........  ........  A         Extensive             9.20          NA            NA         6.74          6.33        1.14          NA            NA        17.08         16.67         090
                                     finger surgery.
26262.........  ........  A         Partial removal       5.66          NA            NA         4.58          5.16        0.88          NA            NA        11.12         11.70         090
                                     of finger.
26320.........  ........  A         Removal of            3.97          NA            NA         3.71          4.17        0.59          NA            NA         8.27          8.73         090
                                     implant from
                                     hand.
26340.........  ........  A         Manipulate            2.50          NA            NA         4.54          4.80        0.39          NA            NA         7.43          7.69         090
                                     finger w/
                                     anesth.
26350.........  ........  A         Repair finger/        5.98          NA            NA         9.32         13.32        0.93          NA            NA        16.23         20.23         090
                                     hand tendon.
26352.........  ........  A         Repair/graft          7.67          NA            NA         9.89         14.02        1.13          NA            NA        18.69         22.82         090
                                     hand tendon.
26356.........  ........  A         Repair finger/       10.06          NA            NA        13.47         17.18        1.21          NA            NA        24.74         28.45         090
                                     hand tendon.
26357.........  ........  A         Repair finger/        8.57          NA            NA        10.13         14.29        1.33          NA            NA        20.03         24.19         090
                                     hand tendon.
26358.........  ........  A         Repair/graft          9.13          NA            NA        10.64         15.18        1.38          NA            NA        21.15         25.69         090
                                     hand tendon.
26370.........  ........  A         Repair finger/        7.10          NA            NA         9.36         13.70        1.12          NA            NA        17.58         21.92         090
                                     hand tendon.
26372.........  ........  A         Repair/graft          8.81          NA            NA        10.32         15.02        1.40          NA            NA        20.53         25.23         090
                                     hand tendon.
26373.........  ........  A         Repair finger/        8.21          NA            NA        10.01         14.57        1.23          NA            NA        19.45         24.01         090
                                     hand tendon.
26390.........  ........  A         Revise hand/          9.24          NA            NA         8.93         12.22        1.40          NA            NA        19.57         22.86         090
                                     finger tendon.
26392.........  ........  A         Repair/graft         10.30          NA            NA        10.84         15.29        1.57          NA            NA        22.71         27.16         090
                                     hand tendon.
26410.........  ........  A         Repair hand           4.62          NA            NA         7.46         10.84        0.73          NA            NA        12.81         16.19         090
                                     tendon.
26412.........  ........  A         Repair/graft          6.30          NA            NA         8.45         12.10        0.97          NA            NA        15.72         19.37         090
                                     hand tendon.
26415.........  ........  A         Excision, hand/       8.33          NA            NA         6.64         10.52        0.98          NA            NA        15.95         19.83         090
                                     finger tendon.
26416.........  ........  A         Graft hand or         9.36          NA            NA         8.62         13.13        0.79          NA            NA        18.77         23.28        090
                                     finger tendon.
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
\1\ CPT codes and descriptors only are copyright 2005 American Medical Association. All rights reserved. Applicable FARS/DFARS apply.
\2\ Copyright 2005 American Dental Association. All rights reserved.
\3\ Indicates RVUs are not used for Medicare payment.


[[Page 37280]]


                                   Addendum B.--Relative Value Units (RVUs) and Related Information Used In Determining Medicare Payments for 2007--Continued
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                   Fully                                                            Fully
                                                     Physician  implemented    Year 2007      Fully       Year 2007      Mal-    implemented    Year 2007      Fully       Year 2007
CPT \1\  HCPCS     Mod     Status     Description    work RVUs      non-     transitional  implemented  transitional   practice      non-     transitional  implemented  transitional    Global
      \2\                                               \3\     facility PE  non-facility  facility PE   facility PE     RVUs      facility   non-facility    facility     facility
                                                                    RVUs        PE RVUs        RVUs         RVUs                    total         total        total         total
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
26418.........  ........  A         Repair finger         4.24          NA            NA         7.97         11.26        0.67          NA            NA        12.88         16.17         090
                                     tendon.
26420.........  ........  A         Repair/graft          6.76          NA            NA         8.61         12.41        1.07          NA            NA        16.44         20.24         090
                                     finger tendon.
26426.........  ........  A         Repair finger/        6.14          NA            NA         8.40         12.00        0.95          NA            NA        15.49         19.09         090
                                     hand tendon.
26428.........  ........  A         Repair/graft          7.20          NA            NA         9.05         12.69        1.09          NA            NA        17.34         20.98         090
                                     finger tendon.
26432.........  ........  A         Repair finger         4.01          NA            NA         6.62          9.37        0.64          NA            NA        11.27         14.02         090
                                     tendon.
26433.........  ........  A         Repair finger         4.55          NA            NA         6.83          9.82        0.72          NA            NA        12.10         15.09         090
                                     tendon.
26434.........  ........  A         Repair/graft          6.08          NA            NA         7.75         10.62        0.93          NA            NA        14.76         17.63         090
                                     finger tendon.
26437.........  ........  A         Realignment of        5.81          NA            NA         7.61         10.60        0.89          NA            NA        14.31         17.30         090
                                     tendons.
26440.........  ........  A         Release palm/         5.01          NA            NA         8.32         12.18        0.75          NA            NA        14.08         17.94         090
                                     finger tendon.
26442.........  ........  A         Release palm &        9.40          NA            NA        11.44         14.85        1.20          NA            NA        22.04         25.45         090
                                     finger tendon.
26445.........  ........  A         Release hand/         4.30          NA            NA         8.00         11.89        0.65          NA            NA        12.95         16.84         090
                                     finger tendon.
26449.........  ........  A         Release forearm/      8.24          NA            NA        11.14         14.65        1.06          NA            NA        20.44         23.95         090
                                     hand tendon.
26450.........  ........  A         Incision of           3.66          NA            NA         5.04          6.77        0.59          NA            NA         9.29         11.02         090
                                     palm tendon.
26455.........  ........  A         Incision of           3.63          NA            NA         4.99          6.72        0.58          NA            NA         9.20         10.93         090
                                     finger tendon.
26460.........  ........  A         Incise hand/          3.45          NA            NA         4.94          6.61        0.55          NA            NA         8.94         10.61         090
                                     finger tendon.
26471.........  ........  A         Fusion of             5.72          NA            NA         7.55         10.34        0.88          NA            NA        14.15         16.94         090
                                     finger tendons.
26474.........  ........  A         Fusion of             5.31          NA            NA         7.38         10.41        0.76          NA            NA        13.45         16.48         090
                                     finger tendons.
26476.........  ........  A         Tendon                5.17          NA            NA         7.29         10.04        0.79          NA            NA        13.25         16.00         090
                                     lengthening.
26477.........  ........  A         Tendon                5.14          NA            NA         7.37         10.16        0.81          NA            NA        13.32         16.11         090
                                     shortening.
26478.........  ........  A         Lengthening of        5.79          NA            NA         7.56         10.79        0.90          NA            NA        14.25         17.48         090
                                     hand tendon.
26479.........  ........  A         Shortening of         5.73          NA            NA         7.54         10.58        0.92          NA            NA        14.19         17.23         090
                                     hand tendon.
26480.........  ........  A         Transplant hand       6.68          NA            NA         9.44         13.67        1.02          NA            NA        17.14         21.37         090
                                     tendon.
26483.........  ........  A         Transplant/           8.28          NA            NA        10.07         14.17        1.26          NA            NA        19.61         23.71         090
                                     graft hand
                                     tendon.
26485.........  ........  A         Transplant palm       7.69          NA            NA         9.79         14.00        1.15          NA            NA        18.63         22.84         090
                                     tendon.
26489.........  ........  A         Transplant/           9.66          NA            NA        10.13         11.60        1.26          NA            NA        21.05         22.52         090
                                     graft palm
                                     tendon.
26490.........  ........  A         Revise thumb          8.40          NA            NA         8.75         11.83        1.21          NA            NA        18.36         21.44         090
                                     tendon.
26492.........  ........  A         Tendon transfer       9.61          NA            NA         9.61         12.63        1.40          NA            NA        20.62         23.64         090
                                     with graft.
26494.........  ........  A         Hand tendon/          8.46          NA            NA         8.87         11.98        1.28          NA            NA        18.61         21.72         090
                                     muscle
                                     transfer.
26496.........  ........  A         Revise thumb          9.58          NA            NA         9.30         12.28        1.45          NA            NA        20.33         23.31         090
                                     tendon.
26497.........  ........  A         Finger tendon         9.56          NA            NA         9.27         12.53        1.41          NA            NA        20.24         23.50         090
                                     transfer.
26498.........  ........  A         Finger tendon        13.98          NA            NA        11.28         14.98        2.10          NA            NA        27.36         31.06         090
                                     transfer.
26499.........  ........  A         Revision of           8.97          NA            NA         8.61         11.96        1.35          NA            NA        18.93         22.28         090
                                     finger.
26500.........  ........  A         Hand tendon           5.95          NA            NA         7.62         10.51        0.90          NA            NA        14.47         17.36         090
                                     reconstruction.
26502.........  ........  A         Hand tendon           7.13          NA            NA         8.20         11.09        1.13          NA            NA        16.46         19.35         090
                                     reconstruction.
26504.........  ........  A         Hand tendon           7.46          NA            NA         8.46         11.58        1.24          NA            NA        17.16         20.28         090
                                     reconstruction.
26508.........  ........  A         Release thumb         6.00          NA            NA         7.64         10.69        0.98          NA            NA        14.62         17.67         090
                                     contracture.
26510.........  ........  A         Thumb tendon          5.42          NA            NA         7.46         10.39        0.79          NA            NA        13.67         16.60         090
                                     transfer.
26516.........  ........  A         Fusion of             7.14          NA            NA         8.11         11.23        1.10          NA            NA        16.35         19.47         090
                                     knuckle joint.
26517.........  ........  A         Fusion of             8.88          NA            NA         9.07         12.42        1.41          NA            NA        19.36         22.71         090
                                     knuckle joints.
26518.........  ........  A         Fusion of             9.07          NA            NA         9.09         12.35        1.35          NA            NA        19.51         22.77         090
                                     knuckle joints.
26520.........  ........  A         Release knuckle       5.29          NA            NA         8.69         12.62        0.80          NA            NA        14.78         18.71         090
                                     contracture.
26525.........  ........  A         Release finger        5.32          NA            NA         8.70         12.68        0.81          NA            NA        14.83         18.81         090
                                     contracture.
26530.........  ........  A         Revise knuckle        6.68          NA            NA         5.33          5.95        1.04          NA            NA        13.05         13.67         090
                                     joint.
26531.........  ........  A         Revise knuckle        7.90          NA            NA         6.05          6.87        1.17          NA            NA        15.12         15.94         090
                                     with implant.
26535.........  ........  A         Revise finger         5.23          NA            NA         3.97          3.81        0.71          NA            NA         9.91          9.75         090
                                     joint.
26536.........  ........  A         Revise/implant        6.36          NA            NA         9.02          9.52        0.96          NA            NA        16.34         16.84         090
                                     finger joint.
26540.........  ........  A         Repair hand           6.42          NA            NA         7.86         10.89        0.99          NA            NA        15.27         18.30         090
                                     joint.
26541.........  ........  A         Repair hand           8.61          NA            NA         8.90         12.30        1.28          NA            NA        18.79         22.19         090
                                     joint with
                                     graft.
26542.........  ........  A         Repair hand           6.77          NA            NA         8.01         11.05        1.02          NA            NA        15.80         18.84         090
                                     joint with
                                     graft.
26545.........  ........  A         Reconstruct           6.91          NA            NA         8.19         11.18        1.05          NA            NA        16.15         19.14         090
                                     finger joint.
26546.........  ........  A         Repair nonunion      10.41          NA            NA        11.25         14.12        1.44          NA            NA        23.10         25.97         090
                                     hand.
26548.........  ........  A         Reconstruct           8.02          NA            NA         8.66         11.83        1.20          NA            NA        17.88         21.05        090
                                     finger joint.
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
\1\ CPT codes and descriptors only are copyright 2005 American Medical Association. All rights reserved. Applicable FARS/DFARS apply.
\2\ Copyright 2005 American Dental Association. All rights reserved.
\3\ Indicates RVUs are not used for Medicare payment.


[[Page 37281]]


                                   Addendum B.--Relative Value Units (RVUs) and Related Information Used In Determining Medicare Payments for 2007--Continued
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                   Fully                                                            Fully
                                                     Physician  implemented    Year 2007      Fully       Year 2007      Mal-    implemented    Year 2007      Fully       Year 2007
CPT \1\  HCPCS     Mod     Status     Description    work RVUs      non-     transitional  implemented  transitional   practice      non-     transitional  implemented  transitional    Global
      \2\                                               \3\     facility PE  non-facility  facility PE   facility PE     RVUs      facility   non-facility    facility     facility
                                                                    RVUs        PE RVUs        RVUs         RVUs                    total         total        total         total
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
26550.........  ........  A         Construct thumb      21.46          NA            NA        15.12         17.00        2.45          NA            NA        39.03         40.91         090
                                     replacement.
26551.........  ........  A         Great toe-hand       48.09          NA            NA        21.34         29.73        7.96          NA            NA        77.39         85.78         090
                                     transfer.
26553.........  ........  A         Single               47.78          NA            NA        19.85         22.03        2.41          NA            NA        70.04         72.22         090
                                     transfer, toe-
                                     hand.
26554.........  ........  A         Double               56.57          NA            NA        19.02         32.99        9.41          NA            NA        85.00         98.97         090
                                     transfer, toe-
                                     hand.
26555.........  ........  A         Positional           16.86          NA            NA        13.64         17.08        2.48          NA            NA        32.98         36.42         090
                                     change of
                                     finger.
26556.........  ........  A         Toe joint            49.27          NA            NA        17.66         29.48        2.57          NA            NA        69.50         81.32         090
                                     transfer.
26560.........  ........  A         Repair of web         5.37          NA            NA         7.00          9.12        0.85          NA            NA        13.22         15.34         090
                                     finger.
26561.........  ........  A         Repair of web        10.90          NA            NA         9.09         11.56        1.45          NA            NA        21.44         23.91         090
                                     finger.
26562.........  ........  A         Repair of web        16.30          NA            NA        13.61         16.30        2.23          NA            NA        32.14         34.83         090
                                     finger.
26565.........  ........  A         Correct               6.73          NA            NA         7.79         10.98        1.00          NA            NA        15.52         18.71         090
                                     metacarpal
                                     flaw.
26567.........  ........  A         Correct finger        6.81          NA            NA         8.02         10.99        1.04          NA            NA        15.87         18.84         090
                                     deformity.
26568.........  ........  A         Lengthen              9.07          NA            NA         9.99         14.10        1.49          NA            NA        20.55         24.66         090
                                     metacarpal/
                                     finger.
26580.........  ........  A         Repair hand          19.40          NA            NA        11.48         13.13        2.28          NA            NA        33.16         34.81         090
                                     deformity.
26587.........  ........  A         Reconstruct          14.28          NA            NA         8.28          9.00        1.53          NA            NA        24.09         24.81         090
                                     extra finger.
26590.........  ........  A         Repair finger        18.43          NA            NA        10.51         13.11        2.77          NA            NA        31.71         34.31         090
                                     deformity.
26591.........  ........  A         Repair muscles        3.25          NA            NA         6.09          8.76        0.48          NA            NA         9.82         12.49         090
                                     of hand.
26593.........  ........  A         Release muscles       5.30          NA            NA         7.63         10.28        0.78          NA            NA        13.71         16.36         090
                                     of hand.
26596.........  ........  A         Excision              8.94          NA            NA         7.35          8.48        1.43          NA            NA        17.72         18.85         090
                                     constricting
                                     tissue.
26600.........  ........  A         Treat                 2.40        3.35          3.55         3.01          2.75        0.30        6.05          6.25         5.71          5.45         090
                                     metacarpal
                                     fracture.
26605.........  ........  A         Treat                 2.85        4.03          4.44         3.45          3.61        0.49        7.37          7.78         6.79          6.95         090
                                     metacarpal
                                     fracture.
26607.........  ........  A         Treat                 5.35          NA            NA         4.80          5.92        0.87          NA            NA        11.02         12.14         090
                                     metacarpal
                                     fracture.
26608.........  ........  A         Treat                 5.35          NA            NA         5.16          5.99        0.88          NA            NA        11.39         12.22         090
                                     metacarpal
                                     fracture.
26615.........  ........  A         Treat                 5.32          NA            NA         4.49          5.11        0.86          NA            NA        10.67         11.29         090
                                     metacarpal
                                     fracture.
26641.........  ........  A         Treat thumb           3.93        4.14          4.47         3.49          3.53        0.39        8.46          8.79         7.81          7.85         090
                                     dislocation.
26645.........  ........  A         Treat thumb           4.40        4.56          5.03         3.87          4.12        0.67        9.63         10.10         8.94          9.19         090
                                     fracture.
26650.........  ........  A         Treat thumb           5.71          NA            NA         5.53          6.42        0.94          NA            NA        12.18         13.07         090
                                     fracture.
26665.........  ........  A         Treat thumb           7.65          NA            NA         5.59          6.37        0.90          NA            NA        14.14         14.92         090
                                     fracture.
26670.........  ........  A         Treat hand            3.68        3.51          4.08         2.92          2.94        0.39        7.58          8.15         6.99          7.01         090
                                     dislocation.
26675.........  ........  A         Treat hand            4.63        4.79          5.32         4.10          4.39        0.77       10.19         10.72         9.50          9.79         090
                                     dislocation.
26676.........  ........  A         Pin hand              5.51          NA            NA         5.48          6.40        0.91          NA            NA        11.90         12.82         090
                                     dislocation.
26685.........  ........  A         Treat hand            7.03          NA            NA         5.16          5.91        1.09          NA            NA        13.28         14.03         090
                                     dislocation.
26686.........  ........  A         Treat hand            7.99          NA            NA         5.83          6.65        1.24          NA            NA        15.06         15.88         090
                                     dislocation.
26700.........  ........  A         Treat knuckle         3.68        3.29          3.65         2.92          2.88        0.35        7.32          7.68         6.95          6.91         090
                                     dislocation.
26705.........  ........  A         Treat knuckle         4.18        4.74          5.20         4.03          4.24        0.66        9.58         10.04         8.87          9.08         090
                                     dislocation.
26706.........  ........  A         Pin knuckle           5.11          NA            NA         4.62          4.98        0.81          NA            NA        10.54         10.90         090
                                     dislocation.
26715.........  ........  A         Treat knuckle         5.73          NA            NA         4.66          5.31        0.91          NA            NA        11.30         11.95         090
                                     dislocation.
26720.........  ........  A         Treat finger          1.66        2.55          2.73         2.28          2.12        0.24        4.45          4.63         4.18          4.02         090
                                     fracture, each.
26725.........  ........  A         Treat finger          3.33        4.04          4.60         3.37          3.48        0.53        7.90          8.46         7.23          7.34         090
                                     fracture, each.
26727.........  ........  A         Treat finger          5.22          NA            NA         5.12          5.97        0.84          NA            NA        11.18         12.03         090
                                     fracture, each.
26735.........  ........  A         Treat finger          5.97          NA            NA         4.74          5.36        0.95          NA            NA        11.66         12.28         090
                                     fracture, each.
26740.........  ........  A         Treat finger          1.94        2.91          3.08         2.62          2.69        0.31        5.16          5.33         4.87          4.94         090
                                     fracture, each.
26742.........  ........  A         Treat finger          3.84        4.27          4.82         3.56          3.81        0.58        8.69          9.24         7.98          8.23         090
                                     fracture, each.
26746.........  ........  A         Treat finger          5.80          NA            NA         4.70          5.36        0.91          NA            NA        11.41         12.07         090
                                     fracture, each.
26750.........  ........  A         Treat finger          1.70        2.22          2.42         2.23          2.07        0.22        4.14          4.34         4.15          3.99         090
                                     fracture, each.
26755.........  ........  A         Treat finger          3.10        3.74          4.26         2.93          2.99        0.42        7.26          7.78         6.45          6.51         090
                                     fracture, each.
26756.........  ........  A         Pin finger            4.38          NA            NA         4.78          5.50        0.71          NA            NA         9.87         10.59         090
                                     fracture, each.
26765.........  ........  A         Treat finger          4.16          NA            NA         3.77          4.24        0.66          NA            NA         8.59          9.06         090
                                     fracture, each.
26770.........  ........  A         Treat finger          3.02        2.88          3.30         2.50          2.44        0.27        6.17          6.59         5.79          5.73         090
                                     dislocation.
26775.........  ........  A         Treat finger          3.70        4.49          5.03         3.76          3.81        0.54        8.73          9.27         8.00          8.05         090
                                     dislocation.
26776.........  ........  A         Pin finger            4.79          NA            NA         4.94          5.75        0.77          NA            NA        10.50         11.31         090
                                     dislocation.
26785.........  ........  A         Treat finger          4.20          NA            NA         3.84          4.37        0.68          NA            NA         8.72          9.25         090
                                     dislocation.
26820.........  ........  A         Thumb fusion          8.25          NA            NA         8.56         12.11        1.30          NA            NA        18.11         21.66        090
                                     with graft.
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
\1\ CPT codes and descriptors only are copyright 2005 American Medical Association. All rights reserved. Applicable FARS/DFARS apply.
\2\ Copyright 2005 American Dental Association. All rights reserved.
\3\ Indicates RVUs are not used for Medicare payment.


[[Page 37282]]


                                   Addendum B.--Relative Value Units (RVUs) and Related Information Used In Determining Medicare Payments for 2007--Continued
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                   Fully                                                            Fully
                                                     Physician  implemented    Year 2007      Fully       Year 2007      Mal-    implemented    Year 2007      Fully       Year 2007
CPT \1\  HCPCS     Mod     Status     Description    work RVUs      non-     transitional  implemented  transitional   practice      non-     transitional  implemented  transitional    Global
      \2\                                               \3\     facility PE  non-facility  facility PE   facility PE     RVUs      facility   non-facility    facility     facility
                                                                    RVUs        PE RVUs        RVUs         RVUs                    total         total        total         total
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
26841.........  ........  A         Fusion of thumb       7.12          NA            NA         8.56         12.09        1.18          NA            NA        16.86         20.39         090
26842.........  ........  A         Thumb fusion          8.29          NA            NA         8.81         12.26        1.32          NA            NA        18.42         21.87         090
                                     with graft.
26843.........  ........  A         Fusion of hand        7.60          NA            NA         8.05         11.31        1.15          NA            NA        16.80         20.06         090
                                     joint.
26844.........  ........  A         Fusion/graft of       8.78          NA            NA         9.00         12.30        1.33          NA            NA        19.11         22.41         090
                                     hand joint.
26850.........  ........  A         Fusion of             6.96          NA            NA         8.07         11.20        1.06          NA            NA        16.09         19.22         090
                                     knuckle.
26852.........  ........  A         Fusion of             8.51          NA            NA         8.89         11.92        1.22          NA            NA        18.62         21.65         090
                                     knuckle with
                                     graft.
26860.........  ........  A         Fusion of             4.68          NA            NA         7.34         10.25        0.73          NA            NA        12.75         15.66         090
                                     finger joint.
26861.........  ........  A         Fusion of             1.74          NA            NA         0.69          0.87        0.27          NA            NA         2.70          2.88         ZZZ
                                     finger jnt,
                                     add-on.
26862.........  ........  A         Fusion/graft of       7.36          NA            NA         8.45         11.40        1.10          NA            NA        16.91         19.86         090
                                     finger joint.
26863.........  ........  A         Fuse/graft            3.89          NA            NA         1.54          1.98        0.56          NA            NA         5.99          6.43         ZZZ
                                     added joint.
26910.........  ........  A         Amputate              7.59          NA            NA         8.09         10.46        1.16          NA            NA        16.84         19.21         090
                                     metacarpal
                                     bone.
26951.........  ........  A         Amputation of         5.75          NA            NA         7.34          9.47        0.71          NA            NA        13.80         15.93         090
                                     finger/thumb.
26952.........  ........  A         Amputation of         6.30          NA            NA         7.72         10.70        0.95          NA            NA        14.97         17.95         090
                                     finger/thumb.
26990.........  ........  A         Drainage of           7.77          NA            NA         6.03          6.93        1.22          NA            NA        15.02         15.92         090
                                     pelvis lesion.
26991.........  ........  A         Drainage of           6.91        8.49         10.52         4.77          5.28        1.11       16.51         18.54        12.79         13.30         090
                                     pelvis bursa.
26992.........  ........  A         Drainage of          13.30          NA            NA         8.29          9.88        2.16          NA            NA        23.75         25.34         090
                                     bone lesion.
27000.........  ........  A         Incision of hip       5.61          NA            NA         4.46          5.09        0.98          NA            NA        11.05         11.68         090
                                     tendon.
27001.........  ........  A         Incision of hip       6.99          NA            NA         5.12          5.86        1.24          NA            NA        13.35         14.09         090
                                     tendon.
27003.........  ........  A         Incision of hip       7.63          NA            NA         5.70          6.30        1.12          NA            NA        14.45         15.05         090
                                     tendon.
27005.........  ........  A         Incision of hip       9.89          NA            NA         6.67          7.55        1.72          NA            NA        18.28         19.16         090
                                     tendon.
27006.........  ........  A         Incision of hip       9.91          NA            NA         6.69          7.67        1.69          NA            NA        18.29         19.27         090
                                     tendons.
27025.........  ........  A         Incision of hip/     12.56          NA            NA         7.97          8.42        1.84          NA            NA        22.37         22.82         090
                                     thigh fascia.
27030.........  ........  A         Drainage of hip      13.47          NA            NA         7.92          9.23        2.26          NA            NA        23.65         24.96         090
                                     joint.
27033.........  ........  A         Exploration of       13.91          NA            NA         8.27          9.53        2.32          NA            NA        24.50         25.76         090
                                     hip joint.
27035.........  ........  A         Denervation of       17.14          NA            NA         9.30         10.77        2.15          NA            NA        28.59         30.06         090
                                     hip joint.
27036.........  ........  A         Excision of hip      14.10          NA            NA         8.84          9.73        2.26          NA            NA        25.20         26.09         090
                                     joint/muscle.
27040.........  ........  A         Biopsy of soft        2.87        5.23          5.25         1.85          1.98        0.27        8.37          8.39         4.99          5.12         010
                                     tissues.
27041.........  ........  A         Biopsy of soft       10.00          NA            NA         5.81          6.45        1.35          NA            NA        17.16         17.80         090
                                     tissues.
27047.........  ........  A         Remove hip/           7.44        7.06          7.11         4.51          4.71        1.03       15.53         15.58        12.98         13.18         090
                                     pelvis lesion.
27048.........  ........  A         Remove hip/           6.36          NA            NA         4.57          4.75        0.92          NA            NA        11.85         12.03         090
                                     pelvis lesion.
27049.........  ........  A         Remove tumor,        15.12          NA            NA         8.10          8.34        2.06          NA            NA        25.28         25.52         090
                                     hip/pelvis.
27050.........  ........  A         Biopsy of             4.59          NA            NA         3.81          4.28        0.60          NA            NA         9.00          9.47         090
                                     sacroiliac
                                     joint.
27052.........  ........  A         Biopsy of hip         7.21          NA            NA         5.57          5.82        1.08          NA            NA        13.86         14.11         090
                                     joint.
27054.........  ........  A         Removal of hip        9.01          NA            NA         6.35          7.11        1.47          NA            NA        16.83         17.59         090
                                     joint lining.
27060.........  ........  A         Removal of            5.72          NA            NA         4.31          4.36        0.80          NA            NA        10.83         10.88         090
                                     ischial bursa.
27062.........  ........  A         Remove femur          5.60          NA            NA         4.53          5.04        0.93          NA            NA        11.06         11.57         090
                                     lesion/bursa.
27065.........  ........  A         Removal of hip        6.37          NA            NA         5.03          5.35        1.01          NA            NA        12.41         12.73         090
                                     bone lesion.
27066.........  ........  A         Removal of hip       10.97          NA            NA         7.30          8.17        1.79          NA            NA        20.06         20.93         090
                                     bone lesion.
27067.........  ........  A         Remove/graft         14.47          NA            NA         8.66         10.18        1.84          NA            NA        24.97         26.49         090
                                     hip bone
                                     lesion.
27070.........  ........  A         Partial removal      11.36          NA            NA         7.62          8.78        1.74          NA            NA        20.72         21.88         090
                                     of hip bone.
27071.........  ........  A         Partial removal      12.16          NA            NA         8.21          9.67        1.92          NA            NA        22.29         23.75         090
                                     of hip bone.
27075.........  ........  A         Extensive hip        36.71          NA            NA        16.24         18.51        5.64          NA            NA        58.59         60.86         090
                                     surgery.
27076.........  ........  A         Extensive hip        24.17          NA            NA        12.43         14.02        3.70          NA            NA        40.30         41.89         090
                                     surgery.
27077.........  ........  A         Extensive hip        42.48          NA            NA        19.47         21.92        6.12          NA            NA        68.07         70.52         090
                                     surgery.
27078.........  ........  A         Extensive hip        14.44          NA            NA         8.56          9.62        2.22          NA            NA        25.22         26.28         090
                                     surgery.
27079.........  ........  A         Extensive hip        14.81          NA            NA         7.40          9.03        1.94          NA            NA        24.15         25.78         090
                                     surgery.
27080.........  ........  A         Removal of tail       6.74          NA            NA         4.64          4.79        0.93          NA            NA        12.31         12.46         090
                                     bone.
27086.........  ........  A         Remove hip            1.87        3.78          4.37         1.53          1.76        0.25        5.90          6.49         3.65          3.88         010
                                     foreign body.
27087.........  ........  A         Remove hip            8.65          NA            NA         5.56          6.40        1.35          NA            NA        15.56         16.40         090
                                     foreign body.
27090.........  ........  A         Removal of hip       11.49          NA            NA         7.30          8.43        1.94          NA            NA        20.73         21.86         090
                                     prosthesis.
27091.........  ........  A         Removal of hip       24.07          NA            NA        12.76         13.71        3.84          NA            NA        40.67         41.62         090
                                     prosthesis.
27093.........  ........  A         Injection for         1.30        3.15          4.14         0.46          0.48        0.13        4.58          5.57         1.89          1.91        000
                                     hip x-ray.
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
\1\ CPT codes and descriptors only are copyright 2005 American Medical Association. All rights reserved. Applicable FARS/DFARS apply.
\2\ Copyright 2005 American Dental Association. All rights reserved.
\3\ Indicates RVUs are not used for Medicare payment.


[[Page 37283]]


                                   Addendum B.--Relative Value Units (RVUs) and Related Information Used In Determining Medicare Payments for 2007--Continued
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                   Fully                                                            Fully
                                                     Physician  implemented    Year 2007      Fully       Year 2007      Mal-    implemented    Year 2007      Fully       Year 2007
CPT \1\  HCPCS     Mod     Status     Description    work RVUs      non-     transitional  implemented  transitional   practice      non-     transitional  implemented  transitional    Global
      \2\                                               \3\     facility PE  non-facility  facility PE   facility PE     RVUs      facility   non-facility    facility     facility
                                                                    RVUs        PE RVUs        RVUs         RVUs                    total         total        total         total
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
27095.........  ........  A         Injection for         1.50        3.78          5.25         0.51          0.52        0.14        5.42          6.89         2.15          2.16         000
                                     hip x-ray.
27096.........  ........  A         Inject                1.40        2.53          3.90         0.33          0.33        0.08        4.01          5.38         1.81          1.81         000
                                     sacroiliac
                                     joint.
27097.........  ........  A         Revision of hip       9.09          NA            NA         6.23          6.38        1.57          NA            NA        16.89         17.04         090
                                     tendon.
27098.........  ........  A         Transfer tendon       9.12          NA            NA         4.73          6.46        0.95          NA            NA        14.80         16.53         090
                                     to pelvis.
27100.........  ........  A         Transfer of          11.12          NA            NA         7.24          8.33        1.85          NA            NA        20.21         21.30         090
                                     abdominal
                                     muscle.
27105.........  ........  A         Transfer of          11.81          NA            NA         7.77          8.84        1.72          NA            NA        21.30         22.37         090
                                     spinal muscle.
27110.........  ........  A         Transfer of          13.54          NA            NA         8.45          8.97        2.18          NA            NA        24.17         24.69         090
                                     iliopsoas
                                     muscle.
27111.........  ........  A         Transfer of          12.37          NA            NA         7.98          8.87        1.94          NA            NA        22.29         23.18         090
                                     iliopsoas
                                     muscle.
27120.........  ........  A         Reconstruction       19.00          NA            NA        10.57         11.55        3.08          NA            NA        32.65         33.63         090
                                     of hip socket.
27122.........  ........  A         Reconstruction       15.86          NA            NA         9.29         10.63        2.61          NA            NA        27.76         29.10         090
                                     of hip socket.
27125.........  ........  A         Partial hip          16.38          NA            NA         9.49         10.36        2.54          NA            NA        28.41         29.28         090
                                     replacement.
27130.........  ........  A         Total hip            17.40          NA            NA         9.46         12.37        3.50          NA            NA        30.36         33.27         090
                                     arthroplasty.
27132.........  ........  A         Total hip            25.41          NA            NA        13.28         15.08        4.04          NA            NA        42.73         44.53         090
                                     arthroplasty.
27134.........  ........  A         Revise hip           30.07          NA            NA        14.52         17.01        4.94          NA            NA        49.53         52.02         090
                                     joint
                                     replacement.
27137.........  ........  A         Revise hip           22.49          NA            NA        11.59         13.38        3.67          NA            NA        37.75         39.54         090
                                     joint
                                     replacement.
27138.........  ........  A         Revise hip           23.49          NA            NA        11.97         13.82        3.84          NA            NA        39.30         41.15         090
                                     joint
                                     replacement.
27140.........  ........  A         Transplant           12.58          NA            NA         7.67          9.00        2.11          NA            NA        22.36         23.69         090
                                     femur ridge.
27146.........  ........  A         Incision of hip      18.64          NA            NA        10.51         11.76        2.96          NA            NA        32.11         33.36         090
                                     bone.
27147.........  ........  A         Revision of hip      21.79          NA            NA        11.73         12.90        3.57          NA            NA        37.09         38.26         090
                                     bone.
27151.........  ........  A         Incision of hip      23.84          NA            NA        12.10          9.00        3.91          NA            NA        39.85         36.75         090
                                     bones.
27156.........  ........  A         Revision of hip      25.95          NA            NA        13.23         15.39        4.21          NA            NA        43.39         45.55         090
                                     bones.
27158.........  ........  A         Revision of          20.79          NA            NA         6.99         10.00        3.16          NA            NA        30.94         33.95         090
                                     pelvis.
27161.........  ........  A         Incision of          17.64          NA            NA        10.20         11.66        2.94          NA            NA        30.78         32.24         090
                                     neck of femur.
27165.........  ........  A         Incision/            19.96          NA            NA        11.48         12.58        3.10          NA            NA        34.54         35.64         090
                                     fixation of
                                     femur.
27170.........  ........  A         Repair/graft         17.40          NA            NA         9.61         10.90        2.81          NA            NA        29.82         31.11         090
                                     femur head/
                                     neck.
27175.........  ........  A         Treat slipped         9.23          NA            NA         5.69          6.44        1.46          NA            NA        16.38         17.13         090
                                     epiphysis.
27176.........  ........  A         Treat slipped        12.69          NA            NA         8.10          8.81        2.22          NA            NA        23.01         23.72         090
                                     epiphysis.
27177.........  ........  A         Treat slipped        15.84          NA            NA         9.50         10.57        2.61          NA            NA        27.95         29.02         090
                                     epiphysis.
27178.........  ........  A         Treat slipped        12.69          NA            NA         8.10          8.36        2.08          NA            NA        22.87         23.13         090
                                     epiphysis.
27179.........  ........  A         Revise head/         13.74          NA            NA         8.38          9.61        2.25          NA            NA        24.37         25.60         090
                                     neck of femur.
27181.........  ........  A         Treat slipped        15.90          NA            NA         9.63         10.08        1.57          NA            NA        27.10         27.55         090
                                     epiphysis.
27185.........  ........  A         Revision of           9.59          NA            NA         6.56          7.30        2.39          NA            NA        18.54         19.28         090
                                     femur
                                     epiphysis.
27187.........  ........  A         Reinforce hip        14.00          NA            NA         8.55          9.90        2.37          NA            NA        24.92         26.27         090
                                     bones.
27193.........  ........  A         Treat pelvic          5.92        4.56          4.97         4.70          5.00        0.96       11.44         11.85        11.58         11.88         090
                                     ring fracture.
27194.........  ........  A         Treat pelvic         10.00          NA            NA         6.48          7.37        1.65          NA            NA        18.13         19.02         090
                                     ring fracture.
27200.........  ........  A         Treat tail bone       1.84        2.05          2.19         2.20          2.17        0.28        4.17          4.31         4.32          4.29         090
                                     fracture.
27202.........  ........  A         Treat tail bone       7.21          NA            NA        11.31         15.51        1.06          NA            NA        19.58         23.78         090
                                     fracture.
27215.........  ........  A         Treat pelvic         10.39          NA            NA         6.41          6.93        1.97          NA            NA        18.77         19.29         090
                                     fracture(s).
27216.........  ........  A         Treat pelvic         15.65          NA            NA         9.05          9.48        2.63          NA            NA        27.33         27.76         090
                                     ring fracture.
27217.........  ........  A         Treat pelvic         14.57          NA            NA         8.52          9.76        2.41          NA            NA        25.50         26.74         090
                                     ring fracture.
27218.........  ........  A         Treat pelvic         20.85          NA            NA        11.15         11.36        3.48          NA            NA        35.48         35.69         090
                                     ring fracture.
27220.........  ........  A         Treat hip             6.65        5.18          5.60         5.09          5.51        1.07       12.90         13.32        12.81         13.23         090
                                     socket
                                     fracture.
27222.........  ........  A         Treat hip            13.88          NA            NA         8.35          9.59        2.19          NA            NA        24.42         25.66         090
                                     socket
                                     fracture.
27226.........  ........  A         Treat hip wall       15.37          NA            NA         8.81          8.08        2.48          NA            NA        26.66         25.93         090
                                     fracture.
27227.........  ........  A         Treat hip            25.13          NA            NA        13.14         14.87        4.05          NA            NA        42.32         44.05         090
                                     fracture(s).
27228.........  ........  A         Treat hip            29.05          NA            NA        14.69         16.93        4.66          NA            NA        48.40         50.64         090
                                     fracture(s).
27230.........  ........  A         Treat thigh           5.61        4.90          5.37         4.83          5.04        0.95       11.46         11.93        11.39         11.60         090
                                     fracture.
27232.........  ........  A         Treat thigh          11.62          NA            NA         5.90          6.87        1.85          NA            NA        19.37         20.34         090
                                     fracture.
27235.........  ........  A         Treat thigh          12.80          NA            NA         7.89          9.08        2.11          NA            NA        22.80         23.99         090
                                     fracture.
27236.........  ........  A         Treat thigh          14.54          NA            NA         8.53         10.44        2.71          NA            NA        25.78         27.69         090
                                     fracture.
27238.........  ........  A         Treat thigh           5.57          NA            NA         4.61          5.02        0.89          NA            NA        11.07         11.48         090
                                     fracture.
27240.........  ........  A         Treat thigh          13.56          NA            NA         7.96          9.12        2.16          NA            NA        23.68         24.84        090
                                     fracture.
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
\1\ CPT codes and descriptors only are copyright 2005 American Medical Association. All rights reserved. Applicable FARS/DFARS apply.
\2\ Copyright 2005 American Dental Association. All rights reserved.
\3\ Indicates RVUs are not used for Medicare payment.


[[Page 37284]]


                                   Addendum B.--Relative Value Units (RVUs) and Related Information Used In Determining Medicare Payments for 2007--Continued
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                   Fully                                                            Fully
                                                     Physician  implemented    Year 2007      Fully       Year 2007      Mal-    implemented    Year 2007      Fully       Year 2007
CPT \1\  HCPCS     Mod     Status     Description    work RVUs      non-     transitional  implemented  transitional   practice      non-     transitional  implemented  transitional    Global
      \2\                                               \3\     facility PE  non-facility  facility PE   facility PE     RVUs      facility   non-facility    facility     facility
                                                                    RVUs        PE RVUs        RVUs         RVUs                    total         total        total         total
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
27244.........  ........  A         Treat thigh          17.00          NA            NA         9.50         10.87        2.77          NA            NA        29.27         30.64         090
                                     fracture.
27245.........  ........  A         Treat thigh          21.01          NA            NA        11.21         13.14        3.52          NA            NA        35.74         37.67         090
                                     fracture.
27246.........  ........  A         Treat thigh           4.70        3.87          4.32         3.90          4.30        0.81        9.38          9.83         9.41          9.81         090
                                     fracture.
27248.........  ........  A         Treat thigh          10.73          NA            NA         6.87          7.89        1.81          NA            NA        19.41         20.43         090
                                     fracture.
27250.........  ........  A         Treat hip             7.12          NA            NA         4.22          4.53        0.62          NA            NA        11.96         12.27         090
                                     dislocation.
27252.........  ........  A         Treat hip            10.85          NA            NA         6.37          7.18        1.66          NA            NA        18.88         19.69         090
                                     dislocation.
27253.........  ........  A         Treat hip            13.38          NA            NA         7.71          9.29        2.24          NA            NA        23.33         24.91         090
                                     dislocation.
27254.........  ........  A         Treat hip            18.71          NA            NA        10.34         11.62        3.17          NA            NA        32.22         33.50         090
                                     dislocation.
27256.........  ........  A         Treat hip             4.23        2.40          3.25         1.38          1.91        0.46        7.09          7.94         6.07          6.60         010
                                     dislocation.
27257.........  ........  A         Treat hip             5.33          NA            NA         2.48          2.74        0.69          NA            NA         8.50          8.76         010
                                     dislocation.
27258.........  ........  A         Treat hip            15.95          NA            NA         9.26         10.49        2.64          NA            NA        27.85         29.08         090
                                     dislocation.
27259.........  ........  A         Treat hip            22.95          NA            NA        12.64         13.78        3.74          NA            NA        39.33         40.47         090
                                     dislocation.
27265.........  ........  A         Treat hip             5.04          NA            NA         3.93          4.58        0.63          NA            NA         9.60         10.25         090
                                     dislocation.
27266.........  ........  A         Treat hip             7.60          NA            NA         5.45          6.13        1.29          NA            NA        14.34         15.02         090
                                     dislocation.
27275.........  ........  A         Manipulation of       2.27          NA            NA         1.86          2.05        0.39          NA            NA         4.52          4.71         010
                                     hip joint.
27280.........  ........  A         Fusion of            14.39          NA            NA         8.87          9.94        2.53          NA            NA        25.79         26.86         090
                                     sacroiliac
                                     joint.
27282.........  ........  A         Fusion of pubic      11.62          NA            NA         7.69          7.94        1.86          NA            NA        21.17         21.42         090
                                     bones.
27284.........  ........  A         Fusion of hip        24.85          NA            NA        12.57         14.24        3.92          NA            NA        41.34         43.01         090
                                     joint.
27286.........  ........  A         Fusion of hip        24.89          NA            NA        13.18         15.18        3.12          NA            NA        41.19         43.19         090
                                     joint.
27290.........  ........  A         Amputation of        24.27          NA            NA        12.25         13.64        3.43          NA            NA        39.95         41.34         090
                                     leg at hip.
27295.........  ........  A         Amputation of        19.46          NA            NA         9.61         10.91        2.95          NA            NA        32.02         33.32         090
                                     leg at hip.
27301.........  ........  A         Drain thigh/          6.60        8.17          9.62         4.61          5.02        1.04       15.81         17.26        12.25         12.66         090
                                     knee lesion.
27303.........  ........  A         Drainage of           8.45          NA            NA         5.96          6.74        1.43          NA            NA        15.84         16.62         090
                                     bone lesion.
27305.........  ........  A         Incise thigh          6.03          NA            NA         4.58          5.05        1.01          NA            NA        11.62         12.09         090
                                     tendon &
                                     fascia.
27306.........  ........  A         Incision of           4.61          NA            NA         4.01          4.55        0.85          NA            NA         9.47         10.01         090
                                     thigh tendon.
27307.........  ........  A         Incision of           5.91          NA            NA         4.73          5.23        1.04          NA            NA        11.68         12.18         090
                                     thigh tendons.
27310.........  ........  A         Exploration of        9.80          NA            NA         6.59          7.35        1.61          NA            NA        18.00         18.76         090
                                     knee joint.
27315.........  ........  A         Partial               7.02          NA            NA         5.20          5.02        1.09          NA            NA        13.31         13.13         090
                                     removal, thigh
                                     nerve.
27320.........  ........  A         Partial               6.29          NA            NA         4.54          5.07        1.06          NA            NA        11.89         12.42         090
                                     removal, thigh
                                     nerve.
27323.........  ........  A         Biopsy, thigh         2.28        4.11          3.67         1.88          1.89        0.24        6.63          6.19         4.40          4.41         010
                                     soft tissues.
27324.........  ........  A         Biopsy, thigh         4.89          NA            NA         3.79          4.09        0.75          NA            NA         9.43          9.73         090
                                     soft tissues.
27327.........  ........  A         Removal of            4.46        6.04          6.02         3.57          3.69        0.64       11.14         11.12         8.67          8.79         090
                                     thigh lesion.
27328.........  ........  A         Removal of            5.56          NA            NA         4.00          4.29        0.84          NA            NA        10.40         10.69         090
                                     thigh lesion.
27329.........  ........  A         Remove tumor,        15.60          NA            NA         8.40          8.89        2.14          NA            NA        26.14         26.63         090
                                     thigh/knee.
27330.........  ........  A         Biopsy, knee          4.96          NA            NA         4.00          4.44        0.86          NA            NA         9.82         10.26         090
                                     joint lining.
27331.........  ........  A         Explore/treat         5.87          NA            NA         4.73          5.34        1.02          NA            NA        11.62         12.23         090
                                     knee joint.
27332.........  ........  A         Removal of knee       8.26          NA            NA         6.01          6.86        1.43          NA            NA        15.70         16.55         090
                                     cartilage.
27333.........  ........  A         Removal of knee       7.35          NA            NA         5.61          6.42        1.26          NA            NA        14.22         15.03         090
                                     cartilage.
27334.........  ........  A         Remove knee           8.99          NA            NA         6.34          7.16        1.51          NA            NA        16.84         17.66         090
                                     joint lining.
27335.........  ........  A         Remove knee          10.35          NA            NA         6.90          7.91        1.74          NA            NA        18.99         20.00         090
                                     joint lining.
27340.........  ........  A         Removal of            4.17          NA            NA         3.96          4.42        0.72          NA            NA         8.85          9.31         090
                                     kneecap bursa.
27345.........  ........  A         Removal of knee       5.91          NA            NA         4.79          5.43        1.00          NA            NA        11.70         12.34         090
                                     cyst.
27347.........  ........  A         Remove knee           6.52          NA            NA         5.14          5.37        0.98          NA            NA        12.64         12.87         090
                                     cyst.
27350.........  ........  A         Removal of            8.46          NA            NA         6.15          6.98        1.41          NA            NA        16.02         16.85         090
                                     kneecap.
27355.........  ........  A         Remove femur          7.82          NA            NA         5.74          6.53        1.32          NA            NA        14.88         15.67         090
                                     lesion.
27356.........  ........  A         Remove femur          9.89          NA            NA         6.71          7.58        1.65          NA            NA        18.25         19.12         090
                                     lesion/graft.
27357.........  ........  A         Remove femur         10.93          NA            NA         7.38          8.39        1.95          NA            NA        20.26         21.27         090
                                     lesion/graft.
27358.........  ........  A         Remove femur          4.73          NA            NA         1.85          2.36        0.82          NA            NA         7.40          7.91         ZZZ
                                     lesion/
                                     fixation.
27360.........  ........  A         Partial              11.26          NA            NA         7.80          9.14        1.83          NA            NA        20.89         22.23         090
                                     removal, leg
                                     bone(s).
27365.........  ........  A         Extensive leg        17.85          NA            NA        10.27         11.35        2.79          NA            NA        30.91         31.99         090
                                     surgery.
27370.........  ........  A         Injection for         0.96        2.85          3.51         0.33          0.32        0.08        3.89          4.55         1.37          1.36         000
                                     knee x-ray.
27372.........  ........  A         Removal of            5.06        8.27          9.63         4.00          4.53        0.84       14.17         15.53         9.90         10.43        090
                                     foreign body.
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
\1\ CPT codes and descriptors only are copyright 2005 American Medical Association. All rights reserved. Applicable FARS/DFARS apply.
\2\ Copyright 2005 American Dental Association. All rights reserved.
\3\ Indicates RVUs are not used for Medicare payment.


[[Page 37285]]


                                   Addendum B.--Relative Value Units (RVUs) and Related Information Used In Determining Medicare Payments for 2007--Continued
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                   Fully                                                            Fully
                                                     Physician  implemented    Year 2007      Fully       Year 2007      Mal-    implemented    Year 2007      Fully       Year 2007
CPT \1\  HCPCS     Mod     Status     Description    work RVUs      non-     transitional  implemented  transitional   practice      non-     transitional  implemented  transitional    Global
      \2\                                               \3\     facility PE  non-facility  facility PE   facility PE     RVUs      facility   non-facility    facility     facility
                                                                    RVUs        PE RVUs        RVUs         RVUs                    total         total        total         total
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
27380.........  ........  A         Repair of             7.27          NA            NA         5.83          6.93        1.24          NA            NA        14.34         15.44         090
                                     kneecap tendon.
27381.........  ........  A         Repair/graft         10.56          NA            NA         7.28          8.66        1.79          NA            NA        19.63         21.01         090
                                     kneecap tendon.
27385.........  ........  A         Repair of thigh       7.93          NA            NA         6.10          7.26        1.36          NA            NA        15.39         16.55         090
                                     muscle.
27386.........  ........  A         Repair/graft of      10.90          NA            NA         7.69          9.08        1.85          NA            NA        20.44         21.83         090
                                     thigh muscle.
27390.........  ........  A         Incision of           5.38          NA            NA         4.52          4.97        0.92          NA            NA        10.82         11.27         090
                                     thigh tendon.
27391.........  ........  A         Incision of           7.31          NA            NA         5.42          6.29        1.23          NA            NA        13.96         14.83         090
                                     thigh tendons.
27392.........  ........  A         Incision of           9.43          NA            NA         6.59          7.36        1.57          NA            NA        17.59         18.36         090
                                     thigh tendons.
27393.........  ........  A         Lengthening of        6.44          NA            NA         4.95          5.63        1.10          NA            NA        12.49         13.17         090
                                     thigh tendon.
27394.........  ........  A         Lengthening of        8.61          NA            NA         6.08          6.95        1.47          NA            NA        16.16         17.03         090
                                     thigh tendons.
27395.........  ........  A         Lengthening of       12.01          NA            NA         7.83          8.97        2.04          NA            NA        21.88         23.02         090
                                     thigh tendons.
27396.........  ........  A         Transplant of         7.97          NA            NA         5.82          6.72        1.34          NA            NA        15.13         16.03         090
                                     thigh tendon.
27397.........  ........  A         Transplants of       12.38          NA            NA         8.25          8.87        1.82          NA            NA        22.45         23.07         090
                                     thigh tendons.
27400.........  ........  A         Revise thigh          9.13          NA            NA         6.10          6.98        1.31          NA            NA        16.54         17.42         090
                                     muscles/
                                     tendons.
27403.........  ........  A         Repair of knee        8.44          NA            NA         5.97          6.89        1.44          NA            NA        15.85         16.77         090
                                     cartilage.
27405.........  ........  A         Repair of knee        8.88          NA            NA         6.33          7.22        1.51          NA            NA        16.72         17.61         090
                                     ligament.
27407.........  ........  A         Repair of knee       10.62          NA            NA         6.55          7.89        1.78          NA            NA        18.95         20.29         090
                                     ligament.
27409.........  ........  A         Repair of knee       13.48          NA            NA         8.27          9.55        2.24          NA            NA        23.99         25.27         090
                                     ligaments.
27412.........  ........  A         Autochondrocyte      24.43          NA            NA        13.45         14.49        4.35          NA            NA        42.23         43.27         090
                                     implant knee.
27415.........  ........  A         Osteochondral        19.69          NA            NA        11.62         12.35        4.35          NA            NA        35.66         36.39         090
                                     knee allograft.
27418.........  ........  A         Repair               11.37          NA            NA         7.46          8.56        1.88          NA            NA        20.71         21.81         090
                                     degenerated
                                     kneecap.
27420.........  ........  A         Revision of          10.06          NA            NA         6.82          7.80        1.71          NA            NA        18.59         19.57         090
                                     unstable
                                     kneecap.
27422.........  ........  A         Revision of          10.01          NA            NA         6.78          7.80        1.70          NA            NA        18.49         19.51         090
                                     unstable
                                     kneecap.
27424.........  ........  A         Revision/            10.04          NA            NA         6.78          7.78        1.70          NA            NA        18.52         19.52         090
                                     removal of
                                     kneecap.
27425.........  ........  A         Lat retinacular       5.21          NA            NA         4.63          5.31        0.90          NA            NA        10.74         11.42         090
                                     release open.
27427.........  ........  A         Reconstruction,       9.59          NA            NA         6.57          7.51        1.63          NA            NA        17.79         18.73         090
                                     knee.
27428.........  ........  A         Reconstruction,      15.23          NA            NA         9.93         10.94        2.42          NA            NA        27.58         28.59         090
                                     knee.
27429.........  ........  A         Reconstruction,      17.12          NA            NA        11.11         12.12        2.70          NA            NA        30.93         31.94         090
                                     knee.
27430.........  ........  A         Revision of           9.96          NA            NA         6.75          7.70        1.69          NA            NA        18.40         19.35         090
                                     thigh muscles.
27435.........  ........  A         Incision of          10.60          NA            NA         7.55          8.26        1.69          NA            NA        19.84         20.55         090
                                     knee joint.
27437.........  ........  A         Revise kneecap.       8.75          NA            NA         6.12          6.98        1.49          NA            NA        16.36         17.22         090
27438.........  ........  A         Revise kneecap       11.69          NA            NA         7.42          8.28        1.95          NA            NA        21.06         21.92         090
                                     with implant.
27440.........  ........  A         Revision of          10.89          NA            NA         7.03          6.27        1.81          NA            NA        19.73         18.97         090
                                     knee joint.
27441.........  ........  A         Revision of          11.34          NA            NA         7.35          6.89        1.88          NA            NA        20.57         20.11         090
                                     knee joint.
27442.........  ........  A         Revision of          12.17          NA            NA         7.63          8.61        2.09          NA            NA        21.89         22.87         090
                                     knee joint.
27443.........  ........  A         Revision of          11.21          NA            NA         7.26          8.38        1.90          NA            NA        20.37         21.49         090
                                     knee joint.
27445.........  ........  A         Revision of          18.43          NA            NA        10.31         11.87        3.08          NA            NA        31.82         33.38         090
                                     knee joint.
27446.........  ........  A         Revision of          16.18          NA            NA         9.18         10.77        2.80          NA            NA        28.16         29.75         090
                                     knee joint.
27447.........  ........  A         Total knee           20.81          NA            NA        11.48         13.85        3.79          NA            NA        36.08         38.45         090
                                     arthroplasty.
27448.........  ........  A         Incision of          11.40          NA            NA         7.23          8.27        1.94          NA            NA        20.57         21.61         090
                                     thigh.
27450.........  ........  A         Incision of          14.38          NA            NA         8.64         10.12        2.42          NA            NA        25.44         26.92         090
                                     thigh.
27454.........  ........  A         Realignment of       18.89          NA            NA        10.53         12.04        3.12          NA            NA        32.54         34.05         090
                                     thigh bone.
27455.........  ........  A         Realignment of       13.16          NA            NA         8.16          9.47        2.24          NA            NA        23.56         24.87         090
                                     knee.
27457.........  ........  A         Realignment of       13.85          NA            NA         8.09          9.49        2.34          NA            NA        24.28         25.68         090
                                     knee.
27465.........  ........  A         Shortening of        18.36          NA            NA        10.09         10.21        2.47          NA            NA        30.92         31.04         090
                                     thigh bone.
27466.........  ........  A         Lengthening of       17.03          NA            NA         9.94         11.38        2.77          NA            NA        29.74         31.18         090
                                     thigh bone.
27468.........  ........  A         Shorten/             19.72          NA            NA        11.04         12.05        3.30          NA            NA        34.06         35.07         090
                                     lengthen
                                     thighs.
27470.........  ........  A         Repair of thigh      16.87          NA            NA         9.88         11.34        2.79          NA            NA        29.54         31.00         090
27472.........  ........  A         Repair/graft of      18.47          NA            NA        10.50         12.17        3.07          NA            NA        32.04         33.71         090
                                     thigh.
27475.........  ........  A         Surgery to stop       8.75          NA            NA         6.66          7.09        1.36          NA            NA        16.77         17.20         090
                                     leg growth.
27477.........  ........  A         Surgery to stop       9.96          NA            NA         6.52          7.44        1.73          NA            NA        18.21         19.13         090
                                     leg growth.
27479.........  ........  A         Surgery to stop      12.96          NA            NA         4.98          8.50        2.78          NA            NA        20.72         24.24        090
                                     leg growth.
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
\1\ CPT codes and descriptors only are copyright 2005 American Medical Association. All rights reserved. Applicable FARS/DFARS apply.
\2\ Copyright 2005 American Dental Association. All rights reserved.
\3\ Indicates RVUs are not used for Medicare payment.


[[Page 37286]]


                                   Addendum B.--Relative Value Units (RVUs) and Related Information Used In Determining Medicare Payments for 2007--Continued
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                   Fully                                                            Fully
                                                     Physician  implemented    Year 2007      Fully       Year 2007      Mal-    implemented    Year 2007      Fully       Year 2007
CPT \1\  HCPCS     Mod     Status     Description    work RVUs      non-     transitional  implemented  transitional   practice      non-     transitional  implemented  transitional    Global
      \2\                                               \3\     facility PE  non-facility  facility PE   facility PE     RVUs      facility   non-facility    facility     facility
                                                                    RVUs        PE RVUs        RVUs         RVUs                    total         total        total         total
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
27485.........  ........  A         Surgery to stop       8.95          NA            NA         6.12          7.10        1.53          NA            NA        16.60         17.58         090
                                     leg growth.
27486.........  ........  A         Revise/replace       20.84          NA            NA        11.49         13.02        3.36          NA            NA        35.69         37.22         090
                                     knee joint.
27487.........  ........  A         Revise/replace       26.83          NA            NA        13.83         15.91        4.39          NA            NA        45.05         47.13         090
                                     knee joint.
27488.........  ........  A         Removal of knee      17.32          NA            NA        10.13         11.33        2.74          NA            NA        30.19         31.39         090
                                     prosthesis.
27495.........  ........  A         Reinforce thigh      16.31          NA            NA         9.50         10.96        2.71          NA            NA        28.52         29.98         090
27496.........  ........  A         Decompression         6.58          NA            NA         4.98          5.46        0.99          NA            NA        12.55         13.03         090
                                     of thigh/knee.
27497.........  ........  A         Decompression         7.64          NA            NA         4.61          5.24        1.15          NA            NA        13.40         14.03         090
                                     of thigh/knee.
27498.........  ........  A         Decompression         8.46          NA            NA         5.36          5.82        1.24          NA            NA        15.06         15.52         090
                                     of thigh/knee.
27499.........  ........  A         Decompression         9.23          NA            NA         5.76          6.57        1.47          NA            NA        16.46         17.27         090
                                     of thigh/knee.
27500.........  ........  A         Treatment of          6.15        5.35          5.94         4.57          4.89        1.02       12.52         13.11        11.74         12.06         090
                                     thigh fracture.
27501.........  ........  A         Treatment of          6.28        4.95          5.60         4.86          5.27        1.03       12.26         12.91        12.17         12.58         090
                                     thigh fracture.
27502.........  ........  A         Treatment of         11.16          NA            NA         6.79          7.80        1.78          NA            NA        19.73         20.74         090
                                     thigh fracture.
27503.........  ........  A         Treatment of         11.05          NA            NA         7.12          8.01        1.84          NA            NA        20.01         20.90         090
                                     thigh fracture.
27506.........  ........  A         Treatment of         19.32          NA            NA        10.98         12.36        3.03          NA            NA        33.33         34.71         090
                                     thigh fracture.
27507.........  ........  A         Treatment of         14.33          NA            NA         8.03          9.41        2.42          NA            NA        24.78         26.16         090
                                     thigh fracture.
27508.........  ........  A         Treatment of          6.00        5.62          6.27         4.99          5.37        0.97       12.59         13.24        11.96         12.34         090
                                     thigh fracture.
27509.........  ........  A         Treatment of          7.94          NA            NA         6.36          7.58        1.34          NA            NA        15.64         16.86         090
                                     thigh fracture.
27510.........  ........  A         Treatment of          9.60          NA            NA         6.22          7.07        1.53          NA            NA        17.35         18.20         090
                                     thigh fracture.
27511.........  ........  A         Treatment of         13.86          NA            NA         8.75         10.61        2.37          NA            NA        24.98         26.84         090
                                     thigh fracture.
27513.........  ........  A         Treatment of         19.37          NA            NA        11.43         13.30        3.12          NA            NA        33.92         35.79         090
                                     thigh fracture.
27514.........  ........  A         Treatment of         18.99          NA            NA        11.55         12.93        3.00          NA            NA        33.54         34.92         090
                                     thigh fracture.
27516.........  ........  A         Treat thigh fx        5.36        5.60          6.18         4.97          5.39        0.81       11.77         12.35        11.14         11.56         090
                                     growth plate.
27517.........  ........  A         Treat thigh fx        8.89          NA            NA         5.93          7.09        1.22          NA            NA        16.04         17.20         090
                                     growth plate.
27519.........  ........  A         Treat thigh fx       15.72          NA            NA         9.50         11.09        2.55          NA            NA        27.77         29.36         090
                                     growth plate.
27520.........  ........  A         Treat kneecap         2.86        4.05          4.43         3.48          3.46        0.47        7.38          7.76         6.81          6.79         090
                                     fracture.
27524.........  ........  A         Treat kneecap        10.17          NA            NA         6.83          7.90        1.74          NA            NA        18.74         19.81         090
                                     fracture.
27530.........  ........  A         Treat knee            3.89        4.76          5.19         4.20          4.37        0.65        9.30          9.73         8.74          8.91         090
                                     fracture.
27532.........  ........  A         Treat knee            7.35        6.35          7.12         5.57          6.25        1.26       14.96         15.73        14.18         14.86         090
                                     fracture.
27535.........  ........  A         Treat knee           11.72          NA            NA         7.92          9.59        2.00          NA            NA        21.64         23.31         090
                                     fracture.
27536.........  ........  A         Treat knee           17.11          NA            NA        10.07         11.25        2.73          NA            NA        29.91         31.09         090
                                     fracture.
27538.........  ........  A         Treat knee            4.86        5.46          5.98         4.84          5.12        0.84       11.16         11.68        10.54         10.82         090
                                     fracture(s).
27540.........  ........  A         Treat knee           13.38          NA            NA         7.84          9.12        2.27          NA            NA        23.49         24.77         090
                                     fracture.
27550.........  ........  A         Treat knee            5.75        5.26          5.84         4.55          4.84        0.76       11.77         12.35        11.06         11.35         090
                                     dislocation.
27552.........  ........  A         Treat knee            7.95          NA            NA         6.01          6.73        1.36          NA            NA        15.32         16.04         090
                                     dislocation.
27556.........  ........  A         Treat knee           14.87          NA            NA         9.06         11.03        2.50          NA            NA        26.43         28.40         090
                                     dislocation.
27557.........  ........  A         Treat knee           17.22          NA            NA        10.31         12.45        2.97          NA            NA        30.50         32.64         090
                                     dislocation.
27558.........  ........  A         Treat knee           17.93          NA            NA        10.33         12.39        3.08          NA            NA        31.34         33.40         090
                                     dislocation.
27560.........  ........  A         Treat kneecap         3.81        3.89          4.61         3.37          3.24        0.40        8.10          8.82         7.58          7.45         090
                                     dislocation.
27562.........  ........  A         Treat kneecap         5.78          NA            NA         4.38          4.68        0.94          NA            NA        11.10         11.40         090
                                     dislocation.
27566.........  ........  A         Treat kneecap        12.51          NA            NA         7.68          8.93        2.12          NA            NA        22.31         23.56         090
                                     dislocation.
27570.........  ........  A         Fixation of           1.74          NA            NA         1.60          1.74        0.30          NA            NA         3.64          3.78         010
                                     knee joint.
27580.........  ........  A         Fusion of knee.      20.82          NA            NA        12.03         14.14        3.37          NA            NA        36.22         38.33         090
27590.........  ........  A         Amputate leg at      13.27          NA            NA         6.15          6.56        1.74          NA            NA        21.16         21.57         090
                                     thigh.
27591.........  ........  A         Amputate leg at      13.74          NA            NA         7.30          8.33        2.02          NA            NA        23.06         24.09         090
                                     thigh.
27592.........  ........  A         Amputate leg at      10.78          NA            NA         5.51          6.02        1.45          NA            NA        17.74         18.25         090
                                     thigh.
27594.........  ........  A         Amputation            7.09          NA            NA         4.74          5.07        1.02          NA            NA        12.85         13.18         090
                                     follow-up
                                     surgery.
27596.........  ........  A         Amputation           11.06          NA            NA         6.03          6.63        1.57          NA            NA        18.66         19.26         090
                                     follow-up
                                     surgery.
27598.........  ........  A         Amputate lower       10.99          NA            NA         6.28          6.85        1.65          NA            NA        18.92         19.49         090
                                     leg at knee.
27600.........  ........  A         Decompression         5.88          NA            NA         3.86          4.37        0.86          NA            NA        10.60         11.11         090
                                     of lower leg.
27601.........  ........  A         Decompression         5.87          NA            NA         4.25          4.71        0.80          NA            NA        10.92         11.38         090
                                     of lower leg.
27602.........  ........  A         Decompression         7.64          NA            NA         4.43          4.96        1.10          NA            NA        13.17         13.70         090
                                     of lower leg.
27603.........  ........  A         Drain lower leg       5.05        7.01          7.39         3.86          4.09        0.74       12.80         13.18         9.65          9.88        090
                                     lesion.
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
\1\ CPT codes and descriptors only are copyright 2005 American Medical Association. All rights reserved. Applicable FARS/DFARS apply.
\2\ Copyright 2005 American Dental Association. All rights reserved.
\3\ Indicates RVUs are not used for Medicare payment.


[[Page 37287]]


                                   Addendum B.--Relative Value Units (RVUs) and Related Information Used In Determining Medicare Payments for 2007--Continued
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                   Fully                                                            Fully
                                                     Physician  implemented    Year 2007      Fully       Year 2007      Mal-    implemented    Year 2007      Fully       Year 2007
CPT \1\  HCPCS     Mod     Status     Description    work RVUs      non-     transitional  implemented  transitional   practice      non-     transitional  implemented  transitional    Global
      \2\                                               \3\     facility PE  non-facility  facility PE   facility PE     RVUs      facility   non-facility    facility     facility
                                                                    RVUs        PE RVUs        RVUs         RVUs                    total         total        total         total
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
27604.........  ........  A         Drain lower leg       4.46        6.41          6.18         3.37          3.82        0.69       11.56         11.33         8.52          8.97         090
                                     bursa.
27605.........  ........  A         Incision of           2.87        5.24          7.09         1.76          2.19        0.41        8.52         10.37         5.04          5.47         010
                                     achilles
                                     tendon.
27606.........  ........  A         Incision of           4.13          NA            NA         2.62          3.18        0.69          NA            NA         7.44          8.00         010
                                     achilles
                                     tendon.
27607.........  ........  A         Treat lower leg       8.44          NA            NA         5.64          6.05        1.31          NA            NA        15.39         15.80         090
                                     bone lesion.
27610.........  ........  A         Explore/treat         8.93          NA            NA         6.05          6.78        1.40          NA            NA        16.38         17.11         090
                                     ankle joint.
27612.........  ........  A         Exploration of        7.92          NA            NA         5.23          5.89        1.13          NA            NA        14.28         14.94         090
                                     ankle joint.
27613.........  ........  A         Biopsy lower          2.17        3.82          3.39         1.72          1.79        0.20        6.19          5.76         4.09          4.16         010
                                     leg soft
                                     tissue.
27614.........  ........  A         Biopsy lower          5.65        7.82          7.32         3.95          4.33        0.78       14.25         13.75        10.38         10.76         090
                                     leg soft
                                     tissue.
27615.........  ........  A         Remove tumor,        12.84          NA            NA         7.90          9.04        1.83          NA            NA        22.57         23.71         090
                                     lower leg.
27618.........  ........  A         Remove lower          5.08        6.35          6.11         3.74          3.94        0.72       12.15         11.91         9.54          9.74         090
                                     leg lesion.
27619.........  ........  A         Remove lower          8.39        9.97          9.65         5.21          5.78        1.25       19.61         19.29        14.85         15.42         090
                                     leg lesion.
27620.........  ........  A         Explore/treat         5.97          NA            NA         4.50          5.24        0.97          NA            NA        11.44         12.18         090
                                     ankle joint.
27625.........  ........  A         Remove ankle          8.29          NA            NA         5.47          6.23        1.28          NA            NA        15.04         15.80         090
                                     joint lining.
27626.........  ........  A         Remove ankle          8.90          NA            NA         5.82          6.66        1.48          NA            NA        16.20         17.04         090
                                     joint lining.
27630.........  ........  A         Removal of            4.79        7.88          7.66         3.74          4.23        0.74       13.41         13.19         9.27          9.76         090
                                     tendon lesion.
27635.........  ........  A         Remove lower          7.83          NA            NA         5.56          6.46        1.31          NA            NA        14.70         15.60         090
                                     leg bone
                                     lesion.
27637.........  ........  A         Remove/graft         10.08          NA            NA         7.07          8.00        1.66          NA            NA        18.81         19.74         090
                                     leg bone
                                     lesion.
27638.........  ........  A         Remove/graft         10.79          NA            NA         6.83          7.94        1.84          NA            NA        19.46         20.57         090
                                     leg bone
                                     lesion.
27640.........  ........  A         Partial removal      12.01          NA            NA         8.04          9.77        1.88          NA            NA        21.93         23.66         090
                                     of tibia.
27641.........  ........  A         Partial removal       9.65          NA            NA         6.68          7.94        1.46          NA            NA        17.79         19.05         090
                                     of fibula.
27645.........  ........  A         Extensive lower      14.69          NA            NA         9.36         11.40        2.41          NA            NA        26.46         28.50         090
                                     leg surgery.
27646.........  ........  A         Extensive lower      13.12          NA            NA         8.56         10.44        2.05          NA            NA        23.73         25.61         090
                                     leg surgery.
27647.........  ........  A         Extensive ankle/     12.76          NA            NA         6.48          7.34        1.75          NA            NA        20.99         21.85         090
                                     heel surgery.
27648.........  ........  A         Injection for         0.96        2.77          3.34         0.32          0.33        0.08        3.81          4.38         1.36          1.37         000
                                     ankle x-ray.
27650.........  ........  A         Repair achilles       9.86          NA            NA         6.16          7.19        1.59          NA            NA        17.61         18.64         090
                                     tendon.
27652.........  ........  A         Repair/graft         10.55          NA            NA         6.30          7.61        1.71          NA            NA        18.56         19.87         090
                                     achilles
                                     tendon.
27654.........  ........  A         Repair of            10.24          NA            NA         5.84          6.83        1.58          NA            NA        17.66         18.65         090
                                     achilles
                                     tendon.
27656.........  ........  A         Repair leg            4.56        8.10          8.44         3.67          3.75        0.69       13.35         13.69         8.92          9.00         090
                                     fascia defect.
27658.........  ........  A         Repair of leg         4.97          NA            NA         3.84          4.39        0.79          NA            NA         9.60         10.15         090
                                     tendon, each.
27659.........  ........  A         Repair of leg         6.92          NA            NA         4.79          5.44        1.09          NA            NA        12.80         13.45         090
                                     tendon, each.
27664.........  ........  A         Repair of leg         4.58          NA            NA         3.88          4.39        0.76          NA            NA         9.22          9.73         090
                                     tendon, each.
27665.........  ........  A         Repair of leg         5.39          NA            NA         4.40          4.84        0.89          NA            NA        10.68         11.12         090
                                     tendon, each.
27675.........  ........  A         Repair lower          7.17          NA            NA         4.64          5.47        1.11          NA            NA        12.92         13.75         090
                                     leg tendons.
27676.........  ........  A         Repair lower          8.53          NA            NA         5.64          6.49        1.37          NA            NA        15.54         16.39         090
                                     leg tendons.
27680.........  ........  A         Release of            5.73          NA            NA         4.28          4.91        0.93          NA            NA        10.94         11.57         090
                                     lower leg
                                     tendon.
27681.........  ........  A         Release of            6.87          NA            NA         4.67          5.62        1.15          NA            NA        12.69         13.64         090
                                     lower leg
                                     tendons.
27685.........  ........  A         Revision of           6.49        8.73          7.67         4.52          5.24        0.97       16.19         15.13        11.98         12.70         090
                                     lower leg
                                     tendon.
27686.........  ........  A         Revise lower          7.57          NA            NA         5.27          6.20        1.24          NA            NA        14.08         15.01         090
                                     leg tendons.
27687.........  ........  A         Revision of           6.23          NA            NA         4.42          5.10        1.00          NA            NA        11.65         12.33         090
                                     calf tendon.
27690.........  ........  A         Revise lower          8.88          NA            NA         5.34          6.11        1.33          NA            NA        15.55         16.32         090
                                     leg tendon.
27691.........  ........  A         Revise lower         10.19          NA            NA         6.57          7.48        1.64          NA            NA        18.40         19.31         090
                                     leg tendon.
27692.........  ........  A         Revise                1.87          NA            NA         0.71          0.88        0.32          NA            NA         2.90          3.07         ZZZ
                                     additional leg
                                     tendon.
27695.........  ........  A         Repair of ankle       6.50          NA            NA         4.90          5.64        1.05          NA            NA        12.45         13.19         090
                                     ligament.
27696.........  ........  A         Repair of ankle       8.38          NA            NA         5.29          6.16        1.28          NA            NA        14.95         15.82         090
                                     ligaments.
27698.........  ........  A         Repair of ankle       9.41          NA            NA         5.78          6.67        1.47          NA            NA        16.66         17.55         090
                                     ligament.
27700.........  ........  A         Revision of           9.46          NA            NA         5.03          5.53        1.30          NA            NA        15.79         16.29         090
                                     ankle joint.
27702.........  ........  A         Reconstruct          14.19          NA            NA         8.56         10.01        2.37          NA            NA        25.12         26.57         090
                                     ankle joint.
27703.........  ........  A         Reconstruction,      16.69          NA            NA         9.69         10.87        2.76          NA            NA        29.14         30.32         090
                                     ankle joint.
27704.........  ........  A         Removal of            7.61          NA            NA         5.60          5.61        1.27          NA            NA        14.48         14.49         090
                                     ankle implant.
27705.........  ........  A         Incision of          10.66          NA            NA         6.78          7.84        1.80          NA            NA        19.24         20.30         090
                                     tibia.
27707.........  ........  A         Incision of           4.60          NA            NA         4.42          4.82        0.76          NA            NA         9.78         10.18         090
                                     fibula.
27709.........  ........  A         Incision of          17.24          NA            NA         9.47          8.48        1.73          NA            NA        28.44         27.45        090
                                     tibia & fibula.
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
\1\ CPT codes and descriptors only are copyright 2005 American Medical Association. All rights reserved. Applicable FARS/DFARS apply.
\2\ Copyright 2005 American Dental Association. All rights reserved.
\3\ Indicates RVUs are not used for Medicare payment.


[[Page 37288]]


                                   Addendum B.--Relative Value Units (RVUs) and Related Information Used In Determining Medicare Payments for 2007--Continued
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                   Fully                                                            Fully
                                                     Physician  implemented    Year 2007      Fully       Year 2007      Mal-    implemented    Year 2007      Fully       Year 2007
CPT \1\  HCPCS     Mod     Status     Description    work RVUs      non-     transitional  implemented  transitional   practice      non-     transitional  implemented  transitional    Global
      \2\                                               \3\     facility PE  non-facility  facility PE   facility PE     RVUs      facility   non-facility    facility     facility
                                                                    RVUs        PE RVUs        RVUs         RVUs                    total         total        total         total
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
27712.........  ........  A         Realignment of       15.59          NA            NA         8.98         10.32        2.47          NA            NA        27.04         28.38         090
                                     lower leg.
27715.........  ........  A         Revision of          15.27          NA            NA         8.83         10.31        2.49          NA            NA        26.59         28.07         090
                                     lower leg.
27720.........  ........  A         Repair of tibia      12.13          NA            NA         7.81          9.03        2.04          NA            NA        21.98         23.20         090
27722.........  ........  A         Repair/graft of      12.22          NA            NA         7.90          8.85        2.05          NA            NA        22.17         23.12         090
                                     tibia.
27724.........  ........  A         Repair/graft of      19.12          NA            NA        10.10         11.83        3.16          NA            NA        32.38         34.11         090
                                     tibia.
27725.........  ........  A         Repair of lower      17.07          NA            NA        10.41         11.56        2.71          NA            NA        30.19         31.34         090
                                     leg.
27727.........  ........  A         Repair of lower      14.59          NA            NA         8.40          9.88        2.43          NA            NA        25.42         26.90         090
                                     leg.
27730.........  ........  A         Repair of tibia       7.52          NA            NA         5.21          6.13        1.72          NA            NA        14.45         15.37         090
                                     epiphysis.
27732.........  ........  A         Repair of             5.31          NA            NA         4.60          4.86        0.77          NA            NA        10.68         10.94         090
                                     fibula
                                     epiphysis.
27734.........  ........  A         Repair lower          8.65          NA            NA         6.08          6.25        1.35          NA            NA        16.08         16.25         090
                                     leg epiphyses.
27740.........  ........  A         Repair of leg         9.41          NA            NA         6.52          7.64        1.62          NA            NA        17.55         18.67         090
                                     epiphyses.
27742.........  ........  A         Repair of leg        10.40        3.04          4.95         5.19          5.48        1.79       15.23         17.14        17.38         17.67         090
                                     epiphyses.
27745.........  ........  A         Reinforce tibia      10.29          NA            NA         6.87          7.86        1.75          NA            NA        18.91         19.90         090
27750.........  ........  A         Treatment of          3.19        4.26          4.64         3.68          3.82        0.55        8.00          8.38         7.42          7.56         090
                                     tibia fracture.
27752.........  ........  A         Treatment of          6.07        5.89          6.48         5.05          5.53        1.01       12.97         13.56        12.13         12.61         090
                                     tibia fracture.
27756.........  ........  A         Treatment of          7.25          NA            NA         5.65          6.27        1.17          NA            NA        14.07         14.69         090
                                     tibia fracture.
27758.........  ........  A         Treatment of         12.31          NA            NA         7.90          8.88        2.03          NA            NA        22.24         23.22         090
                                     tibia fracture.
27759.........  ........  A         Treatment of         14.23          NA            NA         8.54          9.89        2.38          NA            NA        25.15         26.50         090
                                     tibia fracture.
27760.........  ........  A         Treatment of          3.01        4.23          4.58         3.63          3.61        0.48        7.72          8.07         7.12          7.10         090
                                     ankle fracture.
27762.........  ........  A         Treatment of          5.24        5.50          6.14         4.67          5.14        0.85       11.59         12.23        10.76         11.23         090
                                     ankle fracture.
27766.........  ........  A         Treatment of          8.65          NA            NA         6.16          6.97        1.44          NA            NA        16.25         17.06         090
                                     ankle fracture.
27780.........  ........  A         Treatment of          2.65        3.84          4.10         3.28          3.24        0.41        6.90          7.16         6.34          6.30         090
                                     fibula
                                     fracture.
27781.........  ........  A         Treatment of          4.39        4.89          5.36         4.27          4.56        0.73       10.01         10.48         9.39          9.68         090
                                     fibula
                                     fracture.
27784.........  ........  A         Treatment of          7.34          NA            NA         5.50          6.24        1.23          NA            NA        14.07         14.81         090
                                     fibula
                                     fracture.
27786.........  ........  A         Treatment of          2.84        4.01          4.36         3.39          3.35        0.46        7.31          7.66         6.69          6.65         090
                                     ankle fracture.
27788.........  ........  A         Treatment of          4.44        4.93          5.48         4.20          4.55        0.74       10.11         10.66         9.38          9.73         090
                                     ankle fracture.
27792.........  ........  A         Treatment of          7.83          NA            NA         5.83          6.69        1.32          NA            NA        14.98         15.84         090
                                     ankle fracture.
27808.........  ........  A         Treatment of          2.83        4.34          4.69         3.65          3.70        0.46        7.63          7.98         6.94          6.99         090
                                     ankle fracture.
27810.........  ........  A         Treatment of          5.12        5.38          6.04         4.53          5.00        0.82       11.32         11.98        10.47         10.94         090
                                     ankle fracture.
27814.........  ........  A         Treatment of         11.02          NA            NA         7.13          8.22        1.85          NA            NA        20.00         21.09         090
                                     ankle fracture.
27816.........  ........  A         Treatment of          2.89        3.98          4.29         3.31          3.39        0.43        7.30          7.61         6.63          6.71         090
                                     ankle fracture.
27818.........  ........  A         Treatment of          5.49        5.36          6.13         4.40          4.99        0.82       11.67         12.44        10.71         11.30         090
                                     ankle fracture.
27822.........  ........  A         Treatment of         12.04          NA            NA         8.71         10.19        1.91          NA            NA        22.66         24.14         090
                                     ankle fracture.
27823.........  ........  A         Treatment of         14.18          NA            NA         9.33         10.96        2.25          NA            NA        25.76         27.39         090
                                     ankle fracture.
27824.........  ........  A         Treat lower leg       3.14        3.69          3.98         3.50          3.55        0.45        7.28          7.57         7.09          7.14         090
                                     fracture.
27825.........  ........  A         Treat lower leg       6.54        5.78          6.41         4.75          5.24        1.02       13.34         13.97        12.31         12.80         090
                                     fracture.
27826.........  ........  A         Treat lower leg       8.89          NA            NA         6.89          8.36        1.47          NA            NA        17.25         18.72         090
                                     fracture.
27827.........  ........  A         Treat lower leg      15.65          NA            NA        10.62         12.26        2.43          NA            NA        28.70         30.34         090
                                     fracture.
27828.........  ........  A         Treat lower leg      18.07          NA            NA        12.12         13.51        2.81          NA            NA        33.00         34.39         090
                                     fracture.
27829.........  ........  A         Treat lower leg       5.60          NA            NA         5.44          6.46        0.95          NA            NA        11.99         13.01         090
                                     joint.
27830.........  ........  A         Treat lower leg       3.78        4.25          4.36         3.70          3.82        0.54        8.57          8.68         8.02          8.14         090
                                     dislocation.
27831.........  ........  A         Treat lower leg       4.55          NA            NA         3.94          4.34        0.73          NA            NA         9.22          9.62         090
                                     dislocation.
27832.........  ........  A         Treat lower leg       6.60          NA            NA         4.65          5.81        1.03          NA            NA        12.28         13.44         090
                                     dislocation.
27840.........  ........  A         Treat ankle           4.57          NA            NA         3.59          3.73        0.46          NA            NA         8.62          8.76         090
                                     dislocation.
27842.........  ........  A         Treat ankle           6.26          NA            NA         4.81          5.05        1.00          NA            NA        12.07         12.31         090
                                     dislocation.
27846.........  ........  A         Treat ankle          10.08          NA            NA         6.73          7.65        1.70          NA            NA        18.51         19.43         090
                                     dislocation.
27848.........  ........  A         Treat ankle          11.48          NA            NA         7.57          9.20        1.94          NA            NA        20.99         22.62         090
                                     dislocation.
27860.........  ........  A         Fixation of           2.34          NA            NA         1.67          1.91        0.39          NA            NA         4.40          4.64         010
                                     ankle joint.
27870.........  ........  A         Fusion of ankle      15.13          NA            NA         9.00         10.16        2.36          NA            NA        26.49         27.65         090
                                     joint, open.
27871.........  ........  A         Fusion of             9.34          NA            NA         6.40          7.30        1.59          NA            NA        17.33         18.23         090
                                     tibiofibular
                                     joint.
27880.........  ........  A         Amputation of        15.18          NA            NA         7.13          7.15        1.75          NA            NA        24.06         24.08         090
                                     lower leg.
27881.........  ........  A         Amputation of        13.22          NA            NA         7.42          8.51        1.98          NA            NA        22.62         23.71        090
                                     lower leg.
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
\1\ CPT codes and descriptors only are copyright 2005 American Medical Association. All rights reserved. Applicable FARS/DFARS apply.
\2\ Copyright 2005 American Dental Association. All rights reserved.
\3\ Indicates RVUs are not used for Medicare payment.


[[Page 37289]]


                                   Addendum B.--Relative Value Units (RVUs) and Related Information Used In Determining Medicare Payments for 2007--Continued
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                   Fully                                                            Fully
                                                     Physician  implemented    Year 2007      Fully       Year 2007      Mal-    implemented    Year 2007      Fully       Year 2007
CPT \1\  HCPCS     Mod     Status     Description    work RVUs      non-     transitional  implemented  transitional   practice      non-     transitional  implemented  transitional    Global
      \2\                                               \3\     facility PE  non-facility  facility PE   facility PE     RVUs      facility   non-facility    facility     facility
                                                                    RVUs        PE RVUs        RVUs         RVUs                    total         total        total         total
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
27882.........  ........  A         Amputation of         9.59          NA            NA         5.61          6.28        1.29          NA            NA        16.49         17.16         090
                                     lower leg.
27884.........  ........  A         Amputation            8.56          NA            NA         5.09          5.60        1.22          NA            NA        14.87         15.38         090
                                     follow-up
                                     surgery.
27886.........  ........  A         Amputation            9.79          NA            NA         5.74          6.33        1.40          NA            NA        16.93         17.52         090
                                     follow-up
                                     surgery.
27888.........  ........  A         Amputation of        10.14          NA            NA         6.19          7.19        1.51          NA            NA        17.84         18.84         090
                                     foot at ankle.
27889.........  ........  A         Amputation of        10.63          NA            NA         5.44          6.23        1.46          NA            NA        17.53         18.32         090
                                     foot at ankle.
27892.........  ........  A         Decompression         7.74          NA            NA         4.86          5.42        1.10          NA            NA        13.70         14.26         090
                                     of leg.
27893.........  ........  A         Decompression         7.70          NA            NA         5.05          5.37        1.10          NA            NA        13.85         14.17         090
                                     of leg.
27894.........  ........  A         Decompression        12.32          NA            NA         7.30          7.67        1.65          NA            NA        21.27         21.64         090
                                     of leg.
28001.........  ........  A         Drainage of           2.73        3.99          3.24         1.60          1.87        0.33        7.05          6.30         4.66          4.93         010
                                     bursa of foot.
28002.........  ........  A         Treatment of          5.72        6.69          5.42         3.56          3.73        0.61       13.02         11.75         9.89         10.06         010
                                     foot infection.
28003.........  ........  A         Treatment of          8.88        7.77          6.63         4.54          5.07        1.12       17.77         16.63        14.54         15.07         090
                                     foot infection.
28005.........  ........  A         Treat foot bone       9.21          NA            NA         5.24          5.86        1.16          NA            NA        15.61         16.23         090
                                     lesion.
28008.........  ........  A         Incision of           4.44        6.15          4.96         2.97          3.15        0.57       11.16          9.97         7.98          8.16         090
                                     foot fascia.
28010.........  ........  A         Incision of toe       2.84        2.83          2.49         2.31          2.36        0.36        6.03          5.69         5.51          5.56         090
                                     tendon.
28011.........  ........  A         Incision of toe       4.13          NA            NA         3.00          3.23        0.59          NA            NA         7.72          7.95         090
                                     tendons.
28020.........  ........  A         Exploration of        5.00        7.48          6.39         3.62          4.01        0.72       13.20         12.11         9.34          9.73         090
                                     foot joint.
28022.........  ........  A         Exploration of        4.66        6.85          5.62         3.27          3.71        0.62       12.13         10.90         8.55          8.99         090
                                     foot joint.
28024.........  ........  A         Exploration of        4.37        6.62          5.58         3.13          3.73        0.58       11.57         10.53         8.08          8.68         090
                                     toe joint.
28030.........  ........  A         Removal of foot       6.14          NA            NA         3.30          3.57        0.74          NA            NA        10.18         10.45         090
                                     nerve.
28035.........  ........  A         Decompression         5.08        7.40          6.25         3.60          3.98        0.70       13.18         12.03         9.38          9.76         090
                                     of tibia nerve.
28043.........  ........  A         Excision of           3.53        4.78          4.06         2.72          3.07        0.46        8.77          8.05         6.71          7.06         090
                                     foot lesion.
28045.........  ........  A         Excision of           4.71        7.03          5.80         3.23          3.52        0.63       12.37         11.14         8.57          8.86         090
                                     foot lesion.
28046.........  ........  A         Resection of         10.46       10.35          9.18         5.72          6.30        1.36       22.17         21.00        17.54         18.12         090
                                     tumor, foot.
28050.........  ........  A         Biopsy of foot        4.24        6.83          5.38         3.22          3.51        0.60       11.67         10.22         8.06          8.35         090
                                     joint lining.
28052.........  ........  A         Biopsy of foot        3.93        6.40          5.29         2.91          3.31        0.53       10.86          9.75         7.37          7.77         090
                                     joint lining.
28054.........  ........  A         Biopsy of toe         3.44        6.18          5.09         2.74          3.12        0.46       10.08          8.99         6.64          7.02         090
                                     joint lining.
28060.........  ........  A         Partial               5.22        7.09          5.89         3.53          3.79        0.70       13.01         11.81         9.45          9.71         090
                                     removal, foot
                                     fascia.
28062.........  ........  A         Removal of foot       6.51        7.80          6.85         3.78          3.96        0.83       15.14         14.19        11.12         11.30         090
                                     fascia.
28070.........  ........  A         Removal of foot       5.09        7.18          5.72         3.42          3.72        0.73       13.00         11.54         9.24          9.54         090
                                     joint lining.
28072.........  ........  A         Removal of foot       4.57        7.58          6.05         3.59          4.13        0.68       12.83         11.30         8.84          9.38         090
                                     joint lining.
28080.........  ........  A         Removal of foot       4.57        7.63          5.75         4.16          3.81        0.47       12.67         10.79         9.20          8.85         090
                                     lesion.
28086.........  ........  A         Excise foot           4.77        7.76          7.94         3.74          4.45        0.76       13.29         13.47         9.27          9.98         090
                                     tendon sheath.
28088.........  ........  A         Excise foot           3.85        6.94          6.06         3.14          3.71        0.61       11.40         10.52         7.60          8.17         090
                                     tendon sheath.
28090.........  ........  A         Removal of foot       4.40        6.75          5.55         3.15          3.38        0.59       11.74         10.54         8.14          8.37         090
                                     lesion.
28092.........  ........  A         Removal of toe        3.63        6.46          5.54         2.97          3.39        0.49       10.58          9.66         7.09          7.51         090
                                     lesions.
28100.........  ........  A         Removal of            5.65        8.18          8.03         4.03          4.53        0.82       14.65         14.50        10.50         11.00         090
                                     ankle/heel
                                     lesion.
28102.........  ........  A         Remove/graft          7.72          NA            NA         4.87          5.69        1.14          NA            NA        13.73         14.55         090
                                     foot lesion.
28103.........  ........  A         Remove/graft          6.49          NA            NA         4.10          4.49        0.91          NA            NA        11.50         11.89         090
                                     foot lesion.
28104.........  ........  A         Removal of foot       5.11        7.20          5.93         3.43          3.81        0.70       13.01         11.74         9.24          9.62         090
                                     lesion.
28106.........  ........  A         Remove/graft          7.15          NA            NA         4.37          4.42        0.97          NA            NA        12.49         12.54         090
                                     foot lesion.
28107.........  ........  A         Remove/graft          5.55        7.82          6.86         3.70          4.08        0.74       14.11         13.15         9.99         10.37         090
                                     foot lesion.
28108.........  ........  A         Removal of toe        4.15        6.33          5.03         2.96          3.19        0.53       11.01          9.71         7.64          7.87         090
                                     lesions.
28110.........  ........  A         Part removal of       4.07        6.93          5.66         3.04          3.18        0.54       11.54         10.27         7.65          7.79         090
                                     metatarsal.
28111.........  ........  A         Part removal of       5.00        7.31          6.55         3.28          3.57        0.67       12.98         12.22         8.95          9.24         090
                                     metatarsal.
28112.........  ........  A         Part removal of       4.48        7.22          6.17         3.24          3.50        0.61       12.31         11.26         8.33          8.59         090
                                     metatarsal.
28113.........  ........  A         Part removal of       5.78        8.38          6.65         4.60          4.39        0.63       14.79         13.06        11.01         10.80         090
                                     metatarsal.
28114.........  ........  A         Removal of           11.49       13.21         12.04         8.15          8.33        1.42       26.12         24.95        21.06         21.24         090
                                     metatarsal
                                     heads.
28116.........  ........  A         Revision of           8.86        9.42          7.46         5.30          5.21        1.03       19.31         17.35        15.19         15.10         090
                                     foot.
28118.........  ........  A         Removal of heel       5.95        7.89          6.67         3.98          4.26        0.84       14.68         13.46        10.77         11.05         090
                                     bone.
28119.........  ........  A         Removal of heel       5.38        7.18          5.88         3.54          3.68        0.70       13.26         11.96         9.62          9.76         090
                                     spur.
28120.........  ........  A         Part removal of       5.57        8.04          7.49         3.92          4.30        0.77       14.38         13.83        10.26         10.64         090
                                     ankle/heel.
28122.........  ........  A         Partial removal       7.46        8.45          7.25         4.74          5.15        0.98       16.89         15.69        13.18         13.59        090
                                     of foot bone.
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
\1\ CPT codes and descriptors only are copyright 2005 American Medical Association. All rights reserved. Applicable FARS/DFARS apply.
\2\ Copyright 2005 American Dental Association. All rights reserved.
\3\ Indicates RVUs are not used for Medicare payment.


[[Page 37290]]


                                   Addendum B.--Relative Value Units (RVUs) and Related Information Used In Determining Medicare Payments for 2007--Continued
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                   Fully                                                            Fully
                                                     Physician  implemented    Year 2007      Fully       Year 2007      Mal-    implemented    Year 2007      Fully       Year 2007
CPT \1\  HCPCS     Mod     Status     Description    work RVUs      non-     transitional  implemented  transitional   practice      non-     transitional  implemented  transitional    Global
      \2\                                               \3\     facility PE  non-facility  facility PE   facility PE     RVUs      facility   non-facility    facility     facility
                                                                    RVUs        PE RVUs        RVUs         RVUs                    total         total        total         total
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
28124.........  ........  A         Partial removal       4.80        6.73          5.43         3.41          3.60        0.60       12.13         10.83         8.81          9.00         090
                                     of toe.
28126.........  ........  A         Partial removal       3.51        5.92          4.65         2.63          2.91        0.45        9.88          8.61         6.59          6.87         090
                                     of toe.
28130.........  ........  A         Removal of            9.22          NA            NA         5.78          6.49        1.26          NA            NA        16.26         16.97         090
                                     ankle bone.
28140.........  ........  A         Removal of            6.96        7.84          7.39         4.11          4.61        0.92       15.72         15.27        11.99         12.49         090
                                     metatarsal.
28150.........  ........  A         Removal of toe.       4.08        6.39          5.23         2.98          3.21        0.53       11.00          9.84         7.59          7.82         090
28153.........  ........  A         Partial removal       3.65        6.15          4.78         2.84          2.73        0.47       10.27          8.90         6.96          6.85         090
                                     of toe.
28160.........  ........  A         Partial removal       3.73        6.33          5.01         2.92          3.24        0.49       10.55          9.23         7.14          7.46         090
                                     of toe.
28171.........  ........  A         Extensive foot        9.77          NA            NA         5.10          5.36        1.33          NA            NA        16.20         16.46         090
                                     surgery.
28173.........  ........  A         Extensive foot        8.97        8.74          7.89         4.60          5.06        1.12       18.83         17.98        14.69         15.15         090
                                     surgery.
28175.........  ........  A         Extensive foot        6.10        7.08          6.06         3.57          3.68        0.73       13.91         12.89        10.40         10.51         090
                                     surgery.
28190.........  ........  A         Removal of foot       1.96        4.00          3.55         1.32          1.44        0.22        6.18          5.73         3.50          3.62         010
                                     foreign body.
28192.........  ........  A         Removal of foot       4.63        6.71          5.80         3.17          3.53        0.61       11.95         11.04         8.41          8.77         090
                                     foreign body.
28193.........  ........  A         Removal of foot       5.72        7.29          6.04         3.58          3.84        0.73       13.74         12.49        10.03         10.29         090
                                     foreign body.
28200.........  ........  A         Repair of foot        4.59        6.85          5.54         3.20          3.47        0.61       12.05         10.74         8.40          8.67         090
                                     tendon.
28202.........  ........  A         Repair/graft of       6.89        7.91          7.40         4.00          4.38        0.91       15.71         15.20        11.80         12.18         090
                                     foot tendon.
28208.........  ........  A         Repair of foot        4.36        6.64          5.28         3.14          3.27        0.58       11.58         10.22         8.08          8.21         090
                                     tendon.
28210.........  ........  A         Repair/graft of       6.34        7.50          6.55         3.84          3.98        0.81       14.65         13.70        10.99         11.13         090
                                     foot tendon.
28220.........  ........  A         Release of foot       4.52        6.37          5.10         3.03          3.33        0.57       11.46         10.19         8.12          8.42         090
                                     tendon.
28222.........  ........  A         Release of foot       5.61        6.84          5.65         3.27          3.92        0.69       13.14         11.95         9.57         10.22         090
                                     tendons.
28225.........  ........  A         Release of foot       3.65        5.99          4.72         2.69          2.86        0.46       10.10          8.83         6.80          6.97         090
                                     tendon.
28226.........  ........  A         Release of foot       4.52        6.94          5.34         3.27          3.63        0.58       12.04         10.44         8.37          8.73         090
                                     tendons.
28230.........  ........  A         Incision of           4.23        6.26          5.08         2.85          3.47        0.55       11.04          9.86         7.63          8.25         090
                                     foot tendon(s).
28232.........  ........  A         Incision of toe       3.38        5.91          4.88         2.65          3.15        0.44        9.73          8.70         6.47          6.97         090
                                     tendon.
28234.........  ........  A         Incision of           3.36        6.25          5.07         3.01          3.27        0.44       10.05          8.87         6.81          7.07         090
                                     foot tendon.
28238.........  ........  A         Revision of           7.78        8.28          7.52         4.28          4.78        1.06       17.12         16.36        13.12         13.62         090
                                     foot tendon.
28240.........  ........  A         Release of big        4.35        6.38          5.08         2.95          3.36        0.58       11.31         10.01         7.88          8.29         090
                                     toe.
28250.........  ........  A         Revision of           5.91        7.37          6.07         3.70          4.03        0.82       14.10         12.80        10.43         10.76         090
                                     foot fascia.
28260.........  ........  A         Release of            8.01        8.53          6.89         4.64          4.91        1.14       17.68         16.04        13.79         14.06         090
                                     midfoot joint.
28261.........  ........  A         Revision of          12.83       10.60          9.12         6.26          7.06        1.57       25.00         23.52        20.66         21.46         090
                                     foot tendon.
28262.........  ........  A         Revision of          16.93       15.42         14.05         9.62         10.61        2.59       34.94         33.57        29.14         30.13         090
                                     foot and ankle.
28264.........  ........  A         Release of           10.45       10.30          8.39         5.91          6.95        1.54       22.29         20.38        17.90         18.94         090
                                     midfoot joint.
28270.........  ........  A         Release of foot       4.75        6.88          5.40         3.40          3.66        0.62       12.25         10.77         8.77          9.03         090
                                     contracture.
28272.........  ........  A         Release of toe        3.79        5.80          4.59         2.62          2.80        0.46       10.05          8.84         6.87          7.05         090
                                     joint, each.
28280.........  ........  A         Fusion of toes.       5.18        7.31          6.52         3.53          4.25        0.73       13.22         12.43         9.44         10.16         090
28285.........  ........  A         Repair of             4.58        6.67          5.32         3.31          3.40        0.59       11.84         10.49         8.48          8.57         090
                                     hammertoe.
28286.........  ........  A         Repair of             4.55        6.45          5.21         3.00          3.20        0.57       11.57         10.33         8.12          8.32         090
                                     hammertoe.
28288.........  ........  A         Partial removal       5.73        8.58          6.61         4.66          4.83        0.65       14.96         12.99        11.04         11.21         090
                                     of foot bone.
28289.........  ........  A         Repair hallux         8.03        9.38          8.35         5.29          5.66        1.02       18.43         17.40        14.34         14.71         090
                                     rigidus.
28290.........  ........  A         Correction of         5.65        8.13          6.74         3.91          4.53        0.82       14.60         13.21        10.38         11.00         090
                                     bunion.
28292.........  ........  A         Correction of         8.60       10.27          8.18         6.08          5.68        0.91       19.78         17.69        15.59         15.19         090
                                     bunion.
28293.........  ........  A         Correction of        10.96       14.40         11.68         6.84          6.30        1.13       26.49         23.77        18.93         18.39         090
                                     bunion.
28294.........  ........  A         Correction of         8.55        9.03          7.85         4.50          4.67        1.09       18.67         17.49        14.14         14.31         090
                                     bunion.
28296.........  ........  A         Correction of         9.23        9.51          8.51         4.73          5.26        1.19       19.93         18.93        15.15         15.68         090
                                     bunion.
28297.........  ........  A         Correction of         9.23       10.35          9.32         5.24          6.01        1.32       20.90         19.87        15.79         16.56         090
                                     bunion.
28298.........  ........  A         Correction of         7.93        9.16          7.71         4.49          4.88        1.05       18.14         16.69        13.47         13.86         090
                                     bunion.
28299.........  ........  A         Correction of        11.31       10.46          9.21         5.64          5.97        1.37       23.14         21.89        18.32         18.65         090
                                     bunion.
28300.........  ........  A         Incision of           9.53          NA            NA         5.99          6.79        1.54          NA            NA        17.06         17.86         090
                                     heel bone.
28302.........  ........  A         Incision of           9.54          NA            NA         5.64          6.59        1.42          NA            NA        16.60         17.55         090
                                     ankle bone.
28304.........  ........  A         Incision of           9.21        9.46          8.34         5.00          5.56        1.27       19.94         18.82        15.48         16.04         090
                                     midfoot bones.
28305.........  ........  A         Incise/graft         10.54          NA            NA         5.48          6.43        1.27          NA            NA        17.29         18.24         090
                                     midfoot bones.
28306.........  ........  A         Incision of           5.85        8.28          7.21         3.80          4.09        0.84       14.97         13.90        10.49         10.78         090
                                     metatarsal.
28307.........  ........  A         Incision of           6.32        9.45         10.65         4.40          5.08        0.90       16.67         17.87        11.62         12.30         090
                                     metatarsal.
28308.........  ........  A         Incision of           5.28        7.84          6.28         3.76          3.71        0.70       13.82         12.26         9.74          9.69        090
                                     metatarsal.
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
\1\ CPT codes and descriptors only are copyright 2005 American Medical Association. All rights reserved. Applicable FARS/DFARS apply.
\2\ Copyright 2005 American Dental Association. All rights reserved.
\3\ Indicates RVUs are not used for Medicare payment.


[[Page 37291]]


                                   Addendum B.--Relative Value Units (RVUs) and Related Information Used In Determining Medicare Payments for 2007--Continued
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                   Fully                                                            Fully
                                                     Physician  implemented    Year 2007      Fully       Year 2007      Mal-    implemented    Year 2007      Fully       Year 2007
CPT \1\  HCPCS     Mod     Status     Description    work RVUs      non-     transitional  implemented  transitional   practice      non-     transitional  implemented  transitional    Global
      \2\                                               \3\     facility PE  non-facility  facility PE   facility PE     RVUs      facility   non-facility    facility     facility
                                                                    RVUs        PE RVUs        RVUs         RVUs                    total         total        total         total
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
28309.........  ........  A         Incision of          13.88          NA            NA         7.63          7.89        2.04          NA            NA        23.55         23.81         090
                                     metatarsals.
28310.........  ........  A         Revision of big       5.42        7.45          6.18         3.35          3.51        0.70       13.57         12.30         9.47          9.63         090
                                     toe.
28312.........  ........  A         Revision of toe       4.54        7.32          5.92         3.19          3.53        0.63       12.49         11.09         8.36          8.70         090
28313.........  ........  A         Repair                5.00        7.31          5.80         3.61          4.53        0.73       13.04         11.53         9.34         10.26         090
                                     deformity of
                                     toe.
28315.........  ........  A         Removal of            4.85        6.65          5.34         3.19          3.30        0.63       12.13         10.82         8.67          8.78         090
                                     sesamoid bone.
28320.........  ........  A         Repair of foot        9.17          NA            NA         5.67          6.47        1.43          NA            NA        16.27         17.07         090
                                     bones.
28322.........  ........  A         Repair of             8.33        9.92          9.38         5.39          6.11        1.27       19.52         18.98        14.99         15.71         090
                                     metatarsals.
28340.........  ........  A         Resect enlarged       6.97        7.96          6.84         3.99          4.19        0.84       15.77         14.65        11.80         12.00         090
                                     toe tissue.
28341.........  ........  A         Resect enlarged       8.52        8.57          7.36         4.38          4.71        1.01       18.10         16.89        13.91         14.24         090
                                     toe.
28344.........  ........  A         Repair extra          4.25        6.74          6.01         3.13          3.51        0.51       11.50         10.77         7.89          8.27         090
                                     toe(s).
28345.........  ........  A         Repair webbed         5.91        7.72          6.59         3.82          4.47        0.80       14.43         13.30        10.53         11.18         090
                                     toe(s).
28360.........  ........  A         Reconstruct          14.57          NA            NA         6.24          9.45        2.28          NA            NA        23.09         26.30         090
                                     cleft foot.
28400.........  ........  A         Treatment of          2.16        3.34          3.57         2.89          3.02        0.35        5.85          6.08         5.40          5.53         090
                                     heel fracture.
28405.........  ........  A         Treatment of          4.56        4.47          4.75         3.70          4.40        0.73        9.76         10.04         8.99          9.69         090
                                     heel fracture.
28406.........  ........  A         Treatment of          6.36          NA            NA         5.47          6.48        1.11          NA            NA        12.94         13.95         090
                                     heel fracture.
28415.........  ........  A         Treat heel           17.44          NA            NA        10.70         12.67        2.66          NA            NA        30.80         32.77         090
                                     fracture.
28420.........  ........  A         Treat/graft          16.98          NA            NA         9.98         12.21        2.80          NA            NA        29.76         31.99         090
                                     heel fracture.
28430.........  ........  A         Treatment of          2.09        3.10          3.33         2.55          2.57        0.31        5.50          5.73         4.95          4.97         090
                                     ankle fracture.
28435.........  ........  A         Treatment of          3.39        3.72          3.85         3.04          3.57        0.55        7.66          7.79         6.98          7.51         090
                                     ankle fracture.
28436.........  ........  A         Treatment of          4.70          NA            NA         4.79          5.65        0.81          NA            NA        10.30         11.16         090
                                     ankle fracture.
28445.........  ........  A         Treat ankle          16.99          NA            NA         9.53         10.68        2.58          NA            NA        29.10         30.25         090
                                     fracture.
28450.........  ........  A         Treat midfoot         1.90        2.90          3.07         2.40          2.46        0.28        5.08          5.25         4.58          4.64         090
                                     fracture, each.
28455.........  ........  A         Treat midfoot         3.09        3.47          3.44         2.84          3.28        0.44        7.00          6.97         6.37          6.81         090
                                     fracture, each.
28456.........  ........  A         Treat midfoot         2.68          NA            NA         3.46          3.99        0.44          NA            NA         6.58          7.11         090
                                     fracture.
28465.........  ........  A         Treat midfoot         7.06          NA            NA         4.98          5.99        1.10          NA            NA        13.14         14.15         090
                                     fracture, each.
28470.........  ........  A         Treat                 1.99        2.80          3.05         2.36          2.43        0.30        5.09          5.34         4.65          4.72         090
                                     metatarsal
                                     fracture.
28475.........  ........  A         Treat                 2.97        3.14          3.29         2.52          3.05        0.44        6.55          6.70         5.93          6.46         090
                                     metatarsal
                                     fracture.
28476.........  ........  A         Treat                 3.37          NA            NA         4.17          4.79        0.54          NA            NA         8.08          8.70         090
                                     metatarsal
                                     fracture.
28485.........  ........  A         Treat                 5.70          NA            NA         4.49          5.22        0.83          NA            NA        11.02         11.75         090
                                     metatarsal
                                     fracture.
28490.........  ........  A         Treat big toe         1.09        2.09          2.04         1.67          1.65        0.14        3.32          3.27         2.90          2.88         090
                                     fracture.
28495.........  ........  A         Treat big toe         1.58        2.45          2.25         1.85          2.02        0.20        4.23          4.03         3.63          3.80         090
                                     fracture.
28496.........  ........  A         Treat big toe         2.33        7.14          7.99         2.86          3.12        0.36        9.83         10.68         5.55          5.81         090
                                     fracture.
28505.........  ........  A         Treat big toe         3.80        7.43          7.95         3.23          3.74        0.56       11.79         12.31         7.59          8.10         090
                                     fracture.
28510.........  ........  A         Treatment of          1.09        1.66          1.56         1.59          1.55        0.14        2.89          2.79         2.82          2.78         090
                                     toe fracture.
28515.........  ........  A         Treatment of          1.46        2.22          1.98         1.82          1.88        0.18        3.86          3.62         3.46          3.52         090
                                     toe fracture.
28525.........  ........  A         Treat toe             3.32        6.84          7.36         2.87          3.30        0.49       10.65         11.17         6.68          7.11         090
                                     fracture.
28530.........  ........  A         Treat sesamoid        1.06        1.63          1.49         1.34          1.42        0.14        2.83          2.69         2.54          2.62         090
                                     bone fracture.
28531.........  ........  A         Treat sesamoid        2.47        5.77          6.90         2.09          2.08        0.34        8.58          9.71         4.90          4.89         090
                                     bone fracture.
28540.........  ........  A         Treat foot            2.04        2.74          2.49         2.30          2.38        0.26        5.04          4.79         4.60          4.68         090
                                     dislocation.
28545.........  ........  A         Treat foot            2.45        3.28          2.58         2.68          2.43        0.37        6.10          5.40         5.50          5.25         090
                                     dislocation.
28546.........  ........  A         Treat foot            3.20        7.66          7.11         3.43          4.15        0.52       11.38         10.83         7.15          7.87         090
                                     dislocation.
28555.........  ........  A         Repair foot           6.35        9.73          9.88         4.89          5.49        1.04       17.12         17.27        12.28         12.88         090
                                     dislocation.
28570.........  ........  A         Treat foot            1.66        2.57          2.47         1.98          2.25        0.23        4.46          4.36         3.87          4.14         090
                                     dislocation.
28575.........  ........  A         Treat foot            3.31        4.32          3.88         3.63          3.71        0.56        8.19          7.75         7.50          7.58         090
                                     dislocation.
28576.........  ........  A         Treat foot            4.40          NA            NA         3.92          4.12        0.69          NA            NA         9.01          9.21         090
                                     dislocation.
28585.........  ........  A         Repair foot           8.10        9.83          7.96         5.19          5.69        1.25       19.18         17.31        14.54         15.04         090
                                     dislocation.
28600.........  ........  A         Treat foot            1.89        3.02          2.87         2.37          2.61        0.27        5.18          5.03         4.53          4.77         090
                                     dislocation.
28605.........  ........  A         Treat foot            2.71        3.69          3.27         3.10          3.12        0.40        6.80          6.38         6.21          6.23         090
                                     dislocation.
28606.........  ........  A         Treat foot            4.89          NA            NA         4.26          4.59        0.82          NA            NA         9.97         10.30         090
                                     dislocation.
28615.........  ........  A         Repair foot           8.88          NA            NA         6.88          7.77        1.30          NA            NA        17.06         17.95         090
                                     dislocation.
28630.........  ........  A         Treat toe             1.70        1.94          1.66         0.93          0.98        0.20        3.84          3.56         2.83          2.88         010
                                     dislocation.
28635.........  ........  A         Treat toe             1.91        2.24          2.08         1.31          1.48        0.26        4.41          4.25         3.48          3.65        010
                                     dislocation.
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
\1\ CPT codes and descriptors only are copyright 2005 American Medical Association. All rights reserved. Applicable FARS/DFARS apply.
\2\ Copyright 2005 American Dental Association. All rights reserved.
\3\ Indicates RVUs are not used for Medicare payment.


[[Page 37292]]


                                   Addendum B.--Relative Value Units (RVUs) and Related Information Used In Determining Medicare Payments for 2007--Continued
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                   Fully                                                            Fully
                                                     Physician  implemented    Year 2007      Fully       Year 2007      Mal-    implemented    Year 2007      Fully       Year 2007
CPT \1\  HCPCS     Mod     Status     Description    work RVUs      non-     transitional  implemented  transitional   practice      non-     transitional  implemented  transitional    Global
      \2\                                               \3\     facility PE  non-facility  facility PE   facility PE     RVUs      facility   non-facility    facility     facility
                                                                    RVUs        PE RVUs        RVUs         RVUs                    total         total        total         total
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
28636.........  ........  A         Treat toe             2.77        4.36          4.00         2.03          2.48        0.43        7.56          7.20         5.23          5.68         010
                                     dislocation.
28645.........  ........  A         Repair toe            4.21        6.79          5.42         3.14          3.25        0.57       11.57         10.20         7.92          8.03         090
                                     dislocation.
28660.........  ........  A         Treat toe             1.23        1.29          1.27         0.77          0.79        0.13        2.65          2.63         2.13          2.15         010
                                     dislocation.
28665.........  ........  A         Treat toe             1.92          NA            NA         1.32          1.40        0.26          NA            NA         3.50          3.58         010
                                     dislocation.
28666.........  ........  A         Treat toe             2.66        5.25          5.74         1.89          2.42        0.43        8.34          8.83         4.98          5.51         010
                                     dislocation.
28675.........  ........  A         Repair of toe         2.92        6.66          7.04         2.83          3.23        0.45       10.03         10.41         6.20          6.60         090
                                     dislocation.
28705.........  ........  A         Fusion of foot       20.04          NA            NA        10.54         11.99        3.08          NA            NA        33.66         35.11         090
                                     bones.
28715.........  ........  A         Fusion of foot       14.32          NA            NA         8.34          9.42        2.16          NA            NA        24.82         25.90         090
                                     bones.
28725.........  ........  A         Fusion of foot       11.89          NA            NA         6.79          7.89        1.86          NA            NA        20.54         21.64         090
                                     bones.
28730.........  ........  A         Fusion of foot       12.11          NA            NA         7.63          8.28        1.70          NA            NA        21.44         22.09         090
                                     bones.
28735.........  ........  A         Fusion of foot       11.95          NA            NA         6.81          7.58        1.68          NA            NA        20.44         21.21         090
                                     bones.
28737.........  ........  A         Revision of          10.75          NA            NA         5.97          6.61        1.47          NA            NA        18.19         18.83         090
                                     foot bones.
28740.........  ........  A         Fusion of foot        9.01       10.82         10.87         5.94          6.35        1.22       21.05         21.10        16.17         16.58         090
                                     bones.
28750.........  ........  A         Fusion of big         8.29       10.74         11.64         5.84          6.47        1.13       20.16         21.06        15.26         15.89         090
                                     toe joint.
28755.........  ........  A         Fusion of big         4.73        7.21          6.39         3.31          3.65        0.65       12.59         11.77         8.69          9.03         090
                                     toe joint.
28760.........  ........  A         Fusion of big         8.86        9.86          8.46         5.24          5.46        1.05       19.77         18.37        15.15         15.37         090
                                     toe joint.
28800.........  ........  A         Amputation of         8.56          NA            NA         5.05          5.62        1.15          NA            NA        14.76         15.33         090
                                     midfoot.
28805.........  ........  A         Amputation thru      12.47          NA            NA         6.04          5.76        1.18          NA            NA        19.69         19.41         090
                                     metatarsal.
28810.........  ........  A         Amputation toe        6.44          NA            NA         4.13          4.39        0.86          NA            NA        11.43         11.69         090
                                     & metatarsal.
28820.........  ........  A         Amputation of         4.82        7.74          7.61         3.58          3.74        0.61       13.17         13.04         9.01          9.17         090
                                     toe.
28825.........  ........  A         Partial               3.64        7.21          7.06         3.15          3.41        0.50       11.35         11.20         7.29          7.55         090
                                     amputation of
                                     toe.
28890.........  ........  A         High energy           3.30        4.59          5.45         2.27          2.14        0.41        8.30          9.16         5.98          5.85         090
                                     eswt, plantar
                                     f.
29000.........  ........  A         Application of        2.25        4.67          3.40         1.81          1.76        0.41        7.33          6.06         4.47          4.42         000
                                     body cast.
29010.........  ........  A         Application of        2.06        3.33          3.30         1.30          1.66        0.45        5.84          5.81         3.81          4.17         000
                                     body cast.
29015.........  ........  A         Application of        2.41        3.32          3.07         1.44          1.56        0.28        6.01          5.76         4.13          4.25         000
                                     body cast.
29020.........  ........  A         Application of        2.11        3.74          3.33         1.46          1.42        0.28        6.13          5.72         3.85          3.81         000
                                     body cast.
29025.........  ........  A         Application of        2.40        3.58          3.26         1.56          1.79        0.44        6.42          6.10         4.40          4.63         000
                                     body cast.
29035.........  ........  A         Application of        1.77        3.66          3.63         1.46          1.55        0.28        5.71          5.68         3.51          3.60         000
                                     body cast.
29040.........  ........  A         Application of        2.22        3.59          2.75         1.47          1.50        0.36        6.17          5.33         4.05          4.08         000
                                     body cast.
29044.........  ........  A         Application of        2.12        3.93          3.97         1.63          1.84        0.35        6.40          6.44         4.10          4.31         000
                                     body cast.
29046.........  ........  A         Application of        2.41        4.16          3.47         1.77          2.02        0.42        6.99          6.30         4.60          4.85         000
                                     body cast.
29049.........  ........  A         Application of        0.89        1.16          1.27         0.61          0.55        0.13        2.18          2.29         1.63          1.57         000
                                     figure eight.
29055.........  ........  A         Application of        1.78        2.88          2.96         1.29          1.43        0.30        4.96          5.04         3.37          3.51         000
                                     shoulder cast.
29058.........  ........  A         Application of        1.31        1.25          1.48         0.68          0.71        0.17        2.73          2.96         2.16          2.19         000
                                     shoulder cast.
29065.........  ........  A         Application of        0.87        1.27          1.32         0.69          0.74        0.15        2.29          2.34         1.71          1.76         000
                                     long arm cast.
29075.........  ........  A         Application of        0.77        1.10          1.22         0.65          0.67        0.13        2.00          2.12         1.55          1.57         000
                                     forearm cast.
29085.........  ........  A         Apply hand/           0.87        1.25          1.27         0.68          0.64        0.14        2.26          2.28         1.69          1.65         000
                                     wrist cast.
29086.........  ........  A         Apply finger          0.62        1.03          0.98         0.53          0.50        0.07        1.72          1.67         1.22          1.19         000
                                     cast.
29105.........  ........  A         Apply long arm        0.87        1.08          1.19         0.53          0.52        0.12        2.07          2.18         1.52          1.51         000
                                     splint.
29125.........  ........  A         Apply forearm         0.59        0.96          1.01         0.42          0.40        0.07        1.62          1.67         1.08          1.06         000
                                     splint.
29126.........  ........  A         Apply forearm         0.77        1.00          1.16         0.47          0.46        0.07        1.84          2.00         1.31          1.30         000
                                     splint.
29130.........  ........  A         Application of        0.50        0.43          0.46         0.18          0.17        0.06        0.99          1.02         0.74          0.73         000
                                     finger splint.
29131.........  ........  A         Application of        0.55        0.62          0.71         0.26          0.25        0.03        1.20          1.29         0.84          0.83         000
                                     finger splint.
29200.........  ........  A         Strapping of          0.65        0.61          0.69         0.35          0.34        0.04        1.30          1.38         1.04          1.03         000
                                     chest.
29220.........  ........  A         Strapping of          0.64        0.61          0.69         0.35          0.38        0.04        1.29          1.37         1.03          1.06         000
                                     low back.
29240.........  ........  A         Strapping of          0.71        0.67          0.81         0.38          0.37        0.06        1.44          1.58         1.15          1.14         000
                                     shoulder.
29260.........  ........  A         Strapping of          0.55        0.65          0.72         0.36          0.33        0.05        1.25          1.32         0.96          0.93         000
                                     elbow or wrist.
29280.........  ........  A         Strapping of          0.51        0.66          0.77         0.37          0.33        0.03        1.20          1.31         0.91          0.87         000
                                     hand or finger.
29305.........  ........  A         Application of        2.03        3.35          3.35         1.58          1.72        0.35        5.73          5.73         3.96          4.10         000
                                     hip cast.
29325.........  ........  A         Application of        2.32        3.66          3.57         1.73          1.90        0.40        6.38          6.29         4.45          4.62         000
                                     hip casts.
29345.........  ........  A         Application of        1.40        1.65          1.74         0.93          1.03        0.24        3.29          3.38         2.57          2.67        000
                                     long leg cast.
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
\1\ CPT codes and descriptors only are copyright 2005 American Medical Association. All rights reserved. Applicable FARS/DFARS apply.
\2\ Copyright 2005 American Dental Association. All rights reserved.
\3\ Indicates RVUs are not used for Medicare payment.


[[Page 37293]]


                                   Addendum B.--Relative Value Units (RVUs) and Related Information Used In Determining Medicare Payments for 2007--Continued
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                   Fully                                                            Fully
                                                     Physician  implemented    Year 2007      Fully       Year 2007      Mal-    implemented    Year 2007      Fully       Year 2007
CPT \1\  HCPCS     Mod     Status     Description    work RVUs      non-     transitional  implemented  transitional   practice      non-     transitional  implemented  transitional    Global
      \2\                                               \3\     facility PE  non-facility  facility PE   facility PE     RVUs      facility   non-facility    facility     facility
                                                                    RVUs        PE RVUs        RVUs         RVUs                    total         total        total         total
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
29355.........  ........  A         Application of        1.53        1.61          1.69         0.93          1.07        0.26        3.40          3.48         2.72          2.86         000
                                     long leg cast.
29358.........  ........  A         Apply long leg        1.43        2.03          2.06         0.92          1.05        0.25        3.71          3.74         2.60          2.73         000
                                     cast brace.
29365.........  ........  A         Application of        1.18        1.56          1.64         0.84          0.92        0.20        2.94          3.02         2.22          2.30         000
                                     long leg cast.
29405.........  ........  A         Apply short leg       0.86        1.19          1.21         0.65          0.70        0.14        2.19          2.21         1.65          1.70         000
                                     cast.
29425.........  ........  A         Apply short leg       1.01        1.22          1.23         0.65          0.72        0.15        2.38          2.39         1.81          1.88         000
                                     cast.
29435.........  ........  A         Apply short leg       1.18        1.52          1.55         0.80          0.90        0.20        2.90          2.93         2.18          2.28         000
                                     cast.
29440.........  ........  A         Addition of           0.57        0.61          0.67         0.25          0.27        0.08        1.26          1.32         0.90          0.92         000
                                     walker to cast.
29445.........  ........  A         Apply rigid leg       1.78        1.60          1.76         0.91          0.95        0.27        3.65          3.81         2.96          3.00         000
                                     cast.
29450.........  ........  A         Application of        2.08        1.50          1.48         0.84          1.03        0.27        3.85          3.83         3.19          3.38         000
                                     leg cast.
29505.........  ........  A         Application,          0.69        1.05          1.15         0.44          0.45        0.08        1.82          1.92         1.21          1.22         000
                                     long leg
                                     splint.
29515.........  ........  A         Application           0.73        0.95          0.89         0.45          0.46        0.09        1.77          1.71         1.27          1.28         000
                                     lower leg
                                     splint.
29520.........  ........  A         Strapping of          0.54        0.67          0.81         0.38          0.45        0.03        1.24          1.38         0.95          1.02         000
                                     hip.
29530.........  ........  A         Strapping of          0.57        0.65          0.76         0.36          0.34        0.05        1.27          1.38         0.98          0.96         000
                                     knee.
29540.........  ........  A         Strapping of          0.51        0.54          0.45         0.31          0.31        0.06        1.11          1.02         0.88          0.88         000
                                     ankle and/or
                                     ft.
29550.........  ........  A         Strapping of          0.47        0.56          0.46         0.30          0.29        0.06        1.09          0.99         0.83          0.82         000
                                     toes.
29580.........  ........  A         Application of        0.57        0.72          0.67         0.34          0.35        0.07        1.36          1.31         0.98          0.99         000
                                     paste boot.
29590.........  ........  A         Application of        0.76        0.59          0.53         0.26          0.28        0.09        1.44          1.38         1.11          1.13         000
                                     foot splint.
29700.........  ........  A         Removal/              0.57        0.96          0.91         0.26          0.28        0.08        1.61          1.56         0.91          0.93         000
                                     revision of
                                     cast.
29705.........  ........  A         Removal/              0.76        0.76          0.81         0.36          0.38        0.13        1.65          1.70         1.25          1.27         000
                                     revision of
                                     cast.
29710.........  ........  A         Removal/              1.34        1.43          1.51         0.62          0.68        0.20        2.97          3.05         2.16          2.22         000
                                     revision of
                                     cast.
29715.........  ........  A         Removal/              0.94        1.12          1.16         0.40          0.40        0.09        2.15          2.19         1.43          1.43         000
                                     revision of
                                     cast.
29720.........  ........  A         Repair of body        0.68        1.14          1.16         0.34          0.38        0.12        1.94          1.96         1.14          1.18         000
                                     cast.
29730.........  ........  A         Windowing of          0.75        0.75          0.80         0.34          0.35        0.12        1.62          1.67         1.21          1.22         000
                                     cast.
29740.........  ........  A         Wedging of cast       1.12        1.04          1.12         0.48          0.49        0.18        2.34          2.42         1.78          1.79         000
29750.........  ........  A         Wedging of            1.26        0.90          1.02         0.43          0.54        0.21        2.37          2.49         1.90          2.01         000
                                     clubfoot cast.
29800.........  ........  A         Jaw arthroscopy/      6.67          NA            NA         5.64          6.65        0.99          NA            NA        13.30         14.31         090
                                     surgery.
29804.........  ........  A         Jaw arthroscopy/      8.63          NA            NA         7.33          7.56        1.38          NA            NA        17.34         17.57         090
                                     surgery.
29805.........  ........  A         Shoulder              5.88          NA            NA         4.66          5.43        1.02          NA            NA        11.56         12.33         090
                                     arthroscopy,
                                     dx.
29806.........  ........  A         Shoulder             14.85          NA            NA         9.22         10.70        2.49          NA            NA        26.56         28.04         090
                                     arthroscopy/
                                     surgery.
29807.........  ........  A         Shoulder             14.38          NA            NA         9.10         10.54        2.41          NA            NA        25.89         27.33         090
                                     arthroscopy/
                                     surgery.
29819.........  ........  A         Shoulder              7.61          NA            NA         5.56          6.50        1.32          NA            NA        14.49         15.43         090
                                     arthroscopy/
                                     surgery.
29820.........  ........  A         Shoulder              7.06          NA            NA         5.12          5.96        1.22          NA            NA        13.40         14.24         090
                                     arthroscopy/
                                     surgery.
29821.........  ........  A         Shoulder              7.71          NA            NA         5.58          6.51        1.33          NA            NA        14.62         15.55         090
                                     arthroscopy/
                                     surgery.
29822.........  ........  A         Shoulder              7.42          NA            NA         5.51          6.41        1.28          NA            NA        14.21         15.11         090
                                     arthroscopy/
                                     surgery.
29823.........  ........  A         Shoulder              8.16          NA            NA         5.96          6.92        1.41          NA            NA        15.53         16.49         090
                                     arthroscopy/
                                     surgery.
29824.........  ........  A         Shoulder              8.74          NA            NA         6.45          7.28        1.42          NA            NA        16.61         17.44         090
                                     arthroscopy/
                                     surgery.
29825.........  ........  A         Shoulder              7.61          NA            NA         5.57          6.48        1.32          NA            NA        14.50         15.41         090
                                     arthroscopy/
                                     surgery.
29826.........  ........  A         Shoulder              8.98          NA            NA         6.11          7.19        1.55          NA            NA        16.64         17.72         090
                                     arthroscopy/
                                     surgery.
29827.........  ........  A         Arthroscop           15.34          NA            NA         9.19         10.97        2.66          NA            NA        27.19         28.97         090
                                     rotator cuff
                                     repr.
29830.........  ........  A         Elbow                 5.75          NA            NA         4.44          5.13        0.99          NA            NA        11.18         11.87         090
                                     arthroscopy.
29834.........  ........  A         Elbow                 6.27          NA            NA         4.79          5.59        1.08          NA            NA        12.14         12.94         090
                                     arthroscopy/
                                     surgery.
29835.........  ........  A         Elbow                 6.47          NA            NA         4.90          5.65        1.13          NA            NA        12.50         13.25         090
                                     arthroscopy/
                                     surgery.
29836.........  ........  A         Elbow                 7.54          NA            NA         5.48          6.48        1.22          NA            NA        14.24         15.24         090
                                     arthroscopy/
                                     surgery.
29837.........  ........  A         Elbow                 6.86          NA            NA         5.06          5.88        1.19          NA            NA        13.11         13.93         090
                                     arthroscopy/
                                     surgery.
29838.........  ........  A         Elbow                 7.70          NA            NA         5.59          6.58        1.30          NA            NA        14.59         15.58         090
                                     arthroscopy/
                                     surgery.
29840.........  ........  A         Wrist                 5.53          NA            NA         4.54          5.14        0.84          NA            NA        10.91         11.51         090
                                     arthroscopy.
29843.........  ........  A         Wrist                 6.00          NA            NA         4.83          5.44        0.92          NA            NA        11.75         12.36         090
                                     arthroscopy/
                                     surgery.
29844.........  ........  A         Wrist                 6.36          NA            NA         4.87          5.60        1.04          NA            NA        12.27         13.00         090
                                     arthroscopy/
                                     surgery.
29845.........  ........  A         Wrist                 7.51          NA            NA         5.41          6.22        0.99          NA            NA        13.91         14.72         090
                                     arthroscopy/
                                     surgery.
29846.........  ........  A         Wrist                 6.74          NA            NA         5.01          5.81        1.07          NA            NA        12.82         13.62         090
                                     arthroscopy/
                                     surgery.
29847.........  ........  A         Wrist                 7.07          NA            NA         5.08          5.93        1.08          NA            NA        13.23         14.08         090
                                     arthroscopy/
                                     surgery.
29848.........  ........  A         Wrist endoscopy/      6.18          NA            NA         5.20          5.52        0.86          NA            NA        12.24         12.56        090
                                     surgery.
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
\1\ CPT codes and descriptors only are copyright 2005 American Medical Association. All rights reserved. Applicable FARS/DFARS apply.
\2\ Copyright 2005 American Dental Association. All rights reserved.
\3\ Indicates RVUs are not used for Medicare payment.


[[Page 37294]]


                                   Addendum B.--Relative Value Units (RVUs) and Related Information Used In Determining Medicare Payments for 2007--Continued
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                   Fully                                                            Fully
                                                     Physician  implemented    Year 2007      Fully       Year 2007      Mal-    implemented    Year 2007      Fully       Year 2007
CPT \1\  HCPCS     Mod     Status     Description    work RVUs      non-     transitional  implemented  transitional   practice      non-     transitional  implemented  transitional    Global
      \2\                                               \3\     facility PE  non-facility  facility PE   facility PE     RVUs      facility   non-facility    facility     facility
                                                                    RVUs        PE RVUs        RVUs         RVUs                    total         total        total         total
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
29850.........  ........  A         Knee                  8.18          NA            NA         5.13          5.07        1.25          NA            NA        14.56         14.50         090
                                     arthroscopy/
                                     surgery.
29851.........  ........  A         Knee                 13.08          NA            NA         8.16          9.41        2.34          NA            NA        23.58         24.83         090
                                     arthroscopy/
                                     surgery.
29855.........  ........  A         Tibial               10.60          NA            NA         7.25          8.41        1.84          NA            NA        19.69         20.85         090
                                     arthroscopy/
                                     surgery.
29856.........  ........  A         Tibial               14.12          NA            NA         8.58         10.17        2.39          NA            NA        25.09         26.68         090
                                     arthroscopy/
                                     surgery.
29860.........  ........  A         Hip                   8.79          NA            NA         6.11          6.76        1.36          NA            NA        16.26         16.91         090
                                     arthroscopy,
                                     dx.
29861.........  ........  A         Hip arthroscopy/      9.89          NA            NA         6.51          7.15        1.59          NA            NA        17.99         18.63         090
                                     surgery.
29862.........  ........  A         Hip arthroscopy/     10.89          NA            NA         7.48          8.31        1.62          NA            NA        19.99         20.82         090
                                     surgery.
29863.........  ........  A         Hip arthroscopy/     10.89          NA            NA         7.40          8.25        1.42          NA            NA        19.71         20.56         090
                                     surgery.
29866.........  ........  A         Autgrft implnt,      14.38          NA            NA         9.36         10.88        2.39          NA            NA        26.13         27.65         090
                                     knee w/scope.
29867.........  ........  A         Allgrft implnt,      18.08          NA            NA        11.02         12.70        2.78          NA            NA        31.88         33.56         090
                                     knee w/scope.
29868.........  ........  A         Meniscal             24.79          NA            NA        13.64         16.04        4.35          NA            NA        42.78         45.18         090
                                     trnspl, knee w/
                                     scpe.
29870.........  ........  A         Knee                  5.06          NA            NA         4.11          4.70        0.85          NA            NA        10.02         10.61         090
                                     arthroscopy,
                                     dx.
29871.........  ........  A         Knee                  6.54          NA            NA         4.94          5.65        1.14          NA            NA        12.62         13.33         090
                                     arthroscopy/
                                     drainage.
29873.........  ........  A         Knee                  5.99          NA            NA         5.52          6.32        1.04          NA            NA        12.55         13.35         090
                                     arthroscopy/
                                     surgery.
29874.........  ........  A         Knee                  7.04          NA            NA         5.08          5.84        1.11          NA            NA        13.23         13.99         090
                                     arthroscopy/
                                     surgery.
29875.........  ........  A         Knee                  6.30          NA            NA         4.83          5.61        1.09          NA            NA        12.22         13.00         090
                                     arthroscopy/
                                     surgery.
29876.........  ........  A         Knee                  8.66          NA            NA         6.12          6.81        1.37          NA            NA        16.15         16.84         090
                                     arthroscopy/
                                     surgery.
29877.........  ........  A         Knee                  8.09          NA            NA         5.88          6.54        1.28          NA            NA        15.25         15.91         090
                                     arthroscopy/
                                     surgery.
29879.........  ........  A         Knee                  8.78          NA            NA         6.16          6.90        1.39          NA            NA        16.33         17.07         090
                                     arthroscopy/
                                     surgery.
29880.........  ........  A         Knee                  9.24          NA            NA         6.36          7.13        1.47          NA            NA        17.07         17.84         090
                                     arthroscopy/
                                     surgery.
29881.........  ........  A         Knee                  8.50          NA            NA         6.07          6.75        1.34          NA            NA        15.91         16.59         090
                                     arthroscopy/
                                     surgery.
29882.........  ........  A         Knee                  9.39          NA            NA         6.39          7.04        1.50          NA            NA        17.28         17.93         090
                                     arthroscopy/
                                     surgery.
29883.........  ........  A         Knee                 11.53          NA            NA         7.50          8.69        1.92          NA            NA        20.95         22.14         090
                                     arthroscopy/
                                     surgery.
29884.........  ........  A         Knee                  8.07          NA            NA         5.90          6.52        1.27          NA            NA        15.24         15.86         090
                                     arthroscopy/
                                     surgery.
29885.........  ........  A         Knee                  9.95          NA            NA         6.92          7.72        1.58          NA            NA        18.45         19.25         090
                                     arthroscopy/
                                     surgery.
29886.........  ........  A         Knee                  8.28          NA            NA         5.97          6.65        1.30          NA            NA        15.55         16.23         090
                                     arthroscopy/
                                     surgery.
29887.........  ........  A         Knee                  9.90          NA            NA         6.91          7.69        1.57          NA            NA        18.38         19.16         090
                                     arthroscopy/
                                     surgery.
29888.........  ........  A         Knee                 14.06          NA            NA         8.17          9.72        2.41          NA            NA        24.64         26.19         090
                                     arthroscopy/
                                     surgery.
29889.........  ........  A         Knee                 17.05          NA            NA        10.53         11.99        2.78          NA            NA        30.36         31.82         090
                                     arthroscopy/
                                     surgery.
29891.........  ........  A         Ankle                 9.39          NA            NA         6.57          7.29        1.39          NA            NA        17.35         18.07         090
                                     arthroscopy/
                                     surgery.
29892.........  ........  A         Ankle                 9.99          NA            NA         6.45          7.43        1.41          NA            NA        17.85         18.83         090
                                     arthroscopy/
                                     surgery.
29893.........  ........  A         Scope, plantar        5.96        8.75          6.91         4.59          4.15        0.63       15.34         13.50        11.18         10.74         090
                                     fasciotomy.
29894.........  ........  A         Ankle                 7.20          NA            NA         4.61          5.27        1.15          NA            NA        12.96         13.62         090
                                     arthroscopy/
                                     surgery.
29895.........  ........  A         Ankle                 6.98          NA            NA         4.45          5.23        1.11          NA            NA        12.54         13.32         090
                                     arthroscopy/
                                     surgery.
29897.........  ........  A         Ankle                 7.17          NA            NA         4.88          5.65        1.17          NA            NA        13.22         13.99         090
                                     arthroscopy/
                                     surgery.
29898.........  ........  A         Ankle                 8.31          NA            NA         5.19          5.96        1.28          NA            NA        14.78         15.55         090
                                     arthroscopy/
                                     surgery.
29899.........  ........  A         Ankle                15.13          NA            NA         9.12         10.21        2.40          NA            NA        26.65         27.74         090
                                     arthroscopy/
                                     surgery.
29900.........  ........  A         Mcp joint             5.66          NA            NA         4.65          5.57        0.94          NA            NA        11.25         12.17         090
                                     arthroscopy,
                                     dx.
29901.........  ........  A         Mcp joint             6.37          NA            NA         5.45          6.07        1.06          NA            NA        12.88         13.50         090
                                     arthroscopy,
                                     surg.
29902.........  ........  A         Mcp joint             6.94          NA            NA         3.61          5.82        1.12          NA            NA        11.67         13.88         090
                                     arthroscopy,
                                     surg.
30000.........  ........  A         Drainage of           1.43        3.70          3.99         1.21          1.35        0.12        5.25          5.54         2.76          2.90         010
                                     nose lesion.
30020.........  ........  A         Drainage of           1.43        3.82          3.42         1.24          1.41        0.12        5.37          4.97         2.79          2.96         010
                                     nose lesion.
30100.........  ........  A         Intranasal            0.94        2.39          2.08         0.68          0.79        0.07        3.40          3.09         1.69          1.80         000
                                     biopsy.
30110.........  ........  A         Removal of nose       1.63        3.59          3.34         1.30          1.50        0.14        5.36          5.11         3.07          3.27         010
                                     polyp(s).
30115.........  ........  A         Removal of nose       4.34          NA            NA         5.40          5.69        0.41          NA            NA        10.15         10.44         090
                                     polyp(s).
30117.........  ........  A         Removal of            3.16       16.76         14.08         4.46          4.60        0.26       20.18         17.50         7.88          8.02         090
                                     intranasal
                                     lesion.
30118.........  ........  A         Removal of            9.74          NA            NA         7.61          8.82        0.78          NA            NA        18.13         19.34         090
                                     intranasal
                                     lesion.
30120.........  ........  A         Revision of           5.26        6.74          6.57         4.81          5.72        0.52       12.52         12.35        10.59         11.50         090
                                     nose.
30124.........  ........  A         Removal of nose       3.10          NA            NA         3.59          3.61        0.25          NA            NA         6.94          6.96         090
                                     lesion.
30125.........  ........  A         Removal of nose       7.15          NA            NA         6.91          7.98        0.63          NA            NA        14.69         15.76         090
                                     lesion.
30130.........  ........  A         Excise inferior       3.37          NA            NA         5.21          5.51        0.31          NA            NA         8.89          9.19        090
                                     turbinate.
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
\1\ CPT codes and descriptors only are copyright 2005 American Medical Association. All rights reserved. Applicable FARS/DFARS apply.
\2\ Copyright 2005 American Dental Association. All rights reserved.
\3\ Indicates RVUs are not used for Medicare payment.


[[Page 37295]]


                                   Addendum B.--Relative Value Units (RVUs) and Related Information Used In Determining Medicare Payments for 2007--Continued
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                   Fully                                                            Fully
                                                     Physician  implemented    Year 2007      Fully       Year 2007      Mal-    implemented    Year 2007      Fully       Year 2007
CPT \1\  HCPCS     Mod     Status     Description    work RVUs      non-     transitional  implemented  transitional   practice      non-     transitional  implemented  transitional    Global
      \2\                                               \3\     facility PE  non-facility  facility PE   facility PE     RVUs      facility   non-facility    facility     facility
                                                                    RVUs        PE RVUs        RVUs         RVUs                    total         total        total         total
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
30140.........  ........  A         Resect inferior       3.42          NA            NA         6.47          6.28        0.35          NA            NA        10.24         10.05         090
                                     turbinate.
30150.........  ........  A         Partial removal       9.37          NA            NA         8.38         10.38        0.93          NA            NA        18.68         20.68         090
                                     of nose.
30160.........  ........  A         Removal of nose       9.81          NA            NA         7.99          9.68        0.88          NA            NA        18.68         20.37         090
30200.........  ........  A         Injection             0.78        1.86          1.68         0.60          0.71        0.06        2.70          2.52         1.44          1.55         000
                                     treatment of
                                     nose.
30210.........  ........  A         Nasal sinus           1.08        2.29          2.16         1.14          1.27        0.09        3.46          3.33         2.31          2.44         010
                                     therapy.
30220.........  ........  A         Insert nasal          1.54        5.36          4.52         1.27          1.47        0.12        7.02          6.18         2.93          3.13         010
                                     septal button.
30300.........  ........  A         Remove nasal          1.04        4.09          4.50         1.76          1.88        0.08        5.21          5.62         2.88          3.00         010
                                     foreign body.
30310.........  ........  A         Remove nasal          1.96          NA            NA         2.68          3.00        0.16          NA            NA         4.80          5.12         010
                                     foreign body.
30320.........  ........  A         Remove nasal          4.51          NA            NA         5.85          6.76        0.39          NA            NA        10.75         11.66         090
                                     foreign body.
30400.........  ........  R         Reconstruction       10.46          NA            NA        13.49         15.02        1.04          NA            NA        24.99         26.52         090
                                     of nose.
30410.........  ........  R         Reconstruction       13.60          NA            NA        14.12         17.35        1.42          NA            NA        29.14         32.37         090
                                     of nose.
30420.........  ........  R         Reconstruction       16.50          NA            NA        14.47         17.09        1.46          NA            NA        32.43         35.05         090
                                     of nose.
30430.........  ........  R         Revision of           7.84          NA            NA        12.60         15.20        0.77          NA            NA        21.21         23.81         090
                                     nose.
30435.........  ........  R         Revision of          12.33          NA            NA        14.29         18.13        1.22          NA            NA        27.84         31.68         090
                                     nose.
30450.........  ........  R         Revision of          19.26          NA            NA        15.82         20.42        1.96          NA            NA        37.04         41.64         090
                                     nose.
30460.........  ........  A         Revision of          10.20          NA            NA         7.05          9.24        1.03          NA            NA        18.28         20.47         090
                                     nose.
30462.........  ........  A         Revision of          20.04          NA            NA        14.04         18.74        2.53          NA            NA        36.61         41.31         090
                                     nose.
30465.........  ........  A         Repair nasal         12.12          NA            NA        10.08         11.52        1.06          NA            NA        23.26         24.70         090
                                     stenosis.
30520.........  ........  A         Repair of nasal       7.63          NA            NA         6.88          6.73        0.46          NA            NA        14.97         14.82         090
                                     septum.
30540.........  ........  A         Repair nasal          7.74          NA            NA         6.92          8.71        0.67          NA            NA        15.33         17.12         090
                                     defect.
30545.........  ........  A         Repair nasal         11.42          NA            NA         9.88         11.42        1.70          NA            NA        23.00         24.54         090
                                     defect.
30560.........  ........  A         Release of            1.26        4.88          4.81         1.84          2.07        0.10        6.24          6.17         3.20          3.43         010
                                     nasal
                                     adhesions.
30580.........  ........  A         Repair upper          6.68        8.13          7.88         4.66          5.52        0.89       15.70         15.45        12.23         13.09         090
                                     jaw fistula.
30600.........  ........  A         Repair mouth/         6.01        7.43          7.51         4.00          4.77        0.70       14.14         14.22        10.71         11.48         090
                                     nose fistula.
30620.........  ........  A         Intranasal            5.96          NA            NA         7.98          8.64        0.57          NA            NA        14.51         15.17         090
                                     reconstruction.
30630.........  ........  A         Repair nasal          7.11          NA            NA         6.96          7.72        0.61          NA            NA        14.68         15.44         090
                                     septum defect.
30801.........  ........  A         Ablate inf            1.09        3.98          4.10         1.94          1.93        0.09        5.16          5.28         3.12          3.11         010
                                     turbinate,
                                     superf.
30802.........  ........  A         Cauterization,        2.03        4.55          4.60         2.27          2.35        0.16        6.74          6.79         4.46          4.54         010
                                     inner nose.
30901.........  ........  A         Control of            1.21        1.19          1.32         0.27          0.31        0.11        2.51          2.64         1.59          1.63         000
                                     nosebleed.
30903.........  ........  A         Control of            1.54        3.04          2.80         0.37          0.47        0.13        4.71          4.47         2.04          2.14         000
                                     nosebleed.
30905.........  ........  A         Control of            1.97        3.69          3.56         0.45          0.68        0.17        5.83          5.70         2.59          2.82         000
                                     nosebleed.
30906.........  ........  A         Repeat control        2.45        3.92          3.91         0.64          1.06        0.20        6.57          6.56         3.29          3.71         000
                                     of nosebleed.
30915.........  ........  A         Ligation, nasal       7.31          NA            NA         5.71          6.46        0.58          NA            NA        13.60         14.35         090
                                     sinus artery.
30920.........  ........  A         Ligation, upper      10.97          NA            NA         7.97          8.74        0.80          NA            NA        19.74         20.51         090
                                     jaw artery.
30930.........  ........  A         Ther fx, nasal        1.26          NA            NA         1.50          1.59        0.12          NA            NA         2.88          2.97         010
                                     inf turbinate.
31000.........  ........  A         Irrigation,           1.15        2.98          2.88         1.22          1.36        0.09        4.22          4.12         2.46          2.60         010
                                     maxillary
                                     sinus.
31002.........  ........  A         Irrigation,           1.91          NA            NA         2.49          3.06        0.15          NA            NA         4.55          5.12         010
                                     sphenoid sinus.
31020.........  ........  A         Exploration,          2.94        7.98          8.41         5.11          5.18        0.29       11.21         11.64         8.34          8.41         090
                                     maxillary
                                     sinus.
31030.........  ........  A         Exploration,          5.91        9.65         11.06         5.93          6.49        0.60       16.16         17.57        12.44         13.00         090
                                     maxillary
                                     sinus.
31032.........  ........  A         Explore sinus,        6.56          NA            NA         6.38          7.03        0.59          NA            NA        13.53         14.18         090
                                     remove polyps.
31040.........  ........  A         Exploration           9.59          NA            NA         7.13          9.17        0.87          NA            NA        17.59         19.63         090
                                     behind upper
                                     jaw.
31050.........  ........  A         Exploration,          5.27          NA            NA         6.03          6.29        0.49          NA            NA        11.79         12.05         090
                                     sphenoid sinus.
31051.........  ........  A         Sphenoid sinus        7.10          NA            NA         7.58          8.09        0.62          NA            NA        15.30         15.81         090
                                     surgery.
31070.........  ........  A         Exploration of        4.27          NA            NA         5.61          5.87        0.38          NA            NA        10.26         10.52         090
                                     frontal sinus.
31075.........  ........  A         Exploration of        9.33          NA            NA         8.36          9.41        0.75          NA            NA        18.44         19.49         090
                                     frontal sinus.
31080.........  ........  A         Removal of           12.46          NA            NA        10.25         12.74        1.23          NA            NA        23.94         26.43         090
                                     frontal sinus.
31081.........  ........  A         Removal of           13.91          NA            NA        14.48         14.15        2.46          NA            NA        30.85         30.52         090
                                     frontal sinus.
31084.........  ........  A         Removal of           14.67          NA            NA        11.64         13.07        1.19          NA            NA        27.50         28.93         090
                                     frontal sinus.
31085.........  ........  A         Removal of           15.36          NA            NA        12.67         13.67        1.72          NA            NA        29.75         30.75         090
                                     frontal sinus.
31086.........  ........  A         Removal of           14.08          NA            NA        11.48         12.86        1.07          NA            NA        26.63         28.01         090
                                     frontal sinus.
31087.........  ........  A         Removal of           14.31          NA            NA        10.51         12.06        1.44          NA            NA        26.26         27.81         090
                                     frontal sinus.
31090.........  ........  A         Exploration of       10.78          NA            NA        12.11         12.47        0.94          NA            NA        23.83         24.19        090
                                     sinuses.
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
\1\ CPT codes and descriptors only are copyright 2005 American Medical Association. All rights reserved. Applicable FARS/DFARS apply.
\2\ Copyright 2005 American Dental Association. All rights reserved.
\3\ Indicates RVUs are not used for Medicare payment.


[[Page 37296]]


                                   Addendum B.--Relative Value Units (RVUs) and Related Information Used In Determining Medicare Payments for 2007--Continued
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                   Fully                                                            Fully
                                                     Physician  implemented    Year 2007      Fully       Year 2007      Mal-    implemented    Year 2007      Fully       Year 2007
CPT \1\  HCPCS     Mod     Status     Description    work RVUs      non-     transitional  implemented  transitional   practice      non-     transitional  implemented  transitional    Global
      \2\                                               \3\     facility PE  non-facility  facility PE   facility PE     RVUs      facility   non-facility    facility     facility
                                                                    RVUs        PE RVUs        RVUs         RVUs                    total         total        total         total
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
31200.........  ........  A         Removal of            4.96          NA            NA         7.32          8.76        0.29          NA            NA        12.57         14.01         090
                                     ethmoid sinus.
31201.........  ........  A         Removal of            8.42          NA            NA         8.11          8.93        0.82          NA            NA        17.35         18.17         090
                                     ethmoid sinus.
31205.........  ........  A         Removal of           10.40          NA            NA         9.33         11.27        0.67          NA            NA        20.40         22.34         090
                                     ethmoid sinus.
31225.........  ........  A         Removal of           26.34          NA            NA        16.42         17.51        1.59          NA            NA        44.35         45.44         090
                                     upper jaw.
31230.........  ........  A         Removal of           30.46          NA            NA        17.08         18.84        1.77          NA            NA        49.31         51.07         090
                                     upper jaw.
31231.........  ........  A         Nasal                 1.10        3.30          3.37         0.68          0.83        0.09        4.49          4.56         1.87          2.02         000
                                     endoscopy, dx.
31233.........  ........  A         Nasal/sinus           2.18        3.89          4.21         0.97          1.35        0.20        6.27          6.59         3.35          3.73         000
                                     endoscopy, dx.
31235.........  ........  A         Nasal/sinus           2.64        4.24          4.75         1.10          1.57        0.26        7.14          7.65         4.00          4.47         000
                                     endoscopy, dx.
31237.........  ........  A         Nasal/sinus           2.98        4.46          5.02         1.20          1.72        0.28        7.72          8.28         4.46          4.98         000
                                     endoscopy,
                                     surg.
31238.........  ........  A         Nasal/sinus           3.26        4.38          5.03         1.27          1.89        0.27        7.91          8.56         4.80          5.42         000
                                     endoscopy,
                                     surg.
31239.........  ........  A         Nasal/sinus           9.19          NA            NA         6.14          7.55        0.62          NA            NA        15.95         17.36         010
                                     endoscopy,
                                     surg.
31240.........  ........  A         Nasal/sinus           2.61          NA            NA         1.10          1.58        0.24          NA            NA         3.95          4.43         000
                                     endoscopy,
                                     surg.
31254.........  ........  A         Revision of           4.64          NA            NA         1.66          2.56        0.45          NA            NA         6.75          7.65         000
                                     ethmoid sinus.
31255.........  ........  A         Removal of            6.95          NA            NA         2.29          3.66        0.73          NA            NA         9.97         11.34         000
                                     ethmoid sinus.
31256.........  ........  A         Exploration           3.29          NA            NA         1.28          1.91        0.33          NA            NA         4.90          5.53         000
                                     maxillary
                                     sinus.
31267.........  ........  A         Endoscopy,            5.45          NA            NA         1.88          2.95        0.55          NA            NA         7.88          8.95         000
                                     maxillary
                                     sinus.
31276.........  ........  A         Sinus                 8.84          NA            NA         2.80          4.55        0.92          NA            NA        12.56         14.31         000
                                     endoscopy,
                                     surgical.
31287.........  ........  A         Nasal/sinus           3.91          NA            NA         1.45          2.21        0.39          NA            NA         5.75          6.51         000
                                     endoscopy,
                                     surg.
31288.........  ........  A         Nasal/sinus           4.57          NA            NA         1.63          2.52        0.46          NA            NA         6.66          7.55         000
                                     endoscopy,
                                     surg.
31290.........  ........  A         Nasal/sinus          18.46          NA            NA         7.82         11.02        1.40          NA            NA        27.68         30.88         010
                                     endoscopy,
                                     surg.
31291.........  ........  A         Nasal/sinus          19.41          NA            NA         8.42         11.49        1.68          NA            NA        29.51         32.58         010
                                     endoscopy,
                                     surg.
31292.........  ........  A         Nasal/sinus          15.75          NA            NA         7.06          9.75        1.21          NA            NA        24.02         26.71         010
                                     endoscopy,
                                     surg.
31293.........  ........  A         Nasal/sinus          17.32          NA            NA         7.66         10.47        1.28          NA            NA        26.26         29.07         010
                                     endoscopy,
                                     surg.
31294.........  ........  A         Nasal/sinus          20.16          NA            NA         8.52         11.81        1.53          NA            NA        30.21         33.50         010
                                     endoscopy,
                                     surg.
31300.........  ........  A         Removal of           15.63          NA            NA        13.25         14.58        1.17          NA            NA        30.05         31.38         090
                                     larynx lesion.
31320.........  ........  A         Diagnostic            5.55          NA            NA         9.07         10.02        0.46          NA            NA        15.08         16.03         090
                                     incision,
                                     larynx.
31360.........  ........  A         Removal of           27.23          NA            NA        16.41         16.68        1.38          NA            NA        45.02         45.29         090
                                     larynx.
31365.........  ........  A         Removal of           34.85          NA            NA        18.52         19.95        1.97          NA            NA        55.34         56.77         090
                                     larynx.
31367.........  ........  A         Partial removal      27.11          NA            NA        19.04         21.22        1.78          NA            NA        47.93         50.11         090
                                     of larynx.
31368.........  ........  A         Partial removal      33.73          NA            NA        22.36         24.76        2.20          NA            NA        58.29         60.69         090
                                     of larynx.
31370.........  ........  A         Partial removal      27.11          NA            NA        19.92         21.72        1.74          NA            NA        48.77         50.57         090
                                     of larynx.
31375.........  ........  A         Partial removal      25.61          NA            NA        18.36         19.92        1.63          NA            NA        45.60         47.16         090
                                     of larynx.
31380.........  ........  A         Partial removal      25.11          NA            NA        18.05         20.01        1.70          NA            NA        44.86         46.82         090
                                     of larynx.
31382.........  ........  A         Partial removal      28.11          NA            NA        20.22         21.31        1.67          NA            NA        50.00         51.09         090
                                     of larynx.
31390.........  ........  A         Removal of           38.72          NA            NA        22.23         23.90        2.23          NA            NA        63.18         64.85         090
                                     larynx &
                                     pharynx.
31395.........  ........  A         Reconstruct          43.34          NA            NA        26.33         27.87        2.48          NA            NA        72.15         73.69         090
                                     larynx &
                                     pharynx.
31400.........  ........  A         Revision of          11.40          NA            NA        11.27         13.18        0.83          NA            NA        23.50         25.41         090
                                     larynx.
31420.........  ........  A         Removal of           11.25          NA            NA         7.70          9.10        0.83          NA            NA        19.78         21.18         090
                                     epiglottis.
31500.........  ........  A         Insert                2.33          NA            NA         0.42          0.52        0.17          NA            NA         2.92          3.02         000
                                     emergency
                                     airway.
31502.........  ........  A         Change of             0.65        0.16          0.27         0.20          0.26        0.05        0.86          0.97         0.90          0.96         000
                                     windpipe
                                     airway.
31505.........  ........  A         Diagnostic            0.61        1.32          1.42         0.54          0.59        0.05        1.98          2.08         1.20          1.25         000
                                     laryngoscopy.
31510.........  ........  A         Laryngoscopy          1.92        2.95          3.22         0.89          1.16        0.16        5.03          5.30         2.97          3.24         000
                                     with biopsy.
31511.........  ........  A         Remove foreign        2.16        2.72          3.03         0.91          1.02        0.19        5.07          5.38         3.26          3.37         000
                                     body, larynx.
31512.........  ........  A         Removal of            2.07        2.69          3.08         0.93          1.25        0.18        4.94          5.33         3.18          3.50         000
                                     larynx lesion.
31513.........  ........  A         Injection into        2.10          NA            NA         0.95          1.33        0.17          NA            NA         3.22          3.60         000
                                     vocal cord.
31515.........  ........  A         Laryngoscopy          1.80        3.04          3.42         0.82          1.00        0.14        4.98          5.36         2.76          2.94         000
                                     for aspiration.
31520.........  ........  A         Dx                    2.56          NA            NA         1.07          1.44        0.20          NA            NA         3.83          4.20         000
                                     laryngoscopy,
                                     newborn.
31525.........  ........  A         Dx laryngoscopy       2.63        3.18          3.53         1.08          1.52        0.21        6.02          6.37         3.92          4.36         000
                                     excl nb.
31526.........  ........  A         Dx laryngoscopy       2.57          NA            NA         1.08          1.56        0.21          NA            NA         3.86          4.34         000
                                     w/oper scope.
31527.........  ........  A         Laryngoscopy          3.27          NA            NA         1.26          1.73        0.26          NA            NA         4.79          5.26         000
                                     for treatment.
31528.........  ........  A         Laryngoscopy          2.37          NA            NA         0.95          1.33        0.19          NA            NA         3.51          3.89         000
                                     and dilation.
31529.........  ........  A         Laryngoscopy          2.68          NA            NA         1.07          1.55        0.22          NA            NA         3.97          4.45        000
                                     and dilation.
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
\1\ CPT codes and descriptors only are copyright 2005 American Medical Association. All rights reserved. Applicable FARS/DFARS apply.
\2\ Copyright 2005 American Dental Association. All rights reserved.
\3\ Indicates RVUs are not used for Medicare payment.


[[Page 37297]]


                                   Addendum B.--Relative Value Units (RVUs) and Related Information Used In Determining Medicare Payments for 2007--Continued
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                   Fully                                                            Fully
                                                     Physician  implemented    Year 2007      Fully       Year 2007      Mal-    implemented    Year 2007      Fully       Year 2007
CPT \1\  HCPCS     Mod     Status     Description    work RVUs      non-     transitional  implemented  transitional   practice      non-     transitional  implemented  transitional    Global
      \2\                                               \3\     facility PE  non-facility  facility PE   facility PE     RVUs      facility   non-facility    facility     facility
                                                                    RVUs        PE RVUs        RVUs         RVUs                    total         total        total         total
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
31530.........  ........  A         Laryngoscopy w/       3.38          NA            NA         1.26          1.79        0.29          NA            NA         4.93          5.46         000
                                     fb removal.
31531.........  ........  A         Laryngoscopy w/       3.58          NA            NA         1.36          2.05        0.29          NA            NA         5.23          5.92         000
                                     fb & op scope.
31535.........  ........  A         Laryngoscopy w/       3.16          NA            NA         1.24          1.81        0.26          NA            NA         4.66          5.23         000
                                     biopsy.
31536.........  ........  A         Laryngoscopy w/       3.55          NA            NA         1.35          2.03        0.29          NA            NA         5.19          5.87         000
                                     bx & op scope.
31540.........  ........  A         Laryngoscopy w/       4.12          NA            NA         1.51          2.29        0.33          NA            NA         5.96          6.74         000
                                     exc of tumor.
31541.........  ........  A         Larynscop w/          4.52          NA            NA         1.62          2.50        0.37          NA            NA         6.51          7.39         000
                                     tumr exc +
                                     scope.
31545.........  ........  A         Remove vc             6.30          NA            NA         2.14          3.15        0.37          NA            NA         8.81          9.82         000
                                     lesion w/scope.
31546.........  ........  A         Remove vc             9.73          NA            NA         3.62          4.64        0.78          NA            NA        14.13         15.15         000
                                     lesion scope/
                                     graft.
31560.........  ........  A         Laryngoscop w/        5.45          NA            NA         1.83          2.83        0.43          NA            NA         7.71          8.71         000
                                     arytenoidectom.
31561.........  ........  A         Larynscop,            5.99          NA            NA         1.97          3.03        0.49          NA            NA         8.45          9.51         000
                                     remve cart +
                                     scop.
31570.........  ........  A         Laryngoscope w/       3.86        3.88          5.24         1.43          2.15        0.31        8.05          9.41         5.60          6.32         000
                                     vc inj.
31571.........  ........  A         Laryngoscop w/        4.26          NA            NA         1.55          2.35        0.35          NA            NA         6.16          6.96         000
                                     vc inj + scope.
31575.........  ........  A         Diagnostic            1.10        1.54          1.82         0.68          0.84        0.09        2.73          3.01         1.87          2.03         000
                                     laryngoscopy.
31576.........  ........  A         Laryngoscopy          1.97        3.24          3.56         0.92          1.20        0.14        5.35          5.67         3.03          3.31         000
                                     with biopsy.
31577.........  ........  A         Remove foreign        2.47        3.19          3.63         1.07          1.42        0.21        5.87          6.31         3.75          4.10         000
                                     body, larynx.
31578.........  ........  A         Removal of            2.84        3.61          4.12         1.16          1.43        0.23        6.68          7.19         4.23          4.50         000
                                     larynx lesion.
31579.........  ........  A         Diagnostic            2.26        2.59          3.49         1.00          1.36        0.18        5.03          5.93         3.44          3.80         000
                                     laryngoscopy.
31580.........  ........  A         Revision of          14.38          NA            NA        13.18         15.27        1.00          NA            NA        28.56         30.65         090
                                     larynx.
31582.........  ........  A         Revision of          22.73          NA            NA        19.99         24.40        1.75          NA            NA        44.47         48.88         090
                                     larynx.
31584.........  ........  A         Treat larynx         20.27          NA            NA        13.86         17.12        1.71          NA            NA        35.84         39.10         090
                                     fracture.
31587.........  ........  A         Revision of          15.06          NA            NA         7.74          8.90        0.97          NA            NA        23.77         24.93         090
                                     larynx.
31588.........  ........  A         Revision of          14.48          NA            NA        11.11         13.02        1.06          NA            NA        26.65         28.56         090
                                     larynx.
31590.........  ........  A         Reinnervate           7.53          NA            NA        11.97         14.68        0.84          NA            NA        20.34         23.05         090
                                     larynx.
31595.........  ........  A         Larynx nerve          8.69          NA            NA         8.77         10.13        0.68          NA            NA        18.14         19.50         090
                                     surgery.
31600.........  ........  A         Incision of           7.17          NA            NA         2.16          2.94        0.80          NA            NA        10.13         10.91         000
                                     windpipe.
31601.........  ........  A         Incision of           4.44          NA            NA         1.58          2.20        0.40          NA            NA         6.42          7.04         000
                                     windpipe.
31603.........  ........  A         Incision of           4.14          NA            NA         1.09          1.56        0.44          NA            NA         5.67          6.14         000
                                     windpipe.
31605.........  ........  A         Incision of           3.57          NA            NA         0.81          1.10        0.40          NA            NA         4.78          5.07         000
                                     windpipe.
31610.........  ........  A         Incision of           9.23          NA            NA         7.02          7.97        0.79          NA            NA        17.04         17.99         090
                                     windpipe.
31611.........  ........  A         Surgery/speech        5.87          NA            NA         6.36          6.90        0.46          NA            NA        12.69         13.23         090
                                     prosthesis.
31612.........  ........  A         Puncture/clear        0.91        1.06          1.09         0.24          0.32        0.08        2.05          2.08         1.23          1.31         000
                                     windpipe.
31613.........  ........  A         Repair windpipe       4.58          NA            NA         5.73          5.94        0.42          NA            NA        10.73         10.94         090
                                     opening.
31614.........  ........  A         Repair windpipe       8.39          NA            NA         8.70          8.73        0.58          NA            NA        17.67         17.70         090
                                     opening.
31615.........  ........  A         Visualization         2.09        2.18          2.50         0.93          1.13        0.16        4.43          4.75         3.18          3.38         000
                                     of windpipe.
31620.........  ........  A         Endobronchial         1.40        5.98          5.74         0.33          0.50        0.11        7.49          7.25         1.84          2.01         ZZZ
                                     us add-on.
31622.........  ........  A         Dx bronchoscope/      2.78        5.21          5.56         0.88          1.02        0.18        8.17          8.52         3.84          3.98         000
                                     wash.
31623.........  ........  A         Dx bronchoscope/      2.88        5.96          6.32         0.88          1.01        0.13        8.97          9.33         3.89          4.02         000
                                     brush.
31624.........  ........  A         Dx bronchoscope/      2.88        5.32          5.67         0.88          1.01        0.13        8.33          8.68         3.89          4.02         000
                                     lavage.
31625.........  ........  A         Bronchoscopy w/       3.36        5.46          5.74         1.00          1.16        0.18        9.00          9.28         4.54          4.70         000
                                     biopsy(s).
31628.........  ........  A         Bronchoscopy/         3.80        6.93          7.01         1.08          1.25        0.18       10.91         10.99         5.06          5.23         000
                                     lung bx, each.
31629.........  ........  A         Bronchoscopy/         4.09       11.96         13.71         1.15          1.34        0.16       16.21         17.96         5.40          5.59         000
                                     needle bx,
                                     each.
31630.........  ........  A         Bronchoscopy          3.81          NA            NA         1.23          1.60        0.32          NA            NA         5.36          5.73         000
                                     dilate/fx repr.
31631.........  ........  A         Bronchoscopy,         4.36          NA            NA         1.38          1.67        0.34          NA            NA         6.08          6.37         000
                                     dilate w/stent.
31632.........  ........  A         Bronchoscopy/         1.03        0.85          0.82         0.23          0.29        0.18        2.06          2.03         1.44          1.50         ZZZ
                                     lung bx, addIl.
31633.........  ........  A         Bronchoscopy/         1.32        0.98          0.94         0.30          0.38        0.16        2.46          2.42         1.78          1.86         ZZZ
                                     needle bx
                                     addIl.
31635.........  ........  A         Bronchoscopy w/       3.67        5.16          5.89         1.11          1.35        0.24        9.07          9.80         5.02          5.26         000
                                     fb removal.
31636.........  ........  A         Bronchoscopy,         4.30          NA            NA         1.35          1.67        0.31          NA            NA         5.96          6.28         000
                                     bronch stents.
31637.........  ........  A         Bronchoscopy,         1.58          NA            NA         0.41          0.52        0.13          NA            NA         2.12          2.23         ZZZ
                                     stent add-on.
31638.........  ........  A         Bronchoscopy,         4.88          NA            NA         1.53          1.87        0.22          NA            NA         6.63          6.97         000
                                     revise stent.
31640.........  ........  A         Bronchoscopy w/       4.93          NA            NA         1.50          1.94        0.46          NA            NA         6.89          7.33         000
                                     tumor excise.
31641.........  ........  A         Bronchoscopy,         5.02          NA            NA         1.46          1.78        0.35          NA            NA         6.83          7.15        000
                                     treat blockage.
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
\1\ CPT codes and descriptors only are copyright 2005 American Medical Association. All rights reserved. Applicable FARS/DFARS apply.
\2\ Copyright 2005 American Dental Association. All rights reserved.
\3\ Indicates RVUs are not used for Medicare payment.


[[Page 37298]]


                                   Addendum B.--Relative Value Units (RVUs) and Related Information Used In Determining Medicare Payments for 2007--Continued
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                   Fully                                                            Fully
                                                     Physician  implemented    Year 2007      Fully       Year 2007      Mal-    implemented    Year 2007      Fully       Year 2007
CPT \1\  HCPCS     Mod     Status     Description    work RVUs      non-     transitional  implemented  transitional   practice      non-     transitional  implemented  transitional    Global
      \2\                                               \3\     facility PE  non-facility  facility PE   facility PE     RVUs      facility   non-facility    facility     facility
                                                                    RVUs        PE RVUs        RVUs         RVUs                    total         total        total         total
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
31643.........  ........  A         Diag                  3.49          NA            NA         1.03          1.18        0.20          NA            NA         4.72          4.87         000
                                     bronchoscope/
                                     catheter.
31645.........  ........  A         Bronchoscopy,         3.16        4.71          5.04         0.95          1.08        0.16        8.03          8.36         4.27          4.40         000
                                     clear airways.
31646.........  ........  A         Bronchoscopy,         2.72        4.43          4.76         0.84          0.96        0.14        7.29          7.62         3.70          3.82         000
                                     reclear airway.
31656.........  ........  A         Bronchoscopy,         2.17        5.29          6.81         0.64          0.78        0.15        7.61          9.13         2.96          3.10         000
                                     inj for x-ray.
31700.........  ........  A         Insertion of          1.34        2.29          2.19         0.67          0.68        0.08        3.71          3.61         2.09          2.10         000
                                     airway
                                     catheter.
31708.........  ........  A         Instill airway        1.41        1.27          1.85         0.42          0.45        0.07        2.75          3.33         1.90          1.93         000
                                     contrast dye.
31710.........  ........  A         Insertion of          1.30          NA            NA         0.45          0.42        0.12          NA            NA         1.87          1.84         000
                                     airway
                                     catheter.
31715.........  ........  A         Injection for         1.11          NA            NA         0.29          0.33        0.07          NA            NA         1.47          1.51         000
                                     bronchus x-ray.
31717.........  ........  A         Bronchial brush       2.12        5.81          7.66         0.74          0.78        0.14        8.07          9.92         3.00          3.04         000
                                     biopsy.
31720.........  ........  A         Clearance of          1.06        0.25          0.31         0.25          0.31        0.07        1.38          1.44         1.38          1.44         000
                                     airways.
31725.........  ........  A         Clearance of          1.96        0.44          0.60         0.44          0.55        0.14        2.54          2.70         2.54          2.65         000
                                     airways.
31730.........  ........  A         Intro, windpipe       2.85       25.49          8.02         0.71          0.93        0.21       28.55         11.08         3.77          3.99         000
                                     wire/tube.
31750.........  ........  A         Repair of            15.11          NA            NA        15.93         17.18        1.05          NA            NA        32.09         33.34         090
                                     windpipe.
31755.........  ........  A         Repair of            17.05          NA            NA        21.88         23.91        1.29          NA            NA        40.22         42.25         090
                                     windpipe.
31760.........  ........  A         Repair of            23.28          NA            NA         9.87         10.52        2.94          NA            NA        36.09         36.74         090
                                     windpipe.
31766.........  ........  A         Reconstruction       31.52          NA            NA        11.44         13.13        4.52          NA            NA        47.48         49.17         090
                                     of windpipe.
31770.........  ........  A         Repair/graft of      23.44          NA            NA         9.02          9.96        2.83          NA            NA        35.29         36.23         090
                                     bronchus.
31775.........  ........  A         Reconstruct          24.46          NA            NA         8.87         11.08        3.01          NA            NA        36.34         38.55         090
                                     bronchus.
31780.........  ........  A         Reconstruct          19.62          NA            NA         7.96         10.30        1.65          NA            NA        29.23         31.57         090
                                     windpipe.
31781.........  ........  A         Reconstruct          24.72          NA            NA         9.17         11.41        2.24          NA            NA        36.13         38.37         090
                                     windpipe.
31785.........  ........  A         Remove windpipe      18.25          NA            NA         6.80          9.36        1.59          NA            NA        26.64         29.20         090
                                     lesion.
31786.........  ........  A         Remove windpipe      25.29          NA            NA         9.81         12.30        3.29          NA            NA        38.39         40.88         090
                                     lesion.
31800.........  ........  A         Repair of             8.05          NA            NA         8.31          9.03        0.79          NA            NA        17.15         17.87         090
                                     windpipe
                                     injury.
31805.........  ........  A         Repair of            13.29          NA            NA         6.45          7.04        1.82          NA            NA        21.56         22.15         090
                                     windpipe
                                     injury.
31820.........  ........  A         Closure of            4.54        5.37          5.60         2.94          3.48        0.38       10.29         10.52         7.86          8.40         090
                                     windpipe
                                     lesion.
31825.........  ........  A         Repair of             6.92        6.69          7.43         3.93          5.03        0.53       14.14         14.88        11.38         12.48         090
                                     windpipe
                                     defect.
31830.........  ........  A         Revise windpipe       4.49        5.54          5.72         3.29          3.82        0.44       10.47         10.65         8.22          8.75         090
                                     scar.
32000.........  ........  A         Drainage of           1.54        2.46          2.91         0.46          0.48        0.08        4.08          4.53         2.08          2.10         000
                                     chest.
32002.........  ........  A         Treatment of          2.19        2.94          3.15         1.03          1.05        0.12        5.25          5.46         3.34          3.36         000
                                     collapsed lung.
32005.........  ........  A         Treat lung            2.19        5.12          6.13         0.59          0.67        0.23        7.54          8.55         3.01          3.09         000
                                     lining
                                     chemically.
32019.........  ........  A         Insert pleural        4.17       15.73         18.95         1.47          1.61        0.42       20.32         23.54         6.06          6.20         000
                                     catheter.
32020.........  ........  A         Insertion of          3.97          NA            NA         1.15          1.30        0.43          NA            NA         5.55          5.70         000
                                     chest tube.
32035.........  ........  A         Exploration of       11.13          NA            NA         5.99          5.90        1.26          NA            NA        18.38         18.29         090
                                     chest.
32036.........  ........  A         Exploration of       12.14          NA            NA         6.31          6.42        1.43          NA            NA        19.88         19.99         090
                                     chest.
32095.........  ........  A         Biopsy through       10.03          NA            NA         5.31          5.36        1.22          NA            NA        16.56         16.61         090
                                     chest wall.
32100.........  ........  A         Exploration/         16.04          NA            NA         7.19          7.68        2.23          NA            NA        25.46         25.95         090
                                     biopsy of
                                     chest.
32110.........  ........  A         Explore/repair       25.11          NA            NA        10.13         10.60        3.21          NA            NA        38.45         38.92         090
                                     chest.
32120.........  ........  A         Re-exploration       14.23          NA            NA         7.02          7.07        1.63          NA            NA        22.88         22.93         090
                                     of chest.
32124.........  ........  A         Explore chest        15.29          NA            NA         7.20          7.22        1.89          NA            NA        24.38         24.40         090
                                     free adhesions.
32140.........  ........  A         Removal of lung      16.50          NA            NA         7.58          7.67        1.96          NA            NA        26.04         26.13         090
                                     lesion(s).
32141.........  ........  A         Remove/treat         17.14          NA            NA         7.80          7.63        2.00          NA            NA        26.94         26.77         090
                                     lung lesions.
32150.........  ........  A         Removal of lung      16.66          NA            NA         7.64          7.63        2.00          NA            NA        26.30         26.29         090
                                     lesion(s).
32151.........  ........  A         Remove lung          16.78          NA            NA         9.04          8.28        2.03          NA            NA        27.85         27.09         090
                                     foreign body.
32160.........  ........  A         Open chest           13.00          NA            NA         5.96          5.45        1.31          NA            NA        20.27         19.76         090
                                     heart massage.
32200.........  ........  A         Drain, open,         18.42          NA            NA         9.10          8.75        2.13          NA            NA        29.65         29.30         090
                                     lung lesion.
32201.........  ........  A         Drain, percut,        3.99       20.79         20.77         1.40          1.33        0.24       25.02         25.00         5.63          5.56         000
                                     lung lesion.
32215.........  ........  A         Treat chest          12.90          NA            NA         6.48          6.81        1.68          NA            NA        21.06         21.39         090
                                     lining.
32220.........  ........  A         Release of lung      26.31          NA            NA        12.24         12.80        3.56          NA            NA        42.11         42.67         090
32225.........  ........  A         Partial release      16.59          NA            NA         7.61          7.66        2.06          NA            NA        26.26         26.31         090
                                     of lung.
32310.........  ........  A         Removal of           15.13          NA            NA         7.05          7.32        1.99          NA            NA        24.17         24.44         090
                                     chest lining.
32320.........  ........  A         Free/remove          26.96          NA            NA        11.73         12.08        3.51          NA            NA        42.20         42.55         090
                                     chest lining.
32400.........  ........  A         Needle biopsy         1.76        2.21          2.15         0.55          0.55        0.10        4.07          4.01         2.41          2.41        000
                                     chest lining.
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
\1\ CPT codes and descriptors only are copyright 2005 American Medical Association. All rights reserved. Applicable FARS/DFARS apply.
\2\ Copyright 2005 American Dental Association. All rights reserved.
\3\ Indicates RVUs are not used for Medicare payment.


[[Page 37299]]


                                   Addendum B.--Relative Value Units (RVUs) and Related Information Used In Determining Medicare Payments for 2007--Continued
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                   Fully                                                            Fully
                                                     Physician  implemented    Year 2007      Fully       Year 2007      Mal-    implemented    Year 2007      Fully       Year 2007
CPT \1\  HCPCS     Mod     Status     Description    work RVUs      non-     transitional  implemented  transitional   practice      non-     transitional  implemented  transitional    Global
      \2\                                               \3\     facility PE  non-facility  facility PE   facility PE     RVUs      facility   non-facility    facility     facility
                                                                    RVUs        PE RVUs        RVUs         RVUs                    total         total        total         total
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
32402.........  ........  A         Open biopsy           8.85          NA            NA         4.84          5.05        1.07          NA            NA        14.76         14.97         090
                                     chest lining.
32405.........  ........  A         Biopsy, lung or       1.93        0.68          0.67         0.68          0.64        0.11        2.72          2.71         2.72          2.68         000
                                     mediastinum.
32420.........  ........  A         Puncture/clear        2.18          NA            NA         0.74          0.70        0.12          NA            NA         3.04          3.00         000
                                     lung.
32440.........  ........  A         Removal of lung      27.11          NA            NA        11.21         12.50        3.68          NA            NA        42.00         43.29         090
32442.........  ........  A         Sleeve               37.74          NA            NA        14.53         14.73        3.84          NA            NA        56.11         56.31         090
                                     pneumonectomy.
32445.........  ........  A         Removal of lung      40.73          NA            NA        16.04         14.59        3.71          NA            NA        60.48         59.03         090
32480.........  ........  A         Partial removal      25.65          NA            NA        10.46         11.68        3.49          NA            NA        39.60         40.82         090
                                     of lung.
32482.........  ........  A         Bilobectomy....      27.22          NA            NA        11.30         12.54        3.66          NA            NA        42.18         43.42         090
32484.........  ........  A         Segmentectomy..      22.67          NA            NA         9.74         10.99        3.03          NA            NA        35.44         36.69         090
32486.........  ........  A         Sleeve               31.72          NA            NA        12.98         13.21        3.51          NA            NA        48.21         48.44         090
                                     lobectomy.
32488.........  ........  A         Completion           32.69          NA            NA        13.02         13.62        3.80          NA            NA        49.51         50.11         090
                                     pneumonectomy.
32491.........  ........  R         Lung volume          25.03          NA            NA        10.81         12.20        2.98          NA            NA        38.82         40.21         090
                                     reduction.
32500.........  ........  A         Partial removal      24.42          NA            NA        10.53         11.93        3.25          NA            NA        38.20         39.60         090
                                     of lung.
32501.........  ........  A         Repair bronchus       4.68          NA            NA         1.38          1.50        0.65          NA            NA         6.71          6.83         ZZZ
                                     add-on.
32503.........  ........  A         Resect apical        31.55          NA            NA        12.41         14.44        4.37          NA            NA        48.33         50.36         090
                                     lung tumor.
32504.........  ........  A         Resect apical        36.35          NA            NA        13.85         16.00        5.07          NA            NA        55.27         57.42         090
                                     lung tum/chest.
32540.........  ........  A         Removal of lung      23.68          NA            NA        10.38          9.84        2.07          NA            NA        36.13         35.59         090
                                     lesion.
32601.........  ........  A         Thoracoscopy,         5.45          NA            NA         2.13          2.30        0.80          NA            NA         8.38          8.55         000
                                     diagnostic.
32602.........  ........  A         Thoracoscopy,         5.95          NA            NA         2.27          2.47        0.87          NA            NA         9.09          9.29         000
                                     diagnostic.
32603.........  ........  A         Thoracoscopy,         7.80          NA            NA         3.01          3.03        1.14          NA            NA        11.95         11.97         000
                                     diagnostic.
32604.........  ........  A         Thoracoscopy,         8.77          NA            NA         3.10          3.37        1.25          NA            NA        13.12         13.39         000
                                     diagnostic.
32605.........  ........  A         Thoracoscopy,         6.92          NA            NA         2.59          2.83        1.00          NA            NA        10.51         10.75         000
                                     diagnostic.
32606.........  ........  A         Thoracoscopy,         8.39          NA            NA         3.05          3.27        1.22          NA            NA        12.66         12.88         000
                                     diagnostic.
32650.........  ........  A         Thoracoscopy,        10.73          NA            NA         5.36          6.43        1.58          NA            NA        17.67         18.74         090
                                     surgical.
32651.........  ........  A         Thoracoscopy,        16.28          NA            NA         6.99          7.19        1.86          NA            NA        25.13         25.33         090
                                     surgical.
32652.........  ........  A         Thoracoscopy,        23.34          NA            NA         9.43          9.99        2.72          NA            NA        35.49         36.05         090
                                     surgical.
32653.........  ........  A         Thoracoscopy,        19.86          NA            NA         7.60          7.14        1.88          NA            NA        29.34         28.88         090
                                     surgical.
32654.........  ........  A         Thoracoscopy,        18.49          NA            NA         7.37          7.51        1.63          NA            NA        27.49         27.63         090
                                     surgical.
32655.........  ........  A         Thoracoscopy,        14.95          NA            NA         6.64          7.11        1.89          NA            NA        23.48         23.95         090
                                     surgical.
32656.........  ........  A         Thoracoscopy,        13.14          NA            NA         6.07          7.49        1.89          NA            NA        21.10         22.52         090
                                     surgical.
32657.........  ........  A         Thoracoscopy,        14.54          NA            NA         6.52          7.41        1.99          NA            NA        23.05         23.94         090
                                     surgical.
32658.........  ........  A         Thoracoscopy,        11.61          NA            NA         5.68          6.95        1.69          NA            NA        18.98         20.25         090
                                     surgical.
32659.........  ........  A         Thoracoscopy,        11.82          NA            NA         6.01          7.11        1.62          NA            NA        19.45         20.55         090
                                     surgical.
32660.........  ........  A         Thoracoscopy,        17.65          NA            NA         7.59          9.03        2.08          NA            NA        27.32         28.76         090
                                     surgical.
32661.........  ........  A         Thoracoscopy,        13.23          NA            NA         6.30          7.43        1.92          NA            NA        21.45         22.58         090
                                     surgical.
32662.........  ........  A         Thoracoscopy,        17.00          NA            NA         7.28          8.46        2.17          NA            NA        26.45         27.63         090
                                     surgical.
32663.........  ........  A         Thoracoscopy,        19.96          NA            NA         8.99         10.34        2.72          NA            NA        31.67         33.02         090
                                     surgical.
32664.........  ........  A         Thoracoscopy,        14.18          NA            NA         6.48          7.36        2.32          NA            NA        22.98         23.86         090
                                     surgical.
32665.........  ........  A         Thoracoscopy,        17.37          NA            NA         7.66          8.03        2.15          NA            NA        27.18         27.55         090
                                     surgical.
32800.........  ........  A         Repair lung          15.56          NA            NA         7.14          7.36        1.98          NA            NA        24.68         24.90         090
                                     hernia.
32810.........  ........  A         Close chest          14.80          NA            NA         7.16          7.45        1.93          NA            NA        23.89         24.18         090
                                     after drainage.
32815.........  ........  A         Close bronchial      37.94          NA            NA        14.13         11.78        3.27          NA            NA        55.34         52.99         090
                                     fistula.
32820.........  ........  A         Reconstruct          22.27          NA            NA        11.58         12.05        2.52          NA            NA        36.37         36.84         090
                                     injured chest.
32851.........  ........  A         Lung                 40.72          NA            NA        21.07         26.07        5.56          NA            NA        67.35         72.35         090
                                     transplant,
                                     single.
32852.........  ........  A         Lung transplant      44.37          NA            NA        24.10         30.97        6.00          NA            NA        74.47         81.34         090
                                     with bypass.
32853.........  ........  A         Lung                 49.89          NA            NA        23.44         29.74        7.05          NA            NA        80.38         86.68         090
                                     transplant,
                                     double.
32854.........  ........  A         Lung transplant      53.60          NA            NA        26.89         32.85        7.20          NA            NA        87.69         93.65         090
                                     with bypass.
32900.........  ........  A         Removal of           23.66          NA            NA         9.89          9.91        2.93          NA            NA        36.48         36.50         090
                                     rib(s).
32905.........  ........  A         Revise & repair      23.13          NA            NA         9.72         10.05        3.15          NA            NA        36.00         36.33         090
                                     chest wall.
32906.........  ........  A         Revise & repair      29.14          NA            NA        11.47         11.94        3.97          NA            NA        44.58         45.05         090
                                     chest wall.
32940.........  ........  A         Revision of          21.18          NA            NA         8.72          9.31        2.88          NA            NA        32.78         33.37        090
                                     lung.
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
\1\ CPT codes and descriptors only are copyright 2005 American Medical Association. All rights reserved. Applicable FARS/DFARS apply.
\2\ Copyright 2005 American Dental Association. All rights reserved.
\3\ Indicates RVUs are not used for Medicare payment.


[[Page 37300]]


                                   Addendum B.--Relative Value Units (RVUs) and Related Information Used In Determining Medicare Payments for 2007--Continued
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                   Fully                                                            Fully
                                                     Physician  implemented    Year 2007      Fully       Year 2007      Mal-    implemented    Year 2007      Fully       Year 2007
CPT \1\  HCPCS     Mod     Status     Description    work RVUs      non-     transitional  implemented  transitional   practice      non-     transitional  implemented  transitional    Global
      \2\                                               \3\     facility PE  non-facility  facility PE   facility PE     RVUs      facility   non-facility    facility     facility
                                                                    RVUs        PE RVUs        RVUs         RVUs                    total         total        total         total
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
32960.........  ........  A         Therapeutic           1.84        1.65          1.72         0.70          0.60        0.16        3.65          3.72         2.70          2.60         000
                                     pneumothorax.
32997.........  ........  A         Total lung            5.99          NA            NA         1.50          1.82        0.55          NA            NA         8.04          8.36         000
                                     lavage.
33010.........  ........  A         Drainage of           2.24          NA            NA         1.05          0.85        0.14          NA            NA         3.43          3.23         000
                                     heart sac.
33011.........  ........  A         Repeat drainage       2.24          NA            NA         1.13          0.89        0.15          NA            NA         3.52          3.28         000
                                     of heart sac.
33015.........  ........  A         Incision of           8.41          NA            NA         5.15          5.01        0.65          NA            NA        14.21         14.07         090
                                     heart sac.
33020.........  ........  A         Incision of          14.84          NA            NA         6.59          6.75        1.79          NA            NA        23.22         23.38         090
                                     heart sac.
33025.........  ........  A         Incision of          13.62          NA            NA         6.04          6.29        1.80          NA            NA        21.46         21.71         090
                                     heart sac.
33030.........  ........  A         Partial removal      22.23          NA            NA         9.35          9.50        2.83          NA            NA        34.41         34.56         090
                                     of heart sac.
33031.........  ........  A         Partial removal      25.27          NA            NA        10.10         10.07        3.13          NA            NA        38.50         38.47         090
                                     of heart sac.
33050.........  ........  A         Removal of           16.81          NA            NA         7.70          7.82        2.14          NA            NA        26.65         26.77         090
                                     heart sac
                                     lesion.
33120.........  ........  A         Removal of           27.29          NA            NA        10.90         11.43        3.69          NA            NA        41.88         42.41         090
                                     heart lesion.
33130.........  ........  A         Removal of           24.01          NA            NA         9.50          9.98        3.00          NA            NA        36.51         36.99         090
                                     heart lesion.
33140.........  ........  A         Heart                22.72          NA            NA        10.19         10.73        2.85          NA            NA        35.76         36.30         090
                                     revascularize
                                     (tmr).
33141.........  ........  A         Heart tmr w/          4.83          NA            NA         1.53          1.57        0.69          NA            NA         7.05          7.09         ZZZ
                                     other
                                     procedure.
33200.........  ........  A         Insertion of         14.69          NA            NA         7.55          7.03        1.70          NA            NA        23.94         23.42         090
                                     heart
                                     pacemaker.
33201.........  ........  A         Insertion of         12.08          NA            NA         6.47          6.57        1.36          NA            NA        19.91         20.01         090
                                     heart
                                     pacemaker.
33206.........  ........  A         Insertion of          7.27          NA            NA         5.24          4.66        0.52          NA            NA        13.03         12.45         090
                                     heart
                                     pacemaker.
33207.........  ........  A         Insertion of          9.03          NA            NA         5.89          4.98        0.59          NA            NA        15.51         14.60         090
                                     heart
                                     pacemaker.
33208.........  ........  A         Insertion of          8.12          NA            NA         5.54          4.97        0.56          NA            NA        14.22         13.65         090
                                     heart
                                     pacemaker.
33210.........  ........  A         Insertion of          3.30          NA            NA         1.73          1.37        0.18          NA            NA         5.21          4.85         000
                                     heart
                                     electrode.
33211.........  ........  A         Insertion of          3.39          NA            NA         1.71          1.41        0.21          NA            NA         5.31          5.01         000
                                     heart
                                     electrode.
33212.........  ........  A         Insertion of          5.51          NA            NA         3.82          3.48        0.43          NA            NA         9.76          9.42         090
                                     pulse
                                     generator.
33213.........  ........  A         Insertion of          6.36          NA            NA         4.35          3.89        0.45          NA            NA        11.16         10.70         090
                                     pulse
                                     generator.
33214.........  ........  A         Upgrade of            7.74          NA            NA         5.48          5.05        0.58          NA            NA        13.80         13.37         090
                                     pacemaker
                                     system.
33215.........  ........  A         Reposition            4.87          NA            NA         3.58          3.29        0.37          NA            NA         8.82          8.53         090
                                     pacing-defib
                                     lead.
33216.........  ........  A         Insert lead           5.77          NA            NA         4.67          4.33        0.36          NA            NA        10.80         10.46         090
                                     pace-defib,
                                     one.
33217.........  ........  A         Insert lead           5.74          NA            NA         4.58          4.33        0.39          NA            NA        10.71         10.46         090
                                     pace-defib,
                                     dual.
33218.........  ........  A         Repair lead           5.93          NA            NA         4.92          4.46        0.37          NA            NA        11.22         10.76         090
                                     pace-defib,
                                     one.
33220.........  ........  A         Repair lead           6.01          NA            NA         4.99          4.46        0.37          NA            NA        11.37         10.84         090
                                     pace-defib,
                                     dual.
33222.........  ........  A         Revise pocket,        4.95          NA            NA         4.40          4.33        0.42          NA            NA         9.77          9.70         090
                                     pacemaker.
33223.........  ........  A         Revise pocket,        6.45          NA            NA         5.07          4.72        0.45          NA            NA        11.97         11.62         090
                                     pacing-defib.
33224.........  ........  A         Insert pacing         9.04          NA            NA         5.15          4.30        0.54          NA            NA        14.73         13.88         000
                                     lead & connect.
33225.........  ........  A         L ventric             8.33          NA            NA         4.55          3.58        0.45          NA            NA        13.33         12.36         ZZZ
                                     pacing lead
                                     add-on.
33226.........  ........  A         Reposition l          8.68          NA            NA         4.97          4.12        0.59          NA            NA        14.24         13.39         000
                                     ventric lead.
33233.........  ........  A         Removal of            3.29          NA            NA         3.35          3.30        0.22          NA            NA         6.86          6.81         090
                                     pacemaker
                                     system.
33234.........  ........  A         Removal of            7.81          NA            NA         5.63          5.10        0.56          NA            NA        14.00         13.47         090
                                     pacemaker
                                     system.
33235.........  ........  A         Removal               9.85          NA            NA         7.47          6.99        0.73          NA            NA        18.05         17.57         090
                                     pacemaker
                                     electrode.
33236.........  ........  A         Remove               12.58          NA            NA         6.76          7.28        1.68          NA            NA        21.02         21.54         090
                                     electrode/
                                     thoracotomy.
33237.........  ........  A         Remove               13.69          NA            NA         7.78          7.80        1.59          NA            NA        23.06         23.08         090
                                     electrode/
                                     thoracotomy.
33238.........  ........  A         Remove               15.20          NA            NA         8.40          8.27        2.02          NA            NA        25.62         25.49         090
                                     electrode/
                                     thoracotomy.
33240.........  ........  A         Insert pulse          7.59          NA            NA         5.46          4.81        0.41          NA            NA        13.46         12.81         090
                                     generator.
33241.........  ........  A         Remove pulse          3.24          NA            NA         3.10          3.00        0.18          NA            NA         6.52          6.42         090
                                     generator.
33243.........  ........  A         Remove eltrd/        23.36          NA            NA        10.96         11.36        2.09          NA            NA        36.41         36.81         090
                                     thoracotomy.
33244.........  ........  A         Remove eltrd,        13.74          NA            NA         9.73          9.12        0.99          NA            NA        24.46         23.85         090
                                     transven.
33245.........  ........  A         Insert epic          16.81          NA            NA         8.05          7.95        2.01          NA            NA        26.87         26.77         090
                                     eltrd pace-
                                     defib.
33246.........  ........  A         Insert epic          23.11          NA            NA        10.89         10.46        2.63          NA            NA        36.63         36.20         090
                                     eltrd/
                                     generator.
33249.........  ........  A         Eltrd/insert         14.96          NA            NA        10.55          8.92        0.77          NA            NA        26.28         24.65         090
                                     pace-defib.
33250.........  ........  A         Ablate heart         25.75          NA            NA        10.24         10.85        3.18          NA            NA        39.17         39.78         090
                                     dysrhythm
                                     focus.
33251.........  ........  A         Ablate heart         28.77          NA            NA        11.25         11.58        3.59          NA            NA        43.61         43.94         090
                                     dysrhythm
                                     focus.
33253.........  ........  A         Reconstruct          31.33          NA            NA        12.28         13.47        4.52          NA            NA        48.13         49.32         090
                                     atria.
33261.........  ........  A         Ablate heart         28.77          NA            NA        11.49         11.72        3.45          NA            NA        43.71         43.94         090
                                     dysrhythm
                                     focus.
33282.........  ........  A         Implant pat-          4.66          NA            NA         4.37          4.12        0.23          NA            NA         9.26          9.01        090
                                     active ht
                                     record.
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
\1\ CPT codes and descriptors only are copyright 2005 American Medical Association. All rights reserved. Applicable FARS/DFARS apply.
\2\ Copyright 2005 American Dental Association. All rights reserved.
\3\ Indicates RVUs are not used for Medicare payment.


[[Page 37301]]


                                   Addendum B.--Relative Value Units (RVUs) and Related Information Used In Determining Medicare Payments for 2007--Continued
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                   Fully                                                            Fully
                                                     Physician  implemented    Year 2007      Fully       Year 2007      Mal-    implemented    Year 2007      Fully       Year 2007
CPT \1\  HCPCS     Mod     Status     Description    work RVUs      non-     transitional  implemented  transitional   practice      non-     transitional  implemented  transitional    Global
      \2\                                               \3\     facility PE  non-facility  facility PE   facility PE     RVUs      facility   non-facility    facility     facility
                                                                    RVUs        PE RVUs        RVUs         RVUs                    total         total        total         total
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
33284.........  ........  A         Remove pat-           3.00          NA            NA         3.46          3.52        0.14          NA            NA         6.60          6.66         090
                                     active ht
                                     record.
33300.........  ........  A         Repair of heart      29.93          NA            NA        11.69          9.87        2.65          NA            NA        44.27         42.45         090
                                     wound.
33305.........  ........  A         Repair of heart      33.67          NA            NA        12.81         11.18        3.12          NA            NA        49.60         47.97         090
                                     wound.
33310.........  ........  A         Exploratory          20.19          NA            NA         8.93          9.44        2.58          NA            NA        31.70         32.21         090
                                     heart surgery.
33315.........  ........  A         Exploratory          26.01          NA            NA        10.51         10.81        3.27          NA            NA        39.79         40.09         090
                                     heart surgery.
33320.........  ........  A         Repair major         18.42          NA            NA         8.81          8.38        2.07          NA            NA        29.30         28.87         090
                                     blood
                                     vessel(s).
33321.........  ........  A         Repair major         20.67          NA            NA        10.44          9.97        2.90          NA            NA        34.01         33.54         090
                                     vessel.
33322.........  ........  A         Repair major         24.26          NA            NA         9.95         10.28        2.85          NA            NA        37.06         37.39         090
                                     blood
                                     vessel(s).
33330.........  ........  A         Insert major         25.13          NA            NA         9.94         10.20        2.81          NA            NA        37.88         38.14         090
                                     vessel graft.
33332.........  ........  A         Insert major         24.42          NA            NA         9.72         10.34        3.02          NA            NA        37.16         37.78         090
                                     vessel graft.
33335.........  ........  A         Insert major         33.75          NA            NA        13.13         13.31        4.27          NA            NA        51.15         51.33         090
                                     vessel graft.
33400.........  ........  A         Repair of            39.23          NA            NA        15.49         15.66        4.10          NA            NA        58.82         58.99         090
                                     aortic valve.
33401.........  ........  A         Valvuloplasty,       24.33          NA            NA        10.03         12.66        3.56          NA            NA        37.92         40.55         090
                                     open.
33403.........  ........  A         Valvuloplasty,       25.31          NA            NA        10.70         13.43        3.54          NA            NA        39.55         42.28         090
                                     w/cp bypass.
33404.........  ........  A         Prepare heart-       31.21          NA            NA        12.40         14.04        4.32          NA            NA        47.93         49.57         090
                                     aorta conduit.
33405.........  ........  A         Replacement of       39.97          NA            NA        16.02         17.76        5.31          NA            NA        61.30         63.04         090
                                     aortic valve.
33406.........  ........  A         Replacement of       48.87          NA            NA        18.67         19.05        5.43          NA            NA        72.97         73.35         090
                                     aortic valve.
33410.........  ........  A         Replacement of       38.69          NA            NA        15.15         16.26        4.68          NA            NA        58.52         59.63         090
                                     aortic valve.
33411.........  ........  A         Replacement of       57.11          NA            NA        21.08         19.36        5.46          NA            NA        83.65         81.93         090
                                     aortic valve.
33412.........  ........  A         Replacement of       43.71          NA            NA        16.71         19.52        6.37          NA            NA        66.79         69.60         090
                                     aortic valve.
33413.........  ........  A         Replacement of       55.27          NA            NA        20.25         20.72        6.51          NA            NA        82.03         82.50         090
                                     aortic valve.
33414.........  ........  A         Repair of            39.27          NA            NA        16.30         14.70        4.56          NA            NA        60.13         58.53         090
                                     aortic valve.
33415.........  ........  A         Revision,            29.70          NA            NA        11.18         11.83        4.13          NA            NA        45.01         45.66         090
                                     subvalvular
                                     tissue.
33416.........  ........  A         Revise               36.39          NA            NA        13.60         13.56        4.56          NA            NA        54.55         54.51         090
                                     ventricle
                                     muscle.
33417.........  ........  A         Repair of            29.13          NA            NA        12.30         13.31        4.09          NA            NA        45.52         46.53         090
                                     aortic valve.
33420.........  ........  A         Revision of          25.64          NA            NA         8.74          9.38        1.81          NA            NA        36.19         36.83         090
                                     mitral valve.
33422.........  ........  A         Revision of          29.57          NA            NA        12.61         13.42        3.93          NA            NA        46.11         46.92         090
                                     mitral valve.
33425.........  ........  A         Repair of            38.37          NA            NA        14.13         13.35        4.06          NA            NA        56.56         55.78         090
                                     mitral valve.
33426.........  ........  A         Repair of            41.28          NA            NA        16.14         16.92        5.01          NA            NA        62.43         63.21         090
                                     mitral valve.
33427.........  ........  A         Repair of            42.78          NA            NA        16.52         18.70        6.07          NA            NA        65.37         67.55         090
                                     mitral valve.
33430.........  ........  A         Replacement of       49.81          NA            NA        18.82         17.71        5.08          NA            NA        73.71         72.60         090
                                     mitral valve.
33460.........  ........  A         Revision of          27.97          NA            NA        11.09         11.27        3.44          NA            NA        42.50         42.68         090
                                     tricuspid
                                     valve.
33463.........  ........  A         Valvuloplasty,       42.57          NA            NA        16.20         13.76        3.86          NA            NA        62.63         60.19         090
                                     tricuspid.
33464.........  ........  A         Valvuloplasty,       30.93          NA            NA        12.84         13.38        4.14          NA            NA        47.91         48.45         090
                                     tricuspid.
33465.........  ........  A         Replace              33.58          NA            NA        12.72         12.93        4.38          NA            NA        50.68         50.89         090
                                     tricuspid
                                     valve.
33468.........  ........  A         Revision of          32.78          NA            NA        15.74         14.20        4.06          NA            NA        52.58         51.04         090
                                     tricuspid
                                     valve.
33470.........  ........  A         Revision of          21.24          NA            NA         8.84         10.25        1.03          NA            NA        31.11         32.52         090
                                     pulmonary
                                     valve.
33471.........  ........  A         Valvotomy,           22.79          NA            NA         8.23          9.39        3.38          NA            NA        34.40         35.56         090
                                     pulmonary
                                     valve.
33472.........  ........  A         Revision of          22.86          NA            NA         7.07         10.69        3.54          NA            NA        33.47         37.09         090
                                     pulmonary
                                     valve.
33474.........  ........  A         Revision of          25.85          NA            NA        12.31         11.26        3.21          NA            NA        41.37         40.32         090
                                     pulmonary
                                     valve.
33475.........  ........  A         Replacement,         44.81          NA            NA        16.89         15.78        4.92          NA            NA        66.62         65.51         090
                                     pulmonary
                                     valve.
33476.........  ........  A         Revision of          26.37          NA            NA        11.49         11.87        2.41          NA            NA        40.27         40.65         090
                                     heart chamber.
33478.........  ........  A         Revision of          27.34          NA            NA        11.15         12.61        3.88          NA            NA        42.37         43.83         090
                                     heart chamber.
33496.........  ........  A         Repair, prosth       29.67          NA            NA        11.64         12.50        4.12          NA            NA        45.43         46.29         090
                                     valve clot.
33500.........  ........  A         Repair heart         27.79          NA            NA        11.18         11.41        3.86          NA            NA        42.83         43.06         090
                                     vessel fistula.
33501.........  ........  A         Repair heart         19.39          NA            NA         8.28          8.30        1.90          NA            NA        29.57         29.59         090
                                     vessel fistula.
33502.........  ........  A         Coronary artery      21.65          NA            NA         9.42         10.68        2.99          NA            NA        34.06         35.32         090
                                     correction.
33503.........  ........  A         Coronary artery      22.21          NA            NA        10.80         10.02        1.77          NA            NA        34.78         34.00         090
                                     graft.
33504.........  ........  A         Coronary artery      25.26          NA            NA        10.37         11.47        3.35          NA            NA        38.98         40.08         090
                                     graft.
33505.........  ........  A         Repair artery w/     38.33          NA            NA        13.26         13.02        2.18          NA            NA        53.77         53.53         090
                                     tunnel.
33506.........  ........  A         Repair artery,       37.78          NA            NA        16.92         15.18        4.65          NA            NA        59.35         57.61         090
                                     translocation.
33507.........  ........  A         Repair art,          31.33          NA            NA        11.93         13.24        4.05          NA            NA        47.31         48.62        090
                                     intramural.
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
\1\ CPT codes and descriptors only are copyright 2005 American Medical Association. All rights reserved. Applicable FARS/DFARS apply.
\2\ Copyright 2005 American Dental Association. All rights reserved.
\3\ Indicates RVUs are not used for Medicare payment.


[[Page 37302]]


                                   Addendum B.--Relative Value Units (RVUs) and Related Information Used In Determining Medicare Payments for 2007--Continued
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                   Fully                                                            Fully
                                                     Physician  implemented    Year 2007      Fully       Year 2007      Mal-    implemented    Year 2007      Fully       Year 2007
CPT \1\  HCPCS     Mod     Status     Description    work RVUs      non-     transitional  implemented  transitional   practice      non-     transitional  implemented  transitional    Global
      \2\                                               \3\     facility PE  non-facility  facility PE   facility PE     RVUs      facility   non-facility    facility     facility
                                                                    RVUs        PE RVUs        RVUs         RVUs                    total         total        total         total
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
33508.........  ........  A         Endoscopic vein       0.31          NA            NA         0.10          0.10        0.04          NA            NA         0.45          0.45         ZZZ
                                     harvest.
33510.........  ........  A         CABG, vein,          33.45          NA            NA        14.10         15.81        4.40          NA            NA        51.95         53.66         090
                                     single.
33511.........  ........  A         CABG, vein, two      34.59          NA            NA        14.66         16.51        4.55          NA            NA        53.80         55.65         090
33512.........  ........  A         CABG, vein,          38.73          NA            NA        15.96         17.23        4.66          NA            NA        59.35         60.62         090
                                     three.
33513.........  ........  A         CABG, vein,          39.69          NA            NA        16.45         17.49        4.87          NA            NA        61.01         62.05         090
                                     four.
33514.........  ........  A         CABG, vein,          40.50          NA            NA        16.68         17.75        4.76          NA            NA        61.94         63.01         090
                                     five.
33516.........  ........  A         Cabg, vein, six      41.96          NA            NA        17.58         18.53        5.11          NA            NA        64.65         65.60         090
                                     or more.
33517.........  ........  A         CABG, artery-         2.57          NA            NA         0.80          0.83        0.39          NA            NA         3.76          3.79         ZZZ
                                     vein, single.
33518.........  ........  A         CABG, artery-         4.84          NA            NA         1.50          1.56        0.73          NA            NA         7.07          7.13         ZZZ
                                     vein, two.
33519.........  ........  A         CABG, artery-         7.11          NA            NA         2.20          2.30        1.04          NA            NA        10.35         10.45         ZZZ
                                     vein, three.
33521.........  ........  A         CABG, artery-         9.39          NA            NA         2.93          3.04        1.37          NA            NA        13.69         13.80         ZZZ
                                     vein, four.
33522.........  ........  A         CABG, artery-        11.65          NA            NA         3.60          3.77        1.77          NA            NA        17.02         17.19         ZZZ
                                     vein, five.
33523.........  ........  A         Cabg, art-vein,      13.93          NA            NA         4.35          4.49        2.12          NA            NA        20.40         20.54         ZZZ
                                     six or more.
33530.........  ........  A         Coronary              5.85          NA            NA         1.81          1.89        0.88          NA            NA         8.54          8.62         ZZZ
                                     artery, bypass/
                                     reop.
33533.........  ........  A         CABG, arterial,      37.38          NA            NA        15.18         16.18        4.55          NA            NA        57.11         58.11         090
                                     single.
33534.........  ........  A         CABG, arterial,      38.81          NA            NA        15.92         17.30        4.69          NA            NA        59.42         60.80         090
                                     two.
33535.........  ........  A         CABG, arterial,      41.48          NA            NA        16.88         17.86        5.01          NA            NA        63.37         64.35         090
                                     three.
33536.........  ........  A         Cabg, arterial,      40.79          NA            NA        16.50         17.88        5